Influencia del sexo fetal en los marcadores de riesgo utilizados en el cribado prenatal de trisomía 21 / Influence of the gender of the foetus on risk markers used in the prenatal screening of trisomy 21

Introducción. En el cribado combinado de primer trimestre se emplean marcadores bioquímicos y ecográficos que se ven modificados por distintos factores, como peso, gemelaridad, tabaquismo, etc. El objetivo de este estudio es analizar la influencia del sexo fetal en estos marcadores y la repercusión en el resultado del cribado de trisomía 21. Material y métodos. Estudio observacional, descriptivo y retrospectivo (2013-2015). Se excluyeron las gestaciones múltiples. Variables analizadas: medición de la translucencia nucal, la concentración de gonadotropina coriónica humana libre, la proteína plasmática A asociada al embarazo y sus correspondientes múltiplos de la mediana corregidos. Se comparan las medianas de las variables en gestaciones con feto masculino y femenino, afectas y no afectas. Resultados. Incremento del 23,62% en la mediana del múltiplo de la mediana de la gonadotropina coriónica humana libre corregido y del 3,65% en la mediana del múltiplo de la mediana de la proteína plasmática A asociada al embarazo corregido en gestaciones con fetos femeninos. Este aumento se cumple tanto en gestaciones con feto afecto como no afecto de trisomía 21. Sexo masculino: tasa de detección 86,9%, tasa de falsos positivos 3,36%. Sexo femenino: tasa de detección 90,9%, tasa de falsos positivos 4,10%. Conclusiones. El incremento sobre todo de los niveles de gonadotropina coriónica humana libre origina un aumento de la tasa de detección y de la tasa de falsos positivos en gestaciones con feto femenino. La aplicación de un factor de corrección por sexo requiere de estudios coste-efectividad

Introduction. In first trimester combined screening, biochemical and ultrasound markers are used that are modified by different factors such as weight, twins, smoking, etc. The aim of this study is to analyse the influence of foetal gender on these markers, and the repercussion on the result of the screening of trisomy 21. Material and methods. An observational, descriptive and retrospective study (2013-2015) was conducted. Multiple gestations were excluded. Variables analysed: nuchal translucency, free human chorionic gonadotrophin concentration, pregnancy-associated plasma protein A, and their median corrected multiples. A comparison was made of the medians of the variables in gestations with male and female foetuses, affected and non-affected. Results. There was a 23.62% increase in the median of the median corrected multiple free human chorionic gonadotrophin and 3.65% in the median of the median corrected multiple pregnancy-associated plasma protein A, in gestations with female foetuses. This increase is observed in gestations with foetuses affected and non-affected by trisomy 21. Male gender: detection rate 86.9%, false positive rate 3.36%. Female gender: detection rate 90.9%, false positive rate 4.10%. Conclusions. The increase, especially in free human chorionic gonadotrophin levels, leads to an increase in detection rate and false positive rate in gestations with a female foetus. The application of a correction factor by gender requires cost-effectiveness studies

Análisis de los resultados del programa de cribado prenatal de cromosomopatías en el Área Hospitalaria de Valme (Sevilla). Identificación de áreas para la mejora de la calidad / Analysis of the results of the programme of prenatal screening for chromosomal abnormalities in the Hospital Area of Valme (Sevilla). Identification of measures for the improvement of the quality

