Características clínicas e histopatológicas de melanoma subungueal en 57 pacientes mexicanos: una cohorte de 5 años / Clinical and Histopathologic Features of Subungual Melanoma in 57 Mexican Patients: A 5-Year Cohort Study

El melanoma subungueal es un tumor poco común, con peor pronóstico comparado con los de otras localizaciones. Corresponde al 1-23% de los melanomas, según la población. El objetivo de este estudio fue describir las características clínicas e histopatológicas del melanoma subungueal en la población mexicana. Se incluyeron 57 pacientes con melanoma subungueal (19% de los 303 melanomas totales), con una mediana de edad de 71 años. La localización predominante fueron los miembros inferiores (52,6% de los melanomas subungueales) y el primer dedo (75,4% de los casos). El subtipo histológico más frecuente fue el acral lentiginoso (50,9%). La mediana de Breslow fue de 3mm. El estadio IA fue el más frecuente (28,1%). Se encontró una tasa de recurrencia del 19,3% y de metástasis del 8,8%. Las características clínico-patológicas fueron semejantes a lo descrito en la literatura. Es importante realizar un diagnóstico y tratamiento tempranos de cara a mejorar su pronóstico.(AU)

Although subungual melanoma is uncommon, it is associated with worse outcomes than melanomas in other locations and accounts for 1% to 23% of all melanomas, depending on the population. The aim of this study was to describe the clinical and histopathologic features of subungual melanoma in a Mexican population. We identified 303 patients with melanoma, and of these, 19% (57 patients with a median age of 71 years) had subungual melanoma. The main sites affected were the lower limbs (52.6%) and the toe (75.4%). The most common histologic subtype was acral lentiginous melanoma (50.9%). Median Breslow thickness was 3 mm, and stage IA tumors were the most common (in 28.1% of patients). Recurrence and metastasis occurred in 19.3% and 8.8% of patients, respectively. The clinical and histopathologic features identified are similar to those described in the literature. Early diagnosis and treatment are crucial for improving prognosis.(AU)

[Translated article] Clinical and Histopathologic Features of Subungual Melanoma in 57 Mexican Patients: A 5-Year Cohort Study / Características clínicas e histopatológicas de melanoma subungueal en 57 pacientes mexicanos: una cohorte de 5 años

El melanoma subungueal es un tumor poco común, con peor pronóstico comparado con los de otras localizaciones. Corresponde al 1-23% de los melanomas, según la población. El objetivo de este estudio fue describir las características clínicas e histopatológicas del melanoma subungueal en la población mexicana. Se incluyeron 57 pacientes con melanoma subungueal (19% de los 303 melanomas totales), con una mediana de edad de 71 años. La localización predominante fueron los miembros inferiores (52,6% de los melanomas subungueales) y el primer dedo (75,4% de los casos). El subtipo histológico más frecuente fue el acral lentiginoso (50,9%). La mediana de Breslow fue de 3mm. El estadio IA fue el más frecuente (28,1%). Se encontró una tasa de recurrencia del 19,3% y de metástasis del 8,8%. Las características clínico-patológicas fueron semejantes a lo descrito en la literatura. Es importante realizar un diagnóstico y tratamiento tempranos de cara a mejorar su pronóstico.(AU)

Although subungual melanoma is uncommon, it is associated with worse outcomes than melanomas in other locations and accounts for 1% to 23% of all melanomas, depending on the population. The aim of this study was to describe the clinical and histopathologic features of subungual melanoma in a Mexican population. We identified 303 patients with melanoma, and of these, 19% (57 patients with a median age of 71 years) had subungual melanoma. The main sites affected were the lower limbs (52.6%) and the toe (75.4%). The most common histologic subtype was acral lentiginous melanoma (50.9%). Median Breslow thickness was 3 mm, and stage IA tumors were the most common (in 28.1% of patients). Recurrence and metastasis occurred in 19.3% and 8.8% of patients, respectively. The clinical and histopathologic features identified are similar to those described in the literature. Early diagnosis and treatment are crucial for improving prognosis.(AU)

[Translated article] Clinical and Histopathologic Features of Subungual Melanoma in 57 Mexican Patients: A 5-Year Cohort Study.

