Multi-Degree-of-Freedom Force Sensor Incorporated into Soft Robotic Gripper for Improved Grasping Stability.

In recent years, soft robotic grippers have emerged as a promising solution for versatile and safe manipulation of objects in various fields. However, precise force control is critical, especially when handling delicate or fragile objects, to avoid excessive grip force application or to prevent object slippage. Herein, we propose a novel three-degree-of-freedom force sensor incorporated within a soft robotic gripper to realize stable grasping with force feedback. The proposed optical sensor employs lightweight and compact optical fibers, thereby allowing for cost-effective fabrication, and a robust sensing system that is immune to electromagnetic fields. By innervating the soft gripper with optical fibers, a durable system is achieved with the fibers functioning as a strengthening layer, thereby eliminating the need for embedding an external stiffening structure for efficient bending actuation. The innovative contact-based light loss sensing mechanism allows for a robust and stable sensing mechanism with low drift (<0.1% over 9000 cycles) that can be applied to soft pneumatic bending grippers. We used the developed sensor-incorporated soft gripper to grasp various objects, including magnetic materials, and achieved slip detection along with grip force feedback without any signal interference. Overall, this study proposes a robust measuring multi-degree-of-freedom force sensor that can be incorporated into grippers for improved grasping stability.

Comparative effectiveness and duration of protection of ChAdOx1, CoronaVac, BNT162b2, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines for symptomatic and hospitalized Mu, Delta, and Omicron: A test-negative case-control study.

OBJECTIVE: We carried out a study to estimate the vaccine effectiveness (VE) of homologous vaccination schedules against COVID-19, using data from mandatory information systems from Bogota, Colombia. METHODS: A test-negative case-control study in adults from Bogota (Colombia), between March 1st of 2021 and February 25th of 2022. We assess VE among symptomatic COVID-19 cases during the Mul, Delta, and Omicron predominance periods in Bogota, with controls matched by sex, age (±5 years), and date of testing (±7 days), using a case:control ratio of 1:1. We selected homologous vaccination schedules with ChAdOx1, CoronaVac, BNT162b2, mRNA-1273, and Ad26.COV2.S. VE was reported as one minus the odds ratio in adjusted conditional logistic regressions, with their 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant. RESULTS: 52,913 cases were matched to controls, 16,722 for Mu, 14,094 for Delta, and 22,097 for Omicron. VE was high against COVID-19 during Mu weeks with full vaccination using the monovalent BNT162b2 (VE: 69; 95% CI, 65 to 72) vaccine and ChAdOx1 (VE: 64; 95% CI, 31 to 81) and significantly lower with CoronaVac (P < 0.001) and Ad26.COV2.S (P = 0.005). During Delta, VE against COVID-19 was higher with BNT162b2 (VE: 55; 95% CI, 51 to 58). The VE for COVID-19 cases during Omicron was higher with a booster dose of monovalent BNT162b2 (VE: 45; 95% CI, 34 to 54). The VE of primary series and booster for ChAdOx1, Ad26.COV2.S, and CoronaVac did not show protection for Omicron. CONCLUSION: Our study provides further evidence on the protective effect of mRNA vaccines for Omicron, and warrant that the duration of protection against symptomatic infection may last for only a few months.

Pie diabético. Actualización en diagnóstico y tratamiento. Revisión bibliográfica / Diabetic foot. Update in diagnosis and treatment. Literature review

El pie diabético (PD) representa una de las complicaciones crónicas de la enfermedad diabética, que se debe a alteraciones estructurales y funcionales del pie, lo que provoca, entre otros efectos, las úlceras del pie diabético (UPD). Las tasas de mortalidad asociadas con el desarrollo de una UPD se estiman en un 5 % en el primer año y en un 42 % a los cinco años. A menudo puede identificarse un evento iniciador potencialmente prevenible, como un traumatismo menor que causa una lesión cutánea. La presentación clásica de la UPD es la de un pie infectado grave a través de una herida previa, con necrosis rápidamente progresiva. Se observa un tejido necrótico y colecciones purulentas. Las amputaciones del pie, muchas de las cuales pueden prevenirse con un reconocimiento y un tratamiento tempranos, pueden ser necesarias en hasta el 20 % de las úlceras del pie diabético. Los exámenes de detección sistemáticos para la afectación neuropática y vascular de las extremidades inferiores y la inspección cuidadosa de los pies pueden reducir sustancialmente la morbilidad de los problemas de los pies. El tratamiento efectivo de las UPD es complejo y requiere un gasto considerable de recursos y un costo significativo para el sistema de atención médica. En la presente revisión se hace una descripción de la fisiopatología, epidemiología, presentación clínica, diagnóstico y tratamiento de la UPD.(AU)

