ANESTESIA PARA CIRUGÍA CORRECTIVA DE ESCOLIOSIS

La Unidad Docente Asistencial de Anestesiología Pediátrica del Centro Hospitalario Pereira Rossell integra el equipo multidisciplinario de tratamiento de las enfermedades de la columna vertebral desde hace cinco años. La escoliosis es una de las deformidades del raquis que puede requerir cirugía correctiva con implicancias anestesiológicas relevantes. Realizamos un estudio retrospectivo y descriptivo de 95 procedimientos anestesiológicos realizados a los pacientes que fueron sometidos a cirugía correctiva de escoliosis en el período comprendido entre marzo de 2.011 a marzo de 2.016. Los objetivos de este trabajo son comunicar nuestra experiencia junto con una revisión no sistematizada de la evidencia científica disponible en las bases de datos: Pubmed, Medline y SciELO. Concluimos que un manejo óptimo de los pacientes con escoliosis se logra realizando una adecuada evaluación perioperatoria.

Biodiversidade e abundância da ictiofauna associada ao cultivo orgânico de Litopenaeus vannamei (Boone, 1931)

The expansion of shrimp farming has caused a series of environmental impacts, often as a result of lack of planning and adequate management. Organic aquaculture has emerged as an alternative to conventional shrimp farming, and differently, aims at the economical, ecological and farming potential of other organisms, such as fishes, oysters and seaweeds. The present study aimed at evaluating the biological diversity and abundance of the ichthyofauna associated to Litopenaeus vannamei organic culture at PRIMAR farm (Rio Grande do Norte, Brazil). The sampling period consisted of four culture cycles (1, 2, 3, and 4) accomplished in four grow-out ponds (V1, V7, V2, and V4) in 2005. The first two culture cycles were carried out during the rainy season, and the last two cycles, during the dry season. Environmental (temperature, salinity, transparency, and rainfall), biodiversity (diversity and uniformity and abundance indexes) of the ichthyofauna, and shrimp productivity data were collected throughout these four culture cycles. The results obtained for the environmental variables showed that both salinity and transparency oscillated in a significant way (p < 0.001) between culture cycles. In relation to the abundance of the ichthyofauna, fifty four species associated to the organic culture of Litopenaeus vannamei were collected and identified at PRIMAR. For the biodiversity criterion, larger species richness (S = 46) and uniformity (E = 0.59 ± 0.16) were observed during cycles 3 and 4 than in cycles 1 and 2 (S = 41 and E = 0.15 ± 0.12). A positive and significant correlation was obtained for the transparency with diversity and uniformity of fish species between cycles 1 and 2 (wet season) and cycles 3 and 4 (dry season) (p < 0.017 - Shannon Index; p < 0.008 - Pielou Index, respectively). A correlation could not be established between shrimp productivity and fish biomass. However, fish biomass decreased from cycles 1 and 2 to cycles 3 and 4, concomitant with an increase in shrimp productivity, most probably due to a higher (from 58.0% to 71.0%) shrimp survival. Regarding the culture potential of the ichthyofauna, three species (Mugil curema, Mugil liza and Chaetodipterus faber) were identified as potential farming alternatives, either singly or in consortium with Litopenaeus vannamei. A fourth species (Centropomus undecimalis) was indicated as an alternative for single culture or in consortium with other fish species. In conclusion, the large diversity of estuarine fishes associated to Litopenaeus vannamei farming observed at PRIMAR clearly indicated the ecological feasibility for organic aquaculture in northeastern Brazil

Guía clínica para el manejo interdisciplinario del paciente con secuelas de pérdida masiva de peso durante la cirugía plástica reconstructiva

