Benefits of Aeronautical Preform Manufacturing through Arc-Directed Energy Deposition Manufacturing.

The paper introduces an innovative aerospace component production approach employing Wire Arc Additive Manufacturing (WAAM) technology to fabricate near-finished preforms from Ti6Al4V titanium. Tensile tests on WAAM Ti6Al4V workpieces demonstrated reliable mechanical properties, albeit with identified anisotropic behavior in horizontal samples, underscoring the need for optimization. This alternative manufacturing strategy addresses the challenges associated with machining forged preforms, marked by a high Buy To Fly (BTF) ratio (>10), leading to material wastage, prolonged machining durations, elevated tool expenses, and heightened waste and energy consumption. Additionally, logistical and storage costs are increased due to extended delivery timelines, exacerbated by supply issues related to the current unstable situation. The utilization of WAAM significantly mitigates initial BTF, preform costs, waste production, machining durations, and associated expenditures, while notably reducing lead times from months to mere hours. The novelty in this study lies in the application of Wire Arc Additive Manufacturing (WAAM) technology for the fabrication of titanium aircraft components. This approach includes a unique height compensation strategy and the implementation of various deposition strategies, such as single-seam, overlapping, and oscillating.

Central venous-to-arterial CO2 difference as a biomarker of outcome in children who underwent surgery for congenital heart disease.

BACKGROUND: In congenital heart surgery, low cardiac output syndrome (LCOS) is a major cause of morbidity in the immediate post-operative period. A decrease in cardiac output leads to an increase in tissue oxygen consumption. Several biomarkers such as venous oxygen saturation (SvO2), arteriovenous oxygen difference (DavO2), and lactate can assess tissue perfusion in the presence of LCOS. Recently, central venous to arterial CO2 difference (ΔCO2) has been proposed as a biomarker of tissue ischemia that could be used as a predictor of death in neonatal patients. This study aimed to analyze the relationship between ΔCO2 and immediate post-operative outcomes in pediatric patients undergoing congenital heart surgery and its correlation with DavO2, SvO2, and lactate. METHODS: We conducted a longitudinal study of patients aged 0-18 years who underwent congenital heart surgery with or without cardiopulmonary bypass at the Instituto Nacional de Pediatría, from March 2019 to March 2021. RESULTS: Eighty-two patients were included; the median age was 17 months. About 59% had a ΔCO2 ≥ 6 mmHg. Patients with ΔCO2 ≥ 6 mmHg had a vasoactive-inotropic score > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048), and lactate > 2 mmol/L (p = 0.027), as well as a longer hospital stay (p = 0.043). Patients with ΔCO2 > 6 mmHg and vasoactive-inotropic score ≥ 10 were 12.6 times more likely to die. CONCLUSION: ΔCO2 is a good marker of tissue hypoperfusion and outcome in the post-operative period of congenital heart surgery.

INTRODUCCIÓN: En la cirugía cardiaca de malformaciones congénitas, el síndrome de bajo gasto cardiaco (SBGC) es una de las principales causas de morbilidad en el postoperatorio inmediato. La caída del gasto cardiaco aumenta el consumo de oxígeno en los tejidos. Varios biomarcadores, como la saturación venosa de oxígeno (SvO2), la diferencia arteriovenosa de oxígeno (DavO2) y el lactato han sido utilizados como indicadores hipoperfusión tisular en presencia de SBGC. Recientemente, la diferencia arteriovenosa de CO2 (ΔCO2) se ha propuesto como otro biomarcador de isquemia tisular que podría utilizarse como predictor de muerte en pacientes en edad neonatal. El objetivo de este estudio fue analizar la relación entre la ΔCO2 y la evolución postoperatoria de pacientes pediátricos operados de cardiopatías congénitas y correlacionarlo con la DavO2, SvO2 y lactato. MÉTODOS: Se realizó un estudio longitudinal en pacientes de 0 a 18 años operados de corazón con empleo de bomba de circulación extracorpórea en el Instituto Nacional de Pediatría. RESULTADOS: Se incluyeron 82 pacientes; la mediana de edad fue de 17 meses. El 59% presentó un ΔCO2 > 6 mmHg. Los pacientes con un ΔCO2 > 6 mmHg mostraron un puntaje de inotrópicos > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048) y lactato > 2 mmol/L (p = 0.027), así como mayor estancia hospitalaria (p = 0.043). Los pacientes con ΔCO2 > 6 mmHg y un puntaje de inotrópicos ≥ 10 presentaron una probabilidad de muerte 12.6 veces mayor. CONCLUSIONES: El ΔCO2 en el periodo postoperatorio de una cirugía cardiaca congénita es un buen marcador de hipoperfusión tisular y de desenlace.

