Assessment of risk factors for postoperative complications of breast reduction by superior or superomedial pedicle.

BACKGROUND: Some risk factors for breast reduction complications are well known but for others the results are contradictory in scientific literature. The choice between superior pedicle and superomedial pedicle as a risk factor has been rarely studied. We aim to better identify the risk factors for breast reduction complications, including the choice between these two pedicles, in order to better prevent their occurrence. METHODS: We performed a retrospective analysis of the medical records of patients who underwent a bilateral breast reduction from august 2020 to august 2023 in our center. Patient data were obtained and correlated with postoperative complications using statistical tests and a literature search was carried out to compare our results to the current evidence. RESULTS: We included 216 patients. The complication rate was 24.07%. The most frequent complication was wound dehiscence (17.59%), followed by partial Nipple-Areola-Complex necrosis or peroperative suffering requiring conversion to Nipple-Areola-Complex free graft (5.56%). Increased Body Mass Index, superomedial pedicle and resection weight ≥650g were associated with an increased probability of complication occurrence (P=0.048, P=0.005 and P=0.044). The superomedial pedicle and the resection weight ≥650g were associated with an increased probability of wound dehiscence (P=0.005 and P=0.037). The difference between the preoperative and the postoperative Sternal-Notch-Nipple distance was associated with an increased probability of partial Nipple-Areola-Complex necrosis or Nipple-Areola-Complex free graft (P=0.014). CONCLUSION: Correcting modifiable preoperative risk factors and mastering both techniques, enabling the surgeon to choose the one best suited to each patient's clinical situation, reduces the complication rate.

Biocompatibility analysis and chemical characterization of Mn-doped hydroxyapatite.

The present work studies the effect of Mn doping on the crystalline structure of the Hap synthesized by the hydrothermal method at 200 °C for 24 h, from Ca(OH)2 and (NH4)2HPO4, incorporating MnCl2 to 0.1, 0.5, 1.0, 1.5 and 2.0 %wt of Mn concentrations. Samples were characterized by the X-Ray Diffraction technique, which revealed the diffraction peaks that corresponded to the hexagonal and monoclinic phase of the Hap; it was observed that the average size of crystallite decreased from 23.67 to 22.69 nm as the concentration of Mn increased. TEM shows that in all samples, there are two distributions of particle sizes; one corresponds to nanorods with several tens of nanometers in length, and the other in which the diameter and length are very close. FTIR analysis revealed absorption bands corresponding to the PO4-3 and OH- groups characteristic of the Hap. It was possible to establish a substitution mechanism between the Mn and the ions of Ca+2 of the Hap. From the Alamar blue test, a cell viability of 86.88% ± 5 corresponding to the sample of Hap at 1.5 %wt Mn was obtained, considered non-cytotoxic according to ISO 10993-5. It also evaluated and demonstrated the good osteoinductive properties of the materials, which were verified by histology and immunofluorescence expression of osteogenic markers. Adhesion, viability, biocompatibility and osteoinductive properties, make these materials candidates for future applications in bone tissue engineering with likely uses in regenerative medicine.

Molecular epidemiology of parasitic protozoa and Ehrlichia canis in wildlife in Madrid (central Spain).

Wildlife species are involved in the transmission of diverse pathogens. This study aimed to monitor raccoons (Procyon lotor), American minks (Neovison vison), and red foxes (Vulpes vulpes) as potential reservoirs in central Spain. Specifically, 200 spleen and fecal samples (from 194 raccoons, 3 minks, and 3 foxes) were analyzed molecularly by PCR/qPCR and sequencing for the presence of piroplasmids, Hepatozoon spp., Toxoplasma gondii, and Ehrlichia canis infections in the Community of Madrid (Spain). Biological samples were obtained in the years 2014, 2015, and 2016. No pathogen DNA was found in fecal samples. In contrast, analysis of raccoon spleen samples revealed that Toxoplasma was the most prevalent pathogen (prevalence 3.6 ± 2.6%), followed by Hepatozoon canis and E. canis (each with a prevalence of 2.57 ± 2.2%). Hepatozoon canis was also diagnosed in all three of the analyzed foxes. Analysis of yearly prevalence showed that tick-borne pathogens were less frequent in raccoon in 2015, a dry and warm year compared both to 2014 and 2016. These data suggest that fecal PCR assays are unsuitable for detection of DNA of non-erythrocytic pathogens. Furthermore, they demonstrate that the raccoon (an invasive species often living in proximity to domestic areas) and the red fox are putative reservoirs for pathogenic organisms in the Community of Madrid.

