Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes

Abstract Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgicallyinduced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes.

Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgically-induced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep ( Ovis aries ). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

Prediction of daily mean and one-hour maximum PM2.5 concentrations and applications in Central Mexico using satellite-based machine-learning models.

BACKGROUND: Machine-learning algorithms are becoming popular techniques to predict ambient air PM2.5 concentrations at high spatial resolutions (1 × 1 km) using satellite-based aerosol optical depth (AOD). Most machine-learning models have aimed to predict 24 h-averaged PM2.5 concentrations (mean PM2.5) in high-income regions. Over Mexico, none have been developed to predict subdaily peak levels, such as the maximum daily 1-h concentration (max PM2.5). OBJECTIVE: Our goal was to develop a machine-learning model to predict mean PM2.5 and max PM2.5 concentrations in the Mexico City Metropolitan Area from 2004 through 2019. METHODS: We present a new modeling approach based on extreme gradient boosting (XGBoost) and inverse-distance weighting that uses AOD, meteorology, and land-use variables. We also investigated applications of our mean PM2.5 predictions that can aid local authorities in air-quality management and public-health surveillance, such as the co-occurrence of high PM2.5 and heat, compliance with local air-quality standards, and the relationship of PM2.5 exposure with social marginalization. RESULTS: Our models for mean and max PM2.5 exhibited good performance, with overall cross-validated mean absolute errors (MAE) of 3.68 and 9.20 µg/m3, respectively, compared to mean absolute deviations from the median (MAD) of 8.55 and 15.64 µg/m3. In 2010, everybody in the study region was exposed to unhealthy levels of PM2.5. Hotter days had greater PM2.5 concentrations. Finally, we found similar exposure to PM2.5 across levels of social marginalization. SIGNIFICANCE: Machine learning algorithms can be used to predict highly spatiotemporally resolved PM2.5 concentrations even in regions with sparse monitoring. IMPACT: Our PM2.5 predictions can aid local authorities in air-quality management and public-health surveillance, and they can advance epidemiological research in Central Mexico with state-of-the-art exposure assessment methods.

Effect of Mixed Particulate Emulsifiers on Spray-Dried Avocado Oil-in-Water Pickering Emulsions.

Avocado oil is a very valuable agro-industrial product which can be perishable in a short time if it is not stored in the right conditions. The encapsulation of the oils through the spray drying technique protects them from oxidation and facilitates their incorporation into different pharmaceutical products and food matrices; however, the selection of environmentally friendly emulsifiers is a great challenge. Four formulations of the following solid particles: Gum Arabic, HI-CAP®100 starch, and phosphorylated waxy maize starch, were selected to prepare avocado oil Pickering emulsions. Two of the formulations have the same composition, but one of them was emulsified by rotor-stator homogenization. The rest of the emulsions were emulsified by combining rotor-stator plus ultrasound methods. The protective effect of mixed particle emulsifiers in avocado oil encapsulated by spray drying was based on the efficiency of encapsulation. The best results were achieved when avocado oil was emulsified with a mixture of phosphorylated starch/HI-CAP®100, where it presented the highest encapsulation efficiency.

45,X/46,XY Mosaicism with Male Phenotype: Case Report.

Mixed gonadal dysgenesis is the most common chromosomal abnormality with ambiguous genitalia, defined as a 45,X/46,XY mosaicism. It can present with a normal male phenotype, ambiguous genitalia, or features of Turner syndrome. A 14-year-old patient was referred to the genetics clinic due to hypospadia, cryptorchidism, and aortic coarctation. During the physical examination, short stature, webbed neck, and Blashko lines on his back were noted. He had a previous karyotype reported as normal. However, due to an inadequate evolution and a low resolution on the previous test, a higher resolution karyotype was performed, identifying a mosaicism 45,X/46,XY. A multidisciplinary board examined the case, and follow-up with tumor markers was carried out to evaluate the presence of gonadoblastoma, one of the main complications in these patients. Treatment should be transdisciplinary and focused on the particular characteristics of each case. Other treatment alternatives include corrective surgery and hormonal therapy.

