Synthesis and Raman Detection of 5-Amino-2-mercaptobenzimidazole Self-Assembled Monolayers in Nanoparticle-on-a-Mirror Plasmonic Cavity Driven by Dielectric Waveguides.

Functionalization of metallic surfaces by molecular monolayers is a key process in fields such as nanophotonics or biotechnology. To strongly enhance light-matter interaction in such monolayers, nanoparticle-on-a-mirror (NPoM) cavities can be formed by placing metal nanoparticles on such chemically functionalized metallic monolayers. In this work, we present a novel functionalization process of gold surfaces using 5-amino-2-mercaptobenzimidazole (5-A-2MBI) molecules, which can be used for upconversion from THz to visible frequencies. The synthesized surfaces and NPoM cavities are characterized by Raman spectroscopy, atomic force microscopy (AFM), and advancing-receding contact angle measurements. Moreover, we show that NPoM cavities can be efficiently integrated on a silicon-based photonic chip performing pump injection and Raman-signal extraction via silicon nitride waveguides. Our results open the way for the use of 5-A-2MBI monolayers in different applications, showing that NPoM cavities can be effectively integrated with photonic waveguides, enabling on-chip enhanced Raman spectroscopy or detection of infrared and THz radiation.

Disseminated lomentosporiosis in a heart transplant recipient: Case report and review of the literature.

BACKGROUND: Lomentospora prolificans (formerly S prolificans) is a saprophyte fungi that causes opportunistic infections in solid organ transplant (SOT) recipients. Resulting disseminated infections are difficult to treat and have a high mortality. Indications for antifungal prophylaxis after heart transplantation (HT) include CMV disease, reoperation, renal replacement therapy, extracorporeal membrane oxygenation (ECMO), and high environmental exposure to Aspergillus spores. However, the risk of breakthrough infections, such as Lomentosporiosis, remains a cause of concern. METHODS: We report the clinical findings, microbiology, treatment and outcome of a disseminated Lomentosporiosis in a heart transplant recipient with ECMO and antifungal prophylaxis. RESULTS: A 25-year-old male with complex grown-up congenital heart disease (GUCHD) was admitted for HT. He presented severe post-surgical complications including acute kidney injury and right heart and respiratory failure requiring venoarterial-ECMO, continuous renal replacement therapy (CCRT) and later on (+14) a ventricular assist device (VAD). Ganciclovir, cotrimoxazole, and antifungal prophylaxis with anidulafungin at standard doses had been started on day + 3 post HT. The patient presented seizures (+4), pancytopenia with mild neutropenia (days + 6 to + 11), influenza B (+7), and bacteremic Pseudomonas aeruginosa ventilator associated pneumonia (VAP) (+10). On days + 14 to + 16 Lomentospora prolificans was recovered from blood cultures, broncho aspirate, catheter tip, and skin biopsy. Despite treatment with L-AMB, voriconazole and terbinafine the patients died on day 17 after HT. Necropsy revealed disseminated infection with fungal invasion in central nervous system, heart, lung, cutaneous, and subcutaneous tissue. Broth microdilution tests demonstrated resistance to all antifungals. CONCLUSIONS: Lomentosporiosis is a rare complication that may emerge as a breakthrough invasive fungal infection in heart transplant recipients on ECMO despite antifungal prophylaxis.

Long-term outcomes and clinical impact of anti-HLA donor-specific antibodies (DSA) after liver transplantation: a prospective study in a pilot cohort.

INTRODUCTION: the presence of donor-specific antibodies (DSA) is thought to affect survival of the allograft and patient after liver transplantation (LT). However, their significance is not well understood. PATIENTS AND METHODS: a prospective study was performed of 32 adult patients who underwent LT in 2011 to analyze the existence of DSA, associated risk factors and medium-term impact. Immunological determinations were performed immediately before LT and at three, six, 12 months and five years after LT. RESULTS: eight patients (24.2 %) presented pre-formed DSA. However, titers were negative in all patients five years after LT and there were no associated events. Eight out of 24 patients (33.3 %) developed de novo DSA. After five years, only two remained positive; both were class II with high mean fluorescence intensity (MFI) values at diagnosis (over 15,000). No association was found between the development of DSA and the risk of rejection, graft loss or death. However, an increase in liver stiffness values was observed in patients with persistent DSA, and focal sinusoidal deposition of C4d and moderate liver fibrosis were reported. CONCLUSION: the incidence of DSA is high after LT. In addition, the persistence of de novo DSA could be associated with silent liver fibrosis with a potential impact on graft outcomes.

