Feasibility and Safety of Percutaneous Kidney Biopsy in Small Kidneys: Breaking the Paradigm.

INTRODUCTION: The percutaneous kidney biopsy (PKB) is an essential tool in nephrology; small kidney size has been a relative contraindication to PKB and there is limited data on the safety and utility of performing PKB in this setting. Our aim was to describe the complications of PKB in small kidneys and to assess if kidney biopsy results have an impact on medical decisions and outcomes. METHODS: This was a retrospective, descriptive, and observational study. Patients older than 16 years of age with a decreased kidney size (≤8 cm) and undergoing PKB of native kidneys from July 2019 to December 2022 were included. RESULTS: Twenty-five patients were included, 19 women and 6 men. The mean age was 42.3 ± 18.04. The mean kidney length was 7.56 ± 0.33 and the mean width was 4.2 cm. All patients received only 1 puncture, obtaining an average of 12 glomeruli. The mean blood urea nitrogen and serum creatinine were 36 mg/dL and 1.94 mg/dL, respectively and the mean Hgb (hemoglobin) was 12.87 ± 2.81 g/dL. Minor complications occurred in 5 patients, perirenal hematoma in 3 patients, hematuria in 1 patient, and hematoma plus hematuria in 1 patient. Histological examination showed FSGS, lupus nephritis, other Glomerular disease, crescentic glomerulonephritis, and tubulointerstitial nephritis in 36%, 20%, 16%, 16%, and 12% of the cases, respectively. Biopsy resulted in management modification in 64% of cases. In a bivariate analysis, kidney size was not associated with higher complication rates. CONCLUSIONS: PKB in small kidneys is a feasible and safe procedure when properly planned, providing an adequate sample in all cases, with an insignificant number of minor complications, and that is clinically relevant.

Introduction to the Special Issue of Plants on "Advances in Plant Reproductive Ecology and Conservation Biology".

Plant reproductive ecology explores aspects of the biology and ecology of plants ranging from breeding systems, plant-pollinator interactions, seed germination, floral traits, and much more [...].

Hepatocyte nuclear factor 4α mediated quinolinate phosphoribosylltransferase (QPRT) expression in the kidney facilitates resilience against acute kidney injury.

Nicotinamide adenine dinucleotide (NAD+) levels decline in experimental models of acute kidney injury (AKI). Attenuated enzymatic conversion of tryptophan to NAD+ in tubular epithelium may contribute to adverse cellular and physiological outcomes. Mechanisms underlying defense of tryptophan-dependent NAD+ production are incompletely understood. Here we show that regulation of a bottleneck enzyme in this pathway, quinolinate phosphoribosyltransferase (QPRT) may contribute to kidney resilience. Expression of QPRT declined in two unrelated models of AKI. Haploinsufficient mice developed worse outcomes compared to littermate controls whereas novel, conditional gain-of-function mice were protected from injury. Applying these findings, we then identified hepatocyte nuclear factor 4 alpha (HNF4α) as a candidate transcription factor regulating QPRT expression downstream of the mitochondrial biogenesis regulator and NAD+ biosynthesis inducer PPARgamma coactivator-1-alpha (PGC1α). This was verified by chromatin immunoprecipitation. A PGC1α - HNF4α -QPRT axis controlled NAD+ levels across cellular compartments and modulated cellular ATP. These results propose that tryptophan-dependent NAD+ biosynthesis via QPRT and induced by HNF4α may be a critical determinant of kidney resilience to noxious stressors.

Career Advancement Among Women Physicians in Nine Academic Medicine Specialties.

