Disseminated intravascular coagulation phenotype is regulated by the TRPM7 channel during sepsis

BACKGROUND: Sepsis is an uncontrolled inflammatory response against a systemic infection that results in elevated mortality, mainly induced by bacterial products known as endotoxins, producing endotoxemia. Disseminated intravascular coagulation (DIC) is frequently observed in septic patients and is associated with organ failure and death. Sepsis activates endothelial cells (ECs), promoting a prothrombotic phenotype contributing to DIC. Ion channel mediated calcium permeability participates in coagulation. The transient reception potential melastatin 7 (TRPM7) non-selective divalent cation channel that also contains an α-kinase domain, which is permeable to divalent cations including Ca2+, regulates endotoxin-stimulated calcium permeability in ECs and is associated with increased mortality in septic patients. However, whether endothelial TRPM7 mediates endotoxemia-induced coagulation is not known. Therefore, our aim was to examine if TRPM7 mediates coagulation during endotoxemia. RESULTS: The results showed that TRPM7 regulated endotoxin-induced platelet and neutrophil adhesion to ECs, dependent on the TRPM7 ion channel activity and by the α-kinase function. Endotoxic animals showed that TRPM7 mediated neutrophil rolling on blood vessels and intravascular coagulation. TRPM7 mediated the increased expression of the adhesion proteins, von Willebrand factor (vWF), intercellular adhesion molecule 1 (ICAM-1), and P-selectin, which were also mediated by the TRPM7 α-kinase function. Notably, endotoxin-induced expression of vWF, ICAM-1 and P-selectin were required for endotoxin-induced platelet and neutrophil adhesion to ECs. Endotoxemic rats showed increased endothelial TRPM7 expression associated with a procoagulant phenotype, liver and kidney dysfunction, increased death events and an increased relative risk of death. Interestingly, circulating ECs (CECs) from septic shock patients (SSPs) showed increased TRPM7 expression associated with increased DIC scores and decreased survival times. Additionally, SSPs with a high expression of TRPM7 in CECs showed increased mortality and relative risk of death. Notably, CECs from SSPs showed significant results from the AUROC analyses for predicting mortality in SSPs that were better than the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) scores. CONCLUSIONS: Our study demonstrates that sepsis-induced DIC is mediated by TRPM7 in ECs. TRPM7 ion channel activity and α-kinase function are required by DIC-mediated sepsis-induced organ dysfunction and its expression are associated with increased mortality during sepsis. TRPM7 appears as a new prognostic biomarker to predict mortality associated to DIC in SSPs, and as a novel target for drug development against DIC during infectious inflammatory diseases.

Risk factors for severe postoperative complications after gastrectomy for gastric and esophagogastric junction cancers / Fatores de risco para complicações pós-operatórias graves após gastrectomia por câncer do estômago e junção esofagogástrica

ABSTRACT Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.

RESUMO Raciona l: A gastrectomia é o tratamento principal para o câncer de junção esofagogástrica (EGJ) e Siewert tipo II-III. Ela está associada à morbidade significativa. As taxas de morbidade total variam entre os diferentes estudos e poucos avaliaram a morbidade pós-operatória de acordo com a gravidade da complicação. Objetivo: Identificar os preditores de morbidade pós-operatória grave. Métodos: Este foi um estudo de coorte retrospectivo de um banco de dados prospectivo. Foram incluídos pacientes tratados com gastrectomia para câncer gástrico ou EGJ em um único centro. A morbidade severa foi definida como escore de Clavien-Dindo ≥3. Análise multivariada foi realizada para identificar preditores de morbidade grave. Resultados: Duzentos e oitenta e nove gastrectomias foram realizadas (67% homens, mediana de idade: 65 anos). A localização do tumor foi EGJ em 14%, o terço superior do estômago em 30%, o terço médio em 26% e o terço inferior em 28%. Em 196 (67%), foi realizada gastrectomia total com dissecção de linfonodos D2 em 85%. Duzentos e onze pacientes (79%) foram submetidos à gastrectomia aberta. O estado T foi T1 em 23% e T3/T4 em 68%. A mortalidade pós-operatória foi de 2,4% e a taxa de morbidade foi de 41%. A morbidade severa foi de 11% e foi representada principalmente por fístula esofagojejunal (2,4%), fístula duodenal (2,1%) e complicações respiratórias (2%). Na análise multivariada, a localização do EGJ e os tumores T3/T4 foram associados com maior morbidade pós-operatória grave. Conclusão: Morbidade pós-operatória severa após gastrectomia foi de 11%. A localização do tumor na junção esofagogástrica e o estado T3/T4 são fatores de risco para a morbidade pós-operatória grave.

