bZIP transcription factors PcYap1 and PcRsmA link oxidative stress response to secondary metabolism and development in Penicillium chrysogenum.

BACKGROUND: Reactive oxygen species (ROS) trigger different morphogenic processes in filamentous fungi and have been shown to play a role in the regulation of the biosynthesis of some secondary metabolites. Some bZIP transcription factors, such as Yap1, AtfA and AtfB, mediate resistance to oxidative stress and have a role in secondary metabolism regulation. In this work we aimed to get insight into the molecular basis of this regulation in the industrially important fungus Penicillium chrysogenum through the characterization of the role played by two effectors that mediate the oxidative stress response in development and secondary metabolism. RESULTS: In P. chrysogenum, penicillin biosynthesis and conidiation are stimulated by the addition of H2O2 to the culture medium, and this effect is mediated by the bZIP transcription factors PcYap1 and PcRsmA. Silencing of expression of both proteins by RNAi resulted in similar phenotypes, characterized by increased levels of ROS in the cell, reduced conidiation, higher sensitivity of conidia to H2O2 and a decrease in penicillin production. Both PcYap1 and PcRsmA are able to sense H2O2-generated ROS in vitro and change its conformation in response to this stimulus. PcYap1 and PcRsmA positively regulate the expression of brlA, the first gene of the conidiation central regulatory pathway. PcYap1 binds in vitro to a previously identified regulatory sequence in the promoter of the penicillin gene pcbAB: TTAGTAA, and to a TTACTAA sequence in the promoter of the brlA gene, whereas PcRsmA binds to the sequences TGAGACA and TTACGTAA (CRE motif) in the promoters of the pcbAB and penDE genes, respectively. CONCLUSIONS: bZIP transcription factors PcYap1 and PcRsmA respond to the presence of H2O2-generated ROS and regulate oxidative stress response in the cell. Both proteins mediate ROS regulation of penicillin biosynthesis and conidiation by binding to specific regulatory elements in the promoters of key genes. PcYap1 is identified as the previously proposed transcription factor PTA1 (Penicillin Transcriptional Activator 1), which binds to the regulatory sequence TTAGTAA in the pcbAB gene promoter. This is the first report of a Yap1 protein directly regulating transcription of a secondary metabolism gene. A model describing the regulatory network mediated by PcYap1 and PcRsmA is proposed.

Late-Time Mixing Sensitivity to Initial Broadband Surface Roughness in High-Energy-Density Shear Layers.

Using a large volume high-energy-density fluid shear experiment (8.5 cm^{3}) at the National Ignition Facility, we have demonstrated for the first time the ability to significantly alter the evolution of a supersonic sheared mixing layer by controlling the initial conditions of that layer. By altering the initial surface roughness of the tracer foil, we demonstrate the ability to transition the shear mixing layer from a highly ordered system of coherent structures to a randomly ordered system with a faster growing mix layer, indicative of strong mixing in the layer at a temperature of several tens of electron volts and at near solid density. Simulations using a turbulent-mix model show good agreement with the experimental results and poor agreement without turbulent mix.

Sigmoidectomía videoasistida como opción de manejo del vólvulo del sigmoides en la población pediátrica / Video-assisted sigmoidectomy as an option for Sigmoid volvulus management in the pediatric population

Introducción. El objetivo del estudio es evaluar la presentación y el manejo del vólvulo del Colon Sigmoides (VS) en pacientes pediátricos. El (VS) es una de las tres principales causas de obstrucción aguda del colon y constituye entre el 50 y 90% de todos los vólvulos del intestino grueso. En la población pediátrica, solo del 3 al 5% de las obstrucciones intestinales son causadas por vólvulo, y son menos de 100 los casos publicados en la literatura médica. La etiología en la población pediátrica se considera secundaria a la presencia de un meso amplio con una base estrecha asociado a una fijación anormal del colon. Otros factores incluyen historia de malformación anorectal, síndrome de Prune Belly, malrotacion intestinal y enfermedad de Hirschsprung. El manejo inicial por vía endoscópica, seguido de la sigmoidectomía mínimamente invasiva, han demostrado ser seguros y efectivos. Material y Métodos. El presente trabajo recoge la experiencia de 4 pacientes entre los 9 y 14 años manejados en nuestro servicio, en el año 2013, con diagnóstico de vólvulo del sigmoides, los cuales inicialmente fueron llevados a un primer tiempo quirúrgico para descompresión endoscópica del vólvulo y en un segundo tiempo fueron llevados a sigmoidectomía, la cual se llevó a cabo de forma videoasistida. En esta serie no se documentaron complicaciones intraoperatorias y, en el seguimiento a más de 6 meses, solo uno de los pacientes ha requerido nuevas intervenciones, en un caso especial, dado que el paciente presenta asociada una miopatía (leiomioscitis inflamatoria), la cual lo predispone a episodios de obstrucción intestinal. Conclusión. Consideramos que la devolvulación endoscópica seguida de una pronta sigmoidectomía videoasistida es la técnica ideal para el manejo de estos pacientes

