Metamodeling-based reliability analysis framework for activated sludge processes.

The reliability of activated sludge processes will be adversely affected by alterations in wastewater production and pollutant loading foreseen due to population growth, urbanization, and climate change, as well as the tendency to amend environmental regulations to mandate stricter effluent quality standards to alleviate water pollution. Until now, there was no framework capable of effectively managing these multifaceted challenges in reliability analysis. Previous attempts conducted a low number of simulations leading to insufficient statistical significance to properly validate reliability quantification. A metamodeling-based reliability analysis framework for the activated sludge process is introduced to cope with alterations in wastewater production and pollutant loading, assesses the reliability under different effluent regulations, and leverages metamodels to conduct extensive simulation work, to estimate the reliability. All metamodels produced high-resolution results, enabling reliability estimation after 100 000 simulations. The framework effectively assessed the annual failure rates of various activated sludge facility designs under four regulations, demonstrating the impact of stricter effluent quality standards. Integrating metamodels for reliability analysis greatly lowers computational costs, making the framework a time and resource-efficient choice for quick decision-making in facility design.

Association between maternal exposure to particulate matter (PM2.5) and adverse pregnancy outcomes in Lima, Peru.

The literature shows associations between maternal exposures to PM2.5 and adverse pregnancy outcomes. There are few data from Latin America. We have examined PM2.5 and pregnancy outcomes in Lima. The study included 123,034 births from 2012 to 2016, at three public hospitals. We used estimated daily PM2.5 from a newly created model developed using ground measurements, satellite data, and a chemical transport model. Exposure was assigned based on district of residence (n = 39). Linear and logistic regression analyzes were used to estimate the associations between air pollution exposure and pregnancy outcomes. Increased exposure to PM2.5 during the entire pregnancy and in the first trimester was inversely associated with birth weight. We found a decrease of 8.13 g (-14.0; -1.84) overall and 18.6 g (-24.4, -12.8) in the first trimester, for an interquartile range (IQR) increase (9.2 µg/m3) in PM2.5. PM2.5 exposure was positively associated with low birth weight at term (TLBW) during entire pregnancy (OR: 1.11; 95% CI: 1.03-1.20), and at the first (OR: 1.11; 95% CI: 1.03-1.20), second (OR: 1.09; 95% CI: 1.01-1.17), and third trimester (OR: 1.10; 95% CI: 1.02-1.18) per IQR (9.2 µg/m3) increase. Higher exposure to PM2.5 was also associated with increased risk of small for gestational age (SGA). There were no statistically significant associations between PM2.5 exposure and preterm births (PTB). Exposure to higher concentrations of PM2.5 in Lima may decrease birth weight and increase the frequency of TLBW and SGA. Our study was inconsistent with the literature in finding no associations with preterm birth.

Overview of nuclear bodies and their classification in the Terminologia Histologica.

BACKGROUND: Nuclear bodies (NB) are membrane-less subnuclear organelles that perform important functions in the cell, such as transcription, RNA splicing, processing and transport of ribosomal pre-RNA, epigenetic regulation, and others. The aim of the work was to analyse the classification of NB in the Terminologia Histologica (TH) and biological and bibliographical databases. MATERIALS AND METHODS: The semantic structure of the Nucleoplasm section in the TH was analysed and unsystematic bibliographical search was made in the PubMed, SciELO, EMBASE databases and European Bioinformatics Institute (EMBL-EBI) biology database to identify which structures are classified as NB. RESULTS: It was found that the terms Corpusculum convolutum, Macula interchromatinea and Corpusculum PML are not correctly classified in the TH, since they are subordinated under the term Chromatinum and not under Corpusculum nucleare. The bibliography consulted showed that 100%, 92.6% and 81.5% of articles mentioned Corpusculum convolutum, Macula interchromatinea and Corpusculum PML, respectively as nuclear bodies. CONCLUSIONS: It is suggested to relocate the terms Corpusculum convolutum, Macula interchromatinea and Corpusculum PML with the name of Corpusculum nucleare and the incorporation of two new entities to the Histological Terminology according to the information collected: paraspeckles and histone locus body.

Temporomandibular joint arthrocentesis in a rabbit model: technique and recommendations in the study of temporomandibular disorders.

INTRODUCTION: Arthrocentesis has been used in the temporomandibular joint (TMJ) to analyze components of the synovial fluid or as a therapeutic procedure associated or not with the administration of a drug. The rabbit is one of the most commonly used animal species as a model for pathologies that affect the TMJ. The aim of this study was to propose a specific technique to perform arthrocentesis on the rabbit TMJ, emphasizing descriptions of reference points and measurements for a successful puncture without complications. MATERIALS AND METHODS: Fourteen adult rabbits (Oryctolagus cuniculus) were used. The project was approved by the Scientific Ethics Committee of the Universidad de La Frontera (File Nº083/2016). RESULTS: The description of the technique was divided into three steps: 1) Location of the rabbit TMJ, 2) Positioning of the needles in the TMJ, and 3) Passage of fluid through the TMJ. CONCLUSIONS: This arthrocentesis technique could help to simplify the procedure and give the investigator a guide for joint washing and extraction of synovial fluid in the rabbit TMJ.

