El estándar de tratamiento para la enfermedad de la vesícula biliar es la colecistectomía laparoscópica. Una disección del triángulo hepatocístico complicada con sangrado puede resultar en conversión ...a cirugía abierta durante el procedimiento, la cual se asocia a una mayor morbilidad. La identificación de factores de riesgo por la conversión en el contexto de colecistitis aguda permitirá individualizar el cuidado del paciente y mejorar los resultados.
Estudio retrospectivo de casos y controles que incluyó a todos los pacientes admitidos en un centro académico de tercer nivel desde enero de 1991 hasta enero de 2012 con diagnóstico de colecistitis aguda según las guías de Tokio 2018. Analizamos las variables utilizando regresión logística para identificar los factores de riesgo para conversión. Las variables que se identificaron como predictores de conversión significativos en el análisis univariado fueron incluidas en un modelo multivariado. Finalmente realizamos un análisis exploratorio para identificar la sumatoria de factores con mayor sensibilidad para conversión.
El estudio incluyó a 321 pacientes con colecistitis aguda. La edad promedio fue de 49 años (DE: ± 16.8). El 65% fueron del sexo femenino y el 35% del sexo masculino. Treinta y nueve casos (12.14%) se convirtieron a cirugía abierta. En el análisis univariado, la mayor edad, el sexo masculino, el grosor de pared vesicular y el líquido pericolecístico se asociaron con un mayor riesgo de conversión. En el análisis multivariado, todas las variables con excepción del líquido pericolecístico mantuvieron asociación con conversión. Nuestro modelo de predicción de riesgo demostró una sensibilidad del 84%.
Es posible utilizar datos clínicos preoperatorios para identificar a pacientes que tienen un mayor riesgo de conversión a cirugía abierta. Conocer dichos factores puede mejorar la planeación del plan quirúrgico y estar preparados para casos desafiantes.
The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes.
A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion.
The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%.
Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.
Aun teniendo gran relevancia el concepto de calidad de vida en el ámbito de la discapacidad intelectual (DI), existe escasa investigación acerca de su aplicación en jóvenes con trastorno del espectro ...del autismo (TEA), especialmente acerca de la dimensión derechos, área que ha cobrado especial importancia en los últimos años con la ratificación de la Convención de los Derechos de las Personas con Discapacidad de Naciones Unidas. Este estudio se centra en la evaluación de derechos en jóvenes con TEA y DI, comparando sus resultados con dos grupos de jóvenes que presentan DI y otra condición comórbida: síndrome de Down y parálisis cerebral. Para ello, se utilizó la subescala derechos de la versión piloto de la Escala KidsLife en una muestra de 153 participantes con DI entre 4 y 21 años (TEA = 51; síndrome de Down = 51; parálisis cerebral = 51). En el grupo con TEA, el género, el tipo de escolarización, el nivel de DI y de necesidades de apoyo dieron lugar a diferencias significativas. Los tres grupos obtuvieron resultados positivos, aunque los jóvenes con síndrome de Down obtienen resultados significativamente superiores a los obtenidos por jóvenes con TEA.
