Risk of operative delivery for intrapartum fetal compromise in small-for-gestational-age fetuses at term: external validation of the IRIS algorithm.

OBJECTIVES: Small-for-gestational-age fetuses (SGA) are at high risk of intrapartum fetal compromise requiring operative delivery. In a recent study, we developed a model using a combination of three antenatal (gestational age at delivery, parity, cerebroplacental ratio) and three intrapartum (epidural use, labor induction and augmentation using oxytocin) variables for the prediction of operative delivery due to presumed fetal compromise in SGA fetuses - the Individual RIsk aSsessment (IRIS) prediction model. The aim of this study was to test the predictive accuracy of the IRIS prediction model in an external cohort of singleton pregnancies complicated by SGA. METHODS: This was an external validation study using a cohort of pregnancies from two tertiary referral centers in Spain and England. The inclusion criteria were singleton pregnancies diagnosed with an SGA fetus, defined as estimated fetal weight (EFW) below the 10th centile for gestational age at 36 weeks or beyond, which had fetal Doppler assessment and available data on their intrapartum care and pregnancy outcomes. The main outcome in this study was the operative delivery for presumed fetal compromise. External validation was performed using the coefficients obtained in the original development cohort. The predictive accuracies of models were investigated with receiver operating characteristics (ROC) curves. The Hosmer-Lemeshow test was used to test the goodness-of-fit of models and calibration plots were also obtained for visual assessment. A mobile application using the combined model algorithm was developed to facilitate clinical use. RESULTS: Four hundred twelve singleton pregnancies with an antenatal diagnosis of SGA were included in the study. The operative delivery rate was 22.8% (n = 94). The group which required operative delivery for presumed fetal compromise had significantly fewer multiparous women (19.1 versus 47.8%, p < 0.001 in the total study population; 19.0 versus 43.5 and 19.2 versus 49.6%, UK and Spain cohort, respectively), lower cerebroplacental ratio (CPR) multiples of median (MoM) (median: 0.77 versus 0.92, p < 0.001 in the total study population; 0.77 versus 0.92 and 0.77 versus 0.92, UK and Spain cohort, respectively), more inductions of labor (74.5 versus 60.1%, p = 0.010 in the total study population; 85.7 versus 77.2 and 71.2% and 53.1, UK and Spain cohort, respectively) and more use of oxytocin augmentation (57.4 versus 39.3%, p = 0.002 in the total study population; 19.0 versus 12.0 and 68.5 and 50.4%, UK and Spain cohort, respectively) compared to those who did not require operative delivery due to presumed fetal compromise. When the original antenatal model was applied to the present cohort, we observed moderate predictive accuracy (AUC: 0.70, 95% CI: 0.64-0.76), and no signs of poor fit (p = 0.464). The original combined model, when applied to the external cohort, had moderate predictive accuracy (AUC: 0.72, 95% CI: 0.67-0.77) and also no signs of poor fit (p = 0.268) without the need for refitting. A statistically significant increase in the predictive accuracy was not achieved via refitting of the combined model (AUC 0.76 versus 0.72, p = 0.060). CONCLUSIONS: Using our recently published model, the predictive accuracy for fetal compromise requiring operative delivery in term fetuses thought to be SGA was modest and showed no signs of poor fit in an external cohort. The IRIS tool for mobile devices has been developed to facilitate wide clinical use of this prediction model

A Synoptic Overview of Expert Opinion on Fisheries in a Post-Brexit World

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Tratamiento quirúrgico de las lumbalgias de origen coxofemoral

El equilibrio del raquis sobre la pelvis y las extremidades inferiores se ve gravemente comprometido en los casos de importante y antigua actitud viciosa de la cadera. Se constituyen una báscula pélvica, una actitud escoliótica lumbar y una adaptación de las extremidades inferiores a su dismetría real o aparente. La lumbalgia puede ser la traducción clínica y su tratamiento requerirá la corrección de la cadera para reequilibrar la pelvis. El estudio de 17 casos de actitud viciosa de cadera con lumbalgia que desaparece al corregir aquella ponen de manifiesto el valor de esta indicación terapéutica que muchas veces es muy laboriosa debido a la complejidad del desequilibrio. En su conjunto los tratamientos seguidos se resumen en: artrolisis, artroplastia, artrodesis u osteotomía direccional