Sociodemographic factors associated with sexual dysfunction in Mexican women with spinal cord injury.

OBJECTIVES: No studies have reported sexual dysfunction in Mexican women with a spinal cord injury (SCI).The objective of the present study was to determine the association between sociodemographic factors and sexual dysfunction characteristics in Mexican females with SCI. METHODS: An observational, cross-sectional, descriptive study was conducted in different rehabilitation centers in Mexico City from July 2013 to November 2014. Adult females with a SCI without any gynecologic structural abnormalities, which by itself produced sexual dysfunction, were included. The Female Sexual Function Index (FSFI) was answered personally by all participants. Other variables such as AIS (American spinal injury association Impairment Scale), neurologic level, time since injury, age, relationship status, socioeconomic status, spasticity, use of antispasticity drugs, education level, antidepressant medication, Spinal Cord Independence Measure III score, offspring, work activities and neuropathic pain were considered. RESULTS: There is a high percentage of sexual dysfunction among Mexican woman with SCI (81.9%). Age range went from 18- to 78-year old (42.8±15.87-year old). Time since injury went from 2 to 708 months (65.16±117.65 months). The study showed a negative correlation between age and the FSFI questionnaire (correlation coefficient (CC)=-0.384, P<0.001).There was no significant difference between the means (analysis of variance) of the different groups for neurologic level, socioeconomic status, spasticity and education level. CONCLUSION: Results showed that the younger the person is, the better sexual function they have, and offspring decreased sexual function and work activities increased it. Some variables showed small comparative groups (use of antidepressives/antispastics and comorbilities), which may be the reason we could not see significative differences in the means.

Mid-infrared nonlinear optical response of Si-Ge waveguides with ultra-short optical pulses.

We characterize the nonlinear optical response of low loss Si(0.6)Ge(0.4) / Si waveguides in the mid-infrared between 3.3 µm and 4 µm using femtosecond optical pulses. We estimate the three and four-photon absorption coefficients as well as the Kerr nonlinear refractive index from the experimental measurements. The effect of multiphoton absorption on the optical nonlinear Kerr response is evaluated and the nonlinear figure of merit estimated providing some guidelines for designing nonlinear optical devices in the mid-IR. Finally, we compare the impact of free-carrier absorption at mid-infrared wavelengths versus near-infrared wavelengths for these ultra-short pulses.

Nonlinear optical response of low loss silicon germanium waveguides in the mid-infrared.

We have investigated the nonlinear optical response of low loss Si(0.6)Ge(0.4) / Si waveguides in the mid-infrared wavelength range from 3.25- 4.75µm using picosecond optical pulses. We observed and measured the three and four-photon absorption coefficients as well as the Kerr nonlinear refractive index. The dynamics of the spectral broadening suggests that, in addition to multiphoton absorption, the corresponding higher order nonlinear refractive phenomena also needs to be included when high optical pulse intensities are used at mid-infrared wavelengths in this material.

A serial image analysis architecture with positron emission tomography using machine learning combined for the detection of lung cancer.

INTRODUCTION AND OBJECTIVES: Lung cancer is the second type of cancer with the second highest incidence rate and the first with the highest mortality rate in the world. Machine learning through the analysis of imaging tests such as positron emission tomography/computed tomography (PET/CT) has become a fundamental tool for the early and accurate detection of cancer. The objective of this study was to propose an image analysis architecture (PET/CT) ordered in phases through the application of ensemble or combined machine learning methods for the early detection of lung cancer by analyzing PET/CT images. MATERIAL AND METHODS: A retrospective observational study was conducted utilizing a public dataset entitled "A large-scale CT and PET/CT dataset for lung cancer diagnosis." Various imaging modalities, including CT, PET, and fused PET/CT images, were employed. The architecture or framework of this study comprised the following phases: 1. Image loading or collection, 2. Image selection, 3. Image transformation, and 4. Balancing the frequency distribution of image classes. Predictive models for lung cancer detection using PET/CT images included: a) the Stacking model, which used Random Forest and Support Vector Machine (SVM) as base models and complemented them with a logistic regression model, and b) the Boosting model, which employed the Adaptive Boosting (AdaBoost) model for comparison with the Stacking model. Quality metrics used for evaluation included accuracy, precision, recall, and F1-score. RESULTS: This study showed a general performance of 94% with the Stacking method and a general performance of 77% with the Boosting method. CONCLUSIONS: The Stacking method proved to be a model with high performance and quality for lung cancer detection when analyzing PET/CT images.

