Lateral cut as management of late voiding dysfunction syndrome post sling: 'more than a cut' - video article.

INTRODUCTION AND HYPOTHESIS: The mid-urethral sling (MUS) is considered the gold standard for stress urinary incontinence (SUI). Nevertheless, this procedure is not excluded from postsurgical complications, which can be challenging for most clinicians. Hence, one of the main concerns about this procedure is late postoperative voiding dysfunction (LDS), defined as obstructive symptoms 6 weeks after surgery. Primary medical management regularly includes expectant management and rehabilitation, including the mid-urethral cut sling (MUCS) as an alternative when it fails. This video provides an anatomical illustration and detailed description of the surgical steps of the J-cut of the lateral sling. MATERIALS AND METHODS: We set up a step-by-step surgical process and provided some advice for MUCS in a video; this material included how to position the sling, dissect, isolate the synthetic material, release adhesions and make a lateral cut of the MUS. Additionally, a case series of 30 patients from our institution is described to confirm the effectiveness of MUCS to manage delayed voiding dysfunction syndrome. RESULTS: MUCS in LDS was beneficial for our patients. Obstructive symptoms improved clinically from 75% to 100%, and urgency-related symptoms decreased from 57.9% to 26.3%, evidencing 20% SUI post-MUCS surgery. CONCLUSIONS: The lateral cut of the mid-urethral tape should be considered a surgical alternative for the resolution of post-sling late voiding dysfunction syndrome in patients who do not improve with expectant management.

Integral analysis of environmental and economic performance of combined agricultural intensification & bioenergy production in the Orinoquia region.

Agricultural intensification is a key strategy to help meet increasing demand for food and bioenergy. It has the potential to reduce direct and indirect land use change (LUC) and associated environmental impacts while contributing to a favorable economic performance of the agriculture sector. We conduct an integral analysis of environmental and economic impacts of LUC from projected agricultural intensification and bioenergy production in the Orinoquia region in 2030. We compare three agricultural intensification scenarios (low, medium, high) and a reference scenario, which assumes a business-as-usual development of agricultural production. The results show that with current inefficient management or with only very little intensification between 26% and 93% of the existing natural vegetation areas will be converted to agricultural land to meet increasing food demand. This results in the loss of biodiversity by 53% and increased water consumption by 111%. In the medium and high scenarios, the intensification allows meeting increased food demand within current agricultural lands and even generating surplus land which can be used to produce bioenergy crops. This results in the reduction of biodiversity loss by 8-13% with medium and high levels of intensification compared to the situation in 2018. Also, a positive economic performance is observed, stemming primarily from intensification of cattle production and additional energy crop production. Despite increasing irrigation efficiency in more intensive production systems, the water demand for perennial crops and cattle production over the dry season increases significantly, thus sustainable management practices that target efficient water use are needed. Agricultural productivity improvements, particularly for cattle production, are crucial for reducing the pressure on natural areas from increasing demand for both food products and bioenergy. This implies targeted investments in the agricultural sector and integrated planning of land use. Our results showed that production intensification in the Orinoquia region is a mechanism that could reduce the pressure on natural land and its associated environmental and economic impacts.

Características morfométricas de los discos articulares de la rodilla en imágenes de resonancia magnética de mujeres colombianas / Morphometric features of the knee menisci in magnetic resonance images of Colombian female

RESUMEN: La población femenina de adultos mayores suele presentar daños de los discos o meniscos articulares de la rodilla (DAR) generalmente derivados de procesos degenerativos de cartílago ocurridos en osteoartritis. Conocer patrones morfológicos estándares de los DAR en una población demográfica específica permite tener claridad de las características autóctonas de dicha población. Una forma de caracterizar estos patrones es a través del diseño de Modelos de Elementos Finitos (MEF) que permiten predecir anormalidades clínicas y radiológicas. Hasta el momento es escasa la evidencia sobre las características morfométricas de los DAR en la población colombiana. Por esta razón, el objetivo del presente estudio fue describir la morfometría de DAR en imágenes por resonancia magnética (IRM) de mujeres colombianas saludables. En este estudio se tomaron 25 IRM de la rodilla de mujeres colombianas con normo-peso, sin antecedentes de patología de la rodilla, ni historia de trauma o cirugía de esta, y con edades entre los 18 y 60 años. El análisis del ancho del cuerno posterior del DAR medial (12,73 ± 2,42) comparado con el lateral (8,04 ± 1,52) arrojó diferencia estadísticamente significativa (p<0,05). Por otra parte, el DAR medial presentó un diámetro antero-posterior aumentado (38,52 ± 2,71) en comparación con el del DAR lateral (29,18 ± 2,75) cercano a la significancia estadística (p=0.051). De igual manera, la altura del cuerno anterior se encontró aumentada en el DAR medial (4,42 ± 0,79) en comparación con el lateral (3,66 ± 0,76), con tendencia a la significancia estadística (p=0,063). Anatómicamente se reconoce que los DAR medial y lateral se adaptan a la forma y tamaño de los cóndilos femorales, lo que concuerda con las medidas resultantes de la población estudiada, donde se evidencia un DAR medial más largo (diámetro antero-posterior) y menos alto que el lateral.

