Three cases of kyphoplasty performed in the lateral position due to significant comorbidities.

Background: More than 700,000 people suffer from vertebral compression fractures attributed to osteoporosis, metastatic disease, or trauma each year in the United States, and undergo kyphoplasty. They are typical. These often undergo kyphoplasty to treat resultant pain or new neurological deficits. Here, we present three patients who, due to significant comorbidities, underwent kyphoplasty performed in the lateral decubitus rather than the prone position. Case Description: Three females, two with metastatic cancer and one with osteoporosis, presented with lumbar compression fractures and new accompanying pain and/or neurological deficits. Due to significant accompanying comorbidities, kyphoplasty was safely and effectively performed in all three patients utilizing the lateral decubitus rather than the prone position. Conclusion: Although vertebral kyphoplasties are typically performed in the prone position, here, we present three patients who, due to significant comorbidities, safely and effectively underwent kyphoplasties performed in the lateral decubitus position.

Intraocular Lens Unfurling Time Exponentially Decays with Increased Solution Temperature.

Purpose: Intraocular lens (IOL) unfurling can be a rate-limiting step in cataract surgery, limiting operative efficiency. Furthermore, inefficient unfurling has important implications for clinical outcomes. We examine the effects of solution temperature on IOL unfurling time using three in vitro models of the ocular environment. Methods: IOLs were injected into a 6-well plate filled with balanced salt solution (BSS), dispersive ophthalmic viscoelastic device (OVD), or cohesive OVD. Experiments were also performed in a plastic eye filled with dispersive or cohesive OVD. IOL unfurling time was recorded against the temperature of the respective solution. Results: IOL unfurling time decayed exponentially as solution temperature increased in all experiments, including the BSS-filled 6-well plate, the OVD-filled 6-well plate, and the OVD-filled plastic eye. IOLs failed to unfurl within 10 min at 10°C, below the glass transition temperature of the tested IOLs. Increasing solution temperature from 20°C to 30°C decreases IOL unfurling by greater than 2 min. Further heating to 40°C did not significantly decrease IOL unfurling time. Conclusion: Increased solution temperature rapidly decreases IOL unfurling time in vitro. IOLs do not unfurl within a clinically acceptable timeframe at or below their glass transition temperature. Increased BSS and/or OVD temperature may be a potential method to decrease IOL unfurling time in cataract surgery. However, future research is needed to elucidate potential consequences of warmed BSS and/or OVD on post-operative outcomes. This study demonstrates the potential for temperature regulation to decrease cataract surgery operative time and provides preliminary evidence to justify future clinical validation of this relationship.

During cataract surgery, a prosthetic intraocular lens (IOL) is inserted into the eye once the clouded lens is removed. The IOL must then unfurl before the procedure can proceed. When IOLs fail to unfurl or unfurl slowly, this can delay the operation and may even cause post-operative complications. Thus, we studied the effect temperature may have on IOL unfurling time to optimize this segment of the operation. We injected IOLs into solutions of saline (balanced salt solution) or ophthalmic viscoelastic device (OVD), two fluids injected into the eye during surgery. In both a well plate and a plastic eye, we found that increasing the temperature of the solution significantly affected IOL unfurling time. Specifically, heating the solution from refrigeration to room temperature decreased unfurling time from over 10 min to less than four. Heating to physiological temperature further decreased unfurling time to less than a minute. Our results show promise for potentially utilizing heated BSS and/or OVD to accelerate IOL unfurling and decrease cataract surgery operative time.

Sustainable Refining of Vegetable Oil Made Easy with a Designer Phospholipase C Enzyme.

The increasing demand pressures the vegetable oil industry to develop novel refining methods. Degumming with type C phospholipases (PLCs) is a green technology and provides extra oil. However, natural PLCs are not active under the harsh conditions used in oil refining plants, requiring additional unit operations. These upfront capital expenditures and the associated operational costs hinder the adoption of this method. Here, we present a process based on ChPLC, a synthetic PLC obtained by consensus sequence design, possessing superior thermal stability and catalytic properties. Using ChPLC, crude soybean oil degumming was completed at 80 °C in 30 min, the temperature and residence time imposed by the design of existing oil refining plants. Remarkably, an extra yield of oil of 2% was obtained using 60% of the dose recommended for PLCs marketed today, saving upfront investments and reducing the operational cost of degumming. A techno-economic analysis indicates that, for medium size plants, ChPLC reduces the overall cost of soybean oil enzymatic degumming by 58%. The process presented here facilitates the implementation of enzymatic technologies to oil producers, regardless of their processing capacity, bringing potential annual benefits in the billion-dollar range for the global economy.

