ZFYVE21 promotes endothelial nitric oxide signaling and vascular barrier function in the kidney during aging.

ZFYVE21 is an ancient, endosome-associated protein that is highly expressed in endothelial cells (ECs) but whose function(s) in vivo are undefined. Here, we identified ZFYVE21 as an essential regulator of vascular barrier function in the aging kidney. ZFYVE21 levels significantly decline in ECs in aged human and mouse kidneys. To investigate attendant effects, we generated EC-specific Zfyve21-/- reporter mice. These knockout mice developed accelerated aging phenotypes including reduced endothelial nitric oxide (ENOS) activity, failure to thrive, and kidney insufficiency. Kidneys from Zfyve21 EC-/- mice showed interstitial edema and glomerular EC injury. ZFYVE21-mediated phenotypes were not programmed developmentally as loss of ZFYVE21 in ECs during adulthood phenocopied its loss prenatally, and a nitric oxide donor normalized kidney function in adult hosts. Using live cell imaging and human kidney organ cultures, we found that in a GTPase Rab5- and protein kinase Akt-dependent manner, ZFYVE21 reduced vesicular levels of inhibitory caveolin-1 and promoted transfer of Golgi-derived ENOS to a perinuclear Rab5+ vesicular population to functionally sustain ENOS activity. Thus, our work defines a ZFYVE21- mediated trafficking mechanism sustaining ENOS activity and demonstrates the relevance of this pathway for maintaining kidney function with aging.

Prospective Relations between Life Stress, Emotional Clarity, and Suicidal Ideation in an Adolescent Clinical Sample.

OBJECTIVE: Although life stress has been linked to adolescent suicidal ideation, most past research has been cross-sectional, and potential processes characterizing this relation remain unclear. One possibility may be a lack of emotional clarity. Informed by stress generation, the current study examined prospective relations between episodic life stress, lack of emotional clarity, and suicidal ideation in an adolescent clinical sample. METHODS: The sample consisted of 180 youths (Mage = 14.89; SD = 1.35; 71.7% female; 78.9% White; 43.0% sexual minority) recruited from a psychiatric inpatient facility. Suicidal ideation severity was assessed at baseline and 18-month follow-up. Lack of emotional clarity and life stress were assessed at baseline, as well as 6-, and 12-month follow-ups. Two random-intercepts cross-lagged panel models were created to estimate within-person relations for variables of interest. RESULTS: At the within-person level, lack of emotional clarity at baseline predicted greater 6-month impact of interpersonal dependent stressors (b = 0.29, p = .012, 95% CI [0.07, 0.52]), which subsequently predicted a greater 12-month lack of emotional clarity (b = 0.41, p = .005, 95% CI [0.12, 0.70]). Next, a 12-month lack of emotional clarity but not interpersonal dependent stress, predicted greater 18-month suicidal ideation (b = 0.81, p = .006, 95% CI [0.23, 1.30]; R2 = .24, p < .001). No significant relations were found for the lack of emotional clarity and independent stress. CONCLUSIONS: Results support the stress generation hypothesis and suggest that future research should be conducted evaluating whether bolstering youth's understanding of their emotional experiences may reduce subsequent suicidal ideation.

The value of a head turn in neurolocalization.

BACKGROUND: A head turn is a clinically relevant abnormality identified on neurological examination and historically has been an isolated or concomitant sign of ipsilateral forebrain dysfunction. Experimental studies in quadrupedal mammals suggest that changes in head posture may be identified as originating in other parts of the central nervous system (CNS). OBJECTIVES: To identify whether other locations within the CNS could give rise to a head turn and whether the head turn identified is isolated or concomitant with other deviations in head and body posture. ANIMALS: Forty-nine client-owned dogs with a presentation of a head turn, from 6 veterinary referral centers. METHODS: Multicenter observational prospective study including dogs with photographic evidence of a head turn, full neurological examination, and advanced imaging. RESULTS: Of the population, 15/49 had head turn only, 9/49 had head turn and head tilt only, 12/49 had head turn and body turn only, and 13/49 had head turn, head tilt, and body turn. Nearly all dogs with forebrain disease (23/24), and, all with brainstem and cerebellar disease, had an ipsilateral head turn and body turn (if present). In the cerebellar group, all head tilts were contralateral to the lesion location. In the cervical spinal cord group, all head turns, body turns and head tilts were contralateral to the lesion location. CONCLUSION: A head turn, although most likely associated with, is not exclusively seen with forebrain disease. Certain combinations of head turn, head tilt and body turn suggest a neurolocalization other than the forebrain, with appropriate classification needed.

Relations between discrimination, rejection sensitivity, negative affect, and decrements in problem-solving ability following social rejection: An experimental investigation.

