Role of miR-124-3p in regulatory mechanisms of Gpm6a expression in the hippocampus of chronically stressed rats.

The neuronal membrane glycoprotein M6a (GPM6A) belongs to the family of myelin proteolipid protein and plays a role in neuronal remodeling and plasticity. Decreased expression of GPM6A mRNA is observed in the hippocampal tissue of suicide victims who suffered from depression and after chronic stress exposure in animals. The regulatory mechanisms that impact expression of GPM6A under chronic stress or in pathological conditions are not well understood. Previously, miRNAs miR-133b, miR-124-3p, and miR-9-5p have been shown to regulate the expression of Gpm6a mRNA under normal conditions. Here, we employed the paradigm of chronic-restraint stress in rats and using quantitative polymerase chain reaction (qPCR) showed down-regulation of expression of Gpm6a and the brain-derived neurotrophic factor (Bdnf) genes at mRNA level as well as miR-133b, and miR-124-3p, but not miR-9-5p in the hippocampus of chronically stressed rats. Furthermore, we observed alterations in the expression of histone deacetylase (Hdac5) and myocyte enhancer factor 2C (Mef2c) mRNAs. Our data suggest that chronic stress influences Gpm6a expression by miR-124-mediated impact on the expression of Hdac5 and Mef2c. Upon miR-124 over-expression in hippocampal neurons cultured in vitro, we observed enhanced neuronal arborization as evaluated by Sholl analysis, increased Gpm6a and Mef2c expression, and decreased Hdac5 expression. Moreover, treatment of hippocampal neurons cultured in vitro with BDNF resulted in an elevation in the miR-124-3p expression, a decrease in the miR-9-5p expression but did not affect miR-133b. This was accompanied by augmented expression of Gpm6a and Mef2c mRNAs and significantly lower levels of Hdac5 mRNA. Altogether, these results indicate that the regulatory mechanism that influence expression of Gpm6a under chronic stress involves miR-124-mediated impact on the expression of Hdac5 and Mef2c and a role of BDNF in the activation of Gpm6a expression.

Short communication: ultrasound-guided percutaneous cryoanalgesia of intercostal nerves for uniportal video-assisted thoracic surgery.

BACKGROUND: Pain after thoracic surgery impairs lung function and increases the rate of postoperative pulmonary complications. Ultrasound-guided percutaneous cryoanalgesia of intercostal nerves constitutes a valid option for adequate postoperative analgesia. A key issue for a successful cryoanalgesia is placing the cryoprobe tip close to the intercostal nerve. This report describes an ultrasound technique using a high-resolution ultrasound probe to accomplish this goal. FINDINGS: Images of five anesthetized patients undergoing uniportal video-thoracoscopic surgeries are used as clinical examples. In the lateral position, a high-frequency 12 MHz probe is placed longitudinally at 5-7 cm parallel to the spine at the 4th, 5th, and 6th ipsilateral intercostal spaces. Ultrasound images detect the intercostal neurovascular bundle and a 14G angiocath is placed beside the nerve. The cryoprobe is inserted throughout the 14G catheter and the cryoanalgesia cycle is performed for 3 min. Two ultrasound signs confirm the right cryoprobe position close to the nerve: one is a color Doppler twinkling artifact that is seen as the quick shift of colors that delineates the cryoprobe contour. The other is a spherical hypoechoic image caused by the ice ball formed at the cryoprobe tip. CONCLUSIONS: Ultrasound images obtained with a high-frequency probe allow precise location of the cryoprobe tip close to the intercostal nerve for cold axonotmesis.

