Metarhizium carneum Formulations: A Promising New Biological Control to Be Incorporated in the Integrated Management of Meloidogyne enterolobii on Tomato Plants.

The increase in the populations of root-knot nematode Meloidogyne enterolobii in various vegetables such as tomatoes grown under greenhouse conditions as well as increasing restrictions on the use of certain chemical nematicides have led to the search for new, effective management strategies, preferably ones that are sustainable biological alternatives. In this work, two formulations of the nematophagous fungus Metarhizium carneum, one concentrated suspension and one wettable powder, were evaluated under greenhouse conditions to reduce the M. enterolobii infestation in tomato plants. In addition, the effectiveness of the liquid formulation of M. carneum was compared with two biological and three chemical commercial nematicides. The results show that the two M. carneum formulations reduced the M. enterolobii population density by 78 and 66% in relation to the control treatment. In comparison, the liquid formulation of M. carneum and Purpureocillium lilacinum treatments reduced nematode population density by 72 and 43%, respectively, while for metam sodium preplanting applications followed by M. carneum applications during the tomato growth stage, the reduction was 96%. The alternate use of some chemical compounds plus the application of M. carneum as a biocontrol is a good starting strategy for managing M. enterolobii populations. These results confirm that M. carneum is a serious candidate for the short-term commercialization of an environmentally friendly biological nematicide.

Total Synthesis of Altemicidin: A Surprise Ending for a Monoterpene Alkaloid.

Monoterpene alkaloids encompass distinct chemical diversity and wide-ranging bioactivity. Their compact complexity has made them popular as synthetic targets and has inspired many distinct strategies and tactics in the field of heterocyclic chemistry. This article documents the evolution of a synthetic program aimed at accessing the unusual sulfonamide-containing natural product altemicidin, which was generally believed to be a monoterpene alkaloid throughout our entire synthetic investigations but has recently been found to originate through an unexpected and quite disparate biosynthetic pathway. By leveraging a pyridine dearomatization/cycloaddition strategy, we developed a concise pathway to the 5,6-fused bicyclic azaindane core and, after significant experimentation, an ultimate synthesis of altemicidin itself. Tactics to productively manipulate the multiple functional groups present on this highly polar scaffold proved challenging but were eventually realized via several carefully orchestrated and chemoselective transformations-investments that paid dividends in the form of significantly shorter chemical synthesis. Surprisingly, the bond-forming logic between our presumed abiotic synthetic strategy to this alkaloid class and its subsequently identified biosynthetic pathway is eerily similar.

Enabling Broader Adoption of Biocatalysis in Organic Chemistry.

Biocatalysis is becoming an increasingly impactful method in contemporary synthetic chemistry for target molecule synthesis. The selectivity imparted by enzymes has been leveraged to complete previously intractable chemical transformations and improve synthetic routes toward complex molecules. However, the implementation of biocatalysis in mainstream organic chemistry has been gradual to this point. This is partly due to a set of historical and technological barriers that have prevented chemists from using biocatalysis as a synthetic tool with utility that parallels alternative modes of catalysis. In this Perspective, we discuss these barriers and how they have hindered the adoption of enzyme catalysts into synthetic strategies. We also summarize tools and resources that already enable organic chemists to use biocatalysts. Furthermore, we discuss ways to further lower the barriers for the adoption of biocatalysis by the broader synthetic organic chemistry community through the dissemination of resources, demystifying biocatalytic reactions, and increasing collaboration across the field.

Co-producing uncomfortable, transdisciplinary, actionable knowledges against the corporate food regime through critical science approaches.

The current corporate food regime generates some of the most challenging ecological, social, and ethical problems for humanity in its quest for sustainability and ecological justice. Different scientific disciplines have analyzed these problems in-depth, but usually from their comfort zone, i.e., without engagement with other disciplines and epistemologies. The predominance of disciplinary visions seriously limits, however, understanding the complexities of the corporate food regime, including the impacts it generates. Further, most research concerned with this food regime confronts epistemological, methodological, and political limitations to engage with the type of solutions that could lead to transitions to just sustainabilities. Here we review and integrate the findings from scientific literature focused on the ecological, social, or ethical impacts of the corporate food regime, with an emphasis on impacts that operate on a global scale. In addition, we analyze the need for critical science approaches to trigger generative processes for the co-production of uncomfortable, transdisciplinary, actionable knowledges that are fit for designing just and sustainable food regimes. Much of the evidence presented in our analysis is in tension with the interests of the corporate food regime, which fosters decision-making processes based on selective ignorance of the impacts caused by this regime. Our work provides arguments that justify the need to promote transitions to just sustainabilities in agricultural systems from multiple domains (e.g., research and development, public policies, grassroots innovations). We posit that strategies to co-design and build such transitions can emerge from the co-production of uncomfortable, transdisciplinary, actionable knowledges through critical science approaches.

