Successful implementation of prophylactic veno-venoarterial extracorporeal membrane oxygenation in high-risk trauma surgery: A case report.

INTRODUCTION: Extracorporeal Membrane Oxygenation (ECMO) is increasingly utilized in trauma care, yet its elective use during high-risk surgeries remains unreported. CASE REPORT: We report a successful instance of prophylactic ECMO support via a Veno-Venoarterial (V-VA) configuration during high-risk surgery in a patient with extensive trauma, including severe thoracic damage and a highly unstable thoracic spine fracture. V-VA ECMO prevented complications such as hemodynamic and respiratory collapse associated with chest compression during the surgical procedure, as the patient should be in a prone position. DISCUSSION: The potential of ECMO as prophylactic support in high-risk surgery amongst trauma patients underscores a novel application of this technology. Complex configurations must be evaluated to avoid associated ECMO complications. CONCLUSION: Our case highlights the potential of prophylactic ECMO hybrid modes, indicating their safe application during high-risk procedures in select trauma patients.

Cytokines expression from altered motor thalamus and behavior deficits following sublethal administration of Shiga toxin 2a involve the induction of the globotriaosylceramide receptor.

Encephalopathy associated with hemolytic uremic syndrome is produced by enterohemorrhagic E. coli (EHEC) infection, which releases the virulence factors Shiga toxin (Stx) and lipopolysaccharide (LPS). Neurological compromise is a poor prognosis and mortality factor of the disease, and the thalamus is one of the brain areas most frequently affected. We have previously demonstrated the effectiveness of anti-inflammatory drugs to ameliorate the deleterious effects of these toxins. However, the thalamic production of cytokines involved in pro-inflammatory processes has not yet been acknowledged. The aim of this work attempts to determine whether systemic sublethal Stx2a or co-administration of Stx2a with LPS are able to rise a proinflammatory profile accompanying alterations of the neurovascular unit in anterior and lateral ventral nuclei of the thalamus (VA-VL) and motor behavior in mice. After 4 days of treatment, Stx2a affected the lectin-bound microvasculature distribution while increasing the expression of GFAP in reactive astrocytes and producing aberrant NeuN distribution in degenerative neurons. In addition, increased swimming latency was observed in a motor behavioral test. All these alterations were heightened when Stx2a was co-administered with LPS. The expression of pro-inflammatory cytokines TNFα, INF-γ and IL-2 was detected in VA-VL. All these effects were concomitant with increased expression of the Stx receptor globotriaosylceramide (Gb3), which hints at receptor involvement in the neuroinflammatory process as a key finding of this study. In conclusion, Stx2a to Gb3 may be determinant in triggering a neuroinflammatory event, which may resemble clinical outcomes and should thus be considered in the development of preventive strategies.

Fotografía y discapacidad intelectual: estudio sobre el reconocimiento emocional a través de talleres de fotografía en personas con discapacidad intelectual / Photography and intellectual disability: a study on emotional recognition through photography workshops for people with intellectual disabilities

El presente estudio busca explorar el reconocimiento de emociones en personas con discapacidad intelectual. El reconocimiento de emociones es importante para una correcta interacción social. Esto hace que la estimulación y desarrollo de estas habilidades sea in-dispensable para generar vínculos nuevos, comprender el medio en el cual se encuentra el sujeto y la adquisición de un conocimiento positivo gracias al aprendizaje social. En esta investigación se empleó la fotografía como un medio de expresión y de mejoramiento de habilidades cognitivas y sociales. La evaluación fue realizada mediante un test previamente creado para población ecuatoriana. Los objetivos de este estudio intentan comprobar si: a. Las personas con discapacidad intelectual presentan mayores problemas en el reconocimiento de emociones que la población general, y: b. Aprender fotografía mejora el reconocimiento de emociones en personas con discapacidad intelectual. En lo que respecta al método, esta investigación utiliza un diseño pre-experimental con medidas pre-post, contando con una intervención que fue realizada en un periodo de 4 meses y medio, mediante capacitaciones de dos horas de duración dirigidas a cincuenta personas con discapacidad leve y moderada. Se obtiene como principales resultados que: a. Existe diferencia significativa (X2= 37.29 P < 0,001) entre grupo control y personas con discapacidad intelectual para reconocer emociones. b. Hay una mejoría significativa en el factor de reconocimiento emocional, lo que a su vez permite concluir que la fotografía es una herramienta alternativa para estimular el reconocimiento de emociones en la discapacidad intelectual.

