Predictors of Respiratory Failure Development in a Multicenter Cohort of Inpatients With Cirrhosis

INTRODUCTION

Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is associated with a poor prognosis, but predisposing factors are unclear.

METHODS

We prospectively enrolled a multicenter North American cirrhosis inpatient cohort and collected admission and in-hospital data (grading per European Association for the Study of Liver-Chronic Liver Failure scoring system, acute kidney injury [AKI], infections [admission/nosocomial], and albumin use) in an era when terlipressin was not available in North America. Multivariable regression to predict RF was performed using only admission day and in-hospital events occurring before RF.

RESULTS

A total of 511 patients from 14 sites (median age 57 years, admission model for end-stage liver disease [MELD]-Na 23) were enrolled: RF developed in 15%; AKI occurred in 24%; and 11% developed nosocomial infections (NI). At admission, patients who developed RF had higher MELD-Na, gastrointestinal (GI) bleeding/AKI-related admission, and prior infections/ascites. During hospitalization, RF developers had higher NI (especially respiratory), albumin use, and other organ failures. RF was higher in patients receiving albumin (83% vs 59%, P < 0.0001) with increasing doses (269.5 ± 210.5 vs 208.6 ± 186.1 g, P = 0.01) regardless of indication. Admission for AKI, GI bleeding, and high MELD-Na predicted RF. Using all variables, NI (odds ratio [OR] = 4.02, P = 0.0004), GI bleeding (OR = 3.1, P = 0.002), albumin use (OR = 2.93, P = 0.01), AKI (OR = 3.26, P = 0.008), and circulatory failure (OR = 3.73, P = 0.002) were associated with RF risk.

DISCUSSION

In a multicenter inpatient cirrhosis study of patients not exposed to terlipressin, 15% of patients developed RF. RF risk was highest in those admitted with AKI, those who had GI bleeding on admission, and those who developed NI and other organ failures or received albumin during their hospital course. Careful volume monitoring and preventing nosocomial respiratory infections and renal or circulatory failures could reduce this risk.

Emotional Intelligence and Well-being in Adolescents: a Systematic Review and Meta-analysis

Introduction

Adolescent´s subjective well-being (SWB) can be improved through the training of emotional intelligence (EI).

Objectives

The goal of this study is to determine the general link between EI and SWB in adolescents, to analyze the affective (AWB) and cognitive components (CWB) of SWB, and to investigate the moderating effect of EI models on both types of SWB.

Methods

We searched PsycINFO and WOS from inception to December 2020. Eligible studies reported an association between EI and SWB in adolescents aged from 10 to 19 years using instruments that directly measure SWB. Two meta-analyses were conducted, one for the relationship between EI and AWB and the other for EI and CWB.

Results

A total of 41 studies were included, of which 37 were pooled in the meta-analyses. We obtained a significant positive relationship between EI and AWB (estimated effect size = 0.35) and between EI and CWB (0.29). Concerning EI models, self-report ability showed an estimated effect size of 0.33 for AWB and 0.28 for CWB. For the self-report mixed model, we found an estimated effect size of 0.42 for AWB and 0.38 for CWB.

Conclusions

Establishing a quantitative relationship between SWB and EI makes it possible to implement both clinical and educational prevention measures. Introducing EI training in educational and clinical settings can increase SWB, which could significantly impact the prevention of emotional disorders in adolescents.

Disclosure

No significant relationships.

The moderating role of emotion regulation on the relationship between sensitivity to punishment and aggressive behaviour

Introduction

The role of sensitivity to punishment on aggression is controversial, both positive and negative relationships have been observed in previous literature.

Objectives

The aim of this research was to clarify the role of sensitivity to punishment in different types of aggression and provide a better understanding of the influence of emotional regulation on this relationship.

Methods

Two hundred and twenty-nine participants took part in the study (130 women; average age = 21.52 years). All of them were assessed for levels of verbal aggression, physical aggression, anger, and hostility (by Buss-Perry Aggression Questionnaire), levels of sensitivity to punishment (by SPSRQ–20), and emotional regulation ability (by MSCEIT).

