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Avoidance of steroids in pediatric liver transplantation may reduce toxicity and morbidity. The aim of this study was to analyze the feasibility of a steroid-free tacrolimus-basiliximab immunosuppression scheme, the risk factors associated with steroid requirement, and safety parameters. Patients who underwent liver transplantation for biliary atresia between 2011 and 2019 were included and followed for 6 months after transplantation. Immunosuppression consisted of tacrolimus-based treatment with basiliximab induction. Steroid-free survival was estimated, and risk factors for steroid requirement were evaluated using multivariate Cox regression analysis. A total of 76 patients were included, of whom 42 (55.3%) required steroids (>14 d) due to biopsy-proven acute rejection (47.6%, n = 20), instability in liver function tests (35.7%, n = 15), tacrolimus-related adverse drug reactions (14.3%, n = 6), or other reasons (bronchospasm episode, n = 1). Steroid-free survival was 45.9% (95% CI, 35.9-58.8). Independent factors associated with steroid requirement included tortuosity in tacrolimus trough levels (≥1.76 vs. <1.76: HR 5.8, 95% CI, 2.6-12.7; p < 0.001) and mean tacrolimus trough levels (≥ 6.4 ng/mL vs. < 6.4 ng/mL: HR 0.4, 95% CI, 0.2-0.7; p = 0.002). The rate of bacterial and viral infections was comparable between patients with and without steroids, although in the former group, cytomegalovirus infection developed earlier ( p = 0.03). Patients receiving steroids had higher total cholesterol, LDL, and HDL levels ( p < 0.05) during follow-up, but no changes in the height Z-score were observed 1 year after transplantation. Basiliximab induction in combination with tacrolimus-based treatment avoided steroid requirements in 45% of the patients. Tacrolimus variability and trough levels below 6.4 ng/mL independently increased the risk of steroid requirement. Further efforts should be focused on personalizing immunosuppressive treatment.

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Introduction: Virtual environments are increasingly being used for training. It is not fully understood what elements of virtual environments have the most impact and how the virtual training is integrated by the brain on the sought-after skill transference to the real environment. In virtual training, we analyzed how the task level of abstraction modulates the brain activity and the subsequent ability to execute it in the real environment and how this learning generalizes to other tasks. The training of a task under a low level of abstraction should lead to a higher transfer of skills in similar tasks, but the generalization of learning would be compromised, whereas a higher level of abstraction facilitates generalization of learning to different tasks but compromising specific effectiveness. Methods: A total of 25 participants were trained and subsequently evaluated on a cognitive and a motor task following four training regimes, considering real vs. virtual training and low vs. high task abstraction. Performance scores, cognitive load, and electroencephalography signals were recorded. Transfer of knowledge was assessed by comparing performance scores in the virtual vs. real environment. Results: The performance to transfer the trained skills showed higher scores in the same task under low abstraction, but the ability to generalize the trained skills was manifested by higher scores under high level of abstraction in agreement with our hypothesis. Spatiotemporal analysis of the electroencephalography revealed higher initial demands of brain resources which decreased as skills were acquired. Discussion: Our results suggest that task abstraction during virtual training influences how skills are assimilated at the brain level and modulates its manifestation at the behavioral level. We expect this research to provide supporting evidence to improve the design of virtual training tasks.

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Individual-level sibling interactions in the litter huddle have been studied extensively, especially in the domestic rabbit (Oryctolagus cuniculus). However, little is known about inter-litter differences in pup activity patterns during early postnatal life, in particular regarding the drivers of such variation. In our study on 2-3-day-old rabbit pups, we predicted lower locomotor activity in litters with lower mean body masses on the day of birth (starting body mass) and with lower daily milk intake per pup, possibly constituting a behavioral strategy of pups to cope with associated energetic constraints. For an automatized assessment of pup locomotor activity in the litter huddle, we successfully developed and validated a method based on the quantification of dissimilarities between consecutive frames of video footage. Using this method, we could confirm a U-shaped time course of litter-level locomotor activity, with maximum values shortly before and after the once-daily nursing typical for the rabbit. As predicted, between-litter variation in mean starting body mass and in daily milk intake affected the degree of locomotor activity in the litter huddle, in an interactive way. That is, in litters with heavier starting body masses, pup locomotor activity was greater in pups with an initially higher milk intake, suggesting that only pups with better body condition and a higher energy intake could afford higher levels of activity. This interaction was exclusively apparent during the middle phase of the 24 h inter-nursing interval, when litter activity was low. Shortly before nursing, when pups show higher levels of locomotor behavior in anticipation of the mother's arrival, and shortly after nursing when the pups were more active possibly due to adjustments of their positions in the huddle, activity levels were decoupled from pups' starting body mass and previous milk intake. Our findings highlight the importance of pup body mass and daily energy intake, two parameters known to be related to maternal characteristics, in shaping inter-litter differences in pup locomotor activity.

