An extremely rare case of an oversized accessory spleen: case report and review of the literature.

BACKGROUND: The accessory spleen is a congenital defect characterized by a separated ectopic splenic parenchyma. The size is rarely more than 4 cm. The preoperative diagnosis is prohibitive preoperatively. The aims of the present manuscript were to present the case of a patient with a rare oversize accessory spleen and a review of the literature. CASE PRESENTATION: A 15-year-old boy was admitted to the emergency department following blunt abdominal trauma. The computed tomographic scan showed a traumatic rupture of the spleen and a 7-cm mass at the left side of the retroperitoneal space. Conservative treatment started and aborted after 4 h due to the onset of haemodynamic instability. Splenectomy was performed. An accessory spleen was discovered. A second large mass in the retroperitoneum was diagnosed as a second large accessory spleen that was also left in place. The postoperative course was uneventful, and the patient was discharged on the 7th postoperative day. Seven months later, the CT scan showed viability of both accessory spleens. CONCLUSION: An accessory spleen can be variously located and the retroperitoneal position is extremely uncommon. Preoperative diagnosis is still difficult, especially in emergency and as in our case, the literature shows the difficulty of reaching a diagnosis before surgery. The main misdiagnosis is neoplastic disease and for this reason accessory spleen can be wrongly removed. An undiagnosed pre or intra operative retroperitoneal mass, closely to the spleen, have to be managed carefully. The diagnosis of accessory spleen needs to be ever considered as if found, represents a great possibility to conduct a normal life after splenectomy (of main spleen) for trauma.

A new modified Mayo technique: should the surgeons need a new open technique for hernia repair in their armamentarium?

INTRODUCTION: The Mayo technique is one of the most common techniques used to repair incisional, umbilical, and epigastric hernias. A high percentage of recurrences, together with the use of particular expensive types of meshes, are some of the most relevant problems in this surgical field. PATIENTS AND METHODS: This study is a clinical prospective observational and involves all the patients who underwent procedures using a new modified Mayo technique from 2006 through 2013. The general criteria analyzed were age, sex, obesity, smoke abuse, diabetes, chronic diseases, type of hernia, operative time, morbidity and mortality. All the patients involved in this study were followed-up from 6 to 120 months. RESULTS: The types of hernia were 5 epigastic hernia (20,8%), 8 umbilical hernia (33,3%), 11 midline incision hernia (45,9%). Ten patients (41,7%) presented non-complicated hernias; 8 patients (33,3%) presented strangulated hernias and 6 patients (25,0%) presented obstructed hernias. No intestinal resection was necessary in any of the patients. The mean operative time was 55 minutes (range 30-180). The mean hospital stay of the patients' after-post operative procedure was 4.5 days (range, 2 to 8 days). No major complications have been reported. Only one patient present a recurrence. CONCLUSION: These preliminary results suggest that this modified Mayo technique could be useful in the armamentarium of surgeon to repair incisional, umbilical, and epigastric hernias. More studies are needed to validate the technique.

Endocannabinoids participate in placental apoptosis induced by hypoxia inducible factor-1.

During pregnancy, apoptosis is a physiological event critical in the remodeling and aging of the placenta. Increasing evidence has pointed towards the relevance of endocannabinoids (ECs) and hypoxia as modulators of trophoblast cell death. However, the relation between these factors is still unknown. In this report, we evaluated the participation of ECs in placental apoptosis induced by cobalt chloride (CoCl2), a hypoxia mimicking agent that stabilizes the expression of hypoxia inducible factor-1 alpha (HIF-1α). We found that HIF-1α stabilization decreased FAAH mRNA and protein levels, suggesting an increase in ECs tone. Additionally, CoCl2 incubation and Met-AEA treatment reduced cell viability and increased TUNEL-positive staining in syncytiotrophoblast layer. Immunohistochemical analysis demonstrated Bax and Bcl-2 protein expression in the cytoplasm of syncytiotrophoblast. Finally, HIF-1α stabilization produced an increase in Bax/Bcl-2 ratio, activation of caspase 3 and PARP cleavage. All these changes in apoptotic parameters were reversed with AM251, a CB1 antagonist. These results demonstrate that HIF-1α may induce apoptosis in human placenta via intrinsic pathway by a mechanism that involves activation of CB1 receptor suggesting a role of the ECs in this process.

