Proteína C reactiva y su progresión en el tiempo para la detección de las fugas anastomóticas / C-reactive protein and its progression over time for the detection of anastomotic leaks

Introducción. Las fugas anastomóticas son una complicación común y crítica en cirugía gastrointestinal, por lo que su identificación y tratamiento temprano son necesarios para evitar resultados adversos. El uso convencional con un valor límite de la proteína C reactiva ha demostrado una utilidad limitada. El objetivo de este estudio fue determinar la utilidad de la medición seriada de la proteína C reactiva en la detección de fugas anastomóticas. Métodos. Revisión prospectiva de base de datos retrospectiva de pacientes sometidos a cirugía abdominal mayor con al menos una anastomosis intestinal. Se midió la proteína C reactiva al tercer y quinto día posoperatorio. Las complicaciones se categorizaron según la clasificación de Clavien-Dindo. La precisión diagnóstica fue evaluada por el área bajo la curva. Resultados. Se incluyeron 157 pacientes, el 52 % mujeres. La edad promedio fue de 63,7 años. El mayor número de cirugías correspondió a gastrectomía (36,3 %), resección anterior de recto (15,3 %) y hemicolectomía derecha (13,4 %). El 25,5 % tuvieron alguna complicación postoperatoria y el 32,5 % (n=13) presentaron fuga en la anastomosis. El aumento de la proteína C reactiva tuvo un área bajo la curva de 0,918 con un punto de corte de aumento en 1,3 mg/L, sensibilidad de 92,3 % (IC95% 78 ­ 100) y una especificidad de 92,4 % (IC95% 88 ­ 96). Conclusiones. El aumento de 1,3 mg/L en la proteína C reactiva entre el día de la cirugía y el quinto día fue un predictor preciso de fugas anastomóticas en pacientes con cirugía abdominal mayor

Introduction. Anastomotic leaks are a common and critical complication in gastrointestinal surgery. Their identification and early treatment are necessary to avoid adverse results, and conventional use with a cutoff value of C-reactive protein has shown limited utility. The objective of this study was to determine the usefulness of serial measurement of C-reactive protein in the detection of anastomotic leaks. Methods. Prospective review of a retrospective database of patients undergoing major abdominal surgery with at least one intestinal anastomosis. C-reactive protein was measured on the third and fifth postoperative days. Complications were classified according to the Clavien-Dindo classification. Diagnostic accuracy was evaluated by the area under the curve.Results. 157 patients were included, 52% were females. The average age was 63.7 years. The largest number of surgeries corresponded to gastrectomies (36.3%), anterior resection of the rectum (15.3%) and right hemicolectomies (13.4%). 25.5% had some postoperative complication and 32.5% (n=13) had anastomosis leaks. The increase in C-reactive protein had an area under the curve of 0.918 with an increase cut-off point of 1.3 mg/L, sensitivity of 92.3% (95% CI 78-100) and specificity of 92.4%. (95% CI 88-96). Conclusions. The 1.3 mg/L increase in C-reactive protein between the day of surgery and the fifth day was an accurate predictor of anastomotic leaks in patients with major abdominal surgery

Vitamin D and socioeconomic deprivation mediate COVID-19 ethnic health disparities.

Ethnic minorities in developed countries suffer a disproportionately high burden of COVID-19 morbidity and mortality, and COVID-19 ethnic disparities have been attributed to social determinants of health. Vitamin D has been proposed as a modifiable risk factor that could mitigate COVID-19 health disparities. We investigated the relationship between vitamin D and COVID-19 susceptibility and severity using the UK Biobank, a large progressive cohort study of the United Kingdom population. Structural equation modelling was used to evaluate the ability of vitamin D, socioeconomic deprivation, and other known risk factors to mediate COVID-19 ethnic health disparities. Asian ethnicity is associated with higher COVID-19 susceptibility, compared to the majority White population, and Asian and Black ethnicity are both associated with higher COVID-19 severity. Socioeconomic deprivation mediates all three ethnic disparities and shows the highest overall signal of mediation for any COVID-19 risk factor. Vitamin supplements, including vitamin D, mediate the Asian disparity in COVID-19 susceptibility, and serum 25-hydroxyvitamin D (calcifediol) levels mediate Asian and Black COVID-19 severity disparities. Several measures of overall health also mediate COVID-19 ethnic disparities, underscoring the importance of comorbidities. Our results support ethnic minorities' use of vitamin D as both a prophylactic and a supplemental therapeutic for COVID-19.

