Abstract Objective: This study aimed to evaluate the diagnostic utility, disease activity, and phenotypic association of serum anti-Saccharomyces cerevisiae antibody (ASCA), perinuclear anti-neutrophil cytoplasmic antibody (pANCA), PR3-ANCA, and MPO-ANCA in pediatric patients with inflammatory bowel disease (IBD). Methods: Pediatric patients diagnosed with IBD were recruited and classified as Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) through full investigation. The Paris classification was used to evaluate disease phenotypes of pediatric CD and UC. Results: In all, 229 pediatric patients with IBD (CD 147, UC 53, IBD-U 29) were included. The ASCA IgG seropositivity significantly differed among the three groups (CD 75.4%, UC 17.5%, and IBD-U 60.0%; p < 0.001). PR3-ANCA positive rates were the highest in UC (24.0%), followed by IBD-U (17.6%), and none in CD (p = 0.002); pANCA-positive rates were higher in IBD-U (33.6%), followed by UC (28.0%) than in CD (1.4%) (p < 0.001). Regarding disease phenotype, perianal disease revealed higher serum ASCA IgG titers (median 36.7 U/mL in P1 vs. 25.2 U/mL in P0, p = 0.019). Serum ASCA IgG and IgA cutoff values to distinguish CD were 32.7 (U/mL) and 11.9 (U/mL), respectively, with a specificity of 80.0%. Conclusion: Serological biomarkers of ASCA IgG and IgA were effective for differentiating CD in pediatric IBD patients, and serum pANCA and PR3-ANCA, but not MPO-ANCA, were effective in distinguishing UC and IBD-U. Furthermore, measuring serological titers of ASCA IgG and IgA may help differentiate CD and evaluate the disease activity and phenotype of pediatric IBD in practice. Objective utility antiSaccharomyces anti Saccharomyces ASCA, , (ASCA) antineutrophil neutrophil pANCA, (pANCA) PR3ANCA, PR3ANCA PRANCA PR3 ANCA, ANCA PR MPOANCA MPO IBD. . (IBD) Methods Crohns Crohn s CD, (CD) UC, (UC) IBDunclassified unclassified IBDU U (IBD-U investigation Results all 22 147 53 29 included 754 75 4 75.4% 175 17 5 17.5% 60.0% 600 60 0 0.001. 0001 0.001 001 0.001) 24.0%, 240 24.0% 24 (24.0%) 17.6%, 176 17.6% 6 (17.6%) 0.002 0002 002 0.002) pANCApositive 33.6%, 336 33.6% 33 (33.6%) 28.0% 280 28 (28.0% 1.4% 14 1 (1.4% median 367 36 7 36. UmL mL P vs 252 25 2 25. P0 0.019. 0019 0.019 019 0.019) 327 32 32. (U/mL 119 11 9 11. U/mL, respectively 800 80 80.0% Conclusion MPOANCA, IBDU. U. Furthermore practice (ASCA (pANCA (IBD (UC 75.4 17.5 60.0 000 0.00 00 24.0 (24.0% 17.6 (17.6% 33.6 3 (33.6% 28.0 (28.0 1.4 (1.4 0.01 01 8 80.0 75. 17. 60. 0.0 24. (24.0 (17.6 33. (33.6 28. (28. 1. (1. 80. 0. (24. (17. (33. (28 (1 (24 (17 (33 (2 ( (3

Abstract Although ovarian aging is a key cause of decreased ovarian function and oocyte quality, it remains a problem in infertility treatment. Therefore, this study is aimed to investigate whether Paeonia lactiflora (PL), a herb improves ovarian function and oocyte quality using aged female mice. C57BL/6 female mice aged 8 months were treated orally every day with PL of 26.5 mg/kg (n=7) and 53 mg/kg (n=7) of body weight for 4 weeks using an oral zoned needle. The control group (n=7) was treated with normal saline. Ovaries and serum were collected for the H&E stain and the evaluation of reactive oxygen species (ROS) levels, respectively. In the second experiment, female mice were orally administered with PL (26.5 mg/kg: n=12, 53 mg/kg: n=12, control: n=12) and then superovulated with PMSG and hCG, and mated with male mice. Zygotes were retrieved and cultured for 4 days. Ovaries were provided for examination of expressions of genes associated with angiogenesis (VEGF and visfatin), anti-aging (Sirt1 and Sirt2), and follicular development (c-Kit, BMP-15, and GDF-9). PL significantly increased numbers of surviving follicles (primordial, primary, secondary, and antral), numbers of zygotes retrieved, embryo development rate, and ovarian expression of VEGF, visfatin, c-Kit, BMP-15, and GDF-9 at both doses. However, ovarian expression of Sirt1 and Sirt2 was increased at 53.0 mg/kg of PL. ROS levels were not affected by PL. These results suggest that PL may possess beneficial effects regarding ovarian function and oocyte quality, possibly by activation of ovarian angiogenesis and follicular development.