The consensus of the Asociación Mexicana de Gastroenterología on the diagnosis and treatment of gastroesophageal reflux and gastroesophageal reflux disease in infants.

Gastroesophageal reflux (GER) is a frequent normal phenomenon in children of any age. It is more common in infants, in whom the majority of episodes are short-lived and cause no other symptoms or complications, differentiating it from gastroesophageal reflux disease (GERD). The diagnosis and management of GER and GERD continue to be a challenge for the physician. Therefore, the aim of the Asociación Mexicana de Gastroenterología was to adapt international documents to facilitate their adoption by primary care physicians, with the goal of standardizing quality of care and reducing the number of diagnostic tests performed and inappropriate medication use. The ADAPTE methodology was followed, and the recommendations were approved utilizing the Delphi strategy. The executive committee carried out the review of the guidelines, position papers, and international reviews that met the a priori quality criteria and possible applicability in a local context. The recommendations were taken from those sources and adapted, after which they were approved by the working group. The consensus consists of 25 statements and their supporting information on the diagnosis and treatment of GER and GERD in infants. The adapted document is the first systematic effort to provide an adequate consensus for use in Mexico, proposing a practical approach to and management of GER and GERD for healthcare providers.

Safety and pharmacokinetics of multiple doses of aclidinium bromide administered twice daily in healthy volunteers.

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airway obstruction and increased cholinergic tone. The global initiative for chronic obstructive lung disease (GOLD) guidelines recommend long-acting anticholinergics for COPD maintenance treatment. Aclidinium bromide is a novel, long-acting muscarinic antagonist developed for the treatment of COPD. A phase I, randomized, single-blind, multiple-dose clinical trial was conducted to assess the safety and pharmacokinetics (PK) of multiple doses of twice-daily (BID) aclidinium in healthy subjects. Thirty healthy male and female subjects received aclidinium 200 µg, 400 µg, 800 µg, or placebo twice daily for 7 days. Subjects were randomized to 1 of 3 cohorts and 10 subjects in each cohort were randomized (8:2) to either aclidinium or placebo groups. Safety was assessed via adverse events (AEs), laboratory evaluations, vital signs, and ECGs. Plasma samples were obtained at multiple time points throughout the study and analyzed for aclidinium and its inactive acid and alcohol metabolites using a fully validated method of liquid chromatography coupled with tandem mass spectrometry. A total of 9 treatment-emergent AEs were reported (1, placebo; 3, aclidinium 400 µg; 5, aclidinium 800 µg), all of which were mild in severity. No serious AEs were reported. There were no clinically meaningful changes in laboratory parameters or vital signs. PK parameters on Day 7 following BID dosing of aclidinium showed that steady state was achieved for aclidinium and its metabolites. On Days 1 and 7, maximum plasma concentrations (Cmax) of aclidinium were generally observed at the first PK time point (5 min postdose) and rapidly declined, with plasma concentrations generally less than 10% of Cmax by 6 h postdose in all aclidinium groups. Mean effective t(½) after the evening dose on Day 7 ranged from 4.6 to 7.0 h for aclidinium 400 µg and 800 µg, similar to the terminal t(½) observed on Day 1 (4.5-5.9 h). Exposure for aclidinium and both metabolites increased with increasing dose, with the increase in exposure being less than dose proportional between the 400 µg and 800 µg doses. Overall, all doses of aclidinium were safe and well tolerated throughout the study. Pharmacokinetic steady state was reached for aclidinium and both metabolites within the 7-day treatment period for all doses tested. Aclidinium bromide exhibited time-independent PK following dosing to steady state, indicating that similar concentration versus time profiles will occur after repeated administration at the same dose and frequency.

[Hyperintense punctiform images in the white matter: a diagnostic approach]. / Imágenes puntiformes hiperintensas en la sustancia blanca: una aproximación diagnóstica.

The presence of hyperintense punctiform images in the white matter in T2 weighted magnetic resonance (MR) sequences is a very common finding and is occasionally a diagnostic challenge for the radiologist. The present article attempts, using an anatomical approach to the brain circulation, as well as from histopathology correlation studies, to simplify the task of interpreting these images from the description of the three main patterns of hyperintense punctiform images in the white matter: vascular pattern, which corresponds to microvascular lesions; perivascular pattern, which represents inflammatory disease of which the paradigm is multiple sclerosis; and a non-specific pattern, which has to be a microvascular disease. From the various semiological elements in the MR images, a predominant pattern can be determined in each case and, in this way, helps in the differential diagnosis.