The diabetic foot (PD) represents one of the chronic complications of diabetic disease, which occurs due to structur-al and functional alterations of the foot, causing, among others, diabetic foot ulcers (DFU). Mortality rates associatedwith the development of a DFU are estimated at 5 % in the first year, and 42 % at five years. A potentially preventableinitiating event can often be identified, such as minor trauma causing a skin lesion. The classic presentation of DFUis that of a severely infected foot through a previous wound, with rapidly progressive necrosis, necrotic tissue andpurulent collections are observed. Foot amputations, many of which can be prevented with early recognitionand treatment, may be required in up to 20 % of diabetic foot ulcers. Routine screening for neuropathic and vascularinvolvement of the lower extremities and careful inspection of the feet can substantially reduce the morbidity offoot problems. Effective treatment of DFUs is complex and requires considerable expenditure of resources andsignificant cost to the health care system. This review provides a description of the pathophysiology, epidemiology,clinical presentation, diagnosis, and treatment of DFU.(AU)

Hip Arthroscopy in Adolescents Through an Extra-Capsular Approach.

Hip arthroscopic treatment for femoroacetabular impingement syndrome and labral tears is the gold standard in the adult and adolescent population, as we all know the most common surgical approach to the hip is entering the central compartment with fluoroscopy and with continuous distraction. A periportal capsulotomy in traction must be done to have visibility and instrument maneuverability. These maneuvers avoid scuffing the femoral head cartilage. In adolescents, extreme care must be taken in hip distraction, as the force used can cause iatrogenic neurovascular lesions, avascular necrosis, and lacerations of the genitals and foot/ankle. Experienced surgeons around the world have developed an extracapsular approach to the hip with smaller capsulotomies with a low complication rate. This approach to the hip has brought attention in the adolescent population because it is more secure and simple. Less force of distraction is needed because the capsulotomy is done first. This surgical technique allows observation of the cam morphology while entering to the hip without distraction. We describe an extracapsular approach as an option to treat femoral acetabular impingement syndrome and labral tears in the pediatric and adolescent population.

Evaluation of Dosimetry Formalisms in Intraoperative Radiation Therapy of Glioblastoma.

PURPOSE: The intraoperative radiotherapy in newly diagnosed glioblastoma multiforme (INTRAGO) clinical trial assesses survival in patients with glioblastoma treated with intraoperative radiation therapy (IORT) using the INTRABEAM. Treatment planning for INTRABEAM relies on vendor-provided in-water depth dose curves obtained according to the TARGeted Intraoperative radioTherapy (TARGIT) dosimetry protocol. However, recent studies have shown discrepancies between the estimated TARGIT and delivered doses. This work evaluates the effect of the choice of dosimetry formalism on organs at risk (OAR) doses. METHODS AND MATERIALS: A treatment planning framework for INTRABEAM was developed to retrospectively calculate the IORT dose in 8 INTRAGO patients. These patients received an IORT prescription dose of 20 to 30 Gy in addition to external beam radiation therapy. The IORT dose was obtained using (1) the TARGIT method; (2) the manufacturer's V4.0 method; (3) the CQ method, which uses an ionization chamber Monte Carlo (MC) calculated factor; (4) MC dose-to-water; and (5) MC dose-to-tissue. The IORT dose was converted to 2 Gy fractions equivalent dose. RESULTS: According to the TARGIT method, the OAR dose constraints were respected in all cases. However, the other formalisms estimated a higher mean dose to OARs and revealed 1 case where the constraint for the brain stem was exceeded. The addition of the external beam radiation therapy and TARGIT IORT doses resulted in 10 cases of OARs exceeding the dose constraints. The more accurate MC calculation of dose-to-tissue led to the highest dosimetric differences, with 3, 3, 2, and 2 cases (out of 8) exceeding the dose constraint to the brain stem, optic chiasm, optic nerves, and lenses, respectively. Moreover, the mean cumulative dose to brain stem exceeded its constraint of 66 Gy with the MC dose-to-tissue method, which was not evident with the current INTRAGO clinical practice. CONCLUSIONS: The current clinical approach of calculating the IORT dose with the TARGIT method may considerably underestimate doses to nearby OARs. In practice, OAR dose constraints may have been exceeded, as revealed by more accurate methods.