INTRODUCTION: While negative affect and problem-solving deficits have been consistently linked to suicidal thoughts and behaviors, the latter are often conceptualized and studied as time- and/or context-invariant. Though requiring additional empirical support, theory suggests that discrimination may strengthen the relation between rejection sensitivity and increases in negative affect as well as declines in problem-solving abilities following rejection. The aim of the current study was to test this claim using a social rejection paradigm (i.e., Cyberball) with young adults experiencing past-month suicidal ideation. METHODS: The sample consisted of 50 participants. Lifetime discrimination and rejection sensitivity were assessed prior to Cyberball. Negative affect and problem-solving abilities were assessed pre- and post-Cyberball. SPSS and the PROCESS macro were used to test relations among variables of interest. RESULTS: Rejection sensitivity predicted greater problem-solving decrements, but not negative affect, following rejection among individuals who had experienced higher (vs. lower) levels of lifetime discrimination. CONCLUSION: Addressing rejection sensitivity and sources of discrimination within the context of treatment may reduce the impact of social rejection on problem-solving abilities among young adults at risk for suicide.

Perceived burdensomeness and thwarted belongingness as mediators of the relation between anxiety and suicidal ideation among adolescents.

INTRODUCTION: Anxiety and suicidal ideation have been shown to be positively related in adolescents. However, less is known about the strength of this association across different types of anxiety or the mechanisms through which this relation exists. Joiner's interpersonal theory of suicide suggests that thwarted belongingness (TB) and perceived burdensomeness (PB) lead to suicidal ideation; these constructs may explain a pathway through which anxiety and suicidal ideation are related. It was hypothesized that TB would mediate the relation between social anxiety disorder (SAD) symptoms and suicidal ideation, and PB would mediate the relation between generalized anxiety disorder (GAD) symptoms and suicidal ideation. METHODS: These longitudinal mediation models were assessed using data collected from 147 depressed adolescents, who were recently hospitalized for suicidal ideation or behavior, enrolled in a randomized controlled trial (RCT). RESULTS: Consistent with study hypotheses, PB mediated the relation between GAD symptoms and suicidal ideation severity. However, TB did not mediate the relation between SAD symptoms and suicidal ideation severity. CONCLUSION: These results suggest that screening for and addressing PB among youth with GAD may help reduce risk for suicidal behavior.

Managing a Pregnancy in the Presence of the Rare Blood Group Antibody PP1Pk.

Pregnant women with p phenotype, who lack antigens P, P1, and Pk, spontaneously form anti-PP1Pk antibodies whose primary target is the placenta. The risk of miscarriage in these women is 50%-70% and reaches 87% in the second trimester. The therapies aim to reduce the titer of antibodies early in pregnancy. They also have risk of hemolytic transfusion reaction, with very few compatible red blood cell donors in the world. In this study, we present a case of successful pregnancy managed with autologous blood donations and plasmapheresis.

Immunohistochemical Expression of PTEN in Canine Gliomas.

Phosphatase and tensin homolog (PTEN) is a critical tumor suppressor gene with a vital role in regulating cell proliferation, migration, and survival. The loss of PTEN function, either by genetic alterations or decreased protein expression, is frequent in human gliomas and has been correlated with tumor progression, grade, therapeutic resistance, and decreased overall survival in patients with glioma. While different genetic mutations in PTEN gene have been occasionally reported in canine gliomas, no alterations in protein expression have been reported. This study investigates the immunohistochemical expression of PTEN in canine gliomas to evaluate possible alterations, as those reported in human gliomas. Immunohistochemical PTEN expression and pattern distribution were analyzed in 37 spontaneous canine gliomas. Among gliomas, 52.6% cases showed high PTEN expression and 48.6% displayed reduced (13.5%) or highly reduced (35.1%) immunopositivity. Most oligodendrogliomas showed high expression (73.7%), while the majority of astrocytomas (69.2%) showed a reduced or highly reduced expression. A reduced PTEN expression was mostly associated with a heterogeneous loss of PTEN immunopositivity. These observations are in line with those reported in human gliomas and provide a rationale for future studies regarding abnormalities in PTEN expression and PI3K/Akt/mTor pathway in canine gliomas, to evaluate its prognostic and therapeutic implications.

Effects of temperature and moisture fluctuations for suitable use of raw-crushed wind-turbine blade in concrete.

Raw-crushed wind-turbine blade (RCWTB), a waste from the recycling of wind-turbine blades, is used as a raw material in concrete in this research. It contains not only fiberglass-composite fibers that bridge the cementitious matrix but also polyurethane and balsa-wood particles. Therefore, concrete containing RCWTB can be notably affected by moisture and temperature fluctuations and by exposure to high temperatures. In this research, the performance of five concrete mixes with 0.0%, 1.5%, 3.0%, 4.5%, and 6.0% RCWTB, respectively, is studied under moist/dry, alternating-sign-temperature-shock, and high-temperature-shock tests. Two damage mechanisms of RCWTB within concrete were found through these tests: on the one hand, micro-cracking of the cementitious matrix, which was verified by microscopic analyses and was dependent on concrete porosity; on the other, damage and degradation of the RCWTB components, as the polyurethane melted, and the balsa-wood particles burned. Both phenomena led to larger remaining-strain levels and reduced concrete compressive strength by up to 25% under temperature and humidity variations, although the bridging effect of the fiberglass-composite fibers was effective when adding RCWTB amounts higher than 3.0%. The compressive-strength loss after the high-temperature-shock test increased with the RCWTB content, reaching maximum values of 8% after an exposure time of 7 days. Statistical analyses revealed that effect of the RCA amount in the concrete was conditioned by the exposure times in all the tests. The accurate definition of those times is therefore key to set an RCWTB content in concrete that ensures its suitable behavior under the environmental conditions analyzed.