Using an embryo specific promoter to modify iron distribution pattern in Arabidopsis.

Iron is an essential micronutrient for life. During the development of the seed, iron accumulates during embryo maturation. In Arabidopsis thaliana, iron mainly accumulates in the vacuoles of only one cell type, the cell layer that surrounds provasculature in hypocotyl and cotyledons. Iron accumulation pattern in Arabidopsis is an exception in plant phylogeny, most part of the dicot embryos accumulate iron in several cell layers including cortex and, in some cases, even in protodermis. It remains unknown how does iron reach the internal cell layers of the embryo, and in particular, the molecular mechanisms responsible of this process. Here, we use transgenic approaches to modify the iron accumulation pattern in an Arabidopsis model. Using the SDH2-3 embryo-specific promoter, we were able to express VIT1 ectopically in both a wild type background and a mutant vit1 background lacking expression of this vacuolar iron transporter. These manipulations modify the iron distribution pattern in Arabidopsis from one cell layer to several cell layers, including protodermis, cortex cells, and the endodermis. Interestingly, total seed iron content was not modified compared with the wild type, suggesting that iron distribution in embryos is not involved in the control of the total iron amount accumulated in seeds. This experimental model can be used to study the processes involved in iron distribution patterning during embryo maturation and its evolution in dicot plants.

Family history record and hereditary cancer risk perception according to National Cancer Institute criteria in a Spanish medical oncology service: a retrospective study.

INTRODUCTION: Identification of patients at risk of hereditary cancer is an essential component of oncology practice, since it enables clinicians to offer early detection and prevention programs. However, the large number of hereditary syndromes makes it difficult to take them all into account in daily practice. Consequently, the National Cancer Institute (NCI) has suggested a series of criteria to guide initial suspicion. OBJECTIVE: It was the aim of this study to assess the perception of the risk of hereditary cancer according to the NCI criteria in our medical oncology service. METHODS: We retrospectively analyzed the recordings of the family history in new cancer patients seen in our medical oncology service from January to November 2009, only 1 year before the implementation of our multidisciplinary hereditary cancer program. RESULTS: The family history was recorded in only 175/621 (28%) patients. A total of 119 (19%) patients met 1 or more NCI criteria (1 criterion, n = 91; 2 criteria, n = 23; 3 criteria, n = 4; and 4 criteria, n = 1), and only 14 (11.4%) patients were referred to genetic counseling. CONCLUSION: This study shows that few clinicians record the family history. The perception of the risk of hereditary cancer is low according to the NCI criteria in our medical oncology service. These findings can be explained by the lack of a multidisciplinary hereditary cancer program when the study was performed.

Mitochondrial Genetic Diversity of Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) Associated with Cassava in Lao PDR.

Cassava Mosaic Disease (CMD) caused by Sri Lankan cassava mosaic virus (SLCMV), has rapidly spread in Southeast Asia (SEA) since 2016. Recently it has been documented in Lao PDR. Previous reports have identified whitefly species of B. tabaci as potential vectors of CMD in SEA, but their occurrence and distribution in cassava fields is not well known. We conducted a countrywide survey in Lao PDR for adult whiteflies in cassava fields, and determined the abundance and genetic diversity of the B. tabaci species complex using mitochondrial cytochrome oxidase I (mtCOI) sequencing. In order to expedite the process, PCR amplifications were performed directly on whitefly adults without DNA extraction, and mtCOI sequences obtained using nanopore portable-sequencing technology. Low whitefly abundances and two cryptic species of the B. tabaci complex, Asia II 1 and Asia II 6, were identified. This is the first work on abundance and genetic identification of whiteflies associated with cassava in Lao PDR. This study indicates currently only a secondary role for Asia II in spreading CMD or as a pest. Routine monitoring and transmission studies on Asia II 6 should be carried out to establish its potential role as a vector of SLCMV in this region.

Prevalence of Nipple Soreness at 48 Hours Postpartum.