Características electroglotográficas de la tos normal en un grupo de adultos jóvenes / Electroglottographic characteristics of normal cough in a group of young adults

Fisiológicamente, la tos se desarrolla por fases, las cuales otorgan a su característica factores cuantificables para el análisis en el marco de la evaluación clínica deglutoria. Para el abordaje fonoaudiológico/logopédico, la tos como recurso fisiológico de protección es un indicador funcional de ingesta, pues suele aparecer cuando la fisiología deglutoria está alterada, definiéndose en el marco evaluativo como funcional o débil. Para objetivar su análisis, este proyecto propone cuantificar las características de la tos en un grupo de sujetos adultos jóvenes a través de la electroglotografía. La investigación plantea el registro de datos generales, la evaluación electroglotográfica de la tos y finalmente el registro de datos y análisis. Bajo un análisis multivariado, la correlación ordinal de Spearman, indica correlaciones significativas, con un nivel de confianza del 95% para la asociación de variables peso ­ talla y peso ­ frecuencia fundamental, esta última, tanto para la frecuencia de la primera tos como de la última. La edad promedio, estuvo definida en 24,7 años, con una desviación estándar de más o menos 7 años. Los sujetos valorados fueron en su mayoría mujeres. La investigación estimó un análisis directo de las características electroglotográficas, sin vincular aspectos conexos que pueden alterar los datos resultantes. Es necesario poder cruzar los datos con el análisis fisiológico de la toma de aire, la fuerza muscular, el control motor oral, etc

Physiologically, cough develops in phases, which provide its characteristic with quantifiable factors for analysis in the clinical swallowing evaluation. For the phonoaudiological/logopedic approach, cough as a physiological protection resource is a functional indicator of swallowing, since it usually appears when swallowing physiology is altered, being defined in the evaluative framework as functional or weak. In order to objectify its analysis, this project proposes to quantify the characteristics of cough in a group of young adult subjects through electroglottography. The research proposes the recording of general data, the electroglottographic evaluation of cough and finally the data recording and analysis. Under multivariate analysis, Spearman's ordinal correlation indicated significant correlations, with a confidence level of 95% for the association of variables weight ­ height and weight ­ fundamental frequency, the latter for both the frequency of the first and the last cough. The mean age was defined as 24.7 years, with a standard deviation of plus or minus 7 years. The subjects assessed were mostly women. The research estimated a direct analysis of the electroglottographic characteristics, without linking related aspects that may alter the resulting data. It is necessary to be able to crossreference the data with physiological analysis of air intake, muscle strength, oral motor control, etc

Profilaxis para sangrado gastrointestinal en pacientes del servicio de medicina interna de un hospital universitario / Gastrointestinal bleeding prophylaxis in internal medicine patients of a univeristy hospital

Introducción: Los medicamentos antiulcerosos son utilizados frecuentemente en pacientes hospitalizados, sin embargo, a menudo este uso no está indicado. Objetivo: Describir la frecuencia de prescripción e indicación de medicamentos para prevenir el sangrado gastrointestinal en pacientes hospitalizados. Materiales y métodos: Estudio de corte trasversal, descriptivo, prospectivo del servicio de Medicina Interna de la Sociedad de Cirugía de Bogotá- Hospital de San José de Bogotá, Colombia. Se excluyeron pacientes con diagnóstico de sangrado gastrointestinal o antecedente de alergia a los medicamentos antiulcerosos. Se recolectaron datos demográficos, así como fármacos prescritos. Se determinó si la indicación del fármaco era adecuada y se identificó el tipo de error de prescripción. Resultados: Se incluyeron 179 pacientes, 102 (57%) mujeres. Promedio de edad de 61,3 años (±20,2). El principal diagnóstico de ingreso fue enfermedad infecciosa 76 (42,4%). Del total de pacientes, 165 (92,17%) recibieron medicamento para prevención del sangrado gastrointestinal. La indicación fue adecuada en 75 pacientes (41,89%). El error más frecuente fue el uso en pacientes de bajo riesgo de sangrado, 101 (97,1%). Conclusión: Un alto porcentaje de los pacientes recibió medicación para la prevención del sangrado gastrointestinal. En aproximadamente la mitad de estos no estaba indicada.

Introduction: Anti-ulcer medications are frequently used in hospitalized patients, yet their use is not usually indicated. Objective: To describe the frequency of prescription and indication of medications to prevent gastrointestinal bleeding in hospitalized patients. Materials and methods: A cross-sectional, descriptive, prospective study was carried out in the Internal Medicine service of the Surgery Society of Bogota-San Jose Hospital of Bogota (Colombia). Excluded patients were those with either a gastrointestinal bleeding diagnosis or a history of allergy to anti-ulcer medications. Demographic data and information regarding prescribed medications were collected. It was determined whether the medicine indication was adequate and the type of prescription error was identified. Results: 179 patients were included in the study, 57% (102) of which were women. The average age was 61.3 (±20.2) years old. Infectious disease was the main admission diagnosis (76; 42.4%). A 92.17% (165) of the total number of patients received medications to prevent gastrointestinal bleeding. This indication was adequate for 75 (41.89%) patients. The most frequent error was their use in bleeding low-risk patients (101; 97.1%). Conclusion: A high percentage of patients received medication to prevent gastrointestinal bleeding. However, in about half of these patients it was not indicated.