Antecedentes y Objetivos. La obesidad está considerada como una pandemia y México ocupa uno de los primeros lugares mundiales en número de casos en población adulta y el primero en el grupo infantil. Desde 2008 se pusieron en marcha Unidades de Cirugía Bariátrica para el manejo del paciente obeso, con lo cual se inició también la Reconstrucción postpérdida masiva de peso por los Servicios de Cirugía Plástica. Sin embargo, no existen protocolos descritos de manejo perioperatorio de este tipo de pacientes en nuestro país. El objetivo del presente trabajo es crear una guía clínica para el manejo interdisciplinario del paciente con secuelas de pérdida masiva de peso basada en los resultados obtenidos en un centro de reconstrucción postbariátrica. Material y Método. Creamos para ello un equipo de expertos de cada área involucrada y se estandarizó el manejo pre, trans y postoperatorio de todos los pacientes con secuelas de pérdida masiva de peso a fin de evaluar los resultados obtenidos. Resultados. Se realizaron 314 procedimientos reconstructivos en 144 pacientes postbariátricos. El 93% fueron de sexo femenino. La edad promedio fue de 37.2 años. Los procedimientos realizados fueron: abdominoplastia en un 39.17%; mastopexia en un 10.5%; torsoplastia en un 7.69%; braquioplastia en un 7.01%; cruroplastia en un 5.09%; y ritidoplastia en un 2.54%. El tiempo quirúrgico promedio fue de 221.2 minutos, con un sangrado transoperatorio medio de 275 ml. Las complicaciones presentadas alcanzaron el 4.77% y la mortalidad fue de 0%. Las recomendaciones emitidas por cada experto involucrado en el proceso de reconstrucción permitieron obtener resultados favorables en relación a la morbi-mortalidad, que fue equiparable e incluso inferior a la reportada en otras series. Conclusiones. Creemos que el seguimiento de una guía clínica basada en la estandarización del manejo de 314 procedimientos en una población con características similares, nos permite realizar la reconstrucción postpérdida masiva de peso de forma eficaz y segura.

Hibernoma de cavidad oral: una entidad infrecuente

El hibernoma es un tumor adiposo benigno que morfológicamente rememora la grasa fetal. Su presencia a nivel oral es excepcional. Presentamos un caso de hibernoma de cavidad oral, revisamos la entidad y mostramos los distintos diagnósticos diferenciales.

Preparación y caracterización de biomateriales híbridos de hidroxiapatito con fosfonato (2-Hidroxi fosfonoacetato)

El hidroxiapatito es el biomineral de los tejidos duros de los mamíferos y por ello ha sido ampliamente estudiado como biomaterial en cementos óseos, recubrimientos de metales implantables y scaffold en ingeniería de tejidos. En este trabajo, se estudia un proceso síntesis y caracterización de un derivado de este material, donde el ion fosfonato: 2- hidroxifosfonoacetato sustituye parcialmente al ion fosfato [1-10%]. El proceso de síntesis de hidroxiapatito consiste en dos etapas: (1) una reacción a 100ºC entre el ácido fosfórico (añadido lentamente) y una mezcla de hidróxido de calcio + 2-hidroxifosfonoacetato de calcio (Relación Ca/P=1.67). (2) un tratamiento térmico de los sólidos obtenidos en (1) a 150ºC. Los productos finales se han caracterizado mediante análisis químico, análisis termogravimétrico, difracción de rayos-X con análisis de Rietveld, microscopía SEM y determinación de la superficie específica y porosidad. En las fases cristalinas, el grado de pureza de los hidroxiapatitos oscila entre 91-100%. Todos presentan estructura monoclínica, en contraste con la estructura hexagonal que habitualmente se obtiene aplicando métodos de síntesis similares. Esta variación se atribuye a la presencia de fosfonato. El contenido de éste también influye en la morfología y en la porosidad de los materiales, siendo las muestras con más fosfonato las más porosas. Los materiales, al menos aquellos con una cantidad menor o igual 5% de fosfonato, muestran una biocompatibilidad similar a un material de hidroxiapatito de referencia.