SUMMARY: The elderly female population usually presents damage to the articular discs or menisci of the knee (ADK), generally derived from degenerative cartilage processes that occur in osteoarthritis. Knowing the standard morphological patterns of ADKs in a specific demographic population allows clarity of the indigenous characteristics of that population. One way to characterize these patterns is through the design of Finite Element Models (FEM) that would enable predicting clinical and radiological abnormalities. So far, there is little evidence on the morphometric characteristics of ADKs in the Colombian population. Thus, the objective of the present study was to describe the morphometry of ADK in magnetic resonance imaging (MRI) of healthy Colombian women. In this study, 25 MRIs of the knee of Colombian women with normal weight were taken, with no history of knee pathology, trauma, or surgery, and with ages between 18 and 60 years. The analysis of the width of the posterior horn of the medial ADK (12.73 ± 2.42) compared to the lateral (8.04 ± 1.52) showed a statistically significant difference (p <0.05). On the other hand, the medial ADK presented an increased anteroposterior diameter (38.52 ± 2.71) compared to that of the lateral ADK (29.18 ± 2.75) close to statistical significance (p = 0.051). Similarly, the height of the anterior horn was found to be increased in the medial ADK (4.42 ± 0.79) compared to the lateral (3.66 ± 0.76), with a trend towards statistical significance (p = 0.063). Anatomically, it is recognized that the medial and lateral ADK adapt to the shape and size of the femoral condyles, which is in agreement with the results of the studied population where measurements show that medial ADK has a longer (anterior to posterior diameter) and a shorter height than the lateral ADK.

Effect of Silvopastoral Systems in the Thermoregulatory and Feeding Behaviors of Water Buffaloes Under Different Conditions of Heat Stress.

Buffaloes use wallowing behavior to release excess heat in tropical conditions. The aim of this study was to evaluate the impact of silvopastoral systems in the feeding and thermoregulatory behavior of water buffaloes under moderate and intense heat stress. The behavior of water buffaloes was evaluated in two different production systems. The conventional system with Guinea grass (Megathyrsus maximus) only, and the silvopastoral system with Guinea grass and Leucaena leucocephala trees. The relation between the frequency of animal activities and the length of time the animals engaged in each activity was measured during the day time (6:00-18:00 h) by visual observations at 10-min intervals. The results obtained suggest that buffaloes use tree shade to partially supplement wallowing. Feeding behavior increased under intense heat stress in the silvopastoral system indicating that it can be a promising alternative to improve the buffaloes rearing conditions in the tropics.

Diagnóstico y tratamiento de la etapa aguda del accidente cerebrovascular isquémico: Guía de práctica clínica del Seguro Social del Perú (EsSalud) / Diagnosis and therapy for the acute stage of ischemic cerebrovascular accident: A clinical practice guideline from Peruvian Social Security (EsSalud)

RESUMEN Objetivo: proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud. Materiales y métodos: se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en Medline y Cochrane Controlled Register of Trials durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de diagnóstico y tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 128-IETSI-ESSALUD-2019. Resultados: la presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: tamizaje, diagnóstico, tratamiento, soporte y rehabilitación. En base a estas preguntas se formularon 28 recomendaciones (8 fuertes y 20 condicionales), 38 puntos de buena práctica clínica, 1 nota de implementación y 2 flujogramas. Conclusión: el presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud.

