Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva.Objetivos: Describir la experiencia en ...videotoracoscopía (VATS) uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile).Material y métodos: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión, y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6 %) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2º puerto, uno se convirtió a mini toracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones post operatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía.Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor post operatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional.Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.
Theoretical models that are used to describe the stable output states in optical flip-flop configurations based on a single semiconductor-optical-amplifier-based Mach-Zehnder interferometer with ...feedback are derived. The calculated flip-flop states, as well as optical bistability curves, allow for an accurate characterization of the flip-flop operation during the design phase prior to experiments, showing that the system parameters must be carefully chosen to obtain correct operation. Furthermore, dynamic effects such as switching time and pulse-energy requirements are also obtained as a function of the length of the feedback loop.
The idea of merit is at the core of intense contemporary debate related to social justice in general and meritocracy in particular. In this paper, I aim to differentiate the notion of merit from two ...other notions with which it is often mistakenly identified, namely the concepts of talent and achievement. Here, I define “merit” as the value of an action that 1) is imputable to a subject‘s free conduct, 2) implies some sort of effort, and 3) is oriented towards a good. Merit so understood is a valuable phenomenon considered from various perspectives, and therefore the subject who has it deserves to be properly recognized. But, more importantly, this merit is valuable in a sense that is different from the value attached to talent and achievement. We should therefore try to recognize the three of them according to their specificity. I conclude by signaling some problems and limitations associated with the idea of merit that, on the one hand, contribute to the aforementioned confusion and, on the other hand, show that the principle of merit must not be absolutized to the detriment of other forms of value (including talent and achievement).
A novel scheme for all-optical label reading and packet routing is proposed. The architecture is comprised of all-optical logic XOR gates and all-optical flip-flops based on single Mach-Zehnder ...interferometers incorporating semiconductor optical amplifiers (SOA-MZIs). The simulation results show that a very small penalty (less than 0.45 dB) for 10 Gbit/s packet processing can be achieved.
Resumen: El objetivo de este estudio es la descripción de la novedosa y poco invasiva técnica de marcación de pequeños nódulos pulmonares con lipiodol, guiado con TAC para su posterior resección por ...cirugía videotoracoscópica con apoyo radioscópico. Se trata de un estudio retrospectivo que incluye 51 pacientes consecutivos en un tiempo comprendido entre junio del 2012 a septiembre del 2017, obteniendo el diagnóstico final mediante la correlación anatomopatológica, representando los procesos malignos el 81% y los benignos el 19%. Mediante esta técnica se lograron identificar y extraer con éxito el 100% de los nódulos marcados, demostrándose la efectividad y seguridad del procedimiento por las mínimas complicaciones relacionadas.
El cáncer pulmonar es actualmente la primera causa de muerte por cáncer en el mundo. Su incidencia en Chile también ha aumentado en forma progresiva, lo que sumado a la alta tasa de tabaquismo en ...nuestro país hacen prever que se convertirá en un grave problema de salud pública en los próximos años.
El principal factor de riesgo es el cigarrillo, por lo que deben realizarse los máximos esfuerzos para desincentivar su consumo, la exposición a arsénico parece ser un importante factor en el Norte del país. Se han descrito múltiples alteraciones genéticas que interactuarían con los carcinógenos del cigarrillo y cierta predisposición familiar para el desarrollo de cáncer pulmonar.
Este cáncer tiene una alta letalidad con una sobrevida global de 16% a cinco años. Los síntomas son inespecíficos, por lo que el diagnóstico es generalmente tardío. El cáncer pulmonar se divide en Cáncer Pulmonar de Células Pequeñas (CPCP) que representa el 10-15% y el Cáncer Pulmonar de Células no Pequeñas (CPCNP) que representa el 85-90%. El CPCP es agresivo, con metástasis precoces, siendo el tratamiento de elección Quimioterapia. El CPNCP consta de varios tipos histológicos, siendo el más frecuente el Adenocarcinoma, en este sub-tipo se han descrito mutaciones con factor pronóstico (EGFR, KRAS, ALK), lo que ha motivado la revisión de su clasificación y estudio histopatológico incorporando en forma estándar el estudio molecular.