Background: Although most women start breastfeeding after delivery, difficulties often arise. One of the main reasons is nipple soreness, which contributes greatly to early cessation of breastfeeding. A soreness evaluation through validated scales, performed by health care professionals during the first few days, can contribute to improve breastfeeding and support for the mothers. Research Aim: Knowing the prevalence of nipple soreness during breastfeeding at 48 hours postpartum at the Infanta Cristina University Hospital (Madrid, Spain) through a cross-sectional descriptive study. Materials and Methods: The study took place between February and March 2019. A survey of 58 postpartum second day mothers was conducted including the Visual Analogue Scale (VAS) and Lactation Assessment Scale (LATCH) score for breastfeeding assessment. A descriptive analysis of secondary variables and subsequent bivariate inferential was performed for 95% confidence interval (CI). Results: The prevalence of nipple soreness observed is 97% (95% CI = 92-100%). It was found, significantly (p = 0.001), that the higher the score on LATCH, the lower the score on VAS and therefore the less pain. We found a relationship between women who were in skin-to-skin contact with their babies for 2 hours without interruption after birth and a higher pain score (p = 0.046). No other associations were found between VAS and other variables such as parity, type of birth, artificial milk supplements for the newborn, or using a pacifier. Conclusions: The high percentage of nipple soreness detected highlights that breastfeeding can be unpleasant in the first days after delivery. It is important to include in clinical practice the assessment of nipple soreness and the effectiveness of breastfeeding using validated scales.

Modeling of Electric Fields in Individual Imaging Atlas for Capsular Threshold Prediction of Deep Brain Stimulation in Parkinson's Disease: A Pilot Study.

Background: Modeling of deep brain stimulation electric fields and anatomy-based software might improve post-operative management of patients with Parkinson's disease (PD) who have benefitted from subthalamic nucleus deep brain stimulation (STN-DBS). Objective: We compared clinical and software-guided determination of the thresholds for current diffusion to the pyramidal tract, the most frequent limiting side effect in post-operative management of STN-DBS PD patients. Methods: We assessed monopolar reviews in 16 consecutive STN-DBS PD patients and retrospectively compared clinical capsular thresholds, which had been assessed according to standard clinical practice, to those predicted by volume of tissue activated (VTA) model software. All the modeling steps were performed blinded from patients' clinical evaluations. Results: At the group level, we found a significant correlation (p = 0.0001) when performing statistical analysis on the z-scored capsular thresholds, but with a low regression coefficient (r = 0.2445). When considering intra-patient analysis, we found significant correlations (p < 0.05) between capsular threshold as modeled with the software and capsular threshold as determined clinically in five patients (31.2%). Conclusions: In this pilot study, the VTA model software was of limited assistance in identifying capsular thresholds for the whole cohort due to a large inter-patient variability. Clinical testing remains the gold standard in selecting stimulation parameters for STN-DBS in PD.

Association Between Baseline Circulating Tumor Cells, Molecular Tumor Profiling, and Clinical Characteristics in a Large Cohort of Chemo-naïve Metastatic Colorectal Cancer Patients Prospectively Collected.

BACKGROUND: Clinicopathologic characteristics and prognostic and predictive factors offer valuable guidance when selecting optimal first-line treatment in patients with metastatic colorectal cancer (CRC). The association between baseline circulating tumor cell (bCTC) count, molecular tumor profile, and clinicopathologic features was analyzed in a chemo-naïve metastatic CRC population. PATIENTS AND METHODS: A total of 1202 patients from the Spanish VISNÚ-1 (FOLFIRINOX/bevacizumab vs. FOLFOX/bevacizumab) and VISNÚ-2 (FOLFIRI/bevacizumab vs. FOLFIRI/cetuximab; RAS-wildtype) studies were analyzed for mutational status and bCTC count. The association between clinicopathologic characteristics and bCTC count, mutational status, and microsatellite instability (MSI) was analyzed in 589 eligible patients. RESULTS: Interestingly, 41% of the population studied presented ≥3 bCTC count. bCTC count ≥3 was associated with worse performance status (according Eastern Cooperative Oncology Group scale), stage IV at diagnosis, at least 3 metastatic sites, and elevated carcinoembryonic antigen (CEA) levels; but not with RAS or BRAF mutations or high MSI. BRAFmut (BRAF mutated) tumors were associated with right-sided primary tumors, peritoneum, distant lymph node metastasis, and less frequent liver involvement. RASmut (RAS mutated) was associated with worse performance status; stage IV at diagnosis; right-sided primary tumors; liver, lung, and bone metastases; at least 3 metastatic sites; and elevated CEA, whereas PIK3CAmut (PIK3CA mutated) tumors were associated with right-sided primary tumors, high CEA serum levels, and older age. High MSI was associated with right-sided primary tumors, distant lymph nodes metastasis, and lower CEA levels. CONCLUSIONS: In our study, elevated bCTCs and RASmut were associated with clinicopathologic features known to be associated with poor prognosis; whereas the poor prognosis of BRAFmut tumors in chemo-naïve metastatic CRC is not explained by associations with poor clinicopathologic prognostic factors, except right-sided primary tumors. TRIAL REGISTRATION NUMBER: VISNU 1 ClinicalTrials.gov ID: NCT01640405/ VISNU 2 ClinicalTrials.gov ID: NCT01640444.