Conocimiento y adaptación de válvulas de habla a traqueostomía por parte de fonoaudiólogos colombianos / Knowledge of colombian speech- language pathologists and adaptation of tracheostomy speaking valves

El propósito de este estudio fue describir el conocimiento que poseen los fonoaudiólogos colombianos acerca de las válvulas de habla y determinar si las emplean como parte del manejo de usuarios con traqueostomía así como las variables que puedan influir en su uso. Para ello, se distribuyó un formulario digital a fonoaudiólogos egresados en Colombia. Las preguntas se agruparon en cinco secciones a partir de las cuales se ajustaron varios modelos lineales generalizados para determinar la influencia de variables como la ciudad, la experiencia profesional, los posgrados, la población, el escenario de atención y la presencia de equipos de traqueostomía en la adaptación de las válvulas. Las preguntas abiertas se analizaron a partir de tendencias temáticas en las respuestas de los participantes. El cuestionario fue respondido por 27 fonoaudiólogos de distintas latitudes con variedad en el nivel posgradual. La totalidad de los encuestados conoce el insumo; de estos, el 66.66% manifestó haber adaptado válvulas y ratifica su beneficio fisiológico. Solo un 33.33% indica que el proceso administrativo para ordenar el insumo fue sencillo. Ninguna de las variables predictoras fue significativa para explicar la adaptación de válvulas de habla (p>0.05). Este estudio plantea que los fonoaudiólogos conocen las válvulas de habla y sus beneficios. Adicionalmente, advierte que las variables estudiadas no tienen influencia significativa en la adaptación del dispositivo. Por último, ratifica que los procesos administrativos relacionados con órdenes médicas y autorizaciones pueden tener un rol desfavorable para lograr acceder a estos insumos

The purpose of this study was to describe the knowledge that Colombian speech-language pathologist have about sepaking valves and to determine whether they use them as part of the management of tracheostomized clients, as well as the variables that may influence their use. To do this, a digital form was distributed to graduated speech therapists in Colombia. The questions were grouped into five sections from which several generalized linear models were adjusted to determine the influence of variables such as city, professional experience, postgraduate degrees, population, setting of care and the presence of tracheostomy teams in the adaptation of the valves. Open questions were analyzed based on thematic trends in the participants' responses. The questionnaire was answered by 27 speech- language pathologists from different latitudes with a variety at the postgraduate level. All of the respondents know the device; of these, 66.66% stated that they had adapted valves and confirmed their physiological benefit. Only 33.33% indicated that the administrative process to order the device was simple. None of the predictor variables was significant to explain the adaptation of speaking valves (p> 0.05). This study suggests that speech- language pathologists are aware of speaking valves and their benefits. Additionally, it warns that the variables studied have no significant influence on the adaptation of the device. Finally, it confirms that the administrative processes related to medical orders and authorizations may play an unfavorable role in gaining access to these supplies.

A novel lecithin:cholesterol acyltransferase for soybean oil refining provides higher yields and extra nutritional value with a cleaner process.

The growing demand for food and biofuels urges the vegetable oil processing industry to adopt cleaner technologies to mitigate the environmental pollution caused by chemical refining processes. Over the past decade, several enzymatic methods have proven to be efficient at reducing the generated waste, but improving the benefit-cost ratio is still necessary for the widespread adoption of this technology. In this work, we show that lecithin:cholesterol acyltransferase from Aeromonas enteropelogenes (LCATAE) provides a higher extra-yield of soybean oil than a type A1 phospholipase (PLA) enzyme currently commercialized for soybean oil deep degumming. Our model indicates that crude soybean oil treated with the new enzyme generates 87% more neutral oil from phospholipids than the widely used PLA, with the corresponding reduction in waste and byproducts generation. The refined oil retains the phytosterols naturally present in crude oil, enriching its nutritional value. The results presented here position LCATAE as a promising candidate to provide the green solutions needed by the industrial oil processing sector. Key points • Selected LCAT gene candidates were expressed in E. coli. • Aeromonas enteropelogenes LCAT hydrolyzes all the phospholipids present in crude soybean oil. • The LCAT enzyme provides a higher yield of neutral oil than commercial PLA enzymes and generates less waste. • The degummed oil retains sterols with high nutritional value.

Uso de recursos TIC en la enseñanza de las matemáticas: retos y perspectivas / Use of resources TIC in the education of the mathematics: challenges and perspectives / Uso de recursos de TIC no ensino de matemática: desafios e perspectivas

RESUMEN El presente artículo muestra la revisión de literatura en cuanto al uso de recursos tecnológicos en procesos de enseñanza - aprendizaje de las matemáticas en distintos contextos de formación con el fin de identificar cuáles son los aspectos teóricos y tecnológicos que se deben tener en cuenta para la creación de estos recursos, cuál ha sido el impacto de su aplicación y cuáles son los retos y perspectivas que se presentan en este campo de trabajo. Se hizo una revisión de 33 referencias seleccionadas después de una búsqueda en bases de datos aplicando ciertos criterios de inclusión y de exclusión y también una revisión de otros trabajos referenciados en estas mismas. Se concluye que el uso de este tipo de recursos en clases de matemáticas tiene un impacto positivo en los estudiantes, sin embargo hace falta realizar estudios que profundicen más respecto a este impacto en periodos más amplios de tiempo. Se plantea que para lograr aprendizajes significativos de la matemática utilizando recursos tecnológicos es necesario articular en los currículos de formación las competencias comunicativas y tecnológicas, no solo en los estudiantes sino también en los docentes quienes deben transformar los métodos tradiciones de enseñanza de esta área.