Start-up and maturation phases of a full-scale, high-rate anaerobic pond bioreactor(®) plus improved facultative ponds to treat municipal wastewater.

Results of the start-up and maturation phases of a full-scale, high-rate anaerobic pond bioreactor (HRAPB)(®) plus improved facultative ponds (IFPs) to treat municipal wastewater are presented (CODt: 759 mg L⁻¹, CODf: 219 mg L⁻¹, S-SO(4)(2-): 102 mg L⁻¹, and Cr⁺: 1,500 µgL⁻¹). The start-up of the HRAPB(®) comprised, first, the application of a selective pressure increasing up-flow velocity rates. Second, batch stages between successive rates were allowed until 70% of the initial CODf was removed. The IFPs were left in batch and ended when in-pond Chlorophyll-a concentration reached 800 µgL⁻¹. Subsequently, the system underwent gradual maturation and reached effluent concentrations of CODt: 223 mg L⁻¹, CODf: 50 mg L⁻¹, and Cr⁺: 60 µgL⁻¹. The actual efficiency of the system compared with the expected design efficiency was lower given the characteristics of the influent wastewater biochemical oxygen demand/chemical oxygen demand ratios < 0.4, presence of Cr⁺ >1,000 µgL⁻¹, and variations in both conductivity (500-4,500 µScm⁻¹) and pH (6.5-10.5 units). Nonetheless, the system exhibited an adaptation state in less than 1.5 months and yielded an ST/SV ratio of 0.46, and specific methanogenic activity of 0.43 g-CH4-CODg⁻¹SV⁻¹d⁻¹ for HRAPB(®); the in-pond Chlorophyll-a was on average 1,200 µgL⁻¹ in the IFPs, which demonstrated the robustness of these eco-technologies in tropical conditions.

Modified Mayo Technique for Ventral Hernia Repair: An Experimental Study.

BACKGROUND: To reduce the rate of recurrence of incisional hernia repair associated with open anatomic techniques, we present an experimental study, focusing on two different sutures, with the aim to apply clinically in a revised version of the Mayo technique. METHODS: Thirteen biological tissue samples from adult pig central brawn and upper and lower fasciae were measured using two techniques defined as "œunbroken suture thread" and "œseparated suture stitches" to test the breaking resistance of the two types of suture. RESULTS: The t test results show that the two sets can be considered as different populations. The mean tensile stress ƒmax is greater (with reduced deviation) for the specimens of the set sutured with unbroken thread technique. Student'™s t-test performed on values obtained for each set of samples indicated that the unbroken thread suture technique corresponds to higher ultimate failure strength. CONCLUSION: Considering these results, a modified Mayo technique with continuous closure could be suggested. Of course a valid clinical study is required to better clarify this experimental hypothesis.

Anemia as One of Presenting Symptoms in an Adult with Cyst and Torsion of the Omentum - A Case Report.

BACKGROUND: Torsion is an uncommon disorder of the omentum and cysts are one of the rarest causes of omental torsion. To our knowledge, this is the first report of a case of an omental cyst presenting with both omental torsion and anemia. CASE PRESENTATION: We herein present a case report of a 41 year old indian female patient who presented with anemia (hemoglobin concentration 6.5 g/dL) and intermittent abdominal pain caused by torsion of a hemorrhagic omental cyst. A computed tomography scan, showed an omental cyst with free fluid in the abdominal cavity. At abdominal exploration, 1.5 L of hemorrhagic fluid was confirmed in the abdominal cavity. The cyst and twisted omentum were removed en bloc. The patient had an uneventful postoperative course and was discharged on day 8. At her 2-month follow-up, she was no longer anemic (hemoglobin concentration 10.7 g/dL). CONCLUSION: Cases of anemia associated with omental torsion have been reported in children; however, to the best of our knowledge, this is the first reported case of such a presentation in an adult. In such patients, surgical removal is the treatment of choice. Persons with recurrent abdominal pain and anemia must be assessed carefully and their differential diagnosis should include omental torsion. Appropriate diagnosis and treatment help avoid complications.

