Photo-Induced Charge State Dynamics of the Neutral and Negatively Charged Silicon Vacancy Centers in Room-Temperature Diamond.

The silicon vacancy (SiV) center in diamond is drawing much attention due to its optical and spin properties, attractive for quantum information processing and sensing. Comparatively little is known, however, about the dynamics governing SiV charge state interconversion mainly due to challenges associated with generating, stabilizing, and characterizing all possible charge states, particularly at room temperature. Here, multi-color confocal microscopy and density functional theory are used to examine photo-induced SiV recombination - from neutral, to single-, to double-negatively charged - over a broad spectral window in chemical-vapor-deposition (CVD) diamond under ambient conditions. For the SiV0 to SiV- transition, a linear growth of the photo-recombination rate with laser power at all observed wavelengths is found, a hallmark of single photon dynamics. Laser excitation of SiV‒, on the other hand, yields only fractional recombination into SiV2‒, a finding that is interpreted in terms of a photo-activated electron tunneling process from proximal nitrogen atoms.

Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients. / Guías de práctica clínica basadas en la evidencia para el manejo de la sedoanalgesia y delirium en el paciente adulto críticamente enfermo.

Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented.

Luxación expuesta de rodilla: ¿Qué hemos aprendido en los últimos 20 años? / Open knee dislocations: what have we learn about it in the last 20 years?

INTRODUCCIÓN: La luxación expuesta de rodilla es compleja, de incidencia baja con grandes secuelas funcionales. Existen escasos reportes de series en la literatura relativos a su manejo y resultados. OBJETIVO: El objetivo de este trabajo fue describir los resultados obtenidos de todos los pacientes con luxación expuesta de rodilla tratados durante las últimas dos décadas en nuestro hospital bajo un mismo estándar de tratamiento. MÉTODO: Estudio descriptivo retrospectivo en una serie quirúrgica de 11 pacientes con luxación expuesta de rodilla, tratados entre 1994 y 2015. Todos fueron estudiados y manejados según esquema estandarizado: Angiografía/ angioTC, aseo quirúrgico, fijador externo y reparación neurovascular en casos necesarios. Revisión de registros clínicos e imagenológicos consignando datos demográficos, lesiones concomitantes, número y tipo de cirugías, y complicaciones asociadas. Seguimiento promedio fue de 10,7 años con evaluación mediante encuesta funcionales SF-12/IKDC durante el mes de marzo de 2015. RESULTADOS: Diez pacientes eran hombres, 1 mujeres. Edad promedio al accidente 38,6 años. Mecanismo lesional de alta energía; como referencia la clasificación de Schenck, 1 lesión III-M, 4 tipo IV y los 6 restantes una tipo V. 4 lesiones vasculares (36.4%) y 7 lesiones neurológicas (63.6%). Tratamiento definitivo consistió en 4 reconstrucciones ligamentarias, 2 prótesis, 3 artrodesis y 2 amputaciones supracondíleas. Evaluaciones funcionales dieron como resultados un puntaje promedio de 37 y 48,5 para SF-12 físico y mental respectivamente, y de 44,1 para IKDC. CONCLUSIÓN: La luxación expuesta de rodilla es una lesión infrecuente, muy compleja, asociada a accidentes de alta energía, con complicaciones severas, lo que determina resultados funcionales relativamente malos. La estandarización permite sistematizar las distintas etapas de atención, racionalizar los recursos disponibles evitando la improvisación en momentos críticos, lo que podría incidir en la obtención de resultados.

INTRODUCTION: Open knee dislocation is a complex lesion of low incidence and large functional sequelae. There are few series reports in the literature regarding its management and outcomes. OBJECTIVE: Describe the results obtained from all patients with open knee dislocation treated during the last two decades in our hospital under the same treatment standard. METHOD: Retrospective descriptive study in a surgical series of 11 patients with open knee dislocation, treated between 1994 and 2015. All were studied and managed according to a standardized protocol: Angiography/angioCT, surgical debridement, external fixation and neurovascular repair in necessary cases. Review of clinical and imaging records, recording demographic data, concomitant injuries, number and type of surgeries and associated complications. Average follow-up was 10.7 years, with an evaluation through functional surveys SF-12/IKDC during March 2015. RESULTS: 10 patients were men, 1 woman. Average age at accident 38.6 years. High-energy trauma mechanism of injury; Schenk classification as reference, 1 lesion type III-M, 4 type IV and the remaining 6 type V. 4 vascular lesions (41.7%) and 7 neurological lesions (63.6%). Definitive treatment consisted in 4 ligamentous reconstructions, 2 prostheses, 3 arthrodesis and 3 supracondylar amputations. Functional evaluations showed an average score of 37 and 48.5 for SF-12 physical and mental respectively, and 44.1 for IKDC. CONCLUSION: Open knee dislocation is a rare, very complex, associated to high-energy trauma, with severe complications, which determines relatively poor functional outcomes. Standardization allows to systematize the different stages of attention and rationalize available resources avoiding improvisation at critical moments, which could affect the results.

Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients.