Baclofeno intratecal para tratamiento de dolor y espasticidad en síndrome de persona rígida: reporte de un caso / Intratecal baclophene for the treatment of pain and spasticity in stiff man syndrome: a case report

Objetivo: Presentar el caso de una paciente femenina de 32 años con diagnóstico de síndrome de persona rígida, con múltiples tratamientos para el dolor y espasticidad sin respuesta a los mismos, con una prueba por vía intratecal de baclofeno con respuesta positiva, por lo que se colocó un dispositivo implantable definitivo para administración de medicamento intratecal (baclofeno), realizada en el Centro Médico Nacional 20 de noviembre del ISSSTE con una mejora de más de 80 % en cuanto al dolor, disminución de la espasticidad. Metodología: Presentación de caso clínico, estudio descriptivo y observacional realizado en el Centro Médico Nacional 20 de Noviembre, de la Ciudad de México, con seguimiento a la paciente y su evolución por un periodo de 12 meses entre los años 2017 y 2018. Resultados: Posterior a la prueba con dosis única de baclofeno intratecal se realiza colocación del dispositivo permanente para administración de baclofeno intratecal, en la última consulta con dosis de 300 microgramos al día, con una mejora del dolor de más del 80 % y con mejora de 100 % en la espasticidad y mejora en general de la sintomatología y con la reincorporación a su vida habitual. Conclusiones: El uso de baclofeno intratecal se debe considerar una alternativa óptima y real para el tratamiento del síndrome de persona rígida mediante la administración por vía intratecal en México

Objective: To present the case of a 32-year-old female patient with a diagnosis of stiff person syndrome, with multiple treatments for pain and spasticity without response, with an intrathecal baclofen test with a positive response, so a defi nitive implantable device was placed for administration of intrathecal medication (baclofen), performed at the National Medical Center November 20 of the ISSSTE with an improvement of more than 80 % in terms of pain, decreased spasticity. Methodology: Presentation of clinical case, descriptive and observational study carried out in the National Medical Center November 20, of Mexico City, with follow-up of the patient and its evolution for a period of 12 months between 2017 and 2018. Results: After the trial with a single dose of intrathecal baclofen, the permanent device was placed for administration of intrathecal baclofen, in the last consultation with a dose of 300 micrograms a day, with an improvement of pain of more than 80 % and with improvement of 100 % in spasticity and overall improvement of the symptoms and with the reincorporation to his habitual life. Conclusions: The use of intrathecal baclofen should be considered an optimal and real alternative for the treatment of rigid person syndrome through intrathecal administration in Mexico

Congenital dacryocystocele: sonographic evaluation of 11 cases.

PURPOSE: To report prenatal sonographic findings of congenital dacryocystocele. METHODS: The medical records of all cases diagnosed with congenital dacryocystocele at a tertiary care center from 2003 to 2015 were reviewed retrospectively. RESULTS: Eleven cases of congenital dacryocystocele were analyzed. No accompanying fetal anatomic anomalies where detected. Mean maternal age at evaluation was 22 years of age (range, 17-32 years). Four of 10 cases were primigravidas. The mean gestational age at evaluation was 32.6 weeks' gestational age. Ten out of 11 cases occurred in female fetuses (91%). Of the 11, 10 cases were unilateral and 1 was bilateral. The mean diameter at evaluation was 5.1 mm. Spontaneous resolution occurred in 2 cases (18%). In the remaining 9 fetuses, postnatal diagnosis of dacryocystocele were confirmed by an ophthalmologist evaluation. CONCLUSIONS: Prenatally diagnosed congenital dacryocystocele may undergo spontaneous resolution before birth. However, a better understanding of the prenatal sonographic findings can help to appropriately orient parents of potentially affected fetuses. Referral to a pediatrician and pediatric ophthalmologist may be considered for complete evaluation and postnatal management.

Liver transplantation for intrahepatic cholangiocarcinoma.

