Circadian Variation of Blood Pressure in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study.

The aim of this study was to analyze the impact of circadian variation of blood pressure (BP) in patients with chronic musculoskeletal pain (CPM). A further purpose was to study differences in circadian variation of BP between genders and the correlation between BP circadian variation and pain. We performed a cross-sectional, observational study in which seventy-five participants with CMP participated. Circadian variation in BP was calculated using the diurnal/nocturnal BP ratio, and all participants used validated self-measurement BP devices. The Numeric Pain Rating Scale was used to assess pain perception. All circadian BP values from participants who suffered from CPM followed pathologic cardiovascular parameters (BP ratio < 10%). When comparing BP ratios between genders, statistically significant differences were found (p = 0.011). BP itself did not correlate with pain in any subgroup. Circadian variations of BP in those suffering from CMP are shown and new possibilities of research and treatment are proposed.

Divertículo duodenal intraluminal como causa de obstrucción duodenal / Intraluminal duodenal diverticulum as a cause of duodenal obstruction

Introducción. El divertículo duodenal intraluminal, también conocido como windsock diverticulum, es una causa rara de dolor abdominal intermitente y plenitud postpandrial, que puede complicarse con obstrucción, sangrado, pancreatitis o colangitis. Suele cursar de forma asintomática y ante la aparición de síntomas el tratamiento de elección es quirúrgico. Caso clínico. Presentamos el caso de una mujer de 24 años, sin antecedentes de interés, que es estudiada por dolor abdominal y plenitud postpandrial, que resulta finalmente en una obstrucción intestinal alta. Tras estudio exhaustivo y necesidad de una cirugía previa, es diagnosticada de un divertículo duodenal intraluminal. Conclusión. La paciente se trató mediante cirugía con resolución exitosa del cuadro de obstrucción intestinal.

Introduction: Intraluminal duodenal diverticulum, also known as a windsock diverticulum, is a rare cause of intermittent abdominal pain and postprandial fullness, which can be complicated by obstruction, bleeding, pancreatitis, or cholangitis. It is usually asymptomatic and when symptoms appear, the treatment of choice is surgical. Clinical case: We present the case of a 24-year-old woman with no relevant history who is studied for abdominal pain and postprandial fullness, presented with an upper intestinal obstruction. After an exhaustive study and the need for a previous surgery, she was diagnosed with an intraluminal duodenal diverticulum.Conclusion: The patient was treated by surgery with successful resolution of the intestinal obstruction

A Comprehensive View of Frozen Shoulder: A Mystery Syndrome.

Frozen shoulder is a common epidemiological affliction. Data acquired from people who suffer from this type of damage in other joints such as the hip, wrist and ankle also exist; although these syndromes are less common. Treatment for frozen shoulder is primarily physical (physiotherapy, manual therapy), secondary medical (corticosteroid injections) and finally surgical but with limited success. The difficulty in treating this type of condition successfully lies in the lack of knowledge about the risk factors involved and the pathophysiology underlying this mysterious syndrome. This review gives an overview of the current scientific position of frozen shoulder in terms of evolutionary factors, etiology, the different mechanisms of action involved, current treatment options and other possible interventions based on recent discoveries of pathophysiological mechanisms. The overall objective is to clarify several unknown aspects of a syndrome that affects up to 5% of the world's population.

Lessons Learned in Posttraumatic Reconstruction of Labial Defects in Children.

There is no universal technique for reconstructing the different types of labial defects. The etiology, the size and location, the layers compromised and the depth of the defect are the main determinants of the technique to be chosen. The aesthetic form and the function recovery must be the main objective of the therapeutic process.Scarce studies concentrate into the pediatric population and the operational resolution of complex, full-depth defects. The oral contingence, articulation and facial expression (mimicking) are amongst the most important functions of the lower third of the face, and, in terms of reconstruction, they represent a difficult task for the plastic surgeon. In our case, the experience has taught us about new tools, useful and potentially replicable to guide the reconstruction of our infantile population. The authors present different techniques from five different cases, using loco-regional options that spare microsurgical solutions.

