On-Chip Photonic Detection Techniques for Non-Invasive In Situ Characterizations at the Microfluidic Scale.

Microfluidics has emerged as a robust technology for diverse applications, ranging from bio-medical diagnostics to chemical analysis. Among the different characterization techniques that can be used to analyze samples at the microfluidic scale, the coupling of photonic detection techniques and on-chip configurations is particularly advantageous due to its non-invasive nature, which permits sensitive, real-time, high throughput, and rapid analyses, taking advantage of the microfluidic special environments and reduced sample volumes. Putting a special emphasis on integrated detection schemes, this review article explores the most relevant advances in the on-chip implementation of UV-vis, near-infrared, terahertz, and X-ray-based techniques for different characterizations, ranging from punctual spectroscopic or scattering-based measurements to different types of mapping/imaging. The principles of the techniques and their interest are discussed through their application to different systems.

Sub-millisecond microfluidic mixers coupled to time-resolved in situ photonics to study ultra-fast reaction kinetics: the case of ultra-small gold nanoparticle synthesis.

We report a continuous microreactor platform achieving sub-millisecond homogeneous reagent mixing (∼300 µs) for a time-resolved study on the synthesis of ultra-small gold nanoparticles (NPs). The microreactor (coupled with small angle X-ray scattering, UV-vis, and X-ray absorption spectroscopy for in situ and in operando characterizations), operates within mixing time frames below system characteristic times, providing a unique opportunity to deepen the comprehension of reaction and phase transition pathways with unprecedented details. The microreactor channel length can be approximated to a given reaction time when operated in continuous mode and steady state. As a result, the system can be statically investigated, eliminating technique-dependent probing time constraints and local inhomogeneities caused by mixing issues. We have studied Au(0) NP formation kinetics from Au(III) precursors complexed with oleylamine in organic media, using triisopropylsilane as a reducing agent. The existence of Au(III)/Au(I) prenucleation clusters and the formation of a transient Au(I) lamellar phase under certain conditions, before the onset of Au(0) formation, have been observed. Taking advantage of the high frequency time-resolved information, we propose and model two different reaction pathways associated with the presence or absence of the Au(I) lamellar phase. In both cases, non-classical pathways leading to the formation of NPs are discussed.

Liver transplantation in Latin America: reality and challenges.

Healthcare systems in Latin America are broadly heterogeneous, but all of them are burdened by a dramatic rise in liver disease. Some challenges that these countries face include an increase in patients requiring a transplant, insufficient rates of organ donation, delayed referral, and inequitable or suboptimal access to liver transplant programs and post-transplant care. This could be improved by expanding the donor pool through the implementation of education programs for citizens and referring physicians, as well as the inclusion of extended criteria donors, living donors and split liver transplantation. Addressing these shortcomings will require national shifts aimed at improving infrastructure, increasing awareness of organ donation, training medical personnel, and providing equitable access to care for all patients.

Sofosbuvir plus glecaprevir/pibrentasvir as salvage therapy after liver transplantation in NS5A inhibitor-experienced patients. A case series.

BACKGROUND: Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals achieves a sustained virologic response rate higher than 95%. However, virologic failure remains a clinical challenge, and data on retreatment are limited, especially in special populations such as liver transplant (LT) recipients. OBJECTIVES: This study evaluated the sofosbuvir plus glecaprevir-pibrentasvir (GLE/PIB) regimen in LT recipients who had failed to a nonstructural protein 5A (NS5A) inhibitor-based regimen. MATERIAL AND METHODS: Retrospective study of 111 liver transplant recipients between January 2018 and December 2020; 18 patients presented with HCV recurrent infection after LT, out of whom three had a history of at least one NS5A inhibitor-based regimen. Salvage therapy with sofosbuvir plus GLE/PIB was started for 12 weeks; baseline characteristics and outcomes were recorded. RESULTS: All three patients (100%) achieved an undetectable HCV viral load 12 weeks after treatment completion. No serious adverse events were observed. CONCLUSION: In our series, sofosbuvir plus GLE/PIB for 12 weeks is an effective and safe salvage therapy after LT in patients previously treated with NS5A inhibitors.

