Congenital Diaphragmatic Hernia

Congenital Diaphragmatic Hernia (CDH) is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is < 5 in 10,000 live-births. The etiology is unknown although clinical, genetic and experimental evidence points to disturbances in the retinoid-signaling pathway during organogenesis. Antenatal diagnosis is often made and this allows prenatal management (open correction of the hernia in the past and reversible fetoscopic tracheal obstruction nowadays) that may be indicated in cases with severe lung hypoplasia and grim prognosis. Treatment after birth requires all the refinements of critical care including extracorporeal membrane oxygenation prior to surgical correction. The best hospital series report 80% survival but it remains around 50% in population-based studies. Chronic respiratory tract disease, neurodevelopmental problems, neurosensorial hearing loss and gastroesophageal reflux are common problems in survivors. Much more research on several aspects of this severe condition is warranted

Down-regulation of thyroid transcription factor-1 gene expression in fetal lung hypoplasia is restored by glucocorticoids

8 pages, 6 figures.The thyroid transcription factor (TTF)-1 has an essential role in lung morphogenesis and development. It is involved in the transcription of surfactant proteins (SP), which are critical in respiratory function. Neonates with congenital diaphragmatic hernia die of respiratory failure caused by pulmonary hypoplasia with associated biochemical immaturity. To gain new insights into the causes of this disorder and the effect of prenatal hormonal treatment on reducing mortality in these infants, we evaluated the expression of TTF-1 as marker of lung morphogenesis and SP-B as marker of lung maturity. Using a rat model of lung immaturity, we show that TTF-1 and SP-B messenger RNA (mRNA) levels are drastically reduced in congenital lung hypoplasia. Interestingly, prenatal dexamethasone (Dex) treatment increased both TTF-1 and SP-B mRNAs over control levels when administered to rats with lung hypoplasia, but it had no effect on TTF-1 or a moderate effect on SP-B mRNA when administered to control rats. TRH alone also increases TTF-1 and SP-B mRNA levels but to a lesser extent than Dex. When administered together with Dex, TRH counteracts the induction observed with the glucocorticoid. The decrease in TTF-1 mRNA levels in lung hypoplasia is paralleled by a down-regulation of TTF-1 protein levels, as well as by a decrease in the TTF-1/DNA complex when the TTF-1-binding site of the SP-B promoter was used as a probe. Both parameters were reestablished after glucocorticoid treatment. Moreover, the regulation of TTF-1 gene expression described in this report is accompanied by the same regulation in its promoter activity, as demonstrated in transfection experiments performed in H-441 human lung-derived adenocarcinoma cells. In conclusion, our data demonstrate, for the first time, that lung hypoplasia and the associated respiratory dysfunction caused by SP-B deficiency are caused, in part, by down-regulation of TTF-1 gene expression. The observations that prenatal glucocorticoid treatment induces the expression of TTF-1 supports routine in utero glucocorticoid treatment of patients expected to have lung hypoplasia.This work was supported by Grants DGICYT (PB97–0065), CAM 08.1/0025/1997, and FIS (96/0059–01 and 98/0518) (Spain). Alejandro Losada recipient of a fellowship from the Spanish Ministerio de Educación y Cultura.Peer reviewe

Aspectos a considerar en el diseño y ejecución de espigones de baja cota : el caso del espigón de Fuentebravía

Los espigones de baja cota de coronación se han utilizado con éxito como obras necesarias para evitar la pérdida lateral de arena, en los casos en que se minimicen los efectos negativos que dichos espigones puedan causar en las playas cercanas. Han sido varios los espigones de baja cota de coronación utilizados en el litoral gaditano (Playas de Santa María del Mar en Cádiz, Regla en Chipiona, La Costilla en Rota, y Fuentebravía, en El Puerto de Santa María). Entre los factores a tener en cuenta en su diseño, destacan principalmente los siguientes aspectos (Gómez Pina, 2003): i) Técnicos, ii) Ambientales, iii) Económicos, iv) De integración en el entorno, v) Estéticos, vi) Recreacionales. Todos estos aspectos deben abordarse de una forma integral, siendo los tres últimos—aunque puedan parecer de menor importancia—cruciales a la hora de obtener la aceptación social, entre los distintos grupos que utilizan la playa

Structuring an integrated water-energy-food nexus assessment of a local wind energy desalination system for irrigation