Se han producido avances en el diagnóstico y etapificación con la incorporación del EBUS, EUS y PET/CT y adopción de la 7ª Clasificación TNM de la IASLC (International Association for the Study of Lung Cancer), más exacta y con mejor correlación con el pronóstico por etapas. Se ha mostrado recientemente que el diagnóstico precoz mediante TAC de tórax de baja dosis logra una reducción en la mortalidad por cáncer pulmonar.
Dentro del tratamiento, los avances en cirugía mínimamente invasiva permiten realizar actualmente lobectomías por videotoracoscopía con resultados oncológicos absolutamente equivalentes a la cirugía abierta, pero con menores complicaciones, hospitalizaciones más cortas y reincorporación laboral precoz. Se está evaluando además el uso de resecciones sub-lobares en etapas iniciales.
En radioterapia la incorporación de la intensidad modulada ha permitido lograr mejores resultados en sobrevida y control local. Se están estudiando con promisorios resultados nuevas técnicas como la planificación con PET/CT y el uso de radioterapia estereotáctica del cuerpo (SBRT).
En quimioterapia se han incorporado nuevas drogas con mayor efectividad y menor perfil de toxicidad. Sin embargo el explosivo desarrollo de la biología molecular que ha permitido el desarrollo de la terapia personalizada representa el mayor avance en oncología médica de los últimos años. La identificación de mutaciones con factor pronóstico como EGFR y ALK, y el desarrollo de moléculas que actúan en forma específica sobre los productos de los genes mutados, con excelente respuesta y escasa toxicidad, han revolucionado nuestra visión de la quimioterapia. La terapia personalizada de acuerdo a las mutaciones del tumor de cada paciente representa uno de los mayores avances en el tratamiento del cáncer pulmonar y sin duda será un campo de gran desarrollo en los próximos años.
Pese a la letalidad de esta neoplasia y el aumento de su incidencia a nivel mundial, los avances que se describen en el presente artículo permiten vislumbrar un mejor futuro para los pacientes con cáncer pulmonar.
Lung cancer is the leading cause of cancer death worldwide, and its incidence has increased steadily in Chile. Smoking is the main risk factor for lung cancer, while arsenic exposure appears to be important in the North of Chile. Multiple genetic alterations that interact with cigarette carcinogens have been described as well as a family predisposition for the development of lung cancer. Our country has the highest rate of cigarette smoking in Latin-America. Therefore it is expected that lung cancer will become a serious public health problem in upcoming years.
Lung Cancer has poor outcomes, with an overall five-year survival of only 16%. Symptoms are non-specific and occur late in the course of disease, therefore a diagnosis is usually made in advanced stages. Lung cancer is divided into Small Cell Lung Cancer (SCLC), representing the 10-15% of cases, and Non-Small Cell Lung Cancer (NSCLC) accounting for 85-90%. SCLC is aggressive, with early metastasis, and its treatment of choice is Chemotherapy. NSCLC includes several histologic subtypes, the most frequent being Adenocarcinoma. Activating mutations like EGFR and ALK has been recently described in Lung cancer, most commonly in Adenocarcinomas, leading to the revision of its classification incorporating molecular study as standard of care.
There have been advances in diagnosis and staging of Lung Cancer mainly due to the addition of EBUS and PET / CT and adoption of the 7th TNM classification, which is more accurate and has better correlation with the prognosis by stages. Screening with Chest CT has recently proven to reduce lung cancer mortality and could be included in clinical practice.
Great advances have taken place in treatment of Lung cancer. The development of minimally invasive surgery results in equivalent oncologic outcomes with VATS lobectomy, but with fewer complications, shorter hospital stay and earlier return to work. The use of sub-lobar resection in early stages is under study, allowing the sparing of lung tissue for further treatments.
In Radiotherapy the introduction of Intensity modulated Radiotherapy (IMRT) has obtained better results in survival and local control. Other techniques under study with promising results are PET / CT planning radiotherapy and stereotactic body radiotherapy (SBRT).