Algorithm for acne treatment: Ibero-Latin American consensus.

Acne is a chronic, immune-mediated, inflammatory disease with high prevalence among adolescents. By compromising face, thorax and back, with the risk of permanent scars, it has a negative impact on the quality of life. Effective, safe and early treatment is the key to remission, while decreasing the risk of physical and/or emotional sequelae. The Iberian-Latin American Group of Acne Studies joined professionals with expertise and developed a practical therapeutic algorithm, adapted to the reality of Latin American countries, Spain and Portugal. This article intends to disseminate it with an updated review on a rational, safe and effective acne treatment.

Manufacturing Te/PEDOT Films for Thermoelectric Applications.

In this work, flexible Te films have been synthesized by electrochemical deposition using PEDOT [poly(3,4-ethylenedioxythiophene)] nanofilms as working electrodes. The Te electrodeposition time was varied to find the best thermoelectric properties of the Te/PEDOT double layers. To show the high quality of the Te films grown on PEDOT, the samples were analyzed by Raman spectroscopy, showing the three Raman active modes of Te: E1, A1, and E2. The X-ray diffraction spectra also confirmed the presence of crystalline Te on top of the PEDOT films. The morphology of the Te/PEDOT films was studied using scanning electron microscopy, showing a homogeneous distribution of Te along the film. Also an atomic force microscope was used to analyze the quality of the Te surface. Finally, the electrical conductivity and the Seebeck coefficient of the Te/PEDOT films were measured as a function of the Te deposition time. The films showed an excellent thermoelectric behavior, giving a maximum power factor of about 320 ± 16 µW m-1 K-2 after 2.5 h of Te electrochemical deposition, a value larger than that reported for thin films of Te. Qualitative arguments to explain this behavior are given in the discussion.

Development and validation of a risk stratification model for prediction of disability and hospitalisation in patients with heart failure: a study protocol.

BACKGROUND: Chronic heart failure (CHF) reduces quality of life and causes hospitalisation and death. Identifying predictive factors of such events may help change the natural history of this condition. AIM: To develop and validate a stratification system for classifying patients with CHF, according to their degree of disability and need for hospitalisation due to any unscheduled cause, over a period of 1 year. METHODS AND ANALYSIS: Prospective, concurrent, cohort-type study in two towns in the Madrid autonomous region having a combined population of 1 32 851. The study will include patients aged over 18 years who meet the following diagnostic criteria: symptoms and typical signs of CHF (Framingham criteria) and left ventricular ejection fraction (EF)<50% or structural cardiac lesion and/or diastolic dysfunction in the presence of preserved EF (EF>50%).Outcome variables will be(a) Disability, as measured by the WHO Disability Assessment Schedule V.2.0 Questionnaire, and (b) unscheduled hospitalisations. The estimated sample size is 557 patients, 371 for predictive model development (development cohort) and 186 for validation purposes (validation cohort). Predictive models of disability or hospitalisation will be constructed using logistic regression techniques. The resulting model(s) will be validated by estimating the probability of outcomes of interest for each individual included in the validation cohort. ETHICS AND DISSEMINATION: The study protocol has been approved by the Clinical Research Ethics Committee of La Princesa University Teaching Hospital (PI-705). All results will be published in a peer-reviewed journal and shared with the medical community at conferences and scientific meetings.

