Video assisted retroperitoneal debridement for infected pancreatic necrosis: A two port approach for difficult access.

INTRODUCTION AND IMPORTANCE: The incidence of acute pancreatitis varies globally, and its rates are increasing. Timely intervention in cases of infected necrosis is crucial to effective management. The landscape of acute pancreatitis management has undergone transformation through adopting a "step-up" strategy, accentuating the shift towards minimally invasive techniques. CASE PRESENTATION: A 63-year-old patient with acute pancreatitis and infected pancreatic necrosis underwent a challenging yet successful treatment using video-assisted retroperitoneal debridement employing a two-port approach facilitated access for an intricate area. The procedure, performed 45 days after admission, effectively reduced peripancreatic collections, demonstrating the efficacy of this approach in managing complex cases of infected pancreatic necrosis. CLINICAL DISCUSSION: The management of acute pancreatitis has evolved towards a comprehensive strategy involving early hydration, nutritional support, effective pain management, and interventions. Infected pancreatic necrosis poses a serious complication, with minimally invasive techniques such as video-assisted retroperitoneal debridement (VARD) emerging as preferred options. The efficacy and safety of VARD in complex cases are highlighted, although challenges persist, especially in extensive necrosis. CONCLUSION: The VARD procedure, a key component of the step-up approach, exhibits a remarkable safety profile, substantially reducing postoperative complications and mortality compared to open surgical counterparts. However, challenges persist in managing cases of infected Walled-Off Necrosis with deep extension, necessitating carefully considering a minimal-access approach. We report our experience using the VARD in a two-port approach.

Feasibility of aquaculture cultivation of elkhorn sea moss (Kappaphycus alvarezii) in a horizontal long line in the Tropical Eastern Pacific.

Seaweed aquaculture has become a profitable and an attractive alternative of cultivation thanks to its quick biomass production for food, feed, and other non-food applications. In addition, the ecosystem services generated by seaweed cultivation towards carbon fixation represents a more sustainable solution to the ocean's acidification. The growth of elkhorn sea moss (Kappaphycus alvarezii) was evaluated in three plots with 200 propagules during a period of 70 days in a floating raft system covered by a fishing net underneath. Initial weight of propagules was 159.3 ± 12.74 g in wet biomass and 15.3 ± 1.43 g in dry biomass and were sampled up to 19 days (in the lag growth phase; period I), up to 33 days (in the exponential growth phase; period II) and up to 70 days (in the stationarity growth phase; period III). The variations of sea surface water temperature, salinity, turbidity (Secchi depth), total ammonium, nitrites, nitrates, and phosphate were determined. The growth increase was more evident in the exponential phase II when a dry biomass of 28.0 ± 2.48 (1153.3 ± 6.25 g in wet mass) was reached, more than 7 times the biomass of propagules with an average daily growth rate of 15.2% g.day-1. The carrying capacity of the zone was estimated at 86.2% in the area where 53 cultivation units would be projected. The economic analysis presented a financial feasibility with a net profit of 19% over the projected income and an IRR of 16.5%, recovering the investment in an estimated period of 4.3 years. We recommend to continue with larger-scale studies to optimize the cultivation of K. alvarezii in the study area.

Genotypic Findings in Noonan and Non-Noonan RASopathies and Patient Eligibility for Growth Hormone Treatment.

Molecular study has become an invaluable tool in the field of RASopathies. Treatment with recombinant human growth hormone is approved in Noonan syndrome but not in the other RASopathies. The aim of this study was to learn about the molecular base of a large cohort of patients with RASopathies, with particular emphasis on patients with pathogenic variants in genes other than PTPN11, and its potential impact on rGH treatment indication. We reviewed the clinical diagnosis and molecular findings in 451 patients with a genetically confirmed RASopathy. HRAS alterations were detected in only 2 out of 19 patients referred with a Costello syndrome suspicion, whereas pathogenic variants in RAF1 and SHOC2 were detected in 3 and 2, respectively. In 22 patients referred with a generic suspicion of RASopathy, including cardiofaciocutaneous syndrome, pathogenic alterations in classic Noonan syndrome genes (PTPN11, SOS1, RAF1, LZTR1, and RIT1) were found in 7 patients and pathogenic variants in genes associated with other RASopathies (HRAS, SHOC2, and PPPCB1) in 4. The correct nosological classification of patients with RASopathies is critical to decide whether they are candidates for treatment with rhGH. Our data illustrate the complexity of differential diagnosis in RASopathies, as well as the importance of genetic testing to guide the diagnostic orientation in these patients.

