Association of tyrosine hydroxylase 01 (TH01) microsatellite and insulin gene (INS) variable number of tandem repeat (VNTR) with type 2 diabetes and fasting insulin secretion in Mexican population.

PURPOSE: A variable number of tandem repeats (VNTR) in the insulin gene (INS) control region may be involved in type 2 diabetes (T2D). The TH01 microsatellite is near INS and may regulate it. We investigated whether the TH01 microsatellite and INS VNTR, assessed via the surrogate marker single nucleotide polymorphism rs689, are associated with T2D and serum insulin levels in a Mexican population. METHODS: We analyzed a main case-control study (n = 1986) that used univariate and multivariate logistic regression models to calculate the risk conferred by TH01 and rs689 loci for T2D development; rs689 results were replicated in other case-control (n = 1188) and cross-sectional (n = 1914) studies. RESULTS: TH01 alleles 6, 8, 9, and 9.3 and allele A of rs689 were independently associated with T2D, with differences between sex and age at diagnosis. TH01 alleles with ≥ 8 repeats conferred an increased risk for T2D in males compared with ≤ 7 repeats (odds ratio, ≥ 1.46; 95% confidence interval, 1.1-1.95). In females, larger alleles conferred a 1.5-fold higher risk for T2D when diagnosed ≥ 46 years but conferred protection when diagnosed ≤ 45 years. Similarly, rs689 allele A was associated with T2D in these groups. In males, larger TH01 alleles and the rs689 A allele were associated with a significant decrease in median fasting plasma insulin concentration with age in T2D cases; the reverse occurred in controls. CONCLUSION: Larger TH01 alleles and rs689 A allele may potentiate insulin synthesis in males without T2D, a process disabled in those with T2D.

Carriage of Brachyspira hyodysenteriae on common insect vectors.

The interactions of likely insect and murine vectors of the causative agent of swine dysentery, Brachyspira hyodysenteriae, were investigated. Insects were collected and analysed from 3 pig farms positive for B hyodysenteriae. Within these farms, several Musca domestica and Orphyra adult fly, Blatta sp. cockroach digestive tracts and hover fly (Eristalis sp) pupal form contents were positive in a standard PCR assay for B hyodysenteriae, whereas all other insect samples on these and case control farms were negative. In challenge exposure studies, B hyodysenteriae DNA was detected in the digestive tract of cockroaches and M domestica flies from day 1 post-inoculation with cultured B hyodysenteriae, for up to 5 days or 10 days respectively, while control non-inoculated insects remained negative. Isolates consistent with B hyodysenteriae were only cultured from frass samples of these inoculated cockroach and flies on days 1-3 post-inoculation. Isolates consistent with B hyodysenteriae were detected by analysis of agar plates exposed to live B hyodysenteriae-inoculated adult flies wandering and feeding on these plates for 20 min per day. In generational challenge inoculation studies, B hyodysenteriae was detected in the adult emergent flies, and internal components of fly pupae on days 1-7 of the pupation period, after being inoculated with B hyodysenteriae as larvae. Five-week-old conventional mice (C3H) that consumed 2 meals of B hyodysenteriae-infected flies remained negative for B hyodysenteriae throughout the next 10 days. The results indicated that pathogenic Brachyspira sp have a limited ability to internally colonise likely insect vectors and do not readily transmit infection to mice. However, the insect vectors analysed were demonstrably capable of mechanical carriage and likely on-farm involvement in consequence.

Effects of Temperature on Development of Canker-Causing Pathogens in Almond and Prune.

Between 2000 and 2020, canker diseases of nut and stone fruit trees have become very widespread and severe in California. This study determined the effects of temperature on the development of canker-causing pathogens of almond and prune. Five pathogen taxa, Botryosphaeria dothidea, Cytospora leucostoma, Diaporthe (Phomopsis) neotheicola, Lasiodiplodia citricola, and Neofusicoccum mediterraneum, were used. Colony growth on medium and canker lesion development on detached shoots were measured at 10, 15, 20, 25, 30, and 35°C. The effects of temperature on colony growth differed among different pathogen taxa, although 25°C was the optimal temperature for most of the pathogens tested. The patterns of lesion growth as response to temperature were different among the different pathogens and tree crops. On almond, the highest growth rates appeared at 30°C for B. dothidea and L. citricola, but at 20°C for N. mediterraneum. The growth rates for C. leucostoma were lower than those of the other three pathogen taxa, with the highest rates recorded at 25°C. However, on prune, C. leucostoma showed greater lesion growth rates at different temperatures than the other pathogen taxa and maximum growth at 30 to 35°C. Similar trends were observed for L. citricola. The growth rates of B. dothidea and N. mediterraneum were comparatively lower than those of C. leucostoma and L. citricola.

Cost of peripheral facial palsy treatment with Botulinum Toxin type A.