Diagnóstico de la dinámica cardiaca mediante proporciones de la entropía / Heart dynamics diagnosis based on entropy proportions

Introducción: Los valores de la frecuencia cardiaca normales y anormales registrados en los equipos electrocardiográficos ambulatorios o continuos han sido caracterizados mediante nuevas metodologías diagnósticas, las cuales se han desarrollado en el contexto de la teoría de los sistemas dinámicos y la entropía. Objetivo: Evaluar la dinámica cardiaca de adultos, teniendo en cuenta su comportamiento en el contexto de la teoría de sistemas dinámicos y las proporciones de la entropía mediante un estudio ciego. Métodos: Se realizó una prueba diagnóstica mediante un estudio ciego de 500 Holter, aplicando una nueva metodología basada en las proporciones de la entropía del atractor numérico construido con los valores registrados en el Holter. Para esto, los valores máximos y mínimos de la frecuencia cardiaca para cada hora, así como el número de latidos, fueron tomados de cada Holter durante, mínimo, 18 horas. Con estos valores se generó un atractor numérico que cuantificó la probabilidad de parejas de frecuencias cardiacas consecutivas. Se evaluó cada dinámica a partir de los valores de entropía y de sus proporciones. Posteriormente, estos resultados fueron comparados con la evaluación clínica convencional estimando la sensibilidad y especificidad, así como el coeficiente Kappa. Resultados: Se encontraron diferencias entre la dinámica de casos normales y anormales, en las dinámicas cardiacas evaluadas en 18 horas, hallando valores de sensibilidad y especificidad del 100 por ciento y coeficiente Kappa de uno, respecto al diagnóstico clínico convencional. Conclusiones: Los valores de entropía y de sus proporciones permiten diferenciar cuantitativamente la normalidad de la enfermedad en la dinámica cardiaca, durante un mínimo de 18 horas(AU)

Introduction: The normal and abnormal heart rate values recorded on ambulatory or continuous electrocardiographic devices have been characterized with novel diagnostic methodologies developed in the context of dynamic systems and entropy theory. Objective: Through a blind study, evaluate the heart dynamics of adults taking into account their behavior in the context of dynamic systems theory and entropy proportions. Methods: A diagnostic test was conducted through a 500 Holter blind study, applying a novel methodology based on the entropy proportions of the numerical attractor constructed with the values registered on the Holter device. To achieve this end, maximum and minimum heart rate values for each hour, as well as the number of beats, were obtained from each Holter device for at least 18 hours. Based on these values, a numerical attractor was generated which quantified the probability of consecutive heart rate pairs. Each dynamic was evaluated in terms of entropy values and their proportions. These results were then compared with the conventional clinical evaluation, estimating the sensitivity and specificity as well as the kappa coefficient. Results: Differences were found between the dynamics of normal and abnormal cases, in the heart dynamics evaluated in 18 hours, finding sensitivity and specificity values of 100 percent and a kappa coefficient of 1, with respect to conventional clinical diagnosis. Conclusions: Entropy values and their proportions make it possible to quantitatively differentiate the normality of the disease in heart dynamics for a minimum of 18 hours(AU)

Evaluación de la dinámica cardiaca con la aplicación de metodologías basadas en entropía proporcional y la ley Zipf-Mandelbrot.