Improved Recovery Protocols in Cardiac Surgery: A Systematic Review and Meta-Analysis of Observational and Quasi-Experimental Studies.

INTRODUCTION: Improved recovery protocols were implemented in surgical specialties over the last decade, which decreased anesthetic and surgical stress and the incidence of perioperative complications. However, these recovery protocols were introduced more slowly for cardiac surgeries. The most frequent complications in cardiac surgery are related to patient clinical status and the characteristics of the surgical procedures involved, which are becoming more varied and complex every day. The first version of the enhanced recovery program for cardiac surgery was published in 2019, but its recommendations were based on only a few studies, and scant research has evaluated its implementation. Randomized and controlled clinical trials for these protocols are scarce, so research that summarizes the results of studies with other methodological designs are useful in demonstrating their benefits in cardiovascular surgery services in Cuba and in other limited-resource settings. OBJECTIVE: Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery. METHODS: We performed a systematic review and meta-analysis according to the guidelines of manual 5.1.0 for reviews of the Cochrane library. We included observational and quasi-experimental studies published from January 2015 through May 2020 that compared enhanced recovery protocols with conventional treatments in patients older than 18 years, and used a quality score to evaluate them. We used the following sources: the Cochrane Library, PubMed, LILACS, SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate and HINARI. The following keywords were used for the database searches in English: ERAS, protocols and cardiac surgery, enhanced recovery after cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery, perioperative care and cardiac surgery. We used the following search terms for databases in Spanish: protocolos de recuperación precoz and cirugía cardiaca, protocolos de recuperación mejorada and cirugía cardiaca, cuidados perioperatorios and cirugía cardiaca, programas de recuperación precoz and cirugía cardiovascular. Methodological quality of included investigations was evaluated using the surgical research methodology scale. Meta-analyses were performed for perioperative complications, intensive care unit and hospital stays, and hospital readmission within 30 days of surgery. We calculated effect sizes of the interventions and the corresponding 95% confidence intervals. We used mean differences and confidence intervals for continuous variables, and for qualitative variables we calculated relative risk (RR). Random effects analysis was used. Heterogeneity of the studies was assessed using the Q statistic and the I2 statistic. RESULTS: We selected 15 studies (a total of 5059 patients: study group, n = 1706; control group, n = 3353). The average quality score for the 15 articles included was 18.9 (out of a maximum of 36 according to the scale) and 66.6% had a score =18. With improved recovery protocols in cardiac surgery, the incidence of perioperative complications decreased (RR = 0.73; 95% CI 0.52-0.98) as did hospital readmission within 30 days after surgery (RR = 0.51; 95% CI 95% CI: 0.31-0.86). Differences in extubation time, hospital stay and length of stay in intensive care units were less marked, but always favored the group in which the enhanced protocols were implemented. CONCLUSIONS: Improved recovery protocols in cardiac surgery increase quality of care evidenced by reductions in perioperative complications and decreased incidence of hospital readmission in the month following surgery.

Impacto de la anestesia intravenosa en cirugía robótica para paciente de alto riesgo sometido a cirugía oncológica de larga duración en el Centro Médico Naval / Impact of intravenous anesthesia in robotic surgery for high-risk patient undergoing long-term oncologic surgery at the Naval Medical Center

Resumen: La práctica de cirugía robótica es un proceso complejo que implica desarrollo y tecnología no sólo en el campo de la cirugía, sino también en el campo de la anestesiología. Implica un proceso multifactorial, ya que ha generado un cambio drástico multidisciplinario basado en tecnología de punta que pretende ofrecer mejores condiciones durante el manejo perioperatorio en cirugía robótica. La anestesia total intravenosa cumple objetivos específicos en relación a la posición del paciente, relajación cerebral, neuroprotección, hemodinamia, pérdida y recuperación de la conciencia, parálisis neuromuscular, parámetros ventilatorios, etc. Ofrece seguridad y calidad al paciente durante el procedimiento con una mínima interferencia con el monitoreo electrofisiológico y permite modular la profundidad anestésica desde una neurosedación hasta una anestesia general, de acuerdo a las diferentes etapas de la cirugía. Un factor atribuible a la anestesia moderna para el éxito de la cirugía robótica es usar diferentes agentes anestésicos que promuevan inducción, mantenimiento y emersión anestésica más rápida y suave, a fin de reducir el tiempo de recuperación del estado de conciencia, funciones básicas y psicomotoras como la anestesia general multimodal.

