Management of pediatric tibial tubercle fractures: Is surgical treatment really necessary?

Fractures of the anterior tibial tubercle are infrequent lesions. They often occur in male adolescent athletes, usually in relation with sports involving powerful jumps. We present a retrospective study of 10 patients, with an average age of 15.1 years, all of them males, and a total of 11 acute avulsions of the anterior tibial tubercle. We analyzed the etiology of the lesion, the type of treatment used as well as non-weight bearing period, protected immobilization period, and time until sports reincorporation. We obtained 11 acute avulsions: one case of type I; three cases of type II; four cases of type III; and three cases of type IV. Five cases were treated conservatively, including the three cases of type IV, and surgery was only performed in six cases since an anatomical reduction was not obtained with closed reduction. The results were satisfactory in all cases, with 100% percentage of sport reincorporation in less de 25 weeks. We registered only one complication, intolerance of material, which did not require additional surgeries. These fractures, although rare, have an excellent prognosis. Even if they are often treated surgically, we have obtained good results with the conservative treatment in patterns previously reported as surgical.

Anatomy of the olfactory nerve: A comprehensive review with cadaveric dissection.

Because of their anatomical situation, the olfactory nerves constitute a natural obstacle to exploring the anterior cranial fossa, making them vulnerable to traumatic, tumor, or iatrogenic lesions. Consequently, accurate knowledge of their microsurgical anatomy is of particular importance for surgeons to ensure the correct execution of surgical procedures with minimal sequelae, the least functional deterioration, and better therapeutic results. This review describes the functional and microsurgical anatomy of the olfactory nerves, illustrated with pictures of simulations based on cadaveric dissections and original illustrations of the central connections of the olfactory pathway. Clin. Anat, 2017. © 2017 Wiley Periodicals, Inc.

Acute administration of the small-molecule p75(NTR) ligand does not prevent hippocampal neuron loss or development of spontaneous seizures after pilocarpine-induced status epilepticus.

Neurotrophins, such as brain-derived neurotrophic factor (BDNF), are initially expressed in a precursor form (e.g., pro-BDNF) and cleaved to form mature BDNF (mBDNF). After pilocarpine-induced status epilepticus (SE), increases in neurotrophins regulate a wide variety of cell-signaling pathways, including prosurvival and cell-death machinery in a receptor-specific manner. Pro-BDNF preferentially binds to the p75 neurotrophin receptor (p75(NTR) ), whereas mBDNF is the major ligand of the tropomyosin-related kinase receptor. To elucidate a potential role for p75(NTR) in acute stages of epileptogenesis, rats were injected prior to and at onset of SE with LM11A-31, a small-molecule ligand that binds to p75(NTR) to promote survival signaling and inhibit neuronal cell death. Modulation of early p75(NTR) signaling and its effects on electrographic SE, SE-induced neurodegeneration, and subsequent spontaneous seizures were examined after LM11A-31 administration. Despite an established neuroprotective effect of LM11A-31 in several animal models of neurodegenerative disorders (e.g., Alzheimer's disease, traumatic brain injury, and spinal cord injury), high-dose LM11A-31 administration prior to and at onset of SE did not reduce the intensity of electrographic SE, prevent SE-induced neuronal cell injury, or inhibit the progression of epileptogenesis. Further studies are required to understand the role of p75(NTR) activation during epileptogenesis and in seizure-induced cell injury in the hippocampus, among other potential cellular pathologies contributing to the onset of spontaneous seizures. Additional studies utilizing more prolonged treatment with LM11A-31 are required to reach a definite conclusion on its potential neuroprotective role in epilepsy.

Extensive sequence analysis of CFTR, SCNN1A, SCNN1B, SCNN1G and SERPINA1 suggests an oligogenic basis for cystic fibrosis-like phenotypes.

The term cystic fibrosis (CF)-like disease is used to describe patients with a borderline sweat test and suggestive CF clinical features but without two CFTR(cystic fibrosis transmembrane conductance regulator) mutations. We have performed the extensive molecular analysis of four candidate genes (SCNN1A, SCNN1B, SCNN1G and SERPINA1) in a cohort of 10 uncharacterized patients with CF and CF-like disease. We have used whole-exome sequencing to characterize mutations in the CFTR gene and these four candidate genes. CFTR molecular analysis allowed a complete characterization of three of four CF patients. Candidate variants in SCNN1A, SCNN1B, SCNN1G and SERPINA1 in six patients with CF-like phenotypes were confirmed by Sanger sequencing and were further supported by in silico predictive analysis, pedigree studies, sweat test in other family members, and analysis in CF patients and healthy subjects. Our results suggest that CF-like disease probably results from complex genotypes in several genes in an oligogenic form, with rare variants interacting with environmental factors.

Safety of fluoroquinolones.

