[Surgical strategies in Ebstein anomaly: 28 years' experience in a pediatric hospital]. / Estrategias y avances quirúrgicos en la anomalía Ebstein: 28 años de experiencia en un hospital pediátrico.

Objectives: Ebstein anomaly is a congenital defect characterized by a lack of delamination and apical displacement of the tricuspid valve, tricuspid insufficiency, right atrial enlargement, and ventricular dysfunction. To analyze the results and evolution of the different surgical strategies, data were collected from 45 patients operated on during 1990-2018. Twenty-six patients were included with a median age at initial surgery of 11.3 years (range: 13 days-18.6 years). Method: Procedures were plastic 10 patients (38%), cone technique reconstruction 11 (42%), and replacement 5 (19%). Additional interventions were required in 7 patients: cavo-pulmonary anastomosis 4 and Cox-maze 4. Nine patients (34.6%) required reoperation due to severe tricuspid insufficiency. Six had previous plastic, two bioprothesis, and one, cone. Results: Overall mortality was 11.5% (3)at a median of 10.1 years post-surgery (range: 5.7-10.12) associated with arrhythmias (p = 0.05), right (p = 0.008), left (p = 0.0001) ventricular dysfunction and reoperations (p = 0.03). None were previous conus. Median follow-up was 6.5 years (range: 1-29.1). Ninety-one-point-six percent were in functional class I/II and 79.2% in sinus rhythm. Conclusions: The results of the different classic techniques were similar, although not free of complications and reoperations. Cone reconstruction proved to be effective, with low surgical mortality, less need for reoperations, and durability in the medium term.

Objetivos: La anomalía de Ebstein es un defecto congénito caracterizado por falta de deslaminación y desplazamiento apical de la válvula tricúspide, insuficiencia tricúspidea, agrandamiento auricular derecho y disfunción ventricular. Con el propósito de analizar los resultados y evolución de las distintas estrategias quirúrgicas se recolectaron datos de 45 operados durante 1990-2018. Se incluyeron 26 pacientes con una edad mediana en la cirugía inicial de 11.3 años (rango: 13 días-18.6 años). Método: Los procedimientos fueron plastia 10 pacientes (38%), reconstrucción con técnica del cono 11 (42%) y reemplazo 5 (19%). Requirieron intervenciones adicionales 7 pacientes: anastomosis cavo-pulmonar 4 y Cox-maze 4. El 34.6% (9) requirió reoperación por insuficiencia tricúspidea importante. Presentaban plastia previa seis, bioprótesis dos y cono, uno. Resultados: La mortalidad global fue del 11.5% (3 pacientes) a una media de 10.1 años posquirúrgicos (rango: 5.7-10.12) asociada a arritmias (p = 0.05), disfunción ventricular derecha (p = 0.008), izquierda (p = 0.0001) y reoperaciones (p = 0.03). Ninguno fue cono previo. La mediana de seguimiento fue de 6.5 años (rango: 1-29.1). El 91.6% se encontraban en clase funcional I/II y el 79.2% en ritmo sinusal. Conclusiones: Los resultados de las diferentes técnicas clásicas fueron similares aunque no exentas de complicaciones y reoperaciones. La reconstrucción del cono resultó ser efectiva, de baja mortalidad quirúrgica, menor requerimiento de reoperaciones y duradera en el mediano plazo.

Induction of endothelial barrier dysfunction by serum factors in rats subjected to traumatic brain injury and hemorrhagic shock.

