In Vivo Models for the Study of Hyaluronic Acid Fillers: A Review.

BACKGROUND: Hyaluronic acid (HA) filler application is one of the most frequent minimally invasive aesthetic procedures used worldwide. Its properties and characterization, performance, effects in other tissues, and response to complication treatments have been studied in several animal models. This review aims to categorize animal models considering the advantages and disadvantages regarding the purpose of the study. METHODS: Literature research was made using MEDLINE via PubMed by two reviewers using keywords "hyaluronic acid" "filler" and "animal model". Full-text articles published in English and with an in vivo animal model were included for data extraction. RESULTS: The rat model was the most common animal used to evaluate properties or characteristics and degradation of HA fillers. Rabbits were preferred for evaluating HA embolism treatments; however, anatomical names of the arteries differ in some studies. Mice and rats used as vascular occlusion model are challenging due to the size of the vessels and viscosity of the filler. CONCLUSION: There is a wide variability of options of in vivo animal models to evaluate HA fillers. The animal characteristics, laboratory resources, and HA properties should be considered in accordance with the objective of the study, when choosing the ideal model. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Gynecological influencing factors on the rectovaginal septum's morphology.

INTRODUCTION AND HYPOTHESIS: The objective was to determine the mean morphometric characteristics of the rectovaginal septum (RVS) and its variations in correlation with the number of pregnancies, method of delivery, parity, and estrogenic exposure. METHODS: An observational, cross-sectional, retrospective, descriptive, and comparative study was carried out. Pelvic MRI of Hispanic women (≥15 years of age) from the northeast of Mexico were obtained. Age and obstetric and gynecological history were registered and the sample women were categorized by their variables. Length and thickness measurements were standardized. RESULTS: A total of 102 MRI studies were included, with a mean age of 41; 24.5% were nulligravida, the rest primi- or multigravida. Vaginal delivery was the most common type (49.35%), 16.88% had a cesarean section, and 31.17% had mixed delivery. 74.5% of the women were premenopausal. The mean RVS length was 73.2 ± 15.3 mm, with a thickness of 2.8 ± 1.7, 2.2 ± 1.2, and 2.5 ± 1.3 mm for the upper, middle, and lower thirds respectively. There were tendencies to increase the length of the RVS, and the thickness of the upper and middle thirds in the non-pregnancy and the at-least-one-pregnancy groups; to increase the length and middle-third thickness in those with mixed delivery, and increased upper- and lower-third thickness in those with only a cesarean section. Multiparous women with vaginal delivery had significantly longer and thicker RVS than primiparous. Premenopausal women had significantly longer RVS with a tendency to lose thickness toward postmenopause. CONCLUSIONS: The morphology of RVS can be modified by different factors such as age, number of pregnancies, number of births, and estrogenic exposure. This structure should be evaluated and taken into account in preoperative management and surgical technique planning.

Payment with knowledge: A method for a training of anatomy near-peer teachers and formation of future anatomists.

Near-peer teaching has been widely implemented in medical schools and the benefits for the near-peer teachers (NPTs), the students, and the institution have been well documented. However, NPT training methods and perceptions of such have been limited. A four-year clinical anatomy and surgical training program was established (est. 2019) as part of the continuous training timeline for NPTs (n > 60 total) formation at the Universidad Autónoma de Nuevo León, in Mexico. The program provides various training courses for the NPTs according to their hierarchy, including teaching skills, professional development, psychosocial aspects, and career objectives. A "Clinical Anatomy and Surgical Training Diploma" was planned with 12 modules to aid in developing these abilities, along with a higher understanding of clinical anatomy shared by expert clinical specialists, and diverse clinical and surgical skills such as suturing, catheterization, and basic surgical procedures. The program has a completion rate of approximately 15 NPTs/year. All, while creating an environment with a sense of belonging, and facilitating mentorship between fellow NPTs and educators. Near-peer teachers develop leadership, communication, and teaching skills. The program has provided a constant source of anatomy educators, avoiding any shortage.

Gallbladder perforation with fistulous communication.