Microbiological diagnosis in febrile neutropenia secondary to chemotherapy for hematologicmalignancy. A cohort description / Diagnóstico microbiológico en neutropenia febril secundaria a quimioterapia por malignidad hematológica Descripción de una cohorte

Abstract Objective: to describe the demographic, clinical, therapeutic and microbiological characteristics of patients with hematological malignancies undergoing chemotherapy who develop febrile neutropenia during treatment, as well as the mortality at discharge. Methods: a retrospective cohort study of patients with hematologic neoplasms who developed febrile neutropenia and were seen at the Hospital Universitario San Vicente Fundación in Medellín. Results: records of 110 episodes of febrile neutropenia were obtained. The mean age was 45 years. In 55.4%, a microbiological diagnosis was obtained; bacteremia was documented in 83.8% of these. The most common microorganisms wereK.pneumoniae(30%) andE. coli(18%). Antibiotic resistance due to ESBLs or carbapenemases ingram negativebacilli was 33%. Death occurred in 17% of patients. Acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML) were the most prevalent underlying diagnoses; the most prevalent clinical focus was bacteremia (24.5%). Conclusion: in our case series, there are significant differences in the percentage of patients with bacteremia, as well as in global mortality, compared to the rest of the cohorts in the region. A new research study needs to be carried out to clarify the source of these differences.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1386).

Resumen Objetivo: describir las características demográficas, clínicas, terapéuticas y microbiológicas de los pacientes con malignidad hematológica en quimioterapia que desarrollan neutropenia febril durante el tratamiento, así como la mortalidad al egreso. Métodos: estudio de cohorte retrospectivo en pacientes con neoplasia hematológica que desarrollaron neutropenia febril evaluados en el Hospital Universitario San Vicente Fundación de Medellín. Resultados: se obtuvo el registro de 110 episodios de neutropenia febril. Media de edad 45 años. En 55.4% se obtuvo diagnóstico microbiológico, la bacteriemia fue documentada en 83.8% de ellos. Los microorganismos más comunes fueronK.pneumoniae(30%) yE. coli(18%). La resistencia a antibióticos por presencia de BLEE o carbapenemasas en bacilosgram negativosfue de 33%. La mortalidad ocurrió en 17% de los pacientes. La leucemia linfoide aguda (LLA) y leucemia mieloide aguda (LMA) fueron los diagnósticos de base más prevalentes, el foco clínico más prevalente fue bacteriemia (24.5%). Conclusión: en nuestra cohorte se encontró diferencias significativas en cuanto al porcentaje de pacientes con bacteriemia, así como en la mortalidad global respecto al resto de cohortes de la región, es necesario desarrollar un nuevo trabajo de investigación que permita aclarar el origen de estas diferencias.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1386).

La espiritualidad como fuente de inspiración para el cuidado de enfermería / Spirituality as a source of inspiration for the nursing care

Introducción: Este artículo tiene como objetivo reflexionar sobre los términos espiritualidad y religión, la relación entre estos y la influencia que estos tienen en el cuidado de enfermería. Metodología: revisión bibliográfica en libros, revistas y bases de datos: SciELO, Nursing Consult, Redalyc, Dialnet, EBSCOhost. Se revisaron 80 artículos y 6 libros, en español, inglés y portugués, entre los años 2004 y 2016. Resultados: la espiritualidad es un término ambiguo, confuso y que generalmente se equipara a la religiosidad, ésta se caracteriza por una búsqueda de significado y propósito en la vida, por una conexión con otros, por la trascendencia, por un sentido de paz interior y bienestar; se manifiesta también en el contacto con la naturaleza, el arte, la música, la familia o la comunidad. El cuidado espiritual debe ser parte de la atención de enfermería, para lo cual hace falta preparación. Conclusiones: La importancia de dar cuidado espiritual a los pacientes es innegable, pero éste no se provee por falta de tiempo, desconocimiento, desinterés y políticas institucionales. Resulta urgente incluir el tema de cuidado espiritual en los planes de formación académica de los profesionales.

Introduction: This article aims to reflect on the terms spirituality and religion, the relationship between these and the influence they have on nursing care. Methodology: literature review in printed books, journals and databases such as SciELO, Nursing Consult, Redalyc, Dialnet, and EBSCO host. They were reviewed 80 articles and 6 books, in Spanish, English and Portuguese, between the years 2004 and 2016. Main results: spirituality is an ambiguous and confusing term usually related with religion. Spirituality is characterized by a search for meaning and purpose in life, a connection with others, transcendence, a sense of inner peace and wellbeing. It manifests in contact with nature, art, music, family or community. Spiritual care should be part of nursing care, but training is required. Conclusions: The importance of giving spiritual care to patients is undeniable, but this is not provided due to lack of time, lack of knowledge, lack of interest, and institutional policies. It is urgent to include the topic of spiritual care in the academic training programs of nursing professionals

Las virtudes esenciales del cuidado: una mirada de los estudiantes de enfermería / The Essential Virtues of Care: A Look at the Nursing Students / As virtudes essenciais do cuidado: um olhar dos discentes de enfermagem