Histomorphometric analysis of unilateral condylar hyperplasia in the temporomandibular joint: the value of the condylar layer and cartilage island.

This study aimed to describe the condylar layer and cartilage island in subjects with unilateral condylar hyperplasia (UCH). Five individuals (15-18 years old) with a diagnosis of UCH, treated in a university hospital in Temuco, Chile, were included. The analysis examined the presence, extension, and thickness of the layers on the condylar surface, the number, depth, and area of the cartilage islands, and the argyrophilic proteins of the nucleolar organizer region (AgNOR) score. Statistical significance was set at P<0.05. The fibrocartilaginous layer was thickest (0.13±0.05mm) and the joint layer was thinnest (0.07±0.01mm) (P<0.05). With respect to the number, depth, and area of the islands, case 1 presented the highest values, followed by case 2; the cartilage island was related to the fibrocartilaginous layer (P<0.05). All cases had AgNOR proteins in the proliferative and fibrocartilaginous layers, as well as the islands with the greatest presence of chondrocytes (P=0.245). A relationship was observed between the histopathological alterations in the different layers on the condylar surface and the thickness of the fibrocartilaginous layer, as well as the thickness of the latter and the number, depth, and area of the cartilage islands in the trabecular bone.

Evaluación de reactividad inmunohistoquímica con método del Complejo Avidina­Biotina (ABC) / Evaluation of immunohistochemical reactivity with Avidin-Biotin Complex (ABC) method

Inmunohistoquímica es toda técnica que permite detectar in situ componentes celulares y extracelulares por medio de anticuerpos específicos, empleando sistemas de detección enzimáticos. Dentro de los métodos inmunohistoquímicos, la técnica del complejo avidina­biotina(ABC) es ampliamente utilizada debido a su alta sensibilidad. El objetivo del presente estudio fueevaluar la reactividad inmunohistoquímica del anticuerpo 4C4.9 para la detección de la proteínaS-100, utilizando el método ABC. Para la evaluación de la reactividad inmunohistoquímica se utilizaron 2 biopsias de piel humana con diagnóstico histopatológico de melanoma maligno nodular ulcerado y nevus melanocítico intradérmico, provenientes del Laboratorio de Investigación en Biotecnología Animal de la Universidad de La Frontera, Temuco, Chile. Se utilizó el Kit VECTASTAIN®como método de detección, la dilución del anticuerpo 4C4.9 fue 1/250 y la temperatura de incubación fue a 4 ºC ó 37 ºC por 18 horas. Para validar la técnica, se realizó un control positivo y otro negativo para 4C4.9. Los resultados de la tinción inmunohistoquímica por el método del complejo ABC mostraron tinción positiva para la proteína S-100, tanto en melanoma maligno nodular ulcerado, como en nevus melanocítico intradérmico, incubados durante 18 horas a 4 ºC ó 37 ºC. Sin embargo, la inmunotinción fue más intensa cuando el anticuerpo primario se incubó a 37 ºC. Para una correcta interpretación de los resultados, es necesario tener en consideración que la reacción antígeno-anticuerpo se ve influenciada por diversos factores, como la concentración del anticuerpo, el tiempo y la temperatura de incubación. En conclusión, nuestros resultados sugieren incubarlas muestras con el primer anticuerpo (4C4.9) en una dilución de 1/250 en agua destilada, incu-bando durante 18 h a 37 ºC. Se recomienda la utilización del anticuerpo 4C4.9 como apoyo al diagnóstico y diagnóstico diferencial.