Neuropatías periféricas en prótesis total de cadera

Se estudian seis casos de neuropatía periférica como complicación de la artroplastia de cadera. Para investigar la posible causa de la lesión se observa el biotipo del paciente, protocolo de la intervención quirúrgica, radiografía postoperatoria y evolución clínica y electromiográfica de la lesión nerviosa. Los autores encuentran una relación entre la obesidad y la lesión del nervio femoral. La etiología de la lesión de este nervio está en clara relación con la colocación de los separadores necesarios para la exposición del cotilo. En la lesión del nervio ciático, a no ser por graves errores técnicos, como la producción de una falsa vía, la causa de la lesión es oscura y creemos que puede ser debida a la elongación del nervio provocada por un estiramiento del músculo piramidal al colocar el separador de peso de Muller. La evolución satisfactoria de las lesiones nerviosas indican que se trata de una neuropraxia

Liver Graft Hypothermic Static and Oxygenated Perfusion (HOPE) Strategies: A Mitochondrial Crossroads.

Marginal liver grafts, such as steatotic livers and those from cardiac death donors, are highly vulnerable to ischemia-reperfusion injury that occurs in the complex route of the graft from "harvest to revascularization". Recently, several preservation methods have been developed to preserve liver grafts based on hypothermic static preservation and hypothermic oxygenated perfusion (HOPE) strategies, either combined or alone. However, their effects on mitochondrial functions and their relevance have not yet been fully investigated, especially if different preservation solutions/effluents are used. Ischemic liver graft damage is caused by oxygen deprivation conditions during cold storage that provoke alterations in mitochondrial integrity and function and energy metabolism breakdown. This review deals with the relevance of mitochondrial machinery in cold static preservation and how the mitochondrial respiration function through the accumulation of succinate at the end of cold ischemia is modulated by different preservation solutions such as IGL-2, HTK, and UW (gold-standard reference). IGL-2 increases mitochondrial integrity and function (ALDH2) when compared to UW and HTK. This mitochondrial protection by IGL-2 also extends to protective HOPE strategies when used as an effluent instead of Belzer MP. The transient oxygenation in HOPE sustains the mitochondrial machinery at basal levels and prevents, in part, the accumulation of energy metabolites such as succinate in contrast to those that occur in cold static preservation conditions. Additionally, several additives for combating oxygen deprivation and graft energy metabolism breakdown during hypothermic static preservation such as oxygen carriers, ozone, AMPK inducers, and mitochondrial UCP2 inhibitors, and whether they are or not to be combined with HOPE, are presented and discussed. Finally, we affirm that IGL-2 solution is suitable for protecting graft mitochondrial machinery and simplifying the complex logistics in clinical transplantation where traditional (static preservation) and innovative (HOPE) strategies may be combined. New mitochondrial markers are presented and discussed. The final goal is to take advantage of marginal livers to increase the pool of suitable organs and thereby shorten patient waiting lists at transplantation clinics

Polyethylene Glycol 35 as a perfusate additive for mitochondrial and glycocalyx protection in HOPE liver preservation

Organ transplantation is a multifactorial process in which proper graft preservation is a mandatory step for the success of the transplantation. Hypothermic preservation of abdominal organs is mostly based on the use of several commercial solutions, including UW, Celsior, HTK and IGL-1. The presence of the oncotic agents HES (in UW) and PEG35 (in IGL-1) characterize both solution compositions, while HTK and Celsior do not contain any type of oncotic agent. Polyethylene glycols (PEGs) are non-immunogenic, non-toxic and water-soluble polymers, which present a combination of properties of particular interest in the clinical context of ischemia-reperfusion injury (IRI): they limit edema and nitric oxide induction and modulate immunogenicity. Besides static cold storage (SCS), there are other strategies to preserve the organ, such as the use of machine perfusion (MP) in dynamic preservation strategies, which increase graft function and survival as compared to the conventional static hypothermic preservation. Here we report some considerations about using PEG35 as a component of perfusates for MP strategies (such as hypothermic oxygenated perfusion, HOPE) and its benefits for liver graft preservation. Improved liver preservation is closely related to mitochondria integrity, making this organelle a good target to increase graft viability, especially in marginal organs (e.g., steatotic livers). The final goal is to increase the pool of suitable organs, and thereby shorten patient waiting lists, a crucial problem in liver transplantation

Vitamin D levels in children and adolescents with chronic tic disorders: a multicentre study.