Introducción. En los programas de cribado prenatal de aneuploidías el análisis crítico de los resultados del control de calidad, entendido de forma amplia, podría ser una herramienta útil para mejorar la eficacia, sin necesidad de aumentar la complejidad o los costes en dichos programas. En el presente trabajo analizamos nuestros resultados en el periodo 2005-2011 para trisomía 21. Material y método. Se valoraron retrospectivamente los siguientes parámetros: cobertura, solicitudes no conformes, imprecisión y sesgo en la medición de BHCG libre y PAPP-A, evolución de las medianas de múltiplos de mediana de BHCG libre, PAPP-A y translucencia nucal, tasa de detección, tasa de falsos positivos y análisis de falsos negativos para trisomía 21. Los parámetros bioquímicos se determinaron mediante quimioluminiscencia. La estimación del riesgo se realizó mediante el software PRISCA V4.0. Resultados. Se realizaron 26.363 cribados. Cobertura 95,11%. No conformidades entre 12,2% (2005) y 5,8% (2010). Imprecisión inferior al 5% y sesgo inferior al 20% tanto para PAPP-A como para BHCG libre. Mediana de múltiplos de mediana corregidos de 1,066 (PAPP-A), 1,027 (BHCG libre) y 0,829 (translucencia nucal). Sensibilidad del 80% para cribado combinado de primer trimestre (4,6% falsos positivos) con 13 falsos negativos sobre 66 diagnósticos genéticos de trisomía 21. Para trisomía 18, sensibilidad del 77% (4,3% falsos positivos). Conclusión. Áreas de mejoras detectadas: universalización del programa, gestión de solicitudes no conformes, control de calidad ecográfico, diseño del software de cálculo y valoración conjunta de los resultados finales en colaboración entre Unidades de Laboratorio y Obstetricia(AU)

Introduction. Critical analysis of the results of quality control could be a useful tool to improve efficacy without increasing complexity or costs in such programs. We analyzed the results of the prenatal screening program in Valme Hospital in order to, detect and introduce improvement areas. Material and methods. We have studied the non-conformities of the application received, the precision and bias in the measurement of B-HCG and PAPP-A, the medians of PAPP-A, BHCG and nuchal translucency multiples of the medians, the sensibility and false positives rate. We have studied the false negatives results. The biochemical parameters were determined by a chemiluminiscence inmunoassay. Risks estimation was performed using PRISCA V4.0 software. Results. A total of 26,363 prenatal screening were performed. The program reached a coverage of 95,11%. Non-conformities fell from the 12.2 to 5.8%. Imprecision was less than 5% and bias less than 20% for biochemical markers. The corrected medians for PAPP-A, BHCG and nuchal translucency multiples of the medians were 1.066, 1.027 and 0,829, respectively. The sensibility for the first trimester combined screening was 80% (4,6% false positive) for Down's syndrome for a total 66 chromosomal abnormalities diagnosed. We recorded a total of 13 false negatives for trisomy 21. For trysomy 18 detection rate was 77% (4.3% false positive). Conclusion. Areas for improvement identified were: universalization of the program, non-conformities of the received application management, ultrasound quality control, design of risk calculation software and joint evaluation of the final results in collaboration between laboratory and obstetrics units(AU)

Efecto del plasma autógeno rico en plaquetas sobre el infarto de miocardio en ovejas / Effect of autologous platelet-rich plasma on heart infarction in sheep

Objetivo: El infarto de miocardio es la causa más común de fallo cardíaco congestivo. El objetivo de este trabajo es evaluar, en el animal de experimentación, los efectos morfológicos e histológicos de la implantación de plasma autógeno rico en plaquetas en el corazón de ovejas previamente infartadas. Métodos: Se utilizaron 24 ovejas lacha hembras, en las que se produjo quirúrgicamente un infarto agudo de miocardio, mediante toracotomía izquierda y ligadura permanente de 2 arterias coronarias (primera y segunda diagonal). Tras la ligadura de las arterias coronarias 3 ovejas fallecieron por fibrilación ventricular. Pasadas 3 semanas de la ligadura coronaria, las ovejas fueron reoperadas por esternotomía media vertical. En 6 de ellas (grupo control) se inyectó suero fisiológico en la zona del infarto. En 15 se inyectó gel plaquetario. Todas las ovejas fueron sacrificadas a las 9 semanas de evolución de la segunda cirugía. Resultados: En los corazones tratados con plasma rico en factores de crecimiento (PRGF) destaca la neoformación vascular en los cortes de hematoxilina-eosina y de factor VIII, a diferencia de los no tratados. Conclusiones: La inyección de factores de crecimiento plaquetarios, PRGF, en el corazón de ovejas previamente infartadas favorece la mitogénesis y la angiogénesis. El uso de PRGF autógeno es sencillo y seguro, no provocando toxicidad ni desencadenando reacciones inmunológicas ni inflamatorias.