Synthesis and proton conduction properties of lanthanide amino-sulfophosphonates

Crystalline acid-functionalized metal phosphonates are potential candidates as proton conducting electrolytes. Their frameworks can be chemically modified to contain proton carriers such as acidic groups (P-OH; -SO3H, -COOH,…) and guest molecules (H2O, NH3,…) that generates hydrogen bond networks stable in a wide range of temperature [1,2]. In this work, focus is laid on properties derived from the combination of lanthanide ions with the amino-sulfophosphonate ligand (H2O3PCH2)2-N-(CH2)2-SO3H. Hightrough-put screening was followed to reach the optimal synthesis conditions under solvothermal conditions at 140 ºC. Isolated polycrystalline solids, Ln[(O3PCH2)2-NH-(CH2)2-SO3H].2H2O (Ln= La, Pr and Sm), crystallize in the monoclinic (La) and orthorhombic (Pr and Sm) systems with unit cell volume of ~2548 Å3. Preliminary proton conductivity measurements for Sm derivative have been carried out between 25º and 80 ºC at relative humidity (RH) values of 70 % and 95 %. The sample exhibits enhanced conductivity at high RH and T (Figure 1) and constant activation energies of 0.4 eV, typical of a Grothuss mechanism of proton.

Structure-properties correlations in divalent metal phosphonates

Crystalline metal phosphonates may offer acidic sites, structural flexibility and guest molecules (H2O, heterocyclics, etc.) which can act as proton carriers. In addition, some frameworks are also amenable for post‐synthesis modifications in order to enhance desired properties [1,2]. In this work, we present the synthesis and structural characterization of two hydroxyphosphonoacetates hybrids based on magnesium, [Mg5(O3PCHOHCOO)2(HO3PCHOHCOO)2·8H2O] [Mg5(HPAA)2(H1HPAA)2·8H2O], and zinc, [Zn6K(O3PCHOHCOO)4(OH)·6.5H2O] [Zn6K(HPAA)4(OH)·6.5H2O]. Both solids present three-dimensional frameworks and their crystal structures were solved ab initio from X-ray powder diffraction. The proton conductivity of [Zn6K(HPAA)4(OH)·6.5H2O] as well as ammonia derivatives of M(II)(HO3PCHOHCOO)·2H2O [M(II)=Zn, Mg] will be reported and discussed.

Proton conductivity and luminiscence properties of lanthanide aminotriphosphonates

Metal phosphonates are multifunctional solids with tunable properties, such as internal H-bond networks, and high chemical and thermal stability [1]. In the present work, we describe the synthesis, structural characterization, luminescent properties and proton conduction performance of a new family of isostructural cationic compounds with general formula [Ln(H4NMP)(H2O)2]Cl·2H2O [Ln = La3+, Pr3+, Sm3+, Gd3+, Tb3+, Dy3+, Ho3+, H6NMP = nitrilotris(methylphosphonic acid)]. These solids are formed by positively charge layers, which consist of isolated LnO8 polyhedra and bridge chelating NMP2- ligands, held apart by chloride ions and water molecules. This arrangement result in extended interlayer hydrogen networks with possible proton transfer pathways. The proton conductivity of Gd3+ sample, selected as prototype of the series, was measured. In the range between range 25º and 80 ºC, the conductivity increase with the temperature up to a maximum value of 3.10-4 S·cm-1, at relative humidity of 95 %. The activation energy obtained from the Arrhenius plot (Figure 1) is in the range corresponding to a Grotthuss transfer mechanism.

Implicación de las células mesenquimales multipotenciales derivadas del tejido adiposo humano en la patogénesis del síndrome metabólico

