Pleural effusion in a child with a correctly placed ventricle-peritoneal shunt.

Pleural effusions in children (PE) due to ventricle-peritoneal shunt (VPS) is very rare, with few cases reported. We present a new case of an infant with VPS who had a massive hydrothorax not associated with misplacement or migration of the distal catheter or with ascites. After the evacuation of the PE we managed the patient by adjusting the pressure of the adjustable valve (AV). Sequential thoracic ultrasounds showed a satisfactory outcome. We review the literature thoroughly and describe the possible pathophysiological mechanisms.

Eficacia y complicaciones de las técnicas analgésicas para el tratamiento del dolor agudo postoperatorio moderado a intenso / Efficacy and complications of analgesic techniques for the treatment of moderate to severe postoperative acute pain

Introducción: A pesar de los esfuerzos y la evidencia disponible, el dolor agudo postoperatorio (DAP) moderado a intenso continúa teniendo una prevalencia elevada en nuestro medio. Como parte de una estrategia de analgesia balanceada o multimodal, las técnicas de analgesia regional ofrecen un adecuado control analgésico con menores efectos indeseables (que el uso exclusivo de opioides), aunque no están exentas de complicaciones y no son aplicables a todas las cirugías. El objetivo de este trabajo fue valorar la eficacia de las técnicas analgésicas para el tratamiento del DAP moderado a intenso, la incidencia de complicaciones asociadas a estas técnicas y la relación entre DAP y el antecedente de dolor crónico. Pacientes y métodos: Estudio retrospectivo que incluyó 728 pacientes en los que se indicaron técnicas analgésicas, como analgesia epidural, analgesia perineural continua y analgesia controlada por el paciente (PCA) con morfina intravenosa, para el tratamiento del DAP moderado a intenso entre octubre del 2018 y octubre del 2020. Los pacientes fueron valorados por la Unidad de Dolor Agudo Postoperatorio (UDAP) a las 24 y 48 horas, se registró el dolor con la ENV (Escala Numérica Verbal), la presencia de reacciones adversas y/o complicaciones, empleo de analgesia multimodal y consumo de morfina en equivalentes intravenosos. Los niveles de dolor se clasificaron en leve (ENV: 0-3), moderado (ENV: 4-6) e intenso (ENV mayor o igual a 7). Resultados: Cerca del 60 % de los pacientes presentaron dolor leve a las 24 horas y del 70 % a las 48 horas. Un 71,8 % de los portadores de analgésica continua epidural presentaron dolor leve el primer día y un 83 % al segundo. Las cirugías con niveles más altos de dolor moderado e intenso fueron la cirugía espinal en la que se empleó la PCA de morfina y la artroplastia de rodilla en que se utilizó analgesia a través de bloqueo femoral continuo...(AU)

Introduction: Despite the efforts and the available evidence, moderate to severe acute postoperative pain (APP) continues to have a high prevalence in our setting. As part of a balanced or multimodal analgesia strategy, regional analgesia techniques offer adequate analgesic control with fewer undesirable effects (that the exclusive use of opioids), although they are not free of complications and do not apply to all surgeries. This study aimed to assess the efficacy of analgesic techniques for the treatment of moderate to intense APP, the incidence of complications associated with these techniques, and the relationship between APP and the presence of chronic pain. Patients and methods: This retrospective study included 728 patients in which analgesic techniques such as epidural analgesia, continuous perineural analgesia, and morphine Patient Controlled Analgesia (PCA) were indicated to treat moderate to severe APP between October 2018 and October 2020. The patients were evaluated by the APP service at 24 and 48 hours, the pain was recorded with the NRS (Numerical Rating Scale), and the study also registered the presence of adverse reactions and/or complications, the use of multimodal analgesia, and the consumption of morphine in equivalent intravenous doses. Pain levels were classified as mild (NRS: 0-3), moderate (NRS: 4-6) and intense (NRS greater than or equal to 7). Results: Approximately 60 % of all patients presented mild pain at 24 hours and 70 % at 48. Epidural analgesia in abdominal surgery presented 71.8 % mild pain on the first day and 83 % on the second. The surgeries with the highest levels of moderate and severe pain were spinal surgery using morphine PCA and knee replacement with continuous femoral nerve block. The morphine consumption recorded in the PCA was 25.8 mg (SD 18.4) at 24 hours and 18.6 mg (SD: 14.6) at 48 hours...(AU)

Predicting severe pain after root canal therapy in the National Dental PBRN.