Although subungual melanoma is uncommon, it is associated with worse outcomes than melanomas in other locations and accounts for 1% to 23% of all melanomas, depending on the population. The aim of this study was to describe the clinical and histopathologic features of subungual melanoma in a Mexican population. We identified 303 patients with melanoma, and of these, 19% (57 patients with a median age of 71 years) had subungual melanoma. The main sites affected were the lower limbs (52.6%) and the toe (75.4%). The most common histologic subtype was acral lentiginous melanoma (50.9%). Median Breslow thickness was 3 mm, and stage IA tumors were the most common (in 28.1% of patients). Recurrence and metastasis occurred in 19.3% and 8.8% of patients, respectively. The clinical and histopathologic features identified are similar to those described in the literature. Early diagnosis and treatment are crucial for improving prognosis.

Cognitive predictors and decision-making in the experience of coronary syndrome symptoms.

OBJECTIVE: To determine the predictive value of Cognitive Assessment, Symptom Severity, Personal Control and Self-Efficacy on decision making in the experience of Acute Coronary Syndrome symptoms. METHOD: Quantitative study of cross-sectional analytical design, a probabilistic sampling was carried out for 256 participants diagnosed with coronary syndrome in three health institutions. The effects between the independent variables Cognitive Assessment, Symptom Severity, Personal Control, Self-Efficacy and the dependent Decision-Making were analyzed. Using inferential statistics, a Generalized Linear Regression Model was carried out, which allowed establishing the causal relationships between the variables. RESULTS: Two predictive models were obtained between decision making and cognitive evaluation, in which personal control, severity of symptoms, sex and context were significant. Self-efficacy was not reported as a predictor variable. The values ​​of the independent variables showed a behavior directly proportional to the Decision Making score. CONCLUSION: A verification of the conceptual model for the management of symptoms was carried out.

Clinical and Histopathologic Features of Subungual Melanoma in 57 Mexican Patients: A 5-Year Cohort Study. / Características clínicas e histopatológicas de melanoma subungueal en 57 pacientes mexicanos: una cohorte de 5 años.

Although subungual melanoma is uncommon, it is associated with worse outcomes than melanomas in other locations and accounts for 1% to 23% of all melanomas, depending on the population. The aim of this study was to describe the clinical and histopathologic features of subungual melanoma in a Mexican population. We identified 303 patients with melanoma, and of these, 19% (57 patients with a median age of 71 years) had subungual melanoma. The main sites affected were the lower limbs (52.6%) and the toe (75.4%). The most common histologic subtype was acral lentiginous melanoma (50.9%). Median Breslow thickness was 3 mm, and stage IA tumors were the most common (in 28.1% of patients). Recurrence and metastasis occurred in 19.3% and 8.8% of patients, respectively. The clinical and histopathologic features identified are similar to those described in the literature. Early diagnosis and treatment are crucial for improving prognosis.

Resultados de una técnica quirúrgica de trabeculectomía ab-externo modificada en pacientes con glaucoma de ángulo abierto / Results of a modified ab-external trabeculectomy surgical technique in patients with open angle glaucoma

Objetivo Evaluar la seguridad y la eficacia de una técnica quirúrgica de trabeculectomía ab-externo modificada en el control de la presión intraocular (PIO) en los pacientes con glaucoma de ángulo abierto. Método y análisis Estudio retrospectivo de corte transversal en el que se incluyeron pacientes con glaucoma de ángulo abierto sometidos a trabeculectomía ab-externo modificada como primer tratamiento quirúrgico filtrante entre enero de 2008 a marzo de 2015. En el postoperatorio se evaluó la PIO, los medicamentos hipotensores, los tratamientos adicionales y las complicaciones tempranas y tardías. Resultados Se analizaron datos de 48 ojos de 38 pacientes. La media de edad fue de 63,1 años (25 a 85 años) y el tiempo medio de seguimiento fue de 35,3 meses (rango: 1-147 meses). La PIO preoperatoria media fue de 25,21±3,48mmHg y de 15,83±4,4mmHg al final del seguimiento. Catorce ojos (29%) requirieron goniopunción con láser y 4 ojos needling (8,4%). El análisis de supervivencia de Kaplan-Meier mostró una tasa de éxito del 81,7% a los 2 años y del 54,9% del año 4 al año 12. Dos ojos presentaron desprendimiento coroideo, 3 ojos cataratas que requirieron cirugía y 5 ojos tuvieron fugas tempranas de la ampolla. Conclusiones La trabeculectomía ab-externo modificada es eficaz para el tratamiento del glaucoma de ángulo abierto con un buen control de la PIO a largo plazo y una baja incidencia de complicaciones quirúrgicas, y podría utilizarse en casos complejos seleccionados de acuerdo con los resultados obtenidos (AU)