Introduction. The aim of the present study was to evaluate clinical presentation and management of sigmoid volvulus in children. Sigmoid volvulus is one of the three leading causes of acute obstruction of the colon and is between 50 and 90% of all large bowel volvulus. In the pediatric population only 3 to 5% of bowel obstructions are caused by volvulus and there are less than 100 cases reported in the literature. The presence of a redundant sigmoid with a narrow mesentery (dolicosigmoide) is a prerequisite for the volvulus formation. The etiology in the pediatric population is considered secondary to the presence of a broad meso with a narrow base associated with abnormal fixation colon. Other factors include history of anorectal malformation, Prune Belly syndrome, intestinal malrotation and Hirschsprung disease. Initial management followed by endoscopic minimally invasive sigmoidectomy has proven safe and effective. Materials and Methods. This paper presents the experience of 4 patients between 9 and 14 managed in our department in 2013, with a diagnosis of volvulus of the sigmoid, which were initially taken to a first surgical endoscopic decompression of volvulus and a second half were carried sigmoid which took place in a video-assisted. In this series, no intraoperative complications were documented and monitoring more than six months only one patient has required new interventions, in a special case because the patient has associated myopathy; inflammatory leiomioscitis, which predisposes to episodes of intestinal obstruction. Conclusion. We believe that endoscopic detorsion followed by an early video-assisted sigmoid is the ideal technique for the management of these patients

[Video-assisted sigmoidectomy as an option for Sigmoid volvulus management in the pediatric population]. / Sigmoidectomía videoasistida como opción de manejo del vólvulo del sigmoides en la población pediátrica.

INTRODUCTION: The aim of the present study was to evaluate clinical presentation and management of sigmoid volvulus in children. Sigmoid volvulus is one of the three leading causes of acute obstruction of the colon and is between 50 and 90% of all large bowel volvulus. In the pediatric population only 3 to 5% of bowel obstructions are caused by volvulus and there are less than 100 cases reported in the literature. The presence of a redundant sigmoid with a narrow mesentery (dolicosigmoide) is a prerequisite for the volvulus formation. The etiology in the pediatric population is considered secondary to the presence of a broad meso with a narrow base associated with abnormal fixation colon. Other factors include history of anorectal malformation, Prune Belly syndrome, intestinal malrotation and Hirschsprung disease. Initial management followed by endoscopic minimally invasive sigmoidectomy has proven safe and effective. MATERIALS AND METHODS: This paper presents the experience of 4 patients between 9 and 14 managed in our department in 2013, with a diagnosis of volvulus of the sigmoid, which were initially taken to a first surgical endoscopic decompression of volvulus and a second half were carried sigmoid which took place in a video-assisted. In this series, no intraoperative complications were documented and monitoring more than six months only one patient has required new interventions, in a special case because the patient has associated myopathy; inflammatory leiomioscitis, which predisposes to episodes of intestinal obstruction. CONCLUSION: We believe that endoscopic detorsion followed by an early video-assisted sigmoid is the ideal technique for the management of these patients.

INTRODUCCION: El objetivo del estudio es evaluar la presentación y el manejo del vólvulo del Colon Sigmoides (VS) en pacientes pediátricos. El (VS) es una de las tres principales causas de obstrucción aguda del colon y constituye entre el 50 y 90% de todos los vólvulos del intestino grueso. En la población pediátrica, solo del 3 al 5% de las obstrucciones intestinales son causadas por vólvulo, y son menos de 100 los casos publicados en la literatura médica. La etiología en la población pediátrica se considera secundaria a la presencia de un meso amplio con una base estrecha asociado a una fijación anormal del colon. Otros factores incluyen historia de malformación anorectal, síndrome de Prune Belly, malrotacion intestinal y enfermedad de Hirschsprung. El manejo inicial por vía endoscópica, seguido de la sigmoidectomía mínimamente invasiva, han demostrado ser seguros y efectivos. MATERIAL Y METODOS: El presente trabajo recoge la experiencia de 4 pacientes entre los 9 y 14 años manejados en nuestro servicio, en el año 2013, con diagnóstico de vólvulo del sigmoides, los cuales inicialmente fueron llevados a un primer tiempo quirúrgico para descompresión endoscópica del vólvulo y en un segundo tiempo fueron llevados a sigmoidectomía, la cual se llevó a cabo de forma videoasistida. En esta serie no se documentaron complicaciones intraoperatorias y, en el seguimiento a más de 6 meses, solo uno de los pacientes ha requerido nuevas intervenciones, en un caso especial, dado que el paciente presenta asociada una miopatía (leiomioscitis inflamatoria), la cual lo predispone a episodios de obstrucción intestinal. CONCLUSION: Consideramos que la devolvulación endoscópica seguida de una pronta sigmoidectomía videoasistida es la técnica ideal para el manejo de estos pacientes.