ABSTRACT The present article shows the literature review to the use of thecnological resources, these in the mathematics processes of education - learning in different academic training context. In order to identify first of all which are the theoretical and technological aspects that must be taken into consideration for the creation of these resources; second which has been the impact of its application and third which are the challenges and perspectives that are presented in this field work. After a search on the databases one revision of 33 selected references were made applying certain inclusion and exclusion criteria. Beside, one revision of other similar reference works were made selected references were made applying certain inclusion and exclusion criteria. Beside, one revision of other similar reference works were made. It follows that the use of this kind of resources in mathematic classes have a positive impact on students learning. However, it is necessary to have additional studies which emphasize in this impact for longer period of time. It is argued that in order to achieve meaningful learning of mathematic knowledge through technological resources it is necessary to articulate the communicative and technological competences in the curriculum design, not only in the students but also in the teachers who must transform the teaching methods of this area.

RESUMO Este artigo apresenta uma revisão da literatura sobre o uso de recursos tecnológicos no ensino - aprendizagem da matemática em diferentes contextos de formação, a fim de identificar os aspectos teóricos e tecnológicos que devem ser considerados para a criação são desses recursos, qual tem sido o impacto de sua aplicação e quais os desafios e perspectivas que surgem nesse campo de trabalho. Uma revisão de 33 referências selecionadas foi feita após uma busca em bases de dados aplicando certos critérios de inclusão e exclusão e também uma revisão de outros trabalhos referenciados neles. Conclui-se que o uso desses recursos nas aulas de matemática tem um impacto positivo sobre os alunos, no entanto estudos devem aprofundar mais sobre este impacto sobre longos períodos de tempo. Argumenta-se que, para alcançar a aprendizagem significativa da matemática usando recursos tecnológicos necessários para articular nos currículos de formação competência comunicativa e tecnológico, não só estudantes, mas também professores que devem transformar as tradições desta métodos de ensino da área.

Latent tuberculosis infection is associated with increased unstimulated levels of interferon-gamma in Lima, Peru.

BACKGROUND: We previously reported increased unstimulated blood levels of interferon-gamma in persons with latent tuberculosis infection (LTBI) in the United States, suggesting enhanced immune activation in LTBI. To investigate this further in a TB-endemic setting, we assessed interferon-gamma levels in persons with and without LTBI in Peru. METHODS: We analyzed data from patients with and without a recent type 1 (spontaneous) acute myocardial infarction (AMI) who were enrolled from two public hospital networks in Lima, Peru, and underwent LTBI testing using the QuantiFERON® TB Gold In-tube (QFT) assay. Participants with a positive QFT test were defined as having LTBI, whereas participants with a negative QFT test were defined as non-LTBI. Unstimulated interferon-gamma was quantified via enzyme-linked immunosorbent assay in the QFT nil-tube, which does not contain antigens. We compared unstimulated interferon-gamma levels between LTBI and non-LTBI groups using the Wilcoxon rank sum test. We used proportional odds modeling for multivariable analysis. RESULTS: Data from 214 participants were included in this analysis. Of those, 120 (56%) had LTBI. There were no significant differences in age, sex and comorbidities between LTBI and non-LTBI participants, except for recent AMI that was more frequent in LTBI. LTBI participants had higher unstimulated interferon-gamma levels compared to non-LTBI participants (median, interquartile range; 14 pg/mL, 6.5-52.8 vs. 6.5 pg/mL, 4.5-15; P<0.01). LTBI remained associated with higher unstimulated interferon-gamma levels after controlling for age, sex, recent AMI, history of hypertension, diabetes mellitus, dyslipidemia, end stage renal disease, malignancy, obesity, and tobacco use (adjusted odds ratio, 2.93; 95% confidence interval, 1.8-4.9). In a sensitivity analysis that excluded participants with AMI, the association between unstimulated interferon-gamma and LTBI remained present (adjusted odds ratio; 3.93; 95% confidence interval, 1.9-8.2). CONCLUSIONS: LTBI was associated with higher unstimulated interferon-gamma levels. These data suggest ongoing immune activation in LTBI.

Análisis de costo-efectividad del esquema de quimioterapia bortezomib más ciclofosfamida más dexametasona versus bortezomib más talidomida más dexametasona versus lenalidomida más dexametasona como tratamiento de inducción en pacientes con mieloma múltiple activo y riesgo estándar en Colombia / Cost-effectiveness analysis of the chemotherapy regimen bortezomib plus cyclophosphamide plus dexamethasone versus bortezomib plus thalidomide plus dexamethasone versus lenalidomide plus dexamethasone as induction therapy in patients with active

