This article addresses the relationship between masculinity and nationalism, especially in literature of exile. It investigates the militarism of the Cuban national identity that promotes homophobia ...through a disdain for the feminine in the development of national masculinity. Antes que anochezca therefore exemplifies anti-nationalist exile literature as it rejects Castroist censorship and the criminalization of homosexuality. However, while the novel is anti-nationalist, it continues to perpetuate a repudiation of femininity as he valorizes masculinity, showcased in his sexual relationships between men. This is done in the novel through a dichotomy of active and passive roles in men who have sex with men that is established through the roles of penetrator/penetrated. Therefore, femmephobic ideology based on the national development of Cuban masculinity has permeated queer literature in exile, even in an anti-nationalist novel.
Open access (OA) is now a complex multifaceted phenomenon and one of the hottest topics under debate extending to other actors beyond academia. OA has been growing lately not only for ethical or ...ideological reasons, but also due to the pressure of formal mandates from public research funders. Many studies have shown that OA research outputs have greater citation impact as compared to similar toll-access (TA) ones, thus introducing a more pragmatic dimension for scholars considering OA. However, other studies claim there are many confounding factors that often have not been taken into account. To date, no study has been carried out concerning open access citation advantage (OAA) in TIS (translation and interpreting studies). This paper contributes to this debate by carrying out a bibliometric analysis by comparing the performance of documents in terms of accrued citations depending on access type in order to find out whether OA TIS research is cited more than its TA counterpart. We based our analysis on a sample of more than 20,000 TIS-related documents extracted from BITRA, covering a time span of 20 years (1996-2015). The main conclusion is that, although OA publications tend to be cited slightly more often than TA documents in our period of study, this difference is too small to either support or reject the OAA hypothesis in TIS.
Donʼt Underestimate an Old Villain Cerra-Franco, Javier A.; Magno, Priscilla; Estremera-Marcial, Rodolfo ...
The American journal of gastroenterology,
10/2018, Letnik:
113, Številka:
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Metastasis comprises less than 2% of pancreatic malignancies. Having a small clear renal cell carcinoma (RCC) with complete surgical eradication still has a low-risk for recurrence. The indolent ...growth pattern of this entity has resulted in isolated metastatic disease years after nephrectomy. The relevance of this case is the importance of keeping awareness of past malignancies and their innumerable deceptive presentations. A 65 year-old male with alcoholic cirrhosis and a right nephrectomy 14 years ago for a small RCC (T1a N0 M0) was consulted to our service after an abnormal abdominal ultrasound. An MRI with gadoxetate disodium showed no liver or kidney lesions but exposed a 2.4 cm x 1.4 cm oval-shaped solid lesion in the dorsal aspect of the pancreatic body, not present three years ago in a CT with IV contrast. A pancreas protocol CT revealed an arterial enhancing lesion with decreased conspicuity on the portal venous phase without inflammation or pancreatic duct dilatation. Endosonography with FNA showed a round, solid, heterogenous mass with thickened and discrete borders in the pancreatic body (figure-1). Cytological findings of a bloody aspirate described aggregates of epithelial cells with oncocytic cytoplasm. All findings were suggestive of a non-functioning pancreatic neuroendocrine tumor (PNET) which were confirmed by an increased tracer uptake in an octreotide scan (figure-2). Pathology report after subtotal pancreatectomy revealed a 2.0 cm x 1.8 cm metastatic RCC with negative margins. Radiological tumor staging with CT and bone scans were negative for other metastatic lesions. RCC constitutes 3% of adult malignancies with clear cell RCC being the most common histological subtype. Recurrence rates after nephrectomy for RCC are 20-40% with a median time of 15-18 months and lesions larger than 5 cm considered a risk factor. Metastatic RCC and PNET share similar morphological and imaging features making the diagnosis a difficult challenge. In a limited number of case reports, an octreotide scan can be positive in 50-80% of metastatic RCC. EUS-FNA is effective for pancreatic metastasis diagnosis with 89% diagnostic accuracy and improved yield with on-site assessment of aspirate and immunohistochemistry studies. Surgical metastasectomy of solitary lesions is the recommended intervention followed by immunomodulator therapy with pazopanib. Pancreatic metastases from RCC offers a better prognosis when compared to pancreatic adenocarcinoma.