Although hepatocellular carcinoma (HCC) has become a common indication for liver transplantation (LT), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) are historically contraindicated due to their aggressive behavior. On the basis of recent experiences, some groups have proposed a clinical trial investigating the role of LT for patients with early cholangiocarcinoma (CCA), defined as a single lesion ≤ 2 cm. The purpose of this study is to assess the clinicopathologic features and outcomes following LT for patients who were initially diagnosed with HCC and subsequently found to have either ICC or cHCC-CCA on explant. Patients with the diagnosis of primary liver cancer (PLC) after LT from a single center were retrospectively reviewed. Outcomes for patients with early CCA were compared with patients with HCC within Milan criteria (MC). Out of 618 patients transplanted with PLC, 44 patients were found to have CCA on explant. On the basis of preoperative imaging, 12 patients met criteria for early CCA and were compared with 319 patients who had HCC within MC. The 1- and 5-year overall survival for early CCA versus HCC was 63.6% versus 90.0% and 63.6% versus 70.3% (log-rank, P = 0.25), respectively. Overall recurrence was 33.3% for early CCA versus 11% for HCC. On explant the patients with CCA were more likely understaged with higher tumor grade and vascular invasion. In conclusion, patients with CCA present a diagnostic challenge, which often leads to the finding of more aggressive lesions on explant after LT, higher recurrence rates, and worse post-LT survival. Careful consideration of this diagnostic conundrum needs to be made before a clinical trial is undertaken. Liver Transplantation 24 634-644 2018 AASLD.

Using an at-risk salary model to improve throughput in academic medical center operating rooms.

STUDY OBJECTIVE: The objective was to analyze if an at-risk salary model for faculty anesthesiologists could improve on-time first case starts (FCSs) and case turnovers (TOs) in an academic hospital inpatient operating room (IOR) and ambulatory surgery center (ASC). Organizational goals were 65% and 70% on-time FCS and case TO times for IOR and ASC, respectively. DESIGN: This was a retrospective study. SETTING: Surgical cases performed at both the IORs and the ASCs at a large academic medical center were included. INTERVENTIONS: We converted 5% to 7% (academic rank dependent) of anesthesiologist salary from guaranteed to an at-risk salary model. Salary was earned back on a case-by-case basis by starting cases on time or by documenting a valid reason for case delay in the anesthesia record. On-time first case and goal TO times were determined using American Association of Clinical Directors standard definitions. MEASUREMENTS: Data were reviewed for 1 year prior to implementation of the at-risk salary model and for 1 year after the implementation. Monthly average on-time FCS and TO times were compared between the preimplementation and postimplementation time frames. Data were analyzed using analysis of variance for repeated measures. MAIN RESULTS: After the implementation of the at-risk salary model, the organization experienced a 33% and 86% improvement in on-time FCSs (P< .01) in the inpatient and ambulatory operating rooms, respectively. A 41% (IOR) and 44% (ASC) improvement in timely case TOs (P< .01) was also seen. CONCLUSIONS: Anesthesiologists can drive efficiency in an operating room setting. By incentivizing on-time FCS and timely case TO with an at-risk salary model for faculty anesthesiologists, we were able to demonstrate a sustained significant improvement for these metrics. In both an inpatient and an ambulatory setting, operating room efficiency may be best served by aligning provider financial incentives with desired outcome metrics.

Persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation: a case report.

INTRODUCTION: Platypnea-orthodeoxia is a relatively uncommon but striking clinical syndrome characterized by dyspnea and deoxygenation accompanying a change to sitting or standing from a recumbent position. Hypoxemia early after lung transplant can have multiple etiologies. We report a rare case of persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation, as a result of right-to-left interatrial shunt through a patent foramen ovale, with subsequent resolution of hypoxemia after percutaneous closure of the patent foramen ovale. CASE PRESENTATION: Our 66-year-old Caucasian male patient exhibited a persistent patent foramen ovale. Persistent patent foramen ovale produces an intermittent intra-atrial right-to-left shunt and occurs in approximately 25 % of the general population. Although the majority of people with patent foramen ovale are asymptomatic, it is believed to act as a pathway for chemicals or thrombi that can result in a variety of clinical manifestations, including stroke, migraine headache, decompression sickness, high-altitude pulmonary edema, and platypnea-orthodeoxia syndrome. Percutaneous closure of the patent foramen ovale has been shown to be effective in the case of right-to-left shunting with normal pulmonary arterial pressure, but the indication remains controversial in other situations where pulmonary pressures are not normal. The most common causes of hypoxemia immediately after lung transplant include: graft dysfunction, reperfusion injury, acute thromboembolic disease, and acute rejection. We report a case of reopening of a patent foramen ovale after left single-lung transplantation with normal pulmonary pressure. CONCLUSIONS: Our case demonstrates that an open patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplant, with significant morbidity, and that it can be treated successfully using a percutaneously placed occlusion device. Through this case report, we aim to improve pre-transplant procedures by demonstrating that a bubble contrast transesophageal echocardiogram can be performed pre-operatively to detect a patent foramen ovale.