Problema de investigación: calcular los costos y la efectividad esperada de bortezomib+ iclofosfamida+dexametasona comparado con bortezomib+talidomida+dexametasona y con enalidomida+dexametasona para el tratamiento de inducción en pacientes con mieloma múltiple (mm) \r\nactivo con riesgo estándar candidatos a trasplante de células madre sin antecedente de quimioterapia o rasplante de progenitores hematopoyéticos en Colombia. Tipo de evaluación económica: Análisis costo-\r\nefectividad. Población objetivo: Pacientes con diagnóstico de MM activo con riesgo estándar candidatos a trasplante de células madre mayores de 18 años. Intervención y comparadores: Intervención: Bortezomib+\r\nCiclofosfamida+Dexametasona (CyBorD), Comparadores: Bortezomib+Talidomida+Dexametasona(VTD)\r\nLenalidomida+Dexametasona(RD). Horizonte temporal: 20 años. Tasa de descuento: En el caso base se empleó una tasa de descuento del 5% tanto para los costos como para los desenlaces de efectividad. Se llevó a cabo análisis de sensibilidad con tasas de descuento de 0%, 3,5%, 7% y 12%. Estructura del modelo: Los datos de efectividad y seguridad se obtuvieron de ensayos clínicos; los valores de utilidad se obtuvieron de estudios de calidad de vida en pacientes con mieloma múltiple. Desenlaces y valoración: De acuerdo con las recomendaciones del manual metodológico del IETS y por tratarse de una condición que afecta considerablemente la calidad de vida, se empleó los AVAC (años de vida ajustados por calidad) como medida de desenlace. Costos incluidos: Se consideró los costos sanitarios directos asociados a las tecnologías evaluadas y a los desenlaces en salud incluidos en el modelo de decisión planteado de acuerdo al manual \r\nmetodológico del IETS. Fuentes de datos de costos: Se utilizó como fuentes de información de recursos, GPC del manejo del MM, ensayos clínicos y consulta a experto clínico. Los datos de costos de medicamentos se consultaron en el SISMED; los costos de procedimientos, en el tarifario ISS 2001;\r\ny el valor de procedimientos no disponibles en el tarifario se solicitó directamente a prestadores. Resultados del caso base: Los costos descontados al 5% para CyBorD, VTD y RD fueron $ 126.344.818, $ 34.477.346 y $ 132.435.892 respectivamente. Los AVAC descontados al 5% fueron 3.571, 3.778 y 2.927 respectivamente. La alternativa RD fue dominada. La RCEI entre CyBorD y VTD fue de $ 39.360.977/AVAC adicional. Análisis de sensibilidad: Los costos para CyBorD, VTD y RD empleando simulación de MonteCarlo fueron de $146.709.228 (±,$2.622.197); $158.521.482 (±$3.075.068) y $152.524.980 (±$2.528.093) respectivamente. Los AVAC de estas alternativas fueron de 5.531 (±0.161), 4.025 (±0.250) y 3,486 (±0.234) respectivamente. La alternativa CyBorD dominó a VTD y RD en todas las iteraciones. La curva de aceptabilidad mostró que en el 100% de las iteraciones CyBorD fue costo efectiva en comparación a las otras alternativas. Conclusiones y discusión: La alternativa CyBorD fue la estrategia dominante frente a \r\nVTD y RD en pacientes con MM activo con riesgo estándar susceptibles de TCM en Colombia. Este hallazgo está acorde a estudios realizados en otros países. La evaluación tiene varias limitaciones derivadas de la falta de datos a largo plazo de nuestro medio especialmente para utilidades. Otra limitación significativa fue la pobre participación de expertos clínicos en la validación de la pregunta, modelos y uso de recursos.(AU)

Análisis de impacto presupuestal del esquema de quimioterapia Bortezomib más Ciclofosfamida más Dexamestasona versus la inclusión de este esquema en el plan obligatorio de salud como tratamiento de inducción en pacientes con mieloma múltiple activo y ries / Analysis of the budgetary impact of the Bortezomib chemotherapy regimen plus Cyclophosphamide plus Dexamestasone versus the inclusion of this scheme in the mandatory health plan as an induction treatment in patients with active multiple myeloma and R

Tecnologías evaluadas: Bortezomib+Ciclofosfamida+Dexametasona (CyBorD). Sin inclusión del Bortezomib en el plan obligatorio de salud (POS); Bortezomib+Ciclofosfamida+Dexametasona. Asumiendo la inclusión del Bortezomib al POS. Población: Pacientes mayores de 18 años con diagnóstico de Mieloma Múltiple activo con riesgo estándar candidatos a trasplante de células madre (TCM). Perspectiva: Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Horizonte temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Costos directos sanitarios: -Esquema de quimioterapia de inducción con CyBorD, -Tratamiento coadyuvante, \r\n-Tratamiento profiláctico, -Manejo de reacciones adversas, -Terapia de mantenimiento. Fuente de\r\ncostos: -Solicitud a entidades de salud (EPS, IPS), -Tarifario Instituto de Seguro Social (ISS) 2001 (más el 30%), -SISMED, -Circulares de regulación de precios de medicamentos. Escenarios: Se consideró dos escenarios: sustitución optimista y conservadora. En el primero, la tecnología nueva reemplaza a la actual en 80% en el primer año, 90% en el segundo y 100% en el tercero. En el segundo, la tecnología nueva inicia con una adopción del 80%, y 85% y 90%. Resultados: El valor en pesos colombianos que deberá invertirse para la adopción del esquema de quimioterapia de inducción para MM con la tecnología nueva de CyBorD es de $177.291.721.100 y el costo del tratamiento actual es de $162.062.078.657. El impacto presupuestal incremental, es de $15.229.642.443, $35.935.175.989 y $56.901.944.287 para los años 1, 2 y 3\r\nrespectivamente con el nuevo esquema de CyBorD.(AU)

Costo-efectividad de toracotomía versus videotoracoscopia en pacientes con cáncer de pulmón de célula no pequeña en estadio I / Cost-effective of thoracotomy versus videoassisted thoracoscopy in patients whith non-small-cell stage I carcinoma