The corpora lutea proangiogenic state of VEGF system components is turned to antiangiogenic at the later phase of the oestrous cycle in cows.

Blood vessel expansion and reduction in the corpus luteum (CL) is regulated by the vascular endothelial growth factor (VEGF) system and linked to the maintenance of the CL. The VEGF system has both angiogenic and antiangiogenic ligands and receptors. Our objective was to evaluate the relationship between the mRNA expression of angiogenic and antiangiogenic members of the VEGF system in the CL, throughout the luteal phase of the oestrous cycle in cows. The CL of 18 cows were collected by transvaginal surgery on days 4, 6, 9, 12, 15 and 18 of the oestrous cycle and the mRNA expression of VEGF system components was evaluated by quantitative real-time PCR. The mRNA expression of VEGF ligands and receptors increased (P<0.05) from the early- and mid-luteal phase (days 4 to 12) reaching its maximum expression on day 15 of the cycle. We found no expression of VEGF164b throughout the cycle. Expression of sVEGFR1 did not change during the oestrous cycle and exceeded that of the VEGFR1 by 100 times. Nonetheless, as VEGFR1 increased, the relationship between the soluble and membrane receptor decreased (P<0.01). In contrast, the expression of VEGFR2 was higher than that of its soluble isoform for all days studied, however, the ratio between the membrane-bound and its soluble counterpart decreased continuously throughout the cycle (P<0.01). Our results show that the expression levels for VEGF ligands, receptors and their antagonistic counterparts are adjusted during CL development and regression, to upregulate angiogenesis early in the oestrous cycle and restrict it at the time of luteolysis.

Diagnóstico de la prevalencia de trastornos de la salud mental en estudiantes universitarios y los factores de riesgo emocionales asociados / Diagnostic of the prevalence of mental health disorders in college students and associated emotional risk factors

Introduction: In our country Chile it is estimated that approximately a third of the population would have had some psychiatric disorder during its life. Ifwe consider the university population, the evolutionary stage that it experiences and the psychosocial stress that affect them, we observe a group at risk to present psychiatric disorders. The aim of the present study was to estimate the prevalence of the principal mental disorders not psychotic in the population of students of the UACH, during the year 2008. Material and Method: The sample consisted of 804 undergraduate students, that answered individually the Patient Health Questionnaire (PHQ-9), the Scale of Beck's hopelessness (HBS), the Mood Disorder Questionnaire (MDQ), the Questionnaire of detection of problematic consumption of alcohol and drugs in teenagers (DEP-ADO), the questionnaire AUDIT, the Eating Disorder Diagnostic Scale (EDDS) and the Restrain Scale (RE). Results: 27% of the students fulfills with criteria for a depression, 10,4% deals with a bipolar disorder, 5,3% has a moderated risk to severe of committing suicide, 24,2% of the students presents a problematic consumption to alcohol and 15,3% it would have some type of disorder in his supplies when eating. Conclusions: Depression was significantly associated with a greater tendency to have abnormal eating behavior, harmful alcohol consumption and self-destructive behavior.

