Correction: A foot and mouth disease ranking of risk using cattle transportation.

[This corrects the article DOI: 10.1371/journal.pone.0284180.].

Modelling and simulation of brinicle formation.

Below the Arctic sea ice, under the right conditions, a flux of icy brine flows down into the sea. The icy brine has a much lower fusion point and is denser than normal seawater. As a result, it sinks while freezing everything around it, forming an ice channel called a brinicle (also known as ice stalactite). In this paper, we develop a mathematical model for this phenomenon, assuming cylindrical symmetry. The fluid is considered to be viscous and quasi-stationary. The heat and salt transport are weakly coupled to the fluid motion and are modelled with the corresponding conservation equations, accounting for diffusive and convective effects. Finite-element discretization is employed to solve the coupled system of partial differential equations. We find that the model can capture the general behaviour of the physical system and generate brinicle-like structures while also recovering dendrite composition, which is a physically expected feature aligned with previous experimental results. This represents, to our knowledge, the first complete model proposed that captures the global structure of the physical phenomenon even though it has some discrepancies, such as brine accumulation.

El Área del Lenguaje Articulado, Perspectiva Histórica y Denominación Epónima Equívoca: Entre Dax y Broca / Articulated Language Area, Historical Perspective and Erroneous Epomy: Between Dax and Broca

El término epónimo área de Broca corresponde a una región cortical cerebral humana dedicada a la expresión del lenguaje oral y que no siempre se ubica en el giro frontal inferior del lobo frontal en el hemisferio izquierdo. Al estudiar 25 artículos del año 2022 y 25 libros de enseñanza de la neuroanatomía, neurofisiología, neurociencia o áreas asociadas del presente siglo, se estableció y cuantificó la existencia del término área de Broca encontrándose que en los libros había un 96 % de inclusión epónima sobre esta área cortical cerebral y en artículos de revista existía un 100 % del mismo epónimo, además, en ninguno de los libros y artículos se encontró un epónimo diferente. Aunque a lo largo del tiempo, en las ciencias médicas se han usado epónimos para designar estructuras anatómicas como en el caso para tratar de designar el área del cerebro que genera el lenguaje oral, este término no proporciona ninguna información descriptiva ni funcional, lo que equivale a un desatino en la lógica del pensamiento morfológico actual, además que lleva a confusión, pues hace pensar que su descubrimiento inicial fue dado por Broca, equivocando el conocimiento histórico que vincula a Marc Dax como el primero en descubrir esta zona.

SUMMARY: The eponymous Broca's area is a human cerebral cortical region that controls the expression of oral language, and which is not always located in the inferior frontal gyrus of the frontal lobe in the left hemisphere. In a study of 25 articles published in 2022, and 25 teaching books on neuroanatomy, neurophysiology, neuroscience or associated areas, it was found that the term Broca's area was established and quantified. In books there was a 96 % eponymous inclusion of this cerebral cortical area and in journal articles there was 100 % of the same eponym. Furthermore, no other eponyms were found in any of the books and articles. Although over time, eponyms have been used in medical sciences to identify anatomical structures, as in the designation of the area in the brain that controls oral language, this term does not provide any descriptive or functional information. The result is contradictory to current morphological thought and also leads to confusion, erroneously suggesting that the initial discovery was made by Broca, when in fact Marc Dax was the first to discover this area some 30 years earlier.

A foot and mouth disease ranking of risk using cattle transportation.

Foot-and-mouth disease (FMD) is a highly infectious condition that affects domestic and wild cloven-hoofed animals. This disease has substantial economic consequences. Livestock movement is one of the primary causes of disease dissemination. The centrality properties of the livestock mobilization transportation network provide valuable information for surveillance and control of FMD. However, the same transportation network can be described by different centrality descriptions, making it challenging to prioritize the most vulnerable nodes in the transportation network. This work considers the construction of a single network risk ranking, which helps prioritize disease control measurements. Results show that the proposed ranking constructed on 2016 livestock mobilization data may predict an actual outbreak reported in the Cesar (Colombia) region in 2018, with a performance measured by the area under the receiver operating characteristic curve of 0.91. This result constitutes the first quantitative evidence of the predictive capacity of livestock transportation to target FMD outbreaks. This approach may help decision-makers devise strategies to control and prevent FMD.

