ERCP and situs inversus.

An 85-year-old female with situs inversus totalis was admitted due to obstructive jaundice, secondary to multiple choledocholithiasis and distal biliary stenosis due to adenocarcinoma of the head of the pancreas, with duodenal infiltration and metastatic liver disease. An endoscopic retrograde cholangiopancreatography (ERCP) was attempted in the supine position but bile duct cannulation was not possible due to duodenal infiltration. Finally, a palliative biliary stent was placed percutaneously, with resolution of the jaundice.

Identifying groundwater end members by spatio-temporal isotopic and hydrogeochemical records.

Intensive groundwater use has altered the local hydrological cycle within the Bajío Guanajuatense, Mexico. To improve the knowledge of this hydrogeological system and support water management in the area, groundwater end members were identified using multivariate statistical analysis. Pumped groundwater is composed of two well-mixed end members: (a) recent recharge, affected by a reuse cycle through irrigation where nitrate and chloride evolve and reach levels of 368 mg/L and greater than 100 mg/L, respectively, and (b) deep old groundwater. Mixing estimations show that most wells extract at least 70% of deep groundwater, and some of them extract more than 94%, posing a development and groundwater sustainability conundrum in the area.

Caracterización clínico-patológica, genotipificación viral y heterogeneidad genética como determinantes de riesgo en COVID-19: Diseño del estudio y hallazgos iniciales / Clinical-Pathological Characterization, Viral Genotipification And Genetic Heterogeneity As Risk Determinants In COVID-19: Study Design And Initial Findings

Introducción: El objetivo del estudio es describir las características clínicas, patológicas, virológicas y genéticas de la respuesta inmune de los pacientes diagnosticados con infección por SARS-CoV-2 y su relación con el curso desfavorable de la enfermedad. Métodos: Estudio descriptivo, relacional, longitudinal y retrospectivo basado en la revisión de historias clínicas, toma de biopsias tru-cut post-mortem de pulmón e hígado, toma de muestras de sangre e hisopado naso-orofaríngeo o de aspirado del tubo endotraqueal. En la primera fase las biopsias serán procesadas y estudiada scon histología convencional e inmunohistoquímica en el servicio de Anatomía Patológica del hospital Nacional Carlos Seguín Escobedo de Arequipa, Perú. Resultados: La edad media avanzada, el sexo masculino y la presencia de comorbilidades fue predominante en los pacientes fallecidos. Las biopsias pulmonares mostraron predominante mente las fases exudativa y parcialmente proliferativa del daño alveolar difuso y focal, asociada principalmente a una hiperplasia de macrófagos intra alveolares con acumulación dentro del espacio alveolar, semejando una neumonía descamativa, así como neumocitos intra alveolares bi nucleados y atípicos, con nucléolos eosinofílicos (semejante avirocitos) en algunos casos. En la gran mayoría de casos se observaron depósitos de fibrina intravascular asociada al acúmulo de células inflamatorias compuestas por neutrófilos y monocitos, representando micro trombosis. Las biopsias de hígado mostraron esteatosis predominantemente macro vesicular y en dos casos se observó este atosismicro vesicular. Adicionalmente, se observaron diversos grados de necrosis e inflamación portal y lobular. Conclusión: Los hallazgos clínicos y patológicos en este primer reporte son consistentes con publicaciones previas y confirman el patrón de daño alveolar difuso asociado a agregados de macrofagos intra alveolares y micro trombosis; ademasesteatosis macro y micro vesicular hepatocitica, junto a grados variables de necrosis.