Immunohistochemistry is anytechnique that can detect cellular and extracellular components in situ by means of specific antibodies,using enzymatic detection systems. Among immunohistochemical methods, the technique ofavidin - biotin complex (ABC) is widely used because of its high sensitivity. The aim of this study was to evaluate the immunohistochemical reactivity of the4C4.9 antibody for detection of S-100 protein using the ABC method. For the evaluation ofimmunohistochemical reactivity 2 biopsies of humanskin were used with histopathological diagnosis ofulcerated malignant melanoma and melanocyticintradermal nevi from the Research Laboratory onAnimal Biotechnology of the Universidad de La Fron-tera, Chile. The Kit VECTASTAIN® was used asdetection method, the dilution the 4C4.9 antibodywas 1/250 and incubation temperature was at 4 °Cor 37 °C for 18 hours. To validate the technique, apositive control and a negative for 4C4.9 was performed. The results of immunohistochemicalstaining by the method of ABC complex showed positive staining for protein S-100 both in ulcerated malignant melanoma and melanocytic intradermalnevi, incubated for 18 hours at 4 °C or 37 °C.However, immunostaining was more intense when the primary antibody was incubated at 37° C. For acorrect interpretation of the results, it is necessary to take into consideration that the antigen-antibody reaction is influenced by various factors such as the concentration of antibody, time and temperature ofincubation. In conclusion, our results suggest incubating the samples with the first antibody (4C4.9)at 1/250 dilution in distilled water, incubating for 18h at 37 ºC. However, immunostaining was moreintense when the primary antibody was incubated at37° C. For a correct interpretation of the results, it isnecessary to take into consideration that antigen-antibody reaction is influenced by various factors suchas the concentration of antibody, time and temperature of incubation. In conclusion, our results suggest incubating the samples with the first antibody(4C4.9) at 1/250 dilution in distilled water, incubating for 18 h at 37 ºC. The use of the antibody 4C4.9 is recommended to support the diagnosis and differential diagnosis.

Histopathological analysis of unilateral condylar hyperplasia: difficulties in diagnosis and characterization of the disease.

The aim of this study was to perform a histological analysis of the conditions in patients undergoing surgery for unilateral condylar hyperplasia (UCH) using different histopathological analytical techniques and to describe the complications and existing controversy in order to better define the disease. A partial condylectomy was performed in five patients who had been diagnosed with UCH using clinical and imaging methods. The samples obtained were analyzed using routine histological techniques including haematoxylin-eosin, Van Gieson, picrosirius, alcian blue/haematoxylin-eosin, and AgNOR staining. The analyses were performed by an observer who was blinded to the clinical parameters of the disease. The cellularity, tissue layers, size of the anatomical structures, and the relationships between them were assessed. The analysis of these patients was complemented by a review of the scientific literature. Variability was observed in the analysis of the cases. The presence of connective tissue was detected at the bone level, with cartilage formation at different levels. Each island presented levels of involvement that could indicate various degrees of aggressiveness. Type I collagen was observed in most cases, although type III was also identified. The development of histological diagnostic methods to determine the aggressiveness or level of involvement in UCH is not currently possible. Further studies are needed to establish new histological classifications.

Fotografía 2D en el diagnóstico de asimetrías faciales / 2D photography in facial asymmetry diagnosis

El objetivo de esta investigación es identificar la relación entre la asimetría facial y la pérdida de contacto en línea mediana entre dientes maxilares y mandibulares. Se realizó un estudio descriptivo en 18 sujetos portadores de asimetría facial que consultaron en la División de Cirugía Oral y Maxilofacial de la Universidad de La Frontera por tratamiento quirúrgico de la asimetría. En todos ellos se evaluó la presencia y grado de la asimetría facial y la presencia y desvío desde la línea mediana facial del punto mediano mandibular y maxilar mediante la prueba estadística t de student considerando un valor de p <0,05; todas las evaluaciones fueron realizadas mediante fotografías 2D de rostro y dientes obtenidas en condiciones estandarizadas. Se identificó que todos los sujetos portadores de asimetría facial presentaron asimetría dentaria; los desvíos dentarios fueron de casi 7 mm y existió relación estadísticamente significativa entre desvío facial y desvío dentario. Se concluye que los sujetos con asimetría dentaria pueden presentar asimetría facial de forma que la evaluación esqueletal del rostro es necesaria para realizar un diagnóstico correcto.

The aim of this research was to find the relation between facial asymmetry and loss of continuity in median line of maxillary and mandibular teeth. A descriptive study was carried out in 18 subjects with facial asymmetry with surgical indication and observed at the Division of Oral and Maxillofacial Surgery of the Universidad de La Frontera. In all of them the grade of facial asymmetry and the relation in median line of the maxillary and mandibular teeth was evaluated using the t student test considering p value < 0.05; all the evaluations were executed using 2D photography of the face and tooth obtained with standardized conditions. In all the subjects we observed dental asymmetry with almost 7 mm from the median line; statistical relations between dental asymmetry and facial asymmetry. It is concluded that in subjects asking for dental asymmetry treatment a facial evaluation is necessary in view of the relation with skeletal facial deformity.