Most protein concentrates used by the food industry are derived from soybean or wheat, but a pseudocereal like quinoa is gaining interest worldwide. The aim of this study is the characterization of ...the emulsification properties of two quinoa protein concentrates obtained through alkaline extraction (pH 9 (Q9) and 11 (Q11)), followed by precipitation at an acidic pH value. Interfacial rheological measurements point out that Q11 form stronger protein films adsorbed on the interface, which finally results in emulsions with smaller droplet sizes. However, Q9 shows greater interfacial activity due to its more compact structure which results in a lower interfacial tension. An increase in the quinoa content in the emulsion formulation is paired with a reduction in the droplet size diameter as well as a greater stability during quiescent storage. These results prove the feasibility of using a quinoa concentrate as an ingredient in commercial food emulsions.
An Unusual Case of Small Bowel Lymphangioma Fernandez-Cruz, Carlos; Echevarria, Francisco; Vazquez, Ekie ...
The American journal of gastroenterology,
10/2018, Letnik:
113, Številka:
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Lymphangioma is a benign condition characterized by proliferation of lymphatic spaces. Usually these vascular tumors are seen mostly in children although some rare cases may be seen in adults. They ...usually occur in the head, neck or axillary regions. Intra-abdominal lymphangiomas are rare, comprising around only 3% of benign small bowel tumors. The most common gastroenterological lesions are usually located in the mesentery and account for less than 1% of the cases. We present the case of a 67-year- old man who presented to the emergency department based on a call back due to low hemoglobin values on routine labs. He reported increasing fatigue and generalized weakness over the previous two months. He denied melena or hematochezia. Past medical history was remarkable for asthma and hypertension. On physical examination, the patient presented normal vital signs. He was found with generalized paleness. Negative rectal exam. Laboratory data on admission were notable for microcytic anemia with hemoglobin level of 6.3g/dL, transferrin saturation of 4%, low ferritin level (8.8ng/mL), and normal BUN. One year prior to admission hemoglobin level was 16 g/dL. CT scan of the abdomen and pelvis was unremarkable. Colonoscopy was performed and showed one sub-centimeter polyp in the descending colon, not removed based on anemia. Esophagogastroduodenoscopy was unremarkable. Capsule endoscopy revealed a polypoid lesion in the distal jejunum which was further characterized by CT enterography as a large exophytic lesion arising from the mid-jejunum. A push enteroscopy did not reach the jejunal lesion. The patient underwent an exploratory laparotomy and small bowel resection. Pathology report described a jejunal specimen of small bowel which contained a 4 cm intraluminal rubbery jejunal mass consistent with a submucosal lymphangioma. Immunohistochemistry confirmed the reactive nature of the lymphoid infiltrate. Patient had an uneventful recovery. Submucosal jejunal lymphangiomas in an adult are rare. Accurate diagnosis of lymphangiomas may not be established preoperatively despite modern imaging studies. Although most often asymptomatic, small bowel lymphangiomas can present with abdominal pain, gross or occult GI bleeding, obstruction or microcytic anemia as in this patient. It is important to be aware of this rare tumor and possible presentations, as the optimal treatment is radical excision, since incomplete resection may lead to recurrence and further organ invasion.
A Double Agent in the Cecum Pagan-Torres, Hendrick; Class-Vazquez, Walisbeth; Cerra-Franco, Javier A. ...