Fluoroquinolones (FQs) are one of the most commonly prescribed classes of antibiotics. Although they were initially well tolerated in randomized clinical trials, subsequent epidemiological studies have reported an increased risk of threatening, severe, long-lasting, disabling and irreversible adverse effects (AEs), related to neurotoxicity and collagen degradation, such as tendonitis, Achilles tendon rupture, aortic aneurysm, and retinal detachment. This article reviews the main potentially threatening AEs, the alarms issued by regulatory agencies and therapeutic alternatives.

Seroprevalence for measles among healthcare workers in Madrid, Spain.

BACKGROUND: Immunity of healthcare workers (HCWs) against measles is a particular concern. They are more likely to contract it than the general population due to their occupational exposure which may cause a nosocomial outbreak. AIM: To assess the measles immune status of HCWs at five Spanish university hospitals. PATIENTS AND METHODS: Serologic testing (IgG) for measles by chemiluminescence indirect immunoassay (CLIA) was carried out prospectively and consecutively in HCWs from five university hospitals. All HCWs were classified into four epidemiological groups: vaccinated individuals, those with a history of measles disease, subjects with no history of measles or vaccination, and those who did not know whether they had measles or were vaccinated, and into five professional categories: physicians, nurses, nursing assistants, other clinical workers and non-clinical workers. A logistic regression model was constructed to identify the factors independently associated with immunity to measles. RESULTS: The study group was composed of 2157 HCWs. 89% had protective antibodies against measles. Of the 238 non-immune HCWs, 199 (83.6%) had been vaccinated, compared with 1084 of the 1919 (56.5%) immune individuals (P<0.0001). The parameters significantly predictive of having protective antibodies against measles were: older age (P<0.0001), epidemiological status (P=0.0002, mainly past measles disease), and professional category (P=0.02, in particular nurses). CONCLUSION: This study shows that HCWs, including those previously vaccinated, are currently at risk of measles and suggests that those with a natural history of infection are better protected. Therefore, knowledge and maintenance of immunity to measles are an essential part of infection control among HCWs.

Transmission of tropical and geographically restricted infections during solid-organ transplantation.

In recent years, the increasing number of donors from different regions of the world is providing a new challenge for the management and selection of suitable donors. This is a worldwide problem in most countries with transplantation programs, especially due to the increase in immigration and international travel. This paper elaborates recommendations regarding the selection criteria for donors from foreign countries who could potentially transmit tropical or geographically restricted infections to solid-organ transplant recipients. For this purpose, an extensive review of the medical literature focusing on viral, fungal, and parasitic infections that could be transmitted during transplantation from donors who have lived or traveled in countries where these infections are endemic has been performed, with special emphasis on tropical and imported infections. The review also includes cases described in the literature as well as risks of transmission during transplantation, microbiological tests available, and recommendations for each infection. A table listing different infectious agents with their geographic distributions and specific recommendations is included.

[Risk-benefit of some mollusks and processed fishes in the renal patient's diet]. / Riesgo-beneficio de algunos moluscos y pescados procesados en la dieta de los pacientes renales.

The renal diet must include limited amounts of high quality protein, phosphorus P and potassium K. n-3 polyunsaturated fatty acids (n-3PUFA EPA and DHA), present in fishes and mollusks, render beneficial properties against progression of renal damage. The aim of this study was to evaluate protein PR, phosphorus P, potassium K, calcium Ca and n-3PUFA in processed fishes and mollusks as an alimentary option for renal patients. Canned tuna (water AA and oil AC), sardine in tomate sauce ST and chipotle SC and smoked salmon SA, fresh jumbo flying squid CA, common octopus PU and oyster OS were evaluated. Significant difference was detected (p <.0.05) for K between different types of fish. SA contained 38g/100g PR, 307 mg/100g of P, 371 mg/ 100g K and 106 mg/100g n-3PUFA. Sardines contained (279-304 mg/100g of P and 283-322 mg/100g K and tunas 142-160 mg/100g P and 141-154 mg/100g K. Tunas and sardines had elevated concentration of n-3PUFA (4114 and 4790 mg/ 100g respectively), P:n-3PUFA and K:n-3PUFA ratio was low in tunas (0.03) and sardines (0.06). AA and AC contained (10.1 and 11.1 mgP/gPR), while ST and SC provided 26.4-19.1 mg/P/gPR. n-3PUFA/gPR were similar for tunas and sardines (302-424mg/gPR). Mollusks: CA presented the highest values of P and PR (2.4 mg/100g and 18.4g/100g). n-3PUFA ranged from 4.3 to 79 mg/100g in PU and OS respectively. Among processed fishes, only canned tunas are recommended for the diet of renal patients, in an individualized basis. The risk-benefit ratio of sardines in the renal diet should be evaluated, due to their high content of P and n-3PUFA. Salmon and mollusks are not recommended for the renal diet.

