The Kaiser Permanente Northern California research program on genes, environment, and health (RPGEH) pregnancy cohort: study design, methodology and baseline characteristics.

BACKGROUND: Exposures during the prenatal period may have lasting effects on maternal and child health outcomes. To better understand the effects of the in utero environment on children's short- and long-term health, large representative pregnancy cohorts with comprehensive information on a broad range of environmental influences (including biological and behavioral) and the ability to link to prenatal, child and maternal health outcomes are needed. The Research Program on Genes, Environment and Health (RPGEH) pregnancy cohort at Kaiser Permanente Northern California (KPNC) was established to create a resource for conducting research to better understand factors influencing women's and children's health. Recruitment is integrated into routine clinical prenatal care at KPNC, an integrated health care delivery system. We detail the study design, data collection, and methodologies for establishing this cohort. We also describe the baseline characteristics and the cohort's representativeness of the underlying pregnant population in KPNC. METHODS: While recruitment is ongoing, as of October 2014, the RPGEH pregnancy cohort included 16,977 pregnancies (53 % from racial and ethnic minorities). RPGEH pregnancy cohort participants consented to have blood samples obtained in the first trimester (mean gestational age 9.1 weeks ± 4.2 SD) and second trimester (mean gestational age 18.1 weeks ± 5.5 SD) to be stored for future use. Women were invited to complete a questionnaire on health history and lifestyle. Information on women's clinical and health assessments before, during and after pregnancy and women and children's health outcomes are available in the health system's electronic health records, which also allows long-term follow-up. DISCUSSION: This large, racially- and ethnically-diverse cohort of pregnancies with prenatal biospecimens and clinical data is a valuable resource for future studies on in utero environmental exposures and maternal and child perinatal and long term health outcomes. The baseline characteristics of RPGEH Pregnancy Cohort demonstrate that it is highly representative of the underlying population living in the broader community in Northern California.

Reflujo pancreáticobiliar en pacientes con colelitiasis y sin colelitiasis: estudio comparativo / Pancreaticobiliary reflux in patients with cholelithiasis and without cholelithiasis: a comparative study

Background. Pancreaticobiliary reflux is a pathologic phenomenon occurring in patients with gallstones. However, the occurrence of pancreaticobiliary reflux has not been studied in patients without gallstones. The objective of this study was to measure the bile levels of amylase and lipase in patients without gallstones submitted to cholecystectomy as part of another surgical procedure, and to compare these values with patients submitted to cholecystectomy for gallstone disease. Patients and Methods. A prospective observational comparative study was designed. A sample of 136 consecutive patients was included. Amylase and lipase levels were measured in bile. Normal serum amylase levels at our institution are 28-100 U/L and for lipase are 13-60 U/L. There are no established normal levels for pancreatic enzymes in bile. However, we considered elevated the bile amylase and lipase levels whenever they were higher than normal plasma levels. Results. One-hundred three patients (76 percent) had gallstones and 33 (24 percent) liad healthy gallbladders without gallstones. According to normal plasma levels for amylase and lipase, these enzymes in bile were elevated in 83.5 percent patients with gallstones, compared to elevated levels of amylase in 6 percent patients and lipase in 3 percent patients without gallstones. Conclusions. Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and occurs sporadically in patients without gallstones.

Introducción. El reflujo pancreáticobiliar es un fenómeno patológico que ocurre en pacientes con colelitiasis. La ocurrencia de este fenómeno no ha sido estudiada en pacientes sin colelitiasis. El presente estudio tiene por objetivo medir los niveles de amilasa y lipasa en la bilis de pacientes sin colelitiasis, colecistectomizados como parte de otro procedimiento quirúrgico y comparar estos valores con pacientes colecistectomizados por colelitiasis. Pacientes y Métodos. Se diseñó un estudio observacional y comparativo. Una muestra de 136 pacientes consecutivos fue incluida. Se midieron los niveles de amilasa y lipasa en la bilis. En nuestra institución los valores normales para amilasa son 28-100 U/L y para lipasa 13-60 U/L. No se han establecido valores normales de enzimas pancreáticas en la bilis. Para efectos del presente estudio, se consideró como elevados los niveles biliares de amilasa y lipasa cuando fueron mayores a los valores plasmáticos normales. Resultados. 103 pacientes (76 por ciento) tenían colelitiasis y 33 (24 por ciento) tenían vesículas normales sin cálculos. De acuerdo a los valores plasmáticos normales de amilasa y lipasa, estas enzimas se encontraron elevadas en 83,5 por ciento de los pacientes con colelitiasis comparados con valores elevados de amilasa en 6 por ciento en pacientes sin colelitiasis y de lipasa en 3 por ciento de estos pacientes. Conclusiones. El reflujo pancreaticobiliar es un fenómeno común en pacientes con colelitiasis y ocurre esporádicamente en pacientes sin colelitiasis.