Biochemical characterization and gene structure analysis of the 24-kDa glutathione transferase sigma from Taenia solium.

Taenia solium can cause human taeniasis and/or cysticercosis. The latter can in some instances cause human neurocysticercosis which is considered a priority in disease-control strategies and the prevention of mental health problems. Glutathione transferases are crucial for the establishment and long-term survival of T. solium; therefore, we structurally analyzed the 24-kDa glutathione transferase gene (Ts24gst) of T. solium and biochemically characterized its product. The gene promoter showed potential binding sites for transcription factors and xenobiotic regulatory elements. The gene consists of a transcription start site, four exons split by three introns, and a polyadenylation site. The gene architecture is conserved in cestodes. Recombinant Ts24GST (rTs24GST) was active and dimeric. Anti-rTs24GST serum showed slight cross-reactivity with human sigma-class GST. A 3D model of Ts24GST enabled identification of putative residues involved in interactions of the G-site with GSH and of the H-site with CDNB and prostaglandin D2. Furthermore, rTs24GST showed optimal activity at 45 °C and pH 9, as well as high structural stability in a wide range of temperatures and pHs. These results contribute to the better understanding of this parasite and the efforts directed to fight taeniasis/cysticercosis.

La importancia de la determinación de la deuda de oxígeno en el perioperatorio / The importance of oxygen debt determination in the perioperative period

Resumen: El fenómeno de la deuda de oxígeno (dO2) descrito hace varias décadas en el contexto del ejercicio físico se ha incorporado progresivamente al terreno de la medicina. En particular se ha utilizado durante los cambios hemodinámicos producidos por la cirugía y la anestesia en los pacientes de alto riesgo. La dO2 se definió como el aumento en la cantidad de oxígeno consumida por el organismo inmediatamente después de realizar un ejercicio físico hasta que el consumo se normaliza nuevamente. En el perioperatorio se llega a producir cuando se presenta un desbalance entre la oferta (DO2) y la demanda de oxígeno (VO2) que lleva a hipoxia tisular. El grado de la dO2 tisular se ha relacionado directamente con la falla de órganos múltiples y morbimortalidad perioperatoria. A pesar de los avances en la medicina, aún no es posible prevenir o disminuir la dO2 con la administración de líquidos o con el uso de agentes vasoactivos. Por lo que un retardo o manejo inadecuado de la hemodinámica perioperatoria producirá hipoperfusión e hipoxia tisular afectando los resultados de la cirugía. El conocimiento y la valoración de la dO2 es esencial durante la anestesia del paciente de alto riesgo. Para lograr este objetivo se requiere del uso de índices adecuados que permitan detectar y cuantificar la hipoperfusión tisular y el desbalance entre la DO2 y la VO2. En esta revisión se presentan los conceptos fundamentales de la dO2, su mecanismo, detección y cuantificación; además de las intervenciones para evitarla o disminuirla y las recomendaciones para los anestesiólogos con el fin de asegurar mejores resultados en los pacientes quirúrgicos de alto riesgo.

Abstract: The phenomenon of oxygen debt (dO2) described several decades ago in the context of physical exercise has been incorporated into medicine, particularly during the hemodynamic changes produced by surgery and anesthesia in high-risk patients. dO2 is defined as the increase in the amount of oxygen consumed by the body immediately after physical exercise until O2 consumption returns to normal. In the perioperative period, an imbalance between oxygen supply (DO2) and demand (VO2) could generate dO2. The degree of tissue dO2 has been directly related to multiple organ failure and perioperative morbimortality. Despite advances in medicine, it is not yet possible to prevent or lower the dO2 with fluid administration or vasoactive agents. Delay or inadequate management of hemodynamics could produce tissue hypoperfusion and hypoxia, affecting surgery outcomes. Knowledge and assessing dO2 during perioperative are essential during anesthesia for high-risk patients. Adequate indices are required to detect and quantify tissue hypoperfusion and the imbalance between DO2 and VO2 during anesthesia. This review presents the mechanism, detection, and quantification of dO2. In addition to interventions to avoid or reduce dO2 and recommendations for anesthesiologists to ensure better results in high-risk surgical patients.