Some patients experience severe pain following root canal therapy (RCT) despite advancements in care. We sought to identify factors, which can be measured preoperatively, that predict this negative outcome so that future research may focus on preemptive steps to reduce postoperative pain intensity. Sixty-two practitioners (46 general dentists and 16 endodontists) who are members of the National Dental Practice-Based Research Network enrolled patients receiving RCT for this prospective observational study. Baseline data collected from patients and dentists were obtained before treatment. Severe postoperative pain was defined based on a rating of ≥7 on a scale from 0 (no pain) to 10 (pain as bad as can be) for the worst pain intensity experienced during the preceding week, and this was collected 1 wk after treatment. Multiple logistic regression analyses were used to develop and validate the model. A total of 708 patients were enrolled during a 6-m period. Pain intensity data were collected 1 wk postoperatively from 652 patients (92.1%), with 19.5% (n = 127) reporting severe pain. In multivariable modeling, baseline factors predicting severe postoperative pain included current pain intensity (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.07 to 1.25; P = 0.0003), number of days in the past week that the subject was kept from their usual activities due to pain (OR, 1.32; 95% CI, 1.13 to 1.55; P = 0.0005), pain made worse by stress (OR, 2.55; 95% CI, 1.22 to 5.35; P = 0.0130), and a diagnosis of symptomatic apical periodontitis (OR, 1.63; 95% CI, 1.01 to 2.64; P = 0.0452). Among the factors that did not contribute to predicting severe postoperative pain were the dentist's specialty training, the patient's age and sex, the type of tooth, the presence of swelling, or other pulpal and apical endodontic diagnoses. Factors measured preoperatively were found to predict severe postoperative pain following RCT. Practitioners could use this information to better inform patients about RCT outcomes and possibly use different treatment strategies to manage their patients (Clinicaltrials.gov NCT01201681).

Identification of gene interactions in fungal-plant symbiosis through discrete dynamical system modelling.

Fungal-plant root associations involve nutrient exchanges, between the partners and the soil, particularly phosphate, that benefit both organisms. Discrete dynamical system (DDS) models are reconstructed to capture gene regulation in the arbuscular mycorrhizae Glomus versiforme-Medicago trunculata root symbiosis. Previously published time-course gene expression data derived from various days post-inoculation were clustered to identify genes co-regulated in mycorrhizal roots. Uncolonised roots grown with high phosphate provide a key nutritional control condition. First-order linear DDS models were created using a data-driven method to fit to the observed gene expression data. The result of the modelling constitutes active gene interactions in the regulatory network of the plant root at 8, 15, 22, 31 and 36 days post-inoculation. These genes are involved in basic metabolism, development, oxidative stress and defense pathways, and show consistent dynamic behaviours in the model. The functions of previously unannotated genes were further elucidated from the developed system maps.

Canine gonadal dysgenesis syndrome: a case of mosaicism (77,XO-78,XX).

A toy poodle bitch had an abnormal oestrus cycle and apparently persistent follicles. Hormonal therapy was unsuccessful. The bitch was ovariohysterectomised and gross and histological evaluation of the ovaries and uterus, together with karyotyping, led to a diagnosis of 77,XO-78,XX mosaicism.

Ultrasonographic imaging of canine mammary tumours.

The efficiency and reliability of an ultrasonographic technique for evaluating mammary neoplasms was tested in 19 female dogs with palpable tumours. A 7.5 MHz linear-array ultrasound transducer was used, with an aqueous stand-off pad between the probe and the skin. The ultrasonographic images were used to evaluate the shape, size and echogenicity of the mammary lesions, and their relationship with other tissues. The tumours were excised and analysed histologically. A comparison of the ultrasonographic and histological findings revealed that the ultrasonographic images of nine of the 11 malignant tumours had irregular margins and were polymorphous in shape, all 11 were heterogeneous in their internal echogenicity, seven had acoustic shadowing and three showed acoustic enhancement. In contrast, seven of the eight benign tumours had regular margins and were spherical or oval in shape, all eight were homogeneous in their internal echographic pattern, seven had edge shadowing, and all eight showed acoustic enhancement. Moreover, six of the 11 malignant neoplasia were invasive, whereas all the benign tumours were isolated.