Introducción: Se estima que en Chile aproximadamente un tercio de la población ha tenido algún trastorno psiquiátrico durante su vida. Si tenemos en cuenta a la población universitaria, por la etapa evolutiva que experimenta y el estrés psicosocial asociado, ésta se constituye como un grupo en riesgo de presentar trastornos psiquiátricos. El presente estudio se propuso estimar la prevalencia de los principales trastornos mentales no psicóticos presentes en la población de estudiantes depregrado de la UACh, durante el año 2008. Método: La muestra estuvo compuesta por 804 estudiantes de pregrado, que respondieron de manera individual escalas de screening para la depresión (Patient Health Questionnaire-PHQ-9), para el riesgo de suicidio (Escala de desesperanza de Beck-HBS), para los trastornos bipolares (Mood Disorder Questionnaire-MDQ), para el consumo de alcohol y drogas (DEP-ADO y AUDIT), y para los trastornos de la conducta alimentaria (Eating Disorder Diagnostic Scale-EDDS; y Restrain Scale-RS). Resultados: Un 27% de los estudiantes cumple con los criterios diagnósticos para una depresión, un 10,4% estaría cursando con un trastorno bipolar, un 5,3% de los estudiantes tiene un riesgo moderado a severo de cometer suicidio; 24,2% de los estudiantes universitarios presenta un consumo problemático de alcohol y un 15,3% de la muestra tendría algún tipo de trastorno en la alimentación. Conclusiones: La depresión se asoció significativamente con una mayor tendencia a tener un comportamiento de alimentación anormal, el consumo nocivo de alcohol y el comportamiento autodestructivo.

Composition of personalized and standard nutritional mixtures in patients on home parenteral nutrition.

BACKGROUND/OBJECTIVES: The compounding of personalized parenteral nutrition mixtures (PPNMs) for home parenteral nutrition (HPN) gives the possibility to better satisfy nutritional requirements for patients in selected clinical conditions. The objective of this study was to compare the composition of PPNMs prescribed in selected cases, by a practitioner nutritionist, with that of industrially manufactured standard parenteral nutrition mixtures (SPNMs). SUBJECTS/METHODS: Two hundred and ninety-eight patients (151 men, 147 women, aged 17-87 years) on HPN, followed up in 2011 at our Center, were retrospectively recruited. RESULTS: Industrially manufactured SPNMs were prescribed in 230 (77.2%) patients, whereas compounded PPNMs were prescribed in 68 (22.8%). Formulation of PPNMs, adjusted for body weight, did not significantly differ from SPNMs as regards total daily calorie amount, but was significantly different as far as nutrient composition is concerned (P<0.01). Analysis on the daily amount of nutrients per kg of body weight and per patient disease showed that 16/34 (47%) benign chronic intestinal failure (CIF) patients, 47/233 (20%) cancer patients and 5/31 (16%) patients grouped as 'having other diseases' needed personalized mixtures (in PPNMs 4-9 nutrients were significantly different from those in SPNMs). Moreover, in CIF patients receiving PPNMs, frequent changes in the formulation (mean 6 times per year, range 1-28) were necessary. CONCLUSIONS: Our data suggest that, presently, PPNMs cannot be completely replaced by SPNMs owing to special needs in macro and/or micronutrients of some patients and/or the necessity of frequent changes in the nutritional mixture composition, at least until stabilization of clinical and metabolic conditions.

Alternativas de derivación de LCR en pacientes de alta complejidad. Revisión de la literatura a raíz del caso de un recién nacido con Hidrocefalia post hemorrágica / Alternatives CSF shunt in patients highly complex: review of the literature following the case of a newborn with post hemorrhagic hydrocephalus

La hemorragia intraventricular (HIV) es una causa importante de daño cerebral en los recién nacidos prematuros. Su impacto negativo en el resultado del desarrollo neurológico se relaciona no sólo a su impacto directo, sino que también a las lesiones asociadas, como la hidrocefalia posthemorrágica (HPH). En la mayoría de los casos, la hidrocefalia es causada por la alteración de la reabsorción del líquido cefalorraquídeo (LCR) debido a la inflamación de las vellosidades subaracnoideas por el contacto con la sangre. El drenaje ventricular se utiliza a menudo como un procedimiento temporal para manejo de la HPH y algunos pacientes tratados con drenaje ventricular no requieren una derivación permanente; de no ser así, las derivaciones más usadas en los prematuros incluyen la ventriculoperitoneal (DVP), seguida por las derivaciones ventriculosubgaleal y ventriculoatrial. Las derivativas se consideran el tratamiento definitivo para la HPH; pero puede asociarse a complicaciones, tales como la infección, obstrucción, rechazo y el drenaje insuficiente. Otra alternativa, es la derivación ventrículopleural. Sin embargo, esta alternativa de derivación se vincula a otras complicaciones específicas, principalmente el neumotórax y el derrame pleural. Se presenta el caso clínico de EAV, quien a raíz de un parto prematuro, complicado con Hemorragia intraventricular, desarrolló Hidrocefalia y un quiste de Fosa Posterior, debiendo intervenirse en 36 oportunidades, por múltiples complicaciones. Durante su evolución se instalaron catéteres en prácticamente todos los sitios posibles, lográndose finalmente la solución del problema. Se revisa la literatura