Objective: Gender parity lags in academic medicine. We applied the Rank Equity Index (REI) to compare the longitudinal progress of women's academic medicine careers. We hypothesized that women have different rank parity in promotion by specialty based on the proportion of women in the specialty. Materials and Methods: Aggregate data by sex for medical students, residents, assistant professors, associate professors, and professors in nine specialties were obtained from the Association of American Medical Colleges for 2019-2020. Specialties were clustered into terciles based on the proportion of women in the field: upper (obstetrics and gynecology, pediatrics, psychiatry), middle (internal medicine, emergency medicine, anesthesia), and lower (surgery, urology, and orthopedic surgery). We calculated the percentage representation by sex by specialty and rank to calculate REI. Specialty-specific REI comparisons between each rank were performed to assess parity in advancement. Results: Only specialties in the upper tercile recruited proportionally more women medical students to residency training. All specialties advanced women for the resident-to-assistant professor with psychiatry, internal medicine, emergency medicine, anesthesia, urology, and orthopedic surgery that promoted women faculty at rates above parity. No specialty demonstrated parity in advancement based on sex for the assistant professor-to-associate professor or associate professor-to-professor transitions. Conclusion: Gender inequity in advancement is evident in academic medicine starting at the assistant professor-to-associate professor stage, regardless of overall proportion of women in the specialty. This suggests a common set of barriers to career advancement of women faculty in academic medicine that must be addressed starting at the early career stage.

Normal development of the heart: a review of new findings.

Development and formation of the heart, the central organ of the circulatory system in vertebrates, starts early during embryonic development (second week), reaching maturity during the first few postnatal months. Cardiogenesis is a highly complex process that requires the active and orderly participation of different cardiac and non-cardiac cell populations. Thus, this process is sensitive to errors that may trigger a variety of heart-development defects, called congenital heart defects, which have a worldwide incidence of 8-10/1000 live births. A good understanding of normal cardiogenesis is required for better diagnosis and treatment of congenital heart diseases. This article reviews normal cardiogenesis by comparing information from classic studies with more recent findings. Information from descriptive anatomical studies of histological sections and selective in vivo marking of chicken embryos were emphasized. In addition, the discovery of heart fields has fueled the investigation of cardiogenic events that were believed to be understood and has contributed to proposals for new models of heart development.

El corazón, órgano central del aparato circulatorio de los vertebrados, comienza a formarse muy temprano en el desarrollo embrionario (segunda semana de gestación) y alcanza su forma madura durante los primeros meses posteriores al nacimiento. La cardiogénesis se caracteriza por ser un proceso altamente complejo, dependiente de la participación activa y ordenada de diferentes poblaciones celulares cardiacas y no cardiacas. Lo anterior hace que este proceso sea sensible a errores que pueden desencadenar una variedad de defectos del desarrollo cardiaco, llamados cardiopatías congénitas, con una incidencia mundial de 8 a 10/1000 nacidos vivos. Para mejorar el diagnóstico y el tratamiento de las cardiopatías congénitas es necesario comprender adecuadamente los eventos implicados en la cardiogénesis normal. En este artículo se revisa el desarrollo cardiaco normal, contrastando la información de los estudios clásicos con la de hallazgos recientes. Se hace hincapié en la información obtenida de los estudios de anatomía descriptiva de cortes histológicos y marcaje selectivo in vivo en embriones de pollo. Adicionalmente, el descubrimiento de los campos cardiogénicos ha estimulado la investigación de eventos cardiogénicos que se creían comprendidos, contribuyendo con propuestas de nuevos modelos del desarrollo del corazón.

Assessing the Reproductive Ecology of a Rare Mint, Macbridea alba, an Endangered Species Act Protected Species.

Many rare plant species lack up-to-date research about their reproductive ecology, which challenges effective in situ and ex situ conservation, particularly in the face of ongoing environmental and anthropogenic changes. For protected species, outdated and incomplete information also creates barriers to successful recovery planning and delisting. In this study, we gathered a range of reproductive metrics for the federally threatened and state endangered Florida endemic mint, Macbridea alba Chapman (Lamiaceae). We collected data at seven populations within Apalachicola National Forest (Florida, USA) and conducted germination trials to estimate reproductive potential. Additionally, we observed a previously undocumented lepidopteran seed predator for the species and confirmed the occurrence of vivipary. The seed set was low with less than 20% of flowers per inflorescence producing seed across populations; however, germination was high with more than 60% of seeds germinating in five of seven populations. When comparing our results to previous research conducted more than 20 years ago, the results were similar overall (i.e., germination, vivipary); however, new information emerged (i.e., herbivore pressure). As M. alba undergoes reassessment as a potential candidate for delisting from the Endangered Species Act (ESA) list, this information is critical for assessing recovery goals and decisions regarding the species' protected status. For recovery needs related to propagation and reintroduction, these results can inform future seed collection and propagation efforts for the species.