Traumatic brain injury (TBI) has been associated with the development of indirect acute respiratory distress syndrome (ARDS). However, the causative relationship between TBI and lung injury remains unclear. To explore potential mechanisms linking TBI with the development of ARDS, we characterized the effects of serum factors released following TBI and hemorrhagic shock (HS) in a rat model on the pulmonary endothelial cell (EC) barrier dysfunction, a key feature of ARDS. We found that serum samples from animals exposed to both controlled cortical impact (CCI) and HS, but not from sham-operated rats induced significant barrier dysfunction in human pulmonary artery EC monolayers at 2 days post injury. Thrombin inhibitor and thrombin receptor antagonist attenuated the acute phase of the serum-induced trans-endothelial resistance (TER) decline caused by CCI-HS serum, but not in later time points. However, both the early and late phases of CCI-HS-induced EC permeability were inhibited by heparin. The barrier disruptive effects of CCI-HS serum were also prevented by serum preincubation with heparin-sepharose. Pulmonary EC treated for 3 h with serum from CCI-HS rats demonstrated a significant decline in expression of EC junctional protein, VE-Cadherin, and disassembly of peripheral EC adherens junction complexes monitored by immunostaining with VE-cadherin antibody. These results suggest that exposure to CCI-HS causes early and late-phase barrier disruptive effects in vascular endothelium. While thrombin-PAR1 signaling has been identified as a mechanism of acute EC permeability increase by CCI-HS serum, the factor(s) defining long-term EC barrier disruption in CCI-HS model remains to be determined.

Combined Traumatic Brain Injury and Hemorrhagic Shock in Ferrets Leads to Structural, Neurochemical, and Functional Impairments.

Aeromedical evacuation-relevant hypobaria after traumatic brain injury (TBI) leads to increased neurological injury and death in rats relative to those maintained under normobaria. Applicability of rodent brain injury research to humans may be limited, however, by differences in neuroanatomy. Therefore, we developed a model in which ferrets are exposed to polytrauma consisting of controlled cortical impact TBI and hemorrhagic shock subjected 24 h later to 6 h of hypobaria or normobaria. Our objective was to determine whether the deleterious effects of hypobaria observed in rats, with lissencephalic brains, are also present in a species with a human-like gyrencephalic brain. While no deaths were observed, magnetic resonance spectroscopy (MRS) results obtained two days post-injury indicated reduced cortical creatine, N-acetylaspartate, gamma-aminobutyric acid, myo-inositol, and glutamate that were not affected by hypobaria. T2-weighted magnetic resonance imaging quantification revealed increased hyperintensity volume representing cortical edema at the site of impact after polytrauma. Hypobaria did not exacerbate this focal edema but did lead to overall reductions in total cortical volume. Both normobaric and hypobaric ferrets exhibited impaired spatial memory six days post-injury on the Object Location Test, but no differences were noted between groups. Finally, cortical lesion volume was not exacerbated by hypobaria exposure on day 7 post-injury. Results suggest that air travel 24 h after polytrauma is associated with structural changes in the ferret brain. Future studies should investigate secondary injury from hypobaria after polytrauma in greater detail including alternative outcome measures, time points, and exposure to multiple flights.

Enhancing Metabolic Imaging of Energy Metabolism in Traumatic Brain Injury Using Hyperpolarized [1-13C]Pyruvate and Dichloroacetate.

Hyperpolarized magnetic resonance spectroscopic imaging (MRSI) of [1-13C]pyruvate metabolism has previously been used to assess the effects of traumatic brain injury (TBI) in rats. Here, we show that MRSI can be used in conjunction with dichloroacetate to measure the phosphorylation state of pyruvate dehydrogenase (PDH) following mild-to-moderate TBI, and that measurements can be repeated in a longitudinal study to monitor the course of injury progression and recovery. We found that the level of 13C-bicarbonate and the bicarbonate-to-lactate ratio decreased on the injured side of the brain four hours after injury and continued to decrease through day 7. Levels recovered to normal by day 28. Measurements following dichloroacetate administration showed that PDH was inhibited equally by PDH kinase (PDK) on both sides of the brain. Therefore, the decrease in aerobic metabolism is not due to inhibition by PDK.

Air-Evacuation-Relevant Hypobaria Following Traumatic Brain Injury Plus Hemorrhagic Shock in Rats Increases Mortality and Injury to the Gut, Lungs, and Kidneys.