The role of PET-PSMA in guiding prostate cancer radiation therapy: experience in a salvage and curative setting / Radioterapia guiada por PET-PSMA en cáncer de próstata: experiencia en el escenario curativo y en el salvamento

Introduction: The role of positron emission tomography (PET) prostate-specific membrane antigen (PSMA) in guiding radiation therapy treatment plans remains to be defined. Methods: We conducted a retrospective observational study of patients with prostate cancer referred for radiotherapy. Our objective was to establish the role of PET-PSMA in decision-making and changes in the radiotherapy treatment plan. Results: In the entire cohort, 26.8% had lymph node involvement outside the conventional field. The PET results upstaged and changed radiotherapy treatment plans for 75% in primary radiotherapy and 50% in salvage radiation. Conclusions: PET-PSMA changes decision-making and treatment planning for radiotherapy, including treatment volumes not traditionally delimited in contour atlases.

Introducción: El rol del PET-PSMA para guiar los planes de radioterapia aún debe definirse. Métodos: Realizamos un estudio observacional retrospectivo de pacientes con cáncer de próstata localizado remitidos para radioterapia. Nuestro objetivo fue establecer el rol del PET-PSMA en la toma de decisiones y cambios en el plan de tratamiento de radioterapia. Resultados: En toda la cohorte el 26,8% presentaba afectación ganglionar fuera del campo convencional. Los resultados del PET cambiaron los planes de tratamiento en el 75% para radioterapia primaria y en el 50% para salvamento. Conclusiones: El PET-PSMA cambia la toma de decisiones y planificación del tratamiento de radioterapia, incluyendo volúmenes de tratamiento no delimitados tradicionalmente en los atlas de contorneo.

Mechanical ventilation in SARS-CoV-2 patients: state of art / Ventilación mecánica en pacientes con SARS - CoV-2: estado del arte

Abstract CoVID-19-associated infection leads to a pathology of yet unknown clinical behavior, confronting the clinician with various challenges. An extensive search was conducted based on review articles on SARS-CoV-2 infection and studies including mechanical ventilation management strategies in order to complete this narrative review. Evidenced-based treatment for SARS-CoV2 infection is still in the works. We have some tools from our knowledge from past experiences indicating that a step-wise management approach should be used, without neglecting other joint therapeutic measures for improved clinical outcomes of a condition with a high mortality. The current recommendations indicate that patients with severe acute respiratory failure due to SARS-CoV-2 should be managed with protective mechanical ventilation measures. No strong evidence is yet available on the individualization of mechanical ventilation therapy according to phenotypes.

Resumen La infección asociada a COVID-19 produce una patología de comportamiento aún desconocido, planteándole diversos desafíos al clínico. Para esta revisión narrativa se llevó a cabo una extensa búsqueda basada en artículos de revisión sobre la infección por SARS-CoV-2 y estudios que incluían estrategias de manejo con ventilación mecánica. El tratamiento basado en evidencia para la infección por SARS-CoV2 todavía está en desarrollo. Tenemos algunas herramientas basadas en nuestros conocimientos de experiencias en el pasado que indican que se debe usar un abordaje escalonado, sin descuidar otras medidas terapéuticas conjuntas para mejorar los desenlaces clínicos de una condición con una elevada mortalidad. Las actuales recomendaciones indican que los pacientes con falla respiratoria aguda por SARS-CoV-2 deben manejarse con medidas de protección con ventilación mecánica. Aún no tenemos una sólida evidencia sobre la individualización del tratamiento con ventilación mecánica, de acuerdo a los distintos fenotipos.

Prevalence of BRCA1 and BRCA2 Germline Mutations in Patients of African Descent with Early-Onset and Familial Colombian Breast Cancer.