Chemical modulation of the metabolism of an endophytic fungal strain of Cophinforma mamane using epigenetic modifiers and amino-acids.

Endophytic fungi are capable of producing a great diversity of bioactive metabolites. However, the presence of silent and lowly expressed genes represents a main challenge for the discovery of novel secondary metabolites with different potential uses. Epigenetic modifiers have shown to perturb the production of fungal metabolites through the induction of silent biosynthetic pathways leading to an enhanced chemical diversity. Moreover, the addition of bioprecursors to the culture medium has been described as a useful strategy to induce specific biosynthetic pathways. The aim of this study was to assess the effects of different chemical modulators on the metabolic profiles of an endophytic fungal strain of Cophinforma mamane (Botryosphaeriaceae), known to produce 3 thiodiketopiperazine (TDKP) alkaloids (botryosulfuranols A-C), previously isolated and characterized by our team. Four epigenetic modifiers, 5-azacytidine (AZA), sodium butyrate (SB), nicotinamide (NIC), homoserine lactone (HSL) as well as 2 amino acids, l-phenylalanine and l-tryptophan, as bioprecursors of TDKPs, were used. The metabolic profiles were analysed by UHPLC-HRMS/MS under an untargeted metabolomics approach. Our results show that the addition of the two amino acids in C. mamane culture and the treatment with AZA significantly reduced the production of the TDKPs botryosulfuranols A, B and C. Interestingly, the treatment with HSL significantly induced the production of different classes of diketopiperazines (DKPs). The treatment with AZA resulted as the most effective epigenetic modifier for the alteration of the secondary metabolite profile of C. mamane by promoting the expression of cryptic genes.

Evaluation of the prognostic value of the metabolic volumetric parameters calculated with 18F-FDG PET/CT and its value added to the molecular characteristics in patients with diffuse large B-cell lymphoma.

INTRODUCTION AND OBJECTIVES: Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are prognostic predictors in patients with diffuse large B-cell lymphoma (DLBCL). The objective of this study is to evaluate the prognostic impact of the baseline volumetric parameters calculated with positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (18F-FDG PET/CT) and its added value to the molecular characteristics in patients with DLBCL not otherwise specified (NOS). METHODOLOGY: This is a retrospective observational study, which included 35 patients who underwent a baseline 18F-FDG PET/CT prior to treatment. A univariate analysis of the volumetric parameters (MTV and TLG), immunohistochemical study and chromosomal translocations were performed. The method for calculating the volumetric parameters was the SUV 2.5 threshold. The comparison between the predictive models was selected based on the information criterion value of Akaike (AIC), bayesian (BIC) and Harrell's C, after performing a Cox proportional hazards regression model. In addition, a univariate analysis of the volumetric parameters was performed according to the data of the immunohistochemical study using the Wilcoxon-Mann-Whitney test. RESULTS: A univariate analysis revealed that VMT and TLG are predictors of progression-free survival (PFS) and overall survival (OS), with a high discrimination capacity. Adding VMT and TLG to the immunohistochemical study and chromosomal translocation provided a better prognostic value for PFS and OS in patients diagnosed with DLBCL-NOS. Likewise, it was evidenced that the values of the volumetric parameters were lower in patients who presented a germinal center B cell phenotype (GCB) compared to patients with an activated B cell phenotype (ABC) who presented higher values. CONCLUSION: MTV and TLG added to the immunohistochemical study and chromosomal translocation provided a better prognostic value for PFS and OS in patients diagnosed with DLBCL-NOS.

Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador.

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67-52.8), and urine sampling, OR 16.63 (6.79-40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44-18.93), and urine sampling, OR 19.5 (5.83-65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03-0.16), and urine sampling, OR 0.01 (0-0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07-0.34), and urine sampling, OR 0.05 (0.01-0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71-9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods.

A review of the anatomy of the middle cerebral artery for the era of thrombectomy: A radiologic tool based on CT angiography and perfusion CT.