BACKGROUND: The management of gallbladder perforation (GBP) with fistulous communication (Neimeier type I) is controversial. AIM: To recommend management options for GBP with fistulous communication. METHODS: A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines. The search strategy was conducted in Scopus, Web of Science, MEDLINE, and EMBASE (May 2022). Data extraction was obtained for patient characteristics, type of intervention, days of hospitalization (DoH), complications, and site of fistulous communication. RESULTS: A total of 54 patients (61% female) from case reports, series, and cohorts were included. The most frequent fistulous communication occurred in the abdominal wall. Patients from case reports/series had a similar proportion of complications between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) (28.6 vs 12.5; P = 0.569). Mortality was higher in OC (14.3 vs 0.0; P = 0.467) but this proportion was given by only one patient. DoH were higher in OC (mean 26.3 d vs 6.6 d). There was no clear association between higher rates of complications of a given intervention in cohorts, and no mortality was observed. CONCLUSION: Surgeons must evaluate the advantages and disadvantages of the therapeutic options. OC and LC are adequate options for the surgical management of GBP, with no significant differences.

Active Surveillance of Antimicrobial Resistance and Carbapenemase-Encoding Genes According to Sites of Care and Age Groups in Mexico: Results from the INVIFAR Network.

We analyzed the antimicrobial resistance (AMR) data of 6519 clinical isolates of Escherichia coli (n = 3985), Klebsiella pneumoniae (n = 775), Acinetobacter baumannii (n = 163), Pseudomonas aeruginosa (n = 781), Enterococcus faecium (n = 124), and Staphylococcus aureus (n = 691) from 43 centers in Mexico. AMR assays were performed using commercial microdilution systems (37/43) and the disk diffusion susceptibility method (6/43). The presence of carbapenemase-encoding genes was assessed using PCR. Data from centers regarding site of care, patient age, and clinical specimen were collected. According to the site of care, the highest AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from ICU patients. In contrast, in A. baumannii, higher AMR was observed in isolates from hospitalized non-ICU patients. According to age group, the highest AMR was observed in the ≥60 years age group for E. coli, E. faecium, and S. aureus, and in the 19-59 years age group for A. baumannii and P. aeruginosa. According to clinical specimen type, a higher AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from blood specimens. The most frequently detected carbapenemase-encoding gene in E. coli was blaNDM (84%).

Proteomic profile of preeclampsia in the first trimester of pregnancy.

OBJECTIVE: Preeclampsia (PE) is a leading cause of pregnancy-associated maternal and neonatal morbidity and mortality. Detection of patients at risk before the clinical onset of PE is a priority. Proteomics have become a valuable tool for the discovery of new biomarkers; however, the understanding of the underlying mechanism is necessary. The aim of the study was to determine differences between proteomic serum profiles of PE and normotensive pregnancies using quantitative and qualitative approaches. STUDY DESIGN: Serum samples from pregnant women were taken at 10-12 weeks of gestation with follow-up to determine PE development. Samples were analyzed using nano 2-D liquid chromatography UPLC and qTOF-MS/MS. RESULTS: A total of 136 women were recruited, of which eight (5.9%) developed PE, and eight normotensive were randomly selected as a control group for comparison. A different profile was obtained between groups. Nine proteins showed quantitative differences with fold-change over 1.5: PRRC2C (217.02), HEATR5A (179.46), ATP6 (162.38), PRRC2B (83.09), RBM25 (5.36), NUP205 (3.38), HLA-I (2.27), ZC3H13 (2.15), and SREK1 (1.66); and two under 0.66: Importin-4 (0.55) and Cytochrome b (0.26). Using bilateral Fisher's exact test for the qualitative approach, LRRK1 had statistical significance (p = .044), while PRRC2B (p = .121), PRRC2C (p = .134), and NUP205 (p = .134) showed a tendency to be present in PE. CONCLUSION: The found proteins have plausibility with the early pathophysiological events that have been associated with this pathology. Further studies should be performed to confirm these findings and elucidate their specific roles.

Mexican Educators Survey on Anatomical Sciences Education and a Review of World Tendencies.

Anatomical sciences curricula have been under constant reform over the years, with many countries having to reduce course hours while trying to preserve laboratory time. In Mexico, schools have historically been autonomous and unregulated, and data regarding structure and methods are still lacking. A national survey was sent by the Mexican Society of Anatomy to 110 anatomical sciences educators. The questionnaire consisted of 50 items (open and multiple choice) for gross anatomy, microscopic anatomy, neuroanatomy, and embryology courses in medical schools across Mexico. A clinical approach was the most common course approach in all disciplines. Contact course hours and laboratory hours were higher in Mexican anatomy education compared to other countries, with the highest reported contact hours for embryology (133.4 ± 44.1) and histology (125 ± 33.2). There were similar contact hours to other countries for gross anatomy (228.5 ± 60.5). Neuroanatomy course hours (43.9 ± 13.1) were less than reported by the United States and similar to Saudi Arabia and higher than the United Kingdom. Dissection and microscopy with histological slides predominate as the most common laboratory activities. Traditional methods prevail in most of the courses in Mexico and only a few educators have implemented innovative and technological tools. Implementation of new methods, approaches, and curricular changes are needed to enhance anatomical sciences education in Mexico.