Semilleros de investigación como espacio de reconocimiento de personas con altas capacidades / Research hotbeds as a space for the recognition of gifted people / Semilleros de investigación como espaço de reconhecimento de pessoas com altas habilidades

Resumen (analítico) Se presentan los resultados de una investigación sobre semilleros de investigación como espacio de reconocimiento de personas con altas capacidades y talentos. Ejecutado a partir de la ruta fenomenológica y hermenéutica, utilizó como técnica la entrevista semiestructurada a cinco participantes con más de cinco años en semilleros de investigación, la cual fue interpretada a través de un análisis estructural. Se logra refigurar el concepto de semilleros de investigación y plantearlos como espacios de reconocimiento que configuran nuevas identidades y agenciamientos para la constitución de personas capaces, con apertura de sentidos hacia las posibilidades del reconocimiento mutuo y agenciamiento de nuevas prácticas en el ámbito académico, laboral y social. Las líneas de sentido son construidas por los semilleristas en contraposición a los procesos escolares; lo cual deja abierta la posibilidad de otros procesos de reconocimiento.

Abstract (analytical) The present study is the result of the research on research hotbeds (semilleros de investigación) as a space for the recognition of gifted and talented people. Using phenomenological and hermeneutical approaches, semi-structured interviews were used as a data collection technique with five participants who have more than 5 years of experience in research hotbeds. The data was interpreted using a structural analysis. It is possible to redefine the concept of research hotbeds and propose them as a space of recognition that configure new identities and methods for the constitution of capable people, opening up the possibilities of mutual recognition and developing new practices in academic, labor and social dimensions. Meanings are constructed by participants in the research hotbeds in contrast to school processes, creating the possibility of other forms of recognition.

Resumo (analítico) O presente trabalho é o resultado da pesquisa sobre o focos de pesquisa (semilleros de investigación) como espaço de reconhecimento de pessoas com altas capacidades e talentos. Executado a partir do percurso fenomenológico e hermenêutico, utilizando a entrevista semiestruturada como técnica para cinco participantes com mais de cinco anos em focos de pesquisa, interpretada através de uma análise estrutural. É possível reconfigurar o conceito de semilleros de investigación propôlos como um espaço de reconhecimento que configura novas identidades e agenciamentos para a constituição de pessoas capazes com abertura de sentidos para as possibilidades de reconhecimento mútuo e montagem de novas práticas no meio acadêmico, laboral e esferas sociais. As linhas de sentido são construídas pelas semilleristas em contraposição aos processos escolares. A possibilidade de outros processos de reconhecimento é deixada em aberto.

Monte Carlo calculation of the TG-43 dosimetry parameters for the INTRABEAM source with spherical applicators.

OBJECTIVE: The relative TG-43 dosimetry parameters of the INTRABEAM (Carl Zeiss Meditec AG, Jena, Germany) bare probe were recently reported by Ayala Alvarezet al(2020Phys. Med. Biol.65245041). The current study focuses on the dosimetry characterization of the INTRABEAM source with the eight available spherical applicators according to the TG-43 formalism using Monte Carlo (MC) simulations. APPROACH: This report includes the calculated dose-rate conversion coefficients that determine the absolute dose rate to water at a reference point of 10 mm from the applicator surface, based on calibration air-kerma rate measurements at 50 cm from the source on its transverse plane. Since the air-kerma rate measurements are not yet provided from a standards laboratory for the INTRABEAM, the values in the present study were calculated with MC. This approach is aligned with other works in the search for standardization of the dosimetry of electronic brachytherapy sources. As a validation of the MC model, depth dose calculations along the source axis were compared with calibration data from the source manufacturer. MAIN RESULTS: The calculated dose-rate conversion coefficients were 434.0 for the bare probe, and 683.5, 548.3, 449.9, 376.5, 251.0, 225.6, 202.8, and 182.6 for the source with applicators of increasing diameter from 15 to 50 mm, respectively. The radial dose and the 2D anisotropy functions of the TG-43 formalism were also obtained and tabulated in this document. SIGNIFICANCE: This work presents the data required by a treatment planning system for the characterization of the INTRABEAM system in the context of intraoperative radiotherapy applications.

Prevention of road traffic collisions and associated neurotrauma in Colombia: An exploratory qualitative study.

