46 XX Ovotesticular Disorder of Sex Development with Gonadotropin-Releasing Hormone Receptor, Autosomal Recessive Heterozygous Missense Mutation and Autosomal Dominant Heterozygous Missense Mutation of the PROKR2 Gene: A Case Report.

True hermaphroditism is a disorder of sex development (DSD), accounting for less than 5% of all DSD cases, defined by the simultaneous presence of testicular tissue and ovarian tissue in the same individual. In the reported case, the patient presented two genetic mutations involved in the pathogenic pathway of the DSD condition associated with the clinical features of Kallmann syndrome (KS), a developmental disease that associates hypogonadotropic hypogonadism (HH), due to gonadotropin-releasing hormone deficiency, and anosmia, related to the absence or hypoplasia of the olfactory bulbs. Given the variable degree of hyposmia in KS, the distinction between KS and normosmic idiopathic HH is currently unclear, especially as HH patients do not always undergo detailed olfactory testing. This syndrome is very rare, with an estimated prevalence of 1:80,000 in males and 1:40,000 in females. This is the only case report concerning a patient with 46 XX true hermaphroditism affected by HH and digenic inheritance of Kallmann syndrome.

Ultrafast control of the LnF+/LnO+ ratio from Ln(hfac)3.

The photo-induced dissociative ionization of lanthanide complexes Ln(hfac)3 (Ln = Pr, Er, Yb) is studied using ultrafast shaped laser pulses in a time-of-flight (TOF) mass spectrometry setup. Various fluorine and Ln-containing mass fragments were observed, which can be interpreted by the photo-fragmentation mechanistic pathway involving C-C bond rotation processes proposed previously. A set of experiments used pulse shaping guided by closed-loop feedback control to identify pulses that optimize the ratio of LnF+/LnO+. In agreement with previous studies in which very little LnO+ was observed, broad pulses were found to maximize the LnF+/LnO+ ratio, which involves metal-ligand bond-breaking followed by bond rotation and bond rearrangement. In contrast, a transform limited (TL) pulse favored the formation of LnO+. Finally, the recently developed experimental control pulse slicing (CPS) technique was applied to elucidate the dynamics induced by fields that either maximize or minimize the LnF+/LnO+ ratio, which also indicates that longer laser pulses facilitate LnF+ formation during the C-C bond rotation dissociative-ionization process.

Individualized care for patients with intersex (differences of sex development): Diagnosis and treatment of aphallia.

This review discusses issues and concerns in the management of aphallia, updating status of a post-pubertal individual who required further surgery after having initial surgery for aphallia as an infant. Through this case, which discusses an 18-year-old young adult who had penile agenesis, who desired further phalloplasty involving glanuloplasty and implantation of an erectile device, we highlight the importance of periodic evaluation and close follow up. Surgery during infancy or early childhood to create a penis is important for gender development in a boy, especially if there were functional testes during fetal life, even if this surgery would only be the first stage. There is a strong probability of subsequent surgery after initial phalloplasty before puberty, even with the use of currently refined techniques. Here we discuss the changing techniques that document the ongoing, continued refinement of these procedures, highlighting that further outcome data are needed to identify ways to further optimize current techniques.

Biology, Population Fluctuation, and Foliar Consumption Rate of Durrantia arcanella Busk, 1912 (Lepidoptera: Depressariidae), a Defoliator of Oil Palm in the Colombian Caribbean.

Durrantia arcanella is a recurring pest insect of oil palm in Colombia. Because the biology and ecology of D. arcanella are unknown, it was proposed to determine the life cycle and foliar consumption under laboratory conditions. Furthermore, through sequential sampling for two and a half years, its population fluctuation and natural enemies were determined in Agustín Codazzi and El Copey (Cesar, Colombia). Also, temperature, precipitation, and relative humidity were registered. The life cycle of D. arcanella lasted 48.0 ± 10.1 days, the egg 8.0 ± 0.7 days, larva 24.2 ± 6.2 days, pre-pupa 1.5 ± 0.5 days, pupa 7.1 ± 0.9 days, and adult 7.2 ± 2.0 days. The larvae consumed 8.2 ± 5.3 cm2 of leaflets. Correlations were found between the population fluctuation in D. arcanella and the temperature in El Copey (ρ = -0.45; p < 0.0043), relative humidity in Codazzi (ρ = 0.33; p < 0.034), and with the natural control in both locations ((ρ = 0, 61; p < 0.000044) and (ρ = 0.42; p < 0.006)). These results suggest monitoring the pest populations in the second semester of the year and show the importance of promoting native natural enemies.