Técnica de rendez-vous: una alternativa cada vez más válida en el tratamiento de la coledocolitiasis / The rendezvous technique: An increasingly more acceptable option for choledocholithiasis treatment

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Traumatic Telecanthus and Posterior Lacrimal Crest Avulsion in a Six-Year-Old Child.

Pediatric facial fractures are uncommon, especially orbital fractures, which can be unnoticed in 30% of the cases. Any delay regarding either diagnosis or treatment implies the risk of long-term sequels. Limited data exists concerning craniofacial fractures in children, especially the ones compromising the orbital substructures. Distribution varies upon several series; however, there is inexistence of literature regarding specific and isolated fractures of the lacrimal skeletal system. Injuries to the medial orbital wall canthal tendon can lead to disinsertion/ruptures of the medial canthal tendon. A canthopexy is the most indicated treatment to restore the original canthal position and the re-establishment of palpebral normal function. This paper's purpose is to present an isolated posterior lacrimal crest fracture/avulsion case secondary to a high-energy trauma involving a 6-year-old girl and present an exhaust literature revision.

Synthesis and Characterization of a Lignin-Styrene-Butyl Acrylate Based Composite.

In recent years, the pursuit of new polymer materials based on renewable raw materials has been intensified with the aim of reusing waste materials in sustainable processes. The synthesis of a lignin, styrene, and butyl acrylate based composite was carried out by a mass polymerization process. A series of four composites were prepared by varying the amount of lignin in 5, 10, 15, and 20 wt.% keeping the content of butyl acrylate constant (14 wt.%). FTIR and SEM revealed that the -OH functional groups of lignin reacted with styrene, which was observed by the incorporation of lignin in the copolymer. Additionally, DSC analysis showed that the increment in lignin loading in the composite had a positive influence on thermal stability. Likewise, Shore D hardness assays exhibited an increase from 25 to 69 when 5 and 20 wt.% lignin was used respectively. In this same sense, the contact angle (water) measurement showed that the LEBA15 and LEBA20 composites presented hydrophobic properties (whit contact angle above 90°) despite having the highest amount of lignin, demonstrating that the interaction of the polymer chains with the -OH groups of lignin was the main mechanism in the composites interaction.

Barbed Suture versus Conventional Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy: Randomized Controlled Clinical Trial.

STUDY OBJECTIVE: To determine the surgical time, suture time, presence of postoperative dyspareunia, and complications that occur after closing the vaginal cuff with a barbed suture compared with conventional suture. DESIGN: A randomized, controlled clinical trial (Canadian Task Force classification I). SETTING: Private gynecologic clinic in Medellin, Colombia. PATIENTS: One hundred fifty women who underwent total laparoscopic hysterectomy for benign pathology. INTERVENTIONS: The patients underwent total laparoscopic hysterectomy with intracorporeal closure of the vaginal cuff and were randomized to 2 groups, 1 using a barbed suture (V-Loc 90; Medtronic/Covidien, New Haven, CT) and 1 using polyglactin 910 (coated Vicryl suture; Ethicon/Johnson & Johnson, New Brunswick, NJ). MEASUREMENTS AND MAIN RESULTS: The total operative time, closing time of the vaginal vault, presence of complications in the cuff, and incidence of postoperative dyspareunia were recorded. The patients were evaluated at a postoperative office visit 2 weeks after the procedure and by telephone interview at 24 weeks. Seventy-five patients were included in the barbed suture group and 75 patients in the polyglactin 910 group. The average time to complete the suture of the vaginal cuff was 12.01 minutes (± 5.37 standard deviation) for the barbed suture group versus 13.49 minutes (± 6.48) in the polyglactin 910 group (95% confidence interval, -.44 to 3.4; p = .130). Blood loss was 31.56 ± 22.93 mL in the barbed suture group versus 30.82 ± 21.75 mL in the polyglactin 910 group (95% confidence interval, -7.95 to 6.47; p = .840). The frequency of postoperative events such as hematoma, cellulitis, cuff dehiscence, fever, emergency consultation, and hospitalization was not statistically significant between groups. No statistically significant difference was found regarding deep dyspareunia at 24 postoperative weeks. CONCLUSION: No differences were found in surgical time or frequency of adverse events when comparing patients after vaginal cuff closure with barbed suture versus polyglactin 910.

