Baja morbilidad en niños operados de nefrectomía con técnica laparoscópica transperitoneal de 3 puertos

ResumenAntecedentesAunque la nefrectomía laparoscópica actualmente se considera el estándar de oro en la cirugía renal del adulto, aún existe controversia de su papel en la población pediátrica. La nefrectomía laparoscópica ha demostrado ser un procedimiento efectivo y seguro comparado con el abordaje abierto.ObjetivoPresentar una serie de casos de pacientes pediátricos con diversas enfermedades renales, tratados con nefrectomía laparoscópica transperitoneal.Materiales y métodosIncluye 22 pacientes pediátricos sometidos a nefrectomía laparoscópica transperitoneal. Todos los casos se realizaron vía laparoscópica con abordaje transperitoneal usando 3 puertos.ResultadosTodos los riñones se removieron satisfactoriamente. El promedio de tiempo operatorio fue de 142min. En 21 de los 22 casos no hubo complicaciones que requirieran conversión cirugía abierta. Se inició dieta y deambulación el mismo día de la cirugía en todos los pacientes y se dio de alta a 20 de los 21 pacientes sin conversión a los 2 días postoperatorios.ConclusionesEn nuestra serie de casos reportamos el abordaje transperitoneal laparoscópico para nefrectomía usando una técnica con 3 puertos que puede ser usada con seguridad en la población pediátrica con los mismos resultados y seguridad que otros procedimientos laparoscópicos. Es una excelente alternativa a la cirugía abierta tradicional y debe ser considerada para disminuir el riesgo quirúrgico.AbstractBackgroundEven though laparoscopic nephrectomy is considered the gold standard in renal surgery in the adult, its role in the pediatric population is still a subject of debate. Laparoscopic nephrectomy has been shown to be a safe and effective procedure, compared with the open approach.AimTo present a case series of pediatric patients with different renal pathologies treated through transperitoneal laparoscopic nephrectomy.Material and methodsTwenty-two pediatric patients that underwent transperitoneal laparoscopic nephrectomy were included in the study. All of the cases underwent the 3-port transperitoneal laparoscopic approach.ResultsAll the kidneys were satisfactorily removed and the mean surgery duration was 142 min. There were no complications requiring conversion to open surgery in 21 of the 22 cases. Oral diet and ambulation were begun the same day of the surgery for all patients. Twenty of the 21 patients that did not require conversion were released on the second postoperative day.ConclusionsWe report herein on the transperitoneal laparoscopic approach for nephrectomy with the 3-port technique. It can be performed in the pediatric population with the same results and safety as other laparoscopic procedures and is an excellent alternative to traditional open surgery. This procedure should be considered for reducing surgical risk

An Environmental Science and Engineering Framework for Combating Antimicrobial Resistance

On June 20, 2017, members of the environmental engineering and science (EES) community convened at the Association of Environmental Engineering and Science Professors (AEESP) Biennial Conference for a workshop on antimicrobial resistance. With over 80 registered participants, discussion groups focused on the following topics: risk assessment, monitoring, wastewater treatment, agricultural systems, and synergies. In this study, we summarize the consensus among the workshop participants regarding the role of the EES community in understanding and mitigating the spread of antibiotic resistance via environmental pathways. Environmental scientists and engineers offer a unique and interdisciplinary perspective and expertise needed for engaging with other disciplines such as medicine, agriculture, and public health to effectively address important knowledge gaps with respect to the linkages between human activities, impacts to the environment, and human health risks. Recommendations that propose priorities for research within the EES community, as well as areas where interdisciplinary perspectives are needed, are highlighted. In particular, risk modeling and assessment, monitoring, and mass balance modeling can aid in the identification of “hot spots” for antibiotic resistance evolution and dissemination, and can help identify effective targets for mitigation. Such information will be essential for the development of an informed and effective policy aimed at preserving and protecting the efficacy of antibiotics for future generations

Magnetic fields in cosmic particle acceleration sources

We review here some magnetic phenomena in astrophysical particle accelerators associated with collisionless shocks in supernova remnants, radio galaxies and clusters of galaxies. A specific feature is that the accelerated particles can play an important role in magnetic field evolution in the objects. We discuss a number of CR-driven, magnetic field amplification processes that are likely to operate when diffusive shock acceleration (DSA) becomes efficient and nonlinear. The turbulent magnetic fields produced by these processes determine the maximum energies of accelerated particles and result in specific features in the observed photon radiation of the sources. Equally important, magnetic field amplification by the CR currents and pressure anisotropies may affect the shocked gas temperatures and compression, both in the shock precursor and in the downstream flow, if the shock is an efficient CR accelerator. Strong fluctuations of the magnetic field on scales above the radiation formation length in the shock vicinity result in intermittent structures observable in synchrotron emission images. Resonant and non-resonant CR streaming instabilities in the shock precursor can generate mesoscale magnetic fields with scale-sizes comparable to supernova remnants and even superbubbles. This opens the possibility that magnetic fields in the earliest galaxies were produced by the first generation Population III supernova remnants and by clustered supernovae in star forming regions.Comment: 30 pages, Space Science Review

Magnetoluminescence

Pulsar Wind Nebulae, Blazars, Gamma Ray Bursts and Magnetars all contain regions where the electromagnetic energy density greatly exceeds the plasma energy density. These sources exhibit dramatic flaring activity where the electromagnetic energy distributed over large volumes, appears to be converted efficiently into high energy particles and gamma-rays. We call this general process magnetoluminescence. Global requirements on the underlying, extreme particle acceleration processes are described and the likely importance of relativistic beaming in enhancing the observed radiation from a flare is emphasized. Recent research on fluid descriptions of unstable electromagnetic configurations are summarized and progress on the associated kinetic simulations that are needed to account for the acceleration and radiation is discussed. Future observational, simulation and experimental opportunities are briefly summarized.Comment: To appear in "Jets and Winds in Pulsar Wind Nebulae, Gamma-ray Bursts and Blazars: Physics of Extreme Energy Release" of the Space Science Reviews serie