Safety and outcomes analysis: transcatheter implantation of autologous angiogenic cell precursors for the treatment of cardiomyopathy.

BACKGROUND: Stem cell transplantation is an emerging therapy for severe cardiomyopathy, proffering stem cell recruitment, anti-apoptosis, and proangiogenic capabilities. Angiogenic cell precursors (ACP-01) are autologous, lineage-specific, cells derived from a multipotent progenitor cell population, with strong potential to effectively engraft, form blood vessels, and support tissue survival and regeneration. METHODS: This IRB approved outcome analysis reports upon 74 consecutive patients who failed medical management for severe cardiomyopathy, and were selected to undergo transcatheter intramyocardial or intracoronary implantation of ACP-01. Serious adverse events (SAEs) were reported. Cell analysis was conducted for each treatment. The left ventricular ejection fraction (LVEF) was measured by multi-gated acquisition scan (MUGA) or echocardiogram at 4 months ± 1.9 months and 12 months ± 5.5 months. Patients reported quality of life statements at 6 months (± 5.6 months). RESULTS: Fifty-four of 74 patients met requirements for inclusion (48 males and five females; age 68.1 ± 11.3 years). The mean treatment cell number of 57 × 106 ACP-01 included 7.7 × 106 CD34 + and 21 × 106 CD31 + cells with 97.6% viability. SAEs included one death (previously unrecognized silent MI), ventricular tachycardia (n = 2) requiring cardioversion, and respiratory infection (n = 2). LVEF in the ischemic subgroup (n = 41) improved by 4.7% ± 9.7 from pre-procedure to the first follow-up (4 months ± 1.9 months) (p < 0.004) and by 7.2% ± 10.9 at final follow-up (n = 25) at average 12 months (p < 0.004). The non-ischemic dilated cardiomyopathy subgroup (n = 8) improved by 7.5% ± 6.0 at the first follow-up (p < 0.017) and by 12.2% ± 6.4 at final follow-up (p < 0.003, n = 6). Overall improvement in LVEF from pre-procedure to post-procedure was significant (Fisher's exact test p < 0.004). LVEF improvement was most marked in the patients with the most severe cardiomyopathy (LVEF < 20%) improving from a mean 14.6% ± 3.4% pre-procedurally to 28.4% ± 8% at final follow-up. Quality of life statements reflected improvement in 33/50 (66%), no change in 14/50 (28%), and worse in 3/50 (6%). CONCLUSION: Transcatheter implantation of ACP-01 for cardiomyopathy is safe and improves LVEF in the setting of ischemic and non-ischemic cardiomyopathy. The results warrant further investigation in a prospective, blinded, and controlled clinical study. TRIAL REGISTRATION: IRB from Genetic Alliance #APC01-001, approval date July 25, 2022. Cardiomyopathy is common and associated with high mortality. Stem cell transplantation is an emerging therapy. Angiogenic cell precursors (ACP-01) are lineage-specific endothelial progenitors, with strong potential for migration, engraftment, angiogenesis, and support of tissue survival and regeneration. A retrospective outcomes analysis of 53 patients with ischemic and non-ischemic dilated cardiomyopathy undergoing transcatheter implantation of ACP-01 demonstrated improvements in the left ventricular ejection fraction of 7.2% ± 10.9 (p < 0.004) and 12.2% ± 6.4, respectively, at 12 months (± 5) follow-up. Quality of life statements reflected improvement in 33/50 (66%) patients.