ANTECEDENTES: El tratamiento del virus de la hepatitis C (VHC) crónica con antivirales de acción directa logra tasas de respuesta virológica sostenida superiores a 95 %. Sin embargo, el manejo del fracaso virológico sigue siendo un desafío clínico y la evidencia sobre el retratamiento es limitada, especialmente en poblaciones como los receptores de trasplante hepático (TH). OBJETIVO: Este estudio evaluó el régimen de sofosbuvir más glecaprevir/pibrentasvir (GLE/PIB) en receptores de TH en quienes falló el régimen basado en inhibidores de la proteína no estructural 5A (NS5A). MATERIAL Y MÉTODOS: Estudio retrospectivo de 111 pacientes trasplantados entre enero de 2018 y diciembre de 2020; 18 pacientes presentaron infección recurrente por VHC posterior al TH, tres de ellos tuvieron antecedentes de al menos un régimen basado en inhibidores de NS5A. Se inició terapia de rescate con sofosbuvir más GLE/PIB durante 12 semanas posterior al TH; se registraron las características basales de los pacientes y sus desenlaces. RESULTADOS: En los tres pacientes se logró obtener una carga viral indetectable de VHC a las 12 semanas de finalizar el tratamiento. No se observaron eventos adversos graves. CONCLUSIÓN: En nuestra serie, sofosbuvir más GLE/PIB durante 12 semanas demostró ser una terapia de rescate efectiva y segura posterior al TH en pacientes previamente tratados con inhibidores de NS5A.

International survey among hepatologists and pulmonologists on the hepatic hydrothorax: plea for recommendations.

BACKGROUND: The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. METHODS: Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. RESULTS: Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p < 0.001). A chest X-ray was performed before a puncture for 73% of the respondeurs (79% hepatogastroenterologists vs 54% pulmonologists; p < 0.001). In case of a spontaneous bacterial empyema, an albumin infusion was used by 73% hepatogastroenterologists and 20% pulmonologists (p < 0.001). A drain was used by 37% of the responders (37% hepatogastroenterologists vs 31% pulmonologists; p = 0.26).An Indwelling pleural catheter was used by 50% pulmonologists and 22% hepatogastroenterologists (p < 0.01). TIPS was recommended by 78% of the responders (85% hepatogastroenterologists vs 52% pulmonologists; p < 0.001) and a liver transplantation, by 76% of the responders (86% hepatogastroenterologists vs 44% pulmonologists; p < 0.001). CONCLUSIONS: The results of this large study provide important data on practices of French speaking hepatogastroenterologists and pulmonologists; it appears that recommendations are warranted.

Implementation of a vascular access specialist team in a tertiary hospital: a cost-benefit analysis.

BACKGROUND: The use of peripherally inserted central catheters and midline catheters is growing due to their potential benefits. These devices can increase patient safety and satisfaction while reducing the use of resources. As a result, many hospitals are establishing vascular access specialist teams staffed by nurses who are trained in the insertion and maintenance of these catheters. The objective of the study is to evaluate previously to the implementation whether the benefits of introducing ultrasound-guided peripheral venous catheters, midline catheters and peripherally inserted central catheters compared to current practice by a vascular access specialist team outweigh their costs. METHODS: Cost-benefit analysis from the perspective of the healthcare provider based on administrative data. The study estimates the reduction in resources used when changing the current practice for the use of ultrasound-guided midline and PICC catheters, as well as the additional resources required for their use. RESULTS: The use of an ultrasound-guided device on peripherally inserted central carheter, results in a measurable resource reduction of approximately €31. When 3 peripheral venous catheters are replaced by an ultrasound-guided peripherally inserted central catheter, the saving is €63. Similarly, the use of an ultrasound-guided device on a midline catheter, results in a reduction of €16, while each ultrasound-guided midline catheter replacing 3 peripheral venous catheters results in a reduction of €96. CONCLUSION: The benefits of using ultrasound-guided midline and PICC catheters compared to current practice by introducing a vascular access specialist team trained in the implantation of ultrasound-guided catheters, outweigh its cost mainly because of the decrease in hospital stay due to the lowered risk of phebitis. These results motivate the implementation of the service, adding to previous experience suggesting that it is also preferable from the point of view of patient safety and satisfaction.