Objective Assess the safety and efficacy of a modified ab-external trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. Methods and analysis Patients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. Results Forty-eight eyes of 38 patients were included. The mean age was 63.1 years (25-85 years), and the follow-up time was 35.3 months (range of 1-147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. Conclusions This proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results (AU)

Results of a modified ab-external trabeculectomy surgical technique in patients with open angle glaucoma.

OBJECTIVE: Assess the safety and efficacy of a Modified Ab-externo Trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. METHODS AND ANALYSIS: Patients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. RESULTS: Forty-eight eyes of 38 patients were included. The mean age was 63.1 years (25-85 years), and the mean follow-up time was 35.3 months (range of 1147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. CONCLUSIONS: This proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results.

ATP increases head volume in capacitated human sperm via a purinergic channel.

Scanning ion-conductance microscopy allowed us to document an external Ca2+ dependent ATP driven volume increase (ATPVI) in capacitated human sperm heads. We examined the involvement of purinergic receptors (PRs) P2X2R and P2X4R in ATPVI using their co-agonists progesterone and Ivermectin (Iver), and Cu2+, which co-activates P2X2Rs and inhibits P2X4Rs. Iver enhanced ATPVI and Cu2+ and 5BDBD inhibited it, indicating P2X4Rs contributed to this response. Moreover, Cu2+ and 5BDBD inhibited the ATP-induced acrosome reaction (AR) which was enhanced by Iver. ATP increased the concentration of intracellular Ca2+ ([Ca2+]i) in >45% of individual sperm, most of which underwent AR monitored using FM4-64. Our findings suggest that human sperm P2X4R activation by ATP increases [Ca2+]i mainly due to Ca2+ influx which leads to a sperm head volume increase, likely involving acrosomal swelling, and resulting in AR.

Evaluation of HKUST-1 as Volatile Organic Compound Adsorbents for Respiratory Filters.

Cyclohexane is a representative of volatile organic compounds (VOCs). VOCs can cause serious health problems in case of continuous exposure; therefore, it is essential to develop efficient personal protective equipment. Historically, activated carbons are used as VOC adsorbents. However, the emergence of promising novel adsorbents, such as metal-organic frameworks, has pushed the research to study their behavior under the same conditions. In this work, the use of the well-known HKUST-1 MOF of different particle sizes (20 µm, 300-600 µm, and 1-1.18 mm) for the adsorption of low-grade (5000 ppm) cyclohexane combined with different water concentrations (dry, 27 and 80% RH) in a fixed bed is proposed. The results were compared under the same conditions for a typically used activated carbon, PICACTIF TA 60. HKUST-1 has higher affinity to cyclohexane than PICACTIF for the whole pressure range studied, especially at low partial pressures. It begins to adsorb much earlier (0.0025 kPa) than the activated carbon (0.01 kPa). However, a different adsorption behavior is evidenced for both materials in the presence of water vapor since HKUST-1 is very hydrophilic in the zone near to the copper open metal sites, whereas PICACTIF is hydrophobic. After three consecutive cycles, good stability results were obtained for the MOF, comparable to activated carbon, even in the presence of water. As the main finding, although the unstability of HKUST-1 is well established under high humid conditions, the kinetic of degradation has not been established so far. Here, it is shown that the time usage of HKUST-1 as the adsorbent for respiratory mask (single pass) is not affected by the degradation of the structure, which may occur on a longer time scale. Finally, shaping by tableting provides good results since it is possible to increase the MOF density by around 69% with minor loss of adsorption capacity. The best fraction is 300-600 µm, reaching cyclohexane breakthrough times around 85 min/cm3 at 80% RH, comparable with PICACTIF-activated carbon and promising for practical applications.

Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment.

INTRODUCTION: Low muscle mass is a common condition in the critically ill population and is associated with adverse clinical outcomes. The primary aim of this study was to analyze the prognostic significance of low muscle mass using computed tomography (CT) scans in COVID-19 critically ill patients. A second objective was to determine the accuracy and agreement in low muscle mass identification using diverse markers compared to CT as the gold standard. METHODS: This was a prospective cohort study of COVID-19 critically ill patients. Skeletal muscle area at the third lumbar vertebra was measured. Clinical outcomes (intensive care unit [ICU] and hospital length of stay [LOS], tracheostomy, days on mechanical ventilation [MV], and in-hospital mortality) were assessed. Phase angle, estimated fat-free mass index, calf circumference, and mid-upper arm circumference were measured as surrogate markers of muscle mass. RESULTS: Eighty-six patients were included (mean age ± SD: 48.6 ± 12.9; 74% males). Patients with low muscle mass (48%) had a higher rate of tracheostomy (50 vs 20%, p = 0.01), prolonged ICU (adjusted HR 0.53, 95%CI 0.30-0.92, p = 0.024) and hospital LOS (adjusted HR 0.50, 95% CI 0.29-0.86, p = 0.014). Bedside markers of muscle mass showed poor to fair agreement and accuracy compared to CT-assessed low muscle mass. CONCLUSION: Low muscle mass at admission was associated with prolonged length of ICU and hospital stays. Further studies are needed to establish targeted nutritional interventions to halt and correct the catabolic impact of COVID-19 in critically ill patients, based on standardized and reliable measurements of body composition.

Using CDOM spectral shape information to improve the estimation of DOC concentration in inland waters: A case study of Andean Patagonian Lakes.

For the last two decades different scientific disciplines have focused on lacustrine dissolved organic matter (DOM) given its importance in the biogeochemistry of carbon and in ecosystem functioning. New satellites supply the appropriate resolutions to evaluate chromophoric dissolved organic matter (CDOM) in inland waters, opening the possibility to estimate DOM at appropriate spatiotemporal scales. This requires, however, a robust relationship between CDOM and dissolved organic carbon (DOC). In this work, we evaluated the use of CDOM as a proxy of DOC in 7 Andean Patagonian lakes. Considering the entire data set, CDOM absorption coefficients (a355 and a440) were linearly related with DOC. Shallow lakes, however, drove this relationship showing a moderate relationship, whereas, deep lakes with lower colour presented a weaker relationship. Therefore, we assessed the use of CDOM spectral shape information to improve DOC estimates regardless of observed DOM differences due to climatic seasonality and lakes' morphometry. The use of well-known CDOM spectral shape metrics (i.e., S275-295 and a250:a365 ratio) significantly improved DOC estimation. Particularly, using a Gaussian decomposition approach we found that much of the variation in the spectral shape, associated with the variability of CDOM:DOC ratio, was explained by differences in two dynamic regions centred at 270 and 320 nm. A strong nonlinear relationship was found between the a270:a320 ratio and the DOC-specific absorption coefficients a*355 and a*440. This was translated into a further improvement in DOC estimation yielding the higher R2 and lower mean absolute differences (MAPD < 16%), either considering the entire data set or shallow and deep lakes separately. Our results highlight that incorporating the CDOM spectral shape information improves the characterization of the DOC pool of inland waters, which is particularly relevant for remote and/or inaccessible sites and has significant implications for the environmental management, biogeochemical studies and future remote sensing applications.

[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

On the structure of Au11(SR)9 and Au13(SR)11 clusters.