Introducción: la enseñanza de las virtudes se da en diferentes espacios, uno de los cuales es el universitario, y para los profesionales de enfermería practicarlas debe ser un compromiso con la excelencia profesional. Objetivo: analizar los conocimientos y la práctica de las virtudes de prudencia, responsabilidad y compasión de los estudiantes de enfermería de una universidad pública e identificar la percepción que tienen sobre la vivencia de estas virtudes en los docentes de la facultad. Método: estudio de tipo cualitativo. Se realizaron entrevistas semiestructuradas a diez estudiantes. Para el análisis se tuvieron en cuenta las herramientas de la teoría fundamentada, se guardaron las consideraciones éticas de anonimato y firma de consentimiento informado. Resultados: la vivencia de las virtudes es importante, y su aprendizaje se da más por el ejemplo que se brinda que por la enseñanza teórica. La virtud que más sentimientos evoca es la de la compasión. La vivencia de las virtudes en el ámbito comunitario se experimenta muy poco, y ello da la impresión de que el cuidado a la comunidad no tiene la misma importancia que la experiencia clínica. Conclusiones: la enseñanza de la ética en los currículos de enfermería es asunto que debe complementarse con el ejemplo de los docentes de cualquier curso. Aunque las virtudes deben practicarse siempre, es tal vez, en momentos de adversidad y de múltiples carencias, cuando más debe brillar un profesional armónico, que una la ciencia a la virtud para brindar un cuidado humano, integral y comprometido.

Introduction: Teaching of virtues occurs in different spaces, one of them is at the university. For the nursing professionals, putting the virtues into practice should be a commitment of professional excellence. Objective: To analyze the knowledge and practice of virtues such as prudence, responsibility and compassion among the nursing students in a public university and to identify their perception regarding the life experience of these virtues among their teachers. Method: This is a qualitative study including semi-structured interviews to 10 students. The analysis used some tools from the Grounded Theory. The ethical requirements of blindness and informed consent were verified. Results: Life experience with these virtues is important and the learning of virtues is more effective with the examples than the theoretical teaching. The virtue evoking more feelings is the compassion. The life experience of the virtues out in the community is not very common. This fact comes across as if the care out in the community is not as important as the clinical experience. Conclusions: The teaching of ethics in the nursing curricular programs should be complemented with life examples by the teachers in all courses. Although the virtues must always be put into practice, maybe it is in the multiple shortage and adverse times when integral professionals should stand out to the most. They should bring together the science and the virtue in order to provide human, integral, and committed care.

Introdução: O ensino das virtudes é dado em diferentes espaços, um dos quais é o universitário, e para os profissionais de enfermagem praticá-las deve ser um compromisso com a excelência profissional. Objetivo: Analisar os conhecimentos e a prática das virtudes de prudência, responsabilidade e compaixão dos discentes de enfermagem de uma universidade pública e identificar a percepção que eles têm sobre a vivência dessas virtudes nos docentes da faculdade. Método: Estudo qualitativo. Realizaram-se entrevistas semiestruturadas a dez alunos. Para a análise foram consideradas as ferramentas da teoria fundamentada, guardadas as considerações éticas de anonimato e assinatura de consentimento informado. Resultados: A vivência das virtudes é importante, e seu aprendizado é dado mais pelo exemplo do que pelo ensino teórico. A virtude que mais sentimentos evoca é a da compaixão. A vivencia das virtudes no âmbito comunitário, experimenta-se muito pouco, e isso da a impressão de que o cuidado da comunidade não tem a mesma importância que a experiência clínica. Conclusões: O ensino da ética nos currículos de enfermagem é assunto que deve-se complementar ao exemplo dos docentes de qualquer curso. Embora as virtudes devam sempre ser praticadas, talvez é em tempos de adversidade e deficiências múltiplas que um profissional harmonioso mais deve brilhar, unindo ciência e virtude para fornecer um cuidado humano, integral e comprometido.