Factors associated with small ruminant lentivirus infection in goat herds from Pernambuco state, Northeast region of Brazil.

Serum samples (n = 1532) were collected between May 2011 to April 2012 from goats from 76 herds (49 from dairy farms and 27 herds for genetic improvement) from three geographical regions from the state of Pernambuco, Brazil: Zona da Mata, Agreste, and Sertão. Samples were processed using agar gel immunodiffusion test, with p28 CAEV antigen. The objective was to determine the risk factors for small ruminant lentivirus (SRLV) in dairy goats and goats with high genetic value. Overall, seroprevalence was 13.7% (210/1532) [95% CI: 12-15.4%] in animals and 67.1% (51/76) [95% CI: 56.5%- 77.7%] in herds. In dairy farms the seroprevalence was 73.5% (36/49) [95% CI: 61.1%- 85.8%], and in properties with animals of high genetic value it was 55.6% (15/27) [95% CI: 36.8%- 74.3%]. Robust Poisson regression analysis adjusted by the random effect of the herd showed that risk factors were: importing bucks from another Brazilian state (prevalence ratio [PR] = 4.73 [95% CI: 2.05; 10.88]), not isolating sick animals (PR = 3.27 [95% CI: 2.24; 4.76]), and participating in fairs/animal crowding (PR = 1.52 [95% CI: 1.09; 2.11]). Prevalence results show that SRLV is present in caprine herds in the state of Pernambuco and identified risk factors are strongly related to animal transit. Considering the epidemiological situation, the first step for mitigating the consequences of this disease would be controlling animal transit.

The influence of distal and proximal muscle activation on neural crosstalk.

Previous research has indicated that neural crosstalk is asymmetric, with the dominant effector exerting a stronger influence on the non-dominant effector than vice versa. Recently, it has been hypothesized that this influence is more substantial for proximal than distal effectors. The current investigation was designed to determine the effects of distal ((First Dorsal Interosseous (FDI)) and proximal (triceps brachii (TBI)) muscle activation on neural crosstalk. Twelve right-limb dominant participants (mean age = 21.9) were required to rhythmically coordinate a 1:2 pattern of isometric force guided by Lissajous displays. Participants performed 10, 30 s trials with both distal and proximal effectors. Coherence between the two effector groups were calculated using EMG-EMG wavelet coherence. The results indicated that participants could effectively coordinate the goal coordination pattern regardless of the effectors used. However, spatiotemporal performance was more accurate when performing the task with distal than proximal effectors. Force distortion, quantified by harmonicity, indicated that more perturbations occurred in the non-dominant effector than in the dominant effector. The results also indicated significantly lower harmonicity for the non-dominant proximal effector compared to the distal effectors. The current results support the notion that neural crosstalk is asymmetric in nature and is greater for proximal than distal effectors. Additionally, the EMG-EMG coherence results indicated significant neural crosstalk was occurring in the Alpha bands (5-13 Hz), with higher values observed in the proximal condition. Significant coherence in the Alpha bands suggest that the influence of neural crosstalk is occurring at a subcortical level.

Molecular characterization of Burkholderia mallei strains isolated from horses in Brazil (2014-2017).

Glanders is an infectious zoonosis caused by Burkholderia (B.) mallei that mainly affects equids. The objective of this work was to provide additional knowledge on the diversity of the strains circulating in Brazil. Six Burkholderia mallei isolates obtained during necropsies of glanderous horses between 2014 and 2017 in two different states (Pernambuco and Alagoas) were analyzed by polymerase chain reaction-high-resolution melting (PCR-HRM). While four strains (9902 RSC, BM_campo 1, BM_campo 3 and UFAL2) clustered in the L3B2 branch, which already includes the Brazilian 16-2438_BM#8 strain, two strains (BM_campo 2.1 and BM_campo 2.2) clustered within the L3B3sB3 branch, which mostly includes older isolates, from Europe and the Middle East. Whole genome sequencing of two of these strains (UFAL2 and BM_campo 2.1), belonging to different branches, confirmed the HRM typing results and refined the links between the strains, including the description of the L3B3Sb3Gp1SbGp1 genotype, never reported so far for contemporary strains. These results suggest different glanders introduction events in Brazil, including a potential link with strains of European origin, related to colonization or trade.