Survival and perioperative morbidity of totally laparoscopic versus open gastrectomy for early gastric cancer: analysis from a single latin american centre / Comparação da sobrevida e morbidade perioperatória da gastrectomia totalmente laparoscópica vs. laparotômica para tratamento do câncer gástrico precoce em um centro latino-americano

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

Tomografía de Coherencia Óptica, perspectivas de uso en oftalmología. Revisión bibliográfica / Optical Coherence Tomography, perspectives for use in ophtalmology. Literature review

Introducción: la tomografía de coherencia óptica (OCT por sus siglas en inglés) es un tipo de examen de imagen no invasivo que usa ondas de luz para obtener imágenes digitales de alta resolución de tejidos, a nivel microscópico. Objetivo: el objetivo del presente estudio fue conocer las perspectivas de uso en el ámbito de la oftalmología de la OCT. Metodología: se realizó una revisión bibliográfica narrativa usando artículos científicos relacionados al tema, tanto en inglés como en español, extraídos de Pubmed, Latindex, Scielo y Lilacs. La información más relevante según el criterio de los autores fue extraída y sintetizada en el presente artículo. Resultados y Discusión: nuestros hallazgos resaltan la importancia de la OCT en oftalmología, especialmente en el diagnóstico temprano y siguimiento terapeútico de pacientes con patologías oculares. Conclusiones: se debe considerar el uso rutinario de OCT en la consulta de oftalmología, ya que constituye un examen de imagen confiable, no invasivo y con una amplitud de usos.

Introduction: optical coherence tomography (OCT) is a type of non­invasive imaging test that uses light waves to obtain digital high resolution images of tissues at a microscopical level. Objective: the objective of the present study was to know more about perspectives of use in ophtalmology of OCT. Methodology: we performeda a narrative literature review, using cientific articles related to the topic, both in English and Spanish; the articles were extracted from Pubmed, Latindex, Scielo and Lilacs. The most relevant information according to the criterion of the authors was extracted and synthesized and in the present article. Results and Discussion: our findings highlilght the importance of OCT in ophtalmology, spcially in relation to diagnosis and therapeutic follow­up of patients with ocular pathologies. Conclusions: it is worth to consider the routine use of OCT in ophtalmogy consultations since it is relible imaging test, non­invasive and with amplitude of uses.

Experiencia inicial con esofagectomia mínimamente invasiva transtorácica en posición semiprono por cáncer esofágico / Initial experience with minimally invasive transtoraxic esophagectomy in semiprone position for esophageal cancer

Resumen Introducción El tratamiento quirúrgico del cáncer esofágico se asocia a una alta morbimortalidad. El abordaje mínimamente invasivo se ha introducido con el objetivo de disminuir la morbilidad postoperatoria. Objetivo Describir la técnica y los resultados de la esofagectomía mínimamente invasiva (EMI) transtorácica en posición semiprono. Métodos Estudio de cohorte descriptivo. Se incluyeron pacientes con una EMI electiva por cáncer entre abril de 2013 y mayo de 2017. Se registraron variables demográficas, perioperatorias, anatomía patológica y la sobrevida. Resultados Incluimos 33 pacientes (24 hombres, edad 69 años, 91% con comorbilidades). La ubicación predominante del tumor fue en los tercios medio e inferior del esófago (90%). Quince (45%) pacientes recibieron neoadyuvancia. No existieron casos de conversión a toracotomías. La reconstrucción se realizó con estómago en un 93%. Se realizó anastomosis cervical en 66% y torácica en 30%. El tiempo operatorio fue de 420 (330-570) minutos y el sangrado de 200 (20-700) cc. La mortalidad a 90 días fue de 0%. La morbilidad global fue de 78%, se registró un 15% de neumonía y un 9% requirió una reoperación. La estadía hospitalaria fue de 23 (11-81) días. La histología fue carcinoma escamoso en 51% y adenocarcinoma en 45%. Los márgenes fueron RO en 87%. El recuento ganglionar alcanzó 30 (9-45) ganglios. La sobrevida global a 2 años es 68%. Conclusión Los resultados preliminares de esta técnica son favorables; sin ningún caso de mortalidad postoperatoria. Los resultados oncológicos demuestran un alto porcentaje de cirugía RO y adecuado recuento ganglionar.