Butirato de sodio como agente coadyuvante de la acción radioprotectora de la amifostina / Sodium butyrate as a coadyuvant agent of the radioprotecting action of amifostine / Butirato de sódio como agente coadjuvante da ação radioprotetora da amifostina

Entre los escasos radioprotectores en uso, la amifostina resulta eficaz para reducir la toxicidad aguda inducida por la radiación ionizante. Sin embargo, presenta efectos tóxicos importantes que impiden su uso repetido o en dosis altas. Es necesario entonces desarrollar radioprotectores menos tóxicos, por sí mismos o como coadyuvantes de la amifostina en dosis bajas. Se expusieron ratas Sprague-Dawley a una dosis de rayos X de 6 Gy (cuerpo entero). Se ensayó el butirato de sodio como mitigante luego de una dosis baja de amifostina previa a la irradiación. A distintos tiempos después de la irradiación se realizó el recuento de eritrocitos, leucocitos y la fórmula leucocitaria. Los efectos genotóxicos se evaluaron en leucocitos de sangre mediante el ensayo Cometa. Se realizaron también estudios de supervivencia a 60 días y la evaluación histológica del duodeno e intestino grueso. El efecto del tratamiento resultó moderadamente protector respecto de la recuperación de los valores normales de eritrocitos, leucocitos y la fórmula leucocitaria en los animales sobrevivientes en ambos sexos, así como de los epitelios intestinales y el ADN de los leucocitos. También aumentó significativamente la sobrevida a 60 días. La radioprotección con amifostina en una dosis baja seguida de una mitigación con butirato fue claramente significativa.

Among the few radioprotectors in use, amifostine is effective in reducing the acute toxicity induced by ionizing radiation. However, it has important toxic effects that prevent its repeated use or in high doses. It is necessary then to develop less toxic radioprotectors, by themselves or as adjuvants of amifostine in low doses. Sprague-Dawley rats were exposed to an X-ray dose of 6 Gy (whole body). Sodium butyrate was tested as a mitigant after a low dose of amifostine prior to irradiation. At different times after the irradiation, the erythrocytes, leukocytes and the leukocyte formula were counted. Genotoxic effects were evaluated in blood leukocytes by the Comet assay. Sixty-day survival studies and histological evaluation of the duodenum and large intestine were also performed. The effect of the treatment was moderately protective with respect to the recovery of the normal values of erythrocytes, leukocytes and the leukocyte formula in the surviving animals in both sexes as well as for the intestinal epithelia and leukocytes DNA. It also significantly increased the 60-day survival. The radioprotection with amifostine in a low dose followed by mitigation with butyrate was clearly significant.

Entre os poucos radioprotetores em uso, a amifostina é eficaz na redução da toxicidade aguda induzida pela radiação ionizante. No entanto, tem importantes efeitos tóxicos que impedem seu uso repetido ou em altas doses. É necessário, então, desenvolver radioprotetores menos tóxicos, isoladamente ou como coadjuvantes da amifostina em baixas doses. Ratos Sprague-Dawley foram expostos a uma dose de raios X de 6 Gy (corpo inteiro). O butirato de sódio foi testado como mitigante após uma dose baixa de amifostina antes da irradiação. Em diferentes momentos após a irradiação, os eritrócitos, leucócitos e a fórmula de leucócitos foram contados. Os efeitos genotóxicos foram avaliados em leucócitos de sangue pelo ensaio Cometa. Estudos de sobrevida de 60 dias e avaliação histológica do duodeno e do intestino grosso também foram realizados. O efeito do tratamento resultou moderadamente protetor em relação à recuperação de valores normais de eritrócitos, leucócitos e fórmula leucocitária nos animais sobreviventes em ambos os sexos, bem como protegeu epitélios intestinais e o DNA dos leucócitos. Também aumentou significativamente a sobrevida para 60 dias. A radioproteção com amifostina em baixa dose seguida de uma mitigação com butirato foi claramente significativa.

Liposarcoma del cordón espermático simulando una hernia inguinal incarcerada / Liposarcoma of the spermatic cord mimicking an incarcerated inguinal hernia