ABSTRACT Objective: to provide evidence based clinical recommendations for the diagnosis and therapy of the acute stage of ischemic cerebrovascular accident in EsSalud. Materials and methods : a group for producing the guideline was conveyed, including specialized physicians and methodologists. The group prepared 8 clinical questions to be answered by the guideline. Systematic searches of previous reviews were performed, and - when it was deemed necessary - primary studies in Medline and the Cochrane Controlled Registry of Trials for 2018 were reviewed. Evidence was selected aiming to respond each one of the proposed clinical questions. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work sessions, the group used GRADE methodology for reviewing the evidence and generated recommendations, good clinical practice items, and designed flow charts for both diagnosis and therapy. Finally, the guide was approved with the decree N° 128-IETSI-ESSALUD-2019. Results : this clinical practice guideline focused in 8 clinical questions, which were divided into four topics: screening, diagnosis, therapy, support and rehabilitation. On the basis of these questions, 28 recommendations were formulated (8 strong and 20 conditional), 38 items for good clinical practice, 1 implementation note, and 2 flow charts. Conclusion : this paper summarizes both evidence based methodology and conclusions from a new clinical practice guide for diagnosis and therapy of the acute stage of a cerebrovascular accident in EsSalud.

Dynamic analysis of forces in the lumbar spine during bag carrying.

OBJECTIVE: The intervertebral disc supports axial and shear forces generated during tasks such as lifting and carrying weights. The objective of this study was to determine the forces in the lumbar spine of workers carrying a bag on the head, on the shoulder and on the anterior part of the trunk. METHODS: Kinematic measurements were recorded for 10 subjects carrying bags of 10, 20 and 25 kg on each of the three aforementioned positions. A simple dynamic model implemented in a custom program was then developed to determine the lumbar forces using the accelerations and positions obtained from the kinematic analysis. RESULTS: The analyses yielded a maximum compressive force of 2338.4 ± 422 N when a 25-kg bag was carried on the anterior part of the trunk. CONCLUSION: Carrying bags on the anterior part of the trunk generated higher lumbar forces compared to those developed by carrying the bag on the head or on the shoulder. Force levels suggest that this activity represents a moderate risk for the subjects. However, future biomechanical models should be developed to analyze the cumulative effect in the discs when longer periods of time are spent in this activity.

Autoimmunity in Guillain-Barré syndrome associated with Zika virus infection and beyond.

Autoimmune diseases share common immunopathogenic mechanisms (i.e., the autoimmune tautology), which explain the clinical similarities among them as well as their familial clustering. Guillain-Barré syndrome (GBS), an autoimmune peripheral neuropathy, has been recently associated with Zika virus (ZIKV) infection. Based on a series of cases, this review article provides a comparative analysis of GBS associated with ZIKV infection, contrasted with the general characteristics of GBS in light of the autoimmune tautology, including gender differences in prevalence, subphenotypes, polyautoimmunity, familial autoimmunity, age at onset, pathophysiology, ecology, genetics, ancestry, and treatment.

A comprehensive analysis and immunobiology of autoimmune neurological syndromes during the Zika virus outbreak in Cúcuta, Colombia.

We have focused on the epidemiology and immunobiology of Zika virus (ZIKV) infection and factors associated with the development of Guillain-Barré syndrome (GBS) and other neurological syndromes in Cúcuta, the capital of North Santander department, Colombia. Data of patients with ZIKV disease reported to the national population-based surveillance system were used to calculate the basic reproduction number (R0) and the attack rates (ARs) as well as to develop epidemiological maps. Patients with neurological syndromes were contacted and their diagnoses were confirmed. A case-control study in which 29 patients with GBS associated with ZIKV compared with 74-matched control patients with ZIKV infection alone was undertaken. Antibodies against arboviruses and other infections that may trigger GBS were evaluated. The estimated value of R0 ranged between 2.68 (95% CI 2.54-2.67) to 4.57 (95% CI 4.18-5.01). The sex-specific ARs were 1306 per 100,000 females, and 552 per 100,000 males. A non-linear interaction between age and gender on the ARs was observed. The incidence of GBS in Cúcuta increased 4.41 times secondary to ZIKV infection. The lag time between ZIKV infection and neurological symptoms was 7 days (interquartile range 2-14.5). Patients with GBS appeared to represent a lower socioeconomic status and were living near to environmentally contaminated areas. All GBS patients were positive for IgG antibodies against both ZIKV and Dengue virus, and 69% were positive for Chikungunya virus. Noteworthy, GBS was associated with a previous infection with M. pneumoniae (OR: 3.95; 95% CI 1.44-13.01; p = 0.006). No differences in antibody levels against C. jejuni, Epstein-Barr virus and cytomegalovirus were observed. High rates of cranial nerves involvement and dysautonomia were present in 82% and 75.9%, respectively. Intensive care unit (ICU) admission was necessary in 69% of the GBS patients. Most of the patients disclosed a high disability condition (Hughes grade 4). Dysautonomia was the main risk factor of poor GBS prognosis (i.e., ICU admission and disability). Thirteen patients were diagnosed with other neurological syndromes different to GBS (6 with transverse myelitis, 3 with encephalitis, 3 with peripheral facial palsy and one with thoraco-lumbosacral myelopathy). Our data confirm an increased transmission of ZIKV in Cúcuta, and provide support to the view that severe neurological syndromes are related to ZIKV disease. The complex ways by which previous infections and socioeconomic status interact to increase the risk of GBS in people infected by ZIKV should be further investigated.