Neo-phalloplasty in children and adolescents for acquired penile loss.

INTRODUCTION: From 2000 to 2019, the De Castro's neo-phalloplasty was used in 47 patients with congenital and acquired penile loss. PURPOSE: Herein, the technical aspects of penile reconstruction and the outcomes in 17 children and adolescents treated for total or sub-total acquired penile loss are reported. MATERIAL AND METHODS: The median age at the time of injury was 3 months (range: 2 days-15 years). Twelve patients were born with normal penis but suffered injuries (11) or underwent surgical resection of the penis (1). The remaining 5, affected by bladder exstrophy (2) or cloacal exstrophy (3), had penile loss due to surgical complications. RESULTS: The median age at the time of surgery was 5 years (range: 2-20 years). The median length of the procedure was 5 h (range 4-8 h). Skin expander were inserted in preparation of phalloplasty in 9 patients. Corpora-cavernosa remnants were found and incorporated in the neophallus in 12 patients. In 7 patients, urethral remnants were also incorporated into the repair, placing the meatus at the tip of the neophallus. In the remaining patients the urethra was left in the acquired position after penile loss creating a perineal (2), scrotal (3), peno-scrotal (3), or posterior penile (1) urethrostomy. The first patient of this series was the only patient to receive simultaneously phalloplasty and total urethroplasty, with failure of urethral reconstruction. The median follow-up was 2 years (range 1-11 years). The overall complication rate was about 47%. All of the complications were late and required surgical revision. The results were assessed regarding overall functionality (voiding, erection/erogenous areas, masturbation/sexual intercourse) and aesthetic outcome using subjective and objective parameters. Psychological evaluation for both patient and parents was performed in 4 cases. DISCUSSION: There are no specific guidelines for treating significant penile injuries in the pediatric population. We do not think secondary severe penile impairments should wait until adult age for repair. In this specific subgroup of patients technical aspects differ from phalloplasty done for congenital aphallia, due to the possible presence of corpora-cavernosa/urethral remnants and the feasibility to perform a "functional phalloplasty" with very encouraging results. CONCLUSION: The De Castro's neo-phalloplasty remains one of the few techniques available for total penile reconstruction in pediatric age group. Data demonstrate that this technique for acquired aphallia is feasible and reproducible, however, it is a challenging procedure with a high complication rate and likelihood of revisions.

Impact of frailty on 5-year survival in patients older than 70 years undergoing colorectal surgery for cancer.

BACKGROUND: Frailty has been shown to be a good predictor of post-operative complications and death in patients undergoing gastrointestinal surgery. The aim of this study was to analyze the differences between frail and non-frail patients undergoing colorectal cancer surgery, as well as the impact of frailty on long-term survival in these patients. METHODS: A cohort of 149 patients aged 70 years and older who underwent elective surgery for colorectal cancer was followed-up for at least 5 years. The sample was divided into two groups: frail and non-frail patients. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) was used to detect frailty. The two groups were compared with regard to demographic data, comorbidities, functional and cognitive statuses, surgical risk, surgical variables, tumor extent, and post-operative outcomes, which were mortality at 30 days, 90 days, and 1 year after the procedure. Univariate and multivariate analyses were also performed to determine which of the predictive variables were related to 5-year survival. RESULTS: Out of the 149 patients, 96 (64.4%) were men and 53 (35.6%) were women, with a median age of 75 years (IQR 72-80). According to the CSHA-CFS scale, 59 (39.6%) patients were frail, and 90 (60.4%) patients were not frail. Frail patients were significantly older and had more impaired cognitive status, worse functional status, more comorbidities, more operative mortality, and more serious complications than non-frail patients. Comorbidities, as measured by the Charlson Comorbidity Index (p = 0.001); the Lawton-Brody Index (p = 0.011); failure to perform an anastomosis (p = 0.024); nodal involvement (p = 0.005); distant metastases (p < 0.001); high TNM stage (p = 0.004); and anastomosis dehiscence (p = 0.013) were significant univariate predictors of a poor prognosis on univariate analysis. Multivariate analysis of long-term survival, with adjustment for age, frailty, comorbidities and TNM stage, showed that comorbidities (p = 0.002; HR 1.30; 95% CI 1.10-1.54) and TNM stage (p = 0.014; HR 2.06; 95% CI 1.16-3.67) were the only independent risk factors for survival at 5 years. CONCLUSIONS: Frailty is associated with poor short-term post-operative outcomes, but it does not seem to affect long-term survival in older patients with colorectal cancer. Instead, comorbidities and tumor stage are good predictors of long-term survival.