Condiciones de salud enfermedad bucal en adolescentes embarazadas indígenas y no indígenas de Maracaibo-Venezuela / Health conditions oral disease in indigenous and non-indigenous pregnant adolescents from Maracaibo- Venezuela

RESUMEN Objetivo : Comparar las condiciones de salud enfermedad bucal en adolescentes embarazadas indígenas y no indígenas de Maracaibo-Venezuela. Material y Métodos : Fue un estudio epidemiológico, transversal con un diseño de campo, no experimental. La muestra fue de 121 adolescentes embarazadas de la consulta prenatal del Hospital Materno Infantil "Eduardo Soto Peña" y de la Maternidad "Dr. Armando Castillo Plaza" de Maracaibo. Se realizó examen clínico según los criterios de la Organización Mundial de la Salud, se midieron los índices CPO, ISC, IHO-S e IPC. Para procesar los datos se utilizó el software SPSS® versión 25 y se aplicó tanto prueba de t para muestras independientes como Chi cuadrado. Resultados : La experiencia de caries fue 91,7%, el índice CPO fue de 6,84±4,173 y el ISC 11,42±2,374. Para la condición periodontal, el 41,3% presentó condición sana, un 53,7% tenía gingivitis y el 5% presentó periodontitis. El grupo de embarazadas no indígenas tuvo un índice CPO más alto 7,19±4,066 en comparación con un 5,52±4,398 para las indígenas. Respecto a la condición periodontal consolidada, el 52% del grupo de indígenas presentó gingivitis y el resto resultó sana y entre las no indígenas el 54% presentó gingivitis, el 6% tenía periodontitis y el 40% estaba sana. Conclusiones : En este estudio, no se observaron diferencias entre las condiciones de salud enfermedad bucal de las adolescentes embarazadas indígenas y no indígenas. Sin embargo, es necesario dar prioridad a la atención del componente bucal de las adolescentes durante el embarazo.

ABSTRACT Objective: Compare the oral disease health conditions in indigenous and non-indigenous pregnant adolescents from Maracaibo-Venezuela. Material and Methods : It was an epidemiological, cross-sectional study with a field design, not experimental. The sample was 121 pregnant adolescents from the prenatal consultation of the Maternal and Child Hospital "Eduardo Soto Peña" and the Maternity "Dr. Armando Castillo Plaza" in Maracaibo. Clinical examination was performed according to the criteria of the World Health Organization, DMFT, SCI, SOH-I and PCI indexes were measured. SPSS® version 25 software was used to process the data and both the t-test for independent samples and Chi square were applied. Results : the caries experience was 91.7%, the DMFT index was 6.84 ± 4.173 and the SCI was 11.42 ± 2.374. For the periodontal condition, 41.3% had a healthy condition, 53.7% had gingivitis and 5% had periodontitis. The group of non-indigenous pregnant women had a higher DMFT index of 7.19 ± 4.066 compared to 5.52 ± 4.398 for indigenous women. Regarding the consolidated periodontal condition, 52% of the indigenous group presented gingivitis and the rest were healthy and among the non-indigenous 54% presented gingivitis, 6% had periodontitis and 40% was healthy. Conclusion : In this study, no differences were observed between the oral disease health conditions of indigenous and non-indigenous pregnant adolescents. However, it is necessary to give priority to the attention of the oral component of adolescent girls during pregnancy.

Studying the Effect of Temperature on the Tensile Strength of an Intravascular Catheter Using a Degradation Model / Estudiando el Efecto de la Temperatura en la Resistencia Tensil de un Catéter Intravascular Usando un Modelo de Degradación

ABSTRACT The accelerated aging process is incorporated into the design and development of intravascular catheters to assess their reliability assuring that this medical device is safe and effective for the intended use during their shelf life. The accelerated aging process is based on a common approach that assumes that the rate of aging increases by a factor of 2^(∆T/10), where ∆T is the temperature increment. However, with the life data obtained from this empirical method is difficult to do inferences about reliability. This paper presents an accelerated destructive degradation test using thermal stress to obtain degradation data directly relates reliability to critical performance characteristic, which is the tensile strength in the intravascular catheter tip considered as a critical concern in patients' safety. The degradation data model is given by a stochastic Wiener process with the drift parameter being represented as Arrhenius function. The parameters of the Wiener process and Arrhenius function are estimated using maximum likelihood; these parameters are used to estimate the first-passage time (time to failure) distribution when the intravascular catheters degradation path reaches a tensile strength critical value in each thermal stress level. Based on this, a complete product reliability assessment is performed and presented.

RESUMEN El proceso de envejecimiento acelerado es incorporado en el diseño y desarrollo de catéteres intravasculares para evaluar su confiabilidad y asegurar que el dispositivo medico es seguro y efectivo para su uso durante su vida de estante. Este proceso está basado en un enfoque que asume que la tasa de envejecimiento se incrementa por un factor de 2^(∆T/10), en donde ∆T es el incremento de temperatura. Sin embargo, con los datos de vida obtenidos de este método empírico resulta complicado realizar inferencias sobre la confiabilidad del dispositivo. Este articulo presenta una prueba de degradación acelerada destructiva que considera un estrés termal para obtener datos de degradación que se relaciona directamente la confiabilidad con la resistencia tensil de la punta de un catéter intravascular y que es considerada como una característica critica para la seguridad de los pacientes. El modelo de degradación esta dado por un proceso estocástico Wiener, con el parámetro de deriva representado la relación de Arrhenius. Los parámetros del proceso Wiener y la relación de Arrhenius son estimados mediante máxima verosimilitud; estos parámetros son usados para estimar la distribución de primer paso, la cual se caracteriza cuando la resistencia de un catéter alcanza el nivel crítico de resistencia en cada nivel de estrés. Considerando esto, se lleva a cabo y se presenta una evaluación de confiabilidad completa del producto.