A Novel Pathogenic Variant in the MN1 Gene in a Patient Presenting with Rhombencephalosynapsis and Craniofacial Anomalies, Expanding MN1 C-terminal Truncation Syndrome.

Meningioma-1 is a transcription activator that regulates mammalian palate development and is required for appropriate osteoblast proliferation, motility, differentiation, and function. Microdeletions involving the MN1 gene have been linked to syndromes including craniofacial anomalies, such as Toriello-Carey syndrome. Recently, truncating variants in the C-terminal portion of the MN1 transcriptional factor have been linked to a characteristic and distinct phenotype presenting with craniofacial anomalies and partial rhombencephalosynapsis, a rare brain malformation characterized by midline fusion of the cerebellar hemispheres with partial or complete loss of the cerebellar vermis. It has been called MN1 C-terminal truncation (MCTT) syndrome or CEBALID (Craniofacial defects, dysmorphic Ears, Brain Abnormalities, Language delay, and Intellectual Disability) and suggested to be caused by dominantly acting truncated protein MN1 instead of haploinsufficiency. As a proto-oncogene, MN1 is also involved in familial meningioma. In this study, we present a novel case of MCTT syndrome in a female patient presenting with craniofacial anomalies and rhombencephalosynapsis, harboring a de novo pathogenic variant in the MN1 gene: c.3686_3698del, p.(Met1229Argfs*87).

Cancer Progression Is not Different in Mice of Different Gender Inoculated With Cells of the Triple-Negative 4T1 Breast Cancer Model.

Background: Breast cancer in men is a rare and poorly studied disease, and its treatment is based on women breast cancer studies. However, clinical outcome is not the same in men and women. Basic studies and clinical trials in animal models provide detailed information on cancer, origin, development, cell signaling pathways, sites of metastasis, and target molecules. It is necessary to explore the biology of breast cancer in male animal models that allow observing their similarity. Methods: The triple-negative 4T1 breast cancer model was developed in both male and female mice and studied weekly during 4 weeks. For that, twenty 8-week-old female and male BALB/c mice were used. Sixteen mice (eight males and eight females) were inoculated into the second left thoracic mammary pad with 20,000 4T1 cells, resuspended in 20 µL phosphate-buffered saline (PBS). All samples were processed for immunodetection, characterized histopathologically and immunohistochemically. Results: In this work, we describe the development of a triple-negative 4T1 breast cancer model in male BALB/c mice. Breast tumors were characterized histopathologically at different time points and corresponded to a moderately differentiated invasive ductal carcinoma, estrogen receptor ER-/progesterone receptor PR-/human epidermal growth factor receptor 2 HER2-/Ki67+, with histological grade II (moderately differentiated; a solid mass with occasional duct formation and moderate to severe nuclear pleomorphism), infiltrating the adipose and muscular tissue, and metastasis to lungs. From the results, we did not observe differences in the time of tumor development, necrosis, color change of tumor tissue, and lung metastasis between male and female mice. Even though we did not find histological differences, response to treatment and molecular signaling may be different. Conclusions: The histogenesis of male breast tumors was similar to that of female BALB/c mice. The histological and immunohistochemical characteristics of male tumors also match the features reported for stage IV human breast cancer of men and women. The murine male breast cancer model described here can be a significant tool to explore the molecular mechanisms involved in male breast cancer tumorigenesis and metastasis and may bring new approaches for clinical treatment of triple-negative breast cancer in men.

Predictive Factors of Renal Function Decline in Patients with Type 2 Diabetes Treated with Canagliflozin in the Real-Wecan Study.