The middle cerebral artery (MCA) is one of the principal intracranial vessels. It is also the one that is most often involved in ischemic cerebrovascular disease, which accounts for a significant volume of brain imaging tests. With recent updates in the management of ischemic stroke (including intravascular treatment in increasingly distal vessels and in an increasingly widening spectrum of patients), it is becoming more important to know the details of the cerebral vascular anatomy to reach accurate diagnoses quickly and thereby improve patients' prognoses. For these reasons, we present this anatomic review of the MCA, reviewing its segments and anatomic limits, its branching patterns, and its anatomic variants. We also provide a radiologic tool based on correlations between CT angiography and perfusion CT to facilitate the identification of the points of occlusion within the branches of the MCA, taking into account its different variants.

A review of the anatomy of the middle cerebral artery for the era of thrombectomy: a radiologic tool based on CT angiography and perfusion CT. / Repaso anatómico de la arteria cerebral media en la era de la trombectomía: una herramienta radiológica basada en la angio-TC y la TC perfusión.

The middle cerebral artery (MCA) is one of the principal intracranial vessels. It is also the one that is most often involved in ischemic cerebrovascular disease, which accounts for a significant volume of brain imaging tests. With recent updates in the management of ischemic stroke (including intravascular treatment in increasingly distal vessels and in an increasingly widening spectrum of patients), it is becoming more important to know the details of the cerebral vascular anatomy to reach accurate diagnoses quickly and thereby improve patients' prognoses. For these reasons, we present this anatomic review of the MCA, reviewing its segments and anatomic limits, its branching patterns, and its anatomic variants. We also provide a radiologic tool based on correlations between CT angiography and perfusion CT to facilitate the identification of the points of occlusion within the branches of the MCA, taking into account its different variants.

[Primary lung paraganglioma. A case report]. / Paraganglioma pulmonar primario como tumor incidental.

Primary lung paragangliomas are rare. They are 1-2% of the paragangliomas, and most of them occur in patients of 43-61 years. They clinically appear as solitary tumors and are in general asymptomatic. These tumors show a nesting pattern (Zellballen) of chief polygonal cells locked by fibrovascular trabeculae with subtenticular cells. The main cells have uniform nuclei with granular eosinophilic cytoplasm, and they are positive for neuroendocrinal markers (Neuron Specific Enolase, sinaptofisine and cromogranine A). Sustentacular cells are positive for protein S-100 and neurofibrilar protein. A differential diagnosis with the carcinoid tumor can be very difficult. The surgical treatment is mandatory , specially high blood pressure and the chances of malignization.

Evaluation of the prognostic value of different methods of calculating the tumour metabolic volume with 18F-FDG PET/CT, in patients with diffuse large cell B-cell lymphoma. / Evaluación del valor pronóstico de los diferentes métodos de cálculo del volumen metabólico tumoral con 18F-FDG PET/TC, en pacientes con linfoma B difuso de células grandes.

INTRODUCTION AND OBJECTIVES: Metabolic tumor volume (MTV) is a promising indicator of prognosis in diffuse large B-cell lymphoma (DLBCL). The aim of the present study is to evaluate the different methods for the calculation of the basal metabolic tumor volume with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the patients with DLBCL, relating each one of the volumes measured with progression-free survival (PFS) and overall survival (OS). METHODOLOGY: This is a retrospective analytical cohort study, in which 34 patients underwent to 18F-FDG PET/CT baseline prior to treatment. We compared three SUV thresholds 2.5, SUV 40% of the maximum SUV and SUV mean hepatic uptake (PERCIST) for the calculation of MTV and total lesion glycolysis (TLG) biomarkers, relating them to the PFS and OS. The best predictive model was selected based on the Akaike's information criterion (AIC) after performing a Cox proportional hazards regression. RESULTS: In relation to the PFS, they show statistically significant differences: MTV 2.5, TLG 2.5, MTV 40, TLG 40, MTV and TLG calculated with the PERCIST threshold. Among these, the one that has a lower AIC is MTV 2.5, so it is considered the best parameter to predict the PFS. With respect to OS, it shows statistically significant differences: MTV 2.5, VMT and TLG calculated with the PERCIST threshold. Among these three, the one with the lowest AIC is MTV 2.5, which is why it is considered the best parameter to predict OS. In addition, a higher value of MTV and total tumor glycolysis (TLG), is associated with worse PFS and OS CONCLUSION: The MTV calculated with the threshold SUV 2.5 seems to be the best parameter to predict PFS and OS in patients diagnosed with DLBCL with 18F-FDG PET/CT.