Herramientas de manufactura esbelta que inciden en la productividad de una organización: modelo conceptual propuesto / Lean manufacturing tools that influence an organization's productivity: conceptual model proposed / Ferramentas de manufatura enxuta que impactam a produtividade de uma organizacáo: modelo conceitual proposto

Resumen Introducción. Actualmente las empresas industriales enfrentan el desafío de identificar e implantar nuevas técnicas organizacionales y de producción que les permitan competir en un mercado global. Así, el modelo de fabricación esbelta se ha convertido en una alternativa para elevar la productividad y desarrollar competencias de manufactura que incidan en su competitividad. Sin embargo, se desconoce el efecto que aporta cada una de las herramientas de manufactura esbelta al logro de la productividad. Objetivo. Proponer un modelo conceptual que identifique el peso relativo que aporta la implantación de cada una de las herramientas de manufactura esbelta a la productividad. Materiales y métodos. El modelo conceptual parte de una revisión de literatura, donde para ello, se sigue una secuencia ordenada y metodológica para garantizar que el desarrollo de este artículo tenga relevancia en la ciencia y su aplicación. Resultados. En esta investigación las herramientas de manufactura esbelta que más indicen en la productividad de las empresas son: 5S, mantenimiento productivo total, el justo a tiempo (JIT), Kaizen, Kanban, cambio rápido de modelo (SMED) y el mapeo del flujo de valor (VSM) con un peso de 15, 14, 13, 12, 9, 9 y 7 % respectivamente. Además, los indicadores que mejor miden la productividad son los relacionados con la eficiencia, la efectividad y los factores internos. Conclusiones. La principal contribución de este artículo es la propuesta de un modelo conceptual sustentado en evidencia teórica que identifica las herramientas de manufactura esbelta más utilizadas para incidir en la productividad de una organización.

Abstract Introduction. Currently, industrial companies face the challenge of identifying and implementing new organizational and production techniques that allow them to compete in a global market. Thus, the lean manufacturing model has become an alternative to increase productivity and develop manufacturing skills that affect their competitiveness. However, the effect of each of the lean manufacturing tools on achieving productivity is unknown. Objective. Propose a conceptual model that identifies the relative weight in productivity provided by the implementation of each of the lean manufacturing tools. Materials and methods. The conceptual model is based on a literature review where an orderly and methodological sequence is followed to ensure that the development of this article has relevance in science and its application. Results. According to this research, the lean manufacturing tools that most influence the productivity of companies are: 5 s; Total Productive Maintenance; Just in Time (JIT); Kaizen; Kanban; Rapid Model Change (SMED); and Value Stream Mapping (VSM), with a weight of 15, 14, 13, 12, 9, 9 and 7% respectively. In addition, it was found that the indicators that best measure productivity are those related to efficiency, effectiveness and internal factors. Conclusions. The main contribution of this article is the proposal of a conceptual model supported by theoretical evidence that identifies the most used lean tools to influence the productivity of an organization.

Resumo: Introdução. Atualmente as empresas industriais enfrentam o desafio de identificar e introduzir novas técnicas organizacionais e de produção que lhes permitam concorrer num mercado global. Assim, o modelo de fabricação enxuta tem se tornado em uma alternativa para aumentar a produtividade e desenvolver concorrências de manufaturas que indicam na sua competitividade. No entanto, se desconhece o efeito que contribui a cada uma das ferramentas de manufatura enxuta à obtenção da produtividade. Objetivo. Propor um modelo conceitual que identifique o peso relativo que contribua a implantação de cada uma das ferramentas de Manufatura Enxuta à produtividade. Materiais e métodos. O modelo conceitual inicia parte de uma revisão de literatura, onde para isso, segue-se uma sequência ordenada e metodológica para garantir que o desenvolvimento deste artigo tenha relevância na ciência e sua aplicação. Resultados. Nesta pesquisa as ferramentas de manufatura enxuta que mais indiquem na produtividade das empresas são: 5S, Manutenção produtiva total, o Justo ao tempo (JIT), Kaizen, Kanban, mudança rápida de modelo (SMED) e o Mapeamento do fluxo de valor (VSM) com um peso de 15, 14, 13, 12, 9, 9 e 7 % respetivamente. Além, os indicadores que melhor medem a produtividade são os relacionados com a eficácia, a eficiência e os fatores internos. Conclusões. A principal contribuição deste artigo é a proposta de um modelo conceitual sustentado em evidencia teórica que identifica as ferramentas de manufatura enxuta mais utilizadas para incidir na produtividade de uma organização.