Abstract: Esophageal diverticula are evaginations of the esophageal wall in the form of a blind pouch that communicate with the lumen. They are rare, with a reported prevalence of 0.06%-4%, and they are usually incidental findings during endoscopic surveillance. Their peak incidence is in the fifth decade of life; they affect both men and women equally. Case report: Seventy-three year old female. A minimally invasive thoracic approach was performed. A blunt and sharp dissection was made, identifying an epiphrenic diverticula with a 5 cm base. The lesion was totally dissected; the resection was performed using a linear laparoscopic stapler. Total surgical time was 280 minutes, with a transoperative bleeding of 100 cm3. There were no complications and the patient was transferred to recovery without the need for ventilatory support. Conclusion: Laparo-endoscopic management with minimally invasive diverticulectomy and a prophylactic esophageal prosthesis is a feasible option. This approach may lower associated morbidity in high-risk patients. The possible complications of the surgical treatment should always be taken in consideration, and management of these will depend on the patient’s clinical condition and the available hospital resources.

Resumen: Los divertículos esofágicos son evaginaciones de la pared esofágica en forma de bolsa ciega que comunican con la luz principal. Son raros, con una prevalencia reportada de 0.06 a 4%; generalmente, suelen ser hallazgos circunstanciales cuando se examina el esófago de forma endoscópica. Presentan un pico de incidencia a partir de la quinta década de la vida y afectan tanto a hombres como a mujeres. Caso clínico: Paciente femenino de 73 años de edad. Se realizó un abordaje torácico de mínima invasión. Se llevó a cabo una disección roma y cortante; se identificó un divertículo esofágico epifrénico con base de 5 cm. Se disecó la lesión en su totalidad, efectuando la resección del divertículo con una engrapadora lineal laparoscópica. El tiempo quirúrgico total fue de 280 minutos, con hemorragia transoperatoria de 100 cm3. No se evidenciaron complicaciones y la paciente fue egresada a recuperación sin necesidad de apoyo ventilatorio. Conclusión: El manejo laparoendoscópico con diverticulectomía de mínima invasión y colocación de una prótesis esofágica profiláctica del divertículo esofágico es una opción factible para esta patología. Este abordaje puede ofrecer una menor morbilidad asociada en pacientes de alto riesgo. Siempre se deben tener en cuenta las posibles complicaciones del tratamiento quirúrgico, y su manejo dependerá de la condición clínica del paciente y los recursos disponibles del centro hospitalario.

Abstract Introduction: Nowadays, a splenectomy is a therapeutic option for hematologic diseases, especially those that do not respond to medical treatment. It is a minimally invasive surgery and has advantages such as less postoperative pain, rapid recovery, less blood loss and better cosmetic results. Laparoscopy has become the standard approach for patients undergoing a splenectomy. Case report: We present the case of a 34-year old male patient with idiopatic thrombocytopenic purpura. He was treated with steroid and danazol with a persistent thrombocytopenia. Due to the failure of the treatment, a laparoscopic splenectomy was performed without any complication. The extracted spleen measured 25 × 16 cm weighing 1.235 g. The surgical time was of 115 min and the transoperative loss of blood was of 800 cc. Conclusion: The laparoscopic splenectomy is a safe and viable therapeutic option. Various studies have shown low conversion rates, less morbidity and a shorter hospital stay. Laparoscopic splenectomy is an effective therapy regardless of the size of the spleen.

Resumen Introducción: Actualmente, la esplenectomía es una opción terapéutica para diversas patologías hematológicas, especialmente las refractarias a tratamiento médico. Debido a las ventajas del uso de la cirugía de mínima invasión, como son un menor dolor postoperatorio, recuperación rápida, menor sangrado y mejores resultados estéticos, la laparoscopía se ha convertido en el abordaje estándar en pacientes sometidos a esplenectomía. Caso clínico: Varón de 34 años con diagnóstico de púrpura trombocitopénica idiopática (PTI). Recibió tratamiento con esteroide y danazol pero persistió trombocitopenia. Enviado a consulta de cirugía general por falla en el tratamiento médico. Se realizó esplenectomía laparoscópica sin complicaciones, extrayendo pieza quirúrgica con medidas de 25 × 16 cm con un peso de 1,235 gramos. Tiempo quirúrgico de 115 minutos, sangrado transoperatorio de 800 cm3. Conclusión: El tratamiento de la PTI refractaria a tratamiento médico es la esplenectomía laparoscópica, la cual es una opción viable y segura con tasas bajas de complicaciones, no importando el tamaño del órgano.