Hidrocistomas ecrinos múltiples

RESUMEN Los hidrocistomas ecrinos son tumores benignos, únicos o múltiples. Se presentan con mayor frecuencia en la mediana edad y predominan en el sexo femenino. Se presenta un paciente con hidrocistomas ecrinos múltiples, masculino de 74 años.

ABSTRACT Eccrine hydrocystomas are benign tumors, which can be single or multiple. They occur most oftenly in middle aged patients or in the elderly, predominantly female. We present a case of multiple eccrine hydrocystomas, in a 74-year-old male patient.

Heavy metals: Implications associated to fish consumption.

Metals are being utilized of ways in industries and agriculture; particularly heavy metals such as mercury, cadmium, lead and arsenic constitute a significant potential threat to human health because they are associated to many adverse effects on health. The consumption of fish is recommended because it is a good source of omega-3 fatty acids, which have been associated with health benefits due to its cardio-protective effects. However, the content of heavy metals discovered in some fish makes it difficult to establish clearly the role of fish consumption on a healthy diet. Therefore the present mini-review accounts for the recent evidence of the effect of these toxic metals on the human health and their possible implications in fish consumption.

Pelvic exenteration for gynecologic malignancies: Postoperative complications and oncologic outcomes. / Exenteración pélvica para neoplasias ginecológicas: Complicaciones postoperatorias y resultados oncológicos.

INTRODUCTION AND OBJECTIVE: To evaluate complications, morbidity and oncologic outcomes of pelvic exenteration as treatment for gynecologic malignancies. MATERIALS AND METHODS: Between 2008 and 2015, a total of 35 patients underwent pelvic exenteration, due to recurrence of gynecological cancer. Surgical outcomes, early and late postoperative complications, and recurrence/survival outcomes were assessed. RESULTS: Mean patient age was 53.8 years. Anterior exenteration was done in 20 patients, while 15 were total exenterations. Ileal conduit was done in 24 patients, while 8 received a neobladder and 3 a cutaneous ureterostomy. Postoperative complications were divided in 2groups, early (<30 days) and late complications (>30 days). A total of 25 patients (71.4%) had one or more early complications; 16 (45.7%) had fever due to a urinary tract infection, pyelonephritis or intra-abdominal collection; 2 (5.7%) developed a vesicovaginal fistula; 4 (11.4%) a rectovaginal fistula; 3 (8.5%) acute kidney failure and one (2.85%) uronephrosis. Regarding to late complications, 8patients (22.8%) had fever. Six (17%) presented with uronephrosis, and 5 (14.2%) with ureteral-pouch stricture. Five patients (14.2%) had acute renal insufficiency, 3 (8,6%) rectovaginal fistula and one (2.85%) urinary fistula. Mean follow up time was 20.3 month (2-60). A total of 22patients (62.8%) were free of disease. Another 13 (37.1%) patients relapsed. Only 4 (11.4%) patients died after pelvic exenteration due to underlying disease. CONCLUSION: Pelvic exenteration has a high rate of complications and morbidity, but can be the last curative opportunity in patients with recurrent or persistent gynecologic malignancies. This procedure should be performed by multidisciplinary, experienced teams in a tertiary medical center.

Nonbacterial thrombotic endocarditis associated with lung adenocarcinoma.

Nonbacterial thrombotic endocarditis (NBTE) is a rather frequent neoplasic complication, most often occurring in adenocarcinomas of the lung and pancreas. The most frequent clinical manifestation is one of multiple cerebral infarcts, but other ischaemic events can occur. Diagnosis is frequently missed on transthoracic ultrasound, making transoesophagic ultrasound a more reliable diagnostic tool. We present a case of NBTE associated with lung adenocarcinoma.

[n-3 fatty acid evaluation in eighteen Mexican marine fishes as functional food]. / Evaluación de los acidos grasos n-3 de 18 especies de pescados marinos mexicanos como alimentos funcionales.

The objective of the present work was to characterize the n-3 fatty acid composition of eighteen species of Mexican marine fishes and to evaluate their potential as functional food. Total lipids and fatty acid (FA) compositions were obtained of the edible portion of the fish, by solvent extraction and gas chromatography. Fifty percent of the studied species proceeded of the Mexican Pacific and the remainder from the Gulf of Mexico. The total lipid content varied from 0.76 to 7.13 g/100g. Averages of 58.51, 58.74 and 132.85 mg/100g of flesh were obtained for saturated, monounsaturated and polyunsaturated FA, respectively. In all the samples the n-3 fatty acids identified in order of abundance were (mg/100g), C22:6n-3 (DHA) (85.02), C20:5 n-3 (EPA)(16.22), C18:3 n-3 (ALA)(1.95) and the C20:3 n-3 was found only in four species (range from 0.08 to 12.99 mg/100g). Twenty-seven percent of the fishes exhibited low (4 to 40), 66% intermediate (70 to 170) and 7% high values (200 to 300 mg/100g) of n-3 FA. The latter species were identified as picuda (Sphyraena agentea) and sargo (Lagodon rhomboides). Since international standards recommend a daily regular consumption form 200 to 650 mg of EPA + DHA/day as beneficial for good health, it is therefore suggested as functional food.

