5-Year management and outcomes of penetrating neck injury in a trauma center. Penetrating neck injury / Manejo y resultados de trauma penetrante de cuello en 5 años dentro de un centro de urgencias. Trauma penetrante de cuello

Background Penetrating neck injuries represent 5–10% of all traumatic injuries, these bring with them a high rate of morbidity and mortality due to vital structures that could be injured in this area. The aim of this study was to determine the epidemiological and clinical characteristics of penetrating neck injuries. Methods This was a retrospective, unicentric and descriptive study that included all patients who underwent neck exploration surgery. Results A total of 70 neck exploration cases were reviewed, 34 (49%) didn’t had any injury. Thirty (43%) had at least one hard sign, 42 (60%) patients showed at least one soft sign. Statistical analysis showed only surgical time (252±199.5 vs. 155±76.4; p=0.020) and transfusions (1.87±3 vs. 0.4±0.856; p=0.013) were statistically significant. We report a mortality of 2 (3%) patients. Conclusions Our prevalence of neck surgical exploration without vascular injury was slightly higher (49% vs. 40%) than literature. We highlight the importance of not performing neck explorations in all patients who present a penetrating injury. We did not obtain differences between groups for hard signs and soft signs. We were not able to identify whether or not there would be an injury based on clinical characteristics. Imaging studies should be performed to avoid unnecessary neck explorations; however, depending on the clinical scenario some surgery cannot be avoided (AU)

Antecedentes Las lesiones penetrantes de cuello representan entre el 5-10% de todas las lesiones traumáticas, estas traen consigo una alta tasa de morbimortalidad por estructuras vitales que podrían lesionarse en esta área. El propósito de este estudio fue determinar las características epidemiológicas y clínicas del trauma penetrante de cuello. Métodos Estudio retrospectivo, unicéntrico y descriptivo que incluyó a todos los pacientes sometidos a cirugía de exploración de cuello. Resultados Se revisaron un total de 70 casos de exploración de cuello, 34 pacientes (49%) no presentaron ninguna lesión. Treinta pacientes (43%) tenían al menos un signo duro, 42 pacientes (60%) mostraron al menos un signo blando. El análisis estadístico mostró que solo el tiempo quirúrgico (252±199,5 vs. 155±76,4; p=0,020) y las transfusiones (1,87±3 vs, 0,4±0,856; p=0,013) fueron estadísticamente significativas. Reportamos la mortalidad de 2 pacientes (3%). Conclusiones Nuestra prevalencia de exploración quirúrgica de cuello sin lesión vascular fue ligeramente superior (49 vs. 40%) que la literatura. Destacamos la importancia de no realizar exploraciones de cuello en todos los pacientes que presentan una lesión penetrante. No obtuvimos diferencias entre grupos para signos duros y signos blandos. No pudimos identificar si hubiera o no una lesión en función de las características clínicas. Se deben realizar estudios de imagen para evitar exploraciones innecesarias del cuello; sin embargo, dependiendo del escenario clínico, no se pueden evitar algunas cirugías (AU)

[Evaluation of the Aspergillus Galactomannan ag VircliaR Monotest test as an alternative to Platelia™ Aspergillus EIA kit]. / Evaluación de la prueba Aspergillus Galactomannan Ag VircliaR Monotest como alternativa a kit Platelia™ Aspergillus EIA.