Central venous-to-arterial CO2 difference as a biomarker of outcome in children who underwent surgery for congenital heart disease / Diferencia arteriovenosa de CO2 como biomarcador de desenlace en niños operados de cardiopatías congénitas

Abstract Background: In congenital heart surgery, low cardiac output syndrome (LCOS) is a major cause of morbidity in the immediate post-operative period. A decrease in cardiac output leads to an increase in tissue oxygen consumption. Several biomarkers such as venous oxygen saturation (SvO2), arteriovenous oxygen difference (DavO2), and lactate can assess tissue perfusion in the presence of LCOS. Recently, central venous to arterial CO2 difference (ΔCO2) has been proposed as a biomarker of tissue ischemia that could be used as a predictor of death in neonatal patients. This study aimed to analyze the relationship between ΔCO2 and immediate post-operative outcomes in pediatric patients undergoing congenital heart surgery and its correlation with DavO2, SvO2, and lactate. Methods: We conducted a longitudinal study of patients aged 0-18 years who underwent congenital heart surgery with or without cardiopulmonary bypass at the Instituto Nacional de Pediatría, from March 2019 to March 2021. Results: Eighty-two patients were included; the median age was 17 months. About 59% had a ΔCO2 ≥ 6 mmHg. Patients with ΔCO2 ≥ 6 mmHg had a vasoactive-inotropic score > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048), and lactate > 2 mmol/L (p = 0.027), as well as a longer hospital stay (p = 0.043). Patients with ΔCO2 > 6 mmHg and vasoactive-inotropic score ≥ 10 were 12.6 times more likely to die. Conclusion: ΔCO2 is a good marker of tissue hypoperfusion and outcome in the post-operative period of congenital heart surgery.

Resumen Introducción: En la cirugía cardiaca de malformaciones congénitas, el síndrome de bajo gasto cardiaco (SBGC) es una de las principales causas de morbilidad en el postoperatorio inmediato. La caída del gasto cardiaco aumenta el consumo de oxígeno en los tejidos. Varios biomarcadores, como la saturación venosa de oxígeno (SvO2), la diferencia arteriovenosa de oxígeno (DavO2) y el lactato han sido utilizados como indicadores hipoperfusión tisular en presencia de SBGC. Recientemente, la diferencia arteriovenosa de CO2 (ΔCO2) se ha propuesto como otro biomarcador de isquemia tisular que podría utilizarse como predictor de muerte en pacientes en edad neonatal. El objetivo de este estudio fue analizar la relación entre la ΔCO2 y la evolución postoperatoria de pacientes pediátricos operados de cardiopatías congénitas y correlacionarlo con la DavO2, SvO2 y lactato. Métodos: Se realizó un estudio longitudinal en pacientes de 0 a 18 años operados de corazón con empleo de bomba de circulación extracorpórea en el Instituto Nacional de Pediatría. Resultados: Se incluyeron 82 pacientes; la mediana de edad fue de 17 meses. El 59% presentó un ΔCO2 > 6 mmHg. Los pacientes con un ΔCO2 > 6 mmHg mostraron un puntaje de inotrópicos > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048) y lactato > 2 mmol/L (p = 0.027), así como mayor estancia hospitalaria (p = 0.043). Los pacientes con ΔCO2 > 6 mmHg y un puntaje de inotrópicos ≥ 10 presentaron una probabilidad de muerte 12.6 veces mayor. Conclusiones: El ΔCO2 en el periodo postoperatorio de una cirugía cardiaca congénita es un buen marcador de hipoperfusión tisular y de desenlace.

Wire Arc Additive Manufacturing Process for Topologically Optimized Aeronautical Fixtures.

Additive manufacturing (AM) technologies in metallic materials have experienced significant growth over recent decades. Concepts such as design for additive manufacturing have gained great relevance, due to their flexibility and capacity to generate complex geometries with AM technologies. These new design paradigms make it possible to save on material costs oriented toward more sustainable and green manufacturing. On the one hand, the high deposition rates of wire arc additive manufacturing (WAAM) stand out among the AM technologies, but on the other hand, WAAM is not as flexible when it comes to generating complex geometries. A methodology is presented in this study for the topological optimization of an aeronautical part and its adaptation, by means of computer aided manufacturing, for WAAM manufacturing of aeronautical tooling with the objective of producing a lighter part in a more sustainable manner.

Wall Fabrication by Direct Energy Deposition (DED) Combining Mild Steel (ER70) and Stainless Steel (SS 316L): Microstructure and Mechanical Properties.

Direct energy deposition is gaining much visibility in research as one of the most adaptable additive manufacturing technologies for industry due to its ease of application and high deposition rates. The possibility of combining these materials to obtain parts with variable mechanical properties is an important task to be studied. The combination of two types of steel, mild steel ER70-6 and stainless steel SS 316L, for the fabrication of a wall by direct energy deposition was studied for this paper. The separate fabrication of these two materials was studied for the microstructurally flawless fabrication of bimetallic walls. As a result of the application of superimposed and overlapped strategies, two walls were fabricated and the microstructure, mechanical properties and hardness of the resulting walls are analyzed. The walls obtained with both strategies present dissimilar regions; the hardness where the most present material is ER70-6 is around 380 HV, and for SS 316L, it is around 180 HV. The average values of ultimate tensile strength (UTS) are 869 and 628 MPa, yield strength (YS) are 584 and 389 MPa and elongation at break are 20% and 36%, respectively, in the cases where we have more ER70-6 in the sample than SS 316L. This indicates an important relationship between the distribution of the materials and their mechanical behavior.