BACKGROUND: Pathogenic germline mutations in the BRCA1 and BRCA2 (BRCA1/2) genes contribute to hereditary breast/ovarian cancer (OC) in White/mestizo Colombian women. As there is virtually no genetic data on breast cancer (BC) in Colombians of African descent, we conducted a comprehensive BRCA1/2 mutational analysis of 60 Afro-Colombian families affected by breast/OC. MATERIALS AND METHODS: Mutation screening of the complete BRCA1/2 genes for small-scale mutations and large genomic alterations was performed in these families using next-generation sequencing and multiplex ligation-dependent probe amplification analysis. RESULTS: Four pathogenic germline mutations, including one novel mutation, were identified, comprising 3 in BRCA1 and one in BRCA2. The prevalence of BRCA1/2 mutations, including one BRCA1 founder mutation (c.5123C>A) previously identified in this sample set, was 3.9% (2/51) in female BC-affected families and 33.3% (3/9) in those affected by both breast and OC. Haplotype analysis of 2 BRCA2_c.2701delC carriers (one Afro-Colombian and one previously identified White/mestizo Colombian patient with BC) suggested that the mutation arose in a common ancestor. CONCLUSION: Our data showed that 2/5 (40%) mutations (including the one previously identified in this sample set) are shared by White/mestizo Colombian and Afro-Colombian populations. This suggests that these 2 populations are closely related. Nevertheless, variations in the BRCA1/2 mutational spectrum among Afro-Colombian subgroups from different regions of the country were observed, suggesting that specific genetic risk assessment strategies need to be developed.

Hypofractionation as a solution to radiotherapy access in latin america: expert perspective.

Background: Limited radiation therapy resources have resulted in an interest in developing time and cost-saving innovations to expand access to cancer treatment, in Latin America. Therefore, hypofractionated radiotherapy (HRT) is a possible solution, as this modality delivers radiation over a shorter period of time. Materials and methods: A selected panel of Latin American (LA) experts in fields related to HRT were provided with a series of relevant questions to address, prior to the multi-day conference. Within this meeting, each narrative was discussed and edited, through numerous rounds of discussion, until agreement was achieved. Results: The challenges identified in increasing the adoption of HRT in LA include a lack of national and regional clinical practice guidelines and cancer registries; a lack of qualified human resources and personnel education; high up-front costs of equipment; disparate resource distribution and scarce HRT research. An analysis for these overarching challenges was developed and answered with recommendations. Conclusion: Extending the adoption of HRT in LA can provide a path forward to increase access to radiotherapy and overcome the shortage of equipment. HRT has the potential to improve population health outcomes and patient centered care, while offering comparable local control, toxicity, palliation, and late effects for multiple indications, when compared to conventional RT. Concerted efforts from all involved stakeholders are needed to overcome the barriers in adopting this strategy in LA countries. The recommendations presented in this article can serve as a plan of action for HRT adoption in other countries in a similar situation.

Large batch bench-scale dissolved air flotation system for simulating full-scale turbidity removal.

One of the expected outcomes of global warming is increased algal and cyanobacterial blooms. Based on its ability to separate algal particles, dissolved air flotation (DAF) is considered as a climate change adaptation technology for water treatment. The feasibility of DAF treatment is often assessed using DAF jar tests; however, they are not particularly good at predicting a full-scale DAF system's turbidity removals. Therefore, our group has developed a more reliable larger-diameter/larger-volume batch apparatus (LB-DAF), which was optimized by comparison with a full-scale DAF plant treating a low turbidity, highly coloured river water (SUVA ∼ 4.3). The objective of this study was to verify that the LB-DAF was capable of simulating full-scale DAF systems treating two significantly different waters. One was water from a large eutrophic bay in Lake Ontario (SUVA ∼2.6) and the second was a river water (SUVA ∼3.5). The turbidity removals achieved by the full-scale DAF systems treating these waters were compared with those for the LB-DAF tests conducted using different flocculation velocity gradients, saturated water pressures, recycle ratios and water depth to diameter ratios. The LB-DAF tests are good predictors of the full-scale DAF turbidity removals, the average difference for the two waters tested were 2% and 6%. The LB-DAF natural organic matter (NOM) removals for both waters differed by less than 1% from that measured at the corresponding treatment plants. In addition, as in our previous LB-DAF study, varying the different LB-DAF operational variables did not have a significant impact on turbidity and NOM removals.