Combined duodenal and pancreatic major trauma in high risk patients: can a partial reconstruction be safe?

Pancreatic trauma is an uncommon injury, occurring in only about 0.2% of blunt abdominal injuries, while duodenal injuries represent approximately 4% of all blunt abdominal injuries. When trauma of the pancreas and duodenum do not permit reparation, pancreatoduodenectomy (PD) is mandatory. In the reconstructive phase, the use of ductal ligation as an alternative to standard pancreaticojejunostomy has been reported by some authors. We report a case of polytrauma with pancreatic and duodenal injury in which the initial diagnosis failed to recognize the catastrophic duodenal and pancreatic situation. The patient was submitted for PD and the pancreatic stump was abandoned in the abdominal cavity after main pancreatic ductal ligation. This technique can minimize the morbidity and mortality of PD in patients with other organs or apparatus involved severely and extensively in trauma.

Could the complications of megacolon be avoided by monitoring the risk patients? cases report.

We report 2 cases of megacolon associated with cerebrovascular accident and neuropsychiatric drug consumption. Case report 1: a 75-year-old woman with diabetes mellitus, hypertension, tachycardia with atrial fibrillation, bilateral pleural effusions and previous cerebral hemorrhage was admitted in our hospital. She presented clouded sensorium and abdominal distension, with closed alvus. The CT scan showed a distension of the colon, with severe fecal impaction. A volvulus of the sigma was found at surgical intervention.Case report 2: a 59-year-old man with a medical history of oligophrenia was admitted to our hospital for acute abdomen.He presented stupor and closed alvus with abdominal distension. The abdominal CT scan showed a dolichosigma, with fecal impaction. The patient was submitted to a laparotomy and a two millimetres perforation of the sigma was found.The sigma had a diameter of 28 cm and a length of 75 cm.Even if a clear correlation has not been found yet, anomalies of the regulation of the gastro-intestinal motility can occur at different levels in patients with psychiatric or cerebrovascular diseases and drug consumption with anticholinergic properties,and they should be carefully monitored. The purpose is an early diagnosis of colon function anomalies in order to avoid potentially fatal complications.

Role of laparoscopic peritoneal biopsy in the diagnosis of peritoneal tuberculosis. A seven-year experience.

The diagnosis of asymptomatic abdominal tuberculosis,without characteristic laboratory and radiologic findings, is difficult. We therefore investigated the role of diagnostic laparoscopy in patients with suspected peritoneal tuberculosis(PTB). Patients admitted to Hamad General Hospital, Qatar,who underwent laparoscopic peritoneal biopsy for suspected PTB from January 2004 to December 2010 were retrospectively analysed. Factors assessed included patient age, sex, symptoms,clinical signs, CT scan findings, laparoscopic findings andhistopathological diagnosis. A total of 41 patients, 33 males(80.5%) and 8 females (19.5%), of mean age 31 years, underwent laparoscopic peritoneal biopsy for suspected PTB duringthe study period. Abdominal pain was the most common presenting symptom, observed in 33 (80.5%) patients.Computerized tomography (CT) of the abdomen showed as citesin 37 patients (90%), bowel nodules in 22 (54%), peritoneal thickening and nodules in 37 (90%) and enlarged mesenteric lymph nodes in 11 (27%). The classical gross laparoscopic appearance of peritoneal tuberculosis was observed in 38 patients (93%), whereas laparoscopic findings were normal in 3 patients (7%). Histopathological results confirmed granulomatous inflammation in 38 patients (93%). The sensitivity and specificity of gross laparoscopic appearance in diagnosing peritoneal TB were both 100%. Two patients experienced complications from laparoscopy (5%), but there were nolaparoscopy-related deaths. Laparoscopic peritoneal biopsy isa rapid and safe method of accurately diagnosing PTB.