Introducción. Los pacientes con cáncer de pulmón de célula no pequeña en estadio I, pueden someterse a videotoracoscopia o toracotomía. El objetivo de este estudio fue determinar la razón costo-efectividad de estas dos alternativas. Materiales y métodos. Se realizó un estudio de costo-efectividad mediante un modelo de árbol de decisiones extendido con un proceso de Markov desde la perspectiva del sistema de salud colombiano financiado públicamente, para comparar la videotoracoscopia con la toracotomía. Los resultados se midieron en años de vida ganados, obtenidos de revisiones sistemáticas de curvas de supervivencia. Se incluyeron costos médicos directos, obtenidos solamente de prestadores y aseguradores de tres ciudades principales de Colombia. El periodo de estudio fue de 10 años, con tasas de descuento de 3,5 % y 6 %. El modelo se evaluó usando la simulación de Montecarlo con 10.000 iteraciones. Resultados. Los costos totales medios esperados de la toracotomía y de la videotoracoscopia fueron de COP$ 22'831.299 (ICr95%: 22'773.228-22'889.370) y $ 16'955.369 (ICr95%: 16'920.215-16'990.523), respectivamente. Los años de vida ganados para toracotomía fueron 7,85 (ICr95%: 7,84-7,86) y para videotoracoscopia fueron 9,24 (ICr95%: 9,23-9,25). La toracotomía fue superada por la videotoracoscopia para disposiciones a pagar entre COP$ 15'000.000 y $ 45'000.000. Discusión. La videotoracoscopia superó a la toracotomía en el tratamiento de pacientes con cáncer de pulmón de célula no pequeña en estadio I, para diferentes disponibilidades por pagar en el sistema de salud colombiano.

Introduction: Patients with non-small cell lung cancer stage I may undergo VATS or open thoracotomy. The aim of this study was to determine the cost effectiveness of these two alternatives. Methods: A cost-effectiveness study was conducted by using a tree model with an extended Markov decision process. A perspective of public Colombian health system was adopted. The outcomes were measured in life-years saved, which were obtained from systematic reviews of survival analysis. The direct medical costs of providers and insurers of three cities in Colombia were included. The time horizon was 10 years with discount rates of 3.5% and 6%. The model was evaluated using Monte Carlo simulation with 10,000 iterations. Results: The expected average total costs of thoracotomy and thoracoscopy were COP $ 22.831.299 (95% ICr: 22.773.228-22.889.370) and $ 16.955.369 (95% ICr: 16.920.215-16.990.523) respectively. The number of saved life-years for thoracotomy were 7.85 saved LY (95% ICr: 7.84-7.86) and for VATS were 9.24 LYS (95% ICr: 9.23-9.25). The thoracotomy was dominated by VATS for willingness to pay between COP $ 15 million to $ 45 million. Discussion: The videothoracoscopy dominated open thoracotomy in the treatment of patients with non-small cell lung cancer stage I for different willingness to pay in the Colombian health system.

Cuantificación de actividad enzimática en leucocitos para el diagnóstico de mucopolisacaridosis tipo II y tipo IVA / Quantification of enzymatic activity in leukocytes for the diagnosis of mucopolysaccharidosis type II and type IVA

INTRODUCCIÓN: La mucopolisacaridosis tipo II y tipo IVA son enfermedades causadas por la deficiencia de las enzimas iduronato 2 sulfato sulfatasa y galactosamina 6 sulfato sulfatasa respectivamente. El depósito resultante de glucosaminoglicanos produce manifestaciones clínicas variadas. Aunque se han propuesto varias alternativas diagnósticas, tales como el examen físico, la cuantificación de glucosaminoglicanos en orina y la cuantificación de la actividad enzimática en leucocitos, la utilidad diagnóstica de esta última no ha sido estudiada en la práctica clínica rutinaria. La posibilidad de ofrecer terapia de reemplazo enzimático a estos pacientes obliga a evaluar la utilidad de la cuantificación de actividad enzimática para confirmar el diagnóstico de estas entidades. OBJETIVO: Evaluar la utilidad diagnóstica de la cuantificación de actividad enzimática de la iduronato 2 sulfato sulfatasa en leucocitos para la confirmación diagnóstica de la MPS tipo II y la galactosamina 6 sulfato sulfatasa en leucocitos para la confirmación diagnóstica de la MPS tipo IVA. Esta revisión no contempla la evaluación de la utilidad diagnóstica del examen físico, glucosaminoglicanos en orina o pruebas moleculares. METODOLOGÍA: Se realizó una búsqueda de las revisiones panorámicas y sistemáticas de los últimos cinco años y estudios de validez diagnóstica, cohortes descriptivas y series de casos sin límite de fecha en MEDLINE, EMBASE, Cochrane, DARE, LILACS y Google. Los artículos debían estar en texto completo, en inglés o español. Se excluyeron artículos que describieran mutaciones o manifestaciones clínicas de un sistema u órgano específico. Los estudios con criterios de elegibilidad fueron evaluados por dos revisores independientes. A los estudios incluidos se extrajo información sociodemográfica, clínica y métodos diagnósticos empleados. RESULTADOS: No se encontró ninguna revisión panorámica, sistemática o estudio de validez diagnóstica para MPS tipo II o IVA. Se incluyeron 3 estudios de serie de casos para MPS tipo II y 13 series de casos para MPS tipo IVA. El 100% de los estudios de MPS tipo II incluyeron la cuantificación enzimática como prueba confirmatoria. El 63.6% (7/11) de las series de casos de MPS tipo IVA incluyeron la cuantificación enzimática en leucocitos como prueba confirmatoria, el 18.1% (2/11) no la incluyeron por falta de disponibilidad de la tecnología y el otro 18.1% (2/11) por publicación del artículo antes de la fecha de introducción de la tecnología. CONCLUSIONES: La cuantificación de la actividad enzimática de la iduronato 2 sulfato sulfatasa y la galactosamina 6 sulfato sulfatasa en leucocitos representa una tecnología diagnóstica útil para confirmar MPS tipo II y MPS tipo IVA respectivamente en pacientes con sospecha clínica de dichas entidades.(AU)