INTRODUCTION: Facial palsy (FP) is one of the most common neuropathies. Overall, 15%-30% of patients develop chronic sequelae. Several studies support the use of botulinum toxin A (BoNT-A) in the treatment of FP sequelae. No studies have analyzed the cost of treating FP with BoNT-A. METHODS: A retrospective review of data from all clinical records of consultations and procedures that took place at the FP Treatment Unit clinic throughout 2017. Type of BoNT-A used, total dose used, unilateral or bilateral injection, date of consultation, and gender were collected. The price of expendable materials, BoNT-A, and the 2017 salary scale was obtained to establish costs. RESULTS: During 2017, 605 clinical procedures were conducted in 240 patients. The mean number of procedures was 2.5 (0.80). The average time between procedures was 124(28.72) days. The total annual cost was 34.155,10€. The average annual cost of BoNT-A for each procedure was 39,93€, and the total annual cost of BoNT-A was 24.160,58€. On average, more units of IncotoxA were injected. This difference is not reflected in the final cost of each BoNT-A. For patients who achieved treatment stability, the average annual cost per patient was 106,6€ (OnatoxA) and 100,6€ (IncotoxA). CONCLUSION: In our unit, treatment with BoNT-A in FP sequelae had an average annual cost of 124,31€ per patient, requiring a visit to the hospital to receive treatment every 124 days. Given the functional and quality of life improvements, we should consider that it is a beneficial treatment at an acceptable cost.

Disfunción ileostómica en pacientes sometidos a resección anterior baja por un cáncer del recto luego de neoadyuvancia / Ileostomic dysfunction in patients undergoing low anterior resection for rectal cancer after neoadjuvant treatment

Resumen Introducción: La resección anterior baja protegida con una ileostomía en asa (IA) luego de neoadyuvancia es el tratamiento estándar del cáncer del recto bajo localmente avanzado. Objetivos: Investigar la incidencia, características clínicas de la disfunción ileostómica (DI) en estos pacientes y, eventualmente, definir un perfil de riesgo. Materiales y Método: Se analizan 103 pacientes consecutivos. La DI se define como la eliminación por la ileostomía de más de 1,5 litros por día durante 3 o más días consecutivos asociado a distensión y dolor abdominal con intolerancia a la alimentación oral en ausencia de una complicación intraabdominal Clavien-Dindo grado III o mayor. Se comparan el grupo con DI del resto (no DI). Resultados: La DI se presentó en el 14,5% de los casos, se resolvió entre 12 y 70 días (en el 50% superó los 30 días), la tasa de reingreso fue 27% y no hubo reoperaciones en este grupo. No hubo diferencias estadísticamente significativas entre ambos grupos salvo en el tiempo de hospitalizarán y la tasa de reingresos. Discusión: La DI corresponde a un tipo de íleo posoperatorio de gravedad y duración variable que paradojalmente se asocia con la eliminación de altos volúmenes de contenido intestinal por la IA, requiere aporte vigoroso de volumen y electrolitos y en los casos más graves apoyo con nutrición parenteral. El cuadro revierte en plazos variables con manejo conservador. En este estudio no se ha logrado definir un perfil del paciente en riesgo de sufrir esta complicación o factores predictivos de ella.

Background: Diverting loop ileostomy (LI) is commonly performed to protect a distal anastomosis after a low anterior resection. Aim: To investigate the frecuency and clinical features of ileostomic dysfunction (ID) and, eventually, to define a profile of patients at risk of this complicaction. Materials and Method: 103 consecutive patients operated on for rectal cancer were included. ID is defined when the maxime output was more than 1,5 lt/day for three or more consecutive days with biochemical disturbances, associated to abdominal distension and the inability to tolerate oral feeding without postoperative severe complication. Patients with ID were compared with noID group. Results: ID developed in 15 patients, lasting between 12 and 70 days (50% for more then 30 days), the readmission rate was 27% without reoperation in this group. Except for inhospital time and readmission rate, no other difference between both groups were founded. Discussion: ID is a kind of paralitic ileus of variable intensity with paradox high output ileostomy leading to depletion of water and electrolyte imbalance. ID requires reposition of high volumen of fluids and electrolytes and sometimes parenteral nutrition with full recovery in variable periods without invasive treatment. In this study it was not possible to define a patient profile at risk or predictive factores of this complication.

Cirugía radical del cáncer del recto localmente avanzado: análisis comparativo de la cirugía laparoscópica con la cirugía abierta / Radical surgery for locally advanced rectal cancer: comparative analysis of laparoscopic surgery with open surgery

Resumen Introducción: El tratamiento estándar del cáncer del recto localmente avanzado (CRLA) actual es multimodal. La cirugía mínimamente invasiva es factible en el manejo de este tumor, aunque existe controversia sobre sus resultados alejados. Objetivo: Comparar los resultados inmediatos y alejados de una serie laparoscópica (CL) con una serie de cirugía convencional (CA) intervenidos por CRLA. Materiales y Método: Revisión retrospectiva de ambas técnicas de abordaje en un periodo de 14 años. Se analiza la morbilidad, los resultados patológicos, la recidiva local y la sobrevida a largo plazo. Para estimar las curvas de sobrevida se utilizó el método de Kaplan-Meier. Para comparar las curvas de sobrevida se usó el test de log-rank. Resultados: Se compara 163 pacientes intervenidos por CL con 164 operados mediante CA. Ambos grupos resultaron equivalentes en cuanto a las variables demográficas, morbilidad perioperatoria y estadios patológicos finales, salvo un menor tiempo de hospitalización en el grupo CL (p = 0,007). Los tumores bajos recibieron radioterapia preoperatoria en el 90% de los casos. La recidiva local global y la sobrevida a largo plazo no muestran diferencias de acuerdo al tipo de abordaje. Al excluir los pacientes con una lesión en el recto superior se aprecia que los tumores de recto bajo tienen peor pronóstico, independiente de la técnica empleada (p = 0,007). Conclusiones: La CL es equivalente a la CA en el manejo multimodal del CRLA. La inclusión de tumores del recto superior tiende a mejorar artificialmente los resultados de la cirugía en cuanto a recidiva local y sobrevida global.