The American journal of gastroenterology,
10/2018, Letnik:
113, Številka:
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Appendicitis is the most common acute abdominal surgical emergency in the world. Despite its physiology not understood, appendiceal obstruction has been proposed as the primary cause. In older ...patients, appendicitis warrants further evaluation as it may be the first symptom of malignancy. This is a 70 year-old-male with medical history of chronic liver disease secondary to alcohol, paroxysmal atrial fibrillation on Warfarin, arterial hypertension and diabetes mellitus type II who presented to the Emergency Department after a call back from the laboratory reporting a hemoglobin drop from a baseline of 13.5 gm/dL to 9.3 gm/dL. Patient complained of a sharp stabbing abdominal pain localized to the right lower quadrant (RLQ) associated to dizziness, loss of appetite and general malaise for a week prior to presentation. Denied changes in bowel habits, bloody stools, dark stools, weight changes, nausea, vomits, diarrhea, constipation, fever or chills. Vital signs were stable. Physical examination was pertinent for a distended abdomen, adequate bowel sounds, soft and depressible, RLQ tenderness to palpation, but no rebound or guarding. Anemia work up revealed iron deficiency anemia. Abdominal CT without contrast revealed a dilated appendix with surrounding fat stranding and a small amount of fluid indicative of appendicitis with several enlarged lymph nodes in the right abdomen. Abdominopelvic CT with IV and PO contrast 3 days later due to progressive abdominal distention and pain revealed a distended appendix with a mass involving the cecum causing appendiceal obstruction and surrounding lymphadenopathy. Gastroenterology service recommended surgical intervention. Surgery service performed a colonoscopy and a large mass was identified at the cecum obstructing approximately 70% of the lumen. The procedure was aborted and biopsies were not taken because patient developed respiratory distress requiring endotracheal intubation. Patient had a prolonged and complicated admission leading to his demise. Autopsy report confirmed a poorly differentiated adenocarcinoma with metastasis. Cecum-Appendix adenocarcinoma is rare and it may mimic symptoms of an acute appendicitis. Therefore, it should raise concern when evaluating patients with physical and radiological findings suggestive of appendicitis in this age group. Management should be surgical due to increased risk of perforation and complications during colonoscopy.
Save by the DILI Estremera-Marcial, Rodolfo; Figueroa-Rivera, Ivonne; Cerra-Franco, Javier A. ...
The American journal of gastroenterology,
10/2018, Letnik:
113, Številka:
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Case of a 67-year-old Hispanic male with past medical history of Diabetes, coronary artery disease and dyslipidemia who arrived to the emergency department (ED) after noticing cola like urine, ...acholic stools and jaundice. Laboratories were remarkable for elevated liver enzymes; ALT 1,395 U/L, AST 793 U/L, total bilirubin 3.2 mg/dL and alkaline phosphatase of 837 U/L. CBC was within normal limits. Abdominal echo performed at ED showed normal caliber of common bile duct (CBD) and no cholelithiasis. Physical examination was only remarkable for jaundice without chronic liver disease stigmata. During interview, patient reported that symptoms started 2 weeks after completing antibiotic treatment with Augmentin-Clavulanate due to an upper respiratory tract infection. Viral hepatitis profile and serum drug toxicology were unremarkable. Patient was discharged 48 hours later with diagnostic impression of drug-induced liver injury (DILI). One week upon discharge, patient was noticed with worsening jaundice and liver enzymes significative for improving trend in transaminase: ALT 178 U/L, AST 76 U/L, but elevation of total bilirubin at 7.9 mg/dL. CT with liver protocol requested was remarkable for a pancreatic head mass of 2.3 cm x 2.3 cm with secondary dilatation of the CBD, intrahepatic and extra hepatic bile ducts. ERCP was performed due to obstructive jaundice, revealed a distal CBD stricture in favor of a pancreatic head neoplasm. Brushings from the stricture were inconclusive. Surgery service was consulted and patient underwent Whipple's procedure. Pathology report showed evidence of adenocarcinoma of pancreas with T2N1 staging and negative margins. PET scan performed after study, which showed no avid lesions. Patient had an uneventful recovery. Augmentin-Clavulanate is a widely used antibiotic and a frequent cause of idiosyncratic DILI. The onset of presentation is typically on average 3 weeks after antibiotic exposure and commonly presents as cholestatic liver injury. However, DILI is a diagnosis of exclusion for which other causes of hepatic injury should be sought. Hepatobiliary malignancy should be maintained high in differential, especially in an elderly patient. We present an interesting case of pancreatic adenocarcinoma which was found unexpectedly after an initial normal hepatobiliary imaging and negative workup evaluation for acute he patitis secondary to DILI.