Ventricular haemorrhage is an important cause of neurologic damage in preterm babies. Its negative impact in the final neurologic damage is not just related with the direct impact, but also with associated lesions like posthaemorrhagic hydrocephalus (PHH). In most of cases, hydrocephalus is caused by impaired cerebrospinal fluid (CEF) resorption due to the inflammation of the Arachnoid granulations because of the contact with blood. Ventricular drainage system is often used as a temporal procedure for the management of the PHH in children who have not a good response to serials lumbar punctures. Some patients treated with ventricular drainage don't need a permanent derivation, but if they do the most used in preterm babies include ventriculoperitoneal derivation (VPD) followed by ventriculosubgaleal and ventriculoatrial derivation. Derivation is considered the definitive treatment for PHH, but it can be associated with some complications as infection, obstruction and insufficient drainage. Another option is ventriculopleural derivation but this alternative is related to other complications like pneumothorax and pleural effusion. The presentation is about the case of the newborn EAV, who after preterm birth, complicated with intraventricular haemorrhage, developed hydrocephalus and a posterior fossa cyst, requiring 36 surgical interventions because of multiple complications. During its evolution he needed catheters installations in almost every possible sites, finally getting the problem solved. The literature is reviewed

Solid-state and submerged fermentations show different gene expression profiles in cephalosporin C production by Acremonium chrysogenum.

Despite the importance of Acremonium chrysogenum as the only cephalosporin C (CPC) producer, there is still a limited understanding about the molecular mechanisms regulating antibiotic biosynthesis in this fungus. Based on the previously described relationship between environmental pH and antibiotic production in numerous filamentous fungi, we studied the expression of genes related to CPC production in A. chrysogenum. We report for the first time similarities and differences, characterizing CPC production by A. chrysogenum under a variable pH environment, in submerged and solid-state fermentation. This characterization is supported by measurements of parameters, like CPC production, pH, growth, and expression levels of several genes involved, directly or indirectly, in CPC production. Interesting differences in intermediate (Pen N) and certain biosynthetic gene expression levels were observed. Our results point out some relationships between physiological features and gene expression that open important improvement perspectives for both culture systems.

Identification of soluble forms of vascular endothelial growth factor receptors, sVEGFR-1 and sVEGFR-2, in bovine dominant follicles.

The development of dominant follicles requires the parallel growth of a vascular network, regulated by VEGF and its receptors VEGFR-1 and VEGFR-2. Here, we demonstrate the presence of mRNA for the soluble forms of VEGFR-1 and VEGFR-2 by RT-PCR and the respective proteins by Western blot, in bovine dominant follicles. The 3' end of the mRNA coding region and the deduced C-terminal amino acid sequence of the bovine VEGFR soluble forms were similar to those previously described in human and mice. The relative abundance of sVEGFR-1 was higher in dominant follicles of day 4, decreasing on day 6 and further on day 9 of the cycle. In contrast, sVEGFR-2 expression was low on day 4 follicles and increased as the cycle advanced, becoming greater on day 9. The changes of sVEGFR-1 and sVEGFR-2 with the age of the bovine dominant follicle indicate a physiological role in its growth and atresia.

Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis.

INTRODUCTION: Endometriosis represents an important clinical problem in women of reproductive age with high impact on quality of life, work productivity and health care management. The aim of this study is to define the role of 3T magnetom system MRI in the evaluation of endometriosis. MATERIALS AND METHODS: Forty-six women, with transvaginal (TV) ultrasound examination positive for endometriosis, with pelvic pain, or infertile underwent an MR 3.0T examination with the following protocol: T2 weighted FRFSE HR sequences, T2 weighted FRFSE HR CUBE 3D sequences, T1 w FSE sequences, LAVA-flex sequences. Pelvic anatomy, macroscopic endometriosis implants, deep endometriosis implants, fallopian tube involvement, adhesions presence, fluid effusion in Douglas pouch, uterus and kidney pathologies or anomalies associated and sacral nervous routes were considered by two radiologists in consensus. Laparoscopy was considered the gold standard. RESULTS: MRI imaging diagnosed deep endometriosis in 22/46 patients, endometriomas not associated to deep implants in 9/46 patients, 15/46 patients resulted negative for endometriosis, 11 of 22 patients with deep endometriosis reported ovarian endometriosis cyst. We obtained high percentages of sensibility (96.97%), specificity (100.00%), VPP (100.00%), VPN (92.86%). CONCLUSION: Pelvic MRI performed with 3T system guarantees high spatial and contrast resolution, providing accurate information about endometriosis implants, with a good pre-surgery mapping of the lesions involving both bowels and bladder surface and recto-uterine ligaments.