Results

A higher reactivity to punishment had a direct negative effect on physical and verbal aggression. However, a higher reactivity to punishment also showed a positive indirect effect on verbal and physical aggression through an increase in anger and hostility. In addition, ability in regulating emotions moderated the indirect effects of sensitivity to punishment on physical aggression.

Conclusions

Our results suggest that sensitivity to punishment can act both as a protective factor and as a risk factor for aggression. This relationship depended on the type of aggression studied and the emotional regulation abilities. These findings can help to inform the design of programs aimed at reducing aggressive behaviour. This work was funded by Junta de Andalucía (projects: EMERGIA20_00056 and UMA18-FEDERJA-137) to Alberto Megías Robles.

Disclosure

No significant relationships.

Post-infantile giant cell hepatitis: A single center’s experience over 25 years

BACKGROUND

Giant cell hepatitis in the adult population remains very poorly defined with only 100 case reports published in the literature over the last three decades.

AIM

To present our center’s experience in an attempt to learn about the predisposing factors, outcomes and efficacy of proposed therapeutic interventions for giant cell hepatitis.

METHODS

A retrospective chart review was conducted through the electronic records of the University of Pittsburgh Medical Center. We queried 36726 liver biopsy reports from January 1, 1991 to December 6, 2016. Our search yielded 50 patients who were identified as carrying a definite diagnosis of post-infantile giant cell hepatitis (PIGCH) by pathology. The data collected included demographic information, laboratory data (liver function tests, autoimmune markers) and transplant status. In order to better analyze patient characteristics and outcomes, subjects were separated into a non-transplant (native) liver group and a post-liver transplant (allograft) group.

RESULTS

The incidence of PIGCH was approximately 0.14% of all biopsies queried in the 25-year period. The mean age was 48 years with 66% females. Liver function tests were classified as 38.2% cholestatic, 35.3% hepatocellular and 26.5% mixed. Autoimmune hepatitis was found to be the most prevalent predisposing factor leading to PIGCH constituting 32% of cases. Management consisted mainly of immunosuppression, viral targeted therapy, supportive care and in six cases liver transplantations.

CONCLUSION

The diagnosis of PIGCH remains clinically challenging and requires a high index of suspicion as well as a thorough history, physical examination, serological workup and liver biopsy. Treatment of the underlying cause can result in clinical stability in a large number of cases.

Detection of Approximal Caries Lesions in Adults: A Cross-sectional Study

Detection and management of posterior approximal caries lesions are still problematic. Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. Unfortunately, there is no definite radiographic appearance to identify lesion cavitation with absolute certainty. Many lesions detected radiographically within the outer half of dentin are not cavitated, often resulting in unnecessary restorative treatment. Our study compared radiographic depth of approximal caries lesions with presence of cavitation in adults using visual inspection following temporary tooth separation (TTS). We conducted this observational descriptive cross-sectional study at two dental schools in two cities in Chile. Clinicians were unaware of radiographic depths of lesions and examined 147 participants (57.3% female and 42.7% male) following TTS. Using the common classification system that consists of E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (lesion within the inner half of enamel), D1 (lesion within the outer third of dentin), D2 (lesion within the middle third of dentin), and D3 (lesion within the inner third of dentin), a trained dentist evaluated all the processed films. Cavitation was detected in only three sites (0.22%) within the E0 category, seven sites (3.41%) in E1, five sites (14.8%) in E2, four sites (14.8%) in D1, six sites (50%) in D2, and eight sites (61.5%) in D3. Considering that restorative treatment should be indicated strictly for cavitated lesions, our findings support indication for restorative treatment for D3 lesions and the rationale for TTS for D1-D2 caries lesions to allow direct visual inspection to determine whether there is surface cavitation.