Snakes possess a unique sensory system for detecting infrared radiation, enabling them to generate a 'thermal image' of predators or prey. Infrared signals are initially received by the pit organ, a ...highly specialized facial structure that is innervated by nerve fibres of the somatosensory system. How this organ detects and transduces infrared signals into nerve impulses is not known. Here we use an unbiased transcriptional profiling approach to identify TRPA1 channels as infrared receptors on sensory nerve fibres that innervate the pit organ. TRPA1 orthologues from pit-bearing snakes (vipers, pythons and boas) are the most heat-sensitive vertebrate ion channels thus far identified, consistent with their role as primary transducers of infrared stimuli. Thus, snakes detect infrared signals through a mechanism involving radiant heating of the pit organ, rather than photochemical transduction. These findings illustrate the broad evolutionary tuning of transient receptor potential (TRP) channels as thermosensors in the vertebrate nervous system.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
4D printing is an emerging field where 3D printing techniques are used to pattern stimuli‐responsive materials to create morphing structures, with time serving as the fourth dimension. However, ...current materials utilized for 4D printing are typically soft, exhibiting an elastic modulus (E) range of 10−4 to 10 MPa during shape change. This restricts the scalability, actuation stress, and load‐bearing capabilities of the resulting structures. To overcome these limitations, multiscale heterogeneous polymer composites are introduced as a novel category of stiff, thermally responsive 4D printed materials. These inks exhibit an E that is four orders of magnitude greater than that of existing 4D printed materials and offer tunable electrical conductivities for simultaneous Joule heating actuation and self‐sensing capabilities. Utilizing electrically controllable bilayers as building blocks, a flat geometry is designed and printed that morphs into a 3D self‐standing lifting robot, setting new records for weight‐normalized load lifted and actuation stress when compared to other 3D printed actuators. Furthermore, the ink palette is employed to create and print planar lattice structures that transform into various self‐supporting complex 3D shapes. These contributions are integrated into a 4D printed electrically controlled multigait crawling robotic lattice structure that can carry 144 times its own weight.
Electrically controlled stiff morphing structures are built by 4D printing new multiscale polymer composites. Enabling the fabrication of active 3D autonomous structures, capable of self‐sensing actuation, unprecedented levels of actuation stress, and specific mass while undergoing shape change. Integrating these materials with lattice designs enables large scale complex 3D surfaces that are loadbearing, culminating in a crawling multigait robotic lattice.
The continuous release of pharmaceuticals from WWTP effluents to freshwater is a matter of concern, due to their potential effects on non-target organisms. The occurrence of pharmaceuticals in WWTPs ...and their associated hazard have been scarcely studied in Latin American countries. This study aimed at monitoring for the first time the occurrence of 70 pharmaceutical active compounds (PhACs) in WWTPs across Costa Rica; the application of the hazard quotient (HQ) approach coupled to ecotoxicological determinations permitted to identify the hazard posed by specific pharmaceuticals and toxicity of the effluents, respectively. Thirty-three PhACs were found, with 1,7-dimethylxanthine, caffeine, acetaminophen, ibuprofen, naproxen, ketoprofen and gemfibrozil being the most frequently detected (influents/effluents). HQ for specific pharmaceuticals revealed 24 compounds with high/medium hazard in influents, while the amount only decreased to 21 in effluents. The top HQ values were obtained for risperidone, lovastatin, diphenhydramine and fluoxetine (influent/effluent samples), plus caffeine (influent) and trimethoprim (effluent). Likewise, the estimation of overall hazard in WWTP samples (sum of individual HQ, ∑HQ) demonstrated that every influent and 96% of the effluents presented high hazard towards aquatic organisms. Ecotoxicological analysis (Daphnia magna, Lactuca sativa and Microtox test) revealed that 16.7% of the effluents presented toxicity towards all benchmark organisms; the phytotoxicity was particularly frequent, as inhibition values ≥20% in the germination index for L. sativa were obtained for all the effluents. The ∑HQ approach estimated the highest hazard in urban wastewater, while the ecotoxicological results showed the highest toxicity in hospital and landfill wastewater. Likewise, ecotoxicological results and ∑HQ values showed a rather poor correlation; instead, better correlations were obtained between ecotoxicological parameters and HQ values for some individual pharmaceuticals such as cephalexin and diphenhydramine. Findings from this study provide novel information on the occurrence of pharmaceuticals and the performance of WWTPs in the tropical region of Central America.
Display omitted
•Occurrence of 70 pharmaceutical compounds in WWTPs in Costa Rica.•High hazard estimated in every influent and 96% effluents towards aquatic organisms.•Risperidone, lovastatin and diphenhydramine exhibited the highest hazard in influents/effluents.•Toxicity of 16.7% effluents towards all benchmark organisms experimentally tested.•Phytotoxicity (inhibition in seed germination test) particularly critical in effluents.