Fluid overload as a predictor of morbidity and mortality in pediatric patients following congenital heart surgery.

BACKGROUND: Patients undergoing congenital heart surgery with cardiopulmonary bypass frequently require the administration of intravenous fluids and blood products due to hemodynamic instability. Correctly performed fluid resuscitation can revert the state of tissue hypoperfusion in the different organs. However, excessive fluid administration and acute kidney injury may promote fluid overload (FO) and increase the risk of complications, hospital stay, and mortality. METHODS: We conducted a prospective longitudinal study of pediatric patients with congenital heart surgery and cardiopulmonary bypass in the Pediatric Cardiac Intensive Care Unit (PCICU), Instituto Nacional de Pediatría, from July 2018 to December 2019. Fluid overload was quantified every 24 hours during the first 3 days of stay at the PCICU and expressed as a percentage. We recorded PCICU stay, days of mechanical ventilation, and mortality as outcome variables. RESULTS: We included 130 patients. The main factors associated with fluid overload were age < 1 year (p < 0.001), weight < 5 kg (p < 0.001), and longer cardiopulmonary bypass time (p = 0.003). Patients with fluid overload ≥ 5% had higher inotropic score (p < 0.001), higher oxygenation index (p < 0.001), and longer mechanical ventilation time (p < 0.001). Fluid overload ≥ 5% was associated with higher postoperative mortality (odds ratio 89, p = 0.004). CONCLUSIONS: Fluid overload can be used as a prognostic factor in the evolution of pediatric patients undergoing congenital heart surgery since it is associated with increased morbidity and mortality.

INTRODUCCIÓN: Los pacientes con cirugía cardiaca congénita en la que se emplea una bomba de circulación extracorpórea frecuentemente requieren la administración de líquidos intravenosos y hemoderivados por inestabilidad hemodinámica. La resucitación con volumen realizada adecuadamente puede revertir el estado de hipoperfusión tisular en los diferentes órganos. Sin embargo, el ingreso excesivo de líquidos y la falla renal aguda pueden favorecer la sobrecarga hídrica (SH) e incrementar el riesgo de complicaciones, la estancia hospitalaria y la mortalidad. MÉTODOS: Se llevó a cabo un estudio prospectivo longitudinal de pacientes pediátricos con cirugía del corazón y empleo de bomba de circulación extracorpórea en la Unidad de Cuidados Intensivos Cardiovasculares (UCICV), Instituto Nacional de Pediatría, de julio 2018 a diciembre 2019. La SH, registrada como porcentaje, fue cuantificada cada 24 horas durante los primeros 3 días de estancia en UCICV. Como variables de desenlace se registraron la estancia en UCICV, el tiempo de ventilación mecánica y la mortalidad. ­. RESULTADOS: Se incluyeron 130 pacientes. Los principales factores asociados con la SH fueron la edad < 1 año (p < 0.001), peso < 5 kg (p < 0.001) y mayor tiempo de circulación extracorpórea (p = 0.003). Los pacientes con SH ≥ 5% presentaron mayor puntaje inotrópico (p < 0.001), mayor índice de oxigenación (p < 0.001) y mayor tiempo de ventilación mecánica (p < 0.001). La SH ≥ 5% se asoció con una mayor probabilidad de muerte en el periodo posoperatorio (razón de momios: 89, p = 0.004). CONCLUSIONES: La SH puede utilizarse como factor pronóstico en la evolución de los pacientes pediátricos operados de corazón, ya que se asocia con una mayor morbimortalidad.

Validation of the Mechanical Behavior of an Aeronautical Fixing Turret Produced by a Design for Additive Manufacturing (DfAM).

The design of parts in such critical sectors as the manufacturing of aeronautical parts is awaiting a paradigm shift due to the introduction of additive manufacturing technologies. The manufacture of parts designed by means of the design-oriented additive manufacturing methodology (DfAM) has acquired great relevance in recent years. One of the major gaps in the application of these technologies is the lack of studies on the mechanical behavior of parts manufactured using this methodology. This paper focuses on the manufacture of a turret for the clamping of parts for the aeronautical industry. The design of the lightened turret by means of geometry optimization, the manufacture of the turret in polylactic acid (PLA) and 5XXX series aluminum alloy by means of Wire Arc Additive Manufacturing (WAAM) technology and the analysis by means of finite element analysis (FEA) with its validation by means of a tensile test are presented. The behavior of the part manufactured with both materials is compared. The conclusion allows to establish which are the limitations of the part manufactured in PLA for its orientation to the final application, whose advantages are its lower weight and cost. This paper is novel as it presents a holistic view that covers the process in an integrated way from the design and manufacture to the behaviour of the component in use.