An overview of air pollution research in Chile: Bibliometric analysis and scoping review, challenger and future directions.

This study provides a comprehensive overview and bibliometric analysis of air pollution research in Chile from 1980 to 2022. The analysis reveals a significant increase in scientific production, a 9.2 annual growth rate, and an H-index of 60. The research spans 33 countries and is influenced by environmental sciences, meteorology, and atmospheric sciences journals. The top ten authors account for 33.49 % of all publications, with local institutions contributing more than 35 %. The University of Chile and the Pontifical Catholic University of Chile are significant contributors. The most cited articles focus on health impacts and various pollutant sources, emphasizing air pollution as a critical public health concern. The study also emphasizes environmental science, meteorology, and atmospheric science, focusing on topics such as air pollution and health, pollutants, models, sources and chemistry, and social sciences. The findings are affirmed through rigorous discussion and review, providing a roadmap for future research, guiding decision-making processes, and expanding the knowledge frontier in the field.

Thigh emphysema as a first sign of abdominal disease.

Thigh infection is a rare complication of intra-abdominal sepsis that can present with emphysema. We report a case of infection in the thigh resulting from colonic perforation. A 61-year-old woman with cirrhosis, grade Child B6 and diabetes treated with oral hypoglycemic drugs was referred to the emergency department because of a persistent pain in her left thigh and also for some abdominal discomforts during the preceding few days. Ultrasonography identified the presence of gas and fluid in the thigh. The patient received fluids and antibiotics but on the day after she reported an increase in pain. For this reason the patient was submitted to a CT scan that showed a thigh emphysema due to intestinal perforation. The patient was submitted to laparotomy. A Hartmann's procedure was performed, with resection of about 15 cm of affected sigmoid colon. The left thigh wound did not require any treatment.

The oxidative potential of airborne particulate matter in two urban areas of Chile: More than meets the eye.

Oxidative potential (OP) has gained attention as a parameter that can reveal the ability of different properties of particulate matter (PM) to generate reactive oxygen species (ROS) as one single value. Moreover, OP is also believed to be a predictor of toxicity and hence the health effects of PM. This study evaluated the OP of PM10, PM2.5,and PM1.0samples using dithiothreitol assays in two cities of Chile (Santiago and Chillán). The results showed that the OP was different between cities, PM size fractions, and seasons. Additionally, OP was strongly correlated with certain metals and meteorological variables. Higher mass-normalized OP was observed during cold periods in Chillán and warm periods in Santiago and was associated with PM2.5 and PM1. On the other hand, volume-normalized OP was higher during winter in both cities and for PM10. Additionally, we compared the OP values to the Air Quality Index (AQI) scale and found cases of days that were classified as having "good" air quality (supposed to be less harmful to health) showing extremely high OP values that were similar to those on days that were classified as "unhealthy". Based on these results,we suggest using the OP as a complementary measure to the PM mass concentration because it includes important new information related to PM properties and compositions that could help improvecurrent air quality management tools.

Primary anastomosis vs Hartmann procedure in acute complicated diverticulitis. Evolution over the last twenty years.