Manejo del cáncer de próstata oligometastásico: Una perspectiva del radioterapeuta / Management of oligometastatic prostate cancer: A radiation therapist's perspective

La definición de enfermedad oligometastásica actual, corresponde a aquella enfermedad metastásica susceptible de ser tratada con una terapia ablativa - sin importar el número de lesiones -, siendo aun controvertido, si se incluye o no, el compromiso a nivel hepático. Siempre que se hace referencia a esta enfermedad, se debe subclasificar en sincrónica o metacrónica, esto debido a su pronóstico.[1] Los grupos de pronóstico en cáncer de próstata metastásico sensible a la castración se han basado en el número y distribución de metástasis. Si bien hay varios grupos, consorcios o colaboraciones que han evaluado esto como SWOG, MDACC, CHAARTED y LATITUDE, independientemente de la definición, los pacientes con pobre pronóstico o enfermedad de alto volumen, presentan desenlaces oncológicos más pobres en comparación con aquellos de bajo volumen.

The current definition of oligometastatic disease corresponds to metastatic disease that can be treated with ablative therapy - regardless of the number of lesions - and it is still controversial whether or not liver involvement is included. Whenever reference is made to this disease, it should be subclassified into synchronous or metachronous, due to its prognosis.[1]. Prognostic groups in metastatic castration-sensitive prostate cancer have been based on the number and distribution of metastases. While there are several groups, consortia or collaborations that have evaluated this such as SWOG, MDACC, CHAARTED and LATITUDE, regardless of the definition, patients with poor prognosis or high volume disease have poorer oncologic outcomes compared to those with low volume.

Urological Cancer Treatment by a Multidisciplinary Teamthroughout the Covid-19 Pandemic: What Have We Learned? / Tratamiento del cáncer urológico por un equipo multidisciplinario durante la pandemia de Covid-19: ¿Qué hemos aprendido?

Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the Covid-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayed treatment may have consequences regarding the patient's oncological outcomes. The aim of the present article is to report our experience throughout the Covid-19 pandemic treating patients with urological neoplasms at a high-volume center. Methods We used a convenience sampling method. Cases were evaluated and discussed on an individual basis at the MDT meetings, and, after a consensus regarding delaying or scheduling treatment, patients were scheduled according to the risk of postponing the procedures. The Medically Necessary, Time-Sensitive (MeNTS) scoring system was measured in each patient; all patients answered the Centers for Disease Control and Prevention (CDC) Covid-19 self-screening questionnaire prior to surgery. The Covid-19-free survival rate was estimated. Results A total of 194 patients were assessed by themultidisciplinary team and finally treated, with median follow-up of 4 (interquartile range [IQR]: 2.75 to 6) months. Only two patients had Covid-19 confirmed by real-time polymerase chain reaction (RT-PCR). In total, 54 patients underwent oncological surgery, 129 were treated with radiotherapy, and 11 were treated with intravenous chemotherapy. Themedian age was 66 years (IQR: 59 to 94 years), and the median MeNTS score in the surgically-treated cohort was 35 points (IQR: 31 to 47 points). Conclusions The evaluation and treatment of urological cancer should be conducted by an MDT; this is of utmost importance, especially during the Covid-19 pandemic. The data collected in our institution showed that most patients could be safely treated by taking all necessary precautions and discussing each case individually in the MDT meetings and performing a close follow-up.