Nasal deformity in subjects with class III facial deformities / Deformidad nasal en sujetos con deformidad facial clase III

Dentofacial deformities present some shades and variations that determine the inclusion of different anatomical components as part of the disease; the aim of this study was to ascertain the nasal characteristics in patients with a Class III dentofacial deformity. A descriptive study was conducted on 20 patients diagnosed with a Class III facial deformity and a surgical indication; frontal and lateral as well as CT images were taken to analyze variables of nasal morphology and deformities associated with the nasal bridge, tip and septum. The results showed that the nasal angles are outside normal parameters and that the basal width of the nose is approximately 3 mm smaller than the intercanthal width; 45% of the subjects have lateral deviations, 50% bridge deformity and 80% septum deviation. It is concluded that there are nasal deformities in subjects with a Class III facial deformity and that this component must be carefully evaluated in the preoperative stage.

Las deformidades dentofaciales presentan algunos matices y variaciones que determinan la inclusión de diferentes componentes anatómicos dentro de la enfermedad; el objetivo de esta investigación es conocer las características de la nariz en pacientes con deformidad dentofacial de clase III. Se desarrollo un estudio descriptivo en 20 pacientes con diagnóstico de deformidad facial declase III e indicación quirúrgica; se estudiaron análisis fotográficos frontales y laterales así como tomografías computadorizadas para analizar variables de morfología nasal y deformidades asociadas al puente nasal, punta nasal y septo nasal. Los resultados demostraron que los ángulos nasales se encuentran fuera de los parámetros de normalidad y que el ancho basal de la nariz es aproximadamente 3 mm menor que el ancho intercantal; el 45% de los sujetos presentó desviación lateral, 50% deformidad del puente nasal y el 80% desvío de septo nasal. Se concluye que existen deformidades nasales en sujetos con deformidad facial de clase III y que este componente debe ser evaluado criteriosamente en la etapa preoperatoria.

Segmento II del hígado ¿segmento lateral izquierdo o segmento posterior lateral izquierdo? / Segment II of the liver, left lateral segment or left lateral posterior segment?

La división del hígado en segmentos se basa en que, a partir del hilio, cada una de las ramas de la vena porta está acompañada por una arteria y un conducto biliar. El conocimiento preciso de las estructuras vasculares intrahepáticas y su distribución en segmentos es importante para planificar técnicas resectivas y efectuarlas con éxito; se ha señalado que es necesario conocer la anatomía biliar de los segmentos del hígado, así como sus variantes, para prevenir trombosis o complicaciones isquémicas del segmento lateral izquierdo y la aparición de fístulas biliares después del trasplante parcial de hígado. En la Terminologia Anatomica aparece mencionado el segmento lateral izquierdo (segmento II). Es nuestro objetivo revisar este término y recomendar la inclusión del adjetivo "posterior," quedando como segmento posterior lateral izquierdo. Este cambio tiene relación con los objetivos básicos que fueron propuestos por el Programa Federativo Internacional de Terminologia Anatomica, organismo encargado de regular la comunicación anatómica y de recibir recomendaciones como la presente, admitiéndose que las incorporaciones o modificaciones terminológicas deben ser claras, armónicas con la región o estructura y con un valor preferiblemente informativo y descriptivo. Las ramas terminales de la vena porta son dos: las venas portas derecha e izquierda. Esta última emite una vena lateral izquierda, cuyo trayecto es horizontal, posterior e izquierdo correspondiente al segmento lateral izquierdo (II).En base a lo anterior, se justificaría denominar e incorporar a Terminologia Anatomica éste segmento como segmento posterior lateral izquierdo.

The division of the liver into segments is based on, that originating from the hilum, each of the branches of the portal vein is accompanied by an artery and a bile duct. Accurate knowledge of intrahepatic vascular structures and their distribution is important for planning segment resection techniques and perform them successfully. It should be noted that it is necessary to know the anatomy of the biliary liver segments and its variants, to prevent thrombosis or ischemic complications of the left lateral segment and the appearance of biliary fistulas following partial liver transplant. The left lateral segment (segment II) is mentioned in the Terminologia Anatomica. It is our goal to review this term and recommend inclusion of the word "posterior" remaining as the left posterior lateral segment. This change is related to the basic objectives that were proposed by the Federative International Programme on Anatomical Terminologies, which is responsible for regulating the anatomical communication and get recommendations such as this, admitting that additions or terminological changes should be clear, harmonious with the region or structure and have a preferably informative and descriptive value. The terminal branches of the portal vein are two: the right and left portal veins. The latter emits a left lateral vein, where the trajectory is horizontal, rear and left for the left lateral segment (II). Based on the above information, it would be justified to incorporate this segment as left posterior lateral segment in the Terminologia Anatomica.