Normal development of the heart: a review of new findings / Desarrollo normal del corazón: revisión de nuevos hallazgos

Abstract Development and formation of the heart, the central organ of the circulatory system in vertebrates, starts early during embryonic development (second week), reaching maturity during the first few postnatal months. Cardiogenesis is a highly complex process that requires the active and orderly participation of different cardiac and non-cardiac cell populations. Thus, this process is sensitive to errors that may trigger a variety of heart-development defects, called congenital heart defects, which have a worldwide incidence of 8-10/1000 live births. A good understanding of normal cardiogenesis is required for better diagnosis and treatment of congenital heart diseases. This article reviews normal cardiogenesis by comparing information from classic studies with more recent findings. Information from descriptive anatomical studies of histological sections and selective in vivo marking of chicken embryos were emphasized. In addition, the discovery of heart fields has fueled the investigation of cardiogenic events that were believed to be understood and has contributed to proposals for new models of heart development.

Resumen El corazón, órgano central del aparato circulatorio de los vertebrados, comienza a formarse muy temprano en el desarrollo embrionario (segunda semana de gestación) y alcanza su forma madura durante los primeros meses posteriores al nacimiento. La cardiogénesis se caracteriza por ser un proceso altamente complejo, dependiente de la participación activa y ordenada de diferentes poblaciones celulares cardiacas y no cardiacas. Lo anterior hace que este proceso sea sensible a errores que pueden desencadenar una variedad de defectos del desarrollo cardiaco, llamados cardiopatías congénitas, con una incidencia mundial de 8 a 10/1000 nacidos vivos. Para mejorar el diagnóstico y el tratamiento de las cardiopatías congénitas es necesario comprender adecuadamente los eventos implicados en la cardiogénesis normal. En este artículo se revisa el desarrollo cardiaco normal, contrastando la información de los estudios clásicos con la de hallazgos recientes. Se hace hincapié en la información obtenida de los estudios de anatomía descriptiva de cortes histológicos y marcaje selectivo in vivo en embriones de pollo. Adicionalmente, el descubrimiento de los campos cardiogénicos ha estimulado la investigación de eventos cardiogénicos que se creían comprendidos, contribuyendo con propuestas de nuevos modelos del desarrollo del corazón.

Extensive regional variation in the phenology of insects and their response to temperature across North America.

Climate change models often assume similar responses to temperatures across the range of a species, but local adaptation or phenotypic plasticity can lead plants and animals to respond differently to temperature in different parts of their range. To date, there have been few tests of this assumption at the scale of continents, so it is unclear if this is a large-scale problem. Here, we examined the assumption that insect taxa show similar responses to temperature at 96 sites in grassy habitats across North America. We sampled insects with Malaise traps during 2019-2021 (N = 1041 samples) and examined the biomass of insects in relation to temperature and time of season. Our samples mostly contained Diptera (33%), Lepidoptera (19%), Hymenoptera (18%), and Coleoptera (10%). We found strong regional differences in the phenology of insects and their response to temperature, even within the same taxonomic group, habitat type, and time of season. For example, the biomass of nematoceran flies increased across the season in the central part of the continent, but it only showed a small increase in the Northeast and a seasonal decline in the Southeast and West. At a smaller scale, insect biomass at different traps operating on the same days was correlated up to ~75 km apart. Large-scale geographic and phenological variation in insect biomass and abundance has not been studied well, and it is a major source of controversy in previous analyses of insect declines that have aggregated studies from different locations and time periods. Our study illustrates that large-scale predictions about changes in insect populations, and their causes, will need to incorporate regional and taxonomic differences in the response to temperature.

Genomic insights of Leclercia adecarboxylata strains linked to an outbreak in public hospitals in Mexico.