Introduccion La atención del cáncer se aborda mejor con un equipo multidisciplinario (EMD), aspecto que se tornó más importante en la pandemia por Covid-19, en que las opciones para tratar el cáncer urológico están influenciadas por muchos factores. En algunos casos, el tratamiento retrasado puede tener consecuencias en los resultados oncológicos del paciente. El objetivo de este estudio es describir nuestra experiencia en un centro de referencia y de alto volumen para el tratamiento de neoplasias urológicas durante la pandemia por Covid-19. Métodos Realizamos un muestreo por conveniencia. Posteriormente, los casos fueron evaluados y discutidos de forma individual en las reuniones del EMD. Posterior a la obtención de un consenso sobre el tratamiento del paciente, los pacientes fueron programados según el riesgo individual de posponer el manejo. Se midió la puntuación de cada paciente en el sistema Medically Necessary Time-Sensitive (MeNTS, "Médicamente necesario, sensibles al tiempo"). Todos los pacientes respondieron el cuestionario de autoevaluación del Centers for Disease Control and Prevention (CDC) COVID-19 antes de la cirugía. Se estimó la tasa de supervivencia libre de Covid-19. Resultados Un total de 194 pacientes fueron evaluados por el EMD y finalmente tratados, con una mediana de seguimiento de 4 (rango intercuartil [RIC]: 2,75 a 6) meses. Solo dos tenían Covid-19 confirmado por reacción en cadena de la polimerasa en tiempo real (RCP-TR). Un total de 54 pacientes fueron sometidos a cirugía oncológica, 129 fueron tratados con radioterapia, y 11 fueron tratados con quimioterapia intravenosa. La mediana de edad fue de 66 años (RIC: 59 a 94 años), la puntuación mediana en el MeNTS de la cohorte tratada quirúrgicamente fue de 35 puntos (RIC: 31 a 47 puntos). Conclusiones La evaluación y el tratamiento del cáncer urológico debe ser realizado por un EMD durante la pandemia de Covid-19. Los datos recopilados en nuestra institución mostraron que la mayoría de los pacientes podrían ser tratados de manera segura, discutiendo cada caso individualmente y haciendo un seguimiento cercano.

Inestabilidad microsatelital y cáncer gástrico / Microsatellite instability and gastric cancer

La inestabilidad microsatelital es causada por una alteración de los sistemas de reparación de apareamiento incorrecto, que puede afectar los microsatélites dentro de todo el genoma humano, produciendo errores en su replicación. Los estudios publicados, principalmente en la literatura inglesa, han encontrado que algunos tumores, como los gástricos, pueden expresar inestabilidad microsatelital. En la siguiente revisión de tema, se presenta una descripción de los sistemas de reparación de apareamientos incorrectos y su relación con la presencia de inestabilidad microsatelital en los tumores gástricos, así como su posible utilidad clínica, como factor asociado en la respuesta al tratamiento con inmunoterapia en los pacientes con dicha patología

Microsatellite instability is caused by an alteration of the mismatch repair systems, which can affect microsatellites within the entire human genome, causing errors in their replication. Published studies, mainly in the English literature, have found that some tumors, such as gastric ones, can express microsatellite instability. In this review, a description of the mismatch repair systems and their relationship with the presence of microsatellite instability in gastric tumors is presented, as well as its possible clinical utility, as an associated factor in the response to immunotherapy treatment, in patients with gastric cancer

Relación del consumo de VO2pico y el porcentaje de masa muscular en adultos que habitan sobre 2600 M. S. N. M / relationship of vo2 max consumption and muscle mass amiong adults living in altitudes over 2600 MAMSL