Introduction: Total mesorectal excison and preoperative radiotherapy are important components of multimodal treatment in patients with a low locally advanced rectal cancer. Short-term results of laparoscopic surgery has proven to be safe but oncological results are unclear. Aim: To compare short-term and oncologic outcomes of laparoscopic and open resection of locally advanced rectal cancer operated on in the same period. Materials and Method: A total of 327 patientes with rectal cancer treated by open and laparoscopic curative surgery were retrospectively reviewed. Long-term follow up was compared using Kaplan-Meier curves and survival data were tested by log rank test. Results: Demographic data, levels of carcinoembryonaric antigen, perioperative morbidity and pathologic stages were similar in both groups, except for less inhospital time in laparoscopic group (p = 0.007). Over 90% of middle and low tumors recived preoperative radiotherapy. Local recurrence and overall survival shows no difference between both groups. Low and middle rectal cancer showed worst prognosis than tumors of the high rectum, no matter of type of surgery (p = 0.007). Conclusions: Laparoscopic surgery is non-inferior to open resection for pathological and oncological outcomes. It's not convenient to include on trials lesions located in the high rectum, usually treated with primary surgery as colon cancer.

(-)-Stepholidine blocks expression, but not development, of cocaine conditioned place preference in rats.

The purpose of this study was to investigate the effects of (-)-stepholidine (SPD), a compound with dopamine D1 partial agonist and D2/D3 antagonist properties, on the development and expression of cocaine conditioned place preference (CPP). Subjects (N = 65; male Long Evans rats) were tested using a CPP procedure consisting of 3 phases: (1) a 15-min pre-exposure session where animals could explore each compartment freely, (2) eight 30-min conditioning sessions where animals were restricted to one side or the other with cocaine (10 mg/kg) or saline, respectively, on alternating days and (3) a 15-minute preference test session where animals could explore each compartment freely. To test the effects of SPD on expression of cocaine CPP, rats were administered vehicle (distilled water with 20 % DMSO), 10, 15 or 20 mg/kg SPD (intraperitoneally) 30 min prior to the test session. We found that 20 mg/kg of SPD significantly blocked the expression of cocaine CPP. To test the effects of SPD on the development of CPP, 0 (vehicle), 10, 15 or 20mg/kg SPD were administered 30 min prior to each cocaine conditioning session and vehicle before each saline conditioning session; no treatment was given prior to the test session. A preference test showed that each SPD group maintained a CPP similar to the vehicle group. These data indicate that SPD can block the expression of a cocaine CPP but has no effect on its development, suggesting that it inhibits the effects of cocaine cues on cocaine incentive motivated behavior. These results suggest that SPD may be a potential treatment for cue-driven aspects of cocaine use disorder.

Cirugía laparoscópica en cáncer de colon / Laparoscopic surgery in colonic cancer

Resumen La primera colectomía laparoscópica se realizó hace casi 30 años. La adopción como estándar de tratamiento ha sido lenta, a pesar de compartir los beneficios de la cirugía con invasión mínima, como el menor dolor, estadía hospitalaria y recuperación precoz. Esto se explica por el temor generado por reportes iniciales que señalaban la aparición de implantes en los sitios de inserción de los trocares y las dudas sobre la seguridad oncológica. Distintos ensayos clínicos aleatorizados finalmente confirmaron su seguridad y eficacia en el tratamiento del cáncer de colon con resultados comparables a la cirugía abierta. La curva de aprendizaje prolongada, dada por la complejidad técnica, ha incentivado el aprendizaje supervisado por un entrenador experto en el contexto de programas de formación de subespecialidad. Nuestro objetivo es realizar una revisión de los resultados a corto y largo plazo y algunas consideraciones generales y perspectivas futuras.

The first laparoscopic colectomy was performed almost 30 years ago, its expansion has been slow and it did not have the explosive development that laparoscopic cholecystectomy and appendectomy had, despite sharing its benefits such as lower pain, hospital stay and early recovery. This is explained, in part, by the initial fear of implants at trocar sites and the lack of oncological safety. Randomized clinical trials confirmed the safety and efficacy of laparoscopic surgery with short-term and oncological results, comparable to open surgery. The slow learning curve, given by technical complexity, has encouraged learning supervised by an expert coach in the context of subspecialty training programs. Our aim is to review the short-term and oncological results, some general considerations and future perspectives.

Reproductive Behavior of Copitarsia uncilata (Lepidoptera: Noctuidae).

Copitarsia sp. (Hampson) (Lepidoptera: Noctuidae: Cuculliinae) is a quarantine pest in different countries and affects diverse crops of economic importance in South America. The development of ethological control strategies is an important issue that requires knowing the reproductive behavior of the species involved. Therefore, the aim of this study was to establish the reproductive behavior of Copitarsia uncilata (Burgos & Leiva) and to evaluate the attractiveness of synthetic pheromone compounds under laboratory conditions. Observations of nocturnal reproductive behavior of males and females were performed for 7 days in order to register the courtship, mating, and oviposition time. Once the period of the highest reproductive activity was identified, flight behavior and attraction of virgin males were evaluated in a wind tunnel towards synthetic compounds previously reported as commercial pheromones for Copitarsia species, namely (Z)-tetradec-9-enyl acetate (Z9-14Ac), (Z)-tetradec-9-enol (Z9-14OH), and their mixture (Z9-14Ac + Z9-14OH at 4:1 ratio), in comparison with virgin females and clean air flow. We observed that reproductive behavior occurs during the first third of the scotophase and begins on the second day after adult emergence. Highest proportion of courtship and mating occurs on days 2 and 3 after emergence, and oviposition starts the night immediately after the first mating. Wind tunnel assessments showed that males were highly attracted to calling females compared with the blend of synthetic pheromone compounds, with 89% and 12% of males landing at the source, respectively. Moreover, males also showed a low response to the isolated compounds (Z9-14Ac 14% and Z9-14OH 4%).