The relationship between trait psychopathy and emotional intelligence: A meta-analytic review

Psychopathy is a personality construct that has been related to important emotional deficits. These findings have led to a growing interest in exploring if psychopathic traits are associated with emotional intelligence (EI). However, the literature exploring this association has revealed conflicting results. The aim of the present study was to provide a reliable estimate of the relationship between psychopathy traits and EI (measured as performance-based ability) through meta-analysis. A quantitative and systematic review of the literature using Scopus, Medline, Pubmed, and PsicINFO showed a total of 13 studies meeting inclusion criteria with a combined sample of 2401 participants. The meta-analysis revealed a significant negative relationship between both constructs, showing that higher psychopathic trait scores are related to lower EI levels. We propose several future research lines to clarify possible gaps and ambiguities in the current literature and a set of interesting clinical implications for the prevention, evaluation, and treatment of psychopathic traits by including EI factors in traditional models of psychopathy.

Performance on emotional tasks engaging cognitive control depends on emotional intelligence abilities: an ERP study

Cognitive control is a key process in decision making and adequately adapting our behavior to the environment. Previous studies have provided evidence of a lower capacity for cognitive control in emotion-laden contexts in comparison with neutral contexts. The aim of the present research was to study changes in cognitive control performance as a function of emotional intelligence (EI) level in contexts involving emotional information. The study sample was composed of 2 groups of 22 participants each: the high and low EI group. Participants carried out an emotional go/no-go task while brain activity was recorded by EEG. N2 and P3 ERPs were used as indices of cognitive control processing. Participants with higher EI showed a larger N2, reflecting a greater capacity for cognitive control related to changes in conflict monitoring, and to a better detection and evaluation of the emotional stimuli. Moreover, in general, response inhibition accuracy was reduced when emotional information was involved in this process. Our findings reveal that neural mechanisms underlying tasks that engage cognitive control depend on emotional content and EI level. This study indicates the important role played by EI in the relationship between emotion and cognition. EI training may be a very useful tool for improving performance in emotion-laden contexts.

Single administration of recombinant IL-6 restores the gene expression of lipogenic enzymes in liver of fasting IL-6-deficient mice

BACKGROUND AND PURPOSE

Lipogenesis is intimately controlled by hormones and cytokines as well as nutritional conditions. IL-6 participates in the regulation of fatty acid metabolism in the liver. We investigated the role of IL-6 in mediating fasting/re-feeding changes in the expression of hepatic lipogenic enzymes.

EXPERIMENTAL APPROACH

Gene and protein expression of lipogenic enzymes were examined in livers of wild-type (WT) and IL-6-deficient (IL-6(-/-) ) mice during fasting and re-feeding conditions. Effects of exogenous IL-6 administration on gene expression of these enzymes were evaluated in vivo. The involvement of STAT3 in mediating these IL-6 responses was investigated by using siRNA in human HepG2 cells.

KEY RESULTS

During feeding, the up-regulation in the hepatic expression of lipogenic genes presented similar time kinetics in WT and IL-6(-/-) mice. During fasting, expression of lipogenic genes decreased gradually over time in both strains, although the initial drop was more marked in IL-6(-/-) mice. Protein levels of hepatic lipogenic enzymes were lower in IL-6(-/-) than in WT mice at the end of the fasting period. In WT, circulating IL-6 levels paralleled gene expression of hepatic lipogenic enzymes. IL-6 administration in vivo and in vitro showed that IL-6-mediated signalling was associated with the up-regulation of hepatic lipogenic enzyme genes. Moreover, silencing STAT3 in HepG2 cells attenuated IL-6 mediated up-regulation of lipogenic gene transcription levels.

CONCLUSIONS AND IMPLICATIONS

IL-6 sustains levels of hepatic lipogenic enzymes during fasting through activation of STAT3. Our findings indicate that clinical use of STAT3-associated signalling cytokines, particularly against steatosis, should be undertaken with caution.