BACKGROUND: The Aspergillus Galactomannan Ag Virclia® (GMVClia) test is a monotest and automated galactomannan technique based on chemiluminescent immunoassay (CLIA). AIM: To evaluate the performance of the GM-VClia test in serum and bronchioalveolar lavage (BAL) samples previously processed with the Platelia ™ Aspergillus EIA kit (GM-Plat). METHODS: 56 samples of serum 40 from BAL (some of them with galactomaman determination in both samples), from patients with pulmonary diseases, hematological diseases, SLE, Covid-19 and tumors, among others, were studied. Thirteen patients had invasive aspergillosis (1 proven and 12 probable). RESULTS: The correlation between both methods for serum and BAL was r = 0.8861 p < 0.0001 and r = 0.6368 p < 0.001, respectively. There was a global concordance of 67.7% (65/96), being 85.7% (48/56) in sera and 42.5.0% (14/49) in BAL. By raising the cut-off point in LBA by GM-VClia, the agreement increased to 85.7%. CONCLUSION: A greater correlation and concordance was observed in sera than in BAL. The GM-VClia kit had a higher sensitivity and NPV than the GM-Plat kit. The disadvantages of GM-VClia are the "doubtful" category, which makes interpretation difficult and that with the current cut-off points in LBA the correlation with GM-Plat is lower. The advantages are its greater sensitivity, ease of processing and faster results.

Evaluación de la prueba Aspergillus Galactomannan Ag VircliaR Monotest como alternativa a kit Platelia ™ Aspergillus EIA / Evaluation of the Aspergillus Galactomannan ag VircliaR Monotest test as an alternative to Platelia™ Aspergillus EIA kit

INTRODUCCIÓN: La prueba Aspergillus galactomannan Ag Virclia® (GM-VClia) es una técnica de galactomanano monotest, auto-matizada, basada en inmunoensayo quimioluminiscente (CLIA). OBJETIVO: Evaluar el desempeño del test de GM-VClia en muestras de suero y lavado bronquioalveolar (LBA) procesadas previamente con el kit Platelia™ Aspergillus EIA (GM-Plat). MATERIALES Y MÉTODOS: Se estudiaron 56 muestras de suero y 40 de LBA, correspondientes a un total de 59 pacientes (algunos con determinación de galactomamano en ambas muestras) con enfermedades pulmonares, hematológicas, LES, Covid-19 y tumores, entre otros. Trece pacientes tuvieron aspergilosis invasora (1 probada y 12 probables). RESULTADOS: La correlación entre ambos métodos para suero y LBA fue r = 0,8861 p < 0,0001 y r = 0,6368 p < 0,001, respectivamente. Hubo una concordancia global de 67,7% (65/96), siendo de 85,7% (48/56) en sueros y 42,5,0% (14/49) en LBA. Al subir el punto de corte en LBA por GM-VClia la concordancia aumentó a 85,7%. CONCLUSIONES: Se observó una mayor correlación y concordancia en sueros que en LBA. El kit GM-VClia presentó una mayor sensibilidad y valor predictor negativo (VPN), que el kit GM-Plat. Las desventajas de GM-VClia, la constituyen la categoría "dudoso", que dificulta la interpretación y que, con los puntos de corte actuales en LBA, la correlación con GM-Plat es menor. Las ventajas son su mayor sensibilidad, facilidad de procesamiento y una mayor rapidez en los resultados.

BACKGROUND: The Aspergillus Galactomannan Ag Virclia® (GMVClia) test is a monotest and automated galactomannan technique based on chemiluminescent immunoassay (CLIA). AIM: To evaluate the performance of the GM-VClia test in serum and bronchioalveolar lavage (BAL) samples previously processed with the Platelia ™ Aspergillus EIA kit (GM-Plat). METHODS: 56 samples of serum 40 from BAL (some of them with galactomaman determination in both samples), from patients with pulmonary diseases, hematological diseases, SLE, Covid-19 and tumors, among others, were studied. Thirteen patients had invasive aspergillosis (1 proven and 12 probable). RESULTS: The correlation between both methods for serum and BAL was r = 0.8861 p < 0.0001 and r = 0.6368 p < 0.001, respectively. There was a global concordance of 67.7% (65/96), being 85.7% (48/56) in sera and 42.5.0% (14/49) in BAL. By raising the cut-off point in LBA by GM-VClia, the agreement increased to 85.7%. CONCLUSION: A greater correlation and concordance was observed in sera than in BAL. The GM-VClia kit had a higher sensitivity and NPV than the GM-Plat kit. The disadvantages of GM-VClia are the "doubtful" category, which makes interpretation difficult and that with the current cut-off points in LBA the correlation with GM-Plat is lower. The advantages are its greater sensitivity, ease of processing and faster results.