[Clinical and epidemiological characteristics of humeral supracondylar fractures in pediatric patients in a Regional General Hospital]. / Perfil clínico-epidemiológico de las fracturas supracondíleas de húmero en pacientes pediátricos en un hospital general regional.

BACKGROUND: Supracondylar humerus fractures are common in children between 5-7 years of age and more frequent in the males, 90-95% of these fractures are in extension mechanism, the urgency of immediate attention is to prevent complications and sequelae. OBJECTIVE: To establish the clinical and epidemiological profile of supracondylar humerus fractures, in a General Regional Hospital from the Instituto Mexicano del Seguro Social in Yucatan Mexico, during 2011-2013. MATERIAL AND METHODS: A cross-sectional study. Strength association was measured by odds ratios and statistical significance with chi(2) test, p value was considered in < 0.05 RESULTS: 56 cases were analyzed, the mean age was 2.6 ± 5.33 years, the mechanism of injury was falling over at home, male gender is associated with extent injure mechanism (OR 5.6, 95% CI 1.0-30.1, p = 0.03), we observed that at most time elapsed between injury and medical means more hospital days (r = 0.40; p = 0.002), surgical treatment was established in 44 cases (78.6%), 18 (40.9%) with closed technique and placement of cloves and 26 (59.1%) with open reduction, in 100% cross configuration was used, ten complications were reported. CONCLUSIONS: Supracondylar humerus fractures are a common injury in children, males are more likely to be injured by extension, and the speed in medical treatment is an important issue.

Caspase-8 Deficiency Presenting as Late-Onset Multi-Organ Lymphocytic Infiltration with Granulomas in two Adult Siblings.

Caspase-8 deficiency (CED) was originally described in 2002 in two pediatric patients presenting with clinical manifestations resembling autoimmune lymphoproliferative syndrome (ALPS) accompanied by infections, and T, B and NK cell defects. Since then, no new CED patients were published. Here we report two adult siblings (Pt1 and Pt2) presenting in their late thirties with pulmonary hypertension leading to lung transplant (Pt1), and a complex neurological disease leading to multiple cranial nerves palsies (Pt2) as their main manifestations. A thorough clinical and immunological evaluation was performed at the Primary Immunodeficiency Clinic at NIH, followed by whole exome sequencing. The patients had multiorgan lymphocytic infiltration and granulomas, as well as clinical signs of immune deficiency/ immune dysregulation. Both siblings carried homozygous mutations in CASP8, c.1096C > T, p.248R > W. This was the same mutation described on the previously published CED patients, to whom these new patients were likely distantly related. We report two new CED patients presenting during adulthood with life-threatening end-organ lymphocyte infiltrates affecting the lungs, liver, spleen, bone marrow and central nervous system. This phenotype broadens the clinical spectrum of manifestations associated with this disease and warrants the search of CASP8 mutations in other cohorts of patients.

Renal function after low central venous pressure-assisted liver resection: assessment of 2116 cases.

OBJECTIVES: Low central venous pressure (LCVP)-assisted hepatectomy is associated with decreased blood loss and lower transfusion rates. Concerns about its impact on renal function have prevented widespread application. This study was conducted to review the dynamics of renal function after LCVP-assisted hepatectomy. METHODS: A retrospective analysis of a prospective surgical database was carried out. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The RIFLE (risk-injury-failure-loss-end-stage) criteria were used to define postoperative biochemical acute kidney injury (bAKI). Occurrences of clinically relevant AKI (cAKI) were identified in the study center postoperative database. RESULTS: During the period 2003-2012, 2116 LCVP-assisted hepatectomies were performed. The median patient age was 61 years [interquartile range (IQR): 51-70 years] and 51% of patients were male. The median number of resected segments was two; resections involved from one to four segments. Median estimated blood loss was 300 ml (IQR: 200-600 ml). Rates of morbidity and 90-day mortality were 21% and 2%, respectively. Low baseline eGFR (<90 ml/min) was seen in 84% of patients; 29% of patients had eGFR of <30 ml/min. Postoperative bAKI was seen in 17% (n = 350) of patients. Biochemical AKI with low eGFR was seen in 336 patients, representing 16% of the whole cohort; 13% of patients had been at risk, 2% experienced injury and 1% experienced failure. Kidney function had normalized at discharge in 159 of these patients. Nine patients (<1%) developed postoperative cAKI. CONCLUSIONS: The majority of patients in the study cohort had low baseline eGFR. Biochemical alterations in eGFR are transient in the vast majority of patients after LCVP-assisted hepatectomy and their clinical impact is limited. The present data suggest that clinically relevant renal dysfunction is a very uncommon event in patients undergoing LCVP-assisted liver resection.