Unidad de excelencia María de Maeztu MdM-2015-0552Desalination is increasingly put forward as a sustainable local solution to water scarcity in combination with the exploitation of renewable energy sources. However, the complexity of the resource nexus entails the unavoidable existence of pros and cons across its various dimensions that can only be assessed at different scales of analysis. In turn, these pros and cons entail different winners and losers among the different social actors linked through the nexus. To address these challenges, a novel approach to resource nexus assessment is put forward, based on multi-scale integrated analysis of societal and ecosystem metabolism (MuSIASEM) and recognizing the resource nexus as a wicked problem. The integrated representation identifies the existence of biophysical constraints determined by processes both under human control (in the technosphere) and beyond human control (in the biosphere). The approach is illustrated with a local case study of desalination in the Canary Islands, Spain. The material presented has been generated in the context of the project "Moving towards adaptive governance in complexity: Informing nexus security" (MAGIC) for use in participatory processes of co-production of knowledge claims about desalination, a prerequisite for informed policy deliberation

Intramural Ganglion Structures in Esophageal Atresia: A Morphologic and Immunohistochemical Study

Introduction and Aim. Disorders of esophageal motility causing dysphagia and gastroesophageal reflux are frequent in survivors to esophageal atresia (EA) and distal tracheoesophageal fistula (TEF). The aim of the present study was to investigate the histologic and immunohistochemical features in both esophageal atretic segments to further understand the nature of the motor disorders observed in these patients. Material and Methods. Esophageal specimens from 12 newborns with EA/TEF and 5 newborns dead of unrelated causes were examined. The specimens were fixed in 5% buffered formalin, included in paraffin and cut in 5 micron sections that were stained with hematoxilin and eosin (H and E), and immunohistochemical stainings for Actin, S-100 protein, Neurofilament, Neuron-Specific-Enolase, Chromogranin A and Peripherin were evaluated under the microscope. Results. In controls, the distribution of the neural elements was rather homogenous at both levels of the esophagus. In contrast, the atretic segments showed quantitative and qualitative differences between them with sparser nervous tissue in the distal one in comparison with the proximal one and with controls. Conclusions. These results further support the assumption that histomorphological alterations of the muscular and nervous elements within the esophageal wall might contribute to esophageal dysmotility in patients surviving neonatal operations for EA/TEF

Clinical Correlation Between Computerized Tomography Findings and Pathologic Diagnosis in Patients Surgically Treated for Complex Renal Cysts in a Colombian Tertiary Center

IntroductionRecent data have reexamined the historical rates of malignancy observed in Bosniak IIF and III cystic lesions, and this has led to an endorsement of the use of active surveillance as the standard of care for Bosniak III renal cysts by affirming that overtreatment rates for this subgroup are close to 50%. In light of this, the present study describes the correlation between imaging studies and pathologic diagnosis in patients surgically treated for complex renal cysts in Colombia.Materials and methodsThis is a retrospective, descriptive, and observational study. We analyzed the medical histories of patients who had been surgically treated for complex renal cysts between 2010 and 2018 in the urology department of a tertiary center in Bogota, Colombia. The exclusion criteria were incomplete clinical histories and absent diagnostic images or their official interpretation.ResultsOut of the 235 urological procedures performed, nine were excluded. And 6.19% (n = 14) were cases of surgically treated complex renal cysts; 38.46% were compatible with Bosniak 46.15% were Bosniak III, and 15.38% were Bosniak IV. The percentage of renal cancer as revealed by the histopathological study was 60, 66.7 and 100 for renal cysts Bosniak IIF, III, and IV, respectively; 77.7% of these confirmed oncological cases had received a diagnosis of clear cell renal carcinoma.ConclusionsIn our study, the percentage of malignancy in patients with renal cysts Bosniak IIF and III was found to be greater compared to the findings in the recent medical literature. We believe that the management offered to the population with complex renal cysts in Colombia should be tailored to the individual risk characteristics of each patient

Endocrine and Metabolic impact of oral ingestion of a carob-pod derived natural syrup containing D-Pinitol: potential use as a novel sweetener in diabetes

The use of added sugars or non-nutritive sweeteners in processed foods and soft drinks are being blamed for multiple complications associated with obesity and diabetes. High fructose content contributes to obesity and liver steatosis, and excessive consumption of non-nutritive sweeteners can generate gut dysbiosis complicating the metabolic control exerted by the liver. Beyond its evolutionary significance in the selection of foods with a high glucose content as an energy source, the fact is that the consumption of sweets produces a hedonic pleasure in our brain. Then, the challenge stands at: how do we control the use of added sugars while providing a safe, palatable, sweet flavour to foods?. The present work explores an alternative approach, in humans and rodents, for sweetening through the use of a simple carob-pod-derived syrup which contains the inositol D-Pinitol. This inositol is known as an insulin sensitizer in muscle capable of keeping glycaemia while avoiding both unnecessary insulin secretion and the conversion of carbohydrates into fat depots .Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Molecular detection and genotyping of intestinal protozoa from different biogeographical regions of Colombia