Abstract: The practice of robotic surgery is a complex process, involving development and technology; not only in the surgery field but also in the anesthesiology field. It implies a multifactorial process since it has generated a drastic multidisciplinary change based on state-of-the-art technology; which aims to offer better conditions during perioperative management in robotic surgery. Intravenous Total Anesthesia accomplishes specific objectives in relation to patient position, brain relaxation, neuroprotection, hemodynamics, loss and recovery of consciousness, neuromuscular paralysis, ventilatory parameters, providing safety and quality during the procedure; with minimal intervention during electrophysiological monitoring and enabling anesthetic depth to be modulated from neurosedation to general anesthesia, according to the different stages of the surgery. A factor attributable to modern anesthesia for robotic surgery success is to employ different anesthetic agents promoting induction, maintenance of general anesthesia, smother and faster anesthetic emersion, for the purpose of reducing recovery time of the state of consciousness), basic and psychomotor functions; as is the general multimodal anesthesia.

Wegener's granulomatosis and differential diagnosis of mucosal leishmaniasis.

Granulomatosis with polyangiitis with nasal septal perforation can be confused with infectious diseases such as mucosal leishmaniasis, so these cases warrant an in-depth study in order to provide the correct treatment. Among the main characteristics to consider to define a Wegener's granulomatosis as opposed to an infectious disease are vasculitis, lymphadenopathy, and sinusopathy.

Características metodológicas en el estudio del compromiso hacia la práctica de actividad física y ejercicio en población general: una revisión sistemática / Methodological characteristics of studying commitment to the practice of physical activity and exercise in the general population: a systematic review

Resumen Zapata Lamana, R., Fuentes Figueroa, V., Reyes Molina, D., Geisse Zárate, A. E. y Cigarroa, I. (2021). Características metodológicas en el estudio del compromiso hacia la práctica de actividad física y ejercicio en población general: una revisión sistemática. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-23. Aunque la literatura sobre el compromiso deportivo en población deportista es extensa, se requiere profundizar sobre el compromiso hacia la práctica de actividad y ejercicio físicos en la población general. El objetivo del estudio fue sintetizar las características metodológicas de los artículos que han estudiado el compromiso hacia la práctica de actividad y ejercicio físicos en la población general. Se desarrolló una revisión sistemática siguiendo la declaración PRISMA. Se realizaron búsquedas electrónicas en las bases de datos PsycINFO y Medline desde 2009 al 2019. Un total de 14 artículos fueron elegidos, principalmente con diseños transversales. La población más estudiada fue de estudiantes universitarias mujeres, sin condición clínica. Todos los instrumentos utilizados para evaluar el compromiso hacia la actividad física y ejercicio estaban escritos en inglés, en su mayoría aplicados en Estados Unidos. Utilizaban una escala Likert con alta fiabilidad. Las principales variables asociadas a la evaluación del compromiso fueron la edad, género, origen étnico, nivel educativo y económico, nivel de actividad física, comportamiento, patologías alimentarias e índice de masa corporal y variables sociocognitivas, como autoeficacia, apoyo social, barreras y beneficios percibidos para la realización de la actividad física. Esta revisión entrega un perfil de la población en quien se evalúa el compromiso hacia la actividad física y ejercicio, los instrumentos utilizados y variables asociadas, lo que actualiza el conocimiento existente sobre el compromiso hacia la actividad física y ejercicio en la población general.