Introduction Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity. Aim To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position. Material and Methods Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded. Results We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%. Conclusion The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count.

Ley caótica exponencial de los sistemas dinámicos cardiacos para evaluación del Holter: 16 horas / Exponential chaotic law of cardiac dynamical systems for Holter evaluation: 16 hours

Introducción. En un estudio previo se realizó una reducción a 16 horas en la evaluación de la ley exponencial de la dinámica cardiaca caótica, mostrando su efectividad en la caracterización de enfermedad y normalidad. Objetivo. Confirmar la aplicabilidad clínica de la ley matemática exponencial para evaluar la dinámica cardiaca caótica a partir de los registros Holter en 16 horas, observando su utilidad diagnóstica al disminuir su tiempo de evaluación. Diseño. Estudio observacional de corte trasversal donde se avaluó los parámetros electrocardiográficos mediante metodologías físico matemáticas inductivas con una confirmación estadística. Metodología. Se tomaron 100 registros Holter con diferentes tipos de patología, y 40 Holter que fueron diagnosticados como normales. Para cada Holter se construyó un atractor caótico, y midiendo sus espacios de ocupación y dimensión fractal se aplicó la evaluación matemática para diferenciar normalidad de enfermedad. Finalmente se realizaron medidas de concordancia diagnostica respecto al estándar de oro. Resultados. La ocupación espacial de todos los atractores estuvieron dentro de los valores esperados; los registros normales presentaron en la rejilla Kp valores entre 205 y 423. Para los registros con enfermedad aguda, estos valores oscilaron entre 21 y 65; y para los registros de enfermedad crónica estos valores estuvieron entre 104 y 195. Los valores de sensibilidad y especificidad fueron de 100% y el coeficiente Kappa fue de 1. Conclusión. El presente estudio muestra la aplicabilidad clínica de esta metodología para la evaluación en 16 horas de registros electrocardiográficos continuos o Holter.

Introduction: In a previous study, a 16-hour reduction in the evaluation of the exponential law of chaotic cardiac dynamics was done, showing its effectiveness in the characterization of disease and normality. Objective: To confirm the clinical applicability of the exponential mathematical law to evaluate chaotic cardiac dynamics from the Holter registers in 16 hours, observing its diagnostic utility when reducing its evaluation time. Design: Cross-sectional observational study where the electrocardiographic parameters were evaluated using inductive mathematical methodologies with statistical confirmation. Methodology: We obtained 100 Holter records from patients with different types of pathology, and 40 Holter that were diagnosed as normal. For each Holter, a chaotic attractor was constructed, and measuring their spaces of occupation and fractal dimension, the mathematical evaluation to differentiate normality of disease was applied. Finally, we calculated measures of diagnostic concordance in accordance with the gold standard. Results: The spatial occupation of all the attractors was within the expected values; the normal records had values in the Kp grid between 205 and 423. For the records with acute disease, these values ranged from 21 y 65; and for chronic disease registries these values ranged from 104 y 195. The values of sensitivity and specificity were 100% and the Kappa coefficient was 1. Conclusion: The present study shows the clinical applicability of this methodology for the evaluation in 16 hours of continuous electrocardiographic or Holter registers.

Caracterización física, nutricional y no nutricional de las semillas de Inga paterno / Physical, nutritional and non nutritional characterization of Inga paterno seeds

Inga paterno is a tree legume present in various states of Mexico whose sheath is consumed in someplaces as a fruit due seed coat is sweet (Aryl). Seeds are not commonly consumed and there are few studies about its composition. The physical characteristics, nutritional and non-nutritional composition of Inga paterno seeds from México State and Puebla were analyzed. The seeds showed a significant proportion of protein and lipid. The oil from the seeds showed higher proportion of palmitic acid. Non-nutritional compounds such as phenolics, tannins, phytates, saponins and trypsin inhibitors were quantified. The seeds of the two sources of origin showed no statistically significant difference in their physical, chemical and non-nutritional characteristics; however, unlike other legumes, they exhibit high saponins content and high inhibitory trypsin activity.