BACKGROUND/AIMS: Aim of this review is to assess the role and indications for primary sigmoidectomy with direct anastomosis for diverticulitis comparing it with the Hartmann's procedures. METHODS: A literature search was performed using MEDLINE (PubMed), Google Scholar and The Cochrane Library and the articles from January 1990 until June 2011 were analyzed. All patients were divided into three groups: primary anastomosis (PA), primary anastomosis and stoma protection (SP) and Hartmann's procedure (HP). Number of patients, overall mortality and morbidity, the rate of fistulization, the rate of reversal after SP (RSP) and after HP (RHP) and the Hinchey classification have been considered. RESULTS: The mortality was of 38/1010 patients (3.8%) for PA, 11/153 patients (7.2%) for SP and 139/800 patients (17.4%) for HP. The morbidity was reported in 103/325 patients (31.7%) in PA, in 23/97 patients (23.7%) in SP and in 290/586 patients (49.5%) in HP. Fistula formation was recorded in 35/625 patients (5.6%) for PA, in 10/149 patients (16.4%) for RSP and 11/426 patients (6.4%) for RHP. The intestinal continuity was restored in 82/628 patients (56.9%) who underwent SP and in 315/581 patients (54.2%) undergoing HP. A total of 790 patients (54.5%) were classified in class I-II Hinchey and total of 659 patients (45.5%) was classified in class III-IV Hinchey. CONCLUSION: The PA has a lower morbidity and mortality in relation to the HP and except some limited indications, should be used as treatment of choice in the case of diverticulitis.

Ammonia recovery from acidogenic fermentation effluents using a gas-permeable membrane contactor.

A gas-permeable membrane (GPM) contactor was used to recover ammoniacal nitrogen from a synthetic and a biowaste fermentation broth under different pH (from 6 to 11) and temperatures (35 and 55 °C). Ammonia mass transfer constant (Km) increased as pH and temperature increased. For synthetic broth, pH 10 provided the best results, when considering the Km (9.2·10-7 m·s-1) and the reagents consumption (1.0 mol NaOH·mol-1 TAN and 0.6 mol H2SO4·mol-1 TAN). Biowaste fermentation generated a broth with a high concentration of ammoniacal nitrogen (4.9 g N·L-1) and volatile fatty acids (VFA) (41.1 g COD·L-1). Experiments using the biowaste broth showed a lower Km (5.0·10-7 m·s-1 at pH 10) than the synthetic broth, related to the solution matrix and other species interference. VFAs were not detected in the trapping solution. Overall, these results show that GPM is a suitable technology to efficiently separate ammoniacal nitrogen and VFA from fermentation broths.

Diagnostic and prognostic value of alpha-fetoprotein, des-γ-carboxy prothrombin and squamous cell carcinoma antigen immunoglobulin M complexes in hepatocellular carcinoma.

The hepatocellular carcinoma (HCC) is one of the most common malignant tumors. It carries a poor survival rate and has an increasing incidence worldwide. In most cases, HCC is diagnosed at a late stage. Therefore, the prognosis of patients with HCC is generally poor and has a less than 5% 5-year survival rate. The aim of this study was compare the accuracy of α-fetoprotein (AFP), des-γ- carboxy prothrombin (DCP), squamous cell carcinoma antigen-immunoglobulin M complexes (SCCA-IgM Cs) in the early diagnosis and in the prognosis of HCC. A literature search identified the markers for hepatocellular carcinoma. A search of the literature was made using cancer literature and the PubMed database for the following keywords: "markers and HCC", "α-fetoprotein (AFP) and HCC", "Des-γ-carboxy prothrombin"(DCP) and HCC, "squamous cell carcinoma antigen-immunoglobulin M complexes" (SCCA-IgM Cs). Despite the large number of studies devoted to the immunohistochemistry of HCC, at the present time, the absolute positive and negative markers for HCC are still lacking, and even those characterized by very high sensitivity and specificity do not have an universal diagnostic usefulness. In conclusion none of the three biomarkers (AFP, DCP, SCCA-IgM Cs) is optimal. According to recent reviews, these biomarkers should be measured simultaneously and in combination with imaging techniques to increase the sensitivity, specificity, diagnostic accuracy and to make a reliable prognosis. Currently the recommended screening strategy for patients with cirrhosis includes the determination of serum AFP levels and an abdominal ultrasound every six months to detect HCC at an earlier stage.