The Real-WECAN study evaluated the real-life effectiveness and safety of canagliflozin 100 mg daily (initiated in SGLT-2 inhibitors naïve patients) and canagliflozin 300 mg daily (switching from canagliflozin 100 mg or other SGLT-2 inhibitors) in individuals with type 2 diabetes. The objectives of this sub-analysis were to estimate the eGFR slope over the follow-up period and to identify predictive factors of eGFR decline in a multiple linear regression analysis. A total of 583 patients (279 on canagliflozin 100 mg and 304 on canagliflozin 300 mg) were included, with median follow-up at 13 months. The patients had a mean age of 60.4 years, HbA1c of 7.76%, BMI of 34.7 kg/m2, eGFR below 60 mL/min/1.73 m2 8.6%, and urine albumin-to-creatinine ratio (UACR) above 30 mg/g 22.8%. eGFR decreased by −1.9 mL/min/1.73 m2 (p < 0.0001) by the end of the study. The mean eGFR slope during the maintenance phase was −0.16 mL/min/1.73 m2 per year. There were no significant differences between both doses of canagliflozin in the eGFR reduction or in the eGFR slope. The best predictive multivariate model of eGFR decline after canagliflozin therapy included age, hypertension, combined hyperlipidemia, heart failure, eGFR and severely increased albuminuria. All these variables except hypertension were independently associated with the outcome. In conclusion, in this real-world study, individuals with older age, combined hyperlipidemia, heart failure, higher eGFR and UACR > 300 mg/g showed a greater decline in their eGFR after canagliflozin treatment.

Use of EHRs in a Tertiary Hospital During COVID-19 Pandemic: A Multi-Purpose Approach Based on Standards.

This work aims to describe how EHRs have been used to meet the needs of healthcare providers and researchers in a 1,300-beds tertiary Hospital during COVID-19 pandemic. For this purpose, essential clinical concepts were identified and standardized with LOINC and SNOMED CT. After that, these concepts were implemented in EHR systems and based on them, data tools, such as clinical alerts, dynamic patient lists and a clinical follow-up dashboard, were developed for healthcare support. In addition, these data were incorporated into standardized repositories and COVID-19 databases to improve clinical research on this new disease. In conclusion, standardized EHRs allowed implementation of useful multi- purpose data resources in a major Hospital in the course of the pandemic.

Real-World Clinical Outcomes Associated with Canagliflozin in Patients with Type 2 Diabetes Mellitus in Spain: The Real-Wecan Study.

The aims of this multicentric retrospective study were to assess in a real-world setting the effectiveness and safety of canagliflozin 100 mg/d (CANA100) as an add-on to the background antihyperglycemic therapy, and to evaluate the intensification of prior sodium-glucose co-transporter type 2 inhibitor (SGLT-2i) therapy by switching to canagliflozin 300 mg/d (CANA300) in patients with T2DM. One cohort of SGLT2i-naïve patients with T2DM who were initiated on CANA100 and a second cohort of patients with prior background SGLT-2i therapy who switched to CANA300 were included in the study. The primary outcome of the study was the mean change in HbA1c over the follow-up time. In total, 583 patients were included-279 in the cohort of CANA100 (HbA1c 8.05%, weight 94.9 kg) and 304 in the cohort of CANA300 (HbA1c 7.51%, weight 92.0 kg). Median follow-up periods in both cohorts were 9.1 and 15.4 months respectively. CANA100 was associated to significant reductions in HbA1c (-0.90%) and weight (-4.1 kg) at the end of the follow-up. In those patients with baseline HbA1c > 8% (mean 9.25%), CANA100 lowered HbA1c levels by 1.51%. In the second cohort, patients switching to CANA300 experienced a significant decrease in HbA1c (-0.35%) and weight (-2.1 kg). In those patients with baseline HbA1c > 8% (mean 8.94%), CANA300 lowered HbA1c levels by 1.12%. There were significant improvements in blood pressure in both cohorts. No unexpected adverse events were reported. In summary, CANA100 (as an add-on therapy) and CANA300 (switching from prior SGLT-2i therapy) significantly improved several cardiometabolic parameters in patients with T2DM.