Inga paterno es una leguminosa arbórea, que crece varios estados de México. La vaina se consume como fruto, debido a la cubierta dulce (Arilo) de la semilla. Ésta última, no es comúnmente consumida. Las características físicas, composición nutricional y el contenido de compuestos no nutricionales presentes en las semillas de Inga paterno provenientes de los Estados de México y Puebla fueron analizados, mostrando que las semillas son de 1.6 y 1.9 cm largo y 0.9 y 1.08 cm de ancho. Los componentes químicos principales son: proteína (20.42 y 21.59 g/100 g), carbohidratos (28.99 y 36.15 g/100 g), lípidos (9.62 y 8.55 g/100 g) para las procedentes de Ozumba y Tochimilco, respectivamente. Los aceites de las semillas de Inga paterno presentaron una proporción importante de ácido palmítico, así como ácidos 7-octadecanoico, oleico, linoleico y alfa linolénico. Se cuantificaron los compuestos no nutricionales como fenólicos (0.55 y 0.54 mg eq. de ácido gálico/g), taninos (1.46 y 1.51 mg eq. de (+)-catequina/g), fitatos (2.66 y 2.04 mg de ácido fítico/g), saponinas (32.35 y 33.38 mg de diosgenina/g) e inhibidores de tripsina (311.97 y 351.21 mg de tripsina pura inhibida/g de muestra). Ambas semillas analizadas no presentaron diferencia estadísticamente significativa en sus características físicas, químicas y no nutricionales; sin embargo, éstas presentan una elevada actividad inhibitoria de tripsina comparada con otras leguminosas.

Disminución de la grasa corporal mediante ejercicio físico intermitente de alta intensidad y consejería nutricional en sujetos con sobrepeso u obesidad / Effects of 12 sessions of high intensity intermittent training and nutrition counseling on body fat in obese and overweight participants

Background: The search of efficient exercise alternatives to treat obesity is worthwhile. Aim: To demonstrate the effect of high intensity intermittent exercise on body fat reduction in overweight and obese subjects. Material and Methods: A group of 65 overweight and obese adult subjects (25 men), aged 18-65 years, participated during 12 sessions in a high intensity physical exercise program, 3 days/week. Weight, height and body fat was measured before and after the intervention by bioimpedance. Each session consisted of 1 min stationary cycling exercise at high intensity, followed by 2 min inactive rest. This cycle was repeated 10 times, thus the method is called 1*2*10. Results: There was a significant reduction of body fat of -1.88 ± 2.8 and -3.44 ± 2.7 kg, in women and men, respectively (p < 0.05). Conclusions: The 1*2*10 training protocol lasting 12 weeks in association with nutrition counseling is effective in reducing body fat in overweight persons.

Recuperación cardiovascular durante ejercicio intermitente en pacientes con hipertensión y diabetes tipo 2 altamente adherentes / Cardiovascular recovery during intermittent exercise in highly-adherent partic pants with hypertension and type 2 diabetes mellitus

Background: Despite the evidence supporting metabolic benefits of high intensity interval exercise (HIIT), there is little information about the cardiovascular response to this type of exercise in patients with type 2 diabetes (T2D) and hypertension (HTA). Aim: To analyze the changes in heart rate at rest, at the onset and at the end of each interval of training, after twelve weeks of a HIIT program in T2D and HTA patients. Material and Methods: Twenty-three participants with T2D and HTA (20 women) participated in a controlled HIIT program. Fourteen participants attended 90% of more session of exercise and were considered as adherent. Adherent and non-adherent participants had similar body mass index (BMI), and blood pressure. A “1x2x10” (work: rest-time: intervals) HIIT exercise protocol was used both as a test and as training method during twelve weeks. The initial and finishing heart rate (HR) of each of the ten intervals before and after the intervention were measured. Results: After twelve weeks of HIIT intervention, adherent participants had a significant reduction in the heart rate at the onset of exercise, and during intervals 4, 5, 8 and 10. A reduction in the final heart rate was observed during intervals 8 and 10. In the same participants the greatest magnitude of reduction, at the onset or end of exercise was approximately 10 beats/min. No significant changes in BMI, resting heart rate and blood pressure were observed. Conclusions: A HIIT program reduces the cardiovascular effort to a given work-load and improves cardiovascular recovery after exercise.

