Negative pressure wound therapy in preseptal orbital cellulitis complicated with necrotizing fasciitis and preseptal abscess.

PURPOSE: Preseptal cellulitis (PC) may be locally complicated with abscess formation and necrotizing fasciitis. If not treated promptly and adequately, it may result in further complications. The authors report a series of patients where negative pressure wound therapy (NPWT) proved a safe and valuable adjunct therapy in avoiding complications of PC and in accelerating wound healing. METHODS: A 4 patient case series. Four male patients (11 months to 58 years old) with unilateral complicated PC. INTERVENTIONS: Patients were admitted with PC and treated initially with specific intravenous antibiotic therapy. These patients did not respond adequately; therefore, surgical drainage and/or debridement were performed. After surgery, persistent edema and purulent discharge was observed prompting the need for adjunct NPWT every 48 to 72 hours. NPWT is the use of vacuum through a wound filler material covered with an airtight drape connected to a pump. Complete ophthalmologic examination was performed after each 48-hour cycle. Length of hospital stay, days from surgery to discharge, days from start of NPWT to discharge, clinical improvement, and safety. RESULTS: Four patients were diagnosed with PC between 2 and 5 days of evolution. Two diabetic adults developed the condition secondary to trauma, the adolescent as a result of a cosmetic piercing, and the infant associated to sinusitis. NPWT reached -125 mm·Hg, except for the infant who received -75 mm·Hg. The average number of days necessary for improvement with NPWT was 6.7 days. Only 2 patients required surgical reconstruction. Time from debridement to discharge was in average 13.5 days. No ocular complications were observed, and follow up was satisfactory with normal eyelid function and aesthetics and preserved visual acuity. CONCLUSIONS: NPWT proved to be safe and effective for treating locally complicated PC as an adjuvant therapy to antibiotic and surgical treatment that decreased the length of hospital stay, and the time for recovery in patients that were slow responders. No ocular complications were observed in any of these patients' follow up ranging from 1 to 4 years.

Oral Insulin Alleviates Liver Fibrosis and Reduces Liver Steatosis in Patients With Metabolic Dysfunction-associated Steatohepatitis and Type 2 Diabetes: Results of Phase II Randomized, Placebo-controlled Feasibility Clinical Trial.

Background and Aims: Metabolic dysfunction-associated steatohepatitis is an advanced form of nonalcoholic fatty liver disease and a leading cause of end-stage liver disease and transplantation. Insulin resistance and inflammation underlie the pathogenesis of the disease. Methods: This double-blind, randomized, placebo-controlled, multicenter feasibility clinical trial aimed to determine the safety of oral 8 mg insulin in patients with metabolic dysfunction-associated steatohepatitis and type 2 diabetes mellitus. Patients were treated twice daily for 12 weeks with an 8 mg insulin (n = 21) or placebo (n = 11) capsule. Safety was monitored throughout the study. MRI-proton density fat fraction assessed liver fat content, and Fibroscan® measured liver fibrosis and steatosis levels at screening and after 12 weeks of treatment. Results: No severe drug-related adverse events were reported during the study. After 12 weeks of treatment, mean percent reductions in whole-liver (-11.2% vs -6.5%, respectively) and liver segment 3 (-11.7% vs +0.1%, respectively) fat content was higher in the insulin than in the placebo arm. Patients receiving insulin showed a median -1.2 kPa and -21.0 dB/m reduction from baseline fibrosis and steatosis levels, respectively, while placebo-treated patients showed median increases of 0.3 kPa and 13.0 dB/m, respectively. At Week 12, oral insulin was associated with a mean of 0.27% reduction and placebo with a 0.23% increase from baseline hemoglobin A1c levels. Mean percent changes from baseline alanine aminotransferase, and aspartate aminotransferase levels were -10% and -0.8%, respectively, in the oral insulin and 3.0% and 13.4%, in the placebo arm. Conclusion: The results of this feasibility study support the safety and potential therapeutic effect of orally delivered insulin on liver fibrosis, fat accumulation, and inflammatory processes (NIH Clinical Trials No. NCT04618744).

The lateral habenula integrates age and experience to promote social transitions in developing rats.