Experiencia inicial en cirugía laparoscópica por puerto único en un hospital pediátrico de Bogotá / Initial experience in single site laparoscopic surgery in a pediatric hospital of bogotá

Introducción. La cirugía mínimamente invasiva es el abordaje quirúrgico ideal en cirugía abdominal. No obstante, se ha incursionado en técnicas menos invasivas como la cirugía laparoscópica por puerto único (CLPU). Reportamos nuestra experiencia de CLPU. Métodos. Revisión retrospectiva de los pacientes llevados a CLPU en nuestro hospital, en el periodo comprendido entre noviembre de 2009y julio de 2011. Se utilizó un guante acoplado a un retractor de fascia para conformar un multipuerto híbrido. Resultados. Se obtuvieron 80 pacientes, con una edad (años) y peso(kg) promedio de 8,6 y 32,1, respectivamente. El paciente con menor edad tenía 8 días y el más pequeño pesaba 2,5 kg. El tiempo quirúrgico promedio fue de 48,2 minutos. La hospitalización promedio fue de48,7 horas. Se realizaron diversos procedimientos: apendicectomías no perforadas (55%), biopsias hepáticas (15%), apendicectomía perforada(7,5%), y los siguientes casos aislados; colecistectomía, resección del ivertículo de Meckel, ooforectomía, cistectomía de ovario, biopsiaintestinal, resección de bazo accesorio torcido. Se completó exitosamente el procedimiento en 78 casos, dos casos se convirtieron en laparoscopia convencional y ninguno en cirugía abierta. No se presentaron complicaciones relacionadas con la técnica quirúrgica. Las complicaciones postoperatorias se presentaron en 5 casos: una infección del sitio operatorio superficial, tres abscesos intestinales residuales, uno de ellos con obstrucción intestinal y una evisceración; estos dos últimos casos requirieron reintervención. Éstas se presentaron al inicio de nuestra curva de aprendizaje. Conclusiones. El CLPU en niños es una técnica reproducible en nuestro medio, segura y se puede aplicar a diferentes procedimientos y edades, incluso hasta en edad neonatal. El tiempo fue disminuyendo con la curva de aprendizaje. Además, se logró un resultado cosmético excelente dado por una cicatriz umbilical casi imperceptible (AU)

Background. Minimally invasive surgery is the current accepted approach for abdominal surgery. However, less invasive techniques such as single incision laparoscopic surgery (SILS) are being used more frequently and we believe it will become the standard choice for abdominal surgery. This report describes our initial experience with Single Port Incision Surgery (SILS).Methods. We reviewed all the patients who underwent SILS in our hospital between November 2009 and July 2011. We used a surgical glove attached to a wound retractor to yield a multi-port hybrid. Results. We present 80 patients with a mean age of 8.6 years and mean weight of 32,1 kg. The youngest patient was 8 days old and the smallest patient weighed 2.5 kg. The average duration of surgery was48.2 minutes. The average length of stay was 48.7 hours. Different procedures were performed: appendectomies for early appendicitis (55%),hepatic biopsies (15%), appendectomies for perforated appendicitis(7.5%), and the following isolated cases: cholecystectomy, Meckel’s diverticulum resection, oophorectomy, salpingo-oophorectomy, ovarian cystectomy, bowel biopsy, and a resection of an accessory spleen torsion. SILS was successfully completed in 78 cases, and 2 cases were converted to standard laparoscopy and none to open surgery. There were no intraoperative surgical complications. Postoperative complications presented in 5 cases: a superficial incisional site infection, two residual abdominal abscesses, one bowel obstruction and one evisceration. The last two cases subsequently resulted in reoperation and occurred early in our learning curve. Conclusions. SILS is a reproducible and viable technique that maybe used successfully in pediatric surgery. It may be used safely in different procedures and age groups, even in neonates. Time of surgery decreased with our learning curve. Additionally, excellent cosmetic results were obtained as evidenced by imperceptible umbilical scarring (AU)

Fetal MRI as a complement to US in the evaluation of cleft lip and palate.

