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Textbook outcome is a multidimensional quality management tool that uses a set of traditional surgical measures to reflect an "ideal" surgical result for a particular pathology. Retrospective study of all patients undergoing scheduled for adrenal tumors surgery at an endocrine surgery unit from January 2010-December 2022. The definition of Textbook Outcome were: R0 resection, no Clavien-Dindo ≥ IIIa complications, no prolonged stay (< P75), no readmissions, and no mortality in the first 30 days. The main objective was to analyze the rate of Textbook Outcome obtained. One hundred and five patients were included in the study. Textbook Outcome was achieved in 71.4%. Surgical approach (p < 0.001), Charlson scale (p = 0.031), American Society of Anesthesiologists Classification (p = 0.047) and surgical time (p < 0.001) were all significantly associated with the achievement of Textbook Outcome. The laparoscopic approach was associated as an independent factor with obtaining Textbook Outcome (OR:5.394; p = 0.016), as was surgical time (OR:0.986; p = 0.004). Textbook Outcome is a novel, useful, easy-to-interpret tool for measuring results in adrenal surgery. The laparoscopic approach is associated with a higher rate of "ideal" surgical results. The study was registered in the public accessible database clinicaltrials.gov with the ClinicalTrials.gov ID: NCT05888753.

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Endothelial dysfunction is an early event in coronary microvascular disease. Integrin-linked kinase (ILK) prevents endothelial nitric oxide synthase (eNOS) uncoupling and, thus, endothelial dysfunction. However, the specific role of endothelial ILK in cardiac function remains to be fully elucidated. We hypothesised that endothelial ILK plays a crucial role in maintaining coronary microvascular function and contractile performance in the heart. We generated an endothelial cell-specific ILK conditional knock-out mouse (ecILK cKO) and investigated cardiovascular function. Coronary endothelial ILK deletion significantly impaired cardiac function: ejection fraction, fractional shortening and cardiac output decreased, whilst left ventricle diastolic internal diameter decreased and E/A and E/E' ratios increased, indicating not only systolic but also diastolic dysfunction. The functional data correlated with extensive extracellular matrix remodelling and perivascular fibrosis, indicative of adverse cardiac remodelling. Mice with endothelial ILK deletion suffered early ischaemic-like events with ST elevation and transient increases in cardiac troponins, which correlated with fibrotic remodelling. In addition, ecILK cKO mice exhibited many features of coronary microvascular disease: reduced cardiac perfusion, impaired coronary flow reserve and arterial remodelling with patent epicardial coronary arteries. Moreover, endothelial ILK deletion induced a moderate increase in blood pressure, but the antihypertensive drug Losartan did not affect microvascular remodelling whilst only partially ameliorated fibrotic remodelling. The plasma miRNA profile reveals endothelial-to-mesenchymal transition (endMT) as an upregulated pathway in endothelial ILK conditional KO mice. Our results show that endothelial cells in the microvasculature in endothelial ILK conditional KO mice underwent endMT. Moreover, endothelial cells isolated from these mice and ILK-silenced human microvascular endothelial cells underwent endMT, indicating that decreased endothelial ILK contributes directly to this endothelial phenotype shift. Our results identify ILK as a crucial regulator of microvascular endothelial homeostasis. Endothelial ILK prevents microvascular dysfunction and cardiac remodelling, contributing to the maintenance of the endothelial cell phenotype.

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For this research, the properties of the logistic growth model for independent and coexisting species were used to set definitions for the possible regulation of one or two growth variables through their coupling parameters. The present analysis is done for the single-species Verhulst model without coupling, the single-species Verhulst model coupled with an exogenous signal, and the two-species Verhulst coexistence growth model which represents six different ecological regimes of interaction. The models' parameters, such as the intrinsic growth rate and the coupling, are defined. Finally, the control results are expressed as lemmas for regulation, and they are shown using a simulation example of a fish population growing independent of human interaction (no harvesting, no fishing) and the simulation of the regulation of said population when the coupling of fish and humans is involved (harvesting, fishing).