INTRODUCCIÓN: Las metodologías fisicomatemáticas son de utilidad para el diagnóstico de la dinámica cardiaca. OBJETIVO: Comparar la aplicación de dos métodos matemáticos de evaluación de la dinámica cardiaca. Una basada en proporciones de la entropía y otra en la ley de Zipf-Mandelbrot. MÉTODO: Se tomaron 10 registros Holter, cinco de pacientes con enfermedad aguda y cinco normales. Se construyó un atractor numérico, se evaluó la probabilidad, entropía y proporciones de entropía. Para aplicar la segunda metodología se agruparon los valores de frecuencia cardiaca en rangos de 15 latidos/minuto y se aplicó la ley de Zipf-Mandelbrot para obtener la dimensión fractal estadística. Finalmente se comparó la evaluación matemática obtenida por ambas metodologías. RESULTADOS: La metodología basada en las proporciones de la entropía diferenció normalidad, enfermedad y estados intermedios. La segunda metodología diferenció normalidad de enfermedad aguda mediante el grado de complejidad. CONCLUSIÓN: Ambas metodologías establecen evaluaciones de ayuda diagnóstica de la dinámica cardiaca de forma objetiva y reproducible. La entropía proporcional permite cuantificar normalidad, enfermedad y evolución entre estados con carácter predictivo y mayor precisión. INTRODUCTION: Physical-mathematical methodologies have been useful for the diagnosis of cardiac dynamics. OBJECTIVE: To compare the application of two mathematical methodologies for cardiac dynamics evaluation, one of them based on entropy proportions and the other based on of Zipf-Mandelbrot law. METHOD: 10 Holter, 5 acute disease dynamics and 5 normal records were taken. A numerical attractor was constructed; probability, entropy and entropy proportions were evaluated. To apply the second methodology, heart rate values were grouped in 15-beat/min ranges, and Zipf-Mandelbrot's law was applied in order for the statistical fractal dimension to be obtained. Finally, the mathematical evaluation obtained by both methodologies was compared. RESULTS: The methodology based on entropy proportions differentiated normality, disease and intermediate states. The second methodology differentiated normality from acute disease through the degree of complexity. CONCLUSION: Both methodologies establish diagnostically helpful evaluations of cardiac dynamics in an objective and reproducible way. Proportional entropy allows normality, disease and evolution between states to be quantified in a predictive manner and with higher accuracy.

Low doses of paraquat and polyphenols prolong life span and locomotor activity in knock-down parkin Drosophila melanogaster exposed to oxidative stress stimuli: implication in autosomal recessive juvenile parkinsonism.

Previous studies have shown that polyphenols might be potent neuroprotective agents in Drosophila melanogaster wild type Canton-S acutely or chronically treated with paraquat (PQ), a selective toxin for elimination of dopaminergic (DAergic) neurons by oxidative stress (OS), as model of Parkinson's disease (PD). This study reports for the first time that knock-down (K-D) parkin Drosophila melanogaster (TH-GAL4; UAS-RNAi-parkin) chronically exposed to PQ (0.1-0.25 mM), FeSO(4) (Fe, 0.1mM), deferoxamine (DFO, 0.01 mM) alone or (0.1mM) PQ in combination with polyphenols propyl gallate (PG, 0.1mM) and epigallocathecin gallate (EGCG, 0.1, 0.5mM) showed significantly higher life span and locomotor activity than untreated K-D flies or treated with (1, 5, 20mM) PQ alone. Whilst gallic acid (GA, 0.1, 0.5mM) alone or in the presence of PQ provoked no effect on K-D flies, epicathecin (EC, 0.5mM) only showed a positive effect on prolonging K-D flies' life span. It is shown that PG (and EGCG) protected protocerebral posterolateral 1 (PPL1) DAergic neurons against PQ. Interestingly, the protective effect of low PQ concentrations, DFO and iron might be explained by a phenomenon known as "hormesis." However, pre-fed K-D flies with (0.1mM) PQ for 7 days and then exposed to (0.25 mM) for additional 8 days affect neither survival nor climbing of K-D Drosophila compared to flies treated with (0.25 mM) PQ alone. Remarkably, K-D flies treated with 0.1mM PQ (7 days) and then with (0.25 mM) PQ plus PG (8 days) behaved almost as flies treated with (0.25 mM) PQ. Taken these data suggest that antioxidant supplements that synergistically act with low pro-oxidant stimuli to prolong and increase locomotor activity become inefficient once a threshold of OS has been reached in K-D flies. Our present findings support the notion that genetically altered Drosophila melanogaster as suitable model to study genetic and environmental factors as causal and/or modulators in the development of autosomal recessive juvenile Parkinsonism (AR-JD)/PD. Most importantly, we have shown for the first time that low amounts of stressors induce a health-promoting extending effect in K-D parkin flies. Altogether our present results open new avenues for the screening, testing and development of novel antioxidant drugs against OS stimuli in neurodegenerative disorders.