ABSTRACT: Rats exposed to hypobaria equivalent to what occurs during aeromedical evacuation within a few days after isolated traumatic brain injury exhibit greater neurologic injury than those remaining at sea level. Moreover, administration of excessive supplemental O2 during hypobaria further exacerbates brain injury. This study tested the hypothesis that exposure of rats to hypobaria following controlled cortical impact (CCI)-induced brain injury plus mild hemorrhagic shock worsens multiple organ inflammation and associated mortality. In this study, at 24 h after CCI plus hemorrhagic shock, rats were exposed to either normobaria (sea level) or hypobaria (=8,000 ft altitude) for 6 h under normoxic or hyperoxic conditions. Injured rats exhibited mortality ranging from 30% for those maintained under normobaria and normoxia to 60% for those exposed to 6 h under hypobaric and hyperoxia. Lung histopathology and neutrophil infiltration at 2 days postinjury were exacerbated by hypobaria and hyperoxia. Gut and kidney inflammation at 30 days postinjury were also worsened by hypobaric hyperoxia. In conclusion, exposure of rats after brain injury and hemorrhagic shock to hypobaria or hyperoxia results in increased mortality. Based on gut, lung, and kidney histopathology at 2 to 30 days postinjury, increased mortality is consistent with multi-organ inflammation. These findings support epidemiological studies indicating that increasing aircraft cabin pressures to 4,000 ft altitude (compared with standard 8,000 ft) and limiting excessive oxygen administration will decrease critical complications during and following aeromedical transport.

[Neuropsychological study in patients with Parkinson's disease: the effects of deep brain stimulation]. / Estudio neuropsicológico en pacientes parkinsonianos: efectos de la estimulación cerebral profunda.

INTRODUCTION: Parkinson's disease (PD) is a disorder whose clinical manifestations are observed in the motor and neuropsychological domain and have an impact on the patient's quality of life. Several scientific studies evidence the effectiveness of deep brain stimulation as treatment for the motor symptoms, but further research is required on the neuropsychological symptoms. AIM: To analyse the existence of significant differences in neuropsychological processes, such as attention, memory, language, visuoperception and the executive functions in patients with PD prior to and following deep brain stimulation. PATIENTS AND METHODS: Our sample consisted of 20 patients of both sexes, aged 50-70 years, with PD, who were treated by healthcare service providers in Medellin. These subjects were administered the Continuous Performance Test and the Trail Making Test in order to assess attention, the Rey Complex Figure and Ardila memory tests to evaluate memory, the Boston and verbal fluency tests to assess language, the Rey Complex Figure Copy test for visuoperception, and the Wisconsin Card Sorting Test to appraise the executive functions. RESULTS: There are significant differences between the scores before and after deep brain stimulation in patients with PD on attention and memory. CONCLUSIONS: Knowledge of these findings is relevant for the neuropsychological therapy of patients with PD.

TITLE: Estudio neuropsicologico en pacientes parkinsonianos: efectos de la estimulacion cerebral profunda.Introduccion. La enfermedad de Parkinson (EP) es un trastorno cuyas manifestaciones clinicas se observan en el ambito motor y neuropsicologico e influyen en la calidad de vida del paciente. Diversos estudios cientificos muestran la eficacia de la estimulacion cerebral profunda como tratamiento sobre los sintomas motores, pero faltan estudios sobre los sintomas neuropsicologicos. Objetivo. Analizar la existencia de diferencias significativas en procesos neuropsicologicos, como la atencion, la memoria, el lenguaje, la visuopercepcion y la funcion ejecutiva en los pacientes con EP antes y despues de la estimulacion cerebral profunda. Pacientes y metodos. La muestra estuvo formada por 20 pacientes parkinsonianos de 50-70 años de ambos sexos, pertenecientes a entidades prestadoras de servicios de salud de Medellin, a los que se les administraron el Continuous Performance Test y el Trail Making Test para valorar la atencion, la figura compleja de Rey y la prueba de memoria de Ardila para evaluar la memoria, el test de Boston y fluidez verbal para valorar el lenguaje, la figura compleja de Rey copia para la visuopercepcion, y el test de clasificacion de cartas de Wisconsin para valorar la funcion ejecutiva. Resultados. Existen diferencias significativas entre las puntuaciones antes y despues de la estimulacion cerebral profunda en los pacientes con EP en la atencion y la memoria. Conclusiones. El conocimiento de estos hallazgos es relevante para la terapia neuropsicologica de los pacientes con EP.