Introducción: la reducción de la capacidad oxidativa del músculo con el envejecimiento parece jugar un papel importante en la vejez disminuyendo hasta 50%. En zonas elevadas sobre el nivel del mar se producen cambios en la dinámica del oxígeno arterial que se relacionan con el metabolismo del músculo y la sarcopenia. Objetivos: determinar si hay relación entre el VO2pico y el porcentaje de masa muscular, nivel de actividad física e IMC, en adultos que habitan en regiones superiores a 2600 metros sobre el nivel del mar. Metodología: estudio descriptivo de tipo transversal, se incluyeron participantes sin sarcopenia mayores de 50 años, con mínimo un año de residencia en Bogotá, Colombia. Se excluyeron participantes con terapia de reemplazo hormonal, tensión arterial elevada durante la prueba, enfermedad coronaria, valvular o trastornos de la conducción. Se determinó el nivel de actividad física aplicando la encuesta Ainsworthy col, la composición corporal con bioimpedanciometría y VO2pico mediante ergoespirometría. Resultados: la muestra fue de 21 participantes. La mitad de lapoblación mostró VO2pico de 23.7 ml/k/min, IMC de 27.2g/m2 y porcentaje de masa muscular de 35.5%; hay baja correlación entre VO2pico y el porcentaje de masa muscular. La mitad de la población saludable tiene un VO2pico de 28.9 ml/k/min, sedentaria saludable 23.7 ml/k/min y sedentaria riesgosa 21.6 ml/k/min. Conclusiones: el presente estudio mostró que hay baja correlación entre el porcentaje de masa muscular y el VO2pico, sin embargo estos resultados pudieron estar influenciados por el tamaño de la muestra y otros factores.

Introduction: the decrease of muscle oxidative capacity with aging appears to play an important role in old age and is observed to decline by 50%. Changes in arterial oxygen dynamics related to muscle metabolism and sarcopenia are evidenced in high altitudes. Objectives: to determine if there is a relationship between VO2max and muscle mass, physical activity and BMI, in adults living in altitudes over 2600 MAMSL. Methodology: descriptive cross-sectional study in older than 50 years subjects without sarcopenia, who had lived in Bogota, Colombia for at least one year. Subjects with hormone replacement therapy or high blood pressure during this test, coronary artery or valvular heart disease or conduction disorders, were excluded. Physical activity was determined applying the Ainsworthy et al. survey, body composition by bioelectrical impedance analysis and VO2max by ergospirometry. Results: sample size was 21 participants. Half of the population showed a VO2max of 23.7 ml/k/min, BMI of 27.2g/m2 and muscle mass of 35.5%. A low correlation between VO2max and muscle mass was evidenced. Half of the healthy population had a VO2max of 28.9 ml/k/min, healthy sedentary subjects 23.7 ml/k/min and sedentary subjects with risk factors 21.6 ml/k/min. Conclusions: this study showed a low correlation between muscle mass and VO2max. However, these results could have been influenced by the sample size and other factors.

Radiation Oncology Workforce in Colombia.

Colombia is experiencing an epidemiologic transition, with an increasing incidence of cancerous neoplasms prevalent in high-income countries, while infection-associated tumors remain highly prevalent. According to international standards, Colombia has a deficit of radiotherapy machines (a shortage of about 47 machines) and radiation oncology specialists (a shortage of about 19 to 149 specialists based on number of centers and incident cases, respectively) to meet the national demand, which may induce an inappropriate dynamic in radiation oncology services. Estimates based on cancer incidence trends and the rate of new specialists in radiation oncology expected to graduate per year suggest that the current deficit will remain unchanged or may even increase during the next decades. The situation is critical because of the existence of a single training program in the country for a population of 45 million inhabitants and the low availability of educational programs offered in the Latin American region to cover the national demand. A comprehensive analysis of radiotherapy services should include data on medical physicists, radiotherapists, and the oncology nursing workforce; however, we found no reliable information available. A better balance between the educational programs offered and the demand for radiotherapy is highly valuable.