Probiotic Compared with Standard Milk for High-caries Children

The aim of this study was to compare milk supplemented with probiotic lactobacilli with standard milk for the increment of caries in preschool children after 10 mo of intervention. The study was a triple-blind, placebo-controlled randomized trial. Participants were children aged 2 and 3 y ( n = 261) attending 16 nursery schools in a metropolitan region in Chile. Nursery schools were randomly assigned to 2 parallel groups: children in the intervention group were given 150 mL of milk supplemented with Lactobacillus rhamnosus SP1 (107 CFU/mL), while children in the control group were given standard milk. Interventions took place on weekdays for 10 mo. Data were collected through a clinical examination of participants. The primary outcome measure was the increment of caries in preschool children. This was assessed using the International Caries Detection and Assessment System (ICDAS). The dropout rate was 21%. No differences in caries prevalence were detected between the groups at baseline ( P = 0.68). After 10 mo of probiotic intake, the caries prevalence was 54.4% in the probiotic group and 65.8% in the control group. The percentage of new individuals who developed cavitated lesions (ICDAS 5-6) in the control group (24.3%) was significantly higher than that in the probiotic group (9.7%). The increment of dental caries showed an odds ratio of 0.35 ( P < 0.05) in favor of the probiotic group. At the cavitated lesion level, the increment of new caries lesions within the groups showed 1.13 new lesions per child in the probiotic group compared with 1.75 lesions in the control group ( P < 0.05). The probiotic group showed an increment of 0.58 ± 1.17 new lesions compared with 1.08 ± 1.70 new lesions observed in the control group. The difference in caries increment was significant at the cavitated lesion level ( P < 0.01). In conclusion, the regular long-term intake of probiotic-supplemented milk may reduce caries development in high-caries preschool children (ClinicalTrials.gov: NCT01648075).

[Analysis of prognostic factors in biliary atresia]

OBJECTIVE

Biliary atresia presents a worldwide incidence about 1 of every 9000-12000 live newborns. Our goal was to analyze the prognostic variables of our patients with biliary atresia.

MATERIAL AND METHODS

Retrospective study, based on the review of all patients who underwent surgery at our centre by the Kasai technique from March 1983 to January 2012. A total of 52 variables were analyzed such as: clinical history, symptoms, diagnostic tests, use of corticosteroids, complications and evolution.

RESULTS

From 35 patients operated by Kasai Technical we included 29, being 58.82% male; grouped according to the age of surgery: Group A (< 60 days) 14/29; Group B (60-90) 14/29 and Group C (> 90) 1/29. We observed that atresia type II was more common in the Group A and III in group B and C. There was a predominance of hepatic fibrosis in patients from Group A and C, and cirrhosis in B. The mean hospital stay was 24.66; 28.50 and 50.00 days for Group A, B and C respectively. Since 2004 it is established a treatment with corticosteroids in the postoperative period; complications noted in 40% of the treated and in 70% of the untreated. In 10 years, 44.82% are asymptomatic and transplanted 37.9%.

CONCLUSIONS

In this study both the diagnosis and early Kasai technique improve prognosis. Treatment with corticoids could benefit short-term results.

[Study of the expression of neural stem cell markers in neuroblastoma tumor samples and correlation with prognostic factors]

INTRODUCTION

The existence of cancer stem cells (CSC) in neuroblastoma (NB) has been associated with the development of metastasis, resistance to chemotherapy and recurrence. Our objective is to analyze the expression of proliferation and differentiation markers of neural progenitor cells in NB samples, and to correlate this expression with clinical variables such as histology, genetics and response to conventional therapy.

MATERIAL AND METHODS

We performed a retrospective-experimental study with neuroblastoma samples obtained from biopsies or tumor resections between 2010-2012 in our Hospital. Fluorescence immunohistochemistry was used to analyze the expression of the different markers: CD44, CD74, CD133, tyrosine hydroxylase, endothelin receptors type A (ETA) and B (ETB), p75, nestina y and Phox2b, all of them related to neural stem cell biology. The level of expression of the markers was then correlated with clinical variables.