BACKGROUND: Leclercia adecarboxylata is a bacteria closely related to Escherichia coli according to its biochemical characteristics and is commonly considered non-pathogenic although a growing number of publications classify it as an emerging pathogen. Fosfomycin resistance is a common trait for L. adecarboxylata encoded by fosALA gene. OBJECTIVE: To analyze genomic traits of sixteen L. adecarboxylata strains isolated from blood culture and a bottle of total parenteral nutrition. METHODS: Twenty-eight L. adecarboxylata strains isolated from blood culture and a bottle of total parenteral nutrition were identified biochemically with a Vitek ® automated system. The strains were phenotyped by their growth on Eosin Methylene Blue agar or MacConkey agar plates. Additionally, Pulsed field gel electrophoresis (PFGE) was performed to establish the clonal relationship. The genomic DNA of sixteen strains was obtained using a Qubit ® dsDNA HS Assay Kit and sequenced on an Illumina ® MiSeq instrument. Draft genomes were assembled using PROKKA and Rast. Assemblies were submitted to Resfinder and PathogenFinder from the Center for Genomic Epidemiology in order to find resistance genes and pathogenic potential. IslandViewer4 was also used to find Pathogenicity and Phage Islands. For identification of the fosA gene, manual curation and Clustal analysis was performed. A novel FosA variant was identified. Finally, phylogenetic analysis was performed using VAMPhyRE software and Mega X. RESULTS: In this paper, we report the genomes of sixteen strains of Leclercia adecarboxylata causing an outbreak associated with parenteral nutrition in public hospitals in Mexico. The genomes were analyzed for genetic determinants of virulence and resistance. A high pathogenic potential (pathogenicity index 0.82) as well as multiple resistance genes including carbapenemics, colistin and efflux pumps were determined. Based on sequence analysis, a new variant of the fosALA gene was described. Finally, the outbreak was confirmed by establishing the clonal relationship among the sixteen genomes obtained. CONCLUSIONS: Commensal strains of L. adecarboxylata may acquire genetic determinants that provide mechanisms of host damage and go unnoticed in clinical diagnosis. L. adecarboxylata can evolve in a variety of ways including the acquisition of resistance and virulence genes representing a therapeutic challenge in patient care.

Environmental DNA as an emerging tool in botanical research.

Over the past quarter century, environmental DNA (eDNA) has been ascendant as a tool to detect, measure, and monitor biodiversity (species and communities), as a means of elucidating biological interaction networks, and as a window into understanding past patterns of biodiversity. However, only recently has the potential of eDNA been realized in the botanical world. Here we synthesize the state of eDNA applications in botanical systems with emphases on aquatic, ancient, contemporary sediment, and airborne systems, and focusing on both single-species approaches and multispecies community metabarcoding. Further, we describe how abiotic and biotic factors, taxonomic resolution, primer choice, spatiotemporal scales, and relative abundance influence the utilization and interpretation of airborne eDNA results. Lastly, we explore several areas and opportunities for further development of eDNA tools for plants, advancing our knowledge and understanding of the efficacy, utility, and cost-effectiveness, and ultimately facilitating increased adoption of eDNA analyses in botanical systems.

Competing Narratives: Examining Obstetricians' Decision-Making Regarding Indications for Cesarean Sections and Abdominal Incisions.

This article examines the decision-making process among obstetric residents in a public maternity hospital in Mexico where the percentage of cesareans and of classical vertical incisions (rather than the more common transverse incision) were both higher than those recommended by the World Health Organization or national standards. Data were collected in 2018 through free list methodology (listing items that fall within a particular cultural domain or category) and semi-structured interviews with senior obstetric residents. Analysis revealed two competing narratives at work that influenced decision-making regarding the use of cesareans and incision type: though participants emphasized the importance of clinical indications, their reported decisions seemed to rely more heavily on subjective and non-clinical factors. Factors such as patient "type" and perceived pressure from patients influenced obstetricians' decisions to perform cesareans. Decisions about performing incision-type seemed based on a combination of clinical factors, surgical abilities, and structural pressures. The data illustrate the nuanced and contradictory elements within medical decision-making ideas and behaviors.

Camera traps are an effective tool for monitoring insect-plant interactions.

Insect and pollinator populations are vitally important to the health of ecosystems, food production, and economic stability, but are declining worldwide. New, cheap, and simple monitoring methods are necessary to inform management actions and should be available to researchers around the world. Here, we evaluate the efficacy of a commercially available, close-focus automated camera trap to monitor insect-plant interactions and insect behavior. We compared two video settings-scheduled and motion-activated-to a traditional human observation method. Our results show that camera traps with scheduled video settings detected more insects overall than humans, but relative performance varied by insect order. Scheduled cameras significantly outperformed motion-activated cameras, detecting more insects of all orders and size classes. We conclude that scheduled camera traps are an effective and relatively inexpensive tool for monitoring interactions between plants and insects of all size classes, and their ease of accessibility and set-up allows for the potential of widespread use. The digital format of video also offers the benefits of recording, sharing, and verifying observations.