INTRODUCTION: Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes. OBJECTIVE: To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium. METHODOLOGY: A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1=strong, or 2=weak, and quality of evidence as A=high, B=moderate, or C=low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations, that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of this guidelines. RESULTS: Four hundred sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition. CONCLUSIONS: This Guidelines contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to apropiate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropiate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids.

Intervenciones para conservar la sangre en cirugía cardíaca con circulación extracorpórea / Interventions for preserving blood in cardiac surgery with cardiopulmonary bypass)", "_i": "

El paciente que es sometido a cirugía con circulación extracorpórea desarrolla alteraciones hemostáticas causadas por la exposición de sangre a superficies no endoteliales, por la anticoagulación administrada y por la hemodilución secundaria al cebado del circuito extracorpóreo con soluciones no sanguíneas; lo que aumenta el número de transfusiones sanguíneas y el riesgo de complicaciones. Para disminuirlas, actualmente existen múltiples estrategias. El presente trabajo tiene como objetivo dar a conocer las intervenciones basadas en evidencia científica para conservar la sangre en pacientes sometidos a cirugía cardíaca con circulación extracorpórea en la etapa perioperatoria.

The patient who is subjected to cardiopulmonary bypass develops alters the hemostatic system because of the blood exposure to the synthetic surfaces of the CPB circuit, the anticoagulation and the secondary hemodilution with the prime solution. All of these factors raise the blood transfusions and the complications. Now a day, there are a lot of strategies to decrease these complications. In this study it reviewed the preoperative procedures to avoid these complications in the patients that need a cardiac surgery using the cardiopulmonary bypass.

Developmental stages during the rooting of in-vitro-cultured Quercus robur shoots from material of juvenile and mature origin.

In-vitro-cultured shoots of clones initiated from shoots of the basal parts (BS) and the crown (C) of two mature Quercus robur L. trees were subjected to rooting experiments to relate rooting with shoot topophysical origin. The BS shoots exhibited morphologically juvenile characteristics and rooted more easily after indole-3-butyric acid (IBA) treatment than C shoots. When naphthylphthalamic acid (NPA) was applied to BS shoots, rooting capacity decreased and root emergence was delayed at least 2 days compared with shoots treated with IBA only. During the first days of the rooting process, endogenous indole-3-acetic acid (IAA) concentration was higher in C shoots than in BS shoots, regardless of whether the shoots were treated with NPA. Mitotic figures were observed in cells from the basal part of both BS and C shoots 24 h after IBA treatment. After 4 days of IBA treatment, the occurrence of histological events differed between BS shoots and C shoots. Cells of BS shoots became meristematic, giving rise to meristemoids and root primordia, whereas no differentiation of root meristemoids occurred in cells of C shoots. Thus, although adult oak material (C shoots) is capable of responding to the initial stimulus of auxin during the adventitious rooting process, the endogenous IAA concentration is not the factor limiting rooting in adult material.

Protocolo de manejo de traumatismo encefalocraneano: TEC grave pediátrico / Protocol of handling of serious pediatric severe brain injury

Se diseña un protocolo de manejo de TEC pediátrico grave como un intento de unificar criterios de tratamientos a nivel nacional, desde el rescate hasta la UCI pediátrica. En la estructuración del protocolo se han considerado la revisión de la literatura y la experiencia de la UCI Pediátrica y el Servicio de Neurocirugía del Hospital Carlos van Buren de Valparaiso en el manejo de más de 400 TEC graves a través de 20 años. En el protocolo de distinguen dos líneas importantes: 1) el rescate, estabilización y traslado 2) el manejo en el centro terciario. Las medidas que se tomen durante el rescate y traslado son de vital importancia en el pronóstico definitivo. En esta etapa juegan un rol de vital importancia los equipos de rescate, los médicos de hospitales generales y los medios de traslado interhospitalario. Es fundamental que se tenga claro que hacer y que no hacer. En el manejo en la unidad de intensivo es necesario conocer los beneficios y riesgos de las terapias vigentes y las bondades y limitaciones de las técnicas de monitoreo. Pensamos que una estandarización en toda la secuencia de manejo puede ayudar a mejorar el pronóstico definitivo de los pacientes con TEC grave en nuestro medio

Liderazgo en el médico de familia / Leadership in family medicine

El control de los diversos procesos que hay en una organización de salud debe ser coherentemente llevado. Un médico de familia líder debe saber diferenciar entre poder y control. Las personas no pueden ser vistas como máquinas, a quienes se puede controlar. Hay que crear métodos y condiciones en las organizaciones de salud donde impere la confianza y el compromiso de trabajar, siguiendo el comportamineto de ese líder que contagia. El Médico de familia como líder debe irse adaptando a la organización, a su entorno, moldear al equipo de salud, para llegar, de la mejor manera, sin relaciones forzadas, al logro de la meta. El Médico de familia como líder no debe ejercer el poder sobre la gente, debe más bien dar el poder a los miembros de equipo de salud y a los miembros de la comunidad para que juntos se acompañen en la compleja tarea de seguir la ruta hacia éxito. El liderazgo en Medicina Familiar debe dejar implícito la aceptación voluntaria del médico como líder y su capacidad de incorporar intereses e influenciar a otros para obtener compromisos en procura de una causa común: la salud de su comunidad

Characterization of yam bean (Pachyrhizus erosus) proteins.