Linfoma de Burkitt esporádico en cavidad bucal: caso clínico / Sporadic Burkitt´s lymphoma in the oral cavity: a clinical case report

Objetivo: Presentar un caso clínico de Linfoma de Burkitt esporádico en cavidad bucal como manifestación inicial en un paciente adulto joven, tratado en el Hospital Interzonal General de Agudos "General José de San Martín" de La Plata. Caso clínico: Un paciente masculino de 20 años de edad se presenta con una lesión tumoral localizada en sector posterior de reborde mandibular, pérdida espontánea de piezas dentarias y parestesia del nervio dentario inferior. Acompañado de un aumento de volumen testicular, compromiso intestinal y poliadenopatías. El cuadro morfológico y de inmuno-marcación confirma un Linfoma de Células B "agresivo". El paciente fue tratado con esquema intensivo de 6 bloques de quimioterapia y terapia intratecal. No se observaron señales de recurrencia durante el período de seguimiento de 12 meses. Las manifestaciones bucales iniciales del Linfoma de Burkitt deben considerarse en el diagnóstico diferencial de las enfermedades bucales benignas. Debido a su naturaleza agresiva, el reconocimiento temprano y rápido de este linfoma es esencial para la administración oportuna de la terapia adecuada y mejora el pronóstico del paciente (AU)

Aim: To present a case of sporadic Burkitt's lymphoma with oral initial manifestatios in a young adult patient, who received treatment at the Hospital Interzonal General de Agudos "General José de San Martín", La Plata. Clinical case: A 20-year-old male patient presents with a tumor lesion located in the posterior area of the mandibular ridge, spontaneous loss of teeth and paresthesia of the inferior dental nerve, increase in testicular volume, intestinal compromise and polyadenopathy. The morphological and immunostaining conditions confirm an "aggressive" B-Cell Lymphoma. The patient received an intensive scheme of 6 blocks of chemotherapy and intrathecal therapy. No signs of recurrence were observed during the 12-month follow-up period. Oral manifestations of Burkitt´s lymphoma in the initial stages should be considered in the differential diagnosis of benign oral diseases. Due to its aggressive nature, early and rapid recognition of these this lymphoma is essential for the timely administration of adequate therapy and for a patient's better prognosis (AU)

Manejo actual de la enfermedad diverticular aguda del colon / Current management of acute diverticular disease of the colon

Introducción: La colopatía diverticular es la enfermedad benigna más frecuente del colon, llegando a tener una incidencia del 70% a los 65 años de edad. El tratamiento fue variando a lo largo de los años. El objetivo de la presente monografía es realizar una recopilación de datos actualizados que permitan analizar las diferentes variables terapéuticas en relación al tratamiento médico y más específicamente quirúrgico de la enfermedad diverticular aguda. Materiales y Método: Se realizó una revisión bibliográfica actualizada en base a buscadores académicos médicos (PubMed, MedLine, Ovid, ResearchGate, Google Scholar, Lilacs, Rima, Cochrane) a partir de la cual se analizaron las diferentes variables relacionadas al tratamiento (manejo médico y quirúrgico). Resultados: Se desarrolló una guía de tratamiento en relación a la enfermedad diverticular complicada y no complicada y sus variables terapéuticas teniendo en cuenta la clasificación de HINCHEY. Conclusiones: La enfermedad diverticular tiene una incidencia en aumento en las últimas décadas, ya sea por un incremento en los factores de riesgo (dietas hipercalóricas, con un bajo contenido de fibras y verduras; obesidad; estrés) como por los avance en los métodos de diagnósticos, por lo que hay que saber diferenciar la terapéutica teniendo en cuenta no sólo la clasificación de HINCHEY sino también el estado general del paciente. En la mayoría de los casos no requerirá de una conducta quirúrgica para su resolución, siendo está indicada a los tipos III/IV y ante la falta de respuesta al tratamiento médico en los demás tipos. La elección de la técnica quirúrgica (Operación de Hartmann, Resección con anastomosis primaria con o sin ostomía de protección o lavado y drenaje de cavidad abdominal) se establecerá en base al estado general del paciente al momento del acto quirúrgico y a la experiencia del cirujano. (AU)

Lipoma intraoral: reporte de un caso clínico / Intraoral lipoma: report of a clinical case

Dentro de las neoplasias más frecuentes de tejidos blandos mesenquimáticos, el lipoma es el de mayor frecuencia. A nivel de cabeza y cuello, su incidencia es inferior, siendo de 2 a 4 por ciento. En la cavidad bucal, la ubicación más usual es en la lengua. Histológicamente, se observan adipocitos separados por tabiques fibrosos. El diagnóstico diferencial se realiza con tumor de células granulares, neurofibroma, fibroma traumático y malformaciones de las glándulas salivales. En el siguiente artículo se describirá un caso clínico con su técnica quirúrgica.