PEG1/MEST and IGF2 DNA methylation un CIN and in cervical cancer

INTRODUCTION: Although most invasive cervical cancer (ICC) harbor <20 human papillomavirus (HPV) genotypes, use of HPV screening to predict ICC from HPV has low specificity, resulting in multiple and costly follow-up visits and overtreatment. We examined DNA methylation at regulatory regions of imprinted genes in relation to ICC and its precursor lesions to determine if methylation profiles are associated with progression of HPV-positive lesions to ICC. MATERIALS AND METHODS: We enrolled 148 controls, 38 CIN and 48 ICC cases at Kilimanjaro Christian Medical Centre from 2008 to 2009. HPV was genotyped by linear array and HIV-1 serostatus was tested by two rapid HIV tests. DNA methylation was measured by bisulfite pyrosequencing at regions regulating eight imprinted domains. Logistic regression models were used to estimate odd ratios. RESULTS: After adjusting for age, HPV infection, parity, hormonal contraceptive use, and HIV-1 serostatus, a 10 % decrease in methylation levels at an intragenic region of IGF2 was associated with higher risk of ICC (OR 2.00, 95 % CI 1.14-3.44) and cervical intraepithelial neoplasia (CIN) (OR 1.51, 95 % CI 1.00-2.50). Methylation levels at the H19 DMR and PEG1/MEST were also associated with ICC risk (OR 1.51, 95 % CI 0.90-2.53, and OR 1.44, 95 % CI 0.90-2.35, respectively). Restricting analyses to women >30 years further strengthened these associations. CONCLUSIONS: While the small sample size limits inference, these findings show that altered DNA methylation at imprinted domains including IGF2/H19 and PEG1/MEST may mediate the association between HPV and ICC risk (AU)

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PEG1/MEST and IGF2 DNA methylation in CIN and in cervical cancer.

INTRODUCTION: Although most invasive cervical cancer (ICC) harbor <20 human papillomavirus (HPV) genotypes, use of HPV screening to predict ICC from HPV has low specificity, resulting in multiple and costly follow-up visits and overtreatment. We examined DNA methylation at regulatory regions of imprinted genes in relation to ICC and its precursor lesions to determine if methylation profiles are associated with progression of HPV-positive lesions to ICC. MATERIALS AND METHODS: We enrolled 148 controls, 38 CIN and 48 ICC cases at Kilimanjaro Christian Medical Centre from 2008 to 2009. HPV was genotyped by linear array and HIV-1 serostatus was tested by two rapid HIV tests. DNA methylation was measured by bisulfite pyrosequencing at regions regulating eight imprinted domains. Logistic regression models were used to estimate odd ratios. RESULTS: After adjusting for age, HPV infection, parity, hormonal contraceptive use, and HIV-1 serostatus, a 10 % decrease in methylation levels at an intragenic region of IGF2 was associated with higher risk of ICC (OR 2.00, 95 % CI 1.14-3.44) and cervical intraepithelial neoplasia (CIN) (OR 1.51, 95 % CI 1.00-2.50). Methylation levels at the H19 DMR and PEG1/MEST were also associated with ICC risk (OR 1.51, 95 % CI 0.90-2.53, and OR 1.44, 95 % CI 0.90-2.35, respectively). Restricting analyses to women >30 years further strengthened these associations. CONCLUSIONS: While the small sample size limits inference, these findings show that altered DNA methylation at imprinted domains including IGF2/H19 and PEG1/MEST may mediate the association between HPV and ICC risk.

Dolor en mesogastrio e hipocondrio derecho en mujer de 71 años / No disponible

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Comparación entre etil-cianoacrilato y sutura convencional en el cierre de incisiones de piel de conejo (Oryctolagus cuniculus) / Comparison between ethyl-cyanoacrylate and conventional suture for the closure of skin incisions in rabbit (Oryctolagus cuniculus)

Las ventajas de los adhesivos en base a cianoacrilatos para uso en cierre de heridas cutáneas ha sido demostrada, pero escasos estudios reportan el uso del etil-cianoacrilato a nivel nacional. El objetivo fue comparar aspectos morfológicos de cicatrización en piel de conejo entre etil-cianoacrilato y sutura. Utilizamos 10 conejos machos adultos, divididos en 2 grupos de 5 animales, del Centro de Cirugía Experimental de la Universidad de La Frontera, Chile. Al grupo experimental se le realizaron dos incisiones, una en cada lado del dorso del tórax, 4 cm de largo, atravesando epidermis y dermis. La incisión derecha fue cerrada con etil-cianoacrilato, la izquierda con punto intradérmico de ácido poliglicólico. Se tomaron biopsias a los días 7, 14 y 21 días postoperatorio. Al día 7, la incisión tratada con etil-cianoacrilato presentó una reacción inflamatoria moderada, con infiltración moderada de PMN. Las biopsias de sutura presentaban una etapa de regeneración más avanzada, sin presentar desarrollo epidérmico. Al día 14, las incisiones tratadas con etil-cianoacrilato se encontraban en la fase final de la etapa inflamatoria, mientras que las biopsias de sutura se encontraban ya en etapa proliferativa. Al día 21, ambos tipos de cierre se encontraban en etapa de remodelación, con epidermis gruesa y lámina basal formada. La dermis presentó tejido conectivo denso irregular, escasos folículos pilosos y glándulas sebáceas. El etil-cianoacrilato, como adherente cutáneo, es una buena alternativa de uso, mostrando una adecuada biocompatibilidad. Presentando una reacción inflamatoria moderada, limitada y de corta duración a nivel dérmico. La cicatriz logra mejores resultados estéticos con respecto a las incisiones cerradas con sutura. Se debe considerar su uso limitado a sitios no expuestos a movimientos y de baja tensión...