Fluid overload as a predictor of morbidity and mortality in pediatric patients following congenital heart surgery / Sobrecarga hídrica como predictor de morbilidad y mortalidad en pacientes pediátricos operados de corazón

Abstract Background: Patients undergoing congenital heart surgery with cardiopulmonary bypass frequently require the administration of intravenous fluids and blood products due to hemodynamic instability. Correctly performed fluid resuscitation can revert the state of tissue hypoperfusion in the different organs. However, excessive fluid administration and acute kidney injury may promote fluid overload (FO) and increase the risk of complications, hospital stay, and mortality. Methods: We conducted a prospective longitudinal study of pediatric patients with congenital heart surgery and cardiopulmonary bypass in the Pediatric Cardiac Intensive Care Unit (PCICU), Instituto Nacional de Pediatría, from July 2018 to December 2019. Fluid overload was quantified every 24 hours during the first 3 days of stay at the PCICU and expressed as a percentage. We recorded PCICU stay, days of mechanical ventilation, and mortality as outcome variables. Results: We included 130 patients. The main factors associated with fluid overload were age < 1 year (p < 0.001), weight < 5 kg (p < 0.001), and longer cardiopulmonary bypass time (p = 0.003). Patients with fluid overload ≥ 5% had higher inotropic score (p < 0.001), higher oxygenation index (p < 0.001), and longer mechanical ventilation time (p < 0.001). Fluid overload ≥ 5% was associated with higher postoperative mortality (odds ratio 89, p = 0.004). Conclusions: Fluid overload can be used as a prognostic factor in the evolution of pediatric patients undergoing congenital heart surgery since it is associated with increased morbidity and mortality.

Resumen Introducción: Los pacientes con cirugía cardiaca congénita en la que se emplea una bomba de circulación extracorpórea frecuentemente requieren la administración de líquidos intravenosos y hemoderivados por inestabilidad hemodinámica. La resucitación con volumen realizada adecuadamente puede revertir el estado de hipoperfusión tisular en los diferentes órganos. Sin embargo, el ingreso excesivo de líquidos y la falla renal aguda pueden favorecer la sobrecarga hídrica (SH) e incrementar el riesgo de complicaciones, la estancia hospitalaria y la mortalidad. Métodos: Se llevó a cabo un estudio prospectivo longitudinal de pacientes pediátricos con cirugía del corazón y empleo de bomba de circulación extracorpórea en la Unidad de Cuidados Intensivos Cardiovasculares (UCICV), Instituto Nacional de Pediatría, de julio 2018 a diciembre 2019. La SH, registrada como porcentaje, fue cuantificada cada 24 horas durante los primeros 3 días de estancia en UCICV. Como variables de desenlace se registraron la estancia en UCICV, el tiempo de ventilación mecánica y la mortalidad. Resultados: Se incluyeron 130 pacientes. Los principales factores asociados con la SH fueron la edad < 1 año (p < 0.001), peso < 5 kg (p < 0.001) y mayor tiempo de circulación extracorpórea (p = 0.003). Los pacientes con SH ≥ 5% presentaron mayor puntaje inotrópico (p < 0.001), mayor índice de oxigenación (p < 0.001) y mayor tiempo de ventilación mecánica (p < 0.001). La SH ≥ 5% se asoció con una mayor probabilidad de muerte en el periodo posoperatorio (razón de momios: 89, p = 0.004). Conclusiones: La SH puede utilizarse como factor pronóstico en la evolución de los pacientes pediátricos operados de corazón, ya que se asocia con una mayor morbimortalidad.

Evaluating the impacts of leachate co-treatment on a full-scale municipal wastewater treatment plant in Canada.

The objective of this study was to evaluate the impacts of leachate co-treatment on a full-scale municipal WWTPby comparing plant performance at varying levels of leachate contributions and hydraulic loadings.Leachate BOD:COD ratio was 0.08 ± 0.07 and indicated a stabilized, old matrix and concentrations of zinc, iron, aluminum, chloride and sulfate were 0.174, 38, 1.47, 1803 and 119.1 mg/L, respectively. The average volumetric leachate ratio (VLR%) was approximately 0.01% corresponding to a daily volume of 30 m3 but reaching a maximum of 270 m3(VLR% = 0.1%) and fluctuating on a daily-basis. A cluster analysis revealed 5 VLR% groupings that were used for subsequent analyses:no leachate, 0 < Low ≤ 0.001, 0.001 < Medium ≤ 0.02, 0.02 < High ≤ 0.05, 0.05 < Very high ≤ 0.2. Treated effluent concentrations of TKN, ammonia, fecal coliforms (FC),E. coli(EC), TSS and TP experienced atrend where effluent quality was improved at low and medium VLR%compared to no leachate addition, but deteriorated in high and very high VLR%.Treated effluent UVT% and EC were not statistically significantly different at varying VLR%, but FC was.Plant hydraulic had a significant impact on removal rates.Ammonia removals and nitrite concentrations improved inhigh flow conditions, whileTP, BOD and cBODremovals deteriorated. Finally,VLR%, leachate COD, TKN ammonia, chloride and arsenic had significant relationships with plant performance. Thus,for leachate with comparable age and strength, VLR% should not exceedlow to medium contributions(0 and 0.02%)during co-treatment at this WWTP.