Thiolated gold clusters are constituted by building blocks (Au4, Au6, Au12 and so on) and protected by staple motifs (-S-Au-S-Au-S-…). In this study, we propose the structure of Au11(SR)9 and Au13(SR)11 clusters that are in the synthesis route of the ubiquitous Au15(SR)13 cluster. Our DFT-D calculations support one triangular Au3 unit as the smallest one comprising the structure of the Au11(SR)9 cluster, while it competes with the Au4 unit found in the Au13(SR)11 cluster. The ligand effects on the electronic, optical and chiroptical properties were studied by considering H, CH3, phenyl and adamantyl as protecting ligands. In the case of the Au11(SR)9 cluster, its Au3 inner core is protected by one dimer motif and one [Au6(SR)6] cyclomer when H and CH3 were considered as ligands, and the preference for Au3 over Au4 inner core was calculated to be 0.042 (H), 0.190 (CH3), and 0.117 eV (adamantyl). In contrast, the preference for one Au4 core increased when using phenyl ligands (0.23 eV energy difference) and dimer and pentamer motifs. Moreover, the Au13(SR)11 cluster (R = CH3) has one Au4 inner core and is protected by the combination of cyclomer, monomer and dimer motifs, and the isomer containing one Au3 inner core and protected by one tetramer and one [Au6(SR)6] cyclomer is 0.170 eV less stable. This implies that the Au3 unit is important in these small sizes and that the energetic preference depends on the used ligand types. Moreover, we discuss the IR/Raman, optical absorption (UV-vis), and circular dichroism (CD) spectra of our predicted new structures.

Analgesia para cirugía pediátrica ambulatoria / Pain management for pediatric ambulatory surgery

INTRODUCTION: Outpatient pediatric surgery is very frequent. However, sometimes analgesia is insufficient. Implementation of regional anesthesia reduces consume of systemic analgesics, especially opioids. The objective of this article is to review available evidence regarding pain management in pediatric ambulatory surgery, in order to contribute to better care of these patients in this field of medicine. A search was made on Pubmed, ProQuest, and EMBASE databases obtaining a total of 973 articles. The titles of articles found were reviewed, of which 152 merited greater review. Finally, a total of 40 articles to be included in this review were selected. RESULTS: Acetaminophen and nonsteroidal anti-inflammatory drugs are safe in children. Opioid use has de- creased to avoid potential adverse events. Advances in ultrasound technology have contributed to safer and efficient peripheral nerve blocks, comparable to neuroaxial techniques, decreasing the use of systemic analgesia, adverse events and allowing early discharge. CONCLUSIÓN: A multimodal approach handle perioperative pain adequately and minimize perioperative complications. With the use of ultrasound, regional anesthesia is a safe technique that offers multiple advantages in ambulatory surgical proce- dures, ensuring an early discharge. More evidence is needed to recommend the use of adyuvant drugs and continuos peripheral nerve blocks in children.

INTRODUCTION: La cirugía pediátrica es realizada frecuentemente en forma ambulatoria, sin embargo, la analgesia al alta es inadecuada en algunos casos. El uso de analgesia regional ha permitido disminuir el consumo de analgésicos sistémicos, particularmente opioides. El objetivo de este trabajo es revisar la evidencia disponible respecto a técnicas de manejo del dolor pos-operatorio en contexto de cirugía pediátrica ambulatoria, de manera de contribuir al mejor cuidado de estos pacientes en esta área de la medicina. Se realizó una búsqueda en Pubmed, Embase y ProQuest, encontrándose un total de 973 trabajos. Se revisaron los títulos, encontrando 152 de interés para mayor revisión. Se seleccionaron finalmente 40 trabajos para ser incluidos en esta revisión. RESULTADOS: Paracetamol y antiinflamatorios no esteroidales son seguros de usar en niños. El uso de opioides es cada vez menos frecuente dado su perfil de efectos adversos. Con el uso de ecografía los bloqueos de nervio periférico son cada vez más usados, logrando analgesia similar a las técnicas neuroaxiales, disminuyendo el consumo de analgésicos, efectos adversos y logrando un alta precoz. CONCLUSIÓN: La analgesia multimodal permite un adecuado manejo del dolor, reduciendo los efectos adversos. Gracias a la amplia disponibilidad de ultrasonido, la analgesia regional es cada vez más segura y eficaz, ofreciendo ventajas en el contexto de cirugía ambulatoria al permitir un alta precoz. Es necesaria más evidencia para recomendar el uso de adyuvantes y bloqueos continuos de nervio periférico en contexto de cirugía pediátrica ambulatoria.