A salvage procedure for redo penile prosthesis implantation in phalloplasty (De castro technique) for congenital aphallia.

INTRODUCTION: We present a different salvage procedure for penile prosthesis implantation in a De Castro neophallus. METHODS: A patient with congenital aphallia had been operated at the age of 11. Ten years later he had two non successful attempts of prosthesis implantation. Surgery consisted of adapting the implants into the aortic graft and folding it in the middle over the cylinders to reinforce its strength. RESULTS: Patient had a successful postoperative course and has now 6 months of follow-up. DISCUSSION: In a systematic review of penile prosthetic outcomes and complications in gender-affirming surgery, most of the prostheses were inflatable (83.6%) and single-cylinder (61.0%). At a mean follow-up of 3.0 years: 36.2% of prosthesis complications, 60.0% of patients had their original implant present and 83.9% reported achieving penetration. We decided to use vascular grafts as a scaffold because of former non successful attempts. CONCLUSION: The use of vascular prosthesis as a device to implant the penile prosthesis seems to be a safe and effective alternative in an attempt to offer erectile function to the neophallus in case of congenital aphallia.

Principialismo no exercício da medicina e em processos ético-profissionais / Principlism in medical practice and ethical-professional lawsuits / Principialismo en la práctica de la medicina y en los procesos ético-profesionales

Resumo Este estudo objetiva mostrar a importância dos princípios bioéticos de Beauchamp e Childress e reafirmá-los na prática médica a fim de diminuir os números exorbitantes de processos ético-profissionais impetrados por iatrogenia. Além disso, busca-se elucidar as fases do processo de modo a informar a comunidade médica sobre seu andamento. Para tal, realiza-se atualização bibliográfica pautada no Código de Ética Médica, no Código de Processo Ético-Profissional e em guias práticos e dinâmicos aplicados aos princípios da bioética. Conclui-se que o exercício da medicina pautado na ética, além de ser justo e benéfico ao paciente, é também modo de resguardar o profissional de possíveis interpretações equivocadas sobre sua conduta.

Abstract This study aims to show the importance of the bioethical principles of Beauchamp and Childress, contributing to reiterate them in medical practices to reduce the exorbitant numbers of professional lawsuits brought about by iatrogenesis. Furthermore, the text tries to elucidate the phases these litigations undergo to give more information on the subject to the medical community. To this end, this research carries out a bibliographic review encompassing the Code of Medical Ethics, the Code of Ethical-Professional Litigation, as well as practical and modifiable resources applied to bioethical principles. We conclude that, besides being fair and beneficial to the patient, the practice of ethics-based medicine also serves to protect professionals from misinterpretations regarding their conduct.

Resumen El objetivo de este estudio es mostrar la importancia de los principios bioéticos de Beauchamp y Childress y reafirmarlos en la práctica médica, con el fin de reducir la exorbitante cantidad de procesos ético-profesionales provocados por la iatrogenia. Además, se busca dilucidar las fases del proceso ético-profesional para informar a la comunidad médica. Para ello, se realiza una actualización bibliográfica con base en el Código de Ética Médica, el Código de Proceso Ético-Profesional y guías prácticas y dinámicas aplicadas a los principios de la bioética. Se concluye que la práctica de la medicina basada en la ética, además de justa y beneficiosa para el paciente, también protege al profesional de posibles malas interpretaciones sobre su conducta.