Significación social de un entorno virtual para la enseñanza - aprendizaje de la Estadística descriptiva en la carrera de Medicina / Social significance of a virtual environment for the teaching and learning of descriptive Statistics in Medicine degree course

Los estudios de ciencia, tecnología y sociedad revelan las interrelaciones entre la ciencia y la tecnología como procesos sociales. Este artículo persigue como objetivo: valorar la significación social de un entorno virtual en la enseñanza aprendizaje de la Estadística descriptiva en la carrera de Medicina. El diagnóstico preliminar mediante de la observación, la encuesta y el análisis documental, mostró que existen insuficiencias en el uso de las tecnologías de la información y las comunicaciones en el proceso de enseñanza aprendizaje de la Estadística. Se diseñó un entorno virtual constituido por cinco módulos que incluyen contenidos de Estadística descriptiva, ejercicios, bibliografía y ayuda. Con la validación a partir del criterio de especialistas y la sistematización con la introducción en la práctica, se evaluó el mismo como muy adecuado, fue considerado útil, necesario y aplicable al contexto objeto de estudio, lo que contribuye a la formación científica de los estudiantes desde una posición materialista.

Science, technology and society studies reveal the interrelations between science and technology as social processes. This article pursues the following objectives: to assess the social significance of a virtual environment in the teaching and learning of descriptive Statistics in Medicine degree course. The preliminary diagnosis through the observation, opinion poll and documentary analysis, showed that there are insufficiencies in the use of Information and Communication technologies in teaching and learning Statistics. It was designed a virtual environment with five modules that include contents of descriptive Statistics, exercises, bibliography and help. With the validation of specialists and the systematization after putting it in practice, the virtual environment was assessed as adequate, useful, necessary and applicable to the context being studied, which contributes to the scientific training of students from a materialistic position.

Takotsubo syndrome associated with myasthenic crisis. A case report / Síndrome de takotsubo asociado a crisis miasténica. Presentación de un caso

Abstract: Introduction: The takotsubo syndrome is a rare clinical entity commonly associated with elderly women (ratio 6:1), easily confused with an acute ischemic syndrome, strangely associated with a myasthenic crisis. It is characterized with chest pain, elevated biomarkers, ST segment elevation, absence of coronary flow obstruction, and a characteristic deformity (anteroapical dyskinesia) of the left ventricle; these changes associated with a stressor. Case report: A woman of 69 years, diagnosed with myasthenia gravis six years ago, who entered in the intensive care unit with a suspected diagnosis of acute coronary syndrome and respiratory failure which required mechanical ventilation. Coronary angiography discarded a coronary disease. Ventriculography revealed a systolic anteroapical deformation. Treatment was initiated with acetylcholinesterase inhibitors and plasmapheresis with partial response, it required the use of vasoactive amines, with a suitable progressive cardiovascular and neurological outcome, with echocardiographic resolution. Conclusions: The takotsubo syndrome can be associated with myasthenia gravis and myasthenic crisis. The prognosis depends on early diagnosis, appropriate differential diagnosis, immediate treatment of myasthenic crisis, and management of the hemodynamic consequences of the takotsubo syndrome.

Resumen: Introducción: El síndrome de takotsubo es una entidad clínica poco frecuente asociada comúnmente con las mujeres de edad avanzada (relación 6:1), puede fácilmente confundirse con un síndrome isquémico agudo, extrañamente asociado con una crisis miasténica. Se caracteriza por dolor torácico, biomarcadores elevados, elevación del segmento ST, ausencia de obstrucción del flujo coronario, y una deformidad característica (discinesia anteroapical) del ventrículo izquierdo; estos cambios asociados con un factor de estrés. Caso clínico: Una mujer de 69 años, con diagnóstico de miastenia gravis hace seis años, que ingresó en la Unidad de Cuidados Intensivos con un diagnóstico de sospecha de síndrome coronario agudo e insuficiencia respiratoria que requirió de ventilación mecánica. La angiografía descartó una enfermedad coronaria. La ventriculografía reveló una deformación anteroapical sistólica. Se inició el tratamiento con inhibidores de la acetilcolinesterasa y plasmaféresis con respuesta parcial, se requirió el uso de aminas vasoactivas, con un resultado progresivo cardiovascular y neurológico adecuado, con resolución ecocardiográfica. Conclusiones: El síndrome de takotsubo puede estar asociada con miastenia gravis y la crisis miasténica. El pronóstico depende del diagnóstico precoz, el diagnóstico diferencial adecuado, el tratamiento inmediato de la crisis miasténica, y la gestión de las consecuencias hemodinámicas del síndrome takotsubo.