Abstract Zapata Lamana, R., Fuentes Figueroa, V., Reyes Molina, D., Geisse Zárate, A. E. & Cigarroa, I. (2021). Methodological characteristics of studying commitment to the practice of physical activity and exercise in the general population: a systematic review. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-23. Although the literature on sports commitment within the sports population is extensive, in-depth studies of the commitment to the practice of physical activity and exercise in the general population are needed. The aim of this paper was to synthesize the methodological characteristics of articles that have studied the commitment to the practice of physical activity and exercise in the general population. A systematic review was developed following the PRISMA statement. Furthermore, electronic searches were conducted in the PsycINFO and Medline databases from 2009 to 2019. A total of 14 articles was selected, mainly with cross-sectional designs. The most studied population included female university students with no clinical condition. All instruments used to assess commitment to physical activity and exercise were written in English, mostly applied in the United States, and used a Likert scale with high reliability. The main variables associated with the evaluation of commitment were age, gender, ethnic origin, educational and economic level, level of physical activity, behavior, eating disorders, and body mass index, as well as sociocognitive variables such as self-efficacy, social support, and perceived barriers and benefits of physical activity. This review provides a profile of the population in which the commitment to physical activity and exercise is evaluated, the instruments used, and associated variables, which updates the existing knowledge about the commitment to physical activity and exercise in the general population.

Resumo Zapata Lamana, R., Fuentes Figueroa, V., Reyes Molina, D., Geisse Zárate, A. E. e Cigarroa, I. (2021). Características metodológicas no estudo do comprometimento com relação à prática de atividade física e exercício na população em geral: uma revisão sistemática. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-23. Embora a literatura sobre o comprometimento esportivo na população esportista seja extensa, é preciso uma perscrutação sobre o comprometimento na prática de atividade e exercício físicos na população em geral. O estudo teve como objetivo sintetizar as características metodológicas dos artigos que estudaram o comprometimento na prática de atividade e exercício físicos na população em geral. Foi desenvolvida uma revisão sistemática seguindo a declaração PRISMA. Foram realizadas buscas eletrônicas nas bases de dados PsycINFO e Medline de 2009 a 2019. Um total de 14 artigos foram eleitos, principalmente com desenhos transversais. A população mais estudada foi a de estudantes universitárias mulheres, sem condição clínica. Todos os instrumentos utilizados para avaliar o comprometimento com relação à atividade física e ao exercício estavam escritos em inglês, em sua maioria aplicados nos Estados Unidos. Utilizavam uma escala Likert de alta fiabilidade. As principais variáveis associadas à avaliação do comprometimento foram a idade, o gênero, a origem étnica, o nível educativo e económico, o nível de atividade física, o comportamento, as patologias alimentarias e o índice de massa corporal e variáveis sociocognitivas, como autoeficácia, apoio social, barreiras e benefícios percebidos para a realização da atividade física. Esta revisão mostra um perfil da população na qual se avalia o comprometimento com relação à atividade física e ao exercício, os instrumentos utilizados e as variáveis associadas, o que atualiza o conhecimento existente sobre o comprometimento com relação à atividade física e ao exercício na população em geral.

Mobile Clustering Scheme for Pedestrian Contact Tracing: The COVID-19 Case Study.

In the context of smart cities, there is a general benefit from monitoring close encounters among pedestrians. For instance, for the access control to office buildings, subway, commercial malls, etc., where a high amount of users may be present simultaneously, and keeping a strict record on each individual may be challenging. GPS tracking may not be available in many indoor cases; video surveillance may require expensive deployment (mainly due to the high-quality cameras and face recognition algorithms) and can be restrictive in case of low budget applications; RFID systems can be cumbersome and limited in the detection range. This information can later be used in many different scenarios. For instance, in case of earthquakes, fires, and accidents in general, the administration of the buildings can have a clear record of the people inside for victim searching activities. However, in the pandemic derived from the COVID-19 outbreak, a tracking that allows detecting of pedestrians in close range (a few meters) can be particularly useful to control the virus propagation. Hence, we propose a mobile clustering scheme where only a selected number of pedestrians (Cluster Heads) collect the information of the people around them (Cluster Members) in their trajectory inside the area of interest. Hence, a small number of transmissions are made to a control post, effectively limiting the collision probability and increasing the successful registration of people in close contact. Our proposal shows an increased success packet transmission probability and a reduced collision and idle slot probability, effectively improving the performance of the system compared to the case of direct transmissions from each node.

Familismo, Lesbophobia, and Religious Beliefs in the Life Course Narratives of Chilean Lesbian Mothers.