Monitoring the outbreak of equine glanders in Alagoas, Brazil: Clinical, immunological, molecular, and anatomopathological findings / Monitoramento de surtos de mormo nos equídeos em Alagoas, Brasil: achados clínicos, imunológicos, moleculares e anatomopatológico

ABSTRACT: Glanders is an infectious and often lethal zoonotic disease of equines caused by the bacterium, Burkholderia mallei. This condition is characterized by respiratory, lymphatic, and cutaneous lesions. In this study, we monitored the development of clinical symptoms in animals naturally infected with B. mallei across different equine breeds and also isolated and characterized the disease-causing bacteria. We studied two official glanders outbreaks in the state of Alagoas, Brazil. During the outbreaks, we performed clinical and immunological follow-up of the animals, as well as euthanasia and anatomopathological examination. We also collected diagnostic materials for isolative, phenotypic, molecular, and biological testing. We did not observe any clinical patterns of glanders among animals infected with the same strain of B. mallei. Based on our results, we suggest that early diagnosis of infection should be made through highly sensitive and specific immunoassays. In asymptomatic but positive test cases, we confirmed the importance of conducting pathological, microbiological, and molecular examinations.

RESUMO: O mormo é uma enfermidade infectocontagiosa e frequentemente letal, aguda ou crônica, caracterizada por lesões respiratórias, linfáticas e cutâneas em equídeos, porém de caráter zoonótico. Objetivou-se acompanhar o desenvolvimento dos sinais clínicos e de lesões em animais infectados naturalmente por B. mallei em diferentes propriedades de criação de equídeos, e isolar e caracterizar a bactéria causadora da doença. Foram estudados dois focos oficiais para o mormo no estado de Alagoas. Realizou-se o acompanhamento clinico e imunológico dos animais nos focos, eutanásia e exame anatomopatológico dos animais, além de colheita de material para diagnóstico através de técnicas de isolamento, fenotípicas, moleculares e prova biológica. Neste estudo não se observou um padrão clínico para o diagnóstico do mormo em animais infectados com a mesma cepa de B. mallei. O diagnóstico precoce da infecção deve ser realizado por meio de testes imunológicos de elevada sensibilidade e especificidade. Nos casos assintomáticos e positivos nos testes oficiais é importante a realização do exame anatomopatológico, microbiológico e molecular.

Colorectal cancer surgery in selected nonagenarians is relatively safe and it is associated with a good long-term survival: an observational study.

BACKGROUND: Advanced age is a risk factor for colorectal cancer, and very elderly patients often need to be surgically treated. This study aimed to analyze the outcomes of a cohort of nonagenarian patients operated on for colorectal cancer. METHODS: Observational study conducted on a cohort of 40 nonagenarian patients, who were treated surgically for colorectal cancer between 2000 and 2018 in our institution. Clinical data, ASA score, Charlson Comorbidity Index, Surgical Mortality Probability Model, tumor characteristics, and nature and technical features of the surgical procedure, were recorded. The Comprehensive Complication Index (CCI) and survival time after the procedure were recorded as outcome variables. Univariate and multivariate analyses were performed in order to define risk factors for postoperative complications and long-term survival. RESULTS: Out of the 40 patients, 13 (32.5%) were men, 27 (67.5%) women, and mean age 91.6 years (SD ± 1.5). In 24 patients (60%), surgery was elective, and in 16 patients (40%), surgery was emergent. Curative surgery with intestinal resection was performed in 34 patients (85%). In 22 patients (55%), intestinal continuity was restored by performing an anastomosis. The median CCI was 22.6 (IRQ 0.0-42.6). Operative mortality was 10% (4 patients). Cumulative survival at 1, 3, and 5 years was 70%, 47%, and 29%, respectively. In multivariate analysis, only the need for transfusion remained as an independent prognostic factor for complications (p = 0.021) and TNM tumor stage as a significant predictor of survival (HR 3.0, CI95% 1.3-7.2). CONCLUSIONS: Colorectal cancer surgery is relatively safe in selected nonagenarian patients and may achieve long-term survival.