Among the most frequent neoplasms of soft mesenchymal tissues, lipoma is the most frequent. At head and neck level, the incidence is lower, being 2 to 4 percent. In the oral cavity, the most usual location is on the tongue. Histologically, adipocytes are seen separated by fibrous septa. The differential diagnosis is made with granular cell tumor, neurofibroma, traumatic fibroma and malformations of the salivary glands. The following article will describe a clinical case with its surgical technique.

Conversion during thoracoscopic lobectomy: related factors and learning curve impact.

Video-assisted thoracoscopic surgery (VATS) lobectomy has become a standard procedure for lung cancer treatment. Conversion-related factors and learning curve impacts, were poorly described. The aim of this study was to review the reasons and related factor for conversion in VATS lobectomy and the impact on this of the surgeon's learning curve. From June 2009 to May 2014, 154 patients who underwent a VATS lobectomy were included in our study. Patients' characteristics, pathology background, operative times, overall length of stay, overall morbidity and type of major complications were recorded for all patients and compared between non converted (n = 133) and converted (n = 21) patients. To evaluate surgeon's learning curve, we analyzed rates and causes of conversion in the first period (first 77 patients) and in the last period (78-154 patients). Patients characteristics were similar between converted and non-converted groups. Patients who were converted to open thoracotomy presented more frecuently tumors >3 cms (P = 0.02). The average of operative times and the length of stay were not significantly different between groups. Overall morbidity and major complications were also similar in both groups. There were no impact of surgeon's learning curve in overall rate conversion in both groups. Emergency conversion was always secondary to vascular accidents, all in the first group (p = 0.059). Surgeons should be expecting to perform a conversion to a thoracotomy in patients who present in preoperative studies, tumors greater than 3 cms. Learning curve only affected the emergency conversion, occurred all in the first half of our series.

La delimitación de la clínica de las fobias en la postmodernidad

La delimitación del estatuto clínico de la fobia ha sufrido modificaciones a lo largo de la historia de la psiquiatría planteándose desde el siglo XIX, diferencias entre los clínicos e investigadores que abordaron el tema, destacándose entre ellos la figura de Freud quien también, en su vasta obra, concibió la fobia de diversos modos a medida que iba formalizando la teoría psicoanalítica. El objetivo general del trabajo consistirá en establecer la especificidad de la fobia, delimitando su concepto; siendo los objetivos específicos describir la relación entre la noción de fobia definida y las manifestaciones patológicas predominantes en la clínica actual y plantear un abordaje terapéutico posible desde el lugar habilitador y constituyente del deseo, que es la palabra. Para responder los lineamientos del trabajo se realizará un recorrido temático partiendo del empleo del concepto de fobia en la psiquiatría desde el siglo XIX. Luego se planteará cómo la noción de fobia se fue modificando en relación a los diferentes momentos de la obra de Freud y de Lacan a continuación, y desde el marco teórico propuesto por ambos autores, se describirá la relación existente entre las manifestaciones de la fobia en el presente y el contexto sociocultural postmoderno para, finalmente, plantear la posibilidad de su abordaje terapéutico en función de la palabra y atendiendo a la urgencia con que hoy se presenta.

After the nineteenth century, the delineation of clinical status of the phobia has been modified over the history of psychiatry. Such modifications have considered prominent differences between clinicians and researchers who addressed the issue such as Freud, who also in his wide work conceived phobia in several ways as psychoanalytic theory was formalized. The overall objective of this work will be to establish the specificity of the phobia, to limit its concept; as for the specific aims, they will be to describe the relationship between the notion of defined phobia and predominant pathological manifestations in current clinical environment, and to pose a possible therapeutic approach from the enabler place and constitutive of desire, which is the word. To answer the work guidelines, a topic review will be performed, starting from the use of the concept of phobia in psychiatry since the nineteenth century. Then, ways in which the notion of phobia was changing in relation to the different stages of the work of Freud and Lacan will be considered. Then, from the theoretical framework proposed by both authors, the relationship between the manifestations of phobia will be described in the present and the postmodern cultural context to finally raise the possibility of their therapeutic approach based on the word and considering the urgency presented today.