This study aimed to explore the life course identity projects of Chilean lesbian mothers who conceived their children within the context of a previous heterosexual relationship. By exploring the case of Chile, this study examined the family lives of lesbian mothers within the context of a Latino heteronormative society with a Christian (mainly Catholic) heritage. Individual interviews were conducted with eight participants aged between 27 and 40 years old (mean age of 33 years) who were recruited through snowballing and social media. A Structural Narrative Analysis of participants' stories was conducted within a Life Course Perspective theoretical framework. The study found that participants initially followed a heterosexual path to conform to their family of origin and social expectations. After building their own heterosexual family projects and having their children with a man, most participants felt pressured to continue within a heterosexual path and postponed their transition to a lesbian identity trajectory despite a growing feeling that a lesbian identity would be personally fullfilling. Although participants felt proud of their identities, they struggled to express their same-gender feelings because lesbians were often seen as inappropriate models for children within Chilean society. Crucially, lesbian mothers continued to be able to count upon support for their parenting from their own mother despite intense disapproval from their family of origin and often continued opposition from ex-husbands/partners. The findings of this study revealed the strong impact of familismo, lesbophobia and Christian religious beliefs on the life course experiences of Chilean lesbian mothers. Implications for therapy and counselling with lesbian mothers living in Latino countries are reviewed.

Effect of the Degree of Substitution on the Hydrophobicity, Crystallinity, and Thermal Properties of Lauroylated Amaranth Starch.

In this paper, we consider amaranth starch extracted from the seeds of Amaranthus hypochondriacus L. An amphiphilic character is conferred to the starch by a chemical modification, which involves an esterification by lauroyl chloride at three modification levels. The degree of substitution (DS) after the modification ranged from 0.06 to 1.16. X-ray photoelectron spectroscopy analysis confirmed the presence of fatty acyl chains on the surface of the esterified starches. The hydrophobicity of starches was confirmed by their adsorption isotherms, which showed a decrease in the moisture adsorption of lauroylated as DS increased. X-ray diffraction analysis revealed a higher crystallinity, which was observed in the two samples subjected to the highest levels of modification. A higher crystallinity is related to a higher gelatinization enthalpy. These results are in agreement with the thermal characterization obtained by differential scanning calorimetry (DSC). An inhibition of the retrogradation properties of lauroylated amaranth starches was also observed.

Urban airborne particle exposure impairs human lung and blood Mycobacterium tuberculosis immunity.

RATIONALE: Associations between urban (outdoor) airborne particulate matter (PM) exposure and TB and potential biological mechanisms are poorly explored. OBJECTIVES: To examine whether in vivo exposure to urban outdoor PM in Mexico City and in vitro exposure to urban outdoor PM2.5 (< 2.5 µm median aerodynamic diameter) alters human host immune cell responses to Mycobacterium tuberculosis. METHODS: Cellular toxicity (flow cytometry, proliferation assay (MTS assay)), M. tuberculosis and PM2.5 phagocytosis (microscopy), cytokine-producing cells (Enzyme-linked immune absorbent spot (ELISPOT)), and signalling pathway markers (western blot) were examined in bronchoalveolar cells (BAC) and peripheral blood mononuclear cells (PBMC) from healthy, non-smoking, residents of Mexico City (n=35; 13 female, 22 male). In vivo-acquired PM burden in alveolar macrophages (AM) was measured by digital image analysis. MEASUREMENTS AND MAIN RESULTS: In vitro exposure of AM to PM2.5 did not affect M. tuberculosis phagocytosis. High in vivo-acquired AM PM burden reduced constitutive, M. tuberculosis and PM-induced interleukin-1ß production in freshly isolated BAC but not in autologous PBMC while it reduced constitutive production of tumour necrosis factor-alpha in both BAC and PBMC. Further, PM burden was positively correlated with constitutive, PM, M. tuberculosis and purified protein derivative (PPD)-induced interferon gamma (IFN-γ) in BAC, and negatively correlated with PPD-induced IFN-γ in PBMC. CONCLUSIONS: Inhalation exposure to urban air pollution PM impairs important components of the protective human lung and systemic immune response against M. tuberculosis. PM load in AM is correlated with altered M. tuberculosis-induced cytokine production in the lung and systemic compartments. Chronic PM exposure with high constitutive expression of proinflammatory cytokines results in relative cellular unresponsiveness.