Hierarchy systems of the medical field in Mexico: a sociological analysis. / Sistemas de jerarquización del campo médico en México: un análisis sociológico.

The aim of this paper is to describe the main systems of hierarchization in the Mexican medical field (and those of other similar Latin American countries). Drawing on Bourdieu's genetic structuralism, our hypothesis is that the structure of the medical field is closely correlated with the schemes of perception and appreciation of the medical field's agents. These schemes are rooted in hierarchical classifications by which work is organized and the main agents' prestige is allocated. Empirical data include focus groups, interviews and observations in hospitals, as well as images, memes and other graphic displays found in Facebook and other public internet locations. The analysis sought to identify the main systems of hierarchization that structure both the academic training and the professional practice of physicians. Four systems of hierarchization are identified: professional, by subfields, by specialties, and by division of labor. These systems of hierarchization, reciprocally entangled with one another, are part of the complex structure of positions within the medical field, as well of the agents' schemes of perception and appreciation which are embodied under the form of habitus.

El objetivo de este trabajo es presentar los principales sistemas de jerarquización que caracterizan al campo médico en México (y, por extensión, al de muchos países de Latinoamérica con condiciones similares). Adoptando el enfoque del estructuralismo genético de Bourdieu, la hipótesis es que la estructura del campo médico se corresponde con una serie de esquemas de percepción y apreciación de sus agentes, que se basan en clasificaciones jerárquicas con base en las cuales se divide el trabajo y se distribuye el prestigio entre sus actores sociales. El material empírico incluye grupos focales, entrevistas y observación en hospitales, así como imágenes, memes e ilustraciones tomadas de páginas públicas de Facebook y otros espacios de internet. El análisis se realizó buscando identificar los principales sistemas de jerarquización que estructuran la formación académica y la práctica profesional de los médicos. Se identifican cuatro sistemas de jerarquización: profesional, por subcampos, por especialidades y por tipo de división del trabajo. Estos sistemas de jerarquías, imbricados entre sí, forman parte de la compleja estructura de posiciones del campo médico, y de la red de esquemas de percepción y apreciación incorporada por sus agentes sociales en forma de habitus.

Development of a DIVA ELISA for diagnosis of Aujeszky's disease using recombinant gE fused to thioredoxin as antigen.

The major control methods for Aujeszky's Disease (AD) involve SHV1 gE gene-deleted vaccines and ELISA for detection of specific gE antibodies in infected animals, distinguishing infected animals from vaccinated animals (DIVA). This work aimed to develop a DIVA ELISA recombinant gE (gErec) for AD diagnosis using recombinant gE fused to thioredoxin protein. The analytical sensitivity and specificity were assessed with World Organisation for Animal Health (OIE) AD serum and sera from specific pathogen free (SPF), vaccinated SPF and AD-vaccinated SPF animals. The OIE serum reacted up to the recommended limit of detection and the other sera presented negative results. The cut-off point, diagnostic sensitivity and diagnostic specificity were determined by receiver operating curve analysis. This cut-off value corresponded to a diagnostic sensitivity of 97.60% and diagnostic specificity of 96.42%. Furthermore, two other cut-off points were chosen to discuss the ELISAgErec as a screening test in AD-endemic and free areas.

Exogenous Expression of WNT7A in Leukemia-Derived Cell Lines Induces Resistance to Chemotherapeutic Agents.