Introducción: La diminución de la capacidad de expansión del tejido adiposo juega un papel crucial en el origen y desarrollo de los trastornos asociados al síndrome metabólico. Hipótesis y Objetivos: Considerando que la expansión del tejido adiposo depende del estado de sus células mesenquimales multipotenciales (ASCs), es probable que las condiciones tisulares asociadas a los períodos de balance energético positivo generen alteraciones en los patrones heredables de transcripción génica mediante los que las ASCs quedan predispuestas a favor del fenotipo fibrótico e inflamatorio, en detrimento de su función adipogénica y neovascular. Para corroborar ésta hipótesis nos propusimos revelar la implicación de las ASCs en la remodelación tisular adiposa; su contribución a la disminución de la capacidad angiogénica del tejido adiposo; y evaluar su respuesta neovascular, migratoria e inflamatoria ante la hipoxia. Metodología: Aplicamos técnicas de cultivo celular, citometría de flujo, qPCR, western blot y ELISA a las ASCs aisladas del tejido adiposo visceral y subcutáneo de 69 sujetos agrupados en normopesos, y obesos con (SM) y sin síndrome metabólico (NoSM). Resultados: Los adipocitos generados a partir de las ASC visceral y subcutáneo evidenciaronn una disminución en los niveles intrínsecos de expresión del transportador de glucosa GLUT4 conforme aumenta la expresión de proteínas fibróticas, el BMI y el HOMA-IR de los pacientes. El empeoramiento del perfil metabólico de los sujetos estuvo acompañado por la disminución de la tasa proliferativa, el potencial clonogénico y la exportación del FGF2 hacia la superficie celular de las ASC derivadas de ambos tejidos. Las ASC visceral y subcutáneo de los sujetos SM también mostraron una disminución en la capacidad de formación de túbulos respecto a las ASCs de los sujetos obesos NoSM así como alteraciones en los niveles de expresión de proteínas implicadas en el balance redox celular y vinculadas al fenotipo secretor asociado a senescencia. El deterioro de las propiedades neovasculares de las ASC subcutáneo de los sujetos SM se evidenció además en los niveles de secreción del VEGF durante la adipogénesis y en los efectos del medio condicionado adipogénico sobre la formación de túbulos por células endoteliales. Aunque las ASC visceral de los sujetos SM cultivadas bajo hipoxia mostraron mayor porcentaje de células CD140b+/CD44+ y CD140b+/CD184+ así como mayor capacidad migratoria que las ASC visceral de los sujetos NoSM, también evidenciaron menor capacidad de formación de túbulos, transcribieron más RNAm NOX5 y su medio condicionado disminuyó la supervivencia de las células endoteliales. Conclusiones: El funcionamiento del tejido adiposo parece condicionar el deterioro de sus propias células precursoras y ante el cual las ASCs de los sujetos que desarrollan síndrome metabólico son más vulnerables.

Ammonia effects on proton conductivity properties of coordination polymers

Crystalline metal phosphonates are referred to as a type of structurally versatile coordination polymers [1]. Many of them contain guest molecules (H2O, heterocyclics, etc.), acidic sites and, furthermore, their structure can be also amenable for post‐synthesis modifications in order to enhance desired properties [2]. In the present work, we examine the relationships between crystal structure and proton conductivity for several metal phosphonates derive from multifunctional ligands, such as 5-(dihydroxyphosphoryl)isophthalic acid (PiPhtA) [3] and 2-hydroxyphosphonoacetic acid (H3HPAA). Crystalline divalent metal derivatives show a great structural diversity, from 1D to 3D open-frameworks, possessing hydrogen-bonded water molecules and acid groups. These solids present a proton conductivity range between 7.2·10-6 and 1.3·10−3 S·cm-1. Upon exposure to ammonia vapor, from an aqueous solution, solid state transformations are observed accompanied of enhance proton conductivities. The stability of these solids under different environment conditions (temperature and relative humidities) as well as the influence of the ammonia adsorption on the proton conduction properties of the resulting solids will be discussed.

Biodiversidade e abundância da ictiofauna associada ao cultivo orgânico de Litopenaeus vannamei (Boone, 1931)