The advantages of cyanoacrylate based adhesives for use in cutaneous wound closure has been demonstrated, but few studies reporting the use of ethyl cyanoacrylate nationwide. The objective was to compare morphological aspects of healing in rabbit skin between ethyl-cyanoacrylate and suture. We used 10 adult male rabbits divided into 2 groups of 5 animals, the Center for Experimental Surgery, Universidad de La Frontera, Chile. The experimental group was subject to two incisions, one at each side of the dorsum of the thorax, 4 cm long, spanning epidermis and dermis. The incision was closed with ethyl right-cyanoacrylate, intradermal left with point of polyglycolic acid. Biopsies were taken at days 7, 14 and 21 days postoperatively. At day 7, the incision treated with ethyl cyanoacrylate presented a mild inflammatory reaction with moderate infiltration of PMNs. Suture biopsies showed a more advanced stage of regeneration, without presenting epidermal development. At day 14, the incisions treated with ethyl cyanoacrylate were in the final phase of the inflammatory stage, while suture biopsies were already in proliferative stage. At day 21, closing both types were remodeling stage, with thicker epidermis and basal lamina formed. The dermis showed irregular dense connective tissue, poor hair follicles and sebaceous glands. Ethyl-cyanoacrylate as Skin Adhesive is a good alternative use, showing adequate biocompatibility. Featuring a moderate inflammatory reaction, limited and of short duration dermal level. The scar achieves better cosmetic results regarding the incisions closed with sutures. Consideration should be limited to use low-tension sites not exposed to movements...

Perfil del cuidador principal de los pacientes oncológicos que acuden a la consulta de cuidados paliativos en el Instituto Oncológico «Luis Razetti» (junio-agosto 2005) / No disponible

Introducción: el cuidado de personas que han perdido su independencia por enfermedad, generalmente es asumido por la familia, y en la mayoría de los casos lo asume un único miembro de esta llamado cuidador principal. La función de cuidador implica además de la alimentación, aseo personal, cumplimiento de tratamiento y consultas médicas, una implicación afectiva, abandono de las ocupaciones y del propio grupo familiar, aislamiento del grupo social, ausencia de momentos de esparcimiento, etc., generando en algunos casos un nivel de sobrecarga que pudiera afectar tanto la salud física y psíquica del cuidador, además del deterioro en la calidad del cuidado del paciente. Objetivos: a) determinar el perfil del cuidador principal de los pacientes oncológicos que acuden a la consulta de Cuidados Paliativos; y b) conocer el nivel de sobrecarga del cuidador principal y la relación entre la presencia de sobrecarga y el índice de Karnofsky del paciente. Método: se realizó un estudio prospectivo, analítico, durante un periodo de tiempo de 3 meses en donde se aplicaron 2 encuestas a 203 cuidadores principales que acudieron acompañando a los pacientes oncológicos a la consulta de cuidados paliativos. Las encuestas fueron aplicadas una sola vez a cada cuidador principal con la finalidad de conocer las funciones que desempeña como cuidador y establecer la presencia o no de sobrecarga. Resultados: de 203 cuidadores encuestados, sólo 200 cumplieron con los criterios de inclusión, de estos, 77% fue del género femenino, el grupo etario con mayor prevalencia fue el de 40-49 años con 29,5%, los hijos constituyeron el mayor porcentaje de cuidadores con 45%. El 51,5% de los cuidadores dedicó 13 horas o más al día a la atención del paciente, el 38,5% dedicó solamente 1 a 2 veces al mes a las actividades de distracción, el 59% dedicó entre 5 a 7 horas al día de sueño; el 73,5% alternó la atención del paciente con otra persona y el 32,5% debió renunciar a su empleo u ocupación. Del total de cuidadores 98 fueron catalogados con algún nivel de sobrecarga, es decir, el 49%; 50 con sobrecarga leve correspondiendo al 25% y 48 con sobrecarga intensa que representa el 24%. Del total de cuidadores que dedicaron 13 horas o más a la atención del paciente, el 60% presentó sobrecarga; de aquellos que no dedicaron tiempo al esparcimiento el 59% presentaron sobrecarga; los que dedicaron 2 a 4 horas de sueño al día presentaron sobrecarga el 66,7%, y se demostró una relación estadísticamente significativa con una p = 0,0045 entre la presencia de sobrecarga y el índice de Karnofsky < 60%. Conclusión: en la población estudiada existe relación entre la presencia de sobrecarga (leve o intensa) y el número de horas dedicadas a la atención del paciente, la falta de actividad de esparcimiento, las pocas horas de sueño y el índice de Karnofsky del paciente (AU)