Sulfonylurea receptor (SUR) belongs to the adenosine 5′-triphosphate (ATP)-binding cassette (ABC) transporter family; however, SUR is associated with ion channels and acts as a regulatory subunit ...determining the opening or closing of the pore. Abcc8 and Abcc9 genes code for the proteins SUR1 and SUR2, respectively. The SUR1 transcript encodes a protein of 1582 amino acids with a mass around 140-177 kDa expressed in the pancreas, brain, heart, and other tissues. It is well known that SUR1 assembles with Kir6.2 and TRPM4 to establish KATP channels and non-selective cation channels, respectively. Abbc8 and 9 are alternatively spliced, and the resulting transcripts encode different isoforms of SUR1 and SUR2, which have been detected by different experimental strategies. Interestingly, the use of binding assays to sulfonylureas and Western blotting has allowed the detection of shorter forms of SUR (~65 kDa). Identity of the SUR1 variants has not been clarified, and some authors have suggested that the shorter forms are unspecific. However, immunoprecipitation assays have shown that SUR2 short forms are part of a functional channel even coexisting with the typical forms of the receptor in the heart. This evidence confirms that the structure of the short forms of the SURs is fully functional and does not lose the ability to interact with the channels. Since structural changes in short forms of SUR modify its affinity to ATP, regulation of its expression might represent an advantage in pathologies where ATP concentrations decrease and a therapeutic target to induce neuroprotection. Remarkably, the expression of SUR1 variants might be induced by conditions associated to the decrease of energetic substrates in the brain (e.g. during stroke and epilepsy). In this review, we want to contribute to the knowledge of SUR1 complexity by analyzing evidence that shows the existence of short SUR1 variants and its possible implications in brain function.
This writing proposes a reading of Tiempos del incendio (2014), by José Roberto Duque, and Lo que va dictando el fuego (2015), by Juan Antonio Hernández, as a remembrance and update of the events ...that happened in El Caracazo (1989). This text by Duque and Hernández can be understood as «collective devices of enunciation» (Deleuze, 1978) from a popular memory —both rebel and militant— that doesn’t only oppose to the official version of the events, but also starts again the questioning about the use of violence on behalf of the State as a political weapon during the puntofijista democracy (1958-1998) for the present/future.
The Forgotten Biliary Stent Pagan-Torres, Hendrick; Colon-Castellanos, Janet; Medina-Prieto, Rafael ...
The American journal of gastroenterology,
10/2018, Letnik:
113, Številka:
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Endoscopic biliary sphincterotomy with stone removal is the primary treatment for choledocholithiasis. In cases of difficult biliary stones or elderly patients with serious comorbidities, endoscopic ...biliary stenting is an alternative treatment. Plastic stents are the most common type of stents used mainly for short-term biliary drainage. However, if left for a prolonged period, they can result in devastating complications. This is the case of an 84-year-old-male with past medical history of end-stage renal disease, heart failure with preserved ejection fraction, cholecystectomy in 1999, and history of choledocholithiasis s/p ERCP in 2003 who presented to the ER with severe epigastric pain and multiple episodes of non-bloody vomiting of 3 days evolution. Vital signs were unremarkable. Physical examination was notable for abdominal distention with marked diffuse tenderness to palpation, and positive guarding. Laboratories were remarkable for leukocytosis 11.7, and AST 500, ALT 135, normal Alkaline Phosphatase. Total Bilirubin was at 16 with direct predominance of 14 and lipase level was at 676 with normal amylase. Abdominal-pelvic CT scan without contrast showed acute pancreatitis and common bile stent within an abnormally dilatated common bile duct. Abdominopelvic CT with IV contrast showed focal area of hypoattenuation concerning for necrosis. Antibiotic therapy with Meropenem for 14 days was given. ERCP was performed to remove the plastic biliary stent. Patient was discharged to inpatient rehabilitation due to deconditioning secondary to prolonged hospitalization. Endoscopic biliary stenting is an alternative therapy used in patients with choledocholithiasis who are poor surgical candidates or have difficult biliary stones. Demand for new stone extraction techniques have resulted in the development of cholangioscopically directed lithotripsy. Stone fragmentation can be accomplished using electrohydraulic laser lithotripsy; however, cost and accessibility constitute the biggest limitation for this technology. It is imperative to inform patients regarding the long-term follow up of the biliary stents to avoid associated complications. This case illustrates the devastating consequences of a forgotten plastic biliary stent.
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