Collaborative mentoring for effective medical research groups.

This article was migrated. The article was marked as recommended. Research benefits professors and students, mentors and mentees, however, many Universities lack formal programs, especially in basic sciences such as anatomy. Faculty, many times, lack the time, resources, and a well-structured program. Mentoring and collaborative work, have played an important role in creating an effective environment that inspires its members into scientific production, enhances research skills, while gaining experience. The authors presented a student anatomy research group (Grupo de Investigación en Anatomía [GIA]) model that integrates faculty from basic and clinical fields through a collaborative mentoring and tightly organized structure that increases training, experience, and scientific output. The transformation stages described shows the progress, reporting the fundamental elements for integration of the model, with results presented at 16 years of experience of the group in the Anatomy department. Results evidence a steady increase in student/professor involvement, scientific publishing, presentations in meetings (national/international), and cites.

Polymorphic eruption of pregnancy in Mexico.

BACKGROUND: Currently, the exact incidence of Polymorphic Eruption of Pregnancy (PEP) in the Mexican population is unknown. PEP tends to manifest in the abdomen, primarily in the stretch marks caused by distension. It is characterized by severely pruritic urticarial-like papules that converge in plaques, extending to the buttocks and proximal thighs. Our study determined its incidence, along with other common dermatoses in pregnancy. METHODS: Patients between 14 and 45 years of age were evaluated. In each patient, a complete medical history and physical examination was performed with emphasis on skin and adnexa. Patients were followed until the end of their pregnancy. RESULTS: A total of 217 women were included. PEP was identified in three patients (1.38%), all primigravida, with single fetus pregnancy, and all concluded their pregnancy by vaginal delivery. The neonates were 2 females and 1 male. No other gestational pathologies were identified. CONCLUSIONS: We identified a higher incidence of PEP than reported, without association to complications or need for medical management. There may be an association between high maternal weight and the presence of PEP, however a larger sample is needed.

Impacto de innovación en educación en bioética con el uso del plus y las tics / Impact of innovation in bioethics education with the use of plus and tics

Introducción: Las estrategias educativas en la formación médica deben promover un desarrollo integral con el uso de la tecnología y actitud humanista en la práctica médica a través de la bioética. Objetivo: Determinar el impacto que supone la conjunción de una estrategia didáctica con el uso de las Tecnologías de Información y Comunicación (TICs) en la educación Bioética. Material y métodos: Estudio cuali-cuantitativo. A través del método Delphi, un grupo de profesores eligió el uso de la estrategia educativa PLUS durante la cátedra de Bioética de una Facultad de Medicina; el contenido académico resultante fue administrado y divulgado mediante el uso de las TICs en un blog, la determinación del impacto se realizó a través de las métricas digitales obtenidas durante un año mediante dos gadgets digitales. Resultados: Se aplicó la estrategia PLUS obteniendo contenido educativo de calidad difundido a través del blog Bioeticlass, determinando un promedio de 50,000 visitas anuales, provenientes de México, EUA, España y otros 32 países; con un flujo promedio de 30 visitantes diarios, con pronóstico al alza de 50 visitas diarias, interacción de 285 comentarios, sin ningún costo monetario. Conclusión: El impacto sobre la educación en Bioética por el uso del PLUS y gestión a través de las TICs resultó de gran interés social, siendo accesible las 24 horas, perdurable, de muy bajo costo y con un alto impacto global.

Modifications to the delivery of a gross anatomy course during the COVID-19 pandemic at a Mexican medical school

The Coronavirus disease was declared a pandemic this year, causing an impact on medical education. Following the World Health Organization's (WHO) recommendations, Universities around the world implemented social distancing and the use of online platforms. Anatomists lead medical students, most of which are part of Generation Z. Different technological tools have been used in the gross anatomy course in combination with face-to-face classes, but now are forced to move exclusively online. The Human Anatomy Department in the Medical School of the Universidad Autonoma de Nuevo León (UANL) implemented asynchronous sessions as a short-term resolution, transformed to synchronous sessions as the pandemic progressed. It is important to consider the adaptability of the student, the near-peer teacher, and academic staff, with the creation of innovative ideas to facilitate the learning for the student and to maintain the quality of the course. Their role in this modality should be assessed, as it may change medical education and the way to teach in the future for the new generation of medical students. Professors' roles are changing and it is necessary to adapt to new situations

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Near-peer teaching strategy in a large human anatomy course: perceptions of near-peer instructors.