Introduction: The objective of the study is to describe the clinical, pathological, virological and genetic characteristics ofthe immune response of patients diagnosed with SARS-CoV-2 infection and its relationship with the unfavorable courseof the disease. Methods: Descriptive, relational, longitudinal and retrospective study based on the review of medicalrecords, taking post-mortem tru-cut biopsies of the lung and liver, taking blood samples and naso-oropharyngeal swabor endotracheal tube aspirate. In the first phase, the biopsies will be processed and studied with conventional andimmunohistochemical histology in the Pathological Anatomy service of the Carlos Seguín Escobedo National Hospitalin Arequipa, Peru. Results: Advanced mean age, male sex, and the presence of comorbidities were predominant indeceased patients. Lung biopsies showed predominantly the exudative and partially proliferative phases of diffuseand focal alveolar damage, associated primarily with intraalveolar macrophage hyperplasia with accumulation withinthe alveolar space-resembling desquamative pneumonia, as well as atypical binucleated intraalveolar pneumocytes,with eosinophilic nucleoli (similar to virocytes) in some cases. In the vast majority of cases, intravascular fibrin depositsassociated with the accumulation of inflammatory cells composed of neutrophils and monocytes, representingmicrothrombosis, were observed. Liver biopsies showed predominantly macrovesicular steatosis and in twocases microvesicular steatosis was observed. Additionally, varying degrees of necrosis and mild portal and lobularinflammation were observed. Conclusion: The clinical and pathological findings in this first report are consistent withprevious publications and confirm the pattern of diffuse alveolar damage associated with aggregates of intraalveolarmacrophages and microthrombosis; confirms in addition, macro and microvesicular hepatocytic steatosis, togetherwith variable degrees of necrosis.

Bionic design and verification of 3D printed PEEK costal cartilage prosthesis.

Chest wall reconstructions are mainly needed after surgical treatment of tumors or trauma. The costal cartilage is part of the chest wall, connecting sternum and ribs. The currently existing rib prostheses made of Titanium or PEEK were found lacking the costal cartilage portion, causing unsatisfactory functional rehabilitation of breath. This study proposed a newly bionic methodology for designing a costal cartilage prosthesis using a wavy elastic structure. By changing the design parameters, the mechanical properties can be accurately adjusted. Finite element analysis was carried out for the optimization of the prostheses. Then the prostheses were fabricated by fused deposition modelling manufacturing technology, using PEEK. Mechanical tests were carried out to determine the elastic modulus of the prostheses. The equivalent modulus ranged 0.5-17.3 MPa, and the tensile strength ranged 0.7-8.3 MPa. The results indicated that the mechanical behavior of the designed prostheses were close to those of the natural costal cartilage and that the wavy elastic structure was a reasonable choice for designing a costal cartilage prosthesis. Therefore, the designed PEEK costal cartilage prostheses have the potential as replacement of the natural costal cartilage with better breathing function for the patient undergoing chest wall reconstruction.

Aristotelia chilensis, rutin and quercetin amielorates acute vascular endothelial dysfunction in rat thoracic aorta exposed to oxidative stress / Aristotelia chilensis, rutina y quercetina alivia la disfunción endothelial aguda en aorta torácica de rata expuesta a estrés oxidativo

The role of endothelial dysfunction (ED) and excessive oxidative stress in the development of cardiovascular diseases has recently been highlighted. The present study examined the effect of a hydro-ethanolic extract of a Chilean berry Aristotelia chilensis (folk name “maqui), and its flavonoids antioxidants rutin (RT) and quercetin (QC), on the responsivity of blood vessels exposed to oxidative stress. For functional relaxation studies, the isolated rat aortic rings (RARs) of male Wistar rats were used. To model acute oxidative stress in vitro, RARs were incubated in Krebs' solution containing either high glucose (46 mM) or the O2- generator pyrogallol (50 uM). RARs exposed to either glucose or pyrogallol displayed attenuated maximum vasorelaxation responses to the endothelium-dependent vasodilator acetylcholine (Ach), and reduced nitric oxide (NO) bioavailability. These effects were fully suppressed by pre-incubation of the vessels with the maqui berry extract (MBE), RT and QC. Both, removal of the endothelium and the addition of nitric oxide synthase (NOS) inhibitor, NG-Nitro-L-Arginine Methyl Ester (L-NAME) increased the phenylephrine (Phe) response. These observation suggest that MBE, QC and RT may protect against high glucose and pyrogallol-induced endothelial dysfunction via enhanced the generation and bioavailability of NO...