Social behavior deficits are an early-emerging marker of psychopathology and are linked with early caregiving quality. However, the infant neural substrates linking early care to social development are poorly understood. Here, we focused on the infant lateral habenula (LHb), a highly-conserved brain region at the nexus between forebrain and monoaminergic circuits. Despite its consistent links to adult psychopathology, this brain region has been understudied in development when the brain is most vulnerable to environmental impacts. In a task combining social and threat cues, suppressing LHb principal neurons had opposing effects in infants versus juveniles, suggesting the LHb promotes a developmental switch in social approach behavior under threat. We observed that early caregiving adversity (ECA) disrupts typical growth curves of LHb baseline structure and function, including volume, firing patterns, neuromodulatory receptor expression, and functional connectivity with cortical regions. Further, we observed that suppressing cortical projections to the LHb rescued social approach deficits following ECA, identifying this microcircuit as a substrate for disrupted social behavior. Together, these results identify immediate biomarkers of ECA in the LHb and highlight this region as a site of early social processing and behavior control.

The lateral habenula integrates age and experience to promote social transitions in developing rats.

Early caregiving adversity (ECA) is associated with social behavior deficits and later development of psychopathology. However, the infant neural substrates of ECA are poorly understood. The lateral habenula (LHb), a highly conserved brain region with consistent links to adult psychopathology, is understudied in development, when the brain is most vulnerable to environmental impacts. Here, we describe the structural and functional ontogeny of the LHb and its behavioral role in infant and juvenile rat pups. We show that the LHb promotes a developmental transition in social approach behavior under threat as typically reared infants mature. By contrast, we show that ECA disrupts habenular ontogeny, including volume, protein expression, firing properties, and corticohabenular connectivity. Furthermore, inhibiting a specific corticohabenular projection rescues infant social approach deficits following ECA. Together, these results identify immediate biomarkers of ECA in the LHb and highlight this region as a site of early social processing and behavior control.

Inhibition of dendritic cell apoptosis by Leishmania mexicana amastigotes.

Macrophages (Mφ) and dendritic cells are the major target cell populations of the obligate intracellular parasite Leishmania. Inhibition of host cell apoptosis is a strategy employed by multiple pathogens to ensure their survival in the infected cell. Leishmania promastigotes have been shown to protect Mφ, neutrophils, and dendritic cells from both natural and induced apoptosis. Nevertheless, the effect of the infection with Leishmania amastigotes in the apoptosis of these cell populations has not been established, which results are very important since amastigotes persist in cells for many days and are responsible for sustaining infection in the host. As shown in this study, apoptosis of monocyte-derived dendritic cells (moDC) induced by treatment with camptothecin was downregulated by infection with L. mexicana amastigotes from 42.48 to 36.92% as detected by Annexin-V binding to phosphatidylserine. Also, the infection of moDC with L. mexicana amastigotes diminished the fragmentation of DNA as detected by terminal deoxynucleotidyl transferase-mediated fluorescein-dUTP nick end labeling assay, and changes in cell morphology were analyzed by electron microscopy. The observed antiapoptotic effect was found to be associated with an 80% reduction in the presence of active caspase-3 in infected moDC. The capacity of L. mexicana amastigotes to delay apoptosis induction in the infected moDC may have implications for Leishmania pathogenesis by favoring the invasion of its host and the persistence of the parasite in the infected cells.

3D-Printed Tumor-on-Chip for the Culture of Colorectal Cancer Microspheres: Mass Transport Characterization and Anti-Cancer Drug Assays.

Tumor-on-chips have become an effective resource in cancer research. However, their widespread use remains limited due to issues related to their practicality in fabrication and use. To address some of these limitations, we introduce a 3D-printed chip, which is large enough to host ~1 cm3 of tissue and fosters well-mixed conditions in the liquid niche, while still enabling the formation of the concentration profiles that occur in real tissues due to diffusive transport. We compared the mass transport performance in its rhomboidal culture chamber when empty, when filled with GelMA/alginate hydrogel microbeads, or when occupied with a monolithic piece of hydrogel with a central channel, allowing communication between the inlet and outlet. We show that our chip filled with hydrogel microspheres in the culture chamber promotes adequate mixing and enhanced distribution of culture media. In proof-of-concept pharmacological assays, we biofabricated hydrogel microspheres containing embedded Caco2 cells, which developed into microtumors. Microtumors cultured in the device developed throughout the 10-day culture showing >75% of viability. Microtumors subjected to 5-fluorouracil treatment displayed <20% cell survival and lower VEGF-A and E-cadherin expression than untreated controls. Overall, our tumor-on-chip device proved suitable for studying cancer biology and performing drug response assays.