Defining a Standardized Information Model for Multi-Source Representation of Breast Cancer Data.

This work aims to define a standardized information model for representation of multiple data sources in breast cancer. A set of data elements has been identified using ICHOM Breast Cancer as the minimum data set and adapting it to the needs of Hospital Universitario 12 de Octubre. With this, an information model has been defined according to ISO 13606 and SNOMED CT standards.

Cuerpo extraño en vía aérea inferior de dos años de evolución: reporte de caso / Foreign body in lower airway of two years of evolution: case repor

La aspiración de un cuerpo extraño es un acontecimiento fatal que puede conducir a la muerte, definido como el ingreso de manera accidental de un objeto, orgánico o inorgánico, a la vía aérea, alojándose ya sea en la laringe, tráquea o bronquios. Este evento es común en la población pediátrica especialmente entre niños de 18 meses a 3 años. El sitio de alojamiento más común es en el bronquio derecho. El diagnóstico tardío de cuerpo extraño en bronquio está relacionado a neumonías recurrentes, bronquiectasias y atelectasias. Presentamos el caso de un paciente de 12 años de edad con antecedentes de sospecha de aspiración de cuerpo extraño en vía aérea desde hace 2 años. Presentando en ese intervalo de tiempo tos productiva de color verde amarillento y persistente, halitosis, neumonías a repetición, y con hipocratismo digital simétrico. Con ayuda de Imágenes por tomografía axial computarizada y broncoscopia virtual se evidencia el cuerpo extraño alojado en bronquio principal izquierdo, revelando el pulmón izquierdo colapsado, hepatizado, con bronquiectasias inferiores, desplazamiento de corazón hacia la izquierda y pulmón derecho sobre distendido. * Médico residente de Tercer año pediatría, UNHA-VS...(AU)

Are Pediatric Critical Personnel Satisfied With Their Lives? Prediction of Satisfaction With Life From Burnout, Posttraumatic Stress, and Posttraumatic Growth, and Comparison With Noncritical Pediatric Staff.

OBJECTIVES: Staff in PICUs shows high burnout, posttraumatic stress disorder symptoms, and posttraumatic growth levels. However, their levels of satisfaction with life and how positive and negative posttrauma outcomes relate to each other and contribute to predict satisfaction with life remain unknown. Thus, we attempted to explore these aspects and to compare the findings with data from pediatric professionals working in noncritical units. DESIGN: This is an observational multicentric, cross-sectional study. SETTING: The PICU of nine hospitals in Spain, and other pediatric units in the same hospitals. SUBJECTS: Two hundred ninety-eight PICU workers (57 physicians, 177 nurses, and 64 nursing assistants) and 189 professionals working in noncritical pediatric units (53 physicians, 104 nurses, and 32 nursing assistants). INTERVENTION: Participants completed the Maslach Burnout Inventory, the Trauma Screening Questionnaire, the Posttraumatic Growth Inventory, and the Satisfaction With Life Scale. MEASUREMENTS AND MAIN RESULTS: Of PICU staff, 16.4% were very satisfied with their lives, 34.2% were satisfied, 34.6% showed average satisfaction with life, and 14.8% were below average. No differences were found between PICU and non-PICU workers. Women reported lower satisfaction with life than men, and physicians reported higher satisfaction with life than other professional groups. The correlation between posttraumatic stress disorder and posttraumatic growth was low, but significant and positive. According to the path analysis with latent variables, 20% of the variance satisfaction with life could be predicted from burnout, posttraumatic stress disorder symptoms, and posttraumatic growth. Higher distress was inversely associated to satisfaction with life, whereas posttraumatic growth contributed to higher satisfaction with life. CONCLUSIONS: Posttraumatic growth can moderate the negative effect of traumatic work-related experiences in satisfaction with life. PICU and non-PICU workers were equally satisfied with their lives. Positive and negative impact of work-related potentially traumatic events can coexist in the same person. Interventions aimed at reducing distress and fostering posttraumatic growth could impact in an improvement in pediatric health professionals' satisfaction with life.