Últimamente, el rol de la disfunción endotelial y el estrés oxidativo en el desarrollo de enfermedades cardiovasculares ha adquirido un importante foco de atención. El presente estudio examinó el efecto de un extracto hidroalcohólico de frutos de Aristotelia chilensis (nombre vulgar: maqui) y su flavonoides antioxidantes rutina y quercetina sobre la capacidad de respuesta de los vasos sanguíneos expuestos a estrés oxidativo. Para este estudio se utilizaron anillos de aorta aislados de ratas Wistar macho. Los anillos se incubaron en solución Krebs con alta glucosa (46 mM) o con el generador de radical superóxido pirogalol (50 uM) para generar el estrés oxidativo agudo in vitro. Aortas expuestas a glucosa o pirogalol exhibieron una significativa disminución de la respuesta vasorelajante dependiente del endotelio cuando se estimulan con acetilcolina, reduciendo significativamente la biodisponibilidad de óxido nítrico. Dicho fenómeno fue revertido cuando los anillos se pre-incubaron tanto, con el extracto como con los flavonoides rutina y quercetina. La eliminación del endotelio y la presencia de inhibidor de la óxido nítrico sintasa (NG - nitro-L - arginina metil éster, L-NAME) aumentó la respuesta de la fenilefrina. Los hallazgos en este estudio sugieren que el extracto de maqui, quercetina y rutina pueden evitar la disfunción endotelial generada por alta glucosa y pirogalol posiblemente debido a su potente capacidad antioxidante que permite una mayor producción o biodisponibilidad de óxido nítrico...

Maqui (Aristotelia chilensis) and rutin (quercetin-3-O-rutinoside) protects against the functional impairment of the endothelium-dependent vasorelaxation caused by a reduction of nitric oxide availability in diabetes / El Maqui (Aristotelia chilensis) y la rutina (quercetin-3-O-rutinoside) protegen contra el deterioro funcional de la vasorelajación dependiente de endotelio causada por la reducción de la disponibilidad de óxido nítrico en diabetes

The present study evaluated the beneficial effect of hydroalcoholic extract of maqui berry (Aristotelia chilensis, Elaeocarpaceae) and rutin (quercetin-3-o-rutinoside) against vascular reactivity impairment, hyperglycemia and dyslipidemia of alloxan (alx) diabetic rats. The chronic maqui berry extract (mbe) treatment significantly corrected all the above abnormalities in diabetic rats. Rutin reduced fasting blood sugar and improved the impaired endothelium-dependent relaxations. Maqui reduced plasma levels of cholesterol, LDL and triglycerides and increased body weight of diabetic rats. Removal of the endothelium and nitric oxide synthase (NOS) inhibitor, NG-Nitro-L-Arginine Methyl Ester (L-NAME) increased the phenylephrine response, and sensitivity to sodium nitroprusside (SNP) did not differ between tested groups. Maqui and rutin improved nitric oxide bioavailability, and these findings indicate that Aristotelia chilensis could be a candidate of natural medicine for diabetes.

El presente estudio evaluó el efecto beneficioso del extracto hidroalcohólico de maqui (Aristotelia chilensis, Elaeocarpaceae) y rutina (quercetina-3-o-rutinósido) contra el deterioro de la reactividad vascular, hiperglucemia y dislipidemia de ratas diabéticas. El tratamiento crónico con el extracto corrigió en gran medida esas alteraciones. Rutina redujo el azúcar en sangre y mejoró la relajación dependiente de endotelio. Maqui redujo los niveles plasmáticos de colesterol, LDL y triglicéridos y aumentó del peso de las ratas diabéticas. La eliminación del endotelio y el inhibidor de la sintasa de óxido nítrico, NG-Nitro-L-Arginina Metil Éster (L-NAME) aumentaron la respuesta a la fenilefrina y, la sensibilidad al nitroprusiato de sodio, no cambió entre los diferentes grupos. Maqui y rutina mejoraron la biodisponibilidad del óxido nítrico. Estos hallazgos indican que Aristotelia chilensis podría ser un candidato de la medicina natural para la diabetes.

Dual role of junctin in the regulation of ryanodine receptors and calcium release in cardiac ventricular myocytes.