Abstract We aimed to investigate the biological responses induced by acute and chronic gamma irradiation in colored wheat seeds rich in natural antioxidants. After acute and chronic irradiation, the phenotypic effects on plant growth, germination rate, seedling height, and root length were examined, and the biochemical changes were investigated by analyzing the expression of antioxidant enzyme-related genes, antioxidant enzyme activities, and total antioxidant capacity. High dosages of chronic radiation reduced plant growth compared with the controls. Electron spin resonance measurement and 2,2-diphenyl-1-picrylhydrazyl activity analysis showed lower amount of free radicals in colored wheat seeds on chronic irradiation with low dosage of gamma rays compared to seeds subjected to acute irradiation. Expression levels of anthocyanin biosynthesis genes, antioxidant-related genes, and antioxidant enzyme activity in seeds and young leaves of seedling showed diverse effects in response to different dosages and types of gamma irradiation. This suggests that phenotype is affected by the dosage and type of gamma radiation, and the phytochemicals in colored wheat seeds involved in antioxidant activity to scavenge free radicals respond differently to irradiation types. This provides evidence that acute and chronic exposure to radiation have different effects on seeds and young leaves after germination.

Abstract: Introduction: Literature reports the importance of teaching how to teach. There are many studies that mention that medicine students do not receive formal instruction to develop their teaching skills. Teaching training helps students to be better communicators because education is an essential aspect inside the doctor-patient relationship. Objectives: To evaluate declarative and procedural development of third-grade students of the Bachelor’s degree in Medicine with a high academic performance, interested on surgery instruction that have taken the Instructor’s training workshop for Introduction to Surgery. Method: The workshop was given at the end of the second year of the Bachelor’s, during the in between period. It contained 42 theoretical hours and 54 practical, 9 thematic units and 16 practical were reviewed, 1 selection test was applied, just as 4 theoretical-practical tests. Results: During the 2012-2016 period, 225 students applied to assist to the workshop, 111 of them were selected to take it with a composition of 67 women (61%) and 44 men (39%); 78 of these students were awarded (45 women and 33 men) to become instructors of the subject. Conclusions: Students manifested that the workshop fulfils its objectives and expectations, brings them learning-teaching strategies that promote team work and feminization on the workshop is highlighted. Future proposal/Prospective vision: To design a complementary academic program for students interested on entering into the surgical residence, to apply an efficient-proved methodology as Pair Assisted Learning (PAL) that include a department-professor guidance with surgical practice and, to do a qualitative study with focus groups to dig into students perceptions based on their experience during the workshop.

Resumen: Introducción: La literatura reporta la importancia de enseñar a enseñar. Existen diversos estudios en los cuales se menciona que los estudiantes de medicina no suelen recibir instrucción formal para el desarrollo de competencias docentes. La formación docente ayuda a que los estudiantes sean mejores comunicadores y la enseñanza es un aspecto esencial de la relación médico-paciente. Objetivos: Evaluar el desempeño declarativo y procedimental de estudiantes del tercer año de la Licenciatura de Médico Cirujano con alto rendimiento académico, interesados en la enseñanza de la cirugía que cursaron el taller de formación para ayudantes de profesor de la asignatura de Introducción a la Cirugía. Método: El taller se impartió al finalizar el segundo año de la licenciatura en el periodo interanual; comprendió 42 h teóricas y 54 prácticas, se revisaron 9 unidades temáticas y 16 prácticas, se aplicó un examen de selección y 4 exámenes teórico-prácticos. Resultados: Durante el periodo de 2012-2016, 225 estudiantes solicitaron asistir al taller, de los cuales 111 estudiantes fueron seleccionados para cursarlo, con una composición de 67 mujeres (61%) y 44 hombres (39%); y fueron distinguidos 78 educandos, 45 mujeres y 33 hombres, para integrarse como instructores de la asignatura Conclusiones: Los estudiantes manifestaron que el taller cumple sus objetivos y expectativas, les proporciona estrategias de enseñanza-aprendizaje que promueven el trabajo en equipo, y se destaca la feminización en el taller. Propuesta de futuro: Diseñar un programa académico complementario para los estudiantes interesados en ingresar a la residencia quirúrgica; implementar metodología de probada eficacia como el aprendizaje asistido por pares (PAL), que incluya la tutoría de un profesor del departamento con práctica quirúrgica y realizar un estudio cualitativo con la metodología de grupos focales para indagar las percepciones de los estudiantes a partir de su experiencia en el taller.