Maternal education revisited: Vocabulary growth in English and Spanish from 16 to 30 months of age.

This paper reports on a cross-language longitudinal study in which we extend previous research on the effects of maternal education on vocabulary growth in Spanish- and English-dominant children at three time points: 16 months, 22 months, and 30 months of age. This study addresses recent conflicting evidence regarding the role of maternal education in children's acquisition of Spanish. Participants were 62 English-dominant children, 47 Spanish-dominant children, and their mothers. Growth curve models were constructed separately for English and Spanish vocabulary. Strong growth rate reliability and effect sizes were evinced for vocabulary across samples. As expected, in English-dominant children, maternal education predicted English vocabulary and growth from 16 to 30 months of age. However, in Spanish-dominant children, there was no significant effect of maternal education on vocabulary or growth, although there was a descriptive advantage for children of college-educated mothers at 30 months of age. In conjunction with prior evidence, we conclude that the effect of maternal education on maternal input and child vocabulary does not generalize readily to children whose first language is Spanish. Our findings contribute to a literature that suggests that focusing on maternal beliefs, input, and the home literacy environment are more fruitful approaches in the study of children learning Spanish in the U.S. Further, the importance of maternal beliefs highlights the need to support parent investment in the quantity and quality of input in the home language.

Atmospheric, Water and Acoustic Pollution from Hydrocarbon Activities in the American Continent: A Literature Review.

Hydrocarbon activities over the years have been one of the main sources of environmental pollution, creating short and long-term impacts. This study aims to analyze the scientific production of the American continent through a bibliographic review of scientific articles published from the 1970s to the present, in order to contrast relevant scientific information about the types of pollution, water, atmospheric, and acoustic, published in the most important scientific repositories in the world, such as Scopus and Web of Science. The Prisma methodology was adopted for its development. From the plethora of articles collected, a sample of 3879 scientific articles was extracted, from which 3322 of them were excluded, leaving 557 records with remarkable information such as: country, year of publication, type of contamination, remediation if applicable, the associated oil & gas sector, and publication registration on the indexed website. It was noted that the countries with the highest scientific production are the United States, Canada, Brazil, Mexico, and Argentina. Furthermore, the Web of Science, unlike Scopus, contains more indexed publications related to the types of contamination objects relevant to this study. On the other hand, publications focused on water pollution are the only ones that come up with remediations; the rest release a smaller number of publications on these topics.

Determination of hydraulic conductivity from grain-size distribution for different depositional environments.

Over 400 unlithified sediment samples were collected from four different depositional environments in global locations and the grain-size distribution, porosity, and hydraulic conductivity were measured using standard methods. The measured hydraulic conductivity values were then compared to values calculated using 20 different empirical equations (e.g., Hazen, Carman-Kozeny) commonly used to estimate hydraulic conductivity from grain-size distribution. It was found that most of the hydraulic conductivity values estimated from the empirical equations correlated very poorly to the measured hydraulic conductivity values with errors ranging to over 500%. To improve the empirical estimation methodology, the samples were grouped by depositional environment and subdivided into subgroups based on lithology and mud percentage. The empirical methods were then analyzed to assess which methods best estimated the measured values. Modifications of the empirical equations, including changes to special coefficients and addition of offsets, were made to produce modified equations that considerably improve the hydraulic conductivity estimates from grain size data for beach, dune, offshore marine, and river sediments. Estimated hydraulic conductivity errors were reduced to 6 to 7.1 m/day for the beach subgroups, 3.4 to 7.1 m/day for dune subgroups, and 2.2 to 11 m/day for offshore sediments subgroups. Improvements were made for river environments, but still produced high errors between 13 and 23 m/day.