Burnout and posttraumatic stress in paediatric critical care personnel: Prediction from resilience and coping styles.

INTRODUCTION: Our aims were (1) to explore the prevalence of burnout syndrome (BOS) and posttraumatic stress disorder (PTSD) in a sample of Spanish staff working in the paediatric intensive care unit (PICU) and compare these rates with a sample of general paediatric staff and (2) to explore how resilience, coping strategies, and professional and demographic variables influence BOS and PTSD. MATERIALS AND METHODS: This is a multicentre, cross-sectional study. Data were collected in the PICU and in other paediatric wards of nine hospitals. Participants consisted of 298 PICU staff members (57 physicians, 177 nurses, and 64 nursing assistants) and 189 professionals working in non-critical paediatric units (53 physicians, 104 nurses, and 32 nursing assistants). They completed the Brief Resilience Scale, the Coping Strategies Questionnaire for healthcare providers, the Maslach Burnout Inventory, and the Trauma Screening Questionnaire. RESULTS: Fifty-six percent of PICU working staff reported burnout in at least one dimension (36.20% scored over the cut-off for emotional exhaustion, 27.20% for depersonalisation, and 20.10% for low personal accomplishment), and 20.1% reported PTSD. There were no differences in burnout and PTSD scores between PICU and non-PICU staff members, either among physicians, nurses, or nursing assistants. Higher burnout and PTSD rates emerged after the death of a child and/or conflicts with patients/families or colleagues. Around 30% of the variance in BOS and PTSD is predicted by a frequent usage of the emotion-focused coping style and an infrequent usage of the problem-focused coping style. DISCUSSION AND CONCLUSIONS: Interventions to prevent and treat distress among paediatric staff members are needed and should be focused on: (i) promoting active emotional processing of traumatic events and encouraging positive thinking; (ii) developing a sense of detached concern; (iii) improving the ability to solve interpersonal conflicts, and (iv) providing adequate training in end-of-life care.

Perfil molecular y características clínico-patológicas del carcinoma mamario, con énfasis en la expresión del Ki 67: Experiencia inicial en instituto oncológico del norte del Perú / Molecular profile and clinical-pathological characteristics of the mammary carcinoma, with emphasis on the expression of Ki 67: Initial experience at the oncological institute of the north of Peru

Objetivo: Identificar el perfil molecular y las características clínicas y patológicas del carcinoma de mama de acuerdo a la variabilidad en la expresión del Ki 67. Material y métodos. Serie de casos, en el que se evaluaron 157 pacientes con diagnóstico anatomopatológico e inmunohistoquímico de cáncer de mama atendidas en el IREN Norte (Perú) durante el período 2008 ­ 2015. Se clasificaron los tumores en Luminal A, Luminal B, HER2 y Triple negativo. Se utilizo dos puntos de corte para evaluar el Ki 67:> 14% y > 20%, de acuerdo a lo sugerido en St. Gallen 2011 y 2013 respectivamente. Resultados. En el grupo de pacientes con Ki 67 > 20%, el subtipo molecular que predominó fue el Luminal B (n = 54; 34%). El tamaño tumoral más frecuente se ubicó en el grupo de > 2 a < 5 cm. (T2), representando 56% en el subtipo Luminal B, 28% en Luminal A, 69% en HER2 y 41% en el Triple negativo. En los pacientes con Ki 67 > 14%, el subtipo molecular y el tamaño tumoral predominante también fue el Luminal B (n = 73, 46%) y el T2. El tipo histológico más común fue el carcinoma ductal independientemente del punto de corte del valor de Ki 67. Conclusiones. La utilidad del valor porcentual del Ki 67 evaluado en dos puntos de corte es controversial; en nuestro estudio el perfil molecular y las características clínico-patológicas de cáncer de mama fueron relativamente similares en relación a Luminal A y Luminal B.