RESULTS

Nestin expression was positive in 72.2% of samples and ETA in 66.7%. PHOX2B and CD74 expression were lower, being positive in less than 30%. The markers CD44, ETB and PHOX2B were expressed in more aggressive tumors. ETA expression correlated significantly with unfavorable histology tumors (p= 0.01), N-myc amplification (p= 0.05) and recurrence/progression (p= 0.05).

CONCLUSION

The expression of CD44, ETB and ETA was associated with more aggressive tumors and poor prognostic factors. These markers are in the membrane of neural stem cells and may be useful to identify and isolate by flow cytometry CSCs of NB for the study of new therapeutic targets.

[When should a patient be referred to the pediatric surgeon?]

INTRODUCTION

An incorrect transfer of patients to paediatric surgery clinic results in clinic saturation and both patient and medical staff discomfort. As a consequence the quality of medical care is deteriorated.

AIM

1) To evaluate the transfer of new patients to paediatric surgery clinic from primary paediatric care considering the medical diagnosis and the surgical calendar, looking for the most common mistakes. 2) To analyze the inconvenience of a wrong indication for both our patients and the medical staff. 3) To propose new measures to decrease the rate of patients incorrectly transferred.

MATERIAL AND METHOD

An observational retrospective study was performed based on medical records of new patients evaluated in paediatric surgery clinic between september 2010 and january 2012. Age, address, diagnosis, transfer indication and referring centre were collected.

RESULTS

Two thousand four hundred thirty medical records were reviewed from new patients finding an incorrect transfer in 44.28% of them (2.37 children/day). From these cases wrong transfer was related to surgical calendar in 18.59% and wrong diagnosis in 81.41% of them. Most common mistakes due to wrong diagnosis were Phimosis (91.45% n= 113) and Cryptorquidism (85.29% n = 122); mistakes related to surgical calendar were Umbilical Hernia (88.46%), Hypospadias (72.22% n= 31) and Hydrocele (70.83% n = 12). Mean distance of transfer for patients wrongly referred outside the metropolitan area was 35.92 km (Range: 7.1-129).

CONCLUSIONS

We have detected major mistakes in patient transfer from primary paediatric care. The knowledge of surgical calendar and accurate diagnosis should avoid these problems. These mistakes result in deterioration of medical care quality, patient discomfort and clinic saturation. It is necessary to propose and develop measures that improve the knowledge of surgical calendar and to make more accurate surgical diagnosis in primary paediatric care.

[Comparative analysis between the Seldinger technique vs. open dissection in the implantation of intravenous reservoirs]

OBJECTIVE

To analyze advantages and disadvantages between Seldinger's technique (ST) and surgical dissection (SD) on intravenous port-a-caths comparing surgical parameters as time and complications.

MATERIAL AND METHOD

An analytic retrospective study involving historic cohorts was realized, comparing our surgical experience on port-a-cath implantation with Seldinger technique or surgical dissection. Statistical analysis was made reflecting clinical and surgical parameters, such as surgical time length and intra/postoperative complications.

RESULTS

193 Port-a-caths were analyzed (119 SD, 74 ST), mainly placed for chemotherapy treatment (83.41%). Surgical time length expended at single procedures was 72.85 +/- 29.35 minutes for SD and 62.83 +/- 20.08 minutes for ST (p < 0.05). There were none operator-dependent differences. Statistically significant differences were not found between the two cohort's populations, neither at complications percentages. Greater-sized port-a-caths presented a higher average of skin necrosis (p > 0.05) however, lower-sized port-a-caths showed a higher average of infection (16% upon 7.7% p > 0.05). Both ST (51.67 vs. 98.14 min) and SD (78.56 vs. 123.61 min) showed lower surgical time length at left venous accesses (d = 171 vs. i = 19). Average in days for the extraction of port-a-caths with regard to complications was 121 days.

CONCLUSION

Seldinger technique reduced the definitive lost of surgical dissected venous accesses, being possible further utilization of the same vein for subsequent port-a-caths. Seldinger technique reduces surgical time length without increasing complication's rate. Left venous access does not imply higher surgical time length. Complications may be related with port-a-cath's size.