Background: The taking care of people who have lost their independence because of disease is generally assumed by the family, and in most cases by only one member of the family, the so-called main caregiver. In addition to feeding the patient, looking after his personal hygiene, watching for treatment compliance, and accompanying the patient to medical consultations, the main carer has an affective relationship with the patient, abandonment of his or her own occupations and family, isolation from his social group, absence of recreation, etc., which in time will generate a burden that may affect his or her physical and psychological health, and result in a progressive decline of patient care quality. Objectives: a) to determine the profile of main carers for cancer patients attending palliative care consultation; and b) to appraise the burden of main carers and the relationship between said burden and the patient's Karnofsky scale value. Method: a prospective, analytical study was conducted for a period of 3 months in which 2 surveys were administered to 203 main caregivers who accompanied oncological patients attending palliative care consultation. The surveys were administered once to each one of the main carers in order to construe their job as caregivers and to establish the presence or absence of their burden levels. Results: 200 out of 203 surveyed caregivers met the inclusion criteria; 77% were female individuals. The age group including individuals between 40 and 49 years of age had the greatest percentage (29.5%). Patient offspring constituted the greatest percentage of caregivers with 45%; 51.5% of carers devoted 13 hours or more to their caring activity; 38.5% attended recreational activities once or twice a month; 59% devoted 5 to 7 hours to sleep; 73.5% had a substitute to care for the patient, and 32.5% had to quit their formal job or occupation; 98 caregivers (49%) were classified as «having some burden», 50 caregivers (25%) as «having a slight burden level», and 48 carers (24%) as «having a severe burden level». Of all carers who devoted 13 hours or more to a patient, 60% showed burden signs. Out of those who did not spare time for leisure activities, 59% showed burden signs. Of those who devoted 2 or 4 hours to sleep, 66.7% showed burden signs. The study also demonstrated a statistically relevant relationship -with a p = 0.0045- between the presence of burden and a Karnofsky scale value < 60%. Conclusion: There is a relationship between carer burden (whether severe or mild) and number of hours devoted to patient care, lack of recreational activities, small periods of sleep, and patient Karnofsky score (AU)

Efficiency of estrous synchronization in tropical sheep by combining short-interval cloprostenol-based protocols and "male effect".

This study assessed the efficacy of a protocol combining short-interval cloprostenol-based protocols and "male effect" for estrous synchronization in hair sheep. In Experiment 1, 24 ewes were randomly assigned to three groups (n=8) and treated with cloprostenol on Days 3, 5 and 7 after ovulation, respectively. Estradiol secretion during the follicular phase was similar among groups. Onset of estrus (P<0.001) and the timing of maximum LH concentration (P<0.01) were earlier in group D3 than in D5 and D7 groups. During the subsequent cycle, the number and size of corpora lutea were higher (P<0.05) in ewes of the groups D3 (1.9+/-0.3 and 115.1+/-14.3mm(2)) and D5 (1.8+/-0.2 and 100.2+/-11.2mm(2)) than in group D7 (1.3+/-0.2 and 75.6+/-6.4mm(2)) group. In Experiment 2, 24 ewes were treated with two cloprostenol injections (7 days apart). Twelve ewes were exposed to "male effect" previous to an isolation period (ME group), whereas the remaining ewes were controls without male exposure (CTR group). Male effect induced earlier preovulatory LH surge (P<0.05) and ovulation (P<0.001) than CTR group. In Experiment 3, the estrus was synchronized in 68 ewes. Nineteen of them (group FGA) were treated using intravaginal sponges impregnated with fluorogestone acetate for 12 days and inseminated at 55h. Forty-nine females (group ME) were treated like ME group. Twenty-four (ME48 group) and 25 ewes (ME55 group) were inseminated at 48 and 55h after treatment, respectively. The fertility rate was numerically higher in ME48 than ME55 and FGA groups (62.5, 44.0 and 47.4%, respectively). In conclusions, the combined use of short-interval cloprostenol treatment and "male effect" may be an adequate alternative for synchronizing estrus and applying artificial insemination in hair sheep throughout the entire year.

Ovarian and endocrine responses in tropical sheep treated with reduced doses of cloprostenol.