Sofosbuvir más glecaprevir/pibrentasvir como terapia de rescate postrasplante hepático en pacientes con exposición previa a inhibidores de NS5A. Serie de casos / Sofosbuvir plus glecaprevir/pibrentasvir as salvage therapy after liver transplantation in NS5A inhibitor-experienced patients. A case series

Resumen Antecedentes: El tratamiento de la infección crónica por el virus de la hepatitis C (VHC) con antivirales de acción directa logra tasas de respuesta virológica sostenida superiores a 95 %. Sin embargo, el manejo del fracaso virológico sigue siendo un desafío clínico y la evidencia sobre el retratamiento es limitada, especialmente en poblaciones como los receptores de trasplante hepático (TH). Objetivo: Este estudio evaluó el régimen de sofosbuvir más glecaprevir/pibrentasvir (GLE/PIB) en receptores de TH en quienes falló el régimen basado en inhibidores de la proteína no estructural 5A (NS5A). Material y métodos: Estudio retrospectivo de 111 pacientes trasplantados entre enero de 2018 y diciembre de 2020; 18 pacientes presentaron infección recurrente por VHC posterior al TH, tres de ellos tuvieron antecedentes de al menos un régimen basado en inhibidores de NS5A. Se inició terapia de rescate con sofosbuvir más GLE/PIB durante 12 semanas posterior al TH; se registraron las características basales de los pacientes y sus desenlaces. Resultados: En los tres pacientes se logró obtener una carga viral indetectable de VHC a las 12 semanas de finalizar el tratamiento. No se observaron eventos adversos graves. Conclusión: En nuestra serie, sofosbuvir más GLE/PIB durante 12 semanas demostró ser una terapia de rescate efectiva y segura posterior al TH en pacientes previamente tratados con inhibidores de NS5A.

Abstract Background: Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals achieves a sustained virologic response rates higher than 95%. However, virologic failure remains a clinical challenge, and data on retreatment are limited, especially in special populations such as liver transplant (LT) recipients. Objective: This study evaluated the sofosbuvir plus glecaprevir-pibrentasvir (GLE/PIB) regimen in LT recipients who had failed to a nonstructural protein 5A (NS5A) inhibitor-based regimen. Material and methods: Retrospective study of 111 liver transplant recipients between January 2018 and December 2020; 18 patients presented with HCV recurrent infection after LT, out of whom three had a history of at least one NS5A inhibitor-based regimen. Salvage therapy with sofosbuvir plus GLE/PIB was started for 12 weeks; baseline characteristics and outcomes were recorded. Results: All three patients (100%) achieved an undetectable HCV viral load 12 weeks after treatment completion. No serious adverse events were observed. Conclusion: In our series, sofosbuvir plus GLE/PIB for 12 weeks is an effective and safe salvage therapy after LT in patients previously treated with NS5A inhibitors.

Portopulmonary Hypertension: An Updated Review.

Portal hypertension may have major consequences on the pulmonary vasculature due to the complex pathophysiological interactions between the liver and lungs. Portopulmonary hypertension (PoPH), a subset of group 1 pulmonary hypertension (PH), is a serious pulmonary vascular disease secondary to portal hypertension, and is the fourth most common subtype of pulmonary arterial hypertension. It is most commonly observed in cirrhotic patients; however, patients with noncirrhotic portal hypertension can also develop it. On suspicion of PoPH, the initial evaluation is by a transthoracic echocardiogram in which, if elevated pulmonary pressures are shown, patients should undergo right heart catheterization to confirm the diagnosis. The prognosis is extremely poor in untreated patients; therefore, management includes pulmonary arterial hypertension therapies with the aim of improving pulmonary hemodynamics and moving patients to orthotopic liver transplantation (OLT). In this article, we review in detail the epidemiology, pathophysiology, process for diagnosis, and most current treatments including OLT and prognosis in patients with PoPH. In addition, we present a diagnostic algorithm that includes the current criteria to properly select patients with PoPH who are candidates for OLT.