INTRODUCTION: Neurotrauma is an important but preventable cause of death and disability worldwide, with the majority being associated with road traffic collisions (RTCs). The greatest burden is seen in low -and middle- income countries (LMICs) where variations in the environment, infrastructure, population and habits can challenge the success of conventional preventative approaches. It is therefore necessary to understand local perspectives to allow for the development and implementation of context-specific strategies which are effective and sustainable. METHODS: This study took place in Colombia where qualitative data collection was carried out with ten key informants between October and November 2019. Semi-structured interviews were conducted and explored perceptions on RTCs and neurotrauma, preventative strategies and interventions, and the role of research in prevention. Interview transcripts were analysed by thematic analysis using a framework approach. RESULTS: Participants' confirmed that RTCs are a significant problem in Colombia with neurotrauma as an important outcome. Human and organisational factors were identified as key causes of the high rates of RTCs. Participants described the current local preventative strategies, but were quick to discuss limitations and challenges to their success. Key barriers reported were poor attitudes and knowledge, particularly in the community. Suggestions were provided on ways to improve prevention through better education and awareness, stricter enforcement and new policies on prevention, proper budgeting and resource allocation, as well as through collaboration and changes in attitudes and leadership. Participants identified four key research areas they felt would influence prevention of RTCs and associated neurotrauma: causes of RTCs; consequences and impact of RTCs; public involvement in research; improving prevention. CONCLUSION: RTCs are a major problem in Colombia despite the current preventative strategies and interventions. Findings from this study have a potential to influence policy, practice and research by illustrating different solutions to the challenges surrounding prevention and by highlighting areas for further research.

Monte Carlo calculation of the relative TG-43 dosimetry parameters for the INTRABEAM electronic brachytherapy source.

The INTRABEAM system (Carl Zeiss Meditec AG, Jena, Germany) is an electronic brachytherapy (eBT) device designed for intraoperative radiotherapy applications. To date, the INTRABEAM x-ray source has not been characterized according to the AAPM TG-43 specifications for brachytherapy sources. This restricts its modelling in commercial treatment planning systems (TPSs), with the consequence that the doses to organs at risk are unknown. The aim of this work is to characterize the INTRABEAM source according to the TG-43 brachytherapy dosimetry protocol. The dose distribution in water around the source was determined with Monte Carlo (MC) calculations. For the validation of the MC model, depth dose calculations along the source longitudinal axis were compared with measurements using a soft x-ray ionization chamber (PTW 34013) and two synthetic diamond detectors (microDiamond PTW TN60019). In our results, the measurements in water agreed with the MC model calculations within uncertainties. The use of the microDiamond detector yielded better agreement with MC calculations, within estimated uncertainties, compared to the ionization chamber at points of steeper dose gradients. The radial dose function showed a steep fall-off close to the INTRABEAM source ([Formula: see text]10 mm) with a gradient higher than that of commonly used brachytherapy radionuclides (192Ir, 125I and 103Pd), with values of 2.510, 1.645 and 1.232 at 4, 6 and 8 mm, respectively. The radial dose function partially flattens at larger distances with a fall-off comparable to that of the Xoft Axxent® (iCAD, Inc., Nashua, NH) eBT system. The simulated 2D polar anisotropy close to the bare probe walls showed deviations from unity of up to 55% at 10 mm and 155°. This work presents the MC calculated TG-43 parameters for the INTRABEAM, which constitute the necessary data for the characterization of the source as required by a TPS used in clinical dose calculations.

Análisis de los factores radiopatológicos del cáncer de mama triple negativo y determinación de perfiles de riesgo / Analysis of the radio-pathological factors of triple negative breast cancer and determination of risk profiles