Analysis of the Machining Process of Titanium Ti6Al-4V Parts Manufactured by Wire Arc Additive Manufacturing (WAAM).

In the current days, the new range of machine tools allows the production of titanium alloy parts for the aeronautical sector through additive technologies. The quality of the materials produced is being studied extensively by the research community. This new manufacturing paradigm also opens important challenges such as the definition and analysis of the optimal strategies for finishing-oriented machining in this type of part. Researchers in both materials and manufacturing processes are making numerous advances in this field. This article discusses the analysis of the production and subsequent machining in the quality of TI6Al4V produced by Wire Arc Additive Manufacturing (WAAM), more specifically Plasma Arc Welding (PAW). The promising results observed make it a viable alternative to traditional manufacturing methods.

Expresión del receptor del factor de crecimiento epidérmico en carcinoma gástrico: Relación clínico patológica

El Carcinoma Gástrico se mantiene como uno de los tipos más comunes de cáncer a nivel mundial, teniendo una tasa significante de mortalidad. En el estudio de su oncogénesis se han determinado diversos factores genéticos y moleculares que juegan un rol importante en su evolución, entre ellos el receptor del factor de crecimiento epidérmico (RFCE) y su coligandos. En este estudio descriptivo y transversal se analizó la expresión de dicho receptor en los especímenes de un total de 36 gastrectomías por carcinoma gástrico realizadas en el Hospital Central Universitario „Dr. Antonio María Pineda‰ durante el período 2002-2006, mediante el método de la estreptavidina-biotina etiquetada del análisis inmunohistoquimico y se estableció la relación entre esta expresión y diferentes parámetros clínico-patológicos de conocido valor pronóstico. Se observó un mayor porcentaje de expresión del RFCE en los casos con menor profundidad tumoral dentro de la pared gástrica (T1- T2 = 58,33%), en aquellos con invasión a ganglios linfáticos (65.2%; p = 0.15) y órganos distantes (75%; p = 0.53) y en los casos con mayor estadio (IV=75%) y en la enfermedad avanzada (III-IV=61.9%; p = 0.36) y en aquellos con moderado grado de diferenciación (66.67%) con respecto a los otros grados. Sin embargo, el análisis estadístico mostró que los resultados no fueron significativos. El RFCE está relacionado con la progresión del carcinoma gástrico y pudiera ser un factor predictivo de enfermedad avanzada.

Gastric carcinoma is still one of the most common cancer types worldwide, with a significant mortality rate. The study of its oncogenesis has identified several molecular and genetic factors that play an important role in its evolution, including the receptor for epidermal growth factor (CSFR). This cross-sectional descriptive study was aimed to analyze the expression of this receptor in 36 gastrectomy specimens collected in the „Dr. Antonio María Pineda‰ Central University Hospital from 2002 to 2006, using the labeled streptavidin-biotin method of immunohistochemical analysis, and establishing the correlation between its expression and different clinical-pathological parameters of recognized prognostic value. A higher frequency of EGFR expression was found in cases with minor tumoral extension in gastric wall (T1- T2 = 58.33%), in invasions to lymphatic ganglia (65.2%; p = 0.15) and distant organs (75%; p = 0.53), and in cases of advanced stage (IV=75%) and disease (III- IV= 66.67%; p = 0.36) and those with moderate grade of differentiation (66.67%). Statistical analysis showed that there was no correlation between these outcomes. EGFR is related to gastric carcinoma progression and might have a predictive role in the advanced disease.

[TP53 codon 72 polymorphism and gastric cancer risk: a case-control study in individuals from the central-western region of Venezuela]. / Polimorfismo del codón 72 de TP53 y riesgo de cancer gástrico: estudio caso-control en individuos de la región centroccidental de Venezuela.

Codon 72 polymorphism of the tumor suppressor gene TP53 has been associated with a higher risk in the development of several types of cancer. The polymorphism results in a variant protein with either an arginine (CGC) or a proline residue (CCC). The aim of this study was to analyze the association of the TP53 codon 72 polymorphism with the risk of developing gastric cancer in a high-risk population from the central-western region of Venezuela. DNA was extracted from paraffin-embedded gastric adenocarcinoma biopsies (n=65) and endoscopic biopsies from chronic gastritis patients (n=87). TP53 codon 72 polymorphism was determined by PCR-RFLP from all samples. Patients with gastric cancer had a significantly higher frequency (P = 0.037) of the Arg allele than those with chronic gastritis. A logistic regression analysis suggested that Arg carrier individuals had a 4.6-fold higher risk (95% CI 1.0-21.3) of developing gastric cancer. An increment of the Arg/Arg genotype was observed in poor-differentiated gastric adenocarcinoma (OR: 3.1; 95% CI 1.0-9.2), and of the Arg/Pro genotype in well/moderate-differentiated adenocarcinoma samples (OR: 3.5; 95% CI 1.1-11.0), when comparing within the gastric cancer samples; and the last group also when contrasting it with chronic gastritis patients (OR: 2.4; 95% CI 1.1-5.2). The results of this study suggest that the carriage of the Arg allele could be associated with the development of gastric cancer in this Venezuelan population.