Complicaciones de la canalización venosa central con técnica ecoguiada y convencional en el servicio de urgencias del Hospital de San José, Bogotá, Colombia / Complications of the central venous catheter with ecoguide and conventional technique in emergency department of Hospital de San Jose, Bogota, Colombia

Introducción: la utilización de la ultrasonografía como técnica de elección para la colocación de catéteres venosos centrales durante situaciones de emergencia aumenta la seguridad del paciente al presentar baja frecuencia de complicaciones, menor exposición a irradiación e incremento de la calidad de atención. Objetivo: comparar las complicaciones mecánicas de la colocación de catéter venoso central por la técnica guiada por ultrasonografía y la convencional; realizada por residentesde la especialización en Medicina de Urgencias del Hospital de San José (Bogotá,Colombia). Materiales y métodos: estudio descriptivo de dos cohortes en pacientes mayores de 15 años que ingresaron al servicio de urgencias del Hospital de San José, con indicación de colocación de catéter venoso central por técnica convencional entre 2012 y 2013 (cohorte no expuesta) y técnica ecoguiada en 2014 (cohorte expuesta). Como desenlace se observó la presencia de complicacionesen cualquiera de los dos grupos. Resultados: se incluyeron 73 casos, 38 (52,1%) con colocación del catéter venoso central por la técnica ecoguiada. Se presentaron nueve (12,3%) complicaciones, ocho (88,9%) de ellas con la técnica convencional. La mediante del tiempo del procedimiento fue 20 minutos (rango intercuatílico: 15-20 minutos) con la técnica convencional y 10 minutos (rango intercuatílico: 7-10 minutos) con la técnica ecoguiada; esta última con colocación del catéter en un único intento en el 78,9% de los casos. Conclusión: se observó un menor número de complicaciones de tipo mecánico cuando con la técnica ecoguiadarespecto a la técnica convencional en los pacientes críticos con indicación de canulación venosa central.

Introduction: the use of ultrasound as a technique of choice for central venous catheter placement during emergencies increases patient safety due to low frequencyof complications, reduction of exposure to radiation, and increasing quality of care. Objective: To compare the mechanical complications of central venous catheterplacement under ultrasound guided and conventional technique by residents of emergency medicine specialty at the Hospital de San Jose (Bogota, Colombia). Material and methods: Descriptive study of two cohorts, which include patients over 15 years old, admitted to the emergency department of Hospital de San Jose with indication of central venous catheter placement by conventional technique between2012 and 2013 (unexposed cohort) and ultrasound-guided technique in 2014 (exposed cohort). As outcome was observed the presence of complications in both groups. Results: A total of 73 cases were included, 38 (52.1%) of them with central venous catheter placement by ultrasound-guided technique. A total of nine complications(12.3%) were presented, eight (88.9%) of them with the conventional technique.The median of time procedure was of 20 minutes (interquartile range: 15-20 minute) with the conventional technique and 10 minutes (interquartile range: 7-10 minutes) with ecoguide technique. In the ultrasound-guided technique, the catheter placement was achieved in an only attempt in 78.9% of cases. Conclusion: Fewer mechanical complications were observed with ultrasound guided technique respect conventional technique in critically ill patients who have indication of central venous cannulation.

Transnasal endoscopic approach in the treatment of Graves ophthalmopathy: the value of a medial periorbital strip.

OBJECTIVES: Present our experience with orbital decompression using an endoscopic transnasal approach and test whether preservation of an anteroposterior periorbital strip overlying the medial rectus muscle can reduce the incidence of postoperative diplopia. PATIENT AND METHODS: Retrospective, descriptive study conducted on 16 patients with Graves ophthalmopathy operated on with orbital decompression between 2004 and 2009. RESULTS: Twelve women and four men (mean age, 34.6 years), a total of 30 orbits, were operated. A medial periorbital strip along the medial rectus muscle was preserved in 13 patients. A single case (7.7%) presented postoperative diplopia. The mean reduction of proptosis was 4.3mm. CONCLUSIONS: The endoscopic transnasal approach provides comparable results to those obtained with other techniques. The incidence of postoperative diplopia seems to decrease when an anteroposterior periorbital periosteal strip is preserved along the medial rectus muscle.