OBJETIVO: Los tumores triples negativos (TN) constituyen el subgrupo de cáncer de mama (CM) más agresivo. Nuestro objetivo es analizar los principales factores radiopatológicos de estos tumores para crear un perfil de riesgo. MATERIALES Y MÉTODOS: Es un estudio constituido por 140 pacientes diagnosticadas de CM TN desde enero del 2007 a diciembre del 2016. Se analizaron los factores radiológicos en resonancia magnética (RM) de estadificación: tamaño, necrosis, hallazgos asociados, adenopatías, parámetros de perfusión y difusión. En biopsias diagnósticas se estudiaron características del componente infiltrante: tipo histológico, Scarf-Bloom, Ki67 y p53 y el componente in situ. Se analizaron las adenopatías histológicamente positivas y en las piezas quirúrgicas: tamaño, invasión linfovascular/perineural y adenosis microglandular. El seguimiento finalizó en abril de 2018. Se evaluó la relación de los factores radiopatológicos con la recidiva y la supervivencia libre de enfermedad (SLE). RESULTADOS: Los tumores con tamaño igual o superior a 25 mm en RM, realce no nodular, edema mamario o retracción del complejo aréola-pezón y adenopatías presentaron más recidivas y menor SLE. Los carcinomas lobulillares infiltrantes, el tamaño posquirúrgico>20 mm y p53 <15% también se asociaron con la recidiva y una menor SLE. Las adenopatías histológicamente positivas se relacionaron con un mayor porcentaje de recidivas, y la invasión linfovascular, con una menor SLE. El análisis multivariante ha definido que el tamaño en RM>25 mm, el realce no nodular, las adenopatías en RM, y la expresión menor del 15% de p53 son variables pronósticas independientes. CONCLUSIONES: El tamaño igual o superior a 25 mm, realce no nodular y adenopatías en RM, y una expresión inferior al 15% de p53 condicionan una menor SLE

OBJECTIVE: Triple-negative tumors are the most aggressive type of breast cancer. We aimed to analyze the main radiologic and histopathologic factors of these tumors to create a risk profile. MATERIALS AND METHODS: We analyzed data from 140 patients diagnosed with triple-negative breast cancer between January 2007 and December 2016, with follow-up through April 2018. We analyzed the following variables in the breast MRI done for staging: size, necrosis, associated findings, adenopathies, and perfusion and diffusion parameters. We analyzed the following variables in histopathologic studies of biopsy specimens: histological type, Scarf-Bloom, Ki67, and p53 in the infiltrating component as well as in the in situ component. We analyzed the following variables in histopathologic studies of positive lymph nodes and surgical specimens: size, lymphovascular/perineural invasion, and microglandular adenosis. We analyzed the relation between the radiologic and histopathologic factors and recurrence and disease-free survival. RESULTS: MRI tumor size>25mm, non-nodular enhancement, breast edema, areola-nipple complex retraction, and lymph-node involvement were associated with recurrence and lower disease-free survival. Invasive lobular carcinoma, postsurgical size>20mm, and p53<15% were also associated with recurrence and lower disease-free survival. Histologically positive lymph nodes were associated with a greater percentage of recurrence and lymphovascular invasion and with lower disease-free survival. The multivariate analysis found that the variables MRI size>25mm, non-nodular enhancement, adenopathies on MRI, and p53 expression <15% were independent predictors of lower disease-free survival. CONCLUSIONS: In triple-negative breast tumors, factors associated with lower disease-free survival are non-nodular enhancement, size>25mm, and adenopathies on MRI, and p53 expression <15% on histopathologic study

Analysis of the radio-pathological factors of triple negative breast cancer and determination of risk profiles. / Análisis de los factores radiopatológicos del cáncer de mama triple negativo y determinación de perfiles de riesgo.

OBJECTIVE: Triple-negative tumors are the most aggressive type of breast cancer. We aimed to analyze the main radiologic and histopathologic factors of these tumors to create a risk profile. MATERIALS AND METHODS: We analyzed data from 140 patients diagnosed with triple-negative breast cancer between January 2007 and December 2016, with follow-up through April 2018. We analyzed the following variables in the breast MRI done for staging: size, necrosis, associated findings, adenopathies, and perfusion and diffusion parameters. We analyzed the following variables in histopathologic studies of biopsy specimens: histological type, Scarf-Bloom, Ki67, and p53 in the infiltrating component as well as in the in situ component. We analyzed the following variables in histopathologic studies of positive lymph nodes and surgical specimens: size, lymphovascular/perineural invasion, and microglandular adenosis. We analyzed the relation between the radiologic and histopathologic factors and recurrence and disease-free survival. RESULTS: MRI tumor size>25mm, non-nodular enhancement, breast edema, areola-nipple complex retraction, and lymph-node involvement were associated with recurrence and lower disease-free survival. Invasive lobular carcinoma, postsurgical size>20mm, and p53<15% were also associated with recurrence and lower disease-free survival. Histologically positive lymph nodes were associated with a greater percentage of recurrence and lymphovascular invasion and with lower disease-free survival. The multivariate analysis found that the variables MRI size>25mm, non-nodular enhancement, adenopathies on MRI, and p53 expression <15% were independent predictors of lower disease-free survival. CONCLUSIONS: In triple-negative breast tumors, factors associated with lower disease-free survival are non-nodular enhancement, size>25mm, and adenopathies on MRI, and p53 expression <15% on histopathologic study.