Objetive: Identify the molecular profile and the clinical and pathological characteristics of breast carcinoma according to the variability in Ki 67 expression. Material and methods. Case series, in which 157 patients with an anatomopathological and immunohistochemical diagnosis of breast cancer treated at IREN Norte (Peru) were evaluated during the period 2008-2015. The tumors were classified into Luminal A, Luminal B, HER2 and Triple Negative. Two cut-off points were used to evaluate Ki 67: > 14% and > 20%, according to what was suggested in St. Gallen 2011 and 2013 respectively. Results. In the group of patients with Ki 67 > 20%, the mol ecul ar subtype that predominated was Luminal B (n = 54, 34%). The most frequent tumor size was in the group of > 2 to < 5 cm. (T2), representing 56% in the Luminal B subtype, 28% in Luminal A, 69% in HER2 and 41% in the Triple negative. In patients with Ki 67 > 14%, the molecular subtype and the predominant tumor size was also Luminal B (n = 73, 46%) and T2. The most common histological type was ductal carcinoma regardless of the cut-off point of the Ki 67 value Conclusions. The utility of the percentage value of Ki 67 evaluated at two cut points is controversial; in our study, the molecular profile and clinical-pathological characteristics of breast cancer were relatively similar in relation to Luminal A and Luminal B.

Endocarditis infecciosa en Hospital de Talca, período 1998 - 2015 / Infective endocarditis at Hospital de Talca, 1998-2015

Resumen: Introducción: La endocarditis infecciosa es una enfermedad con una alta mortalidad que se ha mantenido estable en los últimos años pese a avances en su diagnóstico y tratamiento. Objetivo: Evaluar las características clínicas de los pacientes con Endocarditis Infecciosa tratados en el Hospital de Talca. Materiales y métodos: Estudio retrospectivo en que se revisaron las historias clínicas de los pacientes con endocarditis infecciosa atendidos entre 1998 y 2015 en el Hospital Regional de Talca. Resultados: Se encontraron 62 pacientes con endocarditis infecciosa con un promedio de edad de 49,7 años, 61,2% de ellos de sexo masculino, 21% de ellos con válvula protésica y 13% con antecedentes de enfermedad reumática. Las comorbilidades más frecuentes fueron hipertensión arterial, diabetes mellitus y enfermedad renal crónica. El 72,5% de los pacientes se presentaron con síndrome febril y soplo asociado. Un 87,1% presentaban vegetaciones al ecocardiograma. El 67,1% de los pacientes tenía hemocultivo positivo, de los cuales el microorganismo más frecuente fue el Staphylococcus aureus (22,6%). Un 24,2 % de los pacientes requirieron tratamiento quirúrgico. La mortalidad intrahospitalaria fue de un 19,3%. Conclusiones: Las características clínicas de los pacientes descritos son similares a estudios nacionales e internacionales, con una mortalidad intrahospitalaria elevada.

Abstract: Background: Infective endocarditis is a disease with high mortality that remains stable in recent years despite advances in it's diagnosis and treatment. Aim: Evaluate the clinical characteristics of patients with infective endocarditis treated at Hospital de Talca, Chile. Material and Methods: Retrospective study in which the clinical records of patients with infective endocarditis treated between 1998 and 2015 at Hospital Regional de Talca were reviewed. Results: 62 patients with infective endocarditis were identified. The median age was 49,7 years, 61,2% were males. 21% carried one or more prosthetic heart valve and 13% had previous rheumatic valve disease. The most common comorbidities were hypertension, diabetes, and chronic kidney disease. 72,5% presented with fever and a cardiac murmur, 87,1% had vegetations in echocardiography. In 67% of patients blood cultures were positive and22,6% of them had blood cultures positive for Staphylococcus aureus. 24,2 % of patients required hearth surgery. Hospital mortality was 19,3%. Conclusions: The clinical characteristics of patients included in this series were similar to those found in national and international studies, Hospital mortality was high

Determination of histone epigenetic marks in Arabidopsis and tomato genes in the early response to Botrytis cinerea.