The incidence of detection of accessory hepatic vein (AHV) using MRI or CT has been reported. However, previous studies had a small sample size or only reported on the incidence of hepatic vein variants. To the best of our knowledge, there has been no previous report evaluating the factors predictive of the presence of an AHV. To evaluate the incidence and morphology of the accessory hepatic vein (AHV) using multidetector row computed tomography (MDCT) and to investigate the factors which may be helpful in predicting the presence of an AHV. We enrolled 360 patients who underwent abdominal MDCT. We investigated whether the AHV was present and evaluated the frequency of AHVs greater than 5 mm in diameter. We classified the morphology of the AHV entering the inferior vena cava (IVC). We also examined the factors that predicted the presence of an AHV by comparing the diameter of the middle hepatic vein (MHV) and the right hepatic vein (RHV). We identified an AHV in 164 of the 360 patients (45.6 %). Among the 164 AHVs, 56.7 % were larger than 5 mm in diameter. The most common morphologies of the inferior RHV were a single main trunk (58.5 %), followed by two main trunks with a V-shape (19.5 %) and two trunks entering the IVC separately (17.0 %). The possibility that an AHV will be present was significantly higher when the diameter of the RHV was smaller than that of the MHV. MDCT can provide important information regarding AHV incidence and morphology. The possibility of an AHV being present was significantly higher when the diameter of the RHV was smaller than that of the MHV.

Se ha informado de la incidencia de la detección de la vena hepática accesoria (VHA) mediante RM o TC. Sin embargo, estudios previos tenían un tamaño muestral pequeño o solo informaban sobre la incidencia de variantes de las venas hepáticas. Hasta donde sabemos, no ha habido ningún informe previo que evalúe los factores predictivos de la presencia de una VHA. El objetivo del estudio fue evaluar la incidencia y morfología de la vena hepática accesoria (VHA) mediante tomografía computarizada multidetector (TCMD) e investigar los factores que pueden ser útiles para predecir la presencia de un VHA. Se evaluaron 360 pacientes que se sometieron a TCMD abdominal. Se investigó si la VHA estaba presente y se evaluó la frecuencia de VHA mayores de 5 mm de diámetro. Se clasificó la morfología del VHA que drenaba en la vena cava inferior (VCI). Además, se examinaron los factores que predijeron la presencia de una VHA mediante la comparación del diámetro de la vena hepática media (VHM) y la vena hepática derecha (VHD). Se identificó un VHA en 164 de los 360 pacientes (45,6%). Entre las 164 VHA, el 56,7% tenía más de 5 mm de diámetro. Las morfologías más frecuentes del VHD inferior fueron un tronco principal único (58,5%), seguido por dos troncos principales con forma de V (19,5%) y dos troncos que drenaban en la VCI por separado (17,0%). La posibilidad de que una VHA esté presente fue significativamente mayor cuando el diámetro de la VHD era menor que la de la VHM. La MDCT puede proporcionar información importante sobre la incidencia de la VHA y su morfología. La posibilidad de que un VHA estuviera presente era significativamente mayor cuando el diámetro del VHD era menor que la VHM.

Abstract Sepsis continues to be a primary cause of high mortality and morbidity in critically ill patients. Despite constant growth in dedicated basic investigation and numerous clinical studies, no remarkable developments have been made for effective and innovative therapies. The physiologic disorders induced by sepsis are primarily due to the overwhelming immune response to invading pathogens rather than the direct effects caused by the pathogen. Sepsis, understood as the systemic inflammatory response to infection is characterized by the unregulated production of proinflammatory cytokines. These mediators collectively lead to multiple organ failure and eventually to death. In this context, the role of inflammation in the physiopathology of sepsis, though not fully understood, is of critical importance. This review provides a perspective of the most current understandings of the molecular mechanisms during sepsis, which may provide an attempt to understand the nature of this unregulated response of the immune systems during sepsis.

Resumen La sepsis es un síndrome que continúa siendo una causa importante de morbilidad y mortalidad entre los pacientes críticamente enfermos. Pese al desarrollo de la investigación básica dedicada al tema y los numerosos ensayos clínicos, no se han logrado avances notables en el desarrollo de terapias vanguardistas y eficaces para su manejo. Los trastornos fisiológicos inducidos por la sepsis son en gran parte debidos a la respuesta del huésped a los microorganismos invasores en contraste con los efectos directos del propio microorganismo. La sepsis, entendida como la respuesta inflamatoria sistémica a la infección, está marcada por la producción desregulada de citocinas proinflamatorias. Estos mediadores conducen de manera colectiva a la insuficiencia orgánica múltiple, y en última instancia, a la muerte. Es en este sentido que el papel de la inflamación en la fisiopatogenia de la sepsis, aunque todavía no entendida completamente, resulta claramente crítico. Esta revisión proporciona una perspectiva de las diversas interacciones moleculares que ocurren durante la sepsis, con el intento de poder comprender la naturaleza de la respuesta desregulada del sistema inmunitario durante ésta.