Child labor and agricultural production in Colombia / Trabajo infantil y producción agrícola en Colombia

Abstract Introduction: Child labor is a global problem affecting 168 million children and adolescents, of which 98 million are found in the agricultural sector. In Colombia, there were 869 000 child workers in 2017. Objective: To characterize child labor in the agricultural production of rice, coffee, cotton, sugar cane, and panela sugar cane in Colombia. Materials and methods: A qualitative study was conducted from a literature review of studies on child labor, a documentary review on Colombian regulations regarding this phenomenon, and the empirical collection of data through participant observation and the use of interviews. Results: According to the official sources of information, given the level of industrialization and formal employment in the rice, cotton and sugar cane production processes there is no evidence of child labor in said sectors. On the contrary, in the case of coffee and panela sugar cane production, most of agricultural work occurs within a family economy scenario, which causes children and adolescents to work as unpaid family members to support their households. It is worth noting that due to the fact that agricultural work in Colombia takes place in rural areas and under informal economy conditions, there is an underreporting of the number of working children and adolescents in the agricultural sector, and therefore, the capacity of the Colombian state to confront this situation is very limited. Conclusions: The informal economy dynamics of the Colombian agricultural sector constitutes a potential scenario for the occurrence of child labor that requires the development and implementation of a public policy supported by a strong supervision by the State, and an educational strategy that, on the one hand, integrates school education with training options in relation to the agricultural production dynamics, so that children and adolescents attendance to school is encouraged, and, on the other, enables them to plan a life project in the context of agricultural work in rural areas.

Resumen Introducción. El trabajo infantil es un problema mundial que afecta a 168 millones de menores, 98 millones de ellos en el campo de la agricultura. En Colombia, en 2017 se reconocieron 869 000 menores trabajadores. Objetivo. Caracterizar el trabajo infantil en la producción de arroz, café, algodón y caña de azúcar y panelera en Colombia. Materiales y métodos. Estudio cualitativo con revisión documental y recopilación empírica de información a través de observación y entrevistas a actores clave. Resultados. De acuerdo con las fuentes oficiales, dado el nivel de industrialización y de formalización en los procesos productivos del arroz, el algodón y la caña de azúcar, en estos sectores no existe el trabajo infantil; por el contrario, la producción del café y de la panela son actividades económicas principalmente de índole familiar, lo que causa que los niños y adolescentes tengan que desempeñar tareas de apoyo en un marco de trabajo familiar. Cabe resaltar que, debido a que la actividad agrícola en Colombia se desarrolla en áreas rurales y en la informalidad, existe un subregistro de la cantidad de niños, niñas y adolescentes que trabajan en estos sectores, lo que hace que la habilidad del Estado para hacer frente al trabajo infantil en el contexto de la producción agrícola sea muy limitada. Conclusiones. La dinámica productiva agrícola informal en Colombia constituye un escenario potencial para el trabajo infantil, lo cual demanda una política pública con fuerte supervisión del Estado y una estrategia educativa que, por un lado, vincule la formación de niños, niñas y adolescentes con la dinámica agraria en la que cobre sentido mantenerse en lo escolar y, por el otro, permita configurar un proyecto de vida en el campo.

Dipyrone (metamizole), overrated risks? / Dipirona, ¿riesgos sobredimensionados?

In their editorial, Gómez-Duarte1 suggests that the association of dipyrone with multiple adverse effects should lead to reconsider its use. We are of the opinion that such position neglects part of the available evidence, although we recognize that based on such evidence different views arise with regard to its use.2,3 Dipyrone is an analgesic agent widely used by the Colombian anesthesiologists. In our country, we have accumulated a vast experience in the area of acute postoperative pain and it is fundamental to assess the available evidence to determine the role of dipyrone in the practice of anesthesia in Colombia.

En su editorial, Gómez-Duarte1 sugiere que la asociación de la dipirona con múltiples efectos adversos debería llevar a reconsiderar su uso. Somos de la opinión de que tal posición descuida parte de la evidencia disponible, aunque reconocemos que con base en dicha evidencia surgen diferentes puntos de vista con respecto a su uso.2,3 La dipirona es un agente analgésico ampliamente utilizado por los anestesiólogos colombianos. En nuestro país hemos acumulado una amplia experiencia en el área del dolor agudo postoperatorio y es fundamental evaluar la evidencia disponible para determinar el papel de la dipirona en la práctica de la anestesia en Colombia.