Interacción entre farmacoterapia hipotensiva y terapia con ejercicio físico requiere regulación farmacológica en pacientes hipertensos / Interaction between antihypertensive therapy and exercise training therapy requires drug regulation in hypertensive patients

Background: Exercise training could interact with the pharmacological therapy of hypertension, increasing the effects of these medications. Aim: To assess the effects of 12 weeks of physical training on blood pressure of hypertensive or diabetic patients, already receiving pharmacological therapy. Material and methods: Twelve participants with diabetes and hypertension, 16 participants with hypertension and 18 healthy participants were studied. During six weeks no intervention was carried out, except the treatment for their underlying conditions. During the ensuing six weeks, participants were subjected 12 sessions of physical training. Blood pressure was measured at baseline and after six and twelve weeks of intervention. Results: During the period without physical training, no changes in blood pressure were observed. After the physical training intervention systolic blood pressure decreased by 16, 17 and 20 mm Hg in participants with diabetes and hypertension, participants with hypertension and healthy participants, respectively. Diastolic blood pressure decreased by 9 and 6 mmHg in participants with diabetes and hypertension and hypertension alone, respectively. Conclusions: There is a decrease in blood pressure among hypertensive participants receiving pharmacological therapy, after a period of physical training.

Gastrectomía totalmente laparoscópica por neoplasias gástricas: Experiencia en un centro público / Totally laparoscopic gastrectomy for the treatment of gastric tumors

Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.

¿Qué sabemos? ¿qué hacemos? ¿por qué lo hacemos? usando antibióticos en infecciones pediátricas / What do we know? What do we do? Why do we do it? using antibiotics in pediatric infections

El uso inadecuado de antibióticos involucra al prescriptor: sobre él influyen diversos factores académicos, sociales, ambientales, económicos, culturales y políticos; ocurre principalmente en el primer nivel de atención en el área pediátrica.Objetivos: Determinar conocimientos, actitudes y prácticas en la prescripción de antibióticos en infecciones prevalentes respiratorias y diarreicas en menores de 5 años. Metodología: Estudio transversal realizado en la región amazónica Morona Santiago, Área de Salud 3, Ecuador. Se valoraron conocimientos y actitudes al universo de 16 prescriptores, mediante casos clínicos elaborados por Herranz, adaptados al medio, relacionados a rinofaringitis, otitis media aguda, neumonía, bronquiolitis, gastroenteritis; para las prácticas se revisaron el universo de 225 historias clínicas de niños diagnosticados en los dos meses previos. La prescripción se valoró mediante los protocolos actualizados de la Organización Panamericana de la Salud. Se tabuló mediante SPSS y se utilizó estadística descriptiva como promedios, frecuencias y porcentajes.Resultados: Existió dificultad en la prescripción de otitis media aguda, neumonía, gastroenteritis bacteriana, especialmente en dosis y duración. La prescripción inadecuada en rinofaringitis fue similar tanto en la teoría como en la práctica (18,7%). El caso de rinosinusitis fue poco diagnosticado (31,3%); en la práctica no se mencionó algún caso. Frente al cuadro hipotético que superpone datos para neumonía como bronquiolitis, el 75% lo diagnosticó como neumonía; en la práctica ningún diagnóstico indicó bronquiolitis. Conclusiones: Existe dificultad en la prescripción de antibióticos siendo necesaria la implementación de un programa integral de educación continua sobre Uso Racional de Antibióticos que considere factores asociados tales como: contexto laboral, ecosistema, nivel socio-económico y cultural de sus pacientes, rol del sistema de salud, y organización política entre otros.