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The most common indications for early liver retransplantation (eRe-LT) are vascular complications and primary nonfunction (PNF). These patients are usually in a critical clinical condition that can affect their chances of survival. In fact, the survival of these patients is usually lower compared with the patients undergoing a first transplant. To the best of our knowledge, no specific series of pediatric patients undergoing eRe-LT has been published to date. Therefore, the aim of this study is to report the results of eRe-LT and to analyze factors potentially related to success or failure. Our work is of a retrospective cohort study of patients who underwent eRe-LT at the Juan P. Garrahan Pediatric Hospital of Buenos Aires, Argentina, between May 1995 and December 2018 (n = 60). Re-LT was considered early when performed ≤30 days after the previous LT. A total of 40 (66.7%) patients were enrolled due to vascular causes and 20 (33.3%) were enrolled because of PNF. Of all the relisted patients, 36 underwent eRe-LT, 14 died on the waiting list, and 10 recovered without eRe-LT. A total of 23 (63.9%) patients died after eRe-LT, most of them due to infection-related complications. Survival rates at 1 and 5 years were 42.4% and 33.9%, respectively. On univariate logistic regression analysis, Pediatric End-Stage Liver Disease (PELD)/Model for End-Stage Liver Disease (MELD) scores, transplant era, and advanced life support at eRe-LT were found to be related to 60-day mortality. However, on multivariate analysis, era (odds ratio [OR], 9.3; 95% confidence interval [CI], 1.19-72.35; P = 0.033) and PELD/MELD scores (OR, 1.07; 95% CI, 1-1.14; P = 0.036) were significantly associated with 60-day patient mortality. This study found that the level of acuity before retransplant, measured by the requirement of advanced life support and the PELD/MELD score at eRe-LT, was significantly associated with the chances of post-eRe-LT patient survival.

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The EYNR is the most important wetland in central Chile because it is protected as a RAMSAR site. It includes coastal lagoons, estuaries and saltmarshes, sustaining an important biodiversity. The chemical complexity was described using water and soil samples, which are characterized by high levels of alkalinity and soil cations. In addition, high concentrations of Cu (0.01-0.080 mg L-1) and Pb (0.120-0.566 mg L-1) in water were measured. Using a simplified index of water quality for oxygen demand, the ecological status of the wetland was classified as bad quality due to the existing use of land. Multivariable analyses and heavy metal index classified this wetland as having low to intermediate deterioration due to the combination of heavy metals. If this trend is allowed to continue unabated, the food web complexes in this wetland are likely to be at the highest risk of induced heavy metal contamination.

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Hepatoblastoma (HB) is the most common malignant liver tumor in children. Twenty percent of the cases may remain unresectable after neoadjuvant chemotherapy and, for these patients, liver transplant (LT) is an accepted therapeutic option. To analyze the risk factors to event-free survival (EFS) that influence the clinical outcome of patients with HB receiving LT, we retrospectively analyzed 21 patients with HB who underwent LT between January 1, 2005, and May 1, 2018. Overall survival (OS) was 90%. The univariate analysis shows that the AFP level at the time of LT was associated with a higher risk of EFS. With a ROC curve analysis, we established a cutoff point value of AFP levels at 16 000 ng/dL, with a sensitivity of 71.43% and a specificity of 85.71%. Multivariate analysis showed that patients with higher values of pretransplant AFP (>16 000 ng/dL) had a significantly higher risk of EFS than those transplanted with lower levels (HR: 10.180; 95% CI: 1.54-66.97; P = .02). Efforts should be made to improve the selection of candidates for LT for unresectable HB, aiming at a better definition of chemoresistance as a risk factor of poor outcomes.

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Being adapted to saline environments, halophytes are plant species that have received considerable attention due to their ability to cope with environmental stress factors, such as high concentrations of soluble salts and heavy metals. In this work, we focused on determining if the Sarcocornia neei (S. neei) plant can be considered as an indicator of heavy metal pollution in soil. This was done by analyzing the concentration of cadmium (Cd), lead (Pb), copper (Cu), and arsenic (As) in plants and soil sampled from two wetlands in the central zone of Chile: a wetland contaminated by industrial activities and a wetland protected by the Chilean government. In addition, 14 fertility parameters (pH, electrical conductivity, organic matter, nitrogen (N), phosphorus (P), potassium (K), sodium (Na), Pb, calcium (Ca), magnesium (Mg), Manganese (Mn), zinc (Zn), iron (Fe), and boron (B)) were analyzed for soil samples in both wetlands. This was done to differentiate between available elements and contamination by heavy metals. Plant and soil samples in the contaminated wetland exhibited significantly higher heavy metal concentrations in comparison to samples analyzed from the protected wetland. This indicates that the S. neei plant can be further researched as an indicator of heavy metal pollution in saline soils and possibly for phytoremediation purposes.