The present study aims to explore emotion recognition in people with intellectual disabilities. Emotion recognition is an important skill to generate adequate social interactions. Thus, the stimulation and development of these skills are essential to build new relations-hips, understand the environment in which the subject develops and acquire a positive knowledge through social learning. In this re-search, photography was used as a tool for expression and improvement of cognitive and social skills. The evaluation was carried out through a test previously created specifically for the Ecuadorian population. The purposes of this study attempt to confirm if: a. People with intellectual disabilities have more difficulties in recognizing emotions than the general population, and: b. Studying photography improves emotion recognition skills in people with intellectual disabilities. Regarding the method, this study uses a pre-experimental design with pre-post measurements, with an intervention of 4 months and a half through two-hour training aimed at fifty subjects with minor and moderate intellectual disabilities. The main results show that: a. There is a significant difference (X

Anti-inflammatory agents reduce microglial response, demyelinating process and neuronal toxin uptake in a model of encephalopathy produced by Shiga Toxin 2.

Infections by Enterohemorrhagic Escherichia coli may cause in addition to hemolytic uremic syndrome neurological disorders which may lead to fatal outcomes in patients. The brain striatum is usually affected during this outcome. The aim of this study was to determine in this area the role of the microglia in pro-inflammatory events that may occur during Shiga toxin 2 intoxication and consequently to this, whether oligodendrocytes were being affected. In the present paper we demonstrated that anti-inflammatory treatments reduced deleterious effects in brain striatal cells exposed to Shiga toxin 2 and LPS. While dexamethasone treatment decreased microglial activation and recovered myelin integrity in the mice striatum, etanercept treatment decreased neuronal uptake of Stx2 in rat striatal neurons, improving the affected area from toxin-derived injury. In conclusion, microglial activation is related to pro-inflammatory events that may deteriorate the brain function during intoxication with Stx2 and LPS. Consequently, the role of anti-inflammatory agents in the treatment of EHEC-derived encephalopathy should be studied in clinical trials.

Penile brachytherapy-Retrospective review of a single institution.

PURPOSE: To analyze the results of exclusive brachytherapy (BT) to treat patients with penile squamous cell carcinoma confined to the glans or prepuce. METHODS AND MATERIALS: Retrospective analysis of 25 patients treated for T1-T2 penile cancer with exclusive interstitial BT between July 1989 and March 2014 at our institution. RESULTS: Median followup was 9.2 years (range, 0-19). The mean patient age was 65.3 years (range, 51-80). Most patients underwent exclusive low-dose-rate BT (56%; n = 14) or pulsed-dose-rate BT (40%; n = 10). Only 1 patient received high-dose-rate BT (4%). The median prescribed dose was 60 Gy. Eight patients died during follow-up because of systemic progression (one case) and other intercurrent causes (seven cases). Two failures were recorded (one local and one regional), both at 4 months after BT. The remaining patients continued follow-up at our institution and maintained response. Two patients underwent partial phallectomy for toxicity. At the time of this report, 12 of the 25 patients are alive and free of disease. The most common late toxicities were telangiectasia, urethral stenosis, and atrophy, in 48%, 43%, and 17.4% of patients, respectively. CONCLUSIONS: BT with low dose rate/pulsed dose rate provides excellent locoregional control for small (≤4 cm) T1-T2 squamous cell carcinoma of the penile glans.