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Epidemiological studies link long term exposure to xenoestrogen Bisphenol-A to adverse cardiovascular effects. Our previous results show that BPA induces hypertension by a mechanism involving CamKII activation and increased redox stress caused by eNOS uncoupling. Recently, CamKII sustained activation has been recognized as a central mediator of programmed cell death in cardiovascular diseases, including necroptosis. However, the role of necroptosis in cardiac response to BPA had not yet been explored. Mice exposed to BPA for 16 weeks showed altered heart function, electrical conduction, and increased blood pressure. Besides, a stress test showed ST-segment depression, indicative of cardiac ischemia. The hearts exhibited cardiac hypertrophy and reduced vascularization, interstitial edema, and large hemorrhagic foci accompanied by fibrinogen deposits. BPA initiated a cardiac inflammatory response, up-regulation of M1 macrophage polarization, and increased oxidative stress, coinciding with the increased expression of CamKII and the necroptotic effector RIP3. In addition, cell death was especially evident in coronary endothelial cells within hemorrhagic areas, and Evans blue extravasation indicated a vascular leak in response to Bisphenol-A. Consistent with the in vivo findings, BPA increased the necroptosis/apoptosis ratio, the expression of RIP3, and CamKII activation in endothelial cells. Necrostatin-1, an inhibitor of necroptosis, alleviated BPA induced cardiac dysfunction and prevented the inflammatory and hemorrhagic response in mice. Mechanistically, silencing of RIP3 reversed BPA-induced necroptosis and CamKII activation in endothelial cells, while inhibition of CamKII activation by KN-93 had no effect on RIP3 expression but decreased necroptotic cell death suggesting that BPA induced necroptosis is mediated by a RIP 3/CamKII dependent pathway. Our results reveal a novel pathogenic role of BPA on the coronary circulation. BPA induces endothelial cell necroptosis, promotes the weakening of coronary vascular wall, which caused internal ventricular hemorrhages, delaying the reparative process and ultimately leading to cardiac dysfunction.

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BACKGROUND: Oral administration of glucocorticoid alters serum cystatin C (sCysC) concentration in humans. OBJECTIVE: To determine if oral administration of prednisone alters sCysC in dogs without pre-existing renal disease. ANIMALS: Forty six dogs were included: 10 dogs diagnosed with steroid responsive meningitis arteritis (SRMA; group A), 20 dogs diagnosed of pituitary-dependent hyperadrenocorticism (PDH; group B), and 16 healthy control dogs (group C). METHODS: Retrospective observational study. SRMA diagnosed dogs were administered prednisone 4 mg/kg/24 h PO 7 days, reducing the dose to 2 mg/kg/24 h 7 days before medication withdrawal. In group A, sampling was performed at days 0, 7, 14 and a final control at day 21. Blood and urine samples were collected in the 3 groups, and in group A, sampling was performed at all time points (days 1, 7, 14, and 21). RESULTS: In group A, sCysC was significantly higher at day 7 compared to the control group (0.4 ± 0.04 mg/L vs. 0.18 ± 0.03 mg/L mean ± SEM respectively P < 0.01); sCysC values decreased to basal at day 14 when the dose was decreased and after 1 week of withdrawal of prednisone (0.27 ± 0.03 mg/L for group A at day 14 and 0.15 ± 0.02 mg/L at day 21; P > 0.05). Dogs with PDH included in group B did not have significant differences in sCysC (0.22 ± 0.03 mg/L) compared to control (P > 0.05). CONCLUSIONS AND CLINICAL IMPORTANCE: Oral administration of prednisone unlike altered endogenous glucocorticoid production, increases sCysC in dogs in a dose-dependent fashion.

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This paper deals with fault detection and isolation (FDI) in sensors applied to a concentric-pipe counter-flow heat exchanger. The proposed FDI is based on the analytical redundancy implementing nonlinear high-gain observers which are used to generate residuals when a sensor fault is presented (as software sensors). By evaluating the generated residual, it is possible to switch between the sensor and the observer when a failure is detected. Experiments in a heat exchanger pilot validate the effectiveness of the approach. The FDI technique is easy to implement allowing the industries to have an excellent alternative tool to keep their heat transfer process under supervision. The main contribution of this work is based on a dynamic model with heat transfer coefficients which depend on temperature and flow used to estimate the output temperatures of a heat exchanger. This model provides a satisfactory approximation of the states of the heat exchanger in order to allow its implementation in a FDI system used to perform supervision tasks.