Enzymatic hydrolysis of steryl glucosides, major contaminants of vegetable oil-derived biodiesel.

Biodiesels are mostly produced from lipid transesterification of vegetable oils, including those from soybean, jatropha, palm, rapeseed, sunflower, and others. Unfortunately, transesterification of oil produces various unwanted side products, including steryl glucosides (SG), which precipitate and need to be removed to avoid clogging of filters and engine failures. So far, efficient and cost-effective methods to remove SGs from biodiesel are not available. Here we describe for the first time the identification, characterization and heterologous production of an enzyme capable of hydrolyzing SGs. A synthetic codon-optimized version of the lacS gene from Sulfolobus solfataricus was efficiently expressed and purified from Escherichia coli, and used to treat soybean derived biodiesel containing 100 ppm of SGs. After optimizing different variables, we found that at pH 5.5 and 87 °C, and in the presence of 0.9 % of the emulsifier polyglycerol polyricinoleate, 81 % of the total amount of SGs present in biodiesel were hydrolyzed by the enzyme. This remarkable reduction in SGs suggests a path for the removal of these contaminants from biodiesel on industrial scale using an environmentally friendly enzymatic process.

Sangrado gastrointestinal en pacientes hospitalizados / Gastrointestinal bleeding in hospitalized patients

El sangrado gastrointestinal es una complicación potencial del paciente que se hospitaliza. Como las descripciones iniciales en cuidados intensivos relacionaban el sangrado por úlceras de estrés con alta mortalidad, la investigación fue creciente en los pacientes críticos. No sucedió lo mismo con los hospitalizados y los trabajos disponibles son escasos. Los principales factores de riesgo se han descrito en los críticos (ventilación mecánica más de 48 horas y coagulopatía). La eficacia de la terapia no se ha demostrado en aquellos en la sala general. La evidencia indirecta muestra utilidad marginal de estos medicamentos en la prevención del sangrado gastrointestinal. En los casos críticos hay abundante información pero la interpretación es confusa. Se ha documentado una tasa alta de formulación para prevenir el sangrado en los hospitalizados, la mayoría sin indicación clara, lo cual puede exponer al paciente a eventos adversos innecesarios y gastos adicionales al sistema de salud. Se recomiendan estrategias para implementación de guías para el uso racional de estos fármacos...

Gastrointestinal bleeding is a potential inpatient complication. Research has extensively focused in critically ill patients due to initial descriptions of high mortality related to bleeding due to stress ulceration. On the other hand, research evaluating GI bleeding in inpatients is scarce with few available reports. The main risk factors have been described in critically ill patients (requiring mechanical ventilation for more than 48 hours and coagulopathy). Treatment efficacy has not been demonstrated in patients hospitalized in the general ward. Indirect evidence show marginal usefulness of these medications in gastrointestinal bleeding prevention. There is plentiful data on critically ill patients but with confusing interpretation. It has been documented that preventive medicines are often prescribed to avoid bleeding in inpatients, with no clear indication in most cases, exposing the patient to unnecessary adverse events and additional costs for the healthcare system. Implementation guidelines are recommended for the rational use of these medicines...

Photoacoustic imaging enhanced by indocyanine green-conjugated single-wall carbon nanotubes.

A photoacoustic contrast agent that is based on bis-carboxylic acid derivative of indocyanine green (ICG) covalently conjugated to single-wall carbon nanotubes (ICG/SWCNT) is presented. Covalently attaching ICG to the functionalized SWCNT provides a more robust system that delivers much more ICG to the tumor site. The detection sensitivity of the new contrast agent in a mouse tumor model is demonstrated in vivo by our custom-built photoacoustic imaging system. The summation of the photoacoustic tomography (PAT) beam envelope, referred to as the "PAT summation," is used to demonstrate the postinjection light absorption of tumor areas in ICG- and ICG/SWCNT-injected mice. It is shown that ICG is able to provide 33% enhancement at approximately 20 min peak response time with reference to the preinjection PAT level, while ICG/SWCNT provides 128% enhancement at 80 min and even higher enhancement of 196% at the end point of experiments (120 min on average). Additionally, the ICG/SWCNT enhancement was mainly observed at the tumor periphery, which was confirmed by fluorescence images of the tumor samples. This feature is highly valuable in guiding surgeons to assess tumor boundaries and dimensions in vivo and to achieve clean tumor margins to improve surgical resection of tumors.

Targeting tumor hypoxia with 2-nitroimidazole-indocyanine green dye conjugates.