KEY MESSAGE: Determination of histone epigenetic marks in Arabidopsis and tomato genes in the early response to Botrytis cinerea may contribute to find biomarkers of the early detection of this devastating pathogen. Recent studies have linked epigenetic modifications with plant responses to biotic stresses. Information about specific histone marks upon necrotrophic pathogens is scarce. Here we wondered whether the altered responsiveness of specific genes in plants infected with Botrytis cinerea was associated with changes in chromatin structure. We performed a chromatin immunoprecipitation analysis that obtained differential epigenetic signature of activating marks H3K4me3, H3K9ac, and the repressor one H3K27me3 on both the promoter and the body of the highly induced PR1 in Arabidopsis plants infected with B. cinerea at 24 and 33 h after inoculation. We also determined the histone marks' profile in two differentially expressed genes in response to B. cinerea, as well as to oxidative stress, given its relevance in this infection. These are both the induced CYP71A13, which encodes a cytochrome P450 involved in camalexin synthesis, and is essential against this necrotroph and the repressed EXL7 (Exordium-like 1). We also adapted our protocol in tomato plants infected with B. cinerea. At 24 hpi, H3K4me3 level increased on the promoter and at different locations of the body of the genes induced upon B. cinerea, including DES (divinyl ethyl synthase), LoxD (lipoxygenase D), DOX1 (α-dioxygenase 1), PR2 (pathogenesis-related protein2), WRKY53 and WRKY33. The histone modifications determined herein will allow future studies on epigenetic marks and their transgenerational inheritance in plants infected with B. cinerea. In addition, the analyzed genes are potential biomarkers of B. cinerea infection that could contribute to its early detection in tomato and related crops.

Comment about "Randomized cross-over clinical trial comparing two pharmacokinetic models of propofol using entropy indices" / Comentario acerca de «Ensayo clínico cruzado y aleatorizado para comparar 2 modelos farmacocinéticos de propofol usando índices de entropía¼

The article, "Clinical cross-section, randomized clinical trial comparing two pharmacokinetic propofol models using entropy indexes",1 published in the July-September 2016 journal, although an interesting and novel idea, it seems to me that a big mistake was made in the study's clinical design, that totally invalidates the results.

El artículo, "Clinical cross-section, randomized clinical trial comparing two pharmacokinetic propofol models using entropy indexes",1 publicado en la revista de julio-septiembre de 2016, aunque es una idea interesante y novedosa, me parece que se cometió un gran error en el diseño clínico del estudio, que invalida totalmente los resultados.

Comment on the article "Postoperative residual paralysis in patients aged over 65 years old at the Post-Anesthesia Care Unit" / Comentario acerca del estudio «Relajación residual postoperatoria en pacientes mayores de 65 años en la Unidad de Cuidado Postanestésico¼

Residual paralysis with the use of non-depolanzmg muscle relaxants is a problem that has beset us for many years.1 Much has been written about avoiding it and about the need to mon itor relaxation at the completion of the surgery in order to avoid undesirable effects in the recovery room,2 nd identify the need for reversal when required.

La parálisis residual con el uso de relajantes musculares no depolanzmg es un problema que nos acosa desde hace muchos años.1 Se ha escrito mucho sobre cómo evitarla y sobre la necesidad de controlar la relajación al finalizar la cirugía para evitar efectos indeseables en la sala de recuperación,2 e identificar la necesidad de revertirla cuando sea necesario.

Posttraumatic growth in pediatric intensive care personnel: Dependence on resilience and coping strategies.

OBJECTIVE: Staff in pediatric intensive care units (PICU) are inherently exposed to potentially traumatic events. Posttraumatic growth (PTG) is the occurrence of positive changes after experiencing a traumatic event. This study aims (a) to evaluate the prevalence of PTG in PICU staff, and whether their scores are different from those reported by professionals working in other pediatric units, (b) to explore the role of resilience and coping strategies in predicting PTG, and (c) to explore the relation of demographic and work-related variables with PTG. METHOD: Participants of this multicentric, cross sectional study were 298 PICU workers and 189 professionals working in noncritical pediatric units. They completed the Brief Resilience Scale, a Coping Strategies Questionnaire, the Posttraumatic Growth Inventory (PTGI), and provided demographic and work-related information. RESULTS: Of PICU staff, 68.8% experienced growth to a "great" or "very great" degree in at least one of the PTGI's dimensions. Higher PTG was reported following the death of a child or after a recent conflict with a work colleague. PICU workers and noncritical pediatric staff showed equivalent PTG levels. Multigroup path analysis with latent variables showed that emotion-focused coping was related to PTG only in PICU staff, whereas problem-focused coping was related to PTG in both groups. The relation between resilience and PTG was not significant. CONCLUSIONS: Work-related trauma can act as a catalyst for positive posttrauma changes. Modifying coping strategies may be a way to foster PTG in health care providers. (PsycINFO Database Record