Simplified biplanar (0-90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve.

PURPOSE: To evaluate the learning curve of the simplified fluoroscopic biplanar (0-90º) puncture technique for percutaneous nephrolithotomy. METHODS: We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution's fellows employing the simplified bi-planar (0-90º) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon. RESULTS: Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon. Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures. CONCLUSION: This study suggests that with the simplified biplanar (0-90º) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.

A protocol for online documentation of spider biodiversity inventories applied to a Mexican tropical wet forest (Araneae, Araneomorphae).

Spider community inventories have relatively well-established standardized collecting protocols. Such protocols set rules for the orderly acquisition of samples to estimate community parameters and to establish comparisons between areas. These methods have been tested worldwide, providing useful data for inventory planning and optimal sampling allocation efforts. The taxonomic counterpart of biodiversity inventories has received considerably less attention. Species lists and their relative abundances are the only link between the community parameters resulting from a biotic inventory and the biology of the species that live there. However, this connection is lost or speculative at best for species only partially identified (e. g., to genus but not to species). This link is particularly important for diverse tropical regions were many taxa are undescribed or little known such as spiders. One approach to this problem has been the development of biodiversity inventory websites that document the morphology of the species with digital images organized as standard views. Their main contributions are the dissemination of phenotypic data for species difficult to identify or new with the assignment of species codes, allowing species comparisons between areas regardless of their taxonomic status. The present paper describes a protocol to produce these websites almost automatically. This protocol was successfully applied to 237 species from a tropical primary forest in Mexico. The time and infrastructure required for the documentation of these species are discussed. Taxonomic information in terms of identification challenges, possible new species, and potential nomenclatural issues is described. In addition, the conventional community parameters (e. g., inventory completeness, species richness estimations, sampling intensity) are also calculated and compared through time and between methods. An optimized version for sampling allocation effort per season is presented and compared with protocols optimized for other tropical forests.

Efectos de la espasticidad en la recuperación motora posterior a un ACV / Effects of spasticity on motor recovery after a stroke

Resumen Antecedentes: el proceso rehabilitador orientado a la recuperación motora posterior a un Ataque Cerebro Vascular (ACV), es un proceso complejo asociado con la aparición de signos positivos y negativos posterior a un daño de moto neurona superior (MNS). Objetivo: describir cuales son las efectos de la espasticidad en el proceso rehabilitador posterior a un ACV. Material y método: se realizó una revisión narrativa, a través de un plan de búsqueda por parte de tres revisores, explorando la base de datos PubMed, donde se utilizaron los términos MesH: Spasticity AND Motor Recovery AND Stroke, los límites de búsqueda fueron revisiones y ensayos clínicos en humanos y animales, publicados en los últimos 10 años con textos completos en inglés y español. Resultado: 71 artículos que cumplían con los criterios de búsqueda, fueron identificados, se seleccionaron 21 (16 ensayos clínicos y 5 revisiones), los que fueron analizados a través de las guías Caspe y se utilizaron para la confección de esta revisión. Conclusión: si bien existe amplia evidencia científica, esta no es concluyente, planteando que la espasticidad es fuente de compromiso funcional y discapacidad, pero no siempre es perjudicial, ya sus efectos pueden ser beneficiosos y en ocasiones no necesita tratamiento.