Metabolic profile and cardiovascular risk factors among Latin American HIV-infected patients receiving HAART

OBJECTIVE

Determine the prevalence of metabolic abnormalities (MA) and estimate the 10-year risk for cardiovascular disease (CVD) among Latin American HIV-infected patients receiving highly active anti-retroviral therapy (HAART).

METHODS

A cohort study to evaluate MA and treatment practices to reduce CVD has been conducted in seven Latin American countries. Adult HIV-infected patients with at least one month of HAART were enrolled. Baseline data are presented in this analysis.

RESULTS

A total of 4,010 patients were enrolled. Mean age (SD) was 41.9 (10) years; median duration of HAART was 35 (IQR: 10-51) months, 44% received protease inhibitors. The prevalence of dyslipidemia and metabolic syndrome was 80.2% and 20.2%, respectively. The overall 10-year risk of CVD, as measured by the Framingham risk score (FRF), was 10.4 (24.7). Longer exposure to HAART was documented in patients with dyslipidemia, metabolic syndrome and type 2 diabetes mellitus. The FRF score increased with duration of HAART. Male patients had more dyslipidemia, high blood pressure, smoking habit and higher 10-year CVD than females.

CONCLUSIONS

Traditional risk factors for CVD are prevalent in this setting leading to intermediate 10-year risk of CVD. Modification of these risk factors through education and intervention programs are needed to reduce CVD.

2,4-Dichloro-benzaldehyde

In the crystal structure of the title compound, C₇H₄Cl₂O, the mol­ecules form a network of weak C—H⋯O inter­actions involving the aldehyde O atom and the ortho-H atom on the benzene ring together with C—H⋯O inter­actions between the formyl groups. Together, these connect the mol­ecules into (10) layers, which are stabilized additionally by π–π stacking inter­actions of the benzene rings [centroid–centroid distance = 3.772 (1) Å]. The aldehyde group is twisted relative to the benzene ring by 7.94 (13)°.

[Temporal relationship between gastroesophageal reflux and cardiorespiratory events]

The acid and non acidic gastroesophageal reflux can trigger apnoea, desaturation and bradicardia events, as well as chronic pulmonary pathology due to microaspirations, whereas the acute or chronic airway closing increase the intrathoracic pressure, triggering the reflux. Our aims were to measurement in preterms newborn the correlations between cardiorespiratory events and gastroesophageal reflux, find out the direction of this relation, identify the patients with association GER->CRE and decide the suitability of antireflux surgery.

METHOD

The study was made in the Motility Unit and in the Intensive Neonatal Care Unit, to preterms newborns without associated pathology except apnoea and/or bradicardia and/or desaturation.

MATERIAL

3 hours manometry study in the Motility Unit. 24 hours impedance, pH and cardiorespiratory parameters monitoring (respiratory and cardiac frequent, O2 saturation and CO2) in Intensive Neonatal Care Unit. We characterised the gastroesophageal barrier, all the reflux events and the association between GER and CRE.

RESULTS

We made 28 records to 28 patients with CRE. The average of the total number of reflux was 61 (22,25-103,00), 29,2% acid reflux and 70,8% weakly acidic. 12 patients had some GER associated with CRE but in only 2 cases was statistically significant (Sympton index: SI; Sympton Sensitivity Index: SSI) (SI > or = 50%; SSI > or = 10%). The surgical management was successfully in these two babies and nowadays they are asymptomatic.

CONCLUSION

There is not any general association between GER and CRE, nevertheless, in a little percentage of patients, this relationship is fulfilled and it is possible to measurement with impedance, pH and cardiorespiratory parameters. In these cases, the surgical management is the right treatment.

Internet as a tool to access high-risk men who have sex with men from a resource-constrained setting: a study from Peru

OBJECTIVES

In Peru, current interventions in high-risk men who have sex with men (MSM) reach a limited number of this population because they rely solely on peer education. The objective of this study was to assess the use of the internet as an alternative tool to access this population.