The Physalis peruviana leaf transcriptome: assembly, annotation and gene model prediction.

BACKGROUND: Physalis peruviana commonly known as Cape gooseberry is a member of the Solanaceae family that has an increasing popularity due to its nutritional and medicinal values. A broad range of genomic tools is available for other Solanaceae, including tomato and potato. However, limited genomic resources are currently available for Cape gooseberry. RESULTS: We report the generation of a total of 652,614 P. peruviana Expressed Sequence Tags (ESTs), using 454 GS FLX Titanium technology. ESTs, with an average length of 371 bp, were obtained from a normalized leaf cDNA library prepared using a Colombian commercial variety. De novo assembling was performed to generate a collection of 24,014 isotigs and 110,921 singletons, with an average length of 1,638 bp and 354 bp, respectively. Functional annotation was performed using NCBI's BLAST tools and Blast2GO, which identified putative functions for 21,191 assembled sequences, including gene families involved in all the major biological processes and molecular functions as well as defense response and amino acid metabolism pathways. Gene model predictions in P. peruviana were obtained by using the genomes of Solanum lycopersicum (tomato) and Solanum tuberosum (potato). We predict 9,436 P. peruviana sequences with multiple-exon models and conserved intron positions with respect to the potato and tomato genomes. Additionally, to study species diversity we developed 5,971 SSR markers from assembled ESTs. CONCLUSIONS: We present the first comprehensive analysis of the Physalis peruviana leaf transcriptome, which will provide valuable resources for development of genetic tools in the species. Assembled transcripts with gene models could serve as potential candidates for marker discovery with a variety of applications including: functional diversity, conservation and improvement to increase productivity and fruit quality. P. peruviana was estimated to be phylogenetically branched out before the divergence of five other Solanaceae family members, S. lycopersicum, S. tuberosum, Capsicum spp, S. melongena and Petunia spp.

El debate axiológico como propuesta de intervención terapeutica complementaria a los debates clásicos de la REBT en la depresión / The axiological argument as a complementary therapeutic proposal to the classic REBT arguments in depression

El objetivo de este estudio fue establecer el efecto diferencial favorable en la reducción de los síntomas depresivos, del debate axiológico administrado adicional y conjuntamente con los debates, lógico, empírico y pragmático de la REBT, a un grupo experimental de 20 pacientes adultos masculinos con depresión, versus otro equivalente de control en el cual se administraron solo los segundos. Con cada grupo se realizaron 15 sesiones, a cargo de dos terapeutas expertos utilizando las estrategias de debate. Los resultados Chi- cuadrado confirman los efectos de mejoría en los participantes del grupo experimental reportados en la escala de Beck con un valor X2=6,97534, superior al X2= 3,551 esperado con p¡Ü0.001 y gl=32. Se concluye que el debate axiológico promueve operaciones evaluativo-emocionales adicionales como la jerarquización, la revaloración, la comparación y la renormatización de principios y valores bajo una perspectiva posibilistica, probabilistica, relativista, diversa y optativa que flexibiliza la filosofía del paciente disminuyendo su sintomatología depresiva.

This study was aimed to establish a differential effect that facilitates reduction of depressive symptoms of the axiological argument administrated in conjunction with the logical, empirical and pragmatic of the REBT, to an experimental group of 20 masculine adult patients, depressed diagnosed, versus another equivalent group of control in which only seconds were administrated. 15 sessions were conducted by two therapists, and strategies of argument were used. The improvement effects in the experimental participants are confirmed by the chi square results and they are reported on the Beck scale with a value of X2=6,97534, higher than the expected with X2= 3,551with p¡Ü0.001 and fg=32. It is concluded, the axiological argument promotes additional evaluative-emotional operations such as ranking, reassessment, comparison, and reformulation of principles and values from a possibilistic, probabilistic, relativistic, and elective view that makes flexible the patient's philosophy and decreases their depressive symptoms.