Estudio neuropsicológico en pacientes parkinsonianos: efectos de la estimulación cerebral profunda / Neuropsychological study in patients with Parkinson’s disease: the effects of deep brain stimulation

Introducción. La enfermedad de Parkinson (EP) es un trastorno cuyas manifestaciones clínicas se observan en el ámbito motor y neuropsicológico e influyen en la calidad de vida del paciente. Diversos estudios científicos muestran la eficacia de la estimulación cerebral profunda como tratamiento sobre los síntomas motores, pero faltan estudios sobre los síntomas neuropsicológicos. Objetivo. Analizar la existencia de diferencias significativas en procesos neuropsicológicos, como la atención, la memoria, el lenguaje, la visuopercepción y la función ejecutiva en los pacientes con EP antes y después de la estimulación cerebral profunda. Pacientes y métodos. La muestra estuvo formada por 20 pacientes parkinsonianos de 50-70 años de ambos sexos, pertenecientes a entidades prestadoras de servicios de salud de Medellín, a los que se les administraron el Continuous Performance Test y el Trail Making Test para valorar la atención, la figura compleja de Rey y la prueba de memoria de Ardila para evaluar la memoria, el test de Boston y fluidez verbal para valorar el lenguaje, la figura compleja de Rey copia para la visuopercepción, y el test de clasificación de cartas de Wisconsin para valorar la función ejecutiva. Resultados. Existen diferencias significativas entre las puntuaciones antes y después de la estimulación cerebral profunda en los pacientes con EP en la atención y la memoria. Conclusiones. El conocimiento de estos hallazgos es relevante para la terapia neuropsicológica de los pacientes con EP (AU)

Introduction. Parkinson’s disease (PD) is a disorder whose clinical manifestations are observed in the motor and neuropsychological domain and have an impact on the patient’s quality of life. Several scientific studies evidence the effectiveness of deep brain stimulation as treatment for the motor symptoms, but further research is required on the neuropsychological symptoms. Aim. To analyse the existence of significant differences in neuropsychological processes, such as attention, memory, language, visuoperception and the executive functions in patients with PD prior to and following deep brain stimulation. Patients and methods. Our sample consisted of 20 patients of both sexes, aged 50-70 years, with PD, who were treated by healthcare service providers in Medellín. These subjects were administered the Continuous Performance Test and the Trail Making Test in order to assess attention, the Rey Complex Figure and Ardila memory tests to evaluate memory, the Boston and verbal fluency tests to assess language, the Rey Complex Figure Copy test for visuoperception, and the Wisconsin Card Sorting Test to appraise the executive functions. Results. There are significant differences between the scores before and after deep brain stimulation in patients with PD on attention and memory. Conclusions. Knowledge of these findings is relevant for the neuropsychological therapy of patients with PD (AU)

Expansion and diversification of BTL ring-H2 ubiquitin ligases in angiosperms: putative Rabring7/BCA2 orthologs.

RING finger E3 ligases are components of the ubiquitin proteasome system (UPS) that mediate the transfer of ubiquitin to substrates. Single-subunit RING finger E3s binds the E2 ubiquitin-conjugating enzyme and contains recognition sequences for the substrate within the same polypeptide. Here we describe the characterization of a class of RING finger E3 ligases that is conserved among eukaryotes. This class encodes a RING-H2 domain related in sequence to the ATL RING-H2 domain, another class of E3 ligases, and a C2/C2 zing finger at the amino-terminus, formerly described as BZF. In viridiplantae (green algae and land plants), we designed this family as BTL for BZF ATLs. BTLs are putative orthologs of the mammalian Rabring7/BCA2 RING-H2 E3s that have expanded in angiosperms. They are found in numbers ranging from three to thirty-one, which is in contrast to the one to three members normally found in animals, fungi, and protists. Furthermore, the number of sequence LOGOs generated in angiosperms is four times greater than that in other eukaryotes. In contrast to ATLs, which show expansion by tandem duplication, tandemly duplicated BTLs are scarce. The mode of action of Rabring7/BCA2 and BTLs may be similar since both the Rabring7/BCA2 BZF and the ath|BTL4 BZF are likely to mediate the binding of ubiquitin. This study introduces valuable information on the evolution and domain structure of the Rabring7/BCA2/BTL class of E3 ligases which may be important for core eukaryotic genes.