BACKGROUND: Dysregulations of the WNT pathway are implicated in the malignant transformation of different types of neoplasia. WNT7A is expressed in normal peripheral lymphocytes, but is decreased in the tumoral counterpart. Furthermore, the treatment of leukemic cells with recombinant WNT7A decreases proliferation, suggesting its possible use as a therapeutic biomolecule. This study aimed to evaluate the concomitant action of WNT7A and different chemotherapeutic agents over proliferation and cell death of leukemia/ lymphoma derived cell lines. METHODS: Ectopic expression of WNT7A was induced in CEM and BJAB cell lines by using a lentiviral system. RNA expression was analyzed by microarrays and qPCR, and protein expression was determined by Western Blot. Cell proliferation was measured by cell counting, metabolic activity by WST-1 assay, cell death and DNA content by flow cytometry. RESULTS: WNT7A ectopic expression was shown to decrease cell proliferation, but the apoptosis rate of leukemic cells was not altered. Moreover, these cells acquired resistance to doxorubicin, vincristine and MG-132. Cell cycle analysis reveals a decrease in G1 and an increase in S and G2 phases with a further upregulation of senescence- associated genes. Microarray analysis reveals that most gene expression changes were related to cancer and metabolic associated pathways. All those changes appear to be independent of the WNT canonical pathway regulation. CONCLUSION: WNT7A negatively regulates cell proliferation in leukemic cell lines and promotes resistance to chemotherapeutic agents by inducing a senescence-like phenotype independently of the WNT canonical pathway.

Usefulness of pre- and intraoperative risk scores in nonagenarian surgical patients.

PURPOSE: Preoperative assessment at extreme ages would identify patients at a high risk of developing postoperative complications. The objective of this study was to compare the usefulness of different risk scales in a series of nonagenarian surgical patients. METHODS: A total of 244 surgical nonagenarians, 148 women (60.7%), median age 91 years (IQR: 90-93), were analysed. The following scales were evaluated: preoperative status (ASA-PS, Charlson Comorbidity Index, Lee Index, Reiss Index, and surgical mortality probability model-S-MPM); intraoperative status (Surgical Apgar Score and SASA score), and, as output variables, surgical outcomes (morbidity measured by the Comprehensive Complication Index-CCI, and death). Univariate analysis and receiver operating characteristic curves (ROC) were performed. Area under ROC curves (AUROC) were evaluated to define the best predictors of poor outcomes. RESULTS: Operative mortality was 27.0%, and 73.4% presented some type of postoperative complication. Operative mortality was associated with the ASA-PS score (p < 0.001), Reiss Index (p < 0.001), Lee Index (p = 0.010), S-MPM (p < 0.001), Surgical Apgar Score (p < 0.001), SASA score (p < 0.001), and emergency surgery (p < 0.001). Postoperative complications were related to the ASA-PS score (p = 0.001), Reiss Index (p < 0.001), Lee Index (p < 0.001), S-MPM (p < 0.001), Surgical Apgar Score (p < 0.001) and SASA score (p < 0.001). The best predictors of operative mortality and complications were the SASA and Surgical Apgar Score (AUROCs > 0.88). CONCLUSION: As in the general population, the Surgical Apgar Score and SASA score are the best predictors of operative mortality and morbidity in nonagenarian patients. These risk scales should be considered in the perioperative management of these patients.

Ultrafast Photofragmentation of Ln(hfac)3 with a Proposed Mechanism for forming High Mass Fluorinated Products.

The photo-induced dissociative-ionization of lanthanide complexes Ln(hfac)3 (Ln = Pr, Er, Yb) is studied using intense ultrafast transform limited (TL) and linearly chirped laser pulses in a time-of-flight (TOF) mass spectrometry setup. Various fluorine and Ln-containing high-mass fragments were observed in this experiment, including the molecular parent ion, which have not been seen with previous studies relying on relatively long-duration laser pulses (i.e., ns or longer). These new high-mass observations provide important formerly missing information for deducing a set of photo-fragmentation mechanistic pathways for Ln(hfac)3. An overall ultrafast control mechanism is proposed by combining insights from earlier studies and the fragments observed in this research to result in three main distinct photo-fragmentation processes: (a) ligand-metal charge transfer, (b) CF3 elimination, and (c) C-C bond rotation processes. We conclude that ultrafast dissociative-ionization could be a promising technique for generating high-mass fragments for potential use in material science applications.