Servicio de atención psicológica a niños y adolescentes convalecientes a la COVID-19 en Villa Clara

Fundamento: los niños y los adolescentes constituyen una población sensible a los impactos psicológicos de la pandemia de COVID-19. Reconocerlo implica la necesidad de evaluación, seguimiento e intervención, especialmente cuando se trata de infantes que padecieron la enfermedad y requieren una atención pediátrica integral. Objetivo implementar un servicio de atención psicológica a niños y adolescentes convalecientes a la COVID-19. Métodos: se aplicó un diseño de investigación acción participativa desde un enfoque cualitativo constructivo-interpretativo. Está integrado por tres ejes de acciones: evaluación psicológica, intervención psicoterapéutica y apoyo social. Su diseño e implementación siguió etapas y se realizó de forma colaborativa. Los participantes implicados establecieron relaciones simétricas y siguieron un proceso cíclico de planificación-actuación-observación-reflexión; procedimiento base para atender y perfeccionar la práctica. Resultados: los resultados se obtuvieron con respecto a la evaluación y las acciones de intervención psicológica. Sobre la evaluación se destacan alteraciones clínico psicológicas con afectación de las funciones psíquicas y necesidades de preservación de la salud en los ámbitos personal y familiar. Respecto a la intervención psicológica, la totalidad de los beneficiarios recibió acciones de orientación psicológica y los diagnosticados con afección psiquiátrica recibieron acciones psicoterapéuticas. Todas las familias recibieron apoyo social. Conclusiones: se constató reducción o remisión de la intensidad de síntomas psicológicos, elaboración del duelo ante la pérdida, adecuación de afrontamientos o modificación de comportamientos, fortalecimiento de la capacidad de las redes sociales de apoyo, ampliación del conocimiento de la familia, y creación de canales de información entre la familia y la escuela.

Background: children and adolescents constitute a sensitive population to the psychological impacts of the COVID-19 pandemic. Recognizing it implies the need for evaluation, monitoring and intervention, especially when it comes to infants who have suffered from the disease and require comprehensive pediatric care. Objective: to implement a psychological care service for children and adolescents convalescent from COVID-19. Methods: a participatory action research design was applied from a constructive-interpretive qualitative approach. It is made up of three lines of action: psychological evaluation, psychotherapeutic intervention and social support. Its design and implementation followed stages and was carried out collaboratively. The participants involved established symmetrical relationships and followed a cyclical process of planning-acting-observing-reflecting; basic procedure to attend and improve the practice. Results: the results were obtained regarding the evaluation and the actions of psychological intervention. Regarding the evaluation, clinical-psychological alterations with affectation of the psychic functions and needs for the preservation of health in the personal and family spheres stand out. Regarding the psychological intervention, all the beneficiaries received psychological counseling actions and those diagnosed with a psychiatric condition received psychotherapeutic actions. All families received social support. Conclusions: The psychological symptoms intensity reduction or remission was verified, elaboration of grief in the loss, adaptation of coping or behavior modification, strengthening of the social support networks' capacity, expansion of family knowledge, and creation of information channels between the family and the school.

Consecuencias psicológicas y recursos psicosociales de afrontamiento en niños y adolescentes convalecientes a la COVID-19 / Psychological consequences and psychosocial coping resources in children and adolescents convalescing from COVID-19