Inappropriate use of antibiotics involves prescribers and occurs mainly in the primary health care units. Academic, social, environmental, economic, cultural and political factors are linked to this health problem. Objectives: To determine knowledge, attitudes and practices in antibiotic prescription in respiratory and diarrheal prevalent infectious affecting children under 5 years.Methods: Cross-sectional study conducted in Morona Santiago province, Health Area: 3, Ecuador.Knowledge and attitudes to the world of prescri-berswere assessed using hypothetical clinical cases made by Herranz, adapted to the environment, about rinopharyngitis, acute otitis media, pneumonia, bronchiolitis, gastroenteritis. The practice was evaluated through the clinical histories of 225 children diagnosed two months before. The pres-cription was analyzed according to Pan American Health Organization protocols. It was tabulated using SPSS and analyzed using descriptive statistics as means, frequencies and percentages. Results: There was difficulty in the acute otitis media, pneumonia, bacterial gastroenteritis prescription; especially in doses and treatment duration. Inappropriate prescription in nasopharyngitis was similar in both theory and practice (18.7%). The rhinosinusitis was diagnosed in the 31.3%; in the practice none case was mentioned. In the hypothetical cli-nical case about low respiratory infection, 75% was diagnosed like pneumonia; in the practice none bronchiolitis case was diagnosed.Conclusions: There is difficulty in prescribing antibiotics. A comprehensive program of continuing education on rational use of antibiotics is being neces-sary. Analysis of the associated factors such as: the employment and ecosystem context, ecosystem, socio economic and cultural level of their patients, the role of health system, and political organization, should be considered.

¿Pueden ocho semanas de ejercicio físico combinado normalizar marcadores metabólicos de sujetos hiperglicémicos y dislipidémicos? / Eight weeks of combined high intensity intermittent exercise normalized altered metabolic parameters in women

Background: Short term physical training programs may improve insulin resistance and hyperglycemia. Aim: To assess the effects of eight weeks of combined exercise program on serum lipids and glycemic level in women with hyperglycemia and hypercholesterolemia. Patients and Methods: Ten healthy women, nine women with hyperglycemia, ten with hypercholesterolemia and nine with hyperglycemia/hypercholesterolemia were studied. Participants were subjected to eight weeks into a program of combined physical exercise (high intensity interval + resistance training). Results: Fasting glycemia decreased by 12 and 14% in hyperglycemic and hyperglycemic/hypercholesterolemic participants, respectively. Serum insulin decreased in all groups in a range from 27 to 37%. HOMA IR for insulin resistance decreased similarly. A significant decrease in TC and TG was observed only in those altered baseline subjects. Conclusions: Eight weeks of combined physical exercise had a favorable effect on insulin resistance in this group of women.

Efectos de una sesión de ejercicio aeróbico en la presión arterial de niños, adolescentes y adultos sanos / Effects of a single bout of aerobic exercise on body weight and blood pressure among healthy participants

Background: Physical inactivity is a major risk factor and aerobic exercise is protective for cardiovascular health. Aim: To determine the effects of aerobic exercise on systolic and diastolic blood pressure in children, adolescents and adults. Material and Methods: We studied 13 children aged 10 ± 1.9 years, 13 adolescents aged 14.3 ± 1.5 and 55 adults aged 41 ± 11.5 years. Participants completed 60 minutes of aerobic exercise in one session. Body weight, systolic and diastolic blood pressure, and resting heart rate were measured before and after the exercise period. Results: Adult men and women experienced a significant decrease in body weight after exercise (-8 and -6%, respectively). No significant changes in weight were observed in children and adolescents. After exercise systolic and diastolic blood pressure decreased significantly in children (-8.3 and -5.4% respectively), adolescents (-7.6 and -8.4% respectively) and adults (-7 and -5.1% respectively). Conclusions: A 60 minute period of aerobic exercise is associated with a reduction in blood pressure in children, adolescents and adults.

Lipoma gástrico gigante sintomático tratado con gastrectomía subtotal laparoscópica: caso clínico / Gastric lipoma removed by laparoscopic subtotal gastrectomy: Report of one case

Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the third postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor.

Composición corporal y estado nutricional de una muestra de estudiantes de 9 a 12 años de edad de colegios municipalizados de la comuna de padre las casas, región de la Araucanía-Chile / Body composition and nutritional status of 9 to 12 year old municipal schools students sample of padre las casas commune, Araucanía region, Chile