Background and Aim: The rehabilitation process oriented to motor recovery after a stroke is a complex process associated with the appearance of positive and negative signs after motor neuron damage. The aim was to describe the effects of spasticity in the rehabilitation process after a stroke. Methods: Three reviewers, exploring the PubMed database, carried out, a narrative review through a search plan, the terms MesH: Spasticity AND Motor Recovery AND Stroke were used; the search limits were reviews and clinical trials in humans and animals, published in the last 10 years with full texts in English and Spanish. Results: Seventy-one articles that met the search criteria were identified, 21 were selected (16 clinical trials and 5 reviews), which were analyzed through the CASPE guide and used for the preparation of this review. Conclusion: Although there is broad scientific evidence, this is not conclusive, stating that spasticity is a source of functional commitment and disability, but it is not always harmful, and its effects can be beneficial and sometimes do not need treatment.

New species of the orb-weaving spider genus Chrysometa (Araneae, Tetragnathidae) from oak forests near of the Pico de Orizaba National Park (Veracruz, Mexico).

Seven new species of the genus Chrysometa Simon are described: C. citlaltepetl n. sp., C. triangulosa n. sp., C. rosarium n. sp., C. atotonilco n. sp., C. xamaticpac n. sp. C. puya n. sp. and C. sagicuta n. sp. Species identities were evaluated and sexes for each species matched with a fragment of the cytochrome c oxidase subunit I. These data were analyzed with maximum likelihood and the resulting cladograms separated all species with high support values (95-100) and an average distance of 0.093 %. The genetic signal also agreed with the diagnostic morphological features used to separate these taxa. The sex matching results discovered that the female of C. chipinque Levi actually belongs to C. puya n. sp.; the correct female of C. chipinque is here described for the first time. A redescription of the male of C. chipinque and the female of C. puya is also provided. All species were collected as part of a faunistic inventory from two oak forests near Pico de Orizaba Volcano National Park. A total of 399 adult specimens, 209 females and 195 males, were sorted and identified. Most individuals were collected from medium height vegetation by beating trays and from high vegetation by direct collecting at night. High resolution images for all species are available at www.unamfcaracnolab.com. Finally, the functional anatomy of the epigynum for the species described here is discussed.

Analysis of pelletizing from corn cob waste.

In recent years, biomass market has constantly increased. Pellet industry has started looking for new products with the potential to be used as biofuels. Among them are agricultural wastes, such as corn cob waste, which presents some characteristics that make its direct use in industrial facilities possible. However, these properties are not enough for its use in domestic stoves and boilers, where higher quality of fuel is needed. For this reason, densification is used. In the present research work a technical and energy analysis of corn cob waste pelletizing was carried out in a semi-industrial pelletizer. Some relationships between variables, such as moisture, bulk density and mechanical durability, were analyzed, as well as their influence on energy use and final productivity. The results were satisfactory, as the pellets manufactured fulfilled with most specifications that were consulted, with higher values than those recorded for similar kinds of pellets. Concerning the energy study, the increase in production justified a higher energy consumption of the process in order to get a higher productivity ratio.

Acanthocotyle gurgesiella n. sp. (Monogenea: Acanthocotylidae) from the deep-sea skate Gurgesiella furvescens (Rajidae) in the south-eastern Pacific.

Little is known about the diversity of parasites of the deep-sea fish of the world's oceans. Here, a new species of monogenean parasite of the deep-sea skate Gurgesiella furvescens is described. Specimens of parasites were obtained from the skin of two specimens of the dusky finless skate, G. furvescens (Rajidae), in the vicinity of Valparaiso (33°S, 72°W), central Chile, from midwater trawl fishing at depths of 350-450 m. Both morphological and molecular analyses were conducted to provide a full description of the new species, named Acanthocotyle gurgesiella. For the molecular analyses, nuclear large subunit (LSU) rDNA and the mitochondrial gene cytochrome c oxidase 1 (COI) were used. From the morphological analysis and a comparison with the known species of the genus, A. gurgesiella can be identified by a combination of morphological characteristics, including the number of testes, number of radial rows of sclerites in the pseudohaptor, aperture of the genital pore and shape of the vitelline follicles. The results from the DNA analysis indicated that A. gurgesiella has a genetic divergence of 3.2-3.7% (LSU rDNA gene) from A. urolophi, the only congener species for which molecular data are available.