RESUMEN Introducción: Los niños y los adolescentes constituyen una población vulnerable al impacto psicológico que desencadena la COVID-19. Objetivo: Develar consecuencias psicológicas y recursos psicosociales de afrontamiento en niños y adolescentes convalecientes a la COVID-19. Métodos: Se realizó una investigación con enfoque cualitativo constructivo interpretativo, en el período comprendido entre abril de 2020 y septiembre de 2021. Las técnicas empleadas para la obtención de la información fueron: el rombo afectivo, la composición temática, la entrevista semiestructurada, el examen psiquiátrico, la Prueba de Percepción del Funcionamiento Familiar FF-SIL y la historia social psiquiátrica. La muestra estuvo conformada por 25 niños y adolescentes, a partir de criterios de conveniencia y disponibilidad, y con previo consentimiento informado de sus padres. En el procesamiento de los datos obtenidos se empleó la herramienta ATLAS.ti 9, software que permitió el análisis de frecuencias y de coocurrencias de códigos. Resultados: Se señalan, entre otros aspectos, alteraciones clínico-psicológicas con afectación de las funciones afectivas, conativas y de relación, así como necesidades de preservación de la salud en los ámbitos personal y familiar. Conclusiones: Las niñas, los niños y los adolescentes convalecientes a la COVID-19, evidencian síntomas clínico-psicológicos como la ansiedad, el miedo, la tristeza y la irritabilidad, y enfermedades psiquiátricas que clasifican dentro de los trastornos de ansiedad y de adaptación; los recursos psicosociales de afrontamiento, se caracterizaron por la limitada movilización de alternativas resilientes, el predominio de estados emocionales de felicidad ante el alta clínica y la presencia de apoyo social de tipo emocional.

ABSTRACT Introduction: children and adolescents constitute a vulnerable population to the psychological impact triggered by COVID-19. Objective: to reveal the psychological consequences and psychosocial coping resources in children and adolescents convalescing from COVID-19. Methods: a qualitative, constructive and interpretive research was carried out between April 2020 and September 2021. The affective rhombus and thematic composition techniques, the semi-structured interview, the psychiatric examination, the Family Functioning Perception Questionnaire (FF-SIL) and the psychiatric social history were used to obtain the information. The sample consisted of 25 children and adolescents, based on criteria of convenience and availability, and with the prior informed consent of their parents. The ATLAS.ti 9 software was the tool used to process the obtained data, allowing us the analysis of frequencies and code co-occurrences. Results: we pointed out, among other aspects, clinical and psychological alterations with impairment of the affective, conative and relational dimensions, as well as health preserving needs in personal and family spheres. Conclusions: children and adolescents convalescing from COVID-19 show clinical and psychological symptoms such as anxiety, fear, sadness, irritability and psychiatric diseases which classify within anxiety and adaptation disorders; the psychosocial coping resources were characterized by the limited mobilization of resilient alternatives, the predominance of emotional states of happiness after being discharge, and the presence of emotional social support.

Microfluidic lab-on-a-chip characterization of nano- to microparticles suspensions by light extinction spectrometry.

The analysis of nano- and microparticle suspensions with micro systems affords improved space-time yields, selectivity, reaction residence times and conversions capabilities. These capabilities are of primary importance in various fields of research and industry. The few microfluidic lab-on-a-chip approaches that have been developed are essentially designed to analyse fluid phases or involve the use of benchtop particle sizing instruments. We report a novel microscale approach to characterize the particle size distribution and absolute concentration of colloidal suspensions. The method is based on a photonic lab-on-a-chip with three scale-specific detection channels to record simultaneous light extinction spectra. Experiments carried out on particle standards with sizes ranging from 30 nm to 0.5 µm and volume concentrations of 1 to 1000ppm, clearly demonstrate the value and potential of the proposed method.

Microfluidic In-Situ Spectrophotometric Approaches to Tackle Actinides Analysis in Multiple Oxidation States.

The study and development of present and future processes for the treatment/recycling of spent nuclear fuels require many steps, from design in the laboratory to setting up on an industrial scale. In all of these steps, analysis and instrumentation are key points. For scientific reasons (small-scale studies, control of phenomena, etc.) but also with regard to minimizing costs, risks, and waste, such developments are increasingly carried out on milli- or microfluidic devices. The logic is the same for the chemical analyses associated with their follow-up and interpretation. Due to this, over the last few years, opto-microfluidic analysis devices adapted to the monitoring of different processes (dissolution, liquid-liquid extraction, precipitation, etc.) have been increasingly designed and developed. In this work, we prove that photonic lab-on-a-chip (PhLoC) technology is fully suitable for all actinides concentration monitoring along the plutonium uranium refining extraction (plutonium, uranium, reduction, extraction, or Purex) process. Several PhLoC microfluidic platforms were specifically designed and used in different nuclear research and development (R&D) laboratories, to tackle actinides analysis in multiple oxidation states even in mixtures. The detection limits reached (tens of µmol·L-1) are fully compliant with on-line process monitoring, whereas a range of analyzable concentrations of three orders of magnitude can be covered with less than 150 µL of analyte. Finally, this work confirms the possibility and the potential of coupling Raman and ultraviolet-visible (UV-Vis) spectroscopies at the microfluidic scale, opening the perspective of measuring very complex mixtures.