Reversible oxygen scavenging at room temperature using electrochemically reduced titanium oxide nanotubes.

A material capable of rapid, reversible molecular oxygen uptake at room temperature is desirable for gas separation and sensing, for technologies that require oxygen storage and oxygen splitting such as fuel cells (solid-oxide fuel cells in particular) and for catalytic applications that require reduced oxygen species (such as removal of organic pollutants in water and oil-spill remediation). To date, however, the lowest reported temperature for a reversible oxygen uptake material is in the range of 200-300 °C, achieved in the transition metal oxides SrCoOx (ref. 1) and LuFe2O(4+x) (ref. 2) via thermal cycling. Here, we report rapid and reversible oxygen scavenging by Ti(2-x) nanotubes at room temperature. The uptake and release of oxygen is accomplished by an electrochemical rather than a standard thermal approach. We measure an oxygen uptake rate as high as 14 mmol O2 g(-1) min(-1), ∼2,400 times greater than commercial, irreversible oxygen scavengers. Such a fast oxygen uptake at a remarkably low temperature suggests a non-typical mechanistic pathway for the re-oxidation of Ti(2-x). Modelling the diffusion of oxygen, we show that a likely pathway involves 'exceptionally mobile' interstitial oxygen produced by the oxygen adsorption and decomposition dynamics, recently observed on the surface of anatase.

Fluorescent labeling and tracking of nanoclay.

We report a methodology developed to detect and track stable fluorescent-labeled nanoclay, in polymer-clay nanocomposite films, and in a contact solvent after migration testing. Fluorescein-5-maleimide (fluorescein) or tetramethylrhodamine-5-maleimide (rhodamine) was covalently bonded to organically modified montmorillonite (o-MMT). Fluorescein- and rhodamine-labeled nanoclay showed good thermal stability up to 220 °C and the rhodamine-labeled nanoclay remained stable at 250 °C. Confocal laser scanning microscopy was used to confirm the tagging and to detect the fluorescent-labeled nanoclays in various systems.

Characterization of pig farms in the main swine producing regions of Colombia / Caracterización de los sistemas de producción porcina en las principales regiones porcicolas colombianas / Caracterização dos sistemas de produção de suínos nas principais regiões suínas da Colômbia

The goal of this study was to characterize intensive pig farms with inventories of 200 or more sows. Farms were located in the three major swine rearing areas of Colombia, representing 62% of the national total sow inventory. A random sample of 67 farms was evaluated, considering a 95% confidence level, 10% precision and 50% variability. A survey was applied to each farm, registering health and production indexes within each production stage, such as acclimatization, farrowing, weaning, and growing/finishing. Index differences between regions were established (p<0.05) and herd performance was analyzed to identify strengths and weaknesses of the main Colombian swine industry. Herds in the evaluated regions had a 87.6% farrowing rate, with a total of 11.7 pigs born per litter, of which 10.8 were born alive; and 10 pigs were weaned per litter, with an average production of 22.3 pigs weaned per sow/year. The average slaughter age was 166.1 days with 102.2 kg per pig. Indexes established in the present study were similar or higher compared to the ones reported for other countries. These data suggest that Colombian swine producers still have great opportunities to increase profitability if production costs decrease and the number of pigs and the amount of pork produced per year is increased.