Arabinosylation of recombinant human immunoglobulin-based protein therapeutics.

Protein glycosylation is arguably the paramount post-translational modification on recombinant glycoproteins, and highly cited in the literature for affecting the physiochemical properties and the efficacy of recombinant glycoprotein therapeutics. Glycosylation of human immunoglobulins follows a reasonably well-understood metabolic pathway, which gives rise to a diverse range of asparagine-linked (N-linked), or serine/threonine-linked (O-linked) glycans. In N-linked glycans, fucose levels have been shown to have an inverse relationship with the degree of antibody-dependent cell-mediated cytotoxicity, and high mannose levels have been implicated in potentially increasing immunogenicity and contributing to less favorable pharmacokinetic profiles. Here, we demonstrate a novel approach to potentially reduce the presence of high-mannose species in recombinant human immunoglobulin preparations, as well as facilitate an approximate 100% replacement of fucosylation with arabinosylation in Chinese hamster ovary cell culture through media supplementation with D-arabinose, an uncommonly used mammalian cell culture sugar substrate. The replacement of fucose with arabinose was very effective and practical to implement, since no cell line engineering or cellular adaptation strategies were required. Arabinosylated recombinant IgGs and the accompanying reduction in high mannose glycans, facilitated a reduction in dendritic cell uptake, increased FcγRIIIa signaling, and significantly increased the levels of ADCC. These aforementioned effects were without any adverse changes to various structural or functional attributes of multiple recombinant human antibodies and a bispecific DVD-Ig. Protein arabinosylation represents an expansion of the N-glycan code in mammalian expressed glycoproteins.

Tumores del estroma gastrointestinal: revisión de nuestra experiencia / Surgery of gastrointestinal stromal tumors: review of our experience in the last five years

Objective: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Surgical resection is the standard treatment for localized primary GISTs. The aim of the study is to present our 5-year surgical experience, as well as the results obtained in terms of survival and disease progression. Material and Method: We conducted a descriptive, retrospective study of primary GISTs treated in our center between 2009-2013. We analyze the most relevant variables, criteria of risk of progression according Fletcher's classification from National Institutes of Health and the Miettinem's classification from the Armed Forces Institute of Pathology, as well as analysis of relapse-free survival (RFS) with Kaplan-Meier survival curves. Results: We present a series of 30 patients. Mean age 65 years (40-84 years). The most common location was the stomach (n = 14, 46.6 percent). The surgery was R0 in 23 cases of 30. The mean tumor diameter was 5.3 cm (0.5-18). 14 patients received adjuvant treatment with Imatinib. After an average follow-up of 31.2 months (6-62 months), it was found relapse in 4 patients, progression and exitus in 1, exitus in 3 and exitus in the immediate postoperative period in 1. RFS at one year was 96.7 percent, and 89.2 percent at 4 years. Mean survival time was 56.2 months (95 percent CI 51.8-60.6). Conclusion: The recommended attitude after radical surgery is follow-up. In selected patients with risk of relapse, adjuvant treatment with Imatinib delays the progression of the disease and increases the survival.