METHODS

Two nearly identical banner ads-both advertising an online survey but only one offering free HIV/syphilis tests and condoms-were displayed randomly on a Peruvian gay website.

RESULTS

The inclusion of the health incentive increased the frequency of completed surveys (5.8% vs 3.4% of delivered impressions; p<0.001), attracting high-risk MSM not previously tested for HIV but interested in a wide variety of preventive Web-based interventions. Eleven per cent (80/713) of participants who said they had completed the survey offering free testing visited our clinic: of those who attended, 6% had already been diagnosed as having HIV, while 5% tested positive for HIV. In addition, 8% tested positive for syphilis.

CONCLUSIONS

The internet can be used as a tool to access MSM in Peru. The compensation of a free HIV/syphilis test increased the frequency of participation in our online survey, indicating that such incentives may be an effective means of reaching this population. However, as only a small percentage of participants actually reported for testing, future research should develop and assess tailored internet interventions to increase HIV/STI testing and delivery of other prevention services to Peruvian MSM.

Calorie restriction attenuates age-related alterations in the plasma membrane antioxidant system in rat liver

Aging is associated with increased production of reactive oxygen species and oxidation-induced damage to intracellular structures and membranes. Caloric restriction (CR) is the only non-genetic method proven to extend lifespan in mammals. Although the mechanisms of CR remain to be clearly elucidated, reductions in oxidative stress have been shown to increase lifespan in several model systems. Oxidative stress can be attenuated by CR. Mitochondria and plasma membrane (PM) are normal sources of free radicals. The PM has a trans-membrane redox system that provides electrons to recycle lipophilic antioxidants, such as alpha-tocopherol and coenzyme Q (CoQ). The idea developed in this study is that the PM is intimately involved in cellular physiology controlling the relationship of the cell to its environment. PM is the key for protecting cellular integrity during aging. Specifically, we have investigated age-related alterations and the effects of CR in the trans-PM redox (antioxidant) system in rat liver. We found that age-related declines in the ratio of CoQ(10)/CoQ(9) and alpha-tocopherol in liver PM were attenuated by CR compared to those fed ad libitum (AL). CoQ-dependent NAD(P)H dehydrogenases were increased in CR old rat liver PMs. As a consequence, the liver PM of CR old rats was more resistant to oxidative stress-induced lipid peroxidation than AL rats. Thus, our results suggest that CR induces a higher capacity to oxidize NAD(P)H in the PM of old rat livers and as a result, a higher resistance to oxidative stress-induced damage.

Thoracoabdominal wall repair with glutaraldehyde-preserved bovine pericardium

Glutaraldehyde-preserved bovine pericardium (GPBP) is evaluated as a bioprosthesis for the reconstruction of surgical defects in the thoracoabdominal wall. The mechanical properties of bovine pericardium preserved at different concentrations of glutaraldehyde were studied. Samples preserved in 0.5% glutaraldehyde showed a significantly higher tensile strength (11.7 +/- 0.8 N/mm2) than samples preserved in 2.5, 5, or 10% (similar to pericardium preserved in normal saline). The percentage of elongation was significantly lower than samples preserved in 1, 2.5, and 5% glutaraldehyde. GPBP at 0.5% was used to repair experimentally induced defects of the abdominal wall (n = 9), chest wall (n = 6), diaphragm (n = 6), and sternum (n = 7). All animals presented adequate tolerance to the material used and no case of infection or rejection of the material was seen in any of the animals. Finally, 0.5% GPBP was used clinically in a series of 40 patients: postincisional abdominal hernia (n = 30), inguinal hernia (n = 8), diaphragmatic hernia (n = 1), and congenital pelvic defect with prolapse of abdominal organs (n = 1). Surgical use showed that GPBP was a very manageable material and long-term results were good in 37 patients with a mean follow up of 18 months (range 5-35 months). Six patients presented seroma formation (all abdominal hernia patients), three of which eventually developed infection and had the GPBP patch removed at 3, 5, and 7 months postoperatively. The rest of the patients presented good scar formation with adequate resistance at the area of implantation. GPBP is a biological material with sufficient resistance to be used surgically in the repair of thoracoabdominal defects. Ideal concentration of glutaraldehyde to be used in the preparation-preservation of the material is 0.5% since higher concentration negatively affect its tensile rupture strength and elongation.