Junctin, a 26 kDa intra-sarcoplasmic reticulum (SR) protein, forms a quaternary complex with triadin, calsequestrin and the ryanodine receptor (RyR) at the junctional SR membrane. The physiological role for junctin in the luminal regulation of RyR Ca(2+) release remains unresolved, but it appears to be essential for proper cardiac function since ablation of junctin results in increased ventricular automaticity. Given that the junctin levels are severely reduced in human failing hearts, we performed an in-depth study of the mechanisms affecting intracellular Ca(2+) homeostasis in junctin-deficient cardiomyocytes. In concurrence with sparks, JCN-KO cardiomyocytes display increased Ca(2+) transient amplitude, resulting from increased SR [Ca(2+)] ([Ca(2+)](SR)). Junctin ablation appears to affect how RyRs 'sense' SR Ca(2+) load, resulting in decreased diastolic SR Ca(2+) leak despite an elevated [Ca(2+)](SR). Surprisingly, the ß-adrenergic enhancement of [Ca(2+)](SR) reverses the decrease in RyR activity and leads to spontaneous Ca(2+) release, evidenced by the development of spontaneous aftercontractions. Single channel recordings of RyRs from WT and JCN-KO cardiac SR indicate that the absence of junctin produces a dual effect on the normally linear response of RyRs to luminal [Ca(2+)]: at low luminal [Ca(2+)] (<1 mmol l(-1)), junctin-devoid RyR channels are less responsive to luminal [Ca(2+)]; conversely, high luminal [Ca(2+)] turns them hypersensitive to this form of channel modulation. Thus, junctin produces complex effects on Ca(2+) sparks, transients, and leak, but the luminal [Ca(2+)]-dependent dual response of junctin-devoid RyRs demonstrates that junctin normally acts as an activator of RyR channels at low luminal [Ca(2+)], and as an inhibitor at high luminal [Ca(2+)]. Because the crossover occurs at a [Ca(2+)](SR) that is close to that present in resting cells, it is possible that the activator-inhibitor role of junctin may be exerted under periods of prevalent parasympathetic and sympathetic activity, respectively.

Phosphatidylinositol 3,5-bisphosphate (PI(3,5)P2) potentiates cardiac contractility via activation of the ryanodine receptor.

Phosphatidylinositol 3,5-bisphosphate (PI(3,5)P2) is the most recently identified phosphoinositide, and its functions have yet to be fully elucidated. Recently, members of our muscle group have shown that PI(3,5)P2 plays an important role in skeletal muscle function by altering Ca(2+) homeostasis. Therefore, we hypothesized that PI(3,5)P2 may also modulate cardiac muscle contractility by altering intracellular Ca(2+) ([Ca(2+)](i)) in cardiac myocytes. We first confirmed that PI(3,5)P2 was present and increased by insulin treatment of cardiomyocytes via immunohistochemistry. To examine the acute effects of PI(3,5)P2 treatment, electrically paced left ventricular muscle strips were incubated with PI(3,5)P2. Treatment with PI(3,5)P2 increased the magnitude of isometric force, the rate of force development, and the area associated with the contractile waveforms. These enhanced contractile responses were also observed in MIP/Mtmr14(-/-) mouse hearts, which we found to have elevated levels of PI(3,5)P2. In cardiac myocytes loaded with fura-2, PI(3,5)P2 produced a robust elevation in [Ca(2+)](i). The PI(3,5)P2-induced elevation of [Ca(2+)](i) was not present in conditions free of extracellular Ca(2+) and was completely blocked by ryanodine. We investigated whether the phosphoinositide acted directly with the Ca(2+) release channels of the sarcoplasmic reticulum (ryanodine receptors; RyR2). PI(3,5)P2 increased [(3)H]ryanodine binding and increased the open probability (P(o)) of single RyR2 channels reconstituted in lipid bilayers. This strongly suggests that the phosphoinositide binds directly to the RyR2 channel. Thus, we provide inaugural evidence that PI(3,5)P2 is a powerful activator of sarcoplasmic reticulum Ca(2+) release and thereby modulates cardiac contractility.

Characterization of hadrucalcin, a peptide from Hadrurus gertschi scorpion venom with pharmacological activity on ryanodine receptors.