El presente estudio tuvo como objeto caracterizar productivamente las granjas porcícolas colombianas de producción intensiva con más de 200 hembras en el pie de cría en las tres regiones con mayor influencia sobre la producción nacional lo cual representó el 62% del inventario nacional de madres. Se seleccionó aleatoriamente una muestra de 67 granjas con un nivel de confianza del 95%, una precisión del 10% y una variabilidad del 50%. Se aplicó una encuesta para estimar los principales indicadores sanitarios y de productividad en cada una de las etapas de producción: aclimatización, cría, precebo y ceba. Se establecieron las diferencias de los indicadores entre las regiones evaluadas (p<0.05) y se obtuvo una aproximación al desempeño productivo de las granjas identificando las fortalezas y debilidades de los sistemas en las regiones estudiadas. En promedio se estimó que las granjas tienen una tasa de parición del 87.6%, un promedio de 11.7 lechones nacidos totales, 10.8 lechones nacidos vivos y 10 lechones destetos por cerda; producen 22.3 lechones por cerda al año y sacrifican animales de 102 kg de peso con 166.1 días al sacrificio en promedio. Los resultados obtenidos demostraron que los indicadores de competitividad son similares a los reportados en otros países e inclusive superiores, siendo importante considerar que la porcicultura colombiana está en capacidad de disminuir costos de producción asociados al incremento en el número de cerdos y kilogramos producidos por cerda al año.

Este estudo teve como objectivo caracterizar produtivamente as empresas suínas com mais de e 200 fêmeas reprodutoras em três regiões com maior influência nacional, que representaram 62% do inventário nacional das mães. Foi seleccionada aleatoreamente uma amostra de 67 granjas com um nível de confiança de 95%, uma precisão de 10% e uma variabilidade de 50%. Um inquérito foi utilizado para estimar indicadores de saúde e produtividade em todas as fases de produção: aclimatação, cria, reprodução, pré engorda e engorda. Foram encontradas diferencias entre granjas nos indicadores entre as regiões avaliadas (p<0.05) e obteve-se uma aproximação do desempenho produtivo das granjas identificando-se os pontos fortes e fracos dos sistemas nas regiões estudadas. Em média as granjas agrícolas apresentaram uma taxa de natalidade do 87.6%, 11.7 leitões nascidos totais, 10.8 leitões nascidos vivos e 10 leitões desmamados por porca, produzidos 22.3 leitões por porca por ano e o abate foi de 102 kg com 166.1 dias. Os resultados mostraram que os indicadores da competitividade são semelhantes aos relatados em outros países e até mesmo maior, sendo importante considerar que o porco da Colômbia é capaz de reduzir os custos de produção associados ao aumento do número de leitões e kilogramas produzidos por porca ao ano.

[Effect of a single dose of zoledronic acid in a case of Paget bone disease]. / Efecto de una sola dosis de ácido zoledrónico en un caso de enfermedad de Paget ósea.

Paget's disease is a chronic disorder of bone remodeling characterized by increase of bone resorption by atypical osteoclasts, followed by rapid increase in bone formation resulting in a disorganized mosaic bone. The biochemical marker for early diagnosis and monitoring is serum alkaline phosphatase (ALP). We report the case of a 90 year old male, with diagnose of Paget's disease. Pamidronate treatment was started orally with partial response, so it was switched to intravenous pamidronate. Pain intensity and FAL levels diminished. The scyntigraphic scan, however, though improved, persisted abnormal. After several years of treatment, with adequate calcium and vitamin D support, the patient presents pain and increase of FAL. We administered intravenous zoledronic acid (4 mg) in a single dose. After this treatment we observed clinical and biochemical remission during four years and a significantly improvement in the scintigraphy. We report a case of Paget's disease, resistant to pamidronate treatment in whom a single dose of zoledronic acid produced clinical and biochemical remission during 4 years and a significant improvement in the scintigraphic scan.