PURPOSE: The aim of our study was to investigate the role of fetal magnetic resonance imaging (MRI) as a complement to ultrasound (US) in the evaluation of cleft lip and palate (CLP), whether isolated or in association with syndromic conditions. MATERIALS AND METHODS: We enrolled 24 pregnant women (27 fetuses) (mean gestational age 23.7 weeks) with a level-two US diagnosis of cleft lip (CL) or CLP with or without associated central nervous system (CNS) or facial-bone anomalies. All individuals underwent a fetal MRI examination to study the facial skeleton, CNS and fetal body. For each fetus, the main anatomical facial landmarks and biometric parameters [anteroposterior diameter (APD), biparietal diameter (BPD), inferior facial angle (IFA), frontomaxillary angle (FMA), bi-orbital diameter (BOD), intraorbital diameter (IOD)] were measured. RESULTS: Twenty-five of 27 fetuses had a US diagnosis of CL or CLP. MRI confirmed the diagnosis in 16/25 fetuses and added information about the extent of the cleft and the degree of involvement of the anterior and posterior palate in 8/25 fetuses. MRI ruled out the diagnosis in 1/25 fetuses and identified an alteration of the parameters IFA, FMA and IOD in 6/24 fetuses. CONCLUSIONS: In the study of CLP fetal, MRI is able to define the degree of involvement of the posterior palate and the lateral extent of the cleft with higher diagnostic accuracy than US. Furthermore, MRI provides a complete study of the fetal head and biometric development of the facial bones, thus enabling early detection of potential syndromic conditions.

[Initial experience in single site laparoscopic surgery in a pediatric hospital of Bogotá]. / Experiencia inicial en cirugía laparoscópica por puerto único en un hospital pediátrico de Bogotá.

BACKGROUND: Minimally invasive surgery is the current accepted approach for abdominal surgery. However, less invasive techniques such as single incision laparoscopic surgery (SILS) are being used more frequently and we believe it will become the standard choice for abdominal surgery. This report describes our initial experience with Single Port Incision Surgery (SILS). METHODS: We reviewed all the patients who underwent SILS in our hospital between November 2009 and July 2011. We used a surgical glove attached to a wound retractor to yield a multi-port hybrid. RESULTS: We present 80 patients with a mean age of 8.6 years and mean weight of 32,1 kg. The youngest patient was 8 days old and the smallest patient weighed 2.5 kg. The average duration of surgery was 48.2 minutes. The average length of stay was 48.7 hours. Different procedures were performed: appendectomies for early appendicitis (55%), hepatic biopsies (15%), appendectomies for perforated appendicitis (7.5%), and the following isolated cases: cholecystectomy, Meckel's diverticulum resection, oophorectomy, salpingo-oophorectomy, ovarian cystectomy, bowel biopsy, and a resection of an accessory spleen torsion. SILS was successfully completed in 78 cases, and 2 cases were converted to standard laparoscopy and none to open surgery. There were no intraoperative surgical complications. Postoperative complications presented in 5 cases: a superficial incisional site infection, two residual abdominal abscesses, one bowel obstruction and one evisceration. The last two cases subsequently resulted in reoperation and occurred early in our learning curve. CONCLUSIONS: SILS is a reproducible and viable technique that may be used successfully in pediatric surgery. It may be used safely in different procedures and age groups, even in neonates. Time of surgery decreased with our learning curve. Additionally, excellent cosmetic results were obtained as evidenced by imperceptible umbilical scarring.

Role of fetal MRI in the diagnosis of cerebral ventriculomegaly assessed by ultrasonography.

PURPOSE: To evaluate the additional diagnostic value of fetal MRI to evaluate cerebral ventriculomegaly assessed by ultrasonography (US) for the possibility to change the diagnosis, the counseling and the management of pregnancy. MATERIALS AND METHODS: From february 2006 to october 2008, we studied 55 pregnant women by fetal MRI (mean age 28 years), 4 with twin pregnancy, for a total of 59 fetuses with mean gestational age of 27 weeks. The number of fetuses affected by ventriculomegaly assessed by US was 55. All fetuses had a US diagnosis of ventriculomegaly: 29 fetuses with isolated ventriculomegaly and 26 fetuses with ventriculomegaly associated with CNS (central nervous system) abnormalities (18) and with no CNS abnormalities (8). RESULTS: The findings showed that the two techniques are substantially in agreement in defining the degree of VM, with the exception of some cases in which the disagreement could be attributed to the possible progression of the dilatation between the US and MRI examinations, which sway between two days and two weeks. We proved a low correlation between US and MRI in the evaluation of ventriculomegaly associated either with CNS or non-CNS anomalies: in fact while fetal MRI detected 26/55 (47,3%) VM associated with CNS anomalies, US demonstrated only 18/55(32,7%). Referring to VM associated with non-CNS anomalies, MRI diagnosed 10/55 cases (18,2%) compared to 8/55 fetuses (14,5%) showed by US. CONCLUSIONS: Our experience demonstrated that fetal MRI has an important role as adjunctive tool to sonography in the evaluation of cerebral ventriculomegaly for the additional informations given to parents and for the possibility to change the diagnosis, the counseling and the management of pregnancy.