BACKGROUND AND PURPOSE: Members of the calcin family, presently including imperatoxin A, maurocalcin, opicalcins and hemicalcin, are basic, 33-mer peptide activators of ryanodine receptors (RyRs), the calcium channels of the sarcoplasmic reticulum (SR) that provide the majority of calcium for muscle contraction. Here we describe hadrucalcin, a novel member of this family. EXPERIMENTAL APPROACH: Hadrucalcin was isolated from the venom of Hadrurus gertschi. Amino acid sequence and mass were determined by Edman degradation and mass spectrometry respectively. A cDNA library was constructed to generate clones for DNA sequence determination. Biological activity of native toxin was confirmed with [(3)H]ryanodine binding, by using SR vesicles from cardiac and skeletal muscle, and with single skeletal (RyR1) and cardiac (RyR2) channels reconstituted in lipid bilayers. Hadrucalcin was applied to intact ventricular myocytes to investigate effects on calcium transients. The secondary structure of hadrucalcin was computer-modelled by using atomic coordinates from maurocalcin, a structurally similar peptide. KEY RESULTS: Hadrucalcin is distinguished from previously described congeners by two additional amino acids in its primary sequence and the lack of prominent amphipathicity. Hadrucalcin activated RyRs with high affinity (EC(50)= 37 nmol.L(-1)), induced a long-lasting subconductance state on RyR1 and RyR2, and rapidly (lag time approximately 2 s) penetrated ventricular cardiomyocytes, eliciting discharge of internal calcium stores and spontaneous contractions. CONCLUSIONS AND IMPLICATIONS: Hadrucalcin is a cell-permeant, powerful activator of RyRs, which has translational potential for targeted delivery of drugs to RyR as novel therapeutic intervention in arrhythmogenic disease.

La primera anestesia en Buenos Aires. Investigación histórica / The first anesthetic procedure in Buenos Aires. Historical research

Debido a las diferentes y discrepantes publicaciones respecto a la primera anestesia realizada en la ciudad de Buenos Aires, los autores hicieron una investigación consultando documentos originales y confrontando las fuentes bibliográficas. La conclusión final es que, hasta el presente, la primera anestesia general practicada y documentada fehacientemente fue la administrada por el médico y cirujano dental Dr. Jacob Merrill Tewksbury, que naciera en 1814 en Estados Unidos y falleciera en 1877 en su país de origen. La misma se realizó a fines de agosto de 1847 en la casa del mencionado facultativo, en la calle Perú, utilizando éter dietílico para dormir un paciente de sexo masculino de alrededor de 30 años. La operación, también efectuada por Tewksbury, fue una corrección de estrabismo, colaborando como ayudante el Dr. en Medicina Teodoro Aubain, nacido en 1814 en Francia y fallecido en 1896 en Buenos Aires. Tanto la operación como la anestesia se realizaron sin inconvenientes.

Production and purification of statins from Pleurotus ostreatus (Basidiomycetes) strains.

Pleurotus ostreatus strains were cultured in liquid medium and on wheat straw. The yields of lovastatin were compared.

Modulation of the hepatic antioxidant defense system by air polluants from urban areas

This study describes the changes induced by organic extracts from airborne particuiate matter in some enzymes related to the antioxidant defense system as well as in peroxisomal acyl CoA oxidase activity in rat liver. After 48 h of i.p. injection (40 mg/kg b.wt.) the hepatic GSH content decreased by about 30 per cent, which was accompanied by a parallel increase in glutathione-S-transferase activity. In contrast the activity of glutathione peroxidase was significantly decreased (p < 0.05).Peroxisomal acyl CoA-oxidase was enhanced by about 40 per cent with a parallel increase of liver catalase (27 per cent), the peroxisomal H2O2-destroying enzyme. With the only exception hepatic lipid peroxidation, that remains unchanged, all the effects showed a dose-dependent response with respect to the content of polycyclic aromatic hydrocarbons in the organic airborne extracts. However, the content of other chemical pollutants such as plasticizers, pestcides and other organic compounds must be taken into account. These results suggest that organic extracts from Santiago airborne particles might induce a prooxidant state. According to this view the increase in GSTs and catalase activity may be considered as a protective response against the damage induced by airborne pollutants.