Oxidative stress in endothelial cells induced by the serum of women with different clinical manifestations of the antiphospholipid syndrome / Estrés oxidativo en células endoteliales inducido por el suero de mujeres con diferentes manifestaciones clínicas del síndrome antifosfolípido

Introduction: The antiphospholipid syndrome is characterized by the persistent presence of antiphospholipid antibodies and clinical manifestations of thrombosis or gestational morbidity that are associated with oxidative stress and endothelial dysfunction. Objective: To evaluate markers of oxidative stress in endothelial cells induced by the serum from women with different clinical manifestations of the antiphospholipid syndrome, and to analyze the antioxidant capacity of the sera. Materials and methods: We included 48 women who were classified as follows: presence of antiphospholipid antibodies and clinical criteria of gestational morbidity alone, vascular thrombosis only, and gestational morbidity/vascular thrombosis. Control groups included antiphospholipid antibodies negative women. In an in vitro model of endothelial cells stimulated with sera from women included in the groups, some markers of oxidative stress were determined by flow cytometry. The antioxidant capacity in the sera of these women was analyzed. Results: The sera from the groups of women with antiphospholipid syndrome that presented thrombosis, with or without gestational morbidity, generated a significant increase (p<0.05 and p<0.001) in endothelial oxidative stress markers in contrast to the control of normal human serum. There were no differences in the effect of the sera from the different study groups on endothelial lipid peroxidation. Also, there was also no difference in the antioxidant activity of the sera. Conclusion: Mitochondrial oxidative stress in the endothelium is associated with the presence of thrombosis; instead, its association with gestational morbidity generates intracellular oxidative stress.

Introducción. El síndrome antifosfolípido se caracteriza por la presencia persistente de anticuerpos antifosfolípidos y manifestaciones clínicas de trombosis o morbilidad gestacional, las cuales se asocian con estrés oxidativo y disfunción endotelial. Objetivo. Evaluar los marcadores de estrés oxidativo en células endoteliales, inducidos por el suero de mujeres con diferentes manifestaciones clínicas del síndrome antifosfolípido y analizar la capacidad antioxidante de los sueros. Materiales y métodos. Se incluyeron 48 mujeres que fueron clasificadas así: presencia de anticuerpos antifosfolípidos y criterios clínicos de morbilidad gestacional, trombosis vascular o ambas. Como grupos control se incluyeron mujeres negativas para anticuerpos antifosfolípidos. En un modelo in vitro de células endoteliales estimuladas con los sueros de las mujeres del estudio, se determinaron algunos marcadores de estrés oxidativo por citometría de flujo. También, se analizó la capacidad antioxidante de los sueros incluidos. Resultados. Los sueros de los grupos de mujeres con síndrome antifosfolípido que presentaban trombosis, con morbilidad gestacional o sin ella, generaron un incremento significativo (p<0,05 y p<0,001) en los marcadores de estrés oxidativo endotelial, en contraste con el control de suero humano normal. No se observaron diferencias en el efecto de los sueros de los diferentes grupos de estudio sobre la lipoperoxidación endotelial. Tampoco se encontró diferencia en la actividad antioxidante de los sueros. Conclusión. El estrés oxidativo mitocondrial en el endotelio se asocia con la presencia de trombosis. Sin embargo, cuando esta se asocia con morbilidad gestacional, también se genera estrés oxidativo intracelular.

Cystic trigeminal schwannomas.

Trigeminal Schwannomas are less than 1% of intracranial tumors, of which only 7% have a cystic component. We documented 2 cases of males with cystic trigeminal Schwannomas, their symptoms, the diagnosis process and the imaging characteristics. In addition, a review of the literature is performed, with emphasis on the radiological classification of this rare entity, that constitutes a diagnostic challenge for the radiologist, who has an essential role in the approach to the disease and therefore in its management.

Acute Hemoptysis Redefined: A Deadly Presentation.

An aortic aneurysm is a permanent localized arterial dilation with more than 50% of the artery diameter. Among the complications of an aortic aneurysm, one of the rarest is the aorto-bronchial fistula, which presents with massive hemoptysis; this condition is lethal if not treated surgically. We report a 90-year-old man with no significant medical history who presented to the emergency department with abrupt onset of hemoptysis; his chest X-ray displayed left upper lobe opacity with widened mediastinum. CT chest revealed aneurysmatic dilatation of the aorta, left upper lobe opacity suspicious of pulmonary aortic fistula. Thoracic surgery was consulted but due to his poor functional status surgery was deferred. On the second day of hospitalization, the patient developed another episode of massive hemoptysis resulting in hypovolemic shock and expired. This case epitomizes the relevance of broad differential diagnosis for hemoptysis and the prompt assessment and management of the patients with this condition.