Non-invasive diagnosis and follow-up of chronic infection with Hepatitis C Virus.

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease. Clinical care for patients with HCV-related liver disease has advanced considerably with developments in screening, diagnostic procedures to evaluate liver fibrosis and improvements in therapy with pangenotypic direct antivirals and prevention. These AFEF guidelines on the non-invasive diagnosis and follow up of chronic infection with HCV describe the optimal management of HCV positive patients with non-invasive methods in screening, in assessing viral disease and liver fibrosis and the follow-up of these patients according to the value of FibroScan®, Fibrotest® or Fibrometer®. Hepatocellular carcinoma screening must continue in patients with liver stiffness by FibroScan® ≥10 kPa or Fibrotest® >0.58 or Fibrometer® >0.78 prior to treatment initiation. After reaching sustained virologic response, patients with a measurement of liver stiffness by FibroScan®<10 kPa or Fibrotest®≤0.58 or Fibrometer®≤0.78 before treatment initiation and without liver comorbidity (alcohol consumption, metabolic syndrome, HBV co-infection etc.) no longer require specific monitoring. The role of liver biopsy is discussed in some rare situations.

Cirrhosis etiology trends in developing countries: Transition from infectious to metabolic conditions. Report from a multicentric cohort in central Mexico.

Background: Cirrhosis is a public health threat associated with high mortality. Alcoholic Liver Disease (ALD) is the leading cause in Latin America and Metabolic Associated Fatty Liver Disease (MAFLD) in western countries. In Mexico, ALD and chronic Hepatitis C Virus infection (HCV) were the most frequent aetiologies during the past decades. We aimed to describe the trends in the aetiologies of cirrhosis in a middle-income country. Methods: We performed a retrospective cohort study including patients diagnosed with cirrhosis between 2000 and 2019 from six different tertiary care hospitals in central Mexico. We collected information regarding cirrhosis etiology, year of diagnosis, hepatocellular carcinoma development, liver transplantation, and death. We illustrated the change in the tendencies of cirrhosis aetiologies by displaying the proportional incidence of each etiology over time stratified by age and gender, and we compared these proportions over time using chi square tests. Findings: Overall, 4,584 patients were included. In 2019, MAFLD was the most frequent cirrhosis etiology (30%), followed by ALD (24%) and HCV (23%). During the study period, MAFLD became the leading etiology, ALD remained second, and HCV passed from first to fourth. When analysed by gender, ALD was the leading etiology for men and MAFLD for women. The annual incidence of HCC was 3·84 cases/100 persons-year, the median survival after diagnosis was 12·1 years, and seven percent underwent LT. Interpretation: Increased alcohol consumption and the obesity epidemic have caused a transition in the aetiologies of cirrhosis in Mexico. Public health policies must be tailored accordingly to mitigate the burden of alcohol and metabolic conditions in developing countries. Funding: None.