Fetal MRI of the cardiovascular system: role of steady-state free precession sequences for the evaluation of normal and pathological appearances.

PURPOSE: This study aimed to evaluate the feasibility of fetal magnetic resonance imaging (MRI) with steady-state free precession (SSFP) sequences to visualise the normal and pathological appearances of the cardiovascular system. MATERIALS AND METHODS: This is a prospective observational study of 83 pregnant women who underwent fetal cardiac MRI: 43 patients (cases) had echocardiographic suspicion of congenital heart disease; 40 patients (controls) did not. Fetal cardiac MRI consisted of a static phase with multiplanar SSFP sequences and a dynamic phase with real-time SSFP sequences. Two radiologists evaluated the diagnostic quality of the SSFP images in both the controls and cases, the MRI morphological and functional features in the controls and the MRI signs of congenital heart disease in the cases. RESULTS: In both groups, SSFP sequences produced goodquality MR images and good visualisation of morphological features. Functional data appeared to be unavailable due to the current small temporal resolution and the technical impossibility of fetal cardiac triggering. MRI detected direct signs of congenital heart disease in 21 fetuses, indirect signs in six and both signs in 15. CONCLUSIONS: SSFP sequences are effective in demonstrating the morphological features of the cardiovascular system, whereas dynamic SSFP cine-MRI sequences may provide adjunctive albeit suboptimal functional information.

Fetal MRI with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) assessment in the evaluation of renal development: preliminary experience in normal kidneys.

PURPOSE: The study aimed to investigate the correlation between apparent diffusion coefficient (ADC) and gestational age by applying diffusion-weighted imaging (DWI) in the study of normal fetal kidneys. MATERIALS AND METHODS: We performed magnetic resonance (MR) imaging on 88 fetuses (gestational age range 17-40 weeks) after ultrasound had ruled out urinary system malformations. A multiplanar study of the urinary system was obtained by using conventional T2-weighted sequences and echoplanar imaging (EPI). DW sequences with ADC maps were subsequently acquired, and kidney ADC values were correlated with gestational age by diving the fetuses into six groups according to age. RESULTS: We found a correlation between ADC values and gestational age. The ADC values, ranging from 0.99 to 1.62x10(-3) mm(2)/s [mean 1.22; 95% confidence interval (CI) 1.19-1.25, standard deviation (SD) 0.147], showed a tendency to decrease with increasing gestational age. The relationship between ADC values and gestational age was expressed by a linear regression equation: ADC (mm(2)/s)=1.69-0.0169 (GA) (R(2)=37.7%, R(2) ADJ=37.0%, p<0.005, Pearson correlation=-0.614). CONCLUSIONS: DWI with ADC mapping provides functional information on fetal renal parenchyma development and may thus become a useful tool in the management of pregnancy and treatment of the newborn child.

Assessment of congenital heart disease (CHD): is there a role for fetal magnetic resonance imaging (MRI)?

PURPOSE: To review our experience with fetal magnetic resonance imaging (MRI) to evaluate congenital heart disease (CHD). METHODS: We performed fetal MRI in 32 fetuses with an echocardiographically assessed CHD. Both direct and indirect signs of CHD were investigated. Direct signs considered were: morpho-volumetric abnormalities of the heart; malrotations; ventricular and atrial septal defects; anomalies of the origin, size and course of the great arteries. Indirect signs considered were: difficulty to recognize a "normal" anatomical structures in the reference projections; increase of the vascular size before a stenosis; hypertrophy of the papillary muscles; cardiomegaly and pericardial effusion. All MRI findings were compared with postnatal or autoptic findings. RESULTS: MRI allowed the CHD to be visualised by direct signs in 17 fetuses, indirect signs in 5 and both direct and indirect signs in 9 fetuses, excluding the prenatal echocardiographic suspect of hypoplastic left heart syndrome in 1 fetus. Postnatal echocardiograms or autoptic findings confirmed a normal heart in 1 fetus and CHD in 31 fetuses including a single cardiac anomaly or syndrome in 19 fetuses, 2 associated cardiac abnormalities in 11 and 3 cardiac anomalies in 1 fetus. However, in 2 fetuses MRI detected a ventricular septal defect successively disclosed by gold standard. CONCLUSIONS: MRI is a promising method for further assessment of the cardiovascular pathologies diagnosed by echocardiography, and may be a valuable tool in assessing associated extracardiac anomalies.