Near-peer teaching (NPT) is a strategy in which senior students assume the instructor role with junior peers (mentees). Senior students develop unique skills and knowledge through NPT, an experience which extends their learning beyond content mastery. Different teaching modules featuring NPT were utilized in the human anatomy course at the School of Medicine, Autonomous University of Nuevo Leon in Monterrey, Mexico. Modules included: Theory, Clinical Hour, Imaging Anatomy, and Laboratory. The aim of this study was to assess instructor participants' perceptions on the benefits of the NPT strategy in the anatomy classroom. A survey was administered to anatomy course instructors who utilized NPT strategies during winter, fall, and spring semesters of the 2012-2013 school year. A total of 120 instructors were enrolled in the study. There were different perceptions of instructors' roles. Theory and Imaging Anatomy instructors considered themselves to be information providers and resource developers, whereas Clinical Hour and Laboratory instructors saw themselves more as facilitators, role models, and planners. All instructors' opinions on the benefits of NPT were positive. Thus, in this article, the authors find NPT to be a strategy that promotes self-learning, a vital skill.

Pelvimetry by reformatted computed tomography in 290 female pelvis: morphometric variations regarding age / Pelvimetría mediante tomografía computadorizada reformada sobre 290 pelvis femeninas: variaciones morfométricas de acuerdo a la edad

The Mexican government passed a new reform of article 11 of the General Law in 2014 regarding Women's Access to a Life Free of Violence, which states that a cesarean section may not be performed if a vaginal birth is viable. Cesarean sections are excessively indicated in Northen Mexico, using the diagnosis of cephalopelvic disproportion due to a narrow pelvis. Currently, there is no standardized morphometry of the female pelvis in a Mexican population to establish adequate diagnostic parameter. Our study measures the pelvic diameters of the birth canal using abdominopelvic computed tomography (CT). Two hundred and ninety CT from Mexican women between the ages of 18 and 50 were collected and 3D reformatted in order to morphologically measure the pelvic diameters of clinical relevance. Measurements were conducted by two diagnostic imaging specialists. The mean and standard deviation of the measured diameters were: anatomical conjugate diameter (ACD) 11.65±0.99 cm, the obstetric conjugate diameter (OCD) 11.73±0.98 cm, diagonal conjugate diameter (DCD) 12.49±0.98 cm and Interspinous distance (ISD) 10.41±0.78 cm. Significant differences were found in all four mean diameters in between the 20­29 age groups versus the >40, as well as between the 30­39 groups versus the >40. Our study shows that as Mexican women get older, the mean pelvic diameters become narrower.

El Gobierno mexicano aprobó una nueva reforma del artículo 11 de la Ley General del 2014, relativa al acceso de las mujeres a una Vida Libre de Violencia, que establece que una cesárea no se puede realizar si un parto vaginal es viable. Los partos por cesárea son indicados excesivamente en el norte de Mexico, con el diagnóstico de desproporción céfalo-pélvica debido a una estrechez de la pelvis. Actualmente, no existe una morfometría estandarizada de la pelvis femenina en una población mexicana para establecer parámetros de diagnóstico adecuado. Nuestro estudio mide los diámetros pélvicos del canal de parto mediante tomografía compudotarizada (TC) abdomino-pélvica. Se usaron 290 TC de mujeres mexicanas entre 18 y 50 años, los que fueron reformateados en 3D para medir morfológicamente los diámetros pélvicos de relevancia clínica. Las mediciones fueron realizadas por dos especialistas en diagnóstico por imagen. La Media y DE de los diámetros medidos fueron: diámetro anatómico conjugado (DAC) 11,65±0,99 cm, diámetro obstétrico conjugado (DOC) 11,73±0,98 cm, diámetro diagonal conjugado (DDC) 12,49±0,98 cm y distancia interespinosa (DIE) 10,41±0,78 cm. Se encontraron diferencias significativas en las Medias de los cuatro diámetros entre los grupos de 20­29 años de edad frente a las >40 años, así como entre los grupos de 30­39 años frente a los >40 años. Nuestro estudio muestra que a medida que las mujeres mexicanas avanzan en edad, los diámetros pélvicos medios son más estrechos.