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Objective To assess the utility of fetal laser surgery in fetuses complicated with cystic lung lesions with systemic arterial blood supply (hybrid lung lesions) at risk of perinatal death. Methods A cohort of 5 consecutive fetuses with large hybrid lung lesions associated with hydrops and/or pleural effusion with severe lung compression was selected for percutaneous ultrasound-guided full laser ablation of the feeding artery (FLAFA) at less than 32 weeks of gestation in a single tertiary national referral center at Queretaro, Mexico. The primary outcomes were survival and need for postnatal surgery. Results Fetal laser surgery with FLAFA was successfully performed in all cases at a median gestational age of 24.9 (range, 24.4-31.7) weeks. After fetal intervention, increasing dimensions in both lungs and fetal fluid effusions disappearance were observed in all cases. All cases were born alive at term at a median gestational age of 39.6 (range, 38.0–39.7) weeks, without respiratory morbidity or need for oxygen support, resulting in perinatal survival of 100%. During follow-up, three cases (60%) showed a progressive regression of the entire lung mass and did not require postnatal surgery, while in 2 cases (40%); a progressive decrement in size of the mass was observed but a cystic portion of the lung mass did not regress requiring postnatal lobectomy. Conclusion This report first suggests that for fetuses with large hybrid lung lesions at risk of perinatal death; fetal surgery with FLAFA is feasible and could be of benefit in improving survival and decreasing the need for postnatal surgery.

The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin. METHODS: In this double-blind, double-dummy, placebo-controlled trial, we randomly assigned acutely ill patients who had congestive heart failure or respiratory failure or other medical disorders and at least one additional risk factor for venous thromboembolism and who were hospitalized with an expected stay of at least 3 days to receive apixaban, administered orally at a dose of 2.5 mg twice daily for 30 days, or enoxaparin, administered subcutaneously at a dose of 40 mg once daily for 6 to 14 days. The primary efficacy outcome was the 30-day composite of death related to venous thromboembolism, pulmonary embolism, symptomatic deep-vein thrombosis, or asymptomatic proximal-leg deep-vein thrombosis, as detected with the use of systematic bilateral compression ultrasonography on day 30. The primary safety outcome was bleeding. All efficacy and safety outcomes were independently adjudicated. RESULTS: A total of 6528 subjects underwent randomization, 4495 of whom could be evaluated for the primary efficacy outcome - 2211 in the apixaban group and 2284 in the enoxaparin group. Among the patients who could be evaluated, 2.71% in the apixaban group (60 patients) and 3.06% in the enoxaparin group (70 patients) met the criteria for the primary efficacy outcome (relative risk with apixaban, 0.87; 95% confidence interval [CI], 0.62 to 1.23; P = 0.44). By day 30, major bleeding had occurred in 0.47% of the patients in the apixaban group (15 of 3184 patients) and in 0.19% of the patients in the enoxaparin group (6 of 3217 patients) (relative risk, 2.58; 95% CI, 1.02 to 7.24; P = 0.04). CONCLUSIONS: In medically ill patients, an extended course of thromboprophylaxis with apixaban was not superior to a shorter course with enoxaparin. Apixaban was associated with significantly more major bleeding events than was enoxaparin, Supported by Bristol-Myers Squibb and Pfizer

http://www.eurodl.org/?p=archives&year=2008&halfyear=1&article=313

Stock structure of eastern Pacific yellowfin tuna was investigated by analyzing allozymes and random amplified polymorphic DNAs (RAPDs) from 10 samples of 20–30 individuals each, collected between 1994 and 1996 from fishing vessels operating in the Inter-American Tropical Tuna Commission (IATTC) yellowfin regulatory area (CYRA). Allozyme analysis resolved 28 loci, eight of which were polymorphic under the 0.95 criterion: Aat-S*, Glud, Gpi-F*, Gpi-S*, La, Lgg, Pap-F*, and 6-Pgd, resulting in a mean heterozygosity over all allozyme loci of H = 0.052. Four polymorphic RAPD loci were selected for analysis, resulting in a mean heterozygosity of H = 0.43. Eight of 45 pairwise comparisons of allozyme allele frequencies among the ten samples showed significant differences after correction for multiple testing (P0.05) revealed little population structure among samples. Mantel tests demonstrated that the genetic relationships among samples did not correspond to an isolation-by-distance model for either class of marker. Four of eight comparisons of coastal and offshore samples revealed differences of allele frequencies at the Gpi-F* locus (P0.001). Results are consistent with the hypothesis that the CYRA yellowfin tuna samples comprise a single genetic stock, although gene flow appears to be greater among coastal samples than between coastal and offshore samples.

Objetivo: Evaluar el comportamiento de la eritropoyetina (EPO) y determinadas citocinas proinflamatorias en la anemia de trastornos crónicos (ATC) de origen infeccioso. Métodos: Determinación secuencial en suero mediante enzimoinmunoanálisis de interleucina-1 beta (IL-1β), factor de necrosis tumoral alfa (TNF-α), interferσn gamma (IFN-γ), interleucina-6 (IL-6) y eritropoyetina (EPO) en 25 pacientes con enfermedades de origen bacteriano, curso clínico prolongado y criterios de ATC. Se analizó la relación de estos mediadores con la anemia y con el metabolismo del hierro.Resultados: Los niveles de EPO experimentaron un descenso significativo respecto al nivel inicial, normalizándose en el control tardío (18,04 ± 19,10 vs 8,56 ± 4,72 UI/mL; p < 0,001; rango normal: 4-15 mUI/mL). Inicialmente, existía correlación inversa no significativa entre los niveles de EPO y la concentración de hemoglobina (r = - 0,115, NS), alcanzándose significación estadística en el control tardío (r = -0,446; p < 0,05). Existía correlación inversa entre el hematocrito y los niveles del TNF-α (r = 0,467; p < 0,05) y entre la hemoglobina y la transformación logarítmica del TNF-α (r = 0,424; p < 0,001). La IL-6 mostró correlación inversa con la hemoglobina (r = 0,366; p < 0,05) y con la sideremia (r = -0,614; p < 0,001), mientras que se correlacionó directamente con los niveles de la EPO (r = 0,297; p < 0,05).Conclusiones: Una deficiente respuesta de la eritropoyetina y la acción del TNF pueden implicarse en la patogenia de la ATC de origen infeccioso. La correlación positiva entre la IL-6 y la EPO sugiere una implicación proeritropoyética de la primera en respuesta a la anemia. Objective: To evaluate the pattern of erythropoietin (EPO) and some proinflammatory cytokines in the anemia of chronic disorders (ACD) secondary to infection Methods: Sequential determination in serum of interleukin-1 beta (IL-1β), necrosis tumoral factor alpha (TNF-α), gamma interferon (IFN-γ), interleukin-6 (IL-6), and erythropoietin (EPO) in 25 patients with chronic bacterial infectious diseases and ACD criteria. We evaluated the relationship of these mediators with the anemia and the iron metabolism.Results: Serum EPO levels significatively decreassed compared with initial values, and the last control was in normal rank (18.04 ± 19.10 vs. 8.56 ± 4.72 UI/mL; p < 0.001; normal rank: 4-15 mUI/mL). In the first control, there was a negative and non significative correlation between the EPO levels and the hemoglobin concentration (r = -0.115, NS), reaching significance in the last control (r = -0.446; p < 0.05). There was negative correlation between the hematocrit and TNF-α levels (r = 0.467; p