Uso de fáscia peitoral maior em preenchimento de dorso nasal: relato de caso / Use of pectoralis major fascia in dorsal nasal augmentation: case report

O aumento do dorso nasal nas rinoplastias é foco de estudo de diversos trabalhos que buscam as melhores fontes de enxerto e técnicas cirúrgicas. A utilização de cartilagem já é consagrada para este fim, a partir do septo nasal, da concha auricular ou dos arcos costais. Nos últimos anos, têm-se buscado meios para reduzir a palpabilidade e dispersibilidade dos enxertos cartilaginosos. Assim, são descritos materiais sintéticos, como o SURGICEL®; e, autólogos, representados pelas fáscias. A fáscia temporal é mais amplamente utilizada, porém requer uma nova incisão cirúrgica, aumentando o tempo e a morbidade da cirurgia. É também descrito o uso de fáscia lata e fáscia reto abdominal, comparativamente mais espessas e menos flexíveis. Em muitos casos de rinoplastia fazse necessária a retirada da cartilagem costal, o que permite a coleta de fáscia do músculo peitoral maior pela mesma incisão cirúrgica. Dessa forma, descrevemos a utilização da fáscia do músculo peitoral maior envolvendo cartilagem costal picada, em uma rinoplastia estruturada com aumento do dorso.

Increasing the nasal dorsum in rhinoplasty is the focus of several studies that seek the best graft sources and surgical techniques. The use of cartilage from the nasal septum, ear shell, or costal arches is already established for this purpose. In recent years, methods have been sought to reduce the palpability and dispersibility of cartilaginous grafts. Thus, synthetic materials such as SURGICEL® and autologous materials such as fascia have been explored. Temporal fascia are more widely used but require a new surgical incision, increasing surgical time and morbidity. Also described is the use of fascia lata and rectus abdominis fascia, which are comparatively thicker and less flexible. In many rhinoplasty procedures, it is necessary to remove the costal cartilage, which allows the collection of fascia from the major chest muscles through the same surgical incision. Thus, we describe the use of major chest muscle fascia and chopped costal cartilage in structured rhinoplasty to increase the dorsum.

Seed predation increases from the Arctic to the Equator and from high to low elevations.

Species interactions have long been predicted to increase in intensity toward the tropics and low elevations because of gradients in climate, productivity, or biodiversity. Despite their importance for understanding global ecological and evolutionary processes, plant-animal interaction gradients are particularly difficult to test systematically across large geographic gradients, and evidence from smaller, disparate studies is inconclusive. By systematically measuring postdispersal seed predation using 6995 standardized seed depots along 18 mountains in the Pacific cordillera, we found that seed predation increases by 17% from the Arctic to the Equator and by 17% from 4000 meters above sea level to sea level. Clines in total predation, likely driven by invertebrates, were consistent across treeline ecotones and within continuous forest and were better explained by climate seasonality than by productivity, biodiversity, or latitude. These results suggest that species interactions play predictably greater ecological and evolutionary roles in tropical, lowland, and other less seasonal ecosystems.

Reconstitución del dantrolene descripción de un modelo de simulación en hipertermnia maligna / Dantrolene reconstitution: description of a simulation model in malignant hyperthermia

Abstract Malignant hyperthermia is a potentially lethal condition triggered by succinylcholine exposure or exposure to halogenated anesthetic agents. Early identification of the crisis, as well as the timely administration of the specific treatment, impact the patient's outcomes. Any potential difficulties for dandrolene reconstitution are critical and may cause delays or preventable errors, if the operator is not familiar with the preparation and administration of the drug. The development of a simulation model to learn the process offers the possibility to acquire one of the skills required when facing a crisis of malignant hyperthermia. The high cost of the vials and sometimes the difficult access to the medication due to lack of availability in many institutions makes the option of simulating dantrolene reconstitution attractive, in order to familiarize the surgical team with the management of the drug. In this scenario, we submit a simulation model to learn the process of preparation of dandrolene in a controlled environment.

Resumen La hipertermia maligna es una condición potencialmente mortal desencadenada por la exposición a la succinilcolina o a los anestésicos halogenados. La identificación