Embarazo ectópico en el Hospital General "Dr. Pastor Oropeza" IVSS Barquisimeto. 1983-1988 / Ectopic pregnancy at the Hospital General \"Dr. Pastor Oropeza\" IVSS, Barquisimeto 1983-1988

Se presentan 136 casos de embarazo ectópico diagnosticados en el Hospital General "Dr. Pastor Oropeza" IVSS de Barquisimeto, durante el quinquenio 1983-1988. Encontramos una frecuencia de 1 por 151 partos y de 1 por 356 pacientes asistidas, con aumento progresivo durante dicho tiempo. La edad materna más frecuente fue de 21 a 30 años (61,76 por ciento), con promedio de II a IV gestas (56,61 por ciento). El 43,38 por ciento de los pacientes presentaron antecedentes quirurgicos importantes. Las manifestaciones clínicas más importantes fueron dolor abdominal y sangramiento genital. En el 74 por ciento de los casos se pensó en embarazo ectópico al ingreso. Se demuestra la gran importancia de la culdocentesis, la ecosonografía, la HGC fracción B y la laparoscopia en el diagnóstico. Al 91,10 por ciento se le practicó salpingectomía uni o bilateral. Se confirmo el diagnóstico histopatológico en el 94,86 por ciento. La morbilidad fue de 18,38 por ciento y no hubo mortalidad

Técnicas de identificación de crytosporidium / Technics of cryptosporidium identification

El diagnóstico de Cryptosporidium en animales y humanos ha requerido la identificación de pequeñas estructuras en preparados de mucosa intestinal en cortes histológicos o en microscopio electrónico, sin embargo con el desarrollo de técnicas para la identificación de ooquistes en heces no ha sido necesario utilizar los métodos invasivos. Una de las técnicas ampliamente usadas para la detección de ooquistes de Cryptosporidium en muestras de heces es la de Ziehl-Neelsen ácido rápido modificado, la cual es considerada relativamente simple y rápida. Describimos los pasos de esta

Cryptosporidium: un nuevo parásito / Cryptosporidium: a new parasite

El Cryptosporidium es un parásito coccideo que ha sido reportado en una gran variedad de especies, incluyendo el hombre, estableciéndose la relación entre el Cryptosporidium y cuadros severos de enterocolitis. Esta es una zoonosis "nueva" conocida como causante de infección en humanos. Presentamos una revisión bibliográfica de este importante parásito

Hernioplastia con malla pre-muscular / Hernioplasty with surgical mesch

Se intervinieron con malla de Polypropileno premuscular 10 pacientes adultos con hernias incisionales grandes en el Hospital Tipo I" Dr. Egidio Montesinos" de El Tocuyo, Estado Lara. Comprobamos que nuestra técnica con malla premuscular, variación de las técnicas actualmente utilizadas, es bien tolerada por los pacientes, sin infección post-operatoria, con un tiempo de hospitalización promedio de 8 días y sin recidivas. Creemos que nuestro trabajo, aunque la serie estudiada es pequeña reviste significativa importancia debido a que se ha creado una variación en la técnica de reparación de las grandes hernias ventrales y cuyos resultados son altamente satisfactorios

Criptosporidiosis en niños con gastroenteritis hospitalizados y tratados ambulatoriamente en Barquisimeto / Cryptosporidiosis in children hospitalized and with ambulatory treatment by gastroenteritis in Barquisimeto

Se realizó un estudio prospectivo con 170 niños menores de 2 años hospitalizados y tratados ambulatoriamente con y sin gastroenteritis. La identificación del Cryptosporidium en las muestras de heces fue llevada a cabo mediante la coloración de Ziehl-Neelsen ácido rápido modificada y la determinación de antígenos rotavirales mediante la técnica de ensayo inmunoenzimático. La proporción de infección por Cryptosporidium en 50 niños hospitalizados con gastroenteritis fue de 4% y en 40 niños hospitalizados sin gastroenteritis no fue identificado el coccidio. La proporción de infección por Cryptosporidium en 40 niños tratados ambulatoriamente con gastroenteritis fue de 2,5% y en 40 niños sin gastroenteritis fue de 2,5%. La proporción de infección por rotavirus en 50 niños hospitalizados con gastroenteritis fue de 24% y en 40 niños tratados ambulatoriamente con gastroenteritis fue de 15%. No detectamos asociación entre la infección por Cryptosporidium y el rotavirus