Schwannoma de colon derecho tratado por colectomía laparoscópica / Schwannoma of the right colon treated by laparoscopic colectomy

Resumen Introducción: Presentamos un caso infrecuente de Schwannoma de colon derecho tratado por una colectomía laparoscópica. Caso Clínico: La presentación clínica fue de un tumor subepitelial del colon derecho que cursa con anemia. La resección fue realizada por vía laparoscópica sin incidentes posoperatorios. El diagnóstico fue realizado por la histopatología y la inmunohistoquímica, que mostró una positividad intensa para S100 en las células tumorales con un índice de proliferación KI67 menor al 1%, por lo que se concluye que se trata de una lesión benigna.

Introduction: We present a rare case of right colon Schwannoma treated by laparoscopic colectomy. Case Report: Clinical presentation was a right colon's subepithelial lession and anemia. The resection was performed laparoscopically without postoperative incidents. The diagnosis was by histopathology and immuno histo chemistry that showed an intense positivity for S100 in tumor cells with KI67 proliferation index less than 1%, so concluded a benign lession.

Cirugía ambulatoria electiva en patología proctológica: experiencia prospectiva de 14 años en un hospital público docente / Elective ambulatory surgery in proctological pathology: 14 years of prospective experience in a public teaching hospital

INTRODUCCIÓN: Se presenta nuestra experiencia en cirugía ambulatoria en patología proctológica. MATERIALES Y MÉTODO: La serie corresponde al análisis de 1.399 pacientes tratados entre agosto de 2003 y diciembre de 2017 en forma prospectiva, RESULTADOS: Fueron intervenidos por fístula anorrectal (20%), enfermedad hemorroidaria (19%), enfermedad pilonidal sacro coccígea (EPSC) (15%), fisura anal (13%), biopsia rectal quirúrgica o resección local endoanal (12%), condilomas (10%) y otras (10%). La morbilidad inmediata es de un caso, por un hematoma luego de una cirugía por EPSC que requirió hemostasia y cierre primario. La tasa de hospitalización inmediata fue de 0,3% y corresponde a 5 casos de retención aguda de orina. La hospitalización tardía fue de un 1,6% y corresponde a 22 pacientes, hospitalizados por sangrado tardío (9), dolor intratable (9) y fiebre (4). Todos fueron tratados en forma conservadora con resolución entre los 2 y 5 días. No se registra morbilidad mayor en esta serie. CONCLUSIONES: La cirugía ambulatoria en patología proctológica es factible y segura.

INTRODUCTION: We present our prospective experience in ambulatory anorectal surgery between August 2003 and December 2017. MATERIALS AND METHOD: The series corresponds to the analysis of 1399 patients treated between August 2003 and December 2017 prospectively. RESULTS: The etiology of the surgerys were anal fistula (20%), hemorrhoidal disease (19%), sacrococcygeal pilonidal disease (15%), anal fissure (13%), rectal surgical biopsy or local resection (12%), condylomata (10%) and others (10%). The immediate morbidity was seen one case, a hematoma after an EPSC surgery that required hemostasis and primary closure. The immediate hospitalization rate was 0.3% and corresponds to 5 cases of acute urinary retention. The late hospitalization was 1.6% and corresponds to 22 patients, due to late bleeding (9), severe pain (9) and fever (4). All were treated conservatively with resolution between 2 and 5 days. No major morbidity is recorded in this series. CONCLUSION: We concluded that outpatient surgery in proctologic pathology is feasible and safe.

Fístulas colónicas de origen diverticular / Colonic fistulas of diverticular origin

INTRODUCCIÓN: La enfermedad diverticular de colon sigmoides representa la principal causa de fistulización del colon a órganos vecinos. OBJETIVO: Describir variables clínicas y terapia quirúrgica de esta entidad. MATERIALES Y MÉTODO: Revisión retrospectiva de los casos de fístulas colónicas de origen diverticular (FCD) operados en forma electiva en un centro terciario. RESULTADOS: En un periodo de 30 años se realizó cirugía resectiva por una FCD en 49 pacientes. Los órganos más afectados fueron la vejiga en 33 casos (68%) y la vagina en 6 (12%). La cirugía efectuada fue la sigmoidectomía en 48 casos (5 con una ileostomía de protección) y una operación de Hartmann. La vía de abordaje fue laparoscópica en 4 pacientes y la morbilidad global de la serie fue 20%, sin mortalidad. Con un seguimiento promedio de 87 meses (extremos 16-178) no hubo casos de recidiva de la fístula. CONCLUSIONES: La FCD representa el 26% de los casos intervenidos por una enfermedad diverticular de colon sigmoides, lo que probablemente refleja un diagnóstico tardío. La fístula colovesical (FCV) es la fístula más común por esta causa y en la mitad de los casos tienen una presentación silenciosa. Las fístulas colovaginales ocurren en mujeres histerectomizadas. La cirugía resectiva del colon en pacientes con riesgo normal es la cirugía estándar con buenos resultados a corto y largo plazo. La cirugía laparoscópica es factible y segura especialmente en los casos de FCV.