Efecto de una sola dosis de ácido zoledrónico en un caso de enfermedad de Paget ósea / Effect of a single dose of zoledronic acid in a case of Paget bone disease

La enfermedad de Paget es un trastorno crónico del remodelado óseo, caracterizado por un aumento de la resorción ósea producido por osteoclastos atípicos, seguido por un incremento acelerado de la formación ósea, lo que resulta en la formación de hueso en mosaico desorganizado. Un excelente marcador bioquímico para orientar el diagnóstico y seguimiento es la fosfatasa alcalina (FAL). Se presenta el caso de un paciente de 90 años, de sexo masculino, con diagnóstico de enfermedad de Paget. Se inicia tratamiento con pamidronato vía oral con respuesta parcial, por lo que se rota a pamidronato endovenoso. Disminuyen el dolor y la concentración plasmática de FAL, persistiendo con centellograma óseo patológico. Luego de varios años de tratamiento, con adecuado aporte de calcio y vitamina D, comienza nuevamente con dolor y valores elevados de FAL. Se decide iniciar tratamiento con ácido zoledrónico endovenoso 4 mg, única aplicación, obteniéndose remisión clínica y bioquímica desde hace cuatro años y mejoría de la imagen centellográfica. Este informe refiere la buena respuesta, sostenida en el tiempo, al tratamiento con única dosis de ácido zoledrónico en un paciente que presentó resistencia al pamidronato.

Paget's disease is a chronic disorder of bone remodeling characterized by increase of bone resorption by atypical osteoclasts, followed by rapid increase in bone formation resulting in a disorganized mosaic bone. The biochemical marker for early diagnosis and monitoring is serum alkaline phosphatase (ALP). We report the case of a 90 year old male, with diagnose of Paget's disease. Pamidronate treatment was started orally with partial response, so it was switched to intravenous pamidronate. Pain intensity and FAL levels diminished. The scyntigraphic scan, however, though improved, persisted abnormal. After several years of treatment, with adequate calcium and vitamin D support, the patient presents pain and increase of FAL. We administered intravenous zoledronic acid (4 mg) in a single dose. After this treatment we observed clinical and biochemical remission during four years and a significantly improvement in the scintigraphy. We report a case of Paget´s disease, resistant to pamidronate treatment in whom a single dose of zoledronic acid produced clinical and biochemical remission during 4 years and a significant improvement in the scintigraphic scan.

Cell morphology of extrusion foamed poly(lactic acid) using endothermic chemical foaming agent.

Poly(lactic acid) (PLA) was foamed with an endothermic chemical foaming agent (CFA) through an extrusion process. The effects of polymer melt flow index, CFA content, and processing speed on the cellular structures, void fraction, and cell-population density of foamed PLA were investigated. The apparent melt viscosity of PLA was measured to understand the effect of melt index on the cell morphology of foamed PLA samples. The void fraction was strongly dependent on the PLA melt index. It increased with increasing melt index, reaching a maximum value, after which it decreased. Melt index showed no significant effect on the cell-population density of foamed samples within the narrow range studied. A gas containment limit was observed in PLA foamed with CFA. Both the void fraction and cell-population density increased with an initial increase in CFA content, reached a maximum value, and then decreased as CFA content continued to increase. The processing speed also affected the morphology of PLA foams. The void fraction reached a maximum value as the extruder's screw speed increased to 40 rpm and a further increase in the processing speed tended to reduce the void fraction of foamed samples. By contrast, cell-population density increased one order of magnitude by increasing the screw speed from 20 to 120 rpm. The experimental results indicate that a homogeneous and finer cellular morphology could be successfully achieved in PLA foamed in an extrusion process with a proper combination of polymer melt flow index, CFA content, and processing speed.

[Change of pulsatile release and luteinizing hormone response to naloxone related to testicle damage]. / Cambio en la secreción pulsátil y en la respuesta de la hormona luteinizante a la naloxona en relación con el daño testicular.

OBJECTIVE: To compare the pulsatile release of LH, the tone of endogenous opioids and the mass of LH secreted after a naloxone infusion in healthy subjects and patients with normogonadotropic oligospermia (NO) in a model of progressive testicular damage. PATIENTS AND METHODS: Pulsatile secretion of LH was analyzed in a period of 8 hours in a group of healthy subjects (group 3, n=5), in patients with NO and FSH/LH ratio <1.6 (group 1, n=5) and in patients with NO and FSH/LH ratio >1.6 (group 2, n=5). The area under the curve of LH response after naloxone infusion was also calculated. RESULTS: Free serum testosterone concentration was lower (p < 0.01) and estradiol concentration higher in patients with NO than control subjects (1 vs. 3: p = 0.01; 2 vs. 3: p = 0.001). Frequency of pulses in group 1 was 3.33 +/- 0.57/8 h, in group 2: 4 +/- 1/8 h; and in group 3: 2.66 - 0.57/8 h (2 vs. 3 p < 0.01; 2 vs. 1 p = 0.05). The area under the curve after naloxone infusion was 19,300.44 +/- 11,403.31 in group 1, 5696.09 +/- 1753.44 in group 2; and 3080.97 +/- 1159.78 in group 3 (1 vs. 3 Anova p = 0.01). CONCLUSIONS: The data indicate that patients with NO have a subclinical pantesticular failure and that the opioid tone is increased at the initial phase of testicular dysfunction, but it decreases at more advanced stages of testicular damage.