Seguimiento de gestante con síndrome de plaquetas pegajosas: primer caso comunicado en Cuba / Gestational follow-up of pregnant woman with sticky platelets syndrome: first patient reported in Cuba

El síndrome de plaquetas pegajosas es una entidad en la que se presentan hiperagregabilidad plaquetaria y manifestaciones clínicas trombóticas. Fue observada hace más de 30 años en personas jóvenes con eventos oclusivos, arteriales, venosos, miorcárdicos, cerebrales y, años más tarde, se describió en mujeres con pérdidas recurrentes de embarazos y complicaciones obstétricas. El tratamiento de elección es la aspirina, con la cual se logra revertir la hiperagregabilidad plaquetaria. Se presenta el seguimiento de una gestante con diagnóstico de síndrome de plaquetas pegajosas tipo II, con antecedentes de dos pérdidas de embarazos. Durante la gestación recibió terapia antiagregante plaquetaria y heparina de bajo peso molecular. A pesar de esta terapéutica surgieron complicaciones en el tercer trimestre de la gestación que condujeron a la interrupción temprana del embarazo. Se logró una recién nacida viva, con bajo peso, sin otras complicaciones perinatales. Actualmente la paciente se mantiene con aspirina y no ha referido eventos oclusivos. Este trabajo demuestra que la atención a estas pacientes por un equipo multidisciplinario permite obtener resultados alentadores.

Sticky platelet syndrome is an entity where patients have platelet hiperaggregability and thrombotic clinical manifestations. It was observed more than 30 years ago in young people with occlusive arterial, venous, myocardial infarctions, stroke, and later it was reported in women with recurrent pregnancy loss and obstetric complication events. The treatment of choice is aspirin which reverted platelet hyperaggregability. We present a pregnant woman diagnosed with type II sticky platelets syndrome with a history of two pregnancy loss. During this pregnancy, she received antiplatelet therapy and molecular weight heparin. Despite this therapy, complications arose in the third quarter that led to the early termination of pregnancy, but we obtained an alive underweight newborn without any perinatal complications. Currently, the patient maintains aspirin and she has no occlusive events. These results demonstrate that the care of these patients by a multidisciplinary team has successful outcome.

Tratamiento de las secuelas por quemadura en cuello / Treatment of sequelae due to neck burn

Introducción: El cuello es una región con amplio rango de movimiento, además es visible porque suele estar al descubierto, y contiene un gran número de estructuras nobles. Estos puntos explican la complejidad que representan las secuelas por quemadura con esta ubicación. Nuestro objetivo en esta presentación es relatar nuestra experiencia en la reparación del cuello secuelado. Casos y métodos. Hemos categorizado estas secuelas en base a la clasifi cación de Yang, escogiendo 8 casos representativos de la misma, acontecidos en los últimos dos años. En la terapéutica instaurada en cada uno de ellos se tuvo en cuenta la clasifi cación antedicha y nuestro repertorio de tratamientos fueron los autoinjertos, los colgajos locales y los colgajos regionales. Resultados. Tanto a nivel funcional como estético se presentó una mejoría apreciable en todos los casos. Conclusiones. Creemos que la categorización de las secuelas por quemadura en cuello, en nuestro caso a través de la clasifi cación de Yang, nos permite seleccionar el tratamiento más idóneo, aumentando este en complejidad cuando la gravedad de la secuela es mayor.

Plastia en J: opción reparadora en cáncer de mamas / Breast cancer: repair option by J thecnique

El tratamiento quirúrgico es uno de los pilares en el manejo del cáncer mamario. Las indicaciones de gestos conservadores han crecido con el avance de las técnicas oncoplásticas que permiten la resección de mayores volúmenes mientras mantienen o mejoran los resultados estéticos. Presentamos nuestra experiencia y descripción de la plastia en J, técnica versátil y reproductible para reconstrucciones parciales, aplicable en tumores de todos los cuadrantes mamarios. Veinte y nueve pacientes fueron sometidas a una cirugÍa conservadora (2 TUM, 28 CUAD), seguidas de reparación plástica por patrón en J. Los resultados estéticos fueron muy buenos en 19 de 29 casos, buenos en 7 y mediocres en 4. En tres casos hemos corregido una asimetrÍa residual mediante simetrización contra lateral o con aumento por implantes de silicona. Con un seguimiento de más de 63 meses, la sobre vida global fue de 91%. No hubo márgenes comprometidos, recidivas locales ni contra laterales. En todos los casos las pacientes manifestaron estar satisfechas con sus resultados estéticos y funcionales. La plastia en J, por su practicidad constituye un elemento a tener en cuenta al momento de decisión en el arsenal quirúrgico para quienes se dediquen a la cirugía por esta enfermedad.

Surgical treatment is one of the pillars in the management of breast cancer. The indications for breast conserving surgery have grown with the advances in oncoplastic techniques, which allow the resection of greater volumes while maintaining or improving esthetic results. We present a description of and our experience with the J plasty, a versatile and reproducible technique for partial breast reconstructions, applicable for tumors in all quadrants. Twenty nine patients underwent breast conserving surgery (27 quadrantectomies, 2 lumpectomies), followed by repair with a J plasty. Esthetic results were good in 19 of the 29 cases, good in 7 and poor in 4. In 3 cases a resulting asymmetry was corrected either with a contralateral symmetrization or silicone implant augmentation. With a follow-up of over 63 months, overall survival was 91%. There were no positive margins, local or contralateral recurrences. All patients reported being satisfied with their esthetic and functional outcomes. The J plasty is a very practical technique and should be considered by all those performing surgery for this disease.