BACKGROUND: Fistula formation is a well-known complication of diverticular disease (FCD). AIM: Determine the clinical presentation and surgical management of this kind of fistulas. MATERIALS AND METHODS: Retrospective revision of all consecutive scheduled cases operated on in a terciary public centre in a thirty-years period. RESULTS: Forty-nine patients with a segmental resection of sigmoid colon were analized. Colovesical fistulas were the most common type (n = 33), followed by colovaginal (n = 6). Resection with anastomosis was performed in 48 cases and Hartmann type operation in one. Laparoscopic procedure was made in 4 cases without conversion. Complication rate was 20% and two patients were reoperated on, without mortality in this series. Follow up showed no case of recurrence. CONCLUSIONS: FDC represent 26% of cases operated on in our series. Colovesical fistula is the most common type, followed by colovaginal fistula in histerectomized women. Resection and primary anastomosis should be the treatment of choice in average risk patients with acceptable morbidity and good long-term results. Laparoscopic approach is safe, specifically in patients with colovesical fistulas.

Operación de Bascom para el tratamiento de la enfermedad pilonidal sacrococcígea abscedada: experiencia inicial / Bascom operation for the treatment of abscessed pilonidal sacrococcygeal disease: initial experience

Resumen Introducción: Una de las formas de presentación de la enfermedad pilonidal sacrococcígea (EPSC) es el absceso, para el que existen distintas alternativas de tratamiento. Objetivo: Presentar nuestra experiencia con la técnica de Bascom para el tratamiento de la EPSC abscedada. Material y Método: Serie prospectiva, consecutiva y no aleatoria. Incluye todos los pacientes mayores de 15 años que presentan un absceso o supuración masiva al momento de la cirugía. Resultados: La serie corresponde a 10 pacientes, 7 de género masculino. No se encuentran los factores de riesgo reconocidos por la literatura como riesgo de EPSC. Ocho pacientes mejoran completamente en un período máximo de 18 días y 2 presentan supuración persistente, por lo que se considera fracaso del tratamiento. Estos son sometidos a una segunda cirugía con otra técnica, con curación de la enfermedad. Conclusión: La técnica de Bascom es sencilla, segura y ofrece una curación de un 80% en un período corto de cicatrización.

Introduction: One of the form of presentation of the sacral coccygeal pilonidal disease is the abscess, for this cases there are various treatment alternatives. Objective: We present our experience with Bascom technique for the treatment of pilonidal abscess. Material and Method: Prospective, consecutive, non-randomized series. It includes all patients older than 15 years who have an abscess or mass discharge at the time of surgery. Results: The series consists of 10 patients, 7 males. They are not risk factors recognized in the literature as risk of pilonidal disease. Eight patients completely better within a maximum period of 18 days and two with persistent discharge by what is considered treatment failure. They were subjected to a second surgery treatment with another technique with good results. Conclusion: Bascom's technique is simple, safe and offers a 80% cure in a short period of healing.

Carbon nanotube conditioning part 1-effect of interwall interaction on the electronic band gap of double-walled carbon nanotubes.

Ab initio density functional theory simulations were used to calculate the electronic structure and the total energy of double-walled carbon nanotubes (DWCNTs). The relaxed configurations studied were uncapped, infinitely-long zigzag@zigzag double-walled carbon nanotubes. The lowest energy configuration was found to correspond to an interwall distance of 0.35 nm, except for the configurations with inner tube chiral indices (5,0), (6,0) and (7,0). The largest binding energies were found to correspond to a 0.35 nm interwall distance for all the DWCNT configurations studied, and increasing with DWCNT average diameter. In terms of the effect of the interwall interaction on the electronic band gap of DWCNTs, four regions of band gap were obtained which were termed: zero band gap, narrow band gap, small band gap, and medium band gap regions. These regions offer the possibility to first tune the electronic band gap to a region with a desired range, and further tune that choice within the region itself by varying the interwall distance. It was also found that zigzag@zigzag DWCNTs with outer tube leading chiral index n = 3k + 1 or n = 3k + 2 (k being an integer) follow, as a general trend, an inversely proportional relation of the electronic band gap with respect to the average diameter.

Tratamiento de la enfermedad hemorroidaria con desarterialización y pexia guiada por doppler (THD®): experiencia inicial / Treatment of haemorrhoidal disease with desarterialization and fixing guided by Doppler

Resumen Introducción: La enfermedad hemorroidaria puede ser tratada de múltiples formas. Una alternativa es la ligadura de las ramas terminales de la arteria rectal y pexia de los paquetes guiados por Doppler (THD®). Objetivo: Presentar nuestra experiencia inicial con esta técnica. Material y Método: Serie prospectiva, consecutiva, no aleatoria. Incluye a los pacientes tratados por enfermedad hemorroidaria que no responde al manejo no quirúrgico. Resultados: La serie corresponde a 11 pacientes, 7 de género masculino. Todos fueron operados en forma ambulatoria. El tiempo quirúrgico promedio fue de 35 min y la evaluación del dolor posoperatorio inmediato no superó un EVA de 3 en todos los pacientes. El seguimiento promedio es de 12 meses y solo un paciente requirió una ligadura con banda elástica por sangrado hemorroidario. Conclusión: La técnica de ligadura y pexia guiada por Doppler es sencilla, con buenos resultados iniciales y con mínimo dolor posoperatorio.