Objective: Myocardial infarction is the most common cause of congestive heart failure. The objective of this work is to evaluate, in experimental animals, morphological and histological effects of the implantation of autologous platelet-rich plasma in infarcted heart sheep. Methods: Twenty-four ewes were used, they were surgically infarcted through left thoracotomy and two coronary arteries were ligated (first and second diagonal). After coronary artery ligation three sheep died of ventricular fibrillation. Three weeks after coronary ligation, sheep were reoperated through median sternotomy. Normal saline solution was injected in the infarcted zone in 6 of them (control group) whereas platelet gel was injected in 15 of them. All sheep were euthanized at 9 weeks of evolution of the second surgery. Results: Noteworthy is the formation of new vessels in hematoxylin-eosin-stained sections and factor VIII in plasma rich in growth-factors (PRGF)-treated hearts. Conclusions: Injection of platelet growth factors, PRGF, in previously infarcted sheep hearts promotes mitogenesis and angiogenesis. The use of autologous PRGF is simple and safe, causing no toxicity or immune-inflammatory reactions.

[Effect of autologous platelet-rich plasma on heart infarction in sheep]. / Efecto del plasma autógeno rico en plaquetas sobre el infarto de miocardio en ovejas.

OBJECTIVE: Myocardial infarction is the most common cause of congestive heart failure. The objective of this work is to evaluate, in experimental animals, morphological and histological effects of the implantation of autologous platelet-rich plasma in infarcted heart sheep. METHODS: Twenty-four ewes were used, they were surgically infarcted through left thoracotomy and two coronary arteries were ligated (first and second diagonal). After coronary artery ligation three sheep died of ventricular fibrillation. Three weeks after coronary ligation, sheep were reoperated through median sternotomy. Normal saline solution was injected in the infarcted zone in 6 of them (control group) whereas platelet gel was injected in 15 of them. All sheep were euthanized at 9 weeks of evolution of the second surgery. RESULTS: Noteworthy is the formation of new vessels in hematoxylin-eosin-stained sections and factor viii in plasma rich in growth-factors (PRGF)-treated hearts. CONCLUSIONS: Injection of platelet growth factors, PRGF, in previously infarcted sheep hearts promotes mitogenesis and angiogenesis. The use of autologous PRGF is simple and safe, causing no toxicity or immune-inflammatory reactions.

Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy.

BACKGROUND: Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. OBJECTIVE: A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. DESIGN, SETTING, AND PARTICIPANTS: From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. MEASUREMENTS: In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. RESULTS AND LIMITATIONS: Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p=0.001) was confirmed as the only factor independently associated with the pentafecta. CONCLUSIONS: A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients' expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease.

History of robotic surgery.

Robotic surgery is one of the most advanced forms of Minimally Invasive Surgery. Although the application of robotic technology to surgical robotics started some 20 years ago, the earliest work in robotics and automation can be traced back to 400 BC. Some of the early pioneers include Archytas of Arentum, Leonardo da Vinci, Gianello Toriano, and Pierre Jaquet-Droz, and we owe to these philosophers and scientists the fact that we can offer the benefit of minimal invasion in surgery. The purpose of this review is to give a brief description of the evolution of robotic surgery from its early history to present-day surgical robotics.