Objetivo: Los tumores del estroma gastrointestinal son las neoplasias mesenquimales más frecuentes del tubo digestivo. La resección quirúrgica es el tratamiento estándar en los GISTs primarios localizados. El objetivo del estudio es presentar nuestra experiencia quirúrgica en 5 años, así como los resultados obtenidos en cuanto supervivencia y progresión de la enfermedad. Material y Método: Serie de casos, estudio observacional descriptivo retrospectivo, que analiza los resultados obtenidos en cuanto al tratamiento quirúrgico de GIST primarios sometidos a resección quirúrgica en nuestro centro entre 2009-2013. Todas las intervenciones fueron realizadas por personal del Staff y dentro de los protocolos de las unidades de cirugía hepato-biliar y esófago-gástrica. Se analizan las variables de mayor relevancia, criterios de riesgo de progresión según la clasificación de Fletcher del National Institutes of Health y la clasificación de Miettinem del Armed Forces Institute of Pathology, así como análisis de la supervivencia libre de recaída (SLR) con curvas de Kaplan-Meier. Resultados: Presentamos una serie de 30 pacientes. Edad media de 65 años (40-84 años). La localización más frecuente fue estómago (n = 14, 46,6 por ciento). La cirugía fue R0 en 23 de los 30 pacientes. El diámetro tumoral medio fue de 5,3 cm (0,5-18, con una mediana de 4 cm. Catorce pacientes recibieron tratamiento adyuvante con Imatinib. Tras un seguimiento medio 31,2 meses (6-62 meses), se detectó recaída en 4 pacientes, progresión y exitus en 1, exitus en 3 y exitus en el postoperatorio inmediato en 1. La SLR al año fue del 96,7 por ciento, siendo del 89,2 por ciento a los 4 años. El tiempo medio de supervivencia fue de 56,2 meses (IC 95 por ciento 51,8-60,6). Conclusiones: La actitud recomendada tras una cirugía radical es el seguimiento. En pacientes seleccionados con riesgo de recaída el tratamiento adyuvante con Imatinib retrasa la progresión de la enfermedad y aumenta la supervivencia.

Characterization of a novel NKG2D and NKp46 double-mutant mouse reveals subtle variations in the NK cell repertoire.

The immunoreceptors NKG2D and NKp46 are known for their capacity to activate natural killer (NK) cell cytotoxicity and secretory responses in the contexts of tumors and infections, yet their roles in NK cell education remain unclear. Here, we provide the first characterization of mice deficient for both NKG2D and NKp46 receptors to address the relevance of their concomitant absence during NK cell development and function. Our findings reveal that NK cells develop normally in double-mutant (DKO) mice. Mice lacking NKG2D but not NKp46 showed subtle differences in the percentages of NK cells expressing inhibitory Ly49 receptors and the adhesion molecule DNAM-1. A slightly increased percentage of terminally differentiated NK cells and functional response to in vitro stimuli was observed in some experiments. These alterations were modest and did not affect NK cell function in vivo in response to mouse cytomegalovirus infection. NKp46 deficiency alone, or in combination with NKG2D deficiency, had no effect on frequency or function of NK cells.

Axillary cannulation for proximal aortic surgery is as safe in the emergent setting as in elective cases.

BACKGROUND: Right axillary artery cannulation and selective antegrade cerebral perfusion (SCP) have become well-described strategies in the surgical treatment of proximal aortic disease. Many series report increases in adverse outcomes with SCP used in emergent settings. We compare outcomes in elective and emergent patients. METHODS: Over 21 months, SCP through right axillary cannulation with a side graft was performed in 61 patients. Thirty-three percent (20 of 61) underwent emergent operation for Stanford type A dissection or intramural hematoma, including 3 of 20 (4.7%) with pericardial tamponade; the remainder of SCP (41 of 61) was elective. The mean follow-up was 9.1 +/- 0.40 months. RESULTS: Selective antegrade cerebral perfusion was used in 20 of 22 emergent cases (91%), with 2 unsuccessful cannulation attempts, and no peripheral arterial dissections encountered. The SCP flows averaged 16.3 +/- 0.71 cc x kg(-1) x min(-1) for a mean perfusion period of 26.1 +/- 1.9 minutes. The average cardiopulmonary bypass time for all patients was 173 +/- 11 minutes. Average hospital stay was 8.1 +/- 0.80 days. One case (1.3%) of permanent and 3 cases (4.8%) of temporary neurologic dysfunction occurred in SCP patients. The hospital mortality rate for emergent SCP cases (2 of 20, 10%) was not statistically different from the mortality rate for elective SCP cases (3 of 41, 7.3%, p = not significant), with no difference in complication rates. All 3 SCP patients with preoperative tamponade survived without complication. Cerebral oximetry data showed a trend toward decreased left-sided (contralateral) scalp perfusion. There was no association of emergent status with neurologic dysfunction, death, or any other adverse outcome. CONCLUSIONS: Axillary cannulation and SCP in the surgical treatment of proximal aortic pathology is safe in both elective and emergent settings.