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Objetivo. Los efectos de la encefalopatía hipóxica isquémica en los recién nacidos pueden reflejarse en el deficiente desarrollo de patrones motores elementales que son el origen de la psicomotricidad. En este estudio se tuvo como objetivo establecer la efectividad de un procedimiento de evaluación e intervención, que precisara el tipo de desorganización motora asociada a este padecimiento. Método. Se evaluaron 15 niños con hipoxia, utilizando la Escala de evaluación del desarrollo cinesiológico de Vojta y la Escala de estimación del desarrollo psicomotor de Hellbrügge, con los que se pudieron identificar tres tipos de desorganización motora: patrón motor de tipo hipotónico/hipoquinético, patrón motor hiperexcitable y patrón motor rígido. Se elaboró un programa de corrección basado en los principios de estimulación vestibular y propioceptiva para activar posturas y posiciones humanas específicas y reducir la expresividad de los tipos identificados. Resultados. Después de ocho meses de tratamiento se identificaron cambios en la organización motriz como resultado de la aplicación del programa de corrección (t(15) = 8.37, p < 0.000). Discusión. Se discute la importancia del diseño de estrategias de intervención temprana para disminuir la manifestación de alguna discapacidad que en el futuro pudiera manifestarse.

Objective. Hypoxic encephalopathy effects in newborn children can be reflected in the inappropriate development of motor patterns that are the cornerstone of psychomotor activity. The main objective of this study was to systematize an assessment-intervention procedure in order to detect different types of motor. Method. 15 children were evaluated using Vojta and Hellbrügge scales. Three types of motor deviation were identified: hypotonic/hypokinetic motor pattern, hyperexcitable motor pattern and rigid motor pattern. A program for correction was subsequently drawn up, based on the principles of vestibular and proprioceptive stimulation to activate specific human postures and positions and reduce the identified motor deviations. Results. After 8 months of the treatment significant changes were detected in the organization of, after the application of the motor program (t(15) = 8.37, p <0.0001). Discussion. These results showed the necessity of the precise design of intervention procedures at an early age for the prevention of the occurrence of any disability.

Escopo. Os efeitos da encefalopatia hipóxico isquêmica nos recém nascidos podem se reflexar no deficiente desenvolvimento de patrões motores elementares que sÃo o origem da psicomotricidade. Em este estudo o escopo foi estabelecer a efetividade de um procedimento de avaliaçÃo e intervençÃo, que precisara o tipo de desorganizaçÃo motora associada a este padecimento. Metodologia. Foram avaliadas 15 crianças usando a Escada de avaliaçÃo do desenvolvimento cinesiolôgico de Vojta e Escada de estimaçÃo do desenvolvimento psicomotor de Hellbrugge, com os que se pode identificar três tipos de desorganizaçÃo motora: patrÃo motor de tipo hipotônico/hipoquinético, patrÃo motor hiperexcitável e patrÃo motor rígido. Depois foi feito um programa de correçÃo baseado nos princípios de estimulaçÃo vestibular e proprioceptiva para ativar as posturas e posiciones humanas específicas e reduzir os tipos de dificuldades motoras identificadas. Resultados. Depois de 8 meses de tratamento foram identificadas mudanças na organizaçÃo motora das como resultado da aplicaçÃo do programa de correçÃo (t(15) = 8.367, p < 0.0001). DiscussÃo. Foi discutida a importância do desenho de estratégias de intervençÃo precoce para diminuir a manifestaçÃo de qualquer possível incapacidade que no futuro possa se manifestar.

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Although most mammals grow up in the company of same or different age sibs (or half sibs), surprisingly little attention has been given to how relations among them might influence the development of individual differences in morphology, physiology, and behavior. Here we review evidence from our work on domestic and wild European rabbits, and more recently on laboratory rats, mice, and domestic cats, supporting the proposition that in mammals early sibling relations contribute to the development of individual differences in these three domains and thereby to long-term behavioral differences of the kind we might consider part of an animal's behavioral style or personality. First we report a consistent and marked negative relation between litter size and individuals' body mass at birth and weaning, as well as marked within-litter differences in prenatal body mass and placental efficiency. We then report individual differences in preweaning behaviors associated with these morphological variables such as position occupied in the litter huddle and development of motor ability, as well as physiological differences in thermoregulation, immune parameters, and endocrine indicators of stress. Finally, we report first evidence from wild rabbits that early relations among littermates may have long-term consequences for individual differences in behavioral style. We conclude that in mammals, individual differences in early growth, physiology and behavior potentially important for the development of animal personality, are shaped to an appreciable extent by early sibling relations and that this little-researched field deserves closer attention.

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Many aspects of an animal's early development might potentially contribute to long-term individual differences in physiology and behavior. Here we asked whether differences among littermates of the domestic rabbit in the position in the litter huddle that they occupy during the early nest period might contribute to the development of distinct behavioral and physiological phenotypes. In each of 12 litters we determined the pup occupying the most peripheral, the most central, and an intermediate position in the huddle during the first postnatal week. We then tested the responses of these same individuals as nestlings, juveniles and young adults when confronted by a range of age-appropriate environmental challenges. Two behavioral tests appeared particularly discriminatory in identifying differences associated with early position in the huddle; latency of pre-weaning pups to jump down from a shelf, and the response of young adults to the fearful screams of a conspecific. In both cases animals that had occupied the periphery of the huddle showed behavioral responses indicative of a more proactive behavioral style than their "intermediate" or "central" littermates. We conclude that while consistent long-term differences in behavioral style associated with early position in the litter huddle exist in rabbits, future work is needed to confirm the causal nature of this association, to identify underlying mechanisms, and to refine methods of behavioral and physiological testing across the life span.

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