Efecto de desarrollo y secado de semillas de physalis ixocarpa brot en germinación, vigor y contenido de azúcares / Germination, vigor and sugar content in reponse to development and desiccation of physalis ixocarapa brot seeds / Efeito de desenvolvimento e seca de sementes de physalis ixocarpa brot em germinaçáo, vigor e conteúdo de açucares

Durante la formación de la semilla el contenido de humedad se reduce y la germinabilidad aumenta, comportamiento denominado como adquisición de tolerancia al secado. Las particularidades del comportamiento de las semillas de Physalis ixocarpa se desconoce, por lo que se estudió la evolución de la calidad fisiológica (germinación y vigor) y la concentración de azúcares durante el desarrollo de la semilla de P. ixocarpa, variedad Chapingo, y su relación con tres tipos de secado de semillas. Una vez extraídas del fruto se secaron con aire a 25ºC, con aire del ambiente y un testigo en donde se sembraron inmediatamente. Las semillas se cosecharon en seis estados de desarrollo (28, 35, 42, 49, 56 y 63 días después de floración, DDF). En todos los estados de desarrollo, ambos secados con aire elevaron la germinación para superar al testigo hasta en 42% (P £ 0,05). La velocidad de emergencia, variable que evalúa vigor, aumentó de 7 plántulas por día a los 28 DDF hasta 18 plántulas por día a los 42 DDF, pero sin diferencias entre secados, lo que evidencia que éstos no afectaron el vigor de la semilla sino la germinabilidad. En todos los tratamientos los contenidos de sacarosa y rafinosa aumentaron durante el desarrollo de la semilla, mientras que los monosacáridos (glucosa, fructosa y sorbitol) no presentaron diferencias significativas entre tratamientos de secado.

During seed development the humidity content decreases while germinability increases, a process known as acquisition of tolerance to desiccation. However, this process is not well known in seeds of Physalis ixocarpa. The effect of three drying methods in the physiological quality (germination and vigor) and sugar content of seeds of P. ixocarpa cv Chapingo was evaluated at different development stages. Seeds were extracted at six fruit development stages (28, 35, 42, 49, 56 and 63 days after flowering, DDF) and exposed to three types of drying: forced air at 25ºC or at room temperature, and a control consisting in planting the seeds inmediately. In all development stages, both drying treatments elevated germination up to 42% (P £ 0.05) over the control. The emergency rate (seed vigor) increased on average from 7 seedlings per day at 28 DDF to 18 seedlings per day at 42 DDF, independent of the drying method, which means that these drying methods affected germinability instead of seed vigor. In all the treatments, saccharose and rafinose contents increased during seed development, whereas monosaccharides contents (glucose, fructuose and sorbitol) were not related to the drying treatments.

Durante a formação da semente o conteúdo de umidade se reduz e a germinação aumenta, comportamento que denominou-se aquisição de tolerância à seca. Desconhece-se o comportamento fisiológico das sementes de Physalis ixocarpa durante sen desenvolvimento. Nesta investigação estudou-se a evolução da qualidade fisiológica (gerrninação e vigor) e a concentração de açúcares durante o desenvolvimento (28, 35, 42, 49, 56, e 63 dias depois da floração, DDF); uma vez extraidas do fruto, as sementes foram sometidas a três tipos de seca com ar a 25°C, com ar do ambiente e uma testemunha sem seca. Em todos os estados de desenvolvimento, ambas secas elevaram a germinação para superar a testemunha até em 42% (P£0,05). A velocidade de emergência aumenta durante a maduração das sementes dum ponto médio de 7 plântulas·dia aos 42 DDF, mas sem diferenças entre tratamentos de seca, o que evidencia que estes não afetaram o vigor da semente senão germinabilidade. Em todos os tratamentos os conteúdos de sacarose e rafinose aumentaram durante o desenvolvimento da semente, enquanto os monosacáridos (glicose, frutose e sorbitol) não presentaram diferenças significativas entre tratamentos de seca.

[Patients suffering dilated chagasic cardiopathy or non chagasic cardiopathy show an increased levels of tumor necrosis factor alpha]. / Pacientes con cardiomiopatía dilatada chagásica y cardiopatia no chagásica presentan niveles elevados del factor de necrosis tumoral alpha.