Influence of surface morphology and internal structure on the mechanical properties and tribological response of Boa Red Tail and Python Regius snake skin.

The understanding of the tribological behavior of natural structures has been used as inspiration to design and optimize surfaces for diverse applications in engineering. In the present work, morphological, microstructural, mechanical and tribological characterization of the shed skin of two snake species, namely Boa Red Tail and Python Regius was carried out. Atomic Force Microscopy (AFM) and Scanning Electron Microscopy (SEM) analyses showed the existence of deterministic patterns, i.e., ordered arrays of geometrical features at the surface, while Transmission Electron Microscopy (TEM) allowed studying the internal structure and chemical composition of the skin sheds. Nanoindentation measurements showed significant variations in hardness and elastic modulus from the surface to the inner layers of the skin, and pin-on-disc tests revealed anisotropic behavior of the friction coefficient (COF) as a function of the sliding direction against balsa wood in dry conditions. Correlations between the friction data, nano-indentation mechanical properties and subsurface skin structure were established for both species taking into account the ways in which the skins' deterministic patterns influence the tribological performance.

Air pollution and COVID-19 lockdown in a large South American city: Santiago Metropolitan Area, Chile.

The implementation of confinement and physical distancing measures to restrict people's activities and transit in the midst of the COVID-19 pandemic allowed us to study how these measures affect the air quality in urban areas with high pollution rates, such as Santiago, Chile. A comparative study between the concentrations of PM10, PM2.5, NOx, CO, and O3 during the months of March to May 2020 and the corresponding concentrations during the same period in 2017-2019 is presented. A combination of surface measurements from the air quality monitoring network of the city, remote satellite measurements, and simulations of traffic activity and road transport emissions allowed us to quantify the change in the average concentrations of each pollutant. Average relative changes of traffic emissions (between 61% and 68%) implied statistically significant concentrations reductions of 54%, 13%, and 11% for NOx, CO, and PM2.5, respectively, during the pandemic period compared to historical period. In contrast, the average concentration of O3 increased by 63% during 2020 compared to 2017-2019. The nonlinear response observed in the pollution levels can be attributed to the changes in the vehicular emission patterns during the pandemic and to the role of other sources such as residential emissions or secondary PM.

ATP-independent glucose stimulation of sphingosine kinase in rat pancreatic islets.

Sphingosine kinase (SPHK) catalyzes sphingosine 1-phosphate production, promoting cell survival and reducing apoptosis in isolated rat pancreatic islets. Glucose, the primary islet beta-cell growth factor and insulin secretagogue, increased islet SPHK activity by 3- to 5-fold following acute (1 h) or prolonged (7 days) stimulation. Prolonged stimulation of islets with glucose induced SPHK1a and SPHK2 mRNA levels; there were no changes in SPHK protein expression. To isolate the metabolic effects of glucose on SPHK activation, islets were stimulated with glucose analogs or metabolites. 2-deoxy-D-glucose (2-DG), an analog phosphorylated by glucokinase but not an effective energy source, activated SPHK similarly to glucose. In contrast, 3-o-methylglucose (3-oMeG), which is transported but neither phosphorylated nor metabolized, did not increase islet SPHK activity. Glyceraldehyde and alpha-ketoisocaproic acid (KIC), metabolites that stimulate glycolysis and the citric acid cycle, respectively, did not activate islet SPHK. Moreover, inorganic phosphate blocked glucose-induced SPHK activation. A role for SPHK activity in beta-cell growth was confirmed when small interfering (si)SPHK2 RNA transfection reduced rat insulinoma INS-1e cell SPHK levels and activity and cell growth. Glucose induced an early and sustained increase in islet SPHK activity that was dependent on glucose phosphorylation, but independent of ATP generation or new protein biosynthesis. Glucose-supported beta-cell growth appears to be in part mediated by SPHK activity.