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INTRODUCTION: Investigation in the field of inguinal hernia surgery is now focused on postoperative pain. The extended use of lightweight meshes and alternative methods of fixation may play a relevant role in the reduction of pain. In this study, a new self-gripping lightweight polypropylene mesh is tested. METHODS: A multicentric, observational study was scheduled to prospectively evaluate this new mesh. Ten centers agreed to participate. Only primary, type 1 or 2 uncomplicated hernias in adults were included. The mesh was placed as a Lichtenstein procedure without any fixation. A complete pain questionnaire was followed at 1 week, and at 1, 3 and 6 months postoperatively. The principal goal of the study was to evaluate maximum pain score at 6 months. Pain was assessed by a visual analog scale. A total of 256 patients were operated. Mean operative time was 35.6 min; 76.2% of patients were operated in an ambulatory setting. RESULTS: There were a few postoperative complications: 2 wound infections, 17 seromas, 21 hematomas, 6 orchitis. The incidence of acute pain was 27.3% at week 1 and 7.5% at month 1. The incidence of chronic pain was 3.6% at month 3 and 2.8% at month 6. No recurrences or long-term complications were observed. CONCLUSION: This self-gripping mesh can be used safely in type 1 and 2 primary, uncomplicated inguinal hernia with minimal morbidity and most patients under ambulatory setting. The registered incidence of chronic pain is lower than 3%.

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Changes in blood flow in the arteries of the canine skull base following compression of the ipsilateral carotid artery were evaluated. Forty healthy conscious dogs were evaluated during examination in lateral recumbency. Using the temporal window, the rostral, middle and caudal cerebral arteries were evaluated. The basilar artery was studied through the suboccipital window. Following compression, the pulse Doppler signal was reduced or inverted when interrogating the rostral or middle cerebral artery, and no change was observed when the caudal cerebral artery or basilar artery was evaluated.

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In this study, two unusual presentations of canine prostatitis are described; in the first case a 10-years-old neutered Boxer dog was presented to the Veterinary Teaching Hospital of the University of Extremadura with a complaint of anorexia, apathy and preputial discharge. In the second case, a local veterinarian referred an 8-years-old male Labrador to the Veterinary Teaching Hospital of the University of Extremadura. The dog had a history of pain in the caudal abdomen and preputial oedema. The final diagnosis in both cases was acute prostatitis. It is concluded that although canine prostatitis is a common disease, sometimes can have presentations that may differ from those classically described in the literature.

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INTRODUCCIÓN: La cirugía infantil es un estresor potencial para el paciente y su familia. La reacción más frecuentemente observada en el paciente pediátrico frente a este estresor es la ansiedad, en sus diversas manifestaciones, que está mediatizada por el estado emocional de sus padres. Esta alteración del estado emocional repercute negativamente en el comportamiento y recuperación física del paciente tras la intervención quirúrgica. El objetivo del presente trabajo se centra en estudiar las manifestaciones de distrés comportamental postquirúrgico en los niños y sus padres y determinar su relación. MÉTODO: La muestra está formada por 57 niños entre 2 y 12 años y sus padres. Los niños han sido intervenidos, en régimen ambulatorio, de patologías otorrinolaringológicas. La ansiedad se evaluó con la Escala de Observación de Distrés Postquirúrgico. RESULTADOS Y DISCUSIÓN: Los resultados indican que los niños menores de 6 años manifiestan mayores niveles de distrés que los de mayor edad, especialmente a través de apego hacia el adulto y lloros, no observándose diferencias respecto al género. Las madres expresan significativamente mayor distrés que los padres, a través de apego hacia el niño y postura corporal rígida. El distrés de los niños está relacionado con el de sus padres. Las manifestaciones de distrés en los niños genera distrés en los padres, que a su vez repercute manteniendo el nivel de distrés de su hijo (AU)