[Seminal quality and hormones in patients with diabetes mellitus type 2]. / Calidad seminal y hormonas en pacientes con diabetes mellitus tipo 2.

INTRODUCTION: The role of the series of metabolic derangements associated to diabetes mellitus type 2 on the function of the hypothalamic-pituitary-testicular axis and on semen quality is still controversial due in part to the lack of information about the selection criteria of subjects included in previously published studies. This is important due to the high prevalence of occult pathology of the seminal tract. OBJECTIVE: To determine if diabetes mellitus type 2 is related to hormonal or seminal disorders. PATIENTS AND METHODS: In this retrospective study serum concentration of the hormones that regulate the hypothalamic-pituitary-testicular axis and semen quality were analyzed comparatively in patients with diabetes mellitus type 2 and normoglycemic subjects. In both groups occult seminal disorders and conditions associated to the hypothalamic-pituitary-testicular axis dysfunction were discarded. RESULTS: Serum concentration of FSH was higher in patients with diabetes mellitus type 2 than in controls (6.06 +/- 2.28 vs. 4.74 +/- 1.92, p = 0.04). Serum concentration of prolactin was lower in diabetics than in controls (6.71 +/- 1.28 vs. 8 +/- 1.97, p = 0.002). The only seminal abnormality found in patients with diabetes mellitus type 2 was a lower progressive mobility (46.52 +/- 17.77 vs. 58.88 +/- 16.81, p = 0.003). CONCLUSION: This suggests that the patients with diabetes mellitus type 2 have subclinical tubular dysfunction manifested by a low sperm progressive mobility and that this might be associated to subfertility.

[Irregular secretion of prolactin in infertile women with normoprolactinemic galactorrhea]. / Secreción irregular de prolactina en mujeres infértiles con galactorrea normoprolactinémica.

BACKGROUND: Abnormal frequency and pulse amplitud of prolactin secretion in micro and macroprolactinomas has been atributed to a dysfunctional tumoral lactotrope. Previous evidence suggests that non tumoral hyperprolactinemia is caused by a hypothalamic dysfunction. The regularity of prolactin secretion has not been studied with cuantitative methods in patients with normoprolactinemic galactorrhea (NPG) which could be considered an entity that precedes non tumoral and tumoral hyperprolactinemia. OBJECTIVE: To analyze the 24-hour prolactin secretion pattern and its secretion regularity in a group of infertile women with normoprolactinemic galatorea. PATIENTS AND METHODS: A transversal-comparative study was carried out in 6 infertile women with normoprolactinemic galactorrhea and 4 healthy women as controls. The 24 hour prolactin profile, the ratio night time mean concentration/daytime mean concentrattion (NM/DM ratio) and apparent entropy (Ap En, Ap En ratio) were compared in the two groups. RESULTS: Blunting of the nyctohemeral rythm and nocturn hyperprolactinaemia occurred in patients with normoprolactinemic galactorrhea (NPG). NM/DM ratio was lower in patients with NPG than in controls (1.28 +/- 0.25 vs. 1.75 +/- 0.05; p= 0.01). Higher irregularity of prolactin secretion was found in patients with NPG (ApEn: 0.853 +/- 0.158 vs 0.608 +/- 0.171, p=0.04; Ap En ratio: 0.839 +/- 0.11 vs 0.661 +/- 0.14; p=0.04). CONCLUSIONS: The irregularity of prolactin secretion in patients with NPG is not dependant on the presence of a pituitary tumour which suggests that a hypothalamic dysfunction underlies this condition. An irregular secretion and a higher daily mass production of prolactin in patients with NPG could explain both galactorrhea and infertility.