Monitoring lumbar plexus integrity in extreme lateral transpsoas approaches to the lumbar spine: a new protocol with anatomical bases.

UNLABELLED: XLIF is an increasingly popular procedure that requires traversing the psoas, with the potential risk of injuring the lumbar plexus nerves. Intraoperative neurophysiological monitoring (IOM) is, therefore, critical in this kind of procedures; nevertheless, there were some reports of neural damage. PURPOSE: To determine the effectiveness of a new protocol for IOM during XLIF. MATERIALS AND METHODS: This prospective, nonrandomized, institutional review board-approved study enrolled adult patients of both sexes undergoing XLIF at the Italian Hospital of Buenos Aires between 2012 and 2014. Preoperative and immediate postoperative neurological examinations were carried out, paying special attention to lumbar plexus motor and sensory territories. IOM included EMG and transpsoas stimulation, considering the territories of every motor and sensory branch of the lumbar plexus. RESULTS: 107 patients (133 lumbar levels) were evaluated. Reproducible responses were obtained in the collateral and terminal branches of the lumbar plexus, which were well preserved. No patient (0%) had new motor postoperative deficits. Nineteen (17.75%) patients had minor and transient sensory symptoms, lasting less than a month. One patient (0.93%) had longer duration of sensory complaints (3 months). CONCLUSION: A detailed IOM of lumbar plexus branches can determine in real time the proximity of intrapsoas nerves during XLIF.

Expression profile of genes as indicators of developmental competence and quality of in vitro fertilization and somatic cell nuclear transfer bovine embryos.

Reproductive biotechnologies such as in vitro fertilization (IVF) and somatic cell nuclear transfer (SCNT) enable improved reproductive efficiency of animals. However, the birth rate of in vitro-derived embryos still lags behind that of their in vivo counterparts. Thus, it is critical to develop an accurate evaluation and prediction system of embryo competence, both for commercial purposes and for scientific research. Previous works have demonstrated that in vitro culture systems induce alterations in the relative abundance (RA) of diverse transcripts and thus compromise embryo quality. The aim of this work was to analyze the RA of a set of genes involved in cellular stress (heat shock protein 70-kDa, HSP70), endoplasmic reticulum (ER) stress (immunoglobulin heavy chain binding protein, Bip; proteasome subunit ß5, PSMB5) and apoptosis (BCL-2 associated X protein, Bax; cysteine aspartate protease-3, Caspase-3) in bovine blastocysts produced by IVF or SCNT and compare it with that of their in vivo counterparts. Poly (A) + mRNA was isolated from three pools of 10 blastocysts per treatment and analyzed by real-time RT-PCR. The RA of three of the stress indicators analyzed (Bax, PSMB5 and Bip) was significantly increased in SCNT embryos as compared with that of in vivo-derived blastocysts. No significant differences were found in the RA of HSP70 and Caspase-3 gene transcripts. This study could potentially complement morphological analyses in the development of an effective and accurate technique for the diagnosis of embryo quality, ultimately aiding to improve the efficiency of assisted reproductive techniques (ART).

Empyema and lung abscess as complication of a perforated appendicitis in a pregnant woman.