Effects of a combination hemoglobin based oxygen carrier-hypertonic saline solution on oxygen transport in the treatment of traumatic shock.

BACKGROUND: Logistics complicate fluid resuscitation of traumatic shock on the battlefield. Traumatic shock can result in oxygen debt (O(2)D) accumulation that is fatal. However, the ability of fluid strategies to repay O(2)D are not commonly reported. This pilot study examined various resuscitation fluids, including a combination of PEGylated bovine hemoglobin and hypertonic saline (AfterShock™) on their ability to repay O(2)D in traumatic shock. METHODS: 41 anesthetized swine underwent hemorrhage to an O(2)D of 80 mL/kg. Animals received one of the following: 500 mL whole blood, 500 mL AfterShock™, 500 mL hypertonic (7.2%) saline, 250 mL hypertonic (7.2%) saline, 500 mL Hetastarch (6%), or 500 mL lactated Ringer's. Oxygen transport variables (O(2)D, oxygen consumption, oxygen delivery, central venous hemoglobin oxygen saturation, oxygen extraction ratios), lactate clearance, and survival were monitored for 3h after treatment. Data were analyzed using mixed-model ANOVA and comparisons were made to the performance of whole blood. RESULTS: Only animals receiving AfterShock™, 500 mL hypertonic saline, and 500 mL Hetastarch survived to 180 min. While not statistically significant AfterShock™ demonstrated trends in improving the repayment of O(2)D and in improving oxygen transport variables despite having lower levels of global oxygen delivery compared to whole blood, Hetastarch and 500 mL hypertonic saline groups. CONCLUSION: Use of 500 mL AfterShock™, 500 mL of 7.2% saline or 500 mL of Hetastarch resulted in improved short-term survival. While not statistically significant, AfterShock™ demonstrated trends in improving O(2)D. These findings may have implications for designing resuscitation fluids for combat casualty care.

QTL for seed iron and zinc concentration and content in a Mesoamerican common bean (Phaseolus vulgaris L.) population.

Iron and zinc deficiencies are human health problems found throughout the world and biofortification is a plant breeding-based strategy to improve the staple crops that could address these dietary constraints. Common bean is an important legume crop with two major genepools that has been the focus of genetic improvement for seed micronutrient levels. The objective of this study was to evaluate the inheritance of seed iron and zinc concentrations and contents in an intra-genepool Mesoamerican × Mesoamerican recombinant inbred line population grown over three sites in Colombia and to identify quantitative trait loci (QTL) for each mineral. The population had 110 lines and was derived from a high-seed iron and zinc climbing bean genotype (G14519) crossed with a low-mineral Carioca-type, prostrate bush bean genotype (G4825). The genetic map for QTL analysis was created from SSR and RAPD markers covering all 11 chromosomes of the common bean genome. A set of across-site, overlapping iron and zinc QTL was discovered on linkage group b06 suggesting a possibly pleiotropic locus and common physiology for mineral uptake or loading. Other QTL for mineral concentration or content were found on linkage groups b02, b03, b04, b07, b08 and b11 and together with the b06 cluster were mostly novel compared to loci found in previous studies of the Andean genepool or inter-genepool crosses. The discovery of an important new locus for seed iron and zinc concentrations may facilitate crop improvement and biofortification using the high-mineral genotype especially within the Mesoamerican genepool.