Cirugía ambulatoria y de corta hospitalización en el cáncer de mama / Ambulatory breast cancer surgery with short hospitalization period

La cirugía mayor ambulatoria y de corta estadía constituye un método eficaz y seguro si se hace una selección adecuada de los enfermos y se utilizan técnicas quirúrgicas depuradas con la creación consecuente de la infraestructura para tales fines. Tradicionalmente, el cáncer de mama ha requerido ingreso hospitalario por el riesgo de hemorragia posoperatoria, la necesidad del control de los drenajes quirúrgicos, etc. Internacionalmente esto ha cambiado tras la introducción de nuevas técnicas quirúrgicas como la biopsia del ganglio centinela, la estandarización de las técnicas preservadoras de tejido mamario, así como la especialización de grupos de cirugía en afecciones de la mama. La creación de un grupo de mastología en nuestro centro permitió incursionar en esta modalidad y ya podamos contar 31 pacientes operadas entre enero de 2004 y junio de 2006. Fueron utilizadas diferentes técnicas quirúrgicas con cirugía de corta estadía, previo establecimiento de los criterios de selección. Pudimos concluir que el tratamiento ambulatorio del cáncer de mama en casos seleccionados es factible, dado que se garantiza la seguridad de la paciente, la calidad asistencial y la continuidad en la atención, que además facilita la recuperación psicológica de la enferma y su reinserción temprana en la familia(AU)

Ambulatory major surgery with short hospitalization period is an efficient and safe method if a proper selection of patients is made and refined surgical techniques are used, all supported on adequate infrastructure to this end. Traditionally, breast cancer has required admission at hospital due to postsurgical hemorrhage risk, need for surgical drainage control, etc. This has changed worlwide after the introduction of new surgical techniques as sentinel node biopsy, standardization of preserving techniques for breast tissue and specialization of surgeon teams in breast illnesses. The creation of a mastology group in our center allowed tackling this modality and we already have 31 operated patients in the period from January 2004 to June 2006. Several surgical techniques were used with short hospitalization periods, after setting the selection criteria. We may conclude that ambulatory breast cancer treatment in selected cases is feasible since it assures the safety of patient, the quality of medical assistance and continuos care, thus facilitating the psychological recovery of the female patient and her early reincorporation into the family(AU)

Cirugía ambulatoria y de corta hospitalización en el cáncer de mama / Ambulatory breast cancer surgery with short hospitalization period

La cirugía mayor ambulatoria y de corta estadía constituye un método eficaz y seguro si se hace una selección adecuada de los enfermos y se utilizan técnicas quirúrgicas depuradas con la creación consecuente de la infraestructura para tales fines. Tradicionalmente, el cáncer de mama ha requerido ingreso hospitalario por el riesgo de hemorragia posoperatoria, la necesidad del control de los drenajes quirúrgicos, etc. Internacionalmente esto ha cambiado tras la introducción de nuevas técnicas quirúrgicas como la biopsia del ganglio centinela, la estandarización de las técnicas preservadoras de tejido mamario, así como la especialización de grupos de cirugía en afecciones de la mama. La creación de un grupo de mastología en nuestro centro permitió incursionar en esta modalidad y ya podamos contar 31 pacientes operadas entre enero de 2004 y junio de 2006. Fueron utilizadas diferentes técnicas quirúrgicas con cirugía de corta estadía, previo establecimiento de los criterios de selección. Pudimos concluir que el tratamiento ambulatorio del cáncer de mama en casos seleccionados es factible, dado que se garantiza la seguridad de la paciente, la calidad asistencial y la continuidad en la atención, que además facilita la recuperación psicológica de la enferma y su reinserción temprana en la familia(AU)

Ambulatory major surgery with short hospitalization period is an efficient and safe method if a proper selection of patients is made and refined surgical techniques are used, all supported on adequate infrastructure to this end. Traditionally, breast cancer has required admission at hospital due to postsurgical hemorrhage risk, need for surgical drainage control, etc. This has changed worlwide after the introduction of new surgical techniques as sentinel node biopsy, standardization of preserving techniques for breast tissue and specialization of surgeon teams in breast illnesses. The creation of a mastology group in our center allowed tackling this modality and we already have 31 operated patients in the period from January 2004 to June 2006. Several surgical techniques were used with short hospitalization periods, after setting the selection criteria. We may conclude that ambulatory breast cancer treatment in selected cases is feasible since it assures the safety of patient, the quality of medical assistance and continuos care, thus facilitating the psychological recovery of the female patient and her early reincorporation into the family(AU)