Introduction: Hemorrhoidal disease can be treated by many surgical options. One of them are Transanal Haemorroidal Dearterialization (THD®). Objective: To present our initial experience with this technique. Material and Methods: Prospective, consecutive, non-random series. It includes patients treated for haemorrhoidal disease unresponsive to no operative management. Results: The series consists of 11 patients, 7 male gender. All were operated on an outpatient basis. The average operating time was 35 minutes and the immediate post-operative pain assessment did not exceed an AVS of 3 in all patients. The average follow up was 12 month. Only one patient needed a rubber band ligation for hemorrhoidal bleeding control. Conclusion: The THD technique is simple, with good initial results and minimal post-operative pain.

Reunión multidisciplinaria sobre técnicas de aplicación para la restitución de fluido sinovial en pacientes con artritis de rodilla: puesta al día / Multidisciplinary meeting on application techniques for restitution of synovial fluid in patients with knee arthritis: update

Resumen: En la degradación del cartílago articular, la limitación funcional y el dolor se asocian a la alteración cuantitativa y cualitativa del ácido hialurónico en un proceso fisiopatológico sobre el que influye una amplia variedad de factores cuyo impacto agrava la enfermedad y disminuye la calidad de vida del paciente. El manejo farmacológico convencional para la osteoartritis es a menudo insuficiente. Por fortuna, en el mundo actual se cuenta con viscosuplementos capaces de mejorar, restituir y promover la producción endógena del ácido hialurónico degradado en los cuadros de osteoartritis. El uso de estos compuestos exige el apego a un conjunto de técnicas específicas, diseñadas para la correcta infiltración intraarticular del viscosuplemento sin necesidad de infligir una carga traumática adicional al paciente; estas técnicas -con referencia especial al paciente afectado por la osteoartritis de rodilla (gonartritis)- se describen en el presente artículo, en el que además se destacan los criterios para la elección del viscosuplemento idóneo, el más semejante al ácido hialurónico nativo de personas jóvenes y sanas y aquel cuyo uso terapéutico reporta mayores beneficios clínicos a corto y a largo plazo.

Abstract: In the degradation of articular cartilage, functional limitation and pain -cardinal signs of osteoarthritis- underlies, as a central factor, the quantitative and qualitative alteration of hyaluronic acid, the main component of synovial fluid and cartilage, in a pathophysiological process influenced by a wide variety of risk factors whose impact complicates the disease and radically reduces the quality of life of the patient. Conventional pharmacological management for osteoarthritis is often insufficient. Fortunately, in our days, there are viscosupplements capable of improving, replacing and promoting the endogenous production of degraded hyaluronic acid in osteoarthritis. The use of these compounds requires the adherence to a set of specific techniques, designed for the correct intra-articular infiltration of the viscosupplement without the need to inflict an additional traumatic load on the patient; these techniques -with special reference to the patient affected by knee osteoarthritis (gonarthritis)- are described in this article, which also highlights the criteria for choosing the ideal viscosupplement, the one most similar to hyaluronic acid native in healthy young people, and one whose therapeutic use reports greater clinical benefits in the short and long term.

Alternativas quirúrgicas en el manejo de la fístula rectovaginal: experiencia de 25 años / Surgical procedures for rectovaginal fistula: 25-years experience

Antecedentes: La fístula rectovaginal (FRV) es una patología de origen muy variado y el tratamiento representa un verdadero desafío terapéutico. No existen estudios prospectivos que orienten sobre el manejo de estas lesiones. Objetivo: Evaluar los resultados del tratamiento quirúrgico de las pacientes con una FRV. Material y método: Estudio descriptivo retrospectivo en el cual se incluyen todas las pacientes intervenidas en un periodo de 25 años. Resultados: Se trata de 63 pacientes con una FRV, la mitad secundaria a una neoplasia y un 27% secundaria al tratamiento radiante de tumores pélvicos. El trauma local y las FRV postoperatorias representan el 28% de los casos. El abordaje de la FRV fue abdominal en 26 pacientes (41%), resecando la FRV neoplásica en 11 y efectuando una cirugía reconstructiva en 15 actínicas. En 17 pacientes con una FRV por persistencia tumoral solo se efectuó una desfuncionalización proximal. De las 5 pacientes con una FRV iatrogénica, en 4 se logró el cierre espontáneo mediante una ostomía transitoria y los 7 casos de FRV posparto fueron reparadas con un abordaje local con resultados satisfactorios en 6. Conclusiones: En este estudio el abordaje local de la FRV se utilizó en 12 casos; el 33% (21/63) de los casos necesitó una ostomía definitiva y en el 40% de las fístulas complejas se logró el cierre de la fístula con conservación esfinteriana. Las series de FRV publicadas son muy heterogéneas, probablemente debido a patrones de referencia muy variables, lo que hace muy difícil realizar un análisis comparativo.

Background: Rectovaginal fistula (RVF) is a distressing condition with no generally accepted standard surgical management. Aim: To assess results of surgery for RVF. Material and method: This is a descriptive retrospective analysis of 63 patients operated on consecutively for RVF in a period of 25 years. Results: Halve of the cases were secondary to a pelvic malignancy and 27% due to radiotherapy of pelvic tumors. RVFs were associated with local (obstetrical) trauma and postsurgical complications in 28% of the cases. High RVFs were approached through abdominal procedures in 26 patients (41%), including radical resection of the primary tumor in 11 cases and coloanal sleeve anastomosis procedure in 15 patients with a RVF due to pelvic radiation. Seventeen patients with persistent pelvic tumors after radiotherapy and/or surgery were handled with a colostomy or ileostomy to improve quality of life. Four of five cases with postsurgical RVF closed spontaneously with a proximal colostomy and, in seven patients with obstetrical RVF, an advancement flaps were performed, with success in 6. Conclusions: In this study local repair of RVF was employed in 12 cases, one third of the cases needed a permanent ostomy, and 40% of the complex cases of RVF were successfully repaired with sphincter preservation. Comparisons with other studies are precluded because of heterogeneity of published RVF series, probably due to different patterns of reference.