Absence of Cu-Zn superoxide dismutase BCSOD1 reduces Botrytis cinerea virulence in Arabidopsis and tomato plants, revealing interplay among reactive oxygen species, callose and signalling pathways.

Plants activate responses against pathogens, including the oxidative burst. Necrotrophic pathogens can produce reactive oxygen species (ROS) that benefit the colonization process. Previously, we have demonstrated that tomato plants challenged with Botrytis cinerea accumulate ROS and callose, together with the induction of genes involved in defence, signalling and oxidative metabolism. Here, we studied the infection phenotype of the Δbcsod1 strain in both tomato and Arabidopsis plants. This mutant lacks bcsod1, which encodes Cu-Zn superoxide dismutase (SOD). This enzyme catalyses the conversion of superoxide ion ( O2-) into hydrogen peroxide (H2 O2 ). ROS play a protective role and act as signals in plants. Δbcsod1 displayed reduced virulence compared with wild-type B05.10 in both species. Plants infected with Δbcsod1 accumulated less H2 O2 and more O2- than those infected with B05.10, which is associated with an increase in the defensive polymer callose. This supports a major role of fungal SOD in H2 O2 production during the plant-pathogen interaction. The early induction of the callose synthase gene PMR4 suggested that changes in ROS altered plant defensive responses at the transcriptional level. The metabolites and genes involved in signalling and in response to oxidative stress were differentially expressed on Δbcsod1 infection, supporting the notion that plants perceive changes in ROS balance and activate defence responses. A higher O2- /H2 O2 ratio seems to be beneficial for plant protection against this necrotroph. Our results highlight the relevance of callose and the oxylipin 12-oxo-phytodienoic acid (OPDA) in the response to changes in the oxidative environment, and clarify the mechanisms that underlie the responses to Botrytis in Arabidopsis and tomato plants.

Trauma cerrado de páncreas / Closed trauma of the pancreas

El trauma cerrado del páncreas es infrecuente, pues el órgano se encuentra ubicado en un sitio que goza de relativa protección. Se considera por diferentes autores que entre el uno y el doce por ciento de los traumatismos abdominales graves presentan una lesión pancreática. Se describe el caso de un paciente masculino de 54 años de edad, que recibió un trauma cerrado en epigastrio por la patada de un buey; acude al cuerpo de guardia de cirugía 72 horas después de haber recibido el trauma. Al examen físico se encuentra reacción peritoneal a ese nivel y en la ecografía abdominal se identifica un hematoma a nivel del cuello pancreático. Se decide realizar laparotomía exploratoria, encontrándose una sección total del cuello del páncreas a la derecha de los vasos mesentéricos. Se le realizó pancreatectomia subtotal más esplenectomía. El paciente tuvo buena evolución postoperatoria (AU)

Closed trauma of the pancreas is a rare condition. The organ is located in a place with a relative protection. It is considered that between 1 and 5 percent of serious abdominal traumatisms present a pancreatic lesion, according to different authors. This study describes the case of a 54-year-old male patient who had a closed trauma in the epigastrium by the kick of an ox, and came to the emergency department 72 hours after the trauma. On physical examination there was peritoneal reaction at that level. Abdominal echography showed a hematoma at the level of the pancreatic neck. It was decided to perform an exploratory laparotomy which revealed a total section of the pancreas neck to the right of the mesenteric vessels. Subtotal pancreatectomy was performed, together with splenectomy. The patient had a good postoperative progress (AU)