The present study aimed to assess the efficacy of reduced doses of cloprostenol for synchronizing estrus and ovulation in hair sheep. With the aim to evaluate the luteolytic activity of reduced cloprostenol doses, a first experiment was performed using a relatively large (group H: 126 microg; n=8), medium (group M: 68.25 microg; n=6) and small (group L: 38.5 microg; n=6) cloprostenol dose. Luteolysis was assessed at Days 3 and 6 after injection (Day 0) by progesterone concentrations (P(4)) and transrectal ultrasonography (US). In Experiment 2, sheep were randomly assigned to the same three doses to evaluate a protocol for estrous synchronization using two injections administered 9 days apart. A third trial was performed with ewes treated (9 days apart) with the large dose (H=126 microg; n=12) and with a small dose adjusted for facilitating volume management (LA=43.75 microg; n=12). Presence of estrous cycling was determined in all the ewes by US and P(4) assay, at Days -9, -6, -2, 0 (Day of second cloprostenol injection), 8 and 11. Bleeding and US were done every 4h from 16 h of the beginning of the estrus during the third trial to assess the preovulatory LH surge and timing of ovulation. Additionally, blood samples were drawn at Days 0, 1, 2 and 3 to assess estradiol (Experiments 2 and 3) and P(4) (Experiment 2) concentrations during the ovarian follicular phase. In all experiments, percentage of animals showing luteolysis, preovulatory follicular dynamics and function and percentage of ewes showing behavioral estrus in response to treatment was similar among groups. Timing of estrus for group H was earlier than group L (28.6+/-1.8h compared with 37.1+/-2.4h; P<0.05). In the third trial, the preovulatory LH peak was higher in the LA group than group H, in terms of maximum mean concentration during the surge (27.7+/-1.8 ng/mL compared with 21.3+/-2.2 ng/mL; P<0.05) and area under the curve (AUC; 183.4+/-12.7 ng/mL compared with 127.7+/-10.9 ng/mL; P<0.01). However, timing of ovulation was similar for H and LA groups. Thereafter, ovulation rate and luteal function at Day 11 were similar. Current results demonstrate that reduced doses of cloprostenol may be applied in a practical manner for reproductive management of sheep, with the additional advantage of reducing treatment costs.

A subcortical network of dysfunction in TLE measured by magnetic resonance spectroscopy.

OBJECTIVE: The goal of this work was to evaluate the relationship between neuronal injury/loss in the hippocampus, thalamus, and putamen in temporal lobe epilepsy (TLE) patients using (1)H magnetic resonance spectroscopic imaging. METHODS: (1)H spectroscopic images from the hippocampus and thalamus of controls and patients with TLE were acquired at 4 T. The spectroscopic imaging data were reconstructed using an automated voxel-shifting method based on anatomic landmarks providing four, six, and three loci for the hippocampus, thalamus, and putamen, respectively. For correlation analysis, the hippocampal and striatal loci were averaged to provide single estimates of the entire structure, whereas the thalamus was divided into two regions, an anterior and posterior measure, using the average of three loci each. RESULTS: The ratio of N-acetyl aspartate to creatine (NAA/Cr), a measure of neuronal injury/loss, was significantly reduced in both the ipsilateral and contralateral hippocampi and thalami. NAA/Cr in the ipsilateral hippocampus was significantly correlated with the ipsilateral and contralateral anterior and posterior thalami, putamen, and contralateral hippocampus. In control subjects, the hippocampi were only correlated with each other. CONCLUSIONS: The data demonstrate that there is significant neuronal injury/loss in both the ipsilateral and contralateral thalami in temporal lobe epilepsy patients, with greater impairment in the anterior portions of the ipsilateral thalamus. The degree of injury/loss in the ipsilateral and contralateral thalamus and putamen is directly correlated with that of the ipsilateral hippocampus. This is consistent with the hypothesis that the impairment and damage associated with recurrent seizures as measured by N-acetyl aspartate originating in the hippocampus results in injury and impairment in other subcortical structures.

Cirugía ortognática: diagnóstico, protocolo, tratamiento y complicaciones: análisis de experiencia clínica / Orthognatic surgery: diagnosis, protocol, treatment and complications: analysis of clinical experience

Los autores muestran su experiencia en el manejo de las malformaciones máxilo mandibulares por métodos ortodoncicoquirúrgicos. Presentan una casuística de 38 pacientes atendidos en el área privada agrupados por edad, sexo y categoría de diagnóstico. Se propone un esquema de estudio y tratamiento protocolizado el cual se expone en forma resumida. Se discuten los aspectos quirúrgicos con las diferentes modalidades de cirugía. Se comunican los casos considerados como complicaciones y se discuten las medidas de resolución para dichos pacientes. A manera de conclusión se entregan algunas recomendaciones para una práctica segura de la cirugía ortognática.