The Mexican experience with laparoscopic cholecystectomy and common bile duct exploration. A multicentric trial

We present here the initial data collected since the first laparoscopic cholecystectomy (LC) was performed in our country (June 1990). Twenty-one centers were surveyed (2,399 patients). The most frequent indication for LC was chronic gallstone disease (76.2%). The female population predominated (69.4%). Seven centers always perform the laparoscopic approach. Antibiotic prophylaxis is the rule, and most centers use nasogastric tube and urinary catheterization. Perioperative cholangiography is done selectively. The instrument of choice to dissect the gallbladder is the electrosurgical hook-knife. General anesthesia is preferred (97%). The complication rate was 8.87%. Injury to the bile duct and bowel perforation occurred in 0.25% and common duct stone retention occurred in 0.29% of patients. Mortality rate reached 0.12%. It is our hope that this study will help in defining the situation of LC in developing countries and that it also can serve as a first step in the organization of minimally invasive surgery groups in Mexico.

[Anomalous origin of left coronary artery in pulmonary artery]

We report 2 infants aged 6 months and one year with an anomalous left coronary artery origin treated surgically at our centre with direct aortic reimplantation of the anomalous coronary. Evolution has been satisfactory, with a great improvement of ventricular function. The mitral incompetence and congestive heart failure have disappeared and myocardic perfusion electrocardiographic patterns were corrected. Because of the unfavorable natural course of the disease and the improvement in techniques of coronary revascularization in infants we recommend an early surgical treatment as soon as it be diagnosed. We consider that the most adequate surgical treatment is the direct aortic reimplantation of the anomalous coronary artery.

[A community program to stimulate smoking cessation]

A community program to stimulate smoking cessation developed on the 1988 World No-smoking Day in the city of Barcelona (Spain) is presented. Participants in this program could make a written commitment to quit, and received support materials by mail. The results are evaluated in a sample of participants: 69% declare having quit on the specified date, and 29% do not smoke after one year.

Inhibition of growth and differentiation of fetal hamster gonads grafted into the adult testis

A cytomorphological analysis of the effect of adult testes on growth and differentiation of grafted fetal testis or ovaries was performed in hamsters. Fetal gonads, taken at 14 days post-coital age, were grafted for 30 days either under the renal capsule or testicular capsule of scrotal or cryptorchid testes of adult hamsters (weight 115 +/- 23 g). Renal grafts were also performed in males castrated 30 days prior to receiving the fetal gonads. Growth and differentiation of the fetal gonads (testis or ovary) was totally inhibited by the scrotal testis. When the cryptorchid testis was the recipient of fetal gonads, inhibition was correlated inversely with the degree of spermatogenic damage elicited in the cryptorchid testis. No inhibition was observed in fetal gonads grafted under the kidney capsule, nor in castrated, normal or cryptorchid animals. As normal growth and differentiation of both testis and ovary occurred when grafted under the kidney capsule, the inhibitory effect of adult gonads seems to be unrelated to plasma testosterone levels in the host, as levels were undetectable in castrated hamsters and reduced drastically in cryptorchid animals. At the same time, the testicular-inhibiting substance in normal animals did not act at a distance, since its effect was restricted to fetal gonads grafted under the testicular capsule. This inhibitory substance may correspond to the spermatogonial chalone, known to be produced by differentiating spermatogenic cells (mainly spermatocytes and round spermatids in the rat and mouse); these chalones prevent spermatogonial proliferation and, consequently, the critical number of spermatogonia needed to enter meiosis is not attained. It is doubtful if the same substance has the ability to differentiate the fetal ovary or if this effect can be ascribed to a more complex situation involving other testicular peptides of paracrine action and/or locally high levels of androgens.