The expansion of shrimp farming has caused a series of environmental impacts, often as a result of lack of planning and adequate management. Organic aquaculture has emerged as an alternative to conventional shrimp farming, and differently, aims at the economical, ecological and farming potential of other organisms, such as fishes, oysters and seaweeds. The present study aimed at evaluating the biological diversity and abundance of the ichthyofauna associated to Litopenaeus vannamei organic culture at PRIMAR farm (Rio Grande do Norte, Brazil). The sampling period consisted of four culture cycles (1, 2, 3, and 4) accomplished in four grow-out ponds (V1, V7, V2, and V4) in 2005. The first two culture cycles were carried out during the rainy season, and the last two cycles, during the dry season. Environmental (temperature, salinity, transparency, and rainfall), biodiversity (diversity and uniformity and abundance indexes) of the ichthyofauna, and shrimp productivity data were collected throughout these four culture cycles. The results obtained for the environmental variables showed that both salinity and transparency oscillated in a significant way (p < 0.001) between culture cycles. In relation to the abundance of the ichthyofauna, fifty four species associated to the organic culture of Litopenaeus vannamei were collected and identified at PRIMAR. For the biodiversity criterion, larger species richness (S = 46) and uniformity (E = 0.59 ± 0.16) were observed during cycles 3 and 4 than in cycles 1 and 2 (S = 41 and E = 0.15 ± 0.12). A positive and significant correlation was obtained for the transparency with diversity and uniformity of fish species between cycles 1 and 2 (wet season) and cycles 3 and 4 (dry season) (p < 0.017 - Shannon Index; p < 0.008 - Pielou Index, respectively). A correlation could not be established between shrimp productivity and fish biomass. However, fish biomass decreased from cycles 1 and 2 to cycles 3 and 4, concomitant with an increase in shrimp productivity, most probably due to a higher (from 58.0% to 71.0%) shrimp survival. Regarding the culture potential of the ichthyofauna, three species (Mugil curema, Mugil liza and Chaetodipterus faber) were identified as potential farming alternatives, either singly or in consortium with Litopenaeus vannamei. A fourth species (Centropomus undecimalis) was indicated as an alternative for single culture or in consortium with other fish species. In conclusion, the large diversity of estuarine fishes associated to Litopenaeus vannamei farming observed at PRIMAR clearly indicated the ecological feasibility for organic aquaculture in northeastern Brazil

Environmental factors correlated with the metabolite profile of Vitis vinifera cv. Pinot Noir berry skins along a European latitudinal gradient

Mature berries of Pinot Noir grapevines were sampled across a latitudinal gradient in Europe, from southern Spain to central Germany. Our aim was to study the influence of latitude-dependent environmental factors on the metabolite composition (mainly phenolic compounds) of berry skins. Solar radiation variables were positively correlated with flavonols and flavanonols and, to a lesser extent, with stilbenes and cinnamic acids. The daily means of global and erythematic UV solar radiation over long periods (bud break-veraison, bud break-harvest, and veraison-harvest), and the doses and daily means in shorter development periods (5–10 days before veraison and harvest) were the variables best correlated with the phenolic profile. The ratio between trihydroxylated and monohydroxylated flavonols, which was positively correlated with antioxidant capacity, was the berry skin variable best correlated with those radiation variables. Total flavanols and total anthocyanins did not show any correlation with radiation variables. Air temperature, degree days, rainfall, and aridity indices showed fewer correlations with metabolite contents than radiation. Moreover, the latter correlations were restricted to the period veraison-harvest, where radiation, temperature, and water availability variables were correlated, making it difficult to separate the possible individual effects of each type of variable. The data show that managing environmental factors, in particular global and UV radiation, through cultural practices during specific development periods, can be useful to promote the synthesis of valuable nutraceuticals and metabolites that influence wine quality.

Gender differences in right ventricular function in patients with non-ischaemic cardiomyopathy

The aim of this study is to evaluate sex-related differences in right ventricular (RV) function, assessed with cardiac magnetic resonance imaging, in patients with stable non-ischaemic dilated cardiomyopathy. Mean age was 60.9 ± 12.2 years. Men presented higher levels of haemoglobin and white blood cell counts than women, and performed better in cardiopulmonary stress testing. A total of 24 patients (12 women) presented severe left ventricular (LV) systolic dysfunction, 32 (13 female) moderate and 15 (8 women) mild LV systolic dysfunction. In the group with severe LV systolic dysfunction, average right ventricular ejection fraction (RVEF) was normal in women (52 ± 4 %), whereas it was reduced in men (39 ± 3 %) p = 0.035. Only one woman (8 %) had severe RV systolic dysfunction (RVEF < 35 %) compared with 6 men (50 %) p < 0.001. In patients with moderate and mild LV dysfunction , the mean RVEF was normal in both men and women. In the 14 healthy volunteers, the lowest value of RVEF was 48 % and mean RVEF was normal in women (56 ± 2 %) and in men (51 ±  1 %), p = 0.08. In patients with dilated cardiomyopathy, RV systolic dysfunction is found mainly in male patients with severe LV systolic dysfunction.