Chagas' disease is a public health problem in Venezuela, affecting people living in rural areas. 30% of the patients evolve to a Chronic Chagasic Myocardiopathy (CCM) characterized by heart failure, arrhythmias, incapacity to work and sudden death. There are not predictive factors to determine the evolution from the indeterminate form of the disease (asymptomatic form) to CCM. In the present paper we have studied 115 patients enrolled in the Cardiology unit at the Baudilio Lara Hospital in Quibor (Lara State, Venezuela) and 12 healthy patients coming from the same area. Patients were evaluated by means of clinical history; echocardiography, electrocardiography and radiology. The presence of anti-T. cruzi antibodies and levels of Tumor Necrosis Factor alpha (TNFalpha) were determined in serum samples. Chagas' disease patients were classified in 3 groups: I (asymptomatic), II (asymptomatic with normal left ventricular ejection fraction (LVEF) and electrocardiographic alterations) and and III (symptomatic, electrocardiographic alterations and LVEF < 70%). The results showed that 33.04% of the patients had anti-T. cruzi antibodies in their serum; we also observed a significant increase in the serum levels of TNFalpha in groups I and III of Chagas' disease patients as compared with the control healthy group. Chagas' disease patients belonging to Group II displayed similar TNFalpha levels as controls. We observed a statistically significant (p < 0.05) negative correlation between serum TNFalpha values and LVEF. Patients suffering of non-chagasic myocardiopathy had a significant increase of TNFalpha as compared with control patients and similar levels to those observed in Chagas' disease group III patients. These results confirm that the elevation of TNFalpha serum levels could be a immunopathogenic mechanism in the evolution of myocardiopathies.

Pacientes con cardiomiopatía dilatada chagásica y cardiopatía no chagásica presentan niveles elevados del factor de necrosis tumoral a / Patients suffering dilated chagasic cardiopathy or non chagasic cardiopathy show an increased levels of tumor necrosis factor a

La Enfermedad de Chagas representa un problema de salud pública en Venezuela, que afecta principalmente individuos que viven en áreas rurales. El 30 por ciento de los infectados evoluciona hacia una Miocardiopatía Chagásica Crónica (MCC) caracterizada por insuficiencia cardíaca, arritmias de difícil tratamiento, incapacidad laboral y muerte súbita. No existen factores predictores definitivos para la evolución de la forma indeterminada (asintomático) hacia la MCC. En el presente trabajo se estudiaron 115 pacientes de la consulta de cardiología del Hospital "Baudilio Lara" (Quíbor, estado Lara, Venezuela) y 12 individuos sanos procedentes de la misma zona. Ambos grupos fueron evaluados desde el punto de vista clínico, radiológico, electrocardiográfico, ecocardiográfico y serológico; se determinó la presencia de anticuerpos anti-T. cruzi y los niveles séricos del Factor de Necrosis Tumoral a (FNTa). Los pacientes con Enfermedad de Chagas fueron clasificados en Grupos: I (asintomáticos), II (asintomáticos, fracción de eyección del ventrículo izquierdo (FEVI) normal y trastornos de la conducción) y III (sintomáticos, trastornos de conducción y FEVI <70 por cientos) y los pacientes con Cardiopatía no Chagásica en dilatados y no dilatados. Los resultados mostraron un 33.04 por ciento de seropositividad, observándose un incremento significativo de los niveles séricos del FNTa en los pacientes con Enfermedad de Chagas en la fases evolutivas I y III, al ser comparado con el grupo control. Los pacientes en fase II mostraron valores séricos similares al control. Los valores del FNTa en los pacientes con Enfermedad de Chagas se correlacionaron negativamente en forma significativa (p < 0,05) con los valores de la fracción de eyección. Los cardiópatas no chagásicos mostraron incrementos significativos de los niveles séricos del FNTa, respecto al control y los valores fueron comparables al observado en pacientes con cardiopatía chagásica. Los resultados confirman que la elevación del FNTa puede ser un mecanismo inmunopatogénico clave en la progresión de las cardiopatías