Tumor hypoxia is a major indicator of treatment resistance to chemotherapeutic drugs, and fluorescence optical tomography has tremendous potential to provide clinically useful, functional information by identifying tumor hypoxia. The synthesis of a 2-nitroimidazole-indocyanine green conjugate using a piperazine linker (piperazine-2-nitroimidazole-ICG) capable of robust fluorescent imaging of tumor hypoxia is described. In vivo mouse tumor imaging studies were completed and demonstrate an improved imaging capability of the new dye relative to an earlier version of the dye that was synthesized with an ethanolamine linker (ethanolamine-2-nitroimidazole-ICG). Mouse tumors located at imaging depths of 1.5 and 2.0 cm in a turbid medium were imaged at various time points after intravenous injection of the dyes. On average, the reconstructed maximum fluorescence concentration of the tumors injected with piperazine-2-nitroimidazole-ICG was twofold higher than that injected with ethanolamine-2-nitroimidazole-ICG within 3 h postinjection period and 1.6 to 1.7 times higher beyond 3 h postinjection. The untargeted bis-carboxylic acid ICG completely washed out after 3 h postinjection. Thus, the optimal window to assess tumor hypoxia is beyond 3 h postinjection. These findings were supported with fluorescence images of histological sections of tumor samples and an immunohistochemistry technique for identifying tumor hypoxia.

Recognition algorithm for assisting ovarian cancer diagnosis from coregistered ultrasound and photoacoustic images: ex vivo study.

Unique features and the underlining hypotheses of how these features may relate to the tumor physiology in coregistered ultrasound and photoacoustic images of ex vivo ovarian tissue are introduced. The images were first compressed with wavelet transform. The mean Radon transform of photoacoustic images was then computed and fitted with a Gaussian function to find the centroid of a suspicious area for shift-invariant recognition process. Twenty-four features were extracted from a training set by several methods, including Fourier transform, image statistics, and different composite filters. The features were chosen from more than 400 training images obtained from 33 ex vivo ovaries of 24 patients, and used to train three classifiers, including generalized linear model, neural network, and support vector machine (SVM). The SVM achieved the best training performance and was able to exclusively separate cancerous from non-cancerous cases with 100% sensitivity and specificity. At the end, the classifiers were used to test 95 new images obtained from 37 ovaries of 20 additional patients. The SVM classifier achieved 76.92% sensitivity and 95.12% specificity. Furthermore, if we assume that recognizing one image as a cancer is sufficient to consider an ovary as malignant, the SVM classifier achieves 100% sensitivity and 87.88% specificity.

FPGA-based reconfigurable processor for ultrafast interlaced ultrasound and photoacoustic imaging.

In this paper, we report, to the best of our knowledge, a unique field-programmable gate array (FPGA)-based reconfigurable processor for real-time interlaced co-registered ultrasound and photoacoustic imaging and its application in imaging tumor dynamic response. The FPGA is used to control, acquire, store, delay-and-sum, and transfer the data for real-time co-registered imaging. The FPGA controls the ultrasound transmission and ultrasound and photoacoustic data acquisition process of a customized 16-channel module that contains all of the necessary analog and digital circuits. The 16-channel module is one of multiple modules plugged into a motherboard; their beamformed outputs are made available for a digital signal processor (DSP) to access using an external memory interface (EMIF). The FPGA performs a key role through ultrafast reconfiguration and adaptation of its structure to allow real-time switching between the two imaging modes, including transmission control, laser synchronization, internal memory structure, beamforming, and EMIF structure and memory size. It performs another role by parallel accessing of internal memories and multi-thread processing to reduce the transfer of data and the processing load on the DSP. Furthermore, because the laser will be pulsing even during ultrasound pulse-echo acquisition, the FPGA ensures that the laser pulses are far enough from the pulse-echo acquisitions by appropriate time-division multiplexing (TDM). A co-registered ultrasound and photoacoustic imaging system consisting of four FPGA modules (64-channels) is constructed, and its performance is demonstrated using phantom targets and in vivo mouse tumor models.

Integrated optical coherence tomography, ultrasound and photoacoustic imaging for ovarian tissue characterization.

Ovarian cancer has the lowest survival rate of the gynecologic cancers because it is predominantly diagnosed in Stages III or IV due to the lack of reliable symptoms, as well as the lack of efficacious screening techniques. Detection before the malignancy spreads or at the early stage would greatly improve the survival and benefit patient health. In this report, we present an integrated optical coherence tomography (OCT), ultrasound (US) and photoacoustic imaging (PAI) prototype endoscopy system for ovarian tissue characterization. The overall diameter of the prototype endoscope is 5 mm which is suitable for insertion through a standard 5-12.5mm endoscopic laparoscopic port during minimally invasive surgery. It consists of a ball-lensed OCT sample arm probe, a multimode fiber having the output end polished at 45 degree angle so as to deliver the light perpendicularly for PAI, and a high frequency ultrasound transducer with 35MHz center frequency. System characterizations of OCT, US and PAI are presented. In addition, results obtained from ex vivo porcine and human ovarian tissues are presented. The optical absorption contrast provided by PAI, the high resolution subsurface morphology provided by OCT, and the deeper tissue structure imaged by US demonstrate the synergy of the combined endoscopy and the superior performance of this hybrid device over each modality alone in ovarian tissue characterization.