[Laparoscopic treatment of ventral hernia under spinal anesthesia]. / Tratamiento laparoscópico de la hernia ventral con anestesia intradural.

INTRODUCTION: Laparoscopic surgery is usually performed with the patient under general anesthesia. In open surgery, regional anesthesia has been found to have fewer adverse effects than general anesthesia. We studied whether spinal anesthesia is feasible in laparoscopic ventral hernia repair. PATIENTS AND METHOD: Bupivacaine and fentanyl were administered to obtain T2 block; midazolam was used for sedation. Patients underwent laparoscopic intraperitoneal hernia repair using an ePTFE prosthesis fixed with a double crown technique. An intra-abdominal pressure of 12 mmHg and low-flow insufflation (1.5 L/minute) were used for pneumoperitoneum. RESULTS: Nineteen out of 23 patients underwent laparoscopic ventral hernia repair under spinal anesthesia; conversion to open surgery or general anesthesia was required in four patients. Additional sedation successfully relieved pain in patients with abdominal and shoulder discomfort (10.5%). Hypotension occurred in 68% of patients but was easily resolved by fluid administration. CONCLUSIONS: Spinal anesthesia is feasible and well tolerated in laparoscopic hernia repair. Studies comparing spinal and general anesthesia in this field are warranted.

Tratamiento laparoscópico de la hernia ventral con anestesia intradural / Laparoscopic treatment of ventral hernia under spinal anesthesia

Introducción. Tradicionalmente, se ha asociado la cirugía laparoscópica a la anestesia general; mientras que en la cirugía abierta las técnicas de anestesia intradural han demostrado una menor morbilidad. En este estudio proponemos la anestesia intradural para la reparación laparoscópica de la hernia ventral. Pacientes y método. Realizamos un bloqueo intradural a nivel de T con bupivacaína hiperbárica y fentanilo, y se añadió una sedación con midazolam. La reparación de la eventración se realizó por vía laparoscópica con prótesis de PTFEe fijada según técnica de doble corona, y se mantuvo una presión intraabdominal máxima de 12 mmHg insuflando el gas a 1,5 l/min. Resultados. De 23 pacientes se intervino a 19 con anestesia intradural, en 4 fue necesario convertir a cirugía abierta o precisaron anestesia general. Fue necesario profundizar la sedación en pacientes que refirieron molestias derivadas del neumoperitoneo (10,5%). El 68% de los pacientes sufrió episodio de hipotensión que se resolvió aumentando el aporte de volumen. Conclusiones. La anestesia intradural es factible y bien tolerada para la eventroplastia laparoscópica. Serán necesarios más estudios que comparen la anestesia espinal con la general en este campo (AU)

Introduction. Laparoscopic surgery is usually performed with the patient under general anesthesia. In open surgery, regional anesthesia has been found to have fewer adverse effects than general anesthesia. We studied whether spinal anesthesia is feasible in laparoscopic ventral hernia repair. Patients and method. Bupivacaine and fentanyl were administered to obtain T2 block; midazolam was used for sedation. Patients underwent laparoscopic intraperitoneal hernia repair using an ePTFE prosthesis fixed with a double crown technique. An intra-abdominal pressure of 12 mmHg and low-flow insufflation (1.5 L/minute) were used for pneumoperitoneum. Results. Nineteen out of 23 patients underwent laparoscopic ventral hernia repair under spinal anesthesia; conversion to open surgery or general anesthesia was required in four patients. Additional sedation successfully relieved pain in patients with abdominal and shoulder discomfort (10.5%). Hypotension occurred in 68% of patients but was easily resolved by fluid administration. Conclusions. Spinal anesthesia is feasible and well tolerated in laparoscopic hernia repair. Studies comparing spinal and general anesthesia in this field are warranted (AU)

[Chyle fistula. Medical management with octreotide]. / Fístula del conducto torácico. Tratamiento médico con octreótida.