Assessment of Bias in Patient Safety Reporting Systems Categorized by Physician Gender, Race and Ethnicity, and Faculty Rank: A Qualitative Study.

Importance: Patient safety reporting systems (PSRSs) are designed to decrease the risk of harm to patients due to medical errors. Owing to the voluntary nature of PSRSs, implicit bias of the reporter may affect the management of safety events reported. Stanford Alert For Events (SAFE) is the PSRS used at Stanford Health Care. Objective: To examine whether variation exists in the content of SAFE reports based on demographic characteristics of physicians who are the subject of the event report. Design, Setting, and Participants: This retrospective qualitative analysis from a single academic medical center evaluated SAFE reports from March 2011 to February 2020. Event reports were coded by theme and categorized by severity (scale of 1 to 3, with 1 being the lowest and 3 the highest). The reports were then analyzed from October 2020 to February 2022 and categorized by physician gender, race and ethnicity, and faculty rank. A total of 501 patient safety events were collected from the adult hospital during the study period, and 100 were excluded owing to incompleteness of information. Main Outcomes and Measures: This qualitative study had no planned outcome. Results: A qualitative analysis was performed on 401 reports representing 187 physicians (138 [73.8%] male and 49 [26.2%] female). In terms of race and ethnicity, 4 physicians (2.1%) were African American, 49 (26.2%) were Asian; 7 (3.7%), Hispanic or Latinx; 108 (57.7%), White; and 19 (10.2%), declined to state. Female physicians had disproportionate representation among reports referencing communication and conversational issues and the lowest severity level. Male physicians had disproportionate representation for ignoring or omitting procedures, process issues, and physical intimidation. African American physicians had disproportionate representation for lack of communication and process issues. Asian physicians had disproportionate representation for lack of communication, process issues, conversational conduct, and the lowest severity level. Latinx physicians had disproportionate representation for conversational conduct. White physicians had disproportionate representation for ignoring or omitting procedures, verbal abuse, physical intimidation, and the highest severity level. Conclusions and Relevance: In this qualitative study, female physicians and physicians who were members of racial and ethnic minority groups were more likely to be reported for low-severity communication issues compared with their male and White counterparts, respectively. These findings suggest that there may be a lower threshold for reporting events when the subject of the report is female and/or a member of a racial or ethnic minority group. Restructuring the reporting and management of patient safety events may be needed to facilitate conflict resolution in a manner that reduces implicit bias and fosters team cohesion.

Qualitatively exploring the impact of a relationship-centered communication skills training program in improving patient perceptions of care.

Objective: To explore qualitative patient experience comments before and after a relationship-centered communication skills training to understand patient experience, program impact, and opportunities for improvement. Methods: Qualitative patient experience evaluation data was captured from January 2016 to December 2018 for 483 health care clinicians who participated in the skills training. A random sampling of available open-ended patient comments (N = 33,223) were selected pre-training (n = 668) and post-training (n = 566). Comments were coded for valence (negative/neutral/positive), generality versus specificity, and based on 12 communication behaviors reflective of training objectives. Results: No significant difference was found in the valence of comments, or generality versus specificity of comments before and after the training. A significant decrease was present in perceived clinician concern. "Confidence in care provider" was the communication skill most frequently identified in comments both pre- and post-training. Conclusion: Perceptions of interactions largely remained the same following training. Key relationship-centered communication skills require further attention in future training efforts. Measurements of patient satisfaction and engagement may not adequately represent patient experience. Innovation: This study identified areas for improvement in the training program and offers a model for utilizing patient experience qualitative data in understanding communication training impact.

A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study.