Large Magnetoresistance of Isolated Domain Walls in La2/3Sr1/3MnO3 Nanowires

Generation, manipulation, and sensing of magnetic domain walls are cornerstones in the design of efficient spintronic devices. Half-metals are amenable for this purpose as large low field magnetoresistance signals can be expected from spin accumulation at spin textures. Among half metals, La1−xSrxMnO3 (LSMO) manganites are considered as promising candidates for their robust half-metallic ground state, Curie temperature above room temperature (Tc = 360 K, for x = 1/3), and chemical stability. Yet domain wall magnetoresistance is poorly understood, with large discrepancies in the reported values and conflicting interpretation of experimental data due to the entanglement of various source of magnetoresistance, namely, spin accumulation, anisotropic magnetoresistance, and colossal magnetoresistance. In this work, the domain wall magnetoresistance is measured in LSMO cross-shape nanowires with single-domain walls nucleated across the current path. Magnetoresistance values above 10% are found to be originating at the spin accumulation caused by the mistracking effect of the spin texture of the domain wall by the conduction electrons. Fundamentally, this result shows the importance on non-adiabatic processes at spin textures despite the strong Hund coupling to the localized t2g electrons of the manganite. These large magnetoresistance values are high enough for encoding and reading magnetic bits in future oxide spintronic sensors. © 2023 The Authors. Advanced Materials published by Wiley-VCH GmbH.G.O. and D.S.-M. contributed equally to this work. The authors ac-knowledge received funding from the project To2Dox of FlagERA ERA-NET Cofund in Quantum Technologies implemented within the Euro-pean Union’s Horizon 2020 Program. This work was supported by Span-ish AEI through grants, PID2020-118078RB-I00, PID2020-11556RB-100and PID2020-117024GB-C43 and by Regional Government of MadridCAM through SINERGICO project Y2020/NMT-6661 CAIRO-CM. S.R.-G.also gratefully acknowledges the financial support of the Alexander vonHumboldt foundation. Work at CNRS/Thales supported by French ANR-22CE30-0020 "SUPERFAST". J.J.R was supported by the CSIC program forthe Spanish Recovery, Transformation and Resilience Plan funded by the Recovery and Resilience EU Facility EU regulation 2020/2094. The authorsthank the Helmholtz-Zentrum Berlin für Materialien und Energie for theallocation of synchrotron radiation beamtime.Open access funding enabled and organized by Projekt DEAL.Supporting InformationPeer reviewe

Isotemporal substitution of inactive time with physical activity and time in bed: cross-sectional associations with cardiometabolic health in the PREDIMEDPlus study

Background: This study explored the association between inactive time and measures of adiposity, clinical parameters, obesity, type 2 diabetes and metabolic syndrome components. It further examined the impact of reallocating inactive time to time in bed, light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on cardio-metabolic risk factors, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults. Methods: This is a cross-sectional analysis of baseline data from 2189 Caucasian men and women (age 55-75 years, BMI 27-40 Kg/m2) from the PREDIMED-Plus study (http://www.predimedplus.com/). All participants had ≥3 components of the metabolic syndrome. Inactive time, physical activity and time in bed were objectively determined using triaxial accelerometers GENEActiv during 7 days (ActivInsights Ltd., Kimbolton, United Kingdom). Multiple adjusted linear and logistic regression models were used. Isotemporal substitution regression modelling was performed to assess the relationship of replacing the amount of time spent in one activity for another, on each outcome, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults. Results: Inactive time was associated with indicators of obesity and the metabolic syndrome. Reallocating 30 min per day of inactive time to 30 min per day of time in bed was associated with lower BMI, waist circumference and glycated hemoglobin (HbA1c) (all p-values < 0.05). Reallocating 30 min per day of inactive time with 30 min per day of LPA or MVPA was associated with lower BMI, waist circumference, total fat, visceral adipose tissue, HbA1c, glucose, triglycerides, and higher body muscle mass and HDL cholesterol (all p-values < 0.05). Conclusions: Inactive time was associated with a poor cardio-metabolic profile. Isotemporal substitution of inactive time with MVPA and LPA or time in bed could have beneficial impact on cardio-metabolic health

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Genomic and phenotypic insights from an atlas of genetic effects on DNA methylation

DNA methylation quantitative trait locus (mQTL) analyses on 32,851 participants identify genetic variants associated with DNA methylation at 420,509 sites in blood, resulting in a database of >270,000 independent mQTLs.Characterizing genetic influences on DNA methylation (DNAm) provides an opportunity to understand mechanisms underpinning gene regulation and disease. In the present study, we describe results of DNAm quantitative trait locus (mQTL) analyses on 32,851 participants, identifying genetic variants associated with DNAm at 420,509 DNAm sites in blood. We present a database of >270,000 independent mQTLs, of which 8.5% comprise long-range (trans) associations. Identified mQTL associations explain 15-17% of the additive genetic variance of DNAm. We show that the genetic architecture of DNAm levels is highly polygenic. Using shared genetic control between distal DNAm sites, we constructed networks, identifying 405 discrete genomic communities enriched for genomic annotations and complex traits. Shared genetic variants are associated with both DNAm levels and complex diseases, but only in a minority of cases do these associations reflect causal relationships from DNAm to trait or vice versa, indicating a more complex genotype-phenotype map than previously anticipated.Molecular Epidemiolog