INTRODUCTION: The development of empyema as a result of an intra-abdominal pathology is a rare condition. PRESENTATION OF CASE: We present a 31-year-old woman at 28 weeks' gestation who was referred to our hospital with diagnosis of pneumonia with pleural effusion. She presented with signs of septicemia and fetal distress. A thoracic-abdominal-pelvic CT-scan showed a right pleural effusion with a retroperitoneal collection in contact with the pleural space. Due to her critical condition, immediate surgical exploration and pregnancy interruption was decided. The fetus was delivered by cesarean with satisfactory vitality. After abdominal exploration, a retrocecal appendicular abscess was evidenced and appendectomy was performed. Subsequently, the right chest was accessed through a posterolateral thoracotomy. An empyema with lung abscess and purulent fluid accessing from the retroperitoneum at the posterior pleural space was found. Due to parenchymal compromise, a right inferior lobectomy was performed. The patient had an uneventful recovery and was discharged at postoperative day 10. DISCUSSION: A septic condition in a pregnant patient with significant thoraco-abdominal infection requires an aggressive approach, with interruption of pregnancy and urgent exploration of the chest and abdomen. CONCLUSION: When an empyema is developed in absence of lung disease or other intrathoracic cause, intra-abdominal origin should be considered.

Ileocolic intussusception due to intestinal metastatic melanoma. Case report and review of the literature.

The small intestine is a frequent site of melanoma metastases and the most common cause of secondary intestinal tumors. Even though, its presentation with intestinal obstruction due to intussusception is very rare. We present a 47-year-old woman with a medical history of facial melanoma operated 17 years ago and recently diagnosed of cervical recurrence who complained of abdominal pain of one week duration accompanied with vomiting and abdominal distension. Computed tomography (CT) scan revealed marked distension of the small intestine with features suggesting intussusception of the distal ileum. At laparoscopic exploration a massive ileocolic intussusception was found with invagination of the last 60 cm of ileum inside the cecum and ascending colon. Surgical reduction revealed a tumor of approximately 2 cm in the distal end of the intussuscepted intestine acting as the lead point. Resection of non-viable ileum along with the tumor and end-to-end anastomosis was performed. Many other lesions of smaller size were found distantly in the proximal small bowel but were not treated. The patient had a full recovery and was discharged three days after surgery. Pathological examination showed metastatic melanoma and a positron emission tomography (PET) scan confirmed disseminated disease with brain metastasis. The patient died three months after surgery. Intestinal occlusion due to metastatic disease is a rare condition but should be taken into account particularly in patients with history of cancer. Surgical intervention with a mini-invasive laparoscopic approach is feasible. Intestinal resection and anastomosis is mandatory for either curative or palliative intentions providing a satisfactory treatment.

Hernioplastía inguinal bilateral simultánea: nuestra experiencia / Simultaneous bilateral inguinal hernia repair: our experience

Introducción: El tratamiento de las hernias bilaterales es un tema controvertido, pues no todos adoptan el mismo abordaje. Las conductas posibles son: A) Abordaje diferido: reparación de un lado y luego de varios meses reparar el contralateral. B) Abordaje intermedio: reparción de un lado y luego de 2 a 7 días realizar la contralateral. C) Abordaje simultaneo: reparación de ambas hernias en un mismo acto. En nuestro servicio optamos, desde hace tiempo, por este último. El objetivo de este trabajo es mostrar las técnicas utilizadas, el porcentaje de complicaciones y recidivas con el abordaje bilateral simultáneo. Material y método: Se realizó el estudio de los pacientes operados de hernia inguinal bilateral simultánea en un período de 22 años. Entre enero 1984 y diciembre 2006 se realizó el fichaje retrospectivo por búsqueda de las historias clínicas y entre enero 1998 y diciembre 2006 el fichaje prospectivo. Se describen características poblacionales, tipos de hernioplastías, complicaciones y porcentaje de recidivas. Se realizó seguimiento periódico por consultorio y telefónico a los 15 y 30 días, posteriormente cada 6 meses. Resultados: Entre 1/1/1984 y 31/12/2006 se operaron un total de 4918 pacientes por patología herniaria inguinal. De esta población 365 (7,4%) fueron operados de hernia inguinal bilateral simultánea. El porcentaje de recidivas fue del 3,4%, complicaciones: 14,7%; promedio de internación: 1,9 días. Las ténicas con malla fueron las más utilizadas. Conclusión: La práctica de la hernioplastía inguinal bilateral simultánea es una técnica segura, con bajo índice de complicaciones y recidivas. Asimismo la técnica a emplearse debe seleccionarse según el tamaño y tipo de hernia.