Preparation and characterization of octenyl succinylated normal and waxy starches of maize as encapsulating agents for anthocyanins by spray-drying.

The encapsulation by spray drying of maize anthocyanins was evaluated using two types of wall materials, consisting of normal and waxy maize starch, which were esterified with octenyl succinic anhydride. The X-ray diffraction analysis revealed that SWMS possessed a completely amorphous, while SNMS had a crystalline structure. SNMS showed peaks at 2θ = 13.1°, 19.8° and 22.4°. The results revealed that SNMS and SWMS had almost the same encapsulation productivity (EP); SNMS showed the best performance because its EP was higher (95%) than in SWMS (90%). The stability of microcapsules produced with SNMS showed the highest anthocyanin retention after storage in the water activity (aw) range of 0.11-0.94 at 40 °C.

Experiencia quirúrgica en el manejo de litiasis urinaria en la población pediátrica: estudio multicéntrico / Surgical Experience in Management of Urinary Lithiasis in Pediatric Population: Multicentric Study

La incidencia de la enfermedad litiásica ha aumentado globalmente en los últimos 25 años. A pesar de que la incidencia de litiasis es baja en la población pediátrica,1 ese aumento no ha sido ajeno a esa población. Se ha visto un incremento importante en su incidencia y prevalencia en los últimos años, alcanzado en países como Estados Unidos de 18,5 por cada 100.000 habitantes.2 La edad de presentación se encuentra entre los 7 y los 8 años de edad.

The incidence of lithium disease has increased globally over the past 25 years. Although the incidence of lithiasis is low in the paediatric population,1 this increase has not been alien to the paediatric population. There has been a significant increase in its incidence and prevalence in recent years, reached in countries such as the United States of 18.5 per 100,000 inhabitants.2 The age of presentation is between 7 and 8 years of age

Intraoperative management and early postoperative outcomes of pediatric renal transplants.

INTRODUCTION: Smaller children are presenting for renal transplantation as the treatment of choice for end-stage renal disease. Adult donor organs are more successful than pediatric deceased donor organs. An adult kidney may sequester ~75% of the circulating volume of a 5 year-old child and requires significantly increased cardiac output to maintain renal perfusion. Treatment includes volume, inotropic or vasopressor agents, or central neuroaxial blockade for sympatholysis. We describe the perioperative anesthestic management as a guide to clinical outcomes. METHODS: A retrospective chart review of renal transplant patients between 2006 and 2014 was performed. We recorded patient demographics, surgical and anesthetic factors and postoperative outcome. RESULTS: One hundred and fifty-six children underwent renal transplantation, of which 38% were from living donors. There were 99/156 (63.5%) males. Median age was 10 years (range 1-17 years) and the mean weight was 36.2 kg (sd 20.6 kg; range 7.6-109.6 kg). There were 36 children ≤5 years of age and 14 children ≤2 years of age. One hundred and nineteen (77%) were dialysis dependent. Pharmacological support to increase renal perfusion included mannitol in 95%, and dopamine in 83%. Furosemide was used in 82% of cases. Inotropic therapy continued into the postoperative period in 34%. Radiological pulmonary edema was diagnosed in 33% and clinical pulmonary edema in 7%. Intraoperative use of dopamine delayed the time to creatinine nadir in all grafts (9.5 days vs 6.5 days, P = 0.04) and in deceased donor grafts (12.9 vs 7.4 days, P = 0.007). Patients who received dopamine had no significant difference in central venous pressure (CVP) preclamp removal, 14 mmHg vs 11.5 mmHg (P = 0.12) but a higher CVP after clamp removal, 14.3 mmHg vs 11.8 mmHg (P = 0.003). CONCLUSION: Dopamine use was common and was an independent risk factor for delayed time to creatinine nadir. Many different agents were used to enhance renal perfusion. The 'supra-physiological' hemodynamics resulted in pulmonary edema in 33% of patients.