Seed proteins from Mexican yam bean seeds (Pachyrhizus erosus L.) were sequentially extracted according to the Osborne classification. Albumins were the major fraction (52.1-31.0%), followed by globulins (30.7-27.5%). The minor protein fraction was prolamins (0.8%). Defatting with chloroform/methanol remarkably affected the distribution of protein solubility classes; albumins were the most affected fraction (4.3-17.5%). Electrophoretic patterns of albumins showed bands at 55, 40, 35, and 31 kDa. After reduction of the globulin fraction exhibited two triplets, one from 35 to 31 kDa and the second from 19 to 21 kDa, these could be compared to the acid and basic polypeptides of 11S-like proteins. Prolamins showed one band at 31 kDa, and glutelins after reduction showed three main bands at 52, 27, and 14 kDa. Trypsin inhibitors were assayed in saline extracts; the values found (1232-2608 IU/g of meal) were lower than those of other legumes. In general, yam bean seed proteins showed an excellent balance of all essential amino acids; albumins contain the highest amount of essential amino acids.

Chylous cysts of the mediastinum: report of a case and review of the literature.

Life-threatening spontaneous chylothorax is a rare clinical entity. Correct diagnosis and understanding of its pathogenesis is paramount in order to apply definite surgical treatment. A case of a ruptured multilocular chylocyst around the thoracic duct and cysterna chyli is presented. Multiple bilateral aspirations, right thoracostomy, right thoracotomy, a frustrated attempt to ligate the thoracic duct, and an attempt to insert a pleuroperitoneal shunt, were all unsuccessful. Definite surgery accomplished rehabilitation of the patient after a 5 1/2 month hospitalization. Revision of the literature and vindicative historical facts are presented.

Chylous cysts of the mediastinum: report of a case and review of the literature

Life-threatening spontaneous chylothorax is a rare clinical entity. Correct diagnosis and understanding of its pathogenesis is paramount in order to apply definite surgical treatment. A case of a ruptured multilocular chylocyst around the thoracic duct and cysterna chyli is presented. Multiple bilateral aspirations, right thoracostomy, right thoracotomy, a frustrated attempt to ligate the thoracic duct, and an attempt to insert a pleuroperitoneal shunt, were all unsuccessful. Definite surgery accomplished rehabilitation of the patient after a 5 1/2 month hospitalization. Revision of the literature and vindicative historical facts are presented

The various scintigraphic patterns of Warthin's tumor.

The authors' experience with salivary gland imaging in patients with Warthin's tumor was reviewed and the scans correlated with the pathologic findings of each tumor in an attempt to explain the scintigraphic variants found. Most Warthin's tumors show increased perfusion on imaging. The predischarge static images have a low sensitivity, detecting only 33% of the tumors. Warthin's tumors may appear hot, warm, or cold on the predischarge images but invariably become hot in the postdischarge study, for a 100% sensitivity. Many tumors reveal internal warm or cold areas. These focal defects correlate well with the presence of intratumoral cysts. The presence of these mixed lesions should not lead the physician away from the diagnosis of Warthin's tumor.

[Melasma in pregnancy: reduction of its appearance with the use of a broad-spectrum photoprotective agent]. / Melasma gravídico: disminución de su aparición mediante uso de un fotoprotector de amplio espectro.

65 pregnant women distributed in two groups, by a double-blind method received a placebo or a sunscreen cream (Pabafil SPF 10, with absorption range from 290 to 360 nm) for daily use on face during the second quarter of their pregnancy in summer time. In 30 patients "with optimum fulfillment" in the products application (16 with placebo and 14 with sunscreen cream) the melasma appearances were significantly lower in those with sunscreen application. In subgroups of the total number of pregnant women, with similar proportion of patients with placebo and sunscreen, the melasma appearances were significantly lower in skin types I-II, and in those that used cosmetics (versus those that did not). No differences were observed in subgroups by age, parity, and with or without history of previous melasma.

Regression analysis of total fatty acids from human whole brain according to age and sex.

Total fatty acids processed from whole brain samples removed at autopsy from men and women, 26-87 years of age, were esterified, the methyl esters analyzed by gas chromatography, and the respective profiles deduced. In the study of the effect of age and sex in relation to the fatty acid levels, regression analysis was applied to smoothened data to take care of extraneous effects or variables. Toward this end, five age groupings were formed and the regression relationships explored for each group per sex. Generally, the saturated homologs occurred in higher amounts among males of advancing age but decreased with age among females. This effect stemmed from the even-carbon acids. For the unsaturated fatty acids, the reverse behavior appeared evident. For the prominent acids, 16:0 and 18:0, the differences were moderately significant for cases 50 years and older, for 18:2, significance based on either sex was noted with all age groups.

Computed tomography, sonographic, and radiographic findings in adrenal myelolipoma.

We report on a patient with a large adrenal myelolipoma which was suspected pre-operatively on the basis of sonographic, computed tomography (CT), and radiographic findings.