Introducción: El páncreas es considerado de los órganos más frecuentemente afectados por recurrencia después de la nefrectomía secundaria a carcinoma de células renales notificándose una incidencia ...de 20%, 85% de estas ocurren dentro de los primeros 3 años. Objetivo: Evaluar la sobrevida general y sobrevida libre de enfermedad en pacientes con cáncer renal y metástasis pancreáticas sometidos a tratamiento quirúrgico. Métodos: Se realizó un estudio retrospectivo transversal de pacientes con diagnóstico histológico de cáncer renal asociado a metástasis pancreática y se incluyeron aquellos tratados mediante cirugía de tipo pancreatoduodenectomía o pancreatectomía distal durante el periodo de tiempo 1987-2020. Resultados: Se incluyeron 14 pacientes con metástasis a páncreas. Se obtuvieron dos grupos de pacientes: sometidos a cirugía pancreática por metástasis y aquellos que no se les realizó procedimiento quirúrgico. De acuerdo a la localización de la metástasis 71.4% correspondía a ubicación única y 28.6% a ubicación múltiple. Al 57.1% se les realizó Whipple y 42.9% pancreatectomía distal. La sobrevida tras el procedimiento quirúrgico, fue de 1150 días vs. 499 días en no operados. Conclusión: Las metástasis a páncreas por CCR pueden ser curables, mejorar la morbilidad y aumentar la sobrevida libre de enfermedad con tratamiento quirúrgico.
El aislamiento y selección de linfocitos T puros de cultivo primario de bazo de ratón puede obtenerse de manera rápida y fácil utilizando kits comerciales con microesferas magnéticas para capturar y ...purificar las células. A pesar de estas ventajas, la carga financiera que puede representar para el presupuesto de un laboratorio, la adquisición constante de estos kits justifica la evaluación de otras opciones de menor costo. Por ello, se comparó el porcentaje de recuperación celular, viabilidad y pureza de tres métodos de aislamiento y purificación de linfocitos T; dos de bajo costo y fácil implementación (aislamiento con amortiguador de amonio- cloruro-potasio (ACK)-adhesión celular y aislamiento con Ficoll), y un kit comercial de selección negativa con microesferas magnéticas. Con el método de amortiguador ACK-adhesión celular se obtuvo un porcentaje de recuperación y purificación de linfocitos T viables comparable al obtenido con el kit. Aunque este método requiere más tiempo, dado que las células deben ser incubadas durante toda la noche, es de fácil implementación y tiene una eficiencia comparable al kit, así como un menor costo. Este método puede ser tomado en cuenta para utilizar en experimentos que puedan trabajar con linfocitos activados.
Display omitted
•B. licheniformis produced an EPSp composed of polyglutamic acid and teichoic acid.•The negative charge content of the EPSp increased its electrostatic properties.•The EPSp was ...efficient at inhibiting viral entry against enveloped viruses.•The EPSp could have potential applications as a prophylactic therapeutic biomolecule.
The exopolymer (EPSp) produced by the strain B. licheniformis IDN-EC was isolated and characterized using different techniques (MALDI-TOF, NMR, ATR-FTIR, TGA, DSC, SEM). The results showed that the low molecular weight EPSp contained a long polyglutamic acid and an extracellular teichoic acid polysaccharide. The latter was composed of poly(glycerol phosphate) and was substituted at the 2-position of the glycerol residues with a αGal and αGlcNH2. The αGal O-6 position was also found to be substituted by a phosphate group. The antiviral capability of this EPSp was also tested on both enveloped (herpesviruses HSV, PRV and vesicular stomatitis VSV) and non-enveloped (MVM) viruses. The EPSp was efficient at inhibiting viral entry for the herpesviruses and VSV but was not effective against non-enveloped viruses. The in vivo assay of the EPSp in mice showed no signs of toxicity which could allow for its application in the healthcare sector.
PDF