New chemotherapeutic agents with higher effectiveness and lower toxicity were introduced in the last years, but the explosive development of molecular biology, which allowed the development of Personalized Therapy, has been the greatest achievement in chemotherapy in the last decade. The discovery of activating mutations in different genes, such as EGFR and ALK, and new drugs which target those mutations with excellent response and low toxicity have renewed our view of chemotherapy. Personalized therapy is the greatest achievement in the treatment of advanced lung cancer, and represents an exciting and promising investigation field for the upcoming years.
Despite the raising incidence and lethality of this tumor, the advances in different fields described in this article allow us to foresee a better future for lung cancer patients.
Washing whole and cut produce by dipping or submerging in chlorinated water has a sanitizing effect, although reduction in microbial populations is minimal and is usually less than 100-fold. A study ...was undertaken to evaluate the efficacy of a spray application of chlorine in killing Salmonella, Escherichia coli O157:H7, Listeria monocytogenes, yeasts and molds, and total aerobic mesophilic microorganisms on whole apples, tomatoes, and lettuce leaves. Inoculated produce was treated (sprayed and then soaked) with water (control) or solutions containing 200 or 2,000 ppm of chlorine for 0, 1, 3, 5, or 10 min, rinsed with sterile water, and analyzed for populations (CFU/cm2) of target microorganisms. Compared to the control treatment, further reductions in numbers of pathogens of 0.35 to 2.30 log CFU/cm2 were achieved by treatment with chlorine. Chlorine was generally more effective at 2,000 ppm than at 200 ppm. Inactivation of microorganisms occurred essentially within 1 min after application of chlorine. These reductions are significant relative to populations of pathogenic microorganisms that may be present on produce. Spray application of chlorine to raw produce at food service or household levels may be a suitable, and more convenient, alternative to treatment by dipping or submersion.
The routing functionality by all-optically interconnecting semiconductor-based all-optical logic gates and flip-flops is demonstrated in the frame of an all-optical label swapping (AOLS) network. We ...experimentally show that the output of the all-optical 2-bit correlator is capable of toggling the states of the integrated flip-flop every 2.5 ns via an adaptation stage. High extinction ratios are obtained at the output of the flip-flop, which can be used to feed a high-speed wavelength converter to complete the routing functionality of the AOLS node. The potential integration of these semiconductor optical amplifier integrated Mach-Zehnder interferometer-based devices make the proposed approach a very interesting solution for future packet switched optical networks.
Raw ground beef patties inoculated with stationary-phase cells of Escherichia coli O157:H7, salmonellae, or Campylobacter jejuni were subjected to gamma irradiation (60Co) treatment, with doses ...ranging from 0 to 2.52 kGy. The influence of two levels of fat (8 to 14% low fat and 27 to 28% high fat) and temperature (frozen -17 to -15 degrees C and refrigerated 3 to 5 degrees C) on the inactivation of each pathogen by irradiation was investigated. In ascending order of irradiation resistance, the D10 values ranged from 0.175 to 0.235 kGy (C. jejuni), from 0.241 to 0.307 kGy (E. coli O157:H7), and from 0.618 to 0.800 kGy (salmonellae). Statistical analysis revealed that E. coli O157:H7 had a significantly (P 0.05) higher D10 value when irradiated at -17 to -15 degrees C than when irradiated at 3 to 5 degrees C. Regardless of the temperature during irradiation, the level of fat did not have a significant effect on the D10 value. Salmonellae behaved like E. coli O157:H7 in low-fat beef, but temperature did not have a significant effect when the pathogen was irradiated in high-fat ground beef. Significantly higher D10 values were calculated for C. jejuni irradiated in frozen than in refrigerated low-fat beef. C. jejuni was more resistant to irradiation in low-fat beef than in high-fat beef when treatment was at -17 to -15 degrees C. Regardless of the fat level and temperature during inactivation, these pathogens were highly sensitive to gamma irradiation. An applied dose of 2.5 kGy would be sufficient to kill 10(8.1) E. coli O157:H7, 10(3.1) salmonellae, and 10(10.6) C. jejuni, resulting in a high probability of complete inactivation of populations much higher than those occasionally present in ground beef patties
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