Sistema de aspiración-tracción en el tratamiento de la fasciitis necrotizante del periné / Negative pressure wound therapy for the treatment of perineal necrotizing fasciitis

Introducción: Se discuten 5 pacientes tratados en nuestra institución. Además del aseo quirúrgico con desbridamiento inicial y terapia antibiótica, utilizamos el sistema de aspiración-tracción (SAT) como parte de su tratamiento. Pacientes y métodos: El SAT fue manufacturado artesanalmente con material disponible en el hospital. Después de que el diagnóstico de fasciitis necrotizante del periné fue establecido, todos los pacientes fueron sometidos a aseo quirúrgico y desbridamiento del tejido necrótico. La herida fue cubierta con el SAT quedando a presión negativa bajo aspiración central. Tiempo después, cuando la herida se encontraba limpia y no se requerían de otros aseos quirúrgicos o curaciones bajo anestesia en pabellón, los pacientes fueron sometidos a curaciones locales. En el momento que se logró buen tejido de granulación, se dejó de utilizar el SAT y se continuó con curaciones planas. Cuando la herida empezó a contraerse, aproximamos los bordes con puntos separados de Nylon y dejamos que cerrara por segunda intención. Conclusión: El uso del SAT constituye otra opción válida para el manejo de la herida que deja el aseo quirúrgico y desbridamiento de la gangrena perineal, además provee un mejor manejo de la herida con mayor comodidad para el paciente.

lntroduction: We discuss five patients treated at our institution. Besides the initial surgical debridement and antibiotic therapy, we used the negative-pressure wound therapy (NPVVT) as part of their treatment. Patients and methods: The NPVVT device was constructed with off-the-shelf components. After the diagnosis of perineal necrotizing fasciitis was established, all patients underwent surgical debridement of necrotic tissue. The wound was closed with the NPVVT system and left under negative-pressure central aspiration. After the wound was clean and no more surgical debridements were necessary, patients underwent local treatment. When they achieved granulation tissue, simple dressings were used. When the wound was contracting, we approximated the edges with an interrupted suture of Nylon, and allowed to heal by second intention. Conclusion: The use of NPWT stands as another valid option to manage the wound left after surgical debridement of the perineal gangrene and provides better and more comfortable management of the wound.

Mean lifetime and first-passage time of the enzyme species involved in an enzyme reaction. Application to unstable enzyme systems.

Taking as starting point the complete analysis of mean residence times in linear compartmental systems performed by Garcia-Meseguer et al. (Bull. Math. Biol. 65:279-308, 2003) as well as the fact that enzyme systems, in which the interconversions between the different enzyme species involved are of first or pseudofirst order, act as linear compartmental systems, we hereby carry out a complete analysis of the mean lifetime that the enzyme molecules spend as part of the enzyme species, forms, or groups involved in an enzyme reaction mechanism. The formulas to evaluate these times are given as a function of the individual rate constants and the initial concentrations of the involved species at the onset of the reaction. We apply the results to unstable enzyme systems and support the results by using a concrete example of such systems. The practicality of obtaining the mean times and their possible application in a kinetic data analysis is discussed.

Dynamic Monte Carlo simulation of the NO + CO reaction on Rh(111).

The kinetics of the catalytic reduction of NO by CO on Rh(111) surfaces was investigated by using dynamic Monte Carlo simulations. Our model takes into account recent experimental findings and introduces relevant modifications to the classical reaction scheme, including an alternative pathway to produce N2 through an (N-NO)* intermediate, the formation of atomic nitrogen islands in the adsorbed phase, and the influence of coadsorbed species on the dissociation of NO. All elementary steps are expressed as activated processes with temperature-dependent rates and realistic values dictated by experiments. Calculated steady-state phase diagrams are presented for the NO + CO reaction showing the windows for the conditions under which the reaction is viable. The model predicts variations in both production rates and adsorbate coverages with temperature consistent with experimental data. The effect of varying the individual kinetic parameters and the importance of each step in the reaction scheme were probed.

[Recurrent fetal loss. A multifactorial problem?]. / Pérdida gestacional recurrente. Un problema multifactorial?

The fetal recurrent loss (P.F.R.), it is a clinical disturbance associated with multiple factors, that it are in a frustrating situation so much for the couples like for the doctor. The objective was to evaluate 39 couples with P.F.R. in order to establish the responsibility of each factor and proceed to treatment I specify, considering as success the get a pregnancy with viable product. The protocol included clinical history, histerosalpingography, ultrasound, analysis cromosomal, antibodies for TORCH and antiphospholipids, test endocrine specifies, genitals cultivation and biopsy of endometrial. 23% it of the fetal losses is due to only factor; 64.2% it is due to multiple factors and 12.8% they don't have apparent factor. The infectious factors, endocrine, anatomical and autoimmunity was the more constants. Pregnancy with viable product in the 82% was achieved of the cases. We concluded that the P.F.R. it is a problem that is due to multiple factors and that it require a diagnosis-therapeutic integral focus.