STUDY OBJECTIVES: Poor sleep impedes children's cognitive, emotional, and psychosocial development. Pediatric sleep dysregulation is common, and children who live in communities of low socioeconomic status experience additional risk factors for short sleep duration and poor sleep quality. School-based training in mindfulness and yoga-informed practices can improve children's behavior and well-being, but effects on objectively measured sleep are unknown. METHODS: Effects of a school-based health and mindfulness curriculum, which taught practices such as paced breathing, on sleep and stress were examined in 115 children (49 girls, ages 8 to 11 at baseline). Fifty-eight children in a community of low socioeconomic status received the curriculum twice weekly for 2 years. Fifty-seven children in a socioeconomic status-matched community engaged in their usual physical education class instead. In-home ambulatory polysomnography and perceived social stress were measured in all children at 3 time points: at baseline (ie, prior to curriculum exposure) and at 2 yearly follow-ups. RESULTS: Children receiving the curriculum gained an average of 74 minutes of total sleep time, and 24 minutes of rapid eye movement sleep, per night over the 2-year study period. Children not receiving the curriculum experienced a decrease in total sleep time averaging 64 minutes per night, with no changes in rapid eye movement sleep. Sleep improved within the first 3 months of curriculum exposure, in a dose-dependent fashion. Higher curriculum engagement (eg, using the breathing exercises outside of class) was associated with larger gains in total and rapid eye movement sleep duration. Aggregate within-group changes in social stress were not significant. However, among children receiving the curriculum, those who experienced larger gains in total and rapid eye movement sleep duration also experienced larger increases in perceived social stress. CONCLUSIONS: A school-based health and mindfulness curriculum improved children's objectively measured sleep over 2 years. Social stress did not mediate these effects; instead, mindfulness training may have increased awareness of environmental stressors, while developing tools to reduce stress vulnerability. CITATION: Chick CF, Singh A, Anker LA, et al. A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study. J Clin Sleep Med. 2022;18(9):2261-2271.

The Long "Race" to Diversity in Otolaryngology.

The number of health disparities disproportionately affecting minority communities continue to rise. Thus, it is imperative to assess whether equity within medical school enrollment and along the academic pipeline has mirrored this growth, especially among elite surgical specialties such as otolaryngology. Census and educational data from 2010 and 2018 were used to assess the current otolaryngology, surgery, and internal medicine physician and faculty workforce diversity across each stage of the academic medicine trajectory by race and ethnicity. We found that disparities exist in medical school enrollment for minority students such that Hispanic/Latinx representation was only 30% and Black representation only 50% of their respective proportions in the US population in 2018. Disparities in achieving full professorship were also observed across all 3 specialties but most prominently in otolaryngology, with 1% Black representation among otolaryngology professors in 2018. A collective strategy toward diversifying the otolaryngology workforce should be explored.

Rank Equity Index: Measuring Parity in the Advancement of Underrepresented Populations in Academic Medicine.

As educators, researchers, clinicians, and administrators, faculty serve pivotal roles in academic medical centers (AMCs). Thus, the quality of faculty members' experiences is inseparable from an AMC's success. In seeking new methods to assess equity in advancement in academic medicine, the authors developed the Rank Equity Index (REI)-adapted from the Executive Parity Index, a scale previously implemented within the business sector-to examine national data on gender and racial/ethnic equity across faculty ranks. The REI was employed on self-reported demographic data, collected by the Association of American Medical Colleges, from U.S. medical school faculty in 2017, to make pairwise rank comparisons of the professoriate by demographic characteristics and department. Overall results indicated that women did not attain parity at any pairwise rank comparison, while men were above parity at all ranks. Similar results were observed across all departments surveyed: women in the basic sciences had REIs closest to parity, women in pediatrics had the highest representation but had REIs that were further from parity than REIs in the basic sciences, and women in surgery demonstrated the lowest REIs. Nationally, REIs were below 1.00 for all racial/ethnic group rank comparisons except for White and, in one case, multiple-race non-Hispanic/Latinx. Across all analyzed departments, Black/African American, Asian, Hispanic/Latinx, and multiple-race Hispanic/Latinx faculty had REIs below parity at all ranks except in 2 cases. In a comparison of 2017 and 2007 data, REIs across both race/ethnicity and gender were lower in 2007 for nearly all groups. REI analyses can highlight inequities in faculty rank that may be masked when using aggregate faculty proportions, which do not account for rank. The REI provides AMCs with a new tool to better analyze institutional data to inform efforts to increase parity across all faculty ranks.

Handcrafted Vacuum-Assisted Device for Skin Ulcers Treatment Versus Traditional Therapy, Randomized Controlled Trial.