Colangiopancreatografia retrograda endoscópica en pacientes con patología biliopancreática: Experiencia en 322 casos

Introducción: La Colangiopancreatografía retrógrada endoscópica (CPRE) es el procedimiento de elección actual en la patología biliopancreática, principalmente en casos de obstrucción biliar y colangitis, jugando un rol importante en el tratamiento de las estenosis benignas y malignas de las vías biliares. Objetivo: Presentar la experiencia de la Unidad de Gastroenterología del Hospital Central Universitario Antonio María Pineda en CPRE en pacientes con patología bilio-pancreatica. Material y métodos: Se realizó un estudio descriptivo retrospectivo mediante la revisión de historias clínicas de pacientes con patología biliopancreática que ameritaron una CPRE en el Servicio de Gastroenterología del Hospital Central Universitario Antonio María Pineda durante 2004- 2007, excluyéndose las historias incompletas para la información requerida. Resultados: Se revisaron 322 casos encontrándose que 69% pertenecía al sexo femenino. El grupo etario predominante estuvo comprendido entre 30 y 42 años. La indicación de la CPRE fue Coledocolitiasis en 61% seguida de neoplasias bilio-pancreaticas en 17%. Los hallazgos ecográficos más frecuentes previos a la CPRE fueron la dilatación de vías biliares en 44% y coledocolitiasis en 19%. Los hallazgos más frecuentes encontrados en la CPRE fueron Odditis en 23%, cálculos en via biliar en 21% y dilatación coledociana en 15%. Se realizaron 202 papiloesfinterotomias, se colocaron 58 prótesis y realizaron 40 dilataciones con balón. El 88% de las CPRE fue exitoso siendo la principal complicación la hemorragia leve en 9%. Conclusiones: la CPRE es un procedimiento seguro y efectivo en el tratamiento y diagnóstico de algunas patologías del árbol hepatobiliar, con resultados de morbilidad comparables a los entregados por las series internacionales.

Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is currently the first choice of treatment for biliopancreatic pathologies, mostly in cases of biliary obstruction and cholangitis, playing a leading role in the treatment of either benign or malign strictures of the biliary tree. Objectives: to present the experience at the Gastroenterology Department of the Antonio Maria Pineda Central University Hospital in patients undergoing ERCP for a biliopancreatic pathology. Materials and methods: a descriptive, retrospective study was conducted by review of clinical histories of patients with biliopancreatic pathology requiring the performance of an ERCP between years 2004-2007, excluding clinical histories with incomplete data. Results: overall, 322 histories were reviewed, 69% of the patients were female and a predominance of subjects aged 30-42 was found. The most frequent indication for ERCP was choledocolithiasis (61%), followed by biliopancreatic neoplasms (17%). The most common echographic findings previous to ERCP were dilation of the biliary tree in 44% and choledocolithiasis in 19% of the cases. Findings on ERCP were mostly odditis (23%), gallstones (21%) and choledocian dilation (16%). 202 papillotomies were performed, 58 prostheses were implanted and 40 balloon dilations were performed. Eighty-eight percent of the ERCPs were successful, with mild bleeding as the most frequent complication (9%). Conclusions: ERCP is both and effective and safe procedure for the treatment and diagnosis of some pathologies of the hepatobiliary tree, with morbidity results matching those seen in international series.

Polimorfismo del codón 72 de TP53 y riesgo de cáncer gástrico: estudio caso-control en individuos de la región centroccidental de Venezuela / TP53 codon 72 polymorphism and gastric cancer risk: a case-control study in individuals from the central-western region of Venezuela

El polimorfismo del codón 72 del gen TP53 ha sido asociado con un riesgo elevado para el desarrollo de cáncer. Este polimorfismo origina dos variantes de la proteína, una con un residuo de Arginina (CGC), y otra con Prolina (CCC). El objetivo del estudio fue analizar la asociación de este polimorfismo con el riesgo de desarrollar cáncer gástrico en individuos procedentes de la región centroccidental de Venezuela, considerada de alto riesgo para esta neoplasia maligna. El ADN fue extraído de biopsias de adenocarcinoma gástrico incluídas en parafina (n = 65) y biopsias endoscópicas de pacientes con gastritis crónica (n = 87). El polimorfismo del codón 72 de TP53 fue determinado por PCR-RFLP. Se observó un incremento significativo de la frecuencia del alelo Arg en los pacientes con cáncer gástrico (P = 0,037), originando un riesgo 4,6 veces mayor (95% IC 1,0-21,3) de desarrollar esta enfermedad. Se evidenció un incremento del genotipo Arg/Arg en adenocarcinoma gástrico poco diferenciado (OR: 3,1; 95% IC 1,0-9,2), y del genotipo Arg/Pro en adenocarcinoma de moderado/buen grado de diferenciación (OR: 3,5; 95% IC 1,1-11,0) al comparar con el grupo de cáncer gástrico, y este último también al contrastar con los individuos con gastritis crónica (OR: 2,4; 95% IC 1,1-5,2). Los resultados de este estudio sugieren que la condición de portador del alelo Arg podría estar asociado con el desarrollo de cáncer gástrico en esta región de Venezuela.