Deep-tissue dynamic monitoring of decubitus ulcers: wound care and assessment.

The use of deep-tissue multiwavelength imaging is of paramount importance in clinical settings as a noninvasive solution to identify and monitor the progression of decubitus ulcers. A point-of-care multiwavelength imager is being developed, whose utility results from the provision of important physiological characteristics and blood flow metrics via analysis of deep-tissue response to light. The noninvasive real-time monitoring and analysis of tissue focusing on wound imaging is integral, because it allows for quantitative in situ measurements that characterize tissue to assess the progress of either tissue healing or necrosis.

Deoxycorticosterone producing tumor as a cause of resistant hypertension.

We describe a young woman with longstanding resistant hypertension. Evaluation for renal artery stenosis and primary aldosteronism was unrevealing. In this setting of a suppressed plasma aldosterone concentration (PAC) and a suppressed plasma renin activity (PRA), a differential diagnosis of a deoxycorticosterone (DOC) producing tumor was entertained. Biochemical and imaging studies confirmed this diagnosis. Rare and novel DOC producing tumors are an important cause of resistant hypertension.

Presencia de animales seropositivos al síndrome reproductivo y respiratorio porcino en Nuevo León / Presence of seropositive animals to the porcine respiratory and reproductive syndrome virus in Nuevo Leon

A preliminary study was carried out to obtain serological evidence of the presence of the porcine respiratory and reproductive syndrome (PRRS) virus and the risk of infection in different areas and phases of production in five full cycle pig farms in the state of Nuevo Leon, Mexico. Sixty blood samples of each farm were obtained (10 for each phase of production: weaning, growing, finishing, pregnancy, lactation and mating-service). The detection of antibodies against the PRRS virus was carried out using a commercial kit. All farms were positives in all phases of production. The highest seroprevalences were found in the growing and finishing phases (36% y 56%, respectively).

Se realizó un estudio preliminar para obtener evidencia serológica de la presencia del virus del síndrome respiratorio y reproductivo porcino (PRRS, por sus siglas en inglés) y del riesgo de infección en las diferentes áreas y etapas de producción en cinco granjas porcinas de ciclo completo en Nuevo León, México. Se obtuvieron 60 muestras de sangre de cada granja (diez para cada etapa de producción: destete, iniciación, finalización, cerdas gestantes, lactando o en monta-servicio). La detección de anticuerpos antivirus del PRRS se realizó utilizando un equipo comercial. Todas las granjas resultaron positivas en las diferentes etapas de producción. La seroprevalencia fue mayor en las etapas de inicio y finalización (36% y 56%, respectivamente).

A new flexible automated system for the study of exhaled gases.

Expired gas analysis has been largely relegated to the measurement of VO2 and VCO2 by a variety of methods. We designed and built a new flexible automated expired gas analysis instrument, the Volume Accumulating Metabolic Monitor (VAMM), capable of simultaneous and continuous quantitative expired gas analysis for a multiplicity of gas species. All expired gas is collected into one of two twin reservoirs. This approach allows analysis of one reservoir while collection occurs into the other. The instrument mixes the expired gas and determines the volume of the desired gas species using a combination of indicator gas dilution and mass spectrometry. We tested the VAMM's ability to measure the 13CO2 2-hr collection after intravenous 13C-aminopyrine. Aminopyrine is metabolized to CO2. Ten healthy volunteers underwent expired gas collection and analysis for 140 min. All studies were performed in the recumbent posture after an 8 hr fast. The initial 20 min were used to establish a baseline 13CO2 production. Following the injection of 2 mg/kg 13C-aminopyrine, expired gas was collected for an additional 120 min. The mean 2-hr 13CO2 enrichment was 7.1 ?2.9 ml (range 3.5 ml to 13.2 ml). This represented a percent collection of 26.8 ?9.1 (range 16.5 to 48.6). Peak excretion occurred at 84.9 ?17.5 min (range 50 min to 108 min). The VAMM provided significantly better 13CO2 excretion profiles than previously described. This technology can easily be customized to study not only other similar metabolic processes but also other gas excretions.