Left ventricle and systemic air embolism after percutaneous lung biopsy.

BACKGROUND: Systemic arterial air embolism following a percutaneous transthoracic lung biopsy is a rare but known complication, with current literature reporting an incidence of 0.01-0.45%. A prompt diagnosis of arterial air embolism is important as complications resulting from migration of air to the systemic circulation with correspondent complications. CASE REPORT: A 60-year-old female who presented for an elective percutaneous lung biopsy of an incidentally found pulmonary nodule. The procedure was performed, following the completion of the procedure the patient experiment syncopal symptoms and was diagnosed by CT scan with Left ventricular air embolism, subsequently transferred to Intensive care unit for medical attention, she was placed on right lateral decubitus Trendelenburg for 24 hours and administer 100% oxygen via a nonrebreather mask. Repeat chest CT the following day revealed complete resolution of her intracardiac free air. CONCLUSION: Although systemic arterial air embolism remains a rare complication of percutaneous lung biopsies, recognition prevents potential mortality which can develop due to neurological and cardiac complications. Close vigilance in the intensive care unit is recommended and hyperbaric chamber when appropriate.

Bilateral thigh methicillin-resistant Staphylococcus aureus necrotising fasciitis in a man with newly diagnosed Human Immunodeficiency Virus (HIV).

Methicillin-resistant Staphylococcus aureus (MRSA) necrotising fasciitis (NF) is rare and constitutes a medical and surgical emergency. We report a case of a 53-year-old man with type-2 diabetes mellitus and newly diagnosed HIV infection who presented with 1 week of progressively worsening bilateral sharp thigh pain. On presentation, he was febrile, tachycardic and had bilateral thigh erythema and mild tenderness without open wounds. He had leucocytosis, lactic acidosis and acute kidney injury. Urgent incision and drainage (I&D) was performed for suspected NF. Blood cultures and I&D were positive for MRSA. Biopsy of bilateral thighs showed NF. He was treated with wound washout and 6 weeks of intravenous antibiotics. After undergoing skin graft for wounds, he was discharged to physical rehabilitation. Here we report severe sepsis from bilateral thigh MRSA NF in a patient with newly diagnosed HIV.

Burkitt's Lymphoma of the Rectosigmoid and Stomach Presenting as Hematochezia.

BACKGROUND: Burkitt's lymphoma (BL) is an uncommon cause of non-Hodgkin lymphoma in adults and accounts for only 0.1-0.5% of all malignant tumors of the colon and rectum. Very few cases of rectosigmoid and stomach BL have been reported in adults. CASE REPORT: A 51-year-old Hispanic woman presented with a 1-month history of hematochezia, associated with a foreign-body sensation in the rectum and 7 kg weight loss. Initial laboratory workup showed normocytic anemia and positive fecal occult blood. Computed tomography of the abdomen revealed an asymmetric appearance of the stomach and pylorus with nodularity of the mucosa and thickening of the posterior wall, and a 10.8-cm rectal mass. Esophagogastroduodenoscopy and colonoscopy were performed and biopsies of the stomach and rectum were obtained; histopathology demonstrated involvement by Burkitt's lymphoma in the gastric body nodule and rectal mass. After 4 cycles of chemotherapy, a follow-up abdominal CT demonstrated complete resolution of the mural thickening of the rectum and no intra-abdominal lymphadenopathy. CONCLUSIONS: Our case illustrates the importance of considering BL in the extensive differential diagnosis of rectal bleeding, change in bowel habits, and other lower and upper GI symptoms, since the rapidly growing nature of this rare malignancy requires a prompt diagnosis and initiation of appropriate therapy.