Preliminary results of hemizona assay (HZA) as a fertility test for canine spermatozoa.

The Hemizona assay (HZA) is considered to be an effective test for predicting the fertilizing potential of spermatozoa. It is a functional test that distinguishes the zona-binding capacity of spermatozoa from fertile and infertile males. The objective of this study was to validate the HZA for canine spermatozoa, as a test for diagnosing canine male fertility status. Various parameters that affect binding capacity were examined: the presence of an adequate number of capacitated and motile spermatozoa for an HZA, the influence of fertility status, sperm-binding variability within fertile dogs over 60 d, variability in sperm-binding capacity of different oocytes, the lower limit number of spermatozoa binding to a zona from the fertile control, and evaluation of HZI to determine the fertilizing capacity of spermatozoa. Hemizonae were obtained from frozen oocytes of spayed bitches. The oocytes were manually cut into nearly equal halves. Spermatozoa were capacitated by swim-up and 1 h incubation at 37 degrees C in modified Ham's F10 medium. Spermatozoa and hemizonae were co-incubated in 100-microL drops at 37 degrees C for 1 h. Spermatozoa from 7 fertile and 3 infertile dogs were used for this study. The optimal sperm concentration for hemizona insemination was 1 x 10(6)/mL capacitated and motile spermatozoa. A significant difference (P < 0.001) was found the number of tightly zonabound spermatozoa between fertile and infertile dogs. Although there was a small difference in zona binding capacity between ejaculates of the same fertile dog (44 +/- 18.24), the main cause for the difference mentioned above was that of poor zona pellucida-binding capacity of spermatozoa from infertile dogs. We found a maximum of 14.28% bad oocytes when we compared sperm samples from 3 fertile and 3 infertile dogs in 56 HZA replicates. To avoid the effect of bad zona on sperm binding we calculated 37 (95% CI) bound spermatozoa from infertile dogs in 56 replicates. Thus, an HZA experiment in which a control dog had < 37 zona bound spermatozoa was repeated. Based on a minimum of 37 bound spermatozoa for fertile males (controls), a differential zona-binding capacity and hemizona index (HZI) between fertile and infertile dogs and between 2 fertile dogs was determined. The binding differential between fertile and infertile dogs was 64.92 +/- 24.29, while between 2 fertile dogs it was 22.38 +/- 10.02 (P < 0.001). According to the HZI values, a value equal to or less than 41.11 indicated an infertile test dog, while an HZI value equal to or greater than 57.95 indicated a fertile test dog. Any value between these two could indicate either fertility or infertility. The evaluation of fertilizing potential of spermatozoa can be improved using the HZA protocols described above.

The effect of ultrasonics on sealer distribution and sealing of root canals.

The purpose of this study was to compare the ultrasonic and hand methods of sealer placement using three types of sealers: Sultan "Grossman's formula," AH-26, and CRCS. The effect of these methods on radiographic density, sealer distribution, and on the apical seal of the different sealers was evaluated. The in vitro experiment was carried out using human extracted mandibular incisors and mesio-buccal roots of maxillary first and second molars. Following standardized canal instrumentation, 120 single canal mandibular incisors were randomly assigned to six groups, depending on the type of sealer and method of sealer placement (hand versus ultrasonic). An additional ten teeth were used as controls. In the molar groups 40 canals were randomly assigned to two groups, with the method of sealer placement as the variable. Eight canals were used as controls. Postsealer analyses using radiographic density scores transformed to mm of sealer indicated that ultrasonics was superior to manual placement only for CRCS. Taken together, our investigation suggests that ultrasonics may enhance the placement of some sealers (i.e. CRCS) but not of others (i.e. AH-26 or Sultan). Method of sealer placement had no effect on apical leakage and therefore apparently on apical seal.