Codon 72 polymorphism of the tumor suppressor gene TP53 has been associated with a higher risk in the development of several types of cancer. The polymorphism results in a variant protein with either an arginine (CGC) or a proline residue (CCC). The aim of this study was to analyze the association of the TP53 codon 72 polymorphism with the risk of developing gastric cancer in a high-risk population from the central-western region of Venezuela. DNA was extracted from paraffin-embedded gastric adenocarcinoma biopsies (n = 65) and endoscopic biopsies from chronic gastritis patients (n = 87). TP53 codon 72 polymorphism was determined by PCR-RFLP from all samples. Patients with gastric cancer had a significantly higher frequency (P = 0.037) of the Arg allele than those with chronic gastritis. A logistic regression analysis suggested that Arg carrier individuals had a 4.6-fold higher risk (95% CI 1.0-21.3) of developing gastric cancer. An increment of the Arg/Arg genotype was observed in poor-differentiated gastric adenocarcinoma (OR: 3.1; 95% CI 1.0-9.2), and of the Arg/Pro genotype in well/ moderate-differentiated adenocarcinoma samples (OR: 3.5; 95% CI 1.1-11.0), when comparing within the gastric cancer samples; and the last group also when contrasting it with chronic gastritis patients (OR: 2.4; 95% CI 1.1-5.2). The results of this study suggest that the carriage of the Arg allele could be associated with the development of gastric cancer in this Venezuelan population.

[Antibodies against T. cruzi in patients with dilated cardiomyopathy in Tuxtla Gutierrez, Chiapas]. / Anticuerpos contra Trypanosoma cruzi en pacientes con miocardiopatía dilatada en Tuxtla Gutiérrez, Chiapas.

UNLABELLED: Chagas disease is caused by the flagellate protozoan T: cruzi. Seroepidemiological surveys in Chiapas, Mexico have shown seropositive individuals, therefore, we searched for people affected by the chronic form of Chagas disease which involves the heart, causing a chronic, progressive and fatal disease called Chronic Chagasic Cardiopathy (CCC). MATERIAL AND METHODS: To establish the frequency of CCC we studied 28 patients seen at the Hospital General Regional "Dr. Rafael Pascacio Gamboa" during October 2002 through October 2003 in Tuxtla Gutierrez, Chiapas, the State capital city, with diagnosis of dilated cardiomyopathy (DC), a serological survey for antibodies against T. cruzi was done. This hospital cares for people from all parts of Chiapas, Mexico. Clinical diagnosis of DC was established there and blind serological studies were performed in Mexico City. RESULTS: Fifteen out of 28 DC patients (54%) had anti T. cruzi antibodies. All of them came from poor rural villages and they had heart failure and/or arrhythmia or heart blockade on EKG. CONCLUSIONS: This observation suggest that in Chiapas were Chagas disease is endemic, there are CCC patients. Any case with a clinical diagnosis of DC should be tested for antibodies against T. cruzi. The low socioeconomic status, culture and environment in this Mexican State favour the presence and transmission of this parasitic disease.

Anticuerpos contra Trypanosoma cruzi en pacientes con miocardiopatía dilatada en Tuxtla Gutiérrez, Chiapas / Antibodies against Trypanosoma cruzi in patients with dilated cardiomyopathy in Tuxtla Gutierrez, Chiapas

La enfermedad de Chagas es causada por el protozoario flagelado Trypanosoma cruzi. Encuestas seroepidemiológicas realizadas en Chiapas informan individuos seropositivos en comunidades rurales, y cabe la posibilidad de que la forma crónica de la enfermedad ocurra en el estado. La expresión clínica dominante en la enfermedad de Chagas crónica es cardíaca. Material y métodos: Con el objeto de conocer la frecuencia de cardiopatía chagásica crónica (CCC) se hizo una encuesta serológica a pacientes con miocardiopatía dilatada (MD) internados entre octubre de 2002 a octubre de 2003, en el Servicio de Cardiología del Hospital General Regional "Dr. Rafael Pascacio Gamboa" de Tuxtla Gutiérrez, Chiapas. El diagnóstico fue establecido en forma independiente y el estudio seroinmunológico fue ciego. Resultados: Quince (54%) de 28 sujetos con MD tenían anticuerpos a T. cruzi. Todos provenían de medio rural pobre, su cuadro clínico incluyó insuficiencia cardíaca y/o trastornos del ritmo o conducción. Conclusiones: Esta evidencia sugiere que en Chiapas, una zona endémica de enfermedad de Chagas, hay CCC. Dentro del estudio de la MD, la etiología chagásica, debe ser considerada, ya que las condiciones socioeconómicas, culturales y regionales favorecen su presencia.