A New Grading System for the Management of Antenatal Hydronephrosis.

BACKGROUND AND OBJECTIVES: Standard clinical assessments do not predict surgical intervention in patients with a moderate degree of upper tract hydronephrosis. This study investigated whether combined measures of renal calyceal dilation and anteroposterior diameter (APD) of the renal pelvis at the first postnatal ultrasound better predict surgical intervention beyond standard assessments of the APD or Society of Fetal Urology (SFU) grading system. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective cohort of 348 children with antenatal hydronephrosis followed from 2003 to 2013 were studied. Using Cox regression, the risk for surgery by APD, SFU, and combined grading on the basis of the first postnatal ultrasound was calculated. The predictive capability of each grading system for surgery was determined by calculating the positive likelihood ratio (LR+). RESULTS: The combination of APD≥6-9 mm and diffuse caliectasis had a hazard ratio (HR) of 19.5 (95% confidence interval [95% CI], 3.94 to 96.9) versus 0.59 (95% CI, 0.05 to 6.53) for APD≥6-9 mm alone and a similar risk of 8.9 for SFU grade 3 (95% CI, 3.84 to 20.9). The combination of APD≥9-15 mm and diffuse caliectasis had an HR of 18.7 (95% CI, 4.36 to 80.4) versus 1.75 (95% CI, 0.29 to 10.5) for APD≥9-15 mm alone. The LR+ for surgery for diffuse caliectasis and APD≥6-9 mm was higher than for APD≥6-9 mm alone (HR=2.62; 95% CI, 0.87 to 7.94 versus HR=0.04; 95% CI, 0.01 to 0.32) and was higher for APD≥9-15 mm and diffuse caliectasis than APD≥9-15 mm alone (HR=2.0; 95% CI, 1.15 to 3.45 versus HR=0.14; 95% CI, 0.04 to 0.43). Both combined groups of moderate hydronephrosis (APD≥6-9 mm or ≥9-15 mm with diffuse caliectasis) had only slightly higher LR+ than SFU grade 3 (HR=1.89; 95% CI, 1.17 to 3.05). CONCLUSIONS: These results suggest a grading system combining APD and diffuse caliectasis distinguishes those children with moderate degrees of upper tract hydronephrosis that are at higher risk of surgery.

Utility and cost-effectiveness of uroflowmetry in a busy pediatric urology practice.

INTRODUCTION: Uroflowmetry (UF) is frequently employed in daily pediatric urology practice for diagnostic and follow-up purposes. We assess the utility and cost-effectiveness of UF in the management of patients seen at a tertiary care centre. METHODS: We retrospectively reviewed the charts of consecutive patients who had a UF between January 1, 2010 and March 31, 2010. We collected data on demographics, diagnosis, UF parameters and the impact of the UF on management. The impact on management was defined as indication for surgery, introduction of new medications and bladder retraining based on clinical and UF findings. RESULTS: In total, 524 patients were included in the study. In 63 (12%) patients, UF was performed as part of the evaluation at the first clinic appointment. The most common diagnoses were voiding dysfunction (VD) 41%, hypospadias 26%, vesicoureteric reflux (VUR) 16%, monosymptomatic nocturnal enuresis (NE) 8%, posterior urethral valves 5% and meatal stenosis (MS) 4%. In the VD group, UF contributed to a management decision in 25.2% of patients. In the MS group, surgical intervention was based on symptoms and supported by the UF in 41% of patients; in the PUV group, 50% of patients demonstrated high (>20 cc) post-void residual, which aided in management decisions. In contrast, there were virtually no changes in management supported by the UF in the NE, VUR and hypospadias groups. Overall, UF parameters had a direct influence in the management decisions in only 67 (12.8%) patients. Nonetheless, a repeat test was ordered for 44.5% of patients. CONCLUSIONS: In an era of financial restraints and in a busy tertiary pediatric urology practice, judicious use of UF for specific indications may translate into a more cost-effective use of time and resources. As expected, patients with VD were the ones that benefited most from the test, as did patients with symptomatic MS and PUV.