Perforación espontánea de aorta infrarrenal por úlcera ateroesclerótica. Reporte de un caso / Spontaneous rupture of infrarenal aorta due to an atheroesclerotic ulcer. Case report

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Outcomes and Surgical Complications in Kidney Transplantation.

BACKGROUND: Kidney transplantation is the most cost-effective therapy for end-stage renal disease. Post-operative complications account for 15%-17% of all cases and are associated with significant morbidity. Currently 4.8% of post-transplantation patients have returned to dialysis. Our center's main transplant origin is cadaveric donation. OBJECTIVE: To review surgical complications of kidney transplantation over the past 5 years. METHODS: This was an observational descriptive study that included all patients from 2011 to 2015. RESULTS: A total of 55 cases were reviewed. Diabetic nephropathy was the etiology in 30.9% of cases. Post-surgical complications occurred in 12.7% of patients with a post-operative mortality of 4%. Graft survival at 1 year was 82.4% with a 91% 1-year patient survival. CONCLUSION: Early identification and treatment of surgical complications are critical for patient and graft survival. Complications are low but significant.

Role of membrane GM1 on early neuronal membrane actions of Aß during onset of Alzheimer's disease.

The ability of beta-amyloid peptide (Aß) to disrupt the plasma membrane through formation of pores and membrane breakage has been previously described. However, the molecular determinants for these effects are largely unknown. In this study, we examined if the association and subsequent membrane perforation induced by Aß was dependent on GM1 levels. Pretreatment of hippocampal neurons with D-PDMP decreased GM1 and Aß clustering at the membrane (Aß fluorescent-punctas/20µm, control=16.2±1.1 vs. D-PDMP=6.4±0.4, p<0.001). Interestingly, membrane perforation with Aß occurred with a slower time course when the GM1 content was diminished (time to establish perforated configuration (TEPC) (min): control=7.8±2 vs. low GM1=12.1±0.5, p<0.01), suggesting that the presence of GM1 in the membrane can modulate the distribution and the membrane perforation by Aß. On the other hand, increasing GM1 facilitated the membrane perforation (TEPC: control=7.8±2 vs. GM1=6.2±1min, p<0.05). Additionally, using Cholera Toxin Subunit-B (CTB) to block the interaction of Aß with GM1 attenuated membrane perforation significantly. Furthermore, pretreatment with CTB decreased the membrane association of Aß (fluorescent-punctas/20µm, Aß: control=14.8±2.5 vs. CTB=8±1.4, p<0.05), suggesting that GM1 also plays a role in both association of Aß with the membrane and in perforation. In addition, blockade of the Aß association with CTB inhibited synaptotoxicity. Taken together, our results strongly suggest that membrane lipid composition can affect the ability of Aß to associate and subsequently perforate the plasma membrane thereby modulating its neurotoxicity in hippocampal neurons.

Epidemiología y evolución perioperatoria de lesión vascular periférica en civiles por trauma penetrante durante una década / Epidemiology and outcomes for civilian peripheral vascular injury in penetrating trauma during a decade

Introducción: Las lesiones causadas por trauma penetrante son una de las principales causas de morbimortalidad en todo el mundo. Para una gestión eficiente y un tratamiento adecuado, es esencial lograr una rápida detección, localización y caracterización de la lesión. Objetivo: Determinar la epidemiología y revisar el manejo perioperatorio de lesiones vasculares periféricas en extremidades durante una década. Material y métodos: Se utilizaron datos de 2006-2015 de un hospital universitario con pacientes con diagnóstico de lesión vascular en extremidades. Resultados: Se reportó un total de 110 casos. En 26 de los pacientes (23,6%) la lesión fue causada por una herida por arma punzo cortante y en 84 pacientes (76,4%) por proyectil de arma de fuego. El sitio lesionado más común fue la extremidad inferior. Veintiséis pacientes (23,6%) no mostraron lesión durante la angiografía. Se identificaron un total de 150 lesiones vasculares. Conclusiones: La arteria más comúnmente lesionada fue la femoral. Los factores predictivos de las lesiones estadísticamente significativos fueron la puntuación de la gravedad de la lesión, el grado de choque y los pacientes con lesiones múltiples. Seis amputaciones reportadas coinciden con un trauma severo. La ausencia de signos duros no descarta la posibilidad de lesión arterial. Se recomienda la reparación con injerto de safena invertido para las lesiones no reparables de manera primaria (AU)