[Multidisciplinary meeting on application techniques for restitution of synovial fluid in patients with knee arthritis: update]. / Reunión multidisciplinaria sobre técnicas de aplicación para la restitución de fluido sinovial en pacientes con artritis de rodilla: puesta al día.

In the degradation of articular cartilage, functional limitation and pain cardinal signs of osteoarthritis underlies, as a central factor, the quantitative and qualitative alteration of hyaluronic acid, the main component of synovial fluid and cartilage, in a pathophysiological process influenced by a wide variety of risk factors whose impact complicates the disease and radically reduces the quality of life of the patient. Conventional pharmacological management for osteoarthritis is often insufficient. Fortunately, in our days, there are viscosupplements capable of improving, replacing and promoting the endogenous production of degraded hyaluronic acid in osteoarthritis. The use of these compounds requires the adherence to a set of specific techniques, designed for the correct intra-articular infiltration of the viscosupplement without the need to inflict an additional traumatic load on the patient; these techniques with special reference to the patient affected by knee osteoarthritis (gonarthritis) are described in this article, which also highlights the criteria for choosing the ideal viscosupplement, the one most similar to hyaluronic acid native in healthy young people, and one whose therapeutic use reports greater clinical benefits in the short and long term.

En la degradación del cartílago articular, la limitación funcional y el dolor se asocian a la alteración cuantitativa y cualitativa del ácido hialurónico en un proceso fisiopatológico sobre el que influye una amplia variedad de factores cuyo impacto agrava la enfermedad y disminuye la calidad de vida del paciente. El manejo farmacológico convencional para la osteoartritis es a menudo insuficiente. Por fortuna, en el mundo actual se cuenta con viscosuplementos capaces de mejorar, restituir y promover la producción endógena del ácido hialurónico degradado en los cuadros de osteoartritis. El uso de estos compuestos exige el apego a un conjunto de técnicas específicas, diseñadas para la correcta infiltración intraarticular del viscosuplemento sin necesidad de infligir una carga traumática adicional al paciente; estas técnicas con referencia especial al paciente afectado por la osteoartritis de rodilla (gonartritis) se describen en el presente artículo, en el que además se destacan los criterios para la elección del viscosuplemento idóneo, el más semejante al ácido hialurónico nativo de personas jóvenes y sanas y aquel cuyo uso terapéutico reporta mayores beneficios clínicos a corto y a largo plazo.

Influencia de la formación sobre el viejismo en los estudiantes de la licenciatura en enfermería de la FES Zaragoza / Influence of the formation on the viejismo in the students of the degree in nursing of the FES Zaragoza

El término viejísimo surge con Butler desde 1975, definiéndolo como las actitudes, prejuicios o estereotipos en contra de las personas por razones de edad. En este sentido, los cambios demográficos, han hecho que este término siga vigente hoy en día, no solo en la sociedad sino también en el sector salud lo que influye en la atención que se le brinda a los adultos mayores, es por esta razón que debemos crear una cultura gerontológica desde la formación; lo cual permitirá cumplir y satisfacer las necesidades de la sociedad, así mismo brindar una atención de calidad. Objetivos: Determinar si existe influencia de la formación académica sobre el viejísimo en los estudiantes de 4to año de la licenciatura en enfermería, en la Facultad de Estudios Superiores Zaragoza. Material y métodos: Se llevó a cabo un estudio de tipo observacional, prolectivo, longitudinal, comparativo; con una muestra de 98 alumnos de cuarto año de la licenciatura en enfermería, a quienes se les aplicó un pretest a inicio del módulo teórico común, para conocer cuál era la percepción que tenían sobre los adultos mayores, para ello se utilizó un instrumento el cual contempla adjetivos relativos a los estereotipos de la vejez, así mismo la concepción del viejo en diferentes escenarios. Después de esto los alumnos continuaron con sus clases habituales, en los módulos que se imparten en 4to año. Posteriormente se aplicó un postest al término de las áreas de pre-especialización, el cual es el último módulo de la carrera, para para ello se utilizó un instrumento que contemplaba los adjetivos relativos a los estereotipos de la vejez, la formación académica en 4to año y su relación con la concepción del adulto mayor, la influencia por parte de los docentes y personal de clínicas; dicho instrumento obtuvo un alfa de Cronbach de 0.891. Para analizar los datos obtenidos se implementaron pruebas descriptivas, como frecuencias y porcentajes, la correlación de Pearson y para ver grado de significancia, t de Student y Ji cuadrada. Resultados: Se obtuvo una muestra de 98 alumnos a quienes se les aplicó un pretest al inicio del 4to año en donde el nivel de viejísimo que presentaban con mayor incidencia fue moderado en un 76% y severo 21%; al final del 4to año se les aplicó un postest en donde se observa que el nivel de viejísimo moderado aumenta en un 77%, no obstante el nivel de viejísimo severo disminuye a un 17%, para corroborar estos resultados se aplicó una t de Student, en donde se obtuvo una significancia estadística de p=0.004 lo cual nos permitió inferir que efectivamente existe un cambio significativo en el nivel de viejísimo encontrado en los alumnos al inicio de su 4to año y al final de este; por otro lado las características negativas con las que se asociaba al adulto mayor con gran facilidad fueron: susceptibles 78%, 72% repetitivos, preocupados e ideáticos 62% respectivamente, parlanchines 61%, cansados y lentos 60% respectivamente, sin embargo encontramos características positivas como sabios 96%, cariñosos y respetables 92%, bondadosos 91%, comprensivos 90%, útiles 89%, generosos 88%, sociables 84%, divertidos 83% y sinceros 83%. Los resultados encontrados en el postest no son muy diferentes, es decir, en relación a las características negativas encontramos que los alumnos perciben a los adultos mayores como susceptibles con un 77%, repetitivos 68%, preocupados 66%, parlanchines 65%, cansados 56% e ideáticos 53%. En comparación con las característica positivas las cuales si modificaron un poco observamos los alumnos refieren que los adultos mayores son confiados con un 50%, seguido por flexibles 64% y pacientes con 71%. Conclusiones: El viejísimo es un tema delicado, en algunas ocasiones se desconoce; sin embargo es un fenómeno que sigue siendo recurrente hoy en día en los diferentes escenarios en los que se desenvuelve un adulto mayor; contemplar esta situación desde enfermería permite percibir cómo es la atención que se le brinda a esta población en particular; y si abordamos esta problemática desde la formación que se le brinda al alumno nos permite identificar cómo influye la formación académica y los agentes de enseñanza, sobre la percepción y las actitudes que se tienen del adulto mayor, esto es con el fin de crear estrategias que modifiquen estas conductas a tiempo, y por ende crear profesionales que satisfagan las necesidades de esta población. Esta investigación permite corroborar que existe un cambio en la percepción del adulto mayor, sin embargo, es mínimo y es porque sólo se contemplan temas de gerontogeriatria en el 4to año de la carrera, cuando los alumnos están por egresar, y por lo cual no es una buena estrategia para crear una cultura gerontológica, puesto que esa integración entre la teoría y la práctica que se lleva en la formación académica, no se consolida del todo y por ello el cambio es mínimo, sin embargo, si se modifica el plan de estudios de la licenciatura en enfermería de modo que la formación en gerontogeriatria sea implementada desde el primer año, la visión que se tenga del adulto mayor al fin de la carrera será diferente.