Chagas disease is caused by the flagellate protozoan T. cruzi. Seroepidemiological surveys in Chiapas, Mexico have shown seropositive individuals, therefore, we searched for people affected by the chronic form of Chagas disease which involves the heart, causing a chronic, progressive and fatal disease called Chronic Chagasic Cardiopathy (CCC). Material and methods: To establish the frequency of CCC we studied 28 patients seen at the Hospital General Regional "Dr. Rafael Pascacio Gamboa" during October 2002 through October 2003 in Tuxtla Gutierrez, Chiapas, the State capital city, with diagnosis of dilated cardiomyopathy (DC), a serological survey for antibodies against T. cruzi was done. This hospital cares for people from all parts of Chiapas, Mexico. Clinical diagnosis of DC was established there and blind serological studies were performed in Mexico City. Results: Fifteen out of 28 DC patients (54%) had anti T. cruzi antibodies. All of them came from poor rural villages and they had heart failure and/or arrhythmia or heart blockade on EKG. Conclusions: This observation suggest that in Chiapas were Chagas disease is endemic, there are CCC patients. Any case with a clinical diagnosis of DC should be tested for antibodies against T. cruzi. The low socioeconomic status, culture and environment in this Mexican State favour the presence and transmission of this parasitic disease.

Pancreatitis post colangiopancreatografía retrógrada endoscópica: un modelo para la liberación de citoquinas en respuesta inflamatoria de fase aguda / Post cholan giopancreatograhy endoscopy retrogade pancreatitis a model to the cytokine liberation to acute phase inflamatory response

Se realizó un estudio prospectivo, descriptivo para determinar que la pancreatitis inducida por la colangiopancreatografía retrógrada endoscópica (CPRE) puede ser usada como un modelo humano para el estudio de indicadores de inflamación liberados durante las primeras horas post trauma. Se practicó CPRE a 41 pacientes que acudieron al servicio de gastroenterología del HCU-AMP en el período febrero-diciembre de 1999, con clínica y paraclínica de síndrome ictérico obstructivo de etiología benigna. Se les practicó determinación de proteína C reactiva, amilasas e interleuquina 6 antes de iniciar y a las 24h posterior al mismo. Los pacientes admitidos en el estudio, 30 correspondían al sexo femenino (73,17 por ciento), 11 al sexo masculino (26,83 por ciento) con los diagnósticos de síndrome ictérico obstructivo, litiasis vesicular y/o coledociana, dilatación de vías biliares y divertículos yuxtapapilares. La edad promedio fue de 44-24 años. Se dividió a los pacientes en tres grupos de acuerdo a la evolución posterior al estudio: Grupo A: conformado por 4 pacientes que presentaron pancreatitis aguda leve según los criterios para pacientes sometidos a ERCP y elevación significativa de interleuquina 6 (IL-6) con respecto al Grupo C. Grupo B: integrado por 5 pacientes que presentaron dolor post canulación de las vías biliares sin hiperamilasemia y elevación de interleuquina 6, significativa con respecto al Grupo C. Grupo C: 32 pacientes que no presentaron molestias ni elevación de IL-6, ni elevación de amilasas. El pico más importante de IL-6 se presentó a las 24 horas. La pancreatitis aguda post ERCP es un excelente modelo para la evaluación de los eventos inflamatorios tempranos y además la IL6 es un indicador diagnóstico y pronóstico de pancreatitis aguda

Evaluación de comprimidos intrarruminales de selenio por concentración sanguínea y lanar de corderas semiestabuladas / Intraruminal mineral selenium boluses evaluation through blood and wool slenium concentration in grassing lambs

La cantidad de selenio (Se) en el forraje se deriva de la del suelo y la primera será la fuente para los animales. La administración oral de comprimidos minerales intrarruminales puede proporcionar cantidades adecuadas durante varios años. El objetivo de este trabajo fue determinar el efecto de la administración de comprimidos minerales intrarruminales con Se, sobre la concentración sanguínea y lanar en corderas semiestabuladas. Se les administraron por vía oral comprimidos de Se a 20 corderas; 10 con 4.6 por ciento, 10 con 1.0 por ciento y 10 sin Se. Las corderas se mantuvieron en pastoreo diurno en praderas de Lollium perenne (Ballico), Penisetum clandestinum (Kikullo) y Trifolium rapens latum (trébol), ofreciéndoles también 250 g de alimento balanceado sin Se y paja de avena en el pesebre. Durante 3 meses, cada 15 días, en 6 muestreos se determinó la concentración de Se en sangre, lana y en los alimentos que consumían los animales. Para la medición del Se, se utilizó un generador de hidruros acoplado a un espectrómetro de absorción atómica. Las concentraciones de Se en los forrajes y concentrado ofrecidos se consideraron como deficientes. Las concentraciones de Se sanguíneo y lanar en los animales que recibieron comprimidos con 4.6 por ciento fue de 182.0 ng/g y 341.7 ng/g, respectivamente. La diferencia resultó estadísticamente más alta (P > 0.05) a la de los grupos sin Se y del que recibió bolos con 1 por ciento. Los hallazgos de este experimento recomiendan la suplementación de Se en corderas en pastoreo con bolos minerales de 4.6 por ciento de Se y 5 g de peso.