INTRODUCCIÓN: Los tumores paratesticulares representan del 7%-10% de las masas intraescrotales. Los sarcomas abarcan el 90% de las lesiones malignas del cordón espermático y de éstas, aproximadamente, el 3%-7% son liposarcomas. CASO CLÍNICO: Presentamos el caso de un varón de 45 años, que consultó en urgencias por una masa inguinoescrotal derecha no reductible, diagnosticándose de hernia inguinal incarcerada. Se realizó cirugía urgente evidenciando una gran tumoración de aspecto lipomatoso, dependiente de cordón espermático. Se realizó orquiectomía y hernioplastía inguinal. La anatomía patológica, reveló un liposarcoma bien diferenciado de cordón espermático. Posteriormente, se realizó estudio de extensión, sin afectación a distancia y no precisó tratamiento adyuvante. Actualmente, tras dos años de seguimiento no ha presentado recidiva. DISCUSIÓN: Sólo alrededor de 200 casos han sido comunicados previamente en la literatura y sólo 61 de éstos se presentaron simulando una hernia inguinal incarcerada. Debido a la baja incidencia de esta patología es difícil de conocer la historia natural y llegar a conclusiones sobre los resultados del tratamiento, el cual hasta el momento sigue siendo la orquiectomía radical, con escisión amplia de los tejidos locales. El papel de la radio y quimioterapia aun es controvertido. CONCLUSIONES: Los sarcomas del cordón espermático son neoplasias raras con alta tasa de recurrencia local. Su manejo inicial es quirúrgico. Se requiere de un alto índice de sospecha clínica para el diagnóstico ya que las implicaciones oncológicas varían en función del tratamiento que, en ocasiones, es llevado a cabo por cirujanos generales al simular una hernia inguinal.

INTRODUCTION: Paratesticular tumors represent 7%-10% of intraescrotal masses. Sarcomas account for 90% of malignant lesions of the spermatic cord and of these approximately 3%-7% are liposarcomas. CLINICAL CASE: This is the case of a 45 year old male who consulted in the emergency department for a non-reducible right inguino-scrotal mass and was diagnosed with an incarcerated inguinal hernia. Emergency surgery was performed which revealed a large lipomatous tumor, originating from the spermatic cord. Orchiectomy and hernioplasty were performed. Histopathology revealed a well-differentiated liposarcoma of the spermatic cord. Later extension study was conducted, without distant affectation, and did not require adjuvant treatment. Today, after two years of monitoring has been no recurrence. DISCUSSION: Only about 200 cases have been previously reported in the literature and only 61 of these were presented mimicking an incarcerated inguinal hernia. Due to the low incidence of this disease it is difficult to know the natural history and draw conclusions on the results of treatment, which so far remains the radical orchiectomy with wide local excision of the tissue. The role of radiotherapy and chemotherapy is still controversial

Epileptogenic lesion quantification in MRI using contralateral 3D texture comparisons.

Epilepsy is a disorder of the brain that can lead to acute crisis and temporary loss of brain functions. Surgery is used to remove focal lesions that remain resistant to treatment. An accurate localization of epileptogenic lesions has a strong influence on the outcome of epilepsy surgery. Magnetic resonance imaging (MRI) is clinically used for lesion detection and treatment planning, mainly through simple visual analysis. However, visual inspection in MRI can be highly subjective and subtle 3D structural abnormalities are not always entirely removed during surgery. In this paper, we introduce a lesion abnormality score based on computerized comparison of the 3D texture properties between brain hemispheres in T1 MRI. Overlapping cubic texture blocks extracted from user-defined 3D regions of interest (ROI) are expressed in terms of energies of 3D steerable Riesz wavelets. The abnormality score is defined as the Hausdorff distance between the ROI and its corresponding contralateral region in the brain, both expressed as ensembles of blocks in the feature space. A classification based on the proposed score allowed an accuracy of 85% with 10 control subjects and 8 patients with epileptogenic lesions. The approach therefore constitutes a valuable tool for the objective pre-surgical evaluation of patients undergoing epilepsy surgery.

[Polio vaccines, eradication and posterradication]. / Vacunas antipoliomieliticas, erradicación y posterradicación.

Vaccination against polio generates herd immunity (both with the attenuated (OPV) and inactivated (IPV) vaccines) and this will allow the eradication of the disease. The OPV vaccine produces 2-4 polio cases per cohort of one million children and therefore IPV is used in countries that can afford its cost (about 15 times more expensive than OPV). In 1988 the World Health Assembly established the polio eradication goal as "interruption of wild poliovirus transmission". If the elimination of wild poliovirus were achieved, the use of OPV will produce annually between 250 and 500 cases of polio in the world. From 1999, it was clear that eradication would require ending of immunization with OPV. On the 25th of January, 2013 it is approved the plan for the eradication and containment of all polioviruses, wild or not, so that no child suffers paralytic poliomyelitis. The most important landmarks include the lack of wild polio cases after 2014, the introduction of at least one dose of IPV in all immunization programs and to cease the type 2 OPV vaccination by the end of 2016 and to stop the use of the oral bivalent vaccine in 2019. To achieve all this, a complex scientific work and economic solidarity will be required.