Frecuencia de Diabetes Mellitus Gestacional y factores de riesgo en gestantes atendidas en clínicas de ASSBASALUD ESE, Manizales (Colombia) 2011-2012: estudio de corte transversal / Frequency of gestational diabetes mellitus and risk factors in pregnant women treated at ASSBASALUD ESE clinics in Manizales (Colombia), in 2011-2012: cross-sectional study

Objetivo: establecer la frecuencia de diabetes mellitus gestacional (DMG) y explorar posibles factores de riesgo para su desarrollo en un grupo de gestantes atendidas en primer nivel de atención. Materiales y métodos: estudio de corte transversal analítico en gestantes atendidas en ASSBASALUD ESE, institución privada de primer nivel de atención en salud ubicada en Manizales (Colombia) en los años 2011-2012. No se incluyeron pacien tes con diabetes mellitus diagnosticada previa al embarazo. Muestreo consecutivo. Se evaluaron las variables demográficas y antropométricas de los recién nacidos, la vía del parto, el diagnóstico de laboratorio de DMG y el resultado de la prueba de O'Sullivan. Se describe la prevalencia de periodo y se hace comparación entre el grupo que presentó DMG y el que no la presentó, mediante la prueba Chi 2 y la prueba t. Resultados: se incluyeron 1.138 mujeres. Se encontró 6,3 % de prevalencia de DMG, y una prevalencia de 10,7 % de prueba de O'Sullivan positiva. La mayor prevalencia de DMG se encontró en mujeres con formación universitaria (15,2 %), con una edad comprendida entre los 40 y 50 años (21,4 %), con dos o más gravideces (7,6 %). De las pacientes del estudio que presentaron sobrepeso, el 8,3 % desarrolló DMG. El peso de los bebés de gestantes con DMG fue de 3.263 g promedio. El 6,5 % de las gestantes con excesivo aumento de peso presentó DMG, comparado con el 3,8 % presentado por las gestantes con aumento de peso normal. No se encontró relación entre el desarrollo de DMG y la no asistencia al curso psicoprofiláctico. Conclusiones: La proporción de DMG en gestantes encontrada en la presente investigación, está dentro de los límites hallados en población mundial. La edad de la gestante, sus partos previos y el nivel educativo mostraron asociación con el desarrollo de DM.

Objective: To determine the frequency of gestational diabetes mellitus (GDM) and explore potential risk factors in pregnant women seen in primary care. Materials and methods: Analytical cross-sectional study in pregnant women seen at ASSBASALUD ESE, a private, level-one healthcare institution in Manizales (Colombia), in 2011- 2012. Patients diagnosed with diabetes mellitus before pregnancy were not included. Consecutive sampling. Demographics and anthropometric variables of the neonates, route of deliver y, laboratory diagnosis of GDM and the result of the O'Sullivan test were assessed. Period prevalence is described and a comparison is made between the group presenting GDM and the group that did not, using the Chi square and t tests. Results: Overall, 1,138 women were included. The prevalence of GDM was found to be 6.3 % and the prevalence of a positive O'Sullivan test was found to be 10.7%. The highest prevalence of GDM was found among women with college education (15.2%), between the ages of 40-50 (21.4%), with two or more pregnancies (7.6 %). Of the patients in the study who were overweight, 8.3% developed GDM. Babies born to mothers with GDM had a mean weight at birth of 3,263 g. Among pregnant women with excess weight gain, 6.5 % developed GDM, compared to 3.8 % in women with normal weight gain. No relationship was found between the development of GDM and non-attendance to psychoprophylactic preparation. Conclusions: The proportion of GDM in the study population was comparable to that found in other populations. No risk factors were found in the study population.

Cirugías de conversión en reconstrucción mamaria / Conversion surgery in breast reconstruction

La cirugía en cáncer de mama puede lograr un buen controllocal en condiciones estéticas aceptables. Estudios con másde 20 años de seguimiento demostraron la seguridad del tratamientoconservador y que la reconstrucción no tiene efectosdeletéreos sobre la evolución de la enfermedad. Debemos haceresfuerzos para lograr resultados cosméticos favorables, y cuandoestos son mediocres o se deterioran con el tiempo debemospoder corregirlos.Presentamos cuatro casos de reconstrucción post mastectomía.Fueron reconstrucciones por implantes con resultados estéticoscomplicados. Tres fueron reconstruidos en otros centros;uno de nuestra propia serie. Luego de una cuidadosa consideraciónde los antecedentes oncológicos y motivos del deterioroestético, realizamos una nueva reconstrucción usando tejidosautólogos para disminuir la probabilidad de futuras complicaciones.Introducimos el término cirugía de conversión para significarel cambio de un tipo de reconstrucción a otro.Los resultados de estas intervenciones fueros exitosos. Elseguimiento de 22 meses no mostró enfermedad recurrente, conresultados satisfactorios y aceptación de los pacientes.Para disminuir las complicaciones y malos resultados encirugías reconstructivas es importante el trabajo multidisciplinarioo una formación en la cirugía oncoplástica.La mastología incluye el control riguroso del cáncer, optimizandolos resultados estéticos con sus consecuencias psico-fisícas