Background: Intestinal parasitic protozoa represent a serious problem of public health particularly in developing countries. Protozoa such as Blastocystis, Giardia intestinalis, Entamoeba histolytica and Cryptosporidium spp. are associated with diarrheal symptoms. In Colombia, there is little region-specific data on the frequency and circulating genotypes/species of these microorganisms. Therefore, the main objective of our study was to employ molecular detection and genotyping of G. intestinalis and Blastocystis, Cryptosporidium and Entamoeba spp. in samples from different biogeographical regions of Colombia. Methods: We collected 649 human fecal samples from five biogeographical regions of Colombia: the Amazon, Andean, Caribbean, Orinoco and Pacific regions. Blastocystis, G. intestinalis, Cryptosporidium spp. and Entamoeba complex were detected by microscopy and conventional PCR. Molecular genotyping was conducted to identify Blastocystis subtypes (STs) (18s), G. intestinalis assemblages (triose phosphate isomerase and glutamate dehydrogenase) and Cryptosporidium species (18s). Genetic diversity indices were determined using dnasp.5. Results: We detected G. intestinalis in 45.4% (n = 280) of samples, Blastocystis in 54.5% (n = 336) of samples, Cryptosporidium spp. in 7.3% (n = 45) of samples, Entamoeba dispar in 1.5% (n = 9) of samples, and Entamoeba moshkovskii in 0.32% (n = 2) of samples. Blastocystis STs 1-4, 8 and 9 and G. intestinalis assemblages AII, BIII, BIV, D and G were identified. The following Cryptosporidium species were identified: C. hominis, C. parvum, C. bovis, C. andersoni, C. muris, C. ubiquitum and C. felis. The Caribbean region had the highest frequency for each of the microorganisms evaluated (91.9% for G. duodenalis, 97.3% for Blastocystis, 10.8% for Cryptosporidium spp., 13.5% for E. dispar and 2.7% for E. moshkovskii). The Orinoco region had a high frequency of Blastocystis (97.2%) and the Andean region had a high frequency of G. intestinalis (69.4%). High and active transmission was apparent in several regions of the country, implying that mechanisms for prevention and control of intestinal parasitosis in different parts of the country must be improved. Copyright © 2020 Higuera et al

Impacto de la pizarra luminosa en estudiantes de contaduría pública de estadística inferencial y fundamentos de matemáticas.

Diagnosticar el uso de la pizarra luminosa en cursos cuantitativos.El uso de recursos que inviten al estudiante a estar más comprometido con su proceso educativo puede incrementar su desempeño. El objetivo del estudio es encontrar el nivel de apreciación percibido en el uso de la pizarra luminosa en dos cursos cuantitativos y establecer las diferencias entre el sexo y la situación laboral de los estudiantes participantes. Se utilizó como instrumento una encuesta que diligenciaron los 97 participantes. Se encontró que el 82% de los estudiantes preferían los videos elaborados por el mismo profesor que orientaba la asignatura, el 82% prefirió verle la cara al profesor mientras escribe en el tablero. En las 3 dimensiones, comprensión, compromiso y satisfacción, se obtuvo 97%, 94% y 95% respectivamente en la categoría “Totalmente de acuerdo”. La apreciación total en relación con el sexo no presentó diferencias significativas, al igual que con la situación laboral

International survey on the management of esophageal atresia

IntroductionBecause many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe. MethodsA survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012. ResultsApproximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p=nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%) and chest drain (69%) are left in situ. Elective paralysis is adopted by 56% of respondents mainly for anastomosis tension (65%). About 72% of respondents routinely request a contrast study on postoperative day 7 (2-14). Approximately 54% of respondents use parenteral nutrition, 40% of respondents start transanastomotic feeds on postoperative day 1, and 89% of respondents start oral feeds after postoperative day 5. Pure EA: 46% of respondents work in centers that repair two or more than two pure EA a year. About 60% of respondents opt for delayed primary anastomosis at 3 months (1-12 months) with gastrostomy formation without esophagostomy. Anastomosis is achieved with open approach by 85% of respondents. About 47% of respondents attempt elongation of esophageal ends via Foker technique (43%) or with serial dilations with bougies (41%). Approximately 67% of respondents always attempt an anastomosis. Gastric interposition is the commonest esophageal substitution. ConclusionMany aspects of EA management are lacking consensus. Minimally invasive repair is still sporadic. We recommend establishment of an EA registry