BACKGROUND: Chronic lower limb ulcers constitute a public health problem, with important socioeconomic implications and high attention cost. This trial evaluates handcrafted vacuum-assisted therapy versus traditional treatment effectiveness for lower limbs ulcers. MATERIALS AND METHODS: It was a prospective randomized clinical trial conducted over 144 patients with lower limbs ulcers. Patients were randomized into two groups of 72 patients: Experimental group were treated with debridement, cure and a handcrafted vacuum-assisted device that was changed every 72 h. Control group was treated with debridement and cure with soap every 24 h. Ulcers were evaluated every 72 h and on 10th day. The presence of systemic inflammatory response, pain, granulation tissue and viability for discharge was registered and analyzed . RESULTS: After exclusion of 18 patients, 126 were included, 65.1% were men with an average of 58 years. Sole region ulcer by diabetic foot was the more frequent in both groups (73%). Leukocytes count, systemic inflammatory response and pain were significantly lower in experimental group (p < 0.05). Discharge criteria and granulation tissue were present earlier in experimental group (p < 0.05). CONCLUSION: Handcrafted vacuum-assisted system is a feasible and safe method to treat chronic ulcers. This system would benefit patients favoring earlier infection control, faster granulation tissue appearance and earlier discharge. Clinical trials registered in https://www.clinicaltrials.gov/ Number NCT02512159.

Hallazgos de trombos intracardíacos por cardioresonancia no diagnosticados por ecocardiograma transtorácico / Intracardiac thrombus identified by nuclear magnetic resonance not previously diagnosed by transthoracic echocardiography

La Resonancia Magnética Cardíaca permite, entre otros, una superior localización espacial y caracterización tisular de las estructuras cardíacas, muchas veces omitidas por modalidades de alto uso como el ultrasonido. Objetivo: Describir los hallazgos de trombos in-tracardíacos en una serie de pacientes enviados a estudio de resonancia cardíaca, en los cuales el ecocar-diograma transtorácico no estableció el diagnóstico de trombo. Método: Se realizó un análisis descriptivo de una serie de 62 casos, 72% hombres, entre 18 y 84 años, con disfunción sistólica severa 63%; moderada 26% y normal 11%. El 38% tenía historia presente o remota de Accidente Vascular Encefálico. Todos tenían ecocardiograma transtorácico sin trombos visibles y fueron enviados a resonancia cardíaca por estudio de cardiomiopatía no isquémica 41%; viabilidad 41% y accidente vascular encefálico isquémico sin fuente embolígena demostrada 18% El estudio se efectuó en Vanderbilt University Medical Center, entre Julio del 2014 a Julio del 2015. Resultados: Las imágenes, correspondientes a trombos cardíacos en los 62 casos, fueron localizados en ventrículo izquierdo en su gran mayoría (58 casos, 94%), orejuela de aurícula izquierda (3, 5%) y ambas orejuelas (1 caso, 1%). Los trombos fueron en su gran mayoría laminares (52 casos, 84%), sésiles (10 casos, 16%) y ninguno pediculado. Conclusión: La resonancia cardíaca es un método de imagen no invasivo muy superior a la ecocardiografía transtorácica en la identificación y localización de trombos intracardíacos, incluyendo pacientes con estudio de fuente embolígena negativos.

Cardiac Magnetic Resonance imaging allows, among others, a better localization and tissue characterization of cardiac structures, which may be missed by other imaging modalities, namely ultrasonography. Aim: to describe the finding and characteristics of intracardiac thrombus in a series of patients referred for cardiac NMR imaging, whose previous transthoracic echocardiogram had been negative for the diagnosis of this condition. Methods: the study is a description of NMR imaging findings in patients with intracardiac thrombus. There were 62 patients, 72% males, aged 18 to 64 years. LV systolic function was normal in 11%, mo-derately decreased in 26% and severely depressed in 63% of patients. A remote or a recent cerebrovas-cular accident (CVA) was present in 38% of cases. All patients had a previous transthoracic echocar-diogram with no evidence of thrombus. Patients had been referred for NMR with a diagnosis of non is-chemic cardiomyopathy (41%), study of myocardial viability (41%) and CVA with unidentified embolic source (18%). The study was performed at Vander-bilt University Medical Center, between July 2014 and July 2015.