Premisas conceptuales acerca de la categoría subjetividad que requiere el proceso formativo del médico general / Conceptual premises about the subjectivity category required by the training process of the general practitioner

RESUMEN El proceso formativo del médico general en la educación médica superior cubana no enfatiza en las premisas conceptuales como garantía de una adecuada comprensión cultural e histórica del sujeto y la subjetividad, que este profesional aporta en acción y relación dentro del tejido social. Se pretende sintetizar las premisas conceptuales implícitas en la categoría subjetividad, devenida objeto de estudio del proceso formativo del médico general; por ello, resultó indispensable la descripción de los principales aportes teóricos que posibilitaron, desde inicios de la década de los 80 del pasado siglo XX, el desarrollo dentro del contexto nacional de una teoría de la subjetividad. Se concluyó que las premisas conceptuales acerca de la categoría subjetividad que requiere el proceso formativo del médico general, aluden a determinadas zonas de sentido donde se vinculan las categorías subjetividad individual y social, sentidos subjetivos, mediaciones por la subjetividad, así como sujeto individual y social.

ABSTRACT The training process of the general practitioner in Cuban higher medical education does not emphasize the conceptual premises as a guarantee of an adequate cultural and historical understanding of the subject and subjectivity, which this professional contributes in action and relationship within the social fabric. The aim is to synthesize the implicit conceptual premises in the subjectivity category, which has become an object of study in the training process of the general practitioner; For this reason, it was essential to describe the main theoretical contributions that made possible, since the beginning of the 80s of the last century, the development within the national context of a theory of subjectivity. It was concluded that the conceptual premises about the subjectivity category required by the training process of the general practitioner, allude to certain areas of meaning where the categories individual and social subjectivity, subjective senses, mediations by subjectivity, as well as individual and social subject are linked.

Microfluidics: A Novel Approach for Dehydration Protein Droplets.

The equation of state of colloids plays an important role in the modelling and comprehension of industrial processes, defining the working conditions of processes such as drying, filtration, and mixing. The determination of the equation is based on the solvent equilibration, by dialysis, between the colloidal suspension and a reservoir with a known osmotic pressure. In this paper, we propose a novel microfluidic approach to determine the equation of state of a lysozyme solution. Monodispersed droplets of lysozyme were generated in the bulk of a continuous 1-decanol phase using a flow-focusing microfluidic geometry. In this multiphasic system and in the working operation conditions, the droplets can be considered to act as a permeable membrane system. A water mass transfer flow occurs by molecule continuous diffusion in the surrounding 1-decanol phase until a thermodynamic equilibrium is reached in a few seconds to minutes, in contrast with the standard osmotic pressure measurements. By changing the water saturation of the continuous phase, the equation of state of lysozyme in solution was determined through the relation of the osmotic pressure between protein molecules and the volume fraction of protein inside the droplets. The obtained equation shows good agreement with other standard approaches reported in the literature.

One-year outcome of patients with cirrhosis who developed spontaneous bacterial empyema: A cohort study.

OBJECTIVE: This study aimed to evaluate outcomes in cirrhotic patients diagnosed with spontaneous bacterial empyema (SBE) compared with those without this complication. METHODS: We performed a retrospective cohort study of cirrhotic patients from a tertiary care center. The primary outcome was time to death or liver transplantation (LT) within one year after diagnosis of infection. We integrated three groups: patients with SBE (group A), patients with spontaneous bacterial peritonitis (SBP; group B), and cirrhotic patients without SBP or SBE (group C), matched by age, model for end-stage liver disease-sodium (MELD-Na) score and year of infection. Outcomes were analyzed using a Cox regression model adjusted for cardiovascular risk factors and MELD-Na score. RESULTS: Between January 1999 and February 2019, 4829 cirrhotic patients were identified. Among them, 73 (1.5%) had hepatic hydrotorax, of whom 22 (30.1%) were diagnosed with SBE. Median age in group A was 58 years, 50% were men, and median MELD-Na was 21.5. Compared with group C, the hazard ratio of death or LT during the first year after infection was 2.98 (95% confidence interval [CI] 1.43-6.22, P = 0.004) for group A and 1.23 (95% CI 0.65-2.32, P = 0.522) for group B. CONCLUSIONS: Our results suggest that patients with SBE have a worse outcome during the first year after infection is diagnosed. Patients who develop SBE should be promptly referred for transplant evaluation. SBE may emerge as new indication that could benefit from MELD exception points.

Macrophage autophagy protects against hepatocellular carcinogenesis in mice.