Background: Penetrating trauma injuries are a leading cause of morbidity and mortality worldwide. For efficient management and appropriate treatment, the injuries need to be rapidly detected, located, and characterised. Objective: To describe the epidemiology and review the management of vascular injuries over a 10-year period. Material and methods: Data were used from patients with a diagnosis of vascular injury in extremities between 2006 and 2015 from a university hospital. Results: A total of 110 cases were reported. In 26 (23.6%) patients the injury was caused by a stab wound, and by a gunshot wound in 84 (76.4%) patients. The most common injury site was the lower limb. Twenty-six (23.6%) patients showed no injury in the angiography. A total of 150 vascular injuries were identified. Conclusion: The most commonly injured artery was the femoral. Statistically significant injury predictive factors were the injury severity score, the degree of shock, and patients with multiple injuries. Six amputations reported were associated with severe trauma. The absence of severe signs does not rule out the possibility of arterial injury. Inverted saphenous vein graft repair is recommended for non-repairable injuries (AU)

Reporte de caso: herida por proyectil de arma de fuego en aorta abdominal / Case report: Gunshot wound to abdominal aorta

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Spatio-temporal patterns of genetic variations in populations of yellowtail kingfish Seriola lalandi from the south-eastern Pacific Ocean and potential implications for its fishery management.

The genetic population structure and genetic diversity of yellowtail kingfish Seriola lalandi from the coastal south-eastern Pacific Ocean (SEP) were evaluated at spatiotemporal scale in order to understand the ecology of this species. Between 2012 and 2015, temporal and spatial population genetic structure and a low genetic diversity were detected in S. lalandi from SEP. These results suggest that S. lalandi specimens arriving annually from offshore to the SEP coast could come from at least two genetically distinct populations, revealing a particular life strategy (i.e. reproductive or habitat segregation) for this fish species. Therefore, the SEP coast might constitute a point of population mixing for this species. Additionally, the low genetic diversity of S. lalandi in the SEP could be a result of a founder effect or overfishing. Regardless of the process explaining the genetic diversity and structure of S. lalandi in this geographical area, this new information should be considered in order to implement successful fishery management of this resource in the South Pacific.

Suprarrenalectomía larascópica single port / Single port laparoscopic adrenalectomy

Introducción: La Suprarrenalectomía quirúrgica es el tratamiento de elección en lesiones tumorales de la glándula suprarrenal mayores de 4 cm o aquellos que resulten funcionales. La técnica laparoscópica esta asociada a menor sangrado, morbilidad perioperatoria y estadía hospitalaria. El apoyo del abordaje single-port (LESS) se asocia además a menor dolor y mejores resultados estéticos, pero conlleva a una mayor complejidad técnica, sin embargo esta dificultad puede ser eliminada con el apoyo robótico, conservando los beneficios de la técnica single port.(AU)

Introduction: Surgical adrenalectomy is the treatment of choice in tumors of the adrenal gland larger than 4 cm or those that are functional. The laparoscopic technique is associated with less bleeding, perioperative morbidity and hospital stay. The support of the single-port approach (LESS) is also associated with less pain and better aesthetic results, but it leads to greater technical complexity, however this difficulty can be eliminated with robotic support, while retaining the benefits of the single port technique.