Responses of Gram-negative bacteria to certain environmental stressors.

Bacteria in nature are exposed to variations in temperature, and are affected by the availability of nutrients and water and the presence of toxic molecules. Their reactions to these changes require a series of rapid adaptive responses. Although transcriptional regulation is of primary importance in these responses, translational regulation and even activation of 'silenced' enzymes are critical for survival in changing environments. Bacteria have developed a series of mechanisms at the membrane structure level to cope with high concentrations of solvents. In addition, solvent-tolerant strains express highly effective efflux pumps to remove solvents from the cytoplasm. Desiccation tolerance is based on the synthesis and accumulation of osmoprotectants together with changes in fatty acid composition to preserve membrane structure. Both cold shock and heat shock responses are mainly regulated at a post-transcriptional level, translation efficiency in the case of cold shock and mRNA half-life and sigma32 stability in the case of heat shock.

Regulated expression of galectin-1 after in vitro productive infection with herpes simplex virus type 1: implications for T cell apoptosis.

Apoptosis of cytotoxic T lymphocytes by herpes simplex virus type-1 (HSV-1) has been reported to be a relevant mechanism of viral immune evasion. Galectin-1 (Gal-1), an endogenous lectin involved in T-cell apoptosis, has recently gained considerable attention as a novel mechanism of tumor-immune evasion. Here we investigated whether infection of cells with HSV-1 can modulate the expression of Gal-1. Results show that pro-apoptotic Gal-1, but not Gal-3, is remarkably up-regulated in cell cultures infected with HSV-1. In addition, this protein is secreted to the extracellular milieu, where it contributes to apoptosis of activated T cells in a carbohydrate-dependent manner. Since many viruses have evolved mechanisms to counteract the antiviral response raised by the infected host, our results suggest that HSV-1 may use galectin-1 as a weapon to kill activated T cells and evade specific immune responses.

Cholesterol and n-3 and n-6 fatty acid content in eggs from laying hens fed with red crab meal (Pleuroncodes planipes).

Red crab (Pleuroncodes planipes) is a marine crustacean that represents an abundant resource that has not been properly used. The aim of this study was to evaluate the effects on cholesterol and n-3 and n-6 FA content in eggs when red crab meal (RCM) was included in laying hen rations. Ninety White Leghorn laying hens were randomly distributed into 3 treatments: control (0%RCM), 3% red crab meal (3%RCM), and 6% red crab meal (6%RCM) for 3 wk. Cholesterol and linoleic (LA), alpha-linolenic (ALA), arachidonic (AA), eicosapentaenoic (EPA), and docosahexaenoic (DHA) acids were analyzed by gas chromatography. Performance parameters and cholesterol content were not different among treatments (P > 0.05). Total lipids were different in the control group and 6%RCM (9.0 and 9.4% respectively) compared with 3%RCM (10.9%). With 3%RCM and 6%RCM, the levels of all fatty acids analyzed were higher than in the control. Diets with 3 and 6% RCM doubled the content of ALA (16.4 and 15.4 mg/100 g of egg, respectively). Eicosapentaenoic acid was lowest in 0%RCM (6 mg/100 g of egg) compared with 3%RCM (13 mg/100 g) and 6%RCM (17 mg/100 g). Similar results were obtained for DHA (56, 133, and 246 mg/100 g of egg). Linoleic acid and AA were highest (1,211 and 228 mg/100 g, respectively) with 3%RCM and with 6%RCM (1,151 and 200 mg/100 g, respectively) vs. control (890 and 163 mg/100 g). The ratio of n-6 to n-3 FA was 3 times lower with 6%RCM than in the control. It was concluded that inclusion of red crab meal in laying hen rations at levels of 3 and 6% (P < 0.05) increased the n-3 and n-6 fatty acids content in eggs.

Site trimer percolation on square lattices.

Percolation of site trimers (k-mers with k=3) is investigated in a detailed way making use of an analytical model based on renormalization techniques in this problem. Results are compared to those obtained here by means of extensive computer simulations. Five different deposition possibilities for site trimers are included according to shape and orientation of the depositing objects. Analytical results for the percolation threshold p(c) are all close to 0.55, while numerical results show a slight dispersion around this value. A comparison with p(c) values previously reported for monomers and dimers establishes the tendency of p(c) to decrease as k increases. Critical exponent ν was also obtained both by analytical and numerical methods. Results for the latter give values very close to the expected value 4/3 showing that this percolation case corresponds to the universality class of random percolation.