Chyle fistula is an infrequent complication after neck surgery. The first line treatment is medical management, with adequate drainage and appropriate nutritional modifications. The use of octreotide in the treatment of chyle fistula is a novel approach that has been documented in only a few cases. We report a new case of thoracic duct injury effectively treated by octreotide, leading to an early decrease in drainage and early fistula closure with minimal adverse effects. This therapy may reduce length of hospital stay and morbidity. Further studies are required to confirm this observation.

Fístula del conducto torácico. Tratamiento médico con octreótida / Chyle fistula. Medical management with octreotide

La fístula del conducto torácico en una complicación poco frecuente tras la cirugía cervical. El primer escalón terapéutico es el tratamiento médico, con un adecuado drenaje y mediante medidas dietéticas. El uso de la octreótida en el tratamiento de la fístula quilosa es novedoso, y los casos comunicados son anecdóticos. Aportamos un nuevo caso en que el tratamiento con octreótida fue efectivo en el tratamiento de la lesión del conducto torácico y el cierre temprano de la fístula, con mínimos efectos secundarios. Este tratamiento permite reducir la estancia hospitalaria y la morbilidad del paciente. Creemos necesarios estudios posteriores que confirmen estos hallazgos (AU)

Chyle fistula is an infrequent complication after neck surgery. The first line treatment is medical management, with adequate drainage and appropriate nutritional modifications. The use of octreotide in the treatment of chyle fistula is a novel approach that has been documented in only a few cases. We report a new case of thoracic duct injury effectively treated by octreotide, leading to an early decrease in drainage and early fistula closure with minimal adverse effects. This therapy may reduce length of hospital stay and morbidity. Further studies are required to confirm this observation (AU)

Aortic reconstruction after complex injury of the mid-transverse arch.

We report the case of a 28-year-old man who suffered a transection of the mid-transverse aortic arch between the innominate and left common carotid artery with complete avulsion of the left common carotid artery after blunt trauma. This patient underwent successful aortic arch replacement proximal to the left subclavian artery and reimplantation of the innominate and left carotid arteries using profound hypothermic circulatory arrest and selective antegrade cerebral perfusion. A literature review revealed no other previous reports of survival after this type of injury.

Antifibrinolytic agents in cardiac surgery: current controversies.

Antifibrinolytic agents play a prominent role in adult cardiac surgery. This article is a review of the modern published experience of antifibrinolytic agent use in adult cardiac surgery. The use of tranexamic acid, epsilon-aminocaproic acid, and aprotinin is examined during primary cardiac surgery, deep hypothermic circulatory arrest, reoperative cardiac surgery, and off-pump coronary artery bypass surgery. In addition, the issues of vein graft patency and hypersensitivity reaction in the presence of antifibrinolytic agents are examined.

Tuba, a novel protein containing bin/amphiphysin/Rvs and Dbl homology domains, links dynamin to regulation of the actin cytoskeleton.

Tuba is a novel scaffold protein that functions to bring together dynamin with actin regulatory proteins. It is concentrated at synapses in brain and binds dynamin selectively through four N-terminal Src homology-3 (SH3) domains. Tuba binds a variety of actin regulatory proteins, including N-WASP, CR16, WAVE1, WIRE, PIR121, NAP1, and Ena/VASP proteins, via a C-terminal SH3 domain. Direct binding partners include N-WASP and Ena/VASP proteins. Forced targeting of the C-terminal SH3 domain to the mitochondrial surface can promote accumulation of F-actin around mitochondria. A Dbl homology domain present in the middle of Tuba upstream of a Bin/amphiphysin/Rvs (BAR) domain activates Cdc42, but not Rac and Rho, and may thus cooperate with the C terminus of the protein in regulating actin assembly. The BAR domain, a lipid-binding module, may functionally replace the pleckstrin homology domain that typically follows a Dbl homology domain. The properties of Tuba provide new evidence for a close functional link between dynamin, Rho GTPase signaling, and the actin cytoskeleton.