Hindsight and the abortion experience: what abortion means to women years later.

PIP: This article provides views on abortion by demonstrating women's retrospective accounts of their abortion experiences. Women's accounts of their abortion experiences are socially constructed both at the time of the abortion and in subsequent years in their lives. Some women reflect on their past abortion as the right decision; however, some also feel varying degrees of pain, grief, and loss. Many view their abortions as mistakes. Profiles of four women are presented in this article to provide several critical points on a continuum pertaining to study participants' retrospective satisfaction with an abortion experience. Based on the profiles, various emotional reactions are possible to occur after abortion and those retrospective interpretations of the experience change as personal growth and circumstances prompt women to reflect about the original experience. It was also documented that the satisfied group in the study was the one composed of women still involved with the partner with whom they became pregnant. With an open conversation on the emotional effects of abortion, women will be able to help inform and transform politicized abortion debates.^ieng

Enanismo Mulibrey en un nino mexicano / Mulibrey nanisn in a Mexican child

Se estudio a un nino de cuatro anos de edad cuyas manifestaciones fenotipicas permitieron llegar al diagnostico de enanismo Mulibrey. Los padres del paciente no eran consaguineos, no tenian ascendencia europea, ni antecedentes de familiares similarmente afectados. La presente observacion concuerda con la herencia autosomica recesiva postulada para esta entidad, corrobora la amplia distribucion geografica de la misma y sugiere que la mutacion tiene un origen multiple

Parto psicoprofilactico vs. atencion obstetrica tradicional. / Psychoprophylactic labor vs. traditional obstetrical care

Se estudiaron 200 embarazadas con ERN atendidas por un mismo ginecoobstetra y grupo de pediatras; se integraron dos grupos de 100 casos cada uno. El primer grupo atendido por el metodo de atencion obstetrica tradicional (analgesia y/o anestesia). El segundo grupo atendido por el metodo psicoprofilactico. Se analizan 22 variables en base de a: Prueba de hipotesis.Resulta evidente el significado estadistico donde se demuestra las ventajas de la atencion del metodo psicoprofilactico sobre el tradicional. Se analiza literatura comparativa

Drenaje venoso anomalo pulmonar parcial. Tratamento quirurgico. / Partial pulmonary anomalous venous drainage.Surgical treatment

Se analizan 32 casos de drenaje venosos anomalo pulmonar parcial, comprobados por cirugia. El cuadro clinico y hemodinamico de esta entidad es indistinguible del cuadro clinico y hemodinamico de la comunicacion interauricular y el angiocardiograma en su fase de retorno por las venas pulmonares, puede, en gran porcentaje, proporcionar el diagnostico y el tipo de retorno. La cirugia de esta entidad debera ser indicada una vez que se llegue al diagnostico y si el paciente tiene tres anos de edad o mas

[Hepatic hamartoma. Study of a case]. / Hamartoma hepático. Estudio de un caso.

The case of a 9 year-old is presented having a mesenchymal hepatic hamartoma. It was diagnosed following Edmondson's classification criteria. Pertinent literature was studied and we found this case may represent the number 30. Useful laboratory analyses are mentioned for the management of these cases and a short preoperative study is emphasized according to the general opinion of pediatric surgeons.

Transposicion corregida de los grandes vasos. Tratamiento quirurgico de la comunicacion interventricular. / Corrected transposition of the great vessels. Surgical treatment of interventricular communication

Se informa de tres casos de transposicion corregida de los grandes vasos que acompana a la comunicacion interventricular, y que fueron enmendados por el ventriculo sistemico, con dos sobrevivientes. No se encontro evidencia de lesion en los tejidos de conduccion de los pacientes que sobrevivieron. Esta via de acceso ofrece la ventaja de poder cerrar la comunicacion interventricular con los tejidos de conduccion lejanos al borde por este ventriculo, especialmente cuando no se tiene un aparato identificador de haz de Hiss

Hamartoma hepatico. Estudio de un caso. / Hepatic hamartoma. Study of a case

Se presenta el caso de un escolar de 9 anos, del sexo femenino con un hamartoma mesenquimatoso del higado siguiendo los criterios de clasificacion de Edmondson. Se reviso la literatura y este tumor, que aparentemente es congenito, parece representar el ejemplo numero 30 y haber sido uno de los mas grandes hasta hoy extirpados. Se mencionan los examenes de gabinete utiles en el manejo de estos pacientes y se senala la conveniencia de un tiempo de estudo preoperatorio corto