The term ageism comes with Butler since 1975, defining it as attitudes, prejudices or stereotypes against persons on grounds of age. In this sense, demographic changes have made this term is still in force today, not only in society but also in the health sector which influence the attention that is given to the elderly, is for this reason that we must create a culture for gerontology training; which allow you to meet and satisfy the needs of society, also provide quality care. Objetive Determine whether there is influence of academic training on ageism in the 4th yearstudents of the degree in nursing at the Faculty of Higher Zaragoza. Material and methods An observational, prolective, longitudinal, comparative type was carried out; with a sample of 98 students in the fourth year of the degree in nursing, who were administered a pretest to start the common theoretical module, to know what was their perception about older adults, for that an instrument was used which includes adjectives relating to the stereotypes of old age, same old conception in different scenarios. After this the students continued their regular classes in the modules taught in 4th year. Subsequently, a post-test at the end of the areas of prespecialization, which is the last module of the race was applied to for it an instrument that looked adjectives relating to the stereotypes of old age was used, academic training in 4th year and its relation to the design of the elderly, the influence by teachers and clinical staff; this instrument obtained a Cronbach's alpha of 0.891. To analyze the data descriptive tests, as frequencies and percentages, Pearson correlation and to see degree of significance, Student's t and chi square were implemented. Results A sample of 98 students who were administered a pretest at the beginning of the 4th year where the level of ageism who presented with the highest incidence was 76% moderate and severe 21% was obtained; at the end of the 4th year they were administered a posttest where it is observed that the level of moderate ageism increases by 77%, however the level of severe ageism decreases to 17%, to corroborate these results we applied a Student t test, where a statistical significance of p = 0.004 which allowed us to infer that there is indeed a significant change in the level of ageism found in students at the start of their 4th year and the end of this was obtained; on the other hand the negative characteristics that are associated to the elderly easily were: susceptible 78%, 72% repetitive, worried and ideáticos 62% respectively, chatty 61%, tired and slow 60% respectively, however we found positive features 96% as wise, loving and respectable 92%, 91% kind, understanding 90%, useful 89%, 88% generous, gregarious 84%, 83% and sincere fun 83%. The results found in the posttest are not very different, ie, in relation to the negative characteristics we found that students perceive higher as susceptible adults with 77%, repetitive 68%, concerned 66%, chatty 65%, tired 56 ideáticos% and 53%. Compared with the positive feature which if changed a little observe students report that older adults are entrusted with 50%, followed by flexible 64% and 71% patients. Conclusions The ageism is a sensitive issue, sometimes it is unknown; however it is a recurring phenomenon that remains today in the different scenarios in which an older person develops; look at this situation from nursing allows us to see how attention that is given to this particular population; and if we approach this problem from the training gives students allows us to identify how it influences the academic training and teaching agents, on perceptions and attitudes that have the elderly, this is in order to create strategies that modify these behaviors in time, and thus create professionals that meet the needs of this population. This research corroborates that there is a change in the perception of the elderly, however, it is minimal and because only issues gerontogeriatry referred to in the 4th year of medical school, when students are about to graduate, and which is not a good strategy to create a gerontological culture, since the integration between theory and practice that takes in academic education, is not consolidated at all and therefore the change is minimal, however, if you change the curriculum the degree in nursing so that training in gerontogeriatry be implemented from the first year, the vision we have of the elderly at the end of the race will be different.