Autophagy is a lysosomal degradation pathway of cellular components that regulates macrophage properties. Macrophages are critically involved in tumor growth, metastasis, angiogenesis and immune suppression. Here, we investigated whether macrophage autophagy may protect against hepatocellular carcinoma (HCC). Experiments were performed in mice with deletion of the autophagy gene Atg5 in the myeloid lineage (ATG5Mye-/- mice) and their wild-type (WT) littermates. As compared to WT, ATG5Mye-/- mice were more susceptible to diethylnitrosamine (DEN)-induced hepatocarcinogenesis, as shown by enhanced tumor number and volume. Moreover, DEN-treated ATG5Mye-/- mice exhibited compromised immune cell recruitment and activation in the liver, suggesting that macrophage autophagy invalidation altered the antitumoral immune response. RNA sequencing showed that autophagy-deficient macrophages sorted from DEN mice are characterized by an enhanced expression of immunosuppressive markers. In vitro studies demonstrated that hepatoma cells impair the autophagy flux of macrophages and stimulate their expression of programmed cell death-ligand 1 (PD-L1), a major regulator of the immune checkpoint. Moreover, pharmacological activation of autophagy reduces hepatoma cell-induced PD-L1 expression in cultured macrophages while inhibition of autophagy further increases PD-L1 expression suggesting that autophagy invalidation in macrophages induces an immunosuppressive phenotype. These results uncover macrophage autophagy as a novel protective pathway regulating liver carcinogenesis.

Configuración subjetiva del afrontamiento psicológico a la COVID-19 de adolescentes convalecientes del primer rebrote / Subjective configuration of psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth

Introducción: Para los adolescentes, enfermar de la COVID-19 constituye un acontecimiento estresante ante las demandas del ingreso hospitalario y la intervención médica. Objetivo: Reflejar la configuración subjetiva del afrontamiento psicológico a la COVID-19 de adolescentes convalecientes del primer rebrote de la enfermedad. Métodos: La investigación siguió un enfoque cualitativo constructivo interpretativo, a través de un estudio de casos múltiples. La muestra se seleccionó de forma intencional; se accedió a 13 adolescentes convalecientes de la COVID-19 en el período abril-octubre de 2020, que fueron incluidos para seguimiento por los servicios de Psicología y Psiquiatría infanto-juvenil, a partir de su permanencia en la provincia de Villa Clara. Se emplearon para la obtención de la información las técnicas composición y el rombo afectivo. El análisis de los contenidos se procesó con la herramienta ATLAS.ti. Resultados: El afrontamiento psicológico a la COVID-19 de adolescentes convalecientes del primer rebrote de la enfermedad, se caracterizó por malestares psicológicos como el miedo y la tristeza, la valoración positiva del trabajo del personal de la salud, la limitada movilización de recursos resilientes y la escasa percepción de apoyo social. Conclusiones: La rehabilitación en contextos de la vida cotidiana se afronta desde la preocupación por el proyecto de formación profesional, la necesidad de seguridad y protección encaminada a erradicar la pandemia, la preservación de la salud personal y familiar, y la compañía de los familiares que viven en el hogar(AU)

Introduction: For adolescent´s getting sick of COVID-19 constitute a stressful situation considering demands of being in hospital and due to the medical attention. Objective: Making known the subjective configuration of psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth of this illness trough a multi-case study. Methods: The research was carried out following an interpretative constructive qualitative approach trough a multi-case study. The sample was selected intentionally, having access to 13 convalescent adolescent´s suffering from COVID-19 over period of April-October, in 2020 that were included in order to be followed by infant and young psychiatric and psychology service from their stay on in our province of Villa Clara. Writing a composition and affective rhombus technique, were used to get some information. Content analysis was processed using the tool ATLAS.ti. Results: The psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth of this illness was characterized by psychological discomfort as fears and sadness, favorable assessment on the work of health staff, limited mobilization of tough resources and short of perception of social support. Conclusions: The rehabilitation on daily life context is faced from the concern for the Project of professional training, the protection and security needs putting into the end of pandemic, family and personal health preservation and the company of family that live at home(AU)