Contaminação microbiológica de dietas enterais / Microbiological contamination of enteral feeding / La contaminación microbiológica de la alimentación enteral

Os serviços públicos de atendimento domiciliar têm sido ampliados no Brasil em virtude do aumento da demanda para os cuidados clínicos de idosos e doentes crônicos, já que vários necessitam de terapia nutricional enteral. As dietas enterais são excelentes meios de crescimento para microorganismos, sendo imprescindível o uso de técnicas de higiene adequadas em sua preparação, especialmente as artesanais. O objetivo deste trabalho foi verificar a qualidade microbiológica de dietas enterais artesanais e industrializadas, sendo a primeira utilizada pela população dependente de terapia nutricional domiciliar e a segunda por enfermos hospitalizados. As amostras foram adequadamente coletadas e analisadas, sendo quatro amostras industrializadas, e doze amostras artesanais, utilizadas por enfermos atendidos num serviço público de assistência domiciliar. Nos resultados, observou-se que das amostras analisadas apenas 31,2% estavam próprias para o consumo, sendo que destas, 80% eram dietas industrializadas. Foram encontrados problemas quanto á contaminação excessiva em 68,7% das amostras, sendo estas de origem artesanal, dentre as dietas artesanais analisadas, verificou-se que apenas uma delas estava em condições propícias para o consumo. A maioria das dietas (91,7%) apresentou contaminação microbiana significativa, sendo esta variável no número e tipo de microorganismos presentes. Desta forma, observou-se que as dietas enterais artesanais não são tão seguras do ponto de vista microbiológico se comparadas às industrializadas. Ressalta-se a necessidade de leis que garantam segurança alimentar e nutricional dos enfermos que fazem uso dessa terapia, que será possível com a adoção de boas práticas de aquisição e preparo das dietas, sob supervisão direta de profissional nutricionista.

Public services of home care have been expanded in Brazil because of increased demand for clinical care of elderly and chronically ill, since many require enteral nutrition therapy. The enteral feeding are excellent growth media for microorganisms and is essential to use techniques appropriate hygiene in its preparation, especialemnte the craft. The aim of this study was to assess the microbiological quality of enteral feeding artisanal and industrialized, the first being used by the population dependent on nutritional therapy and the second home for sick inpatients. The samples were properly collected and analyzed, four samples industrialized, and twelve samples craft, used by sick people attending a public assistance household. The results showed that samples of only 31.2% were fit for consumption, and of these, 80% were industrialized diets. Problems were found as to the excessive contamination in 68.7% of the samples, which are home craft. Among diets craft analyzed, there was only one of which was in conditions conducive to consumption. Most diets (91.7%) showed significant bacterial contamination, and this varied in the number and type of microorganisms present. Thus, it was observed that the enteral feedings craft are not as safe from a microbiological standpoint when compared to industrialized. We highlight the need for laws that ensure food security and nutrition of the sick who make use of this therapy, which is possible with the adoption of best procurement practices and preparation of diets, under direct supervision of dieticians.

Los servicios públicos de atención domiciliaria se han ampliado en Brasil debido a la mayor demanda de atención clínica de los ancianos y los enfermos crónicos, ya que muchos requieren terapia nutricional enteral. La alimentación enteral son excelentes medios para el crecimiento de microorganismos y es esencial utilizar las técnicas de higiene adecuada a su preparación, especialemnte la embarcación. El objetivo de este estudio fue evaluar la calidad microbiológica de la alimentación enteral artesanal e industrializado, la primera fue utilizada por la población dependiente de la terapia nutricional y el segundo hogar para los pacientes enfermos. Las muestras fueron recolectadas y analizadas adecuadamente, cuatro muestras industrializados y doce muestras artesanales, utilizados por los enfermos que asisten a un hogar de asistencia pública. Los resultados mostraron que las muestras de sólo 31,2% eran aptos para el consumo, y de éstos, el 80% fueron dietas industrializados. Los problemas se encontraron en cuanto a la contaminación excesiva en el 68,7% de las muestras, que son embarcaciones de casa. Entre las dietas artesanales analizados, sólo había uno de ellos en condiciones propicias para el consumo. La mayoría de las dietas (91,7%) mostraron contaminación microbiana importante, y esto variaron en el número y tipo de microorganismos presentes. Así, se observó que la embarcación de la alimentación enteral no son tan seguros desde el punto de vista microbiológico, en comparación con industrializadas. Destacamos la necesidad de leyes que garanticen la seguridad alimentaria y la nutrición de los enfermos que hacen uso de esta terapia, que es posible con la adopción de mejores prácticas de contratación y preparación de dietas, bajo la supervisión directa de los nutricionistas.