INTRODUCTION: Surgery on children is potentially stressful for the patient and their family. The most frequently observed reaction of the paediatric patient to this stress is anxiety, in its different manifestations, which is influenced by the parents’ emotional state. Emotional distress has a negative effect on the patients’ behaviour and physical recovery after surgery. The aim of this research is to study postsurgical distress behaviour manifestations in the children and their parents and to determine their relationship. METHODS: The sample is made up of 57 children between two and twelve years old operated on for ear, nose and throat problems and their parents. They were evaluated using the Postsurgical distress observation scale. RESULTS AND CONCLUSIONS: Results showed that children under six presented a higher stress level than older children. This was observed through attachment to the adult and crying. No gender based differences were observed. The mothers presented significantly greater stress than the fathers, and this was manifested by attachment to the child and stiff body movement. There is a link between children’s and parents’ distress. Children’s distress manifestations seemed to create stress in the parents, which in turn maintained their child’s stress level (AU)

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De marzo de 2003 a febrero de 2004 se realizó un estudio prospectivo, transversal y observacional con 204 adultos mayores del grupo geriátrico de la CMF Dr. Ignacio Chávez ISSSTE en Coyoacan, México DF, con el objetivo de reconocer los factores que condicionan una infección de vías urinarias (IVU) y los signos y síntomas clínicos, así como las pruebas de laboratorio que faciliten el diagnóstico. Se utilizó el estadístico de Chi cuadrada, así como los cálculos de sensibilidad y especificidad. Se tuvieron 29% de cultivos positivos, siendo Escherichia coli la más común. Ninguno de los síntomas comúnmente asociados resultó buen predictor, al igual que los parámetros utilizados en una tira reactiva. Los diabéticos con tratamiento farmacológico y los de más de 10 años de evolución tuvieron un riesgo más alto de adquirir una IVU, lo que sugiere una asociación entre la severidad de la diabetes y dicho riesgo

During the period between March 2003 and February 2004, a prospective, transversal, and observational study was carried out with 204 elderly ambulatory patients from the geriatric group of the Medical Center Dr. Ignacio Chavez ISSSTE in Coyoacán, in Mexico City, D.F., Mexico. The objective was to recognize and identify the factors that have an effect in a Urinary Tract Infection (UTI) condition, and its signs and symptoms, as well as the laboratory tests that can facilitate its diagnosis. The statistical Chi-Square was used, as well as the calculations of sensibility and specificity. We obtained a 29% rate of positive culture, being Escherichia coli the predominant pathologic agent. None of the associated symptoms, nor the parameters used in a reactive diagnostic stripe, were good predictors. The diabetic patients with a pharmacological treatment and those with an over ten years evolution had a higher risk to acquire UTI. This suggests a strong association between how severe the diabetes is and the risk to acquire UTI

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OBJECTIVES: To recognise factors in the host that might condition the appearance of the bacterial vaginosis (BV) syndrome, whether gynae-obstetrical factors, habits of sexual conduct, hygiene, or other factors. DESIGN: Cross-sectional, observational study. SETTING: The study was conducted from January 2002 to June 2003 in the Primary Care Dr. Jose Castro Villagrana Community Health Centre at Tlalpan, Mexico City. PARTICIPANTS: 968 patients with an active sexual life who had not taken antibiotics for at least 15 days before the study and who were not menstruating at the moment of taking a swab, 859 of whom had a diagnosis of cervico-vaginitis and 109 had no symptoms. MAIN MEASUREMENTS: Confidential questionnaire and a cervical-vaginal culture. The Amsel criteria were used to make the diagnosis of bacterial vaginosis. RESULTS: There was 32.9% prevalence of BV. There was a statistically significant association with factors such as age, start of active sexual life, the number of sexual relations per week, the number of sexual partners, and pregnancy. CONCLUSIONS: Bacterial vaginosis is the main cause of infectious processes in the vagina. Its appearance appears to be linked to factors involving sexual transmission. Interventions to reduce its prevalence and complications are recommended.

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