This study investigated whether vitamin D is associated with the presence or severity of chronic tic disorders and their psychiatric comorbidities. This cross-sectional study compared serum 25-hydroxyvitamin D [25(OH)D] (ng/ml) levels among three groups: children and adolescents (3-16 years) with CTD (n = 327); first-degree relatives (3-10 years) of individuals with CTD who were assessed for a period of up to 7 years for possible onset of tics and developed tics within this period (n = 31); and first-degree relatives who did not develop tics and were ≥ 10 years old at their last assessment (n = 93). The relationship between 25(OH)D and the presence and severity of tics, as well as comorbid obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD), were analysed controlling for age, sex, season, centre, latitude, family relatedness, and comorbidities. When comparing the CTD cohort to the unaffected cohort, the observed result was contrary to the one expected: a 10 ng/ml increase in 25(OH)D was associated with higher odds of having CTD (OR 2.08, 95% CI 1.27-3.42, p < 0.01). There was no association between 25(OH)D and tic severity. However, a 10 ng/ml increase in 25(OH)D was associated with lower odds of having comorbid ADHD within the CTD cohort (OR 0.55, 95% CI 0.36-0.84, p = 0.01) and was inversely associated with ADHD symptom severity (β = - 2.52, 95% CI - 4.16-0.88, p < 0.01). In conclusion, lower vitamin D levels were not associated with a higher presence or severity of tics but were associated with the presence and severity of comorbid ADHD in children and adolescents with CTD

Contribución al desarrollo territorial de los grupos de productores rurales pertenecientes al programa Cambio Rural del INTA Colonia Benitez

The “Cambio Rural” Program from the Argentine Ministry of Livestock, Agriculture and Fisheries is a tool for rural extension and territorial intervention that promotes productive and socioeconomic improvement of small and medium-sized rural producers, being Nacional Institute of Agricultural Technology (INTA) in charge of coordination and budget execution. The aim of this work is to analyze the results obtained by groups of producers working with Colonia Benítez Agricultural Experiment Station (EEA) INTA, from February 2018 to March 2020. The implemented strategy among the groups is associativism along with workgroup methodology and professional technical assistance. In this sense, the group method is based on: monthly meetings, the group workplans, individual development plans, individual visits to the lots. Most of the producers from the groups reinforced their strengths, agreed to detect the weaknesses in their activities, introduced their problems and opportunities, fostered associated work and took advantage from the assistance provided by the Counselor, the Project Officer and Colonia Benítez INTA technical extension and investigation team. Common achievements were installed through associativism through which technologies adapted to each activity were incorporated, products and services were commercialized, costs were reduced, and value was added to new products, services and processes. Another point achieved is the institutional and inter-institutional connection that allowed articulating actions at local, provincial and national levels; both with private and governmental organizations.El programa Cambio Rural del Ministerio de Agricultura Ganadería y Pesca de la Nación Argentina es una herramienta de extensión rural e intervención territorial que promueve la mejora productiva y socioeconómica de los pequeños y medianos productores rurales, siendo el Instituto Nacional de Tecnología Agropecuaria (INTA) el responsable de su coordinación operativa y ejecución presupuestaria. El objetivo de este trabajo es analizar los resultados obtenidos por los grupos pertenecientes a la Estación Experimental Agropecuaria (EEA) Colonia Benítez del INTA, durante el periodo febrero 2018 a marzo 2020.  La estrategia utilizada en los grupos es el asociativismo, con la metodología de trabajo grupal y la asistencia técnica profesional. En este sentido, el método grupal se sustenta en los siguientes pilares: La reunión mensual, el plan de trabajo grupal, el plan de mejoras individuales y la visita individual predial. La mayoría de los productores integrantes de los grupos afianzaron sus fortalezas, accedieron a detectar los puntos débiles de sus actividades, abordaron problemas y oportunidades, promovieron el trabajo asociado y aprovecharon la asistencia del Promotor Asesor, el Agente de Proyecto y del Equipo Técnico de extensión e investigación del INTA Colonia Benítez. En los grupos quedaron instalados los logros comunes, a través del asociativismo, mediante el cual se incorporaron tecnologías adaptadas a cada actividad, se comercializaron productos y servicios, se disminuyeron costos y se agregó valor obteniendo nuevos productos, servicios y procesos. Otro punto logrado, es la vinculación institucional e interinstitucional que permitió articular acciones a nivel municipal, provincial y nacional; tanto con privados y organismos gubernamentales