El estudio del Índice de Masa Corporal (IMC), es el parámetro recomendado por la OMS para conocer el estado nutricional de acuerdo a la norma técnica nutricional vigente en Chile. Los estudios antropométricos permiten estimar la composición corporal, estudiar la morfología y dimensiones. Este estudio describe la realidad nutricional y la composición corporal de una muestra de los colegios municipalizados de la comuna de Padre las Casas. Evaluamos 122 adolescentes de ambos sexos, 65 hombres (53,2%) y 57 mujeres (46,7%), entre 9 y 12 años de edad. Para obtener la composición corporal se utilizó el método antropométrico descrito por Dhebora Kerr, mientras que la evaluación y clasificación del estado nutricional se realizo de acuerdo a las normas técnica nutricional del Ministerio de Salud de Chile. Los hombres presentaron una composición corporal donde predomina la masa muscular (MM) sobre los otros componentes, con valores de 38,79±3,65% a los 9 años de edad, 40,80±3,36% a los 10 años de edad, 41,47±2,52% a los 11 años de edad, 43,35±1,59% a los 12 años de edad. En las mujeres también predomina la MM pero menores cifras, con un porcentaje de 38,70±6,64% a los 9 años de edad, 39,85±3,84% a los 10 años de edad, 39,56±4,41% a los 11 años de edad, 40,28±2,37% a los 12 años de edad. El estado nutricional de la muestra tiene los siguientes resultados en el caso de los varones el 23,1% fueron obesos y el 35,4% presentaron sobrepeso. En las damas el 26,3% fueron obesas y un 15,8% presentaron sobrepeso...

The study of Body Mass Index (BMI) is the standard recommended by the WHO for nutritional status according to the technical standard nutritional force in Chile. Anthropometric studies to estimate body composition study the morphology and dimensions. This study describes the nutritional situation and body composition of a sample of municipal schools of the municipality of Padre las Casas. We evaluated 122 adolescents of both sexes, 65 men (53.2%) and 57 women (46.7%), between 9 and 12 years old. For body composition was used anthropometric method described by Dhebora Kerr, while evaluation and classification of nutritional status was conducted according to technical rules nutritional Chilean Health Ministry. The men had a body composition dominated muscle mass (MM) on the other components, with values of 38.79±3.65% at 9 years of age, 40.80±3.36% at 10 years age, 41.47±2.52% at 11 years of age, 43.35±1.59% at 12 years of age. In women also predominate MM but lower figures, with a percentage of 38.70±6.64% at 9 years of age, 39.85±3.84% at 10 years of age, 39.56±4.41% at 11 years of age, 40.28±2.37% at 12 years of age. The nutritional status of the sample has the following results in the case of males 23.1% were obese and 35.4% were overweight. In womans 26.3% were obese and 15.8% were overweight...

Matriz para ingenieria de tejido oseo: modificacion superficial con zinc: estudio preliminar / Scaffold for bone tissue engineering: superficial modification with zinc: preliminary study

El objetivo del presente trabajo es desarrollar un metodo de sintesis de matrices para ingenieria de tejidos, capaces de acelerar los procesos reparativos y disminuir el riesgo de infeccion, destinadas a cirugias reconstructivas que involucren el tejido oseo. A este fin se emplea la fase mineral de hueso bovino, la hidroxiapatita, conservando su estructura tridimensional. Esta se obtiene a partir de un proceso de lavado quimico, seguido de un proceso termico que elimina todos los componentes organicos. Esta matriz es modificada superficialmente con oxido de zinc (ZnO), elemento reconocido por su accion en diversos procesos biologicos y su accion antibacteriana. El procedimiento involucra la intrusion de dispersiones de ZnO en solucion de alcohol-1,2,3 propanotriol, efectuadas en un bano termico y el ulterior sinterizado a alta temperatura. El grado de fijacion y la concentracion del Zn sobre la matriz de hidroxiapatita se determinan por medio de microscopia electronica y espectrometria en energias. La difraccion de rayos X muestra que la incorporacion de los iones de Zn en la superficie forma fosfatos de Zn. El original proceso desarrollado permite modificar, en forma sencilla, injertos oseos sinteticos, otorgando capacidad antibacteriana y osteoproliferativa al sustrato osteconductor.

The aim of this study is to develop a method of matrix synthesis for tissue engineering, capable of accelerating reparative processes and reducing the risk of infection, destined to reconstructive surgeries involving bone tissue. For this purpose the bovine bone mineral phase, hydroxyapatite, was used while retaining its dimensional structure. This is obtained from a chemical wash process followed by a thermal process that removes the entire organic components. This matrix is superficially modified with zinc oxide (ZnO), element known for its action in various biological processes and its antibacterial action. The procedure involves the intrusion of ZnO dispersions in alcohol solution-1,2,3-propanetriol, made in a thermal bath and the subsequent high temperature sintering. The degree of attachment and the Zn concentration on the hydroxyapatite matrix is determined by electron microscopy and energy spectrometry. X-ray diffraction shows that the incorporation of Zn ions in the surface forms Zn phosphates. The developed original process allows modifying in a simple way synthetic bone grafts, by providing antibacterial and osteoproliferative properties to the osteoconductive substrate.

Somatotipo y estado nutricional de 10 a 14 años de edad en una muestra de Mapuches de la IX Región, Temuco-Chile / Somatotype and nutritional status from 10 to 14 years of age in a sample of Mapuche subjects in the IX Region, Temuco-Chile

El grupo étnico mapuche tiene una amplia distribución en la Novena Región, el proceso migratorio propio del desarrollo urbano, han hecho que parte de la etnia mapuche se traslade a la ciudad de Temuco, modificando sus estilos de vida. El estudio del Índice de Masa Corporal (IMC), es el parámetro recomendado por la OMS (Organización Mundial de la Salud), para conocer el estado nutricional de acuerdo a la norma técnica nutricional vigente en Chile. El somatotipo es utilizado para estimar la forma corporal y su composición. Este estudio describe la realidad nutricional y el somatotipo de una muestra de mapuches de los colegios municipalizados de la ciudad de Temuco. Se evaluaron 292 adolescentes mapuches de ambos sexos, 154 hombres (52,7 por ciento) y 138 mujeres (47,3 por ciento), entre 10 y 14 años de edad. Para obtener el somatotipo se utilizó el método antropométrico descrito por Heath & Carter mientras que la evaluación y clasificación del estado nutricional de acuerdo a las normas técnica nutricional. Los hombres presentaron un somatotipo mesoendomórficos (4.9/4.4). Las mujeres son endomesomórfico (5.4/4.3). El estado nutricional de la muestra tiene los siguientes resultados en el caso de los varones el 11,7 por ciento fueron obesos y el 20,1 por ciento presentaron sobrepeso. En las damas el 9,5 por ciento fueron obesas y un 27,5 por ciento presentaron sobrepeso. Al comparar por sexo se encontraron diferencias significativas en la Endomorfía a favor de las mujeres (p =0.00) y en los varones la Mesomorfía, con un (p= 0.00). No así en la Ectomorfía que no presentó diferencias. No obstante, no se encontraron diferencias al comparar los componentes del somatotipo entre las edades de la muestra. El ambiente Obesigénico donde destaca la modificación del estilo de vida, la alimentación, el efecto del sedentarismo, está afectando de igual forma a la población mapuche que al resto de la población escolar al ser comparados con muestras de estudiantes de...

The Mapuche ethnic group has a wide distribution in the IX Region, the migration process of urban development itself, has made part of the Mapuche people move to the city of Temuco, modifying their lifestyles. The study of Body Mass Index (BMI) is the standard recommended by the WHO to know the nutritional status according to the technical standard nutritional norm in Chile. The somatotype is used to estimate body shape and composition. This study describes the nutritional situation and somatotype of a sample of Mapuche municipal schools of the city of Temuco. We evaluated 292 Mapuche adolescents of both sexes, 154 men (52.7 percent) and 138 women (47.3 percent), between 10 and 14 years of age. For somatotype anthropometric method was used described by Heath & Carter while the assessment and classification of nutritional status according to technical standards nutrition. The men presented a mesomorphic somatotype (4.9/4.4). Women are endomesomórfico (5.4/4.3). The nutritional status of the sample has the following results in the case of males and 11.7 percent were obese and 20.1 percent were overweight. In checkers, 9.5 percent were obese and 27.5 percent were overweight. A comparison by gender differences were found in the endomorphy for women (p = 0.00) and mesomorphy in boys, one (p = 0.00). Not so in ectomorphy that did not differ. However, no differences were found when comparing the somatotype components between the ages of the sample. Obese-genic environment which emphasizes the modification of lifestyle, diet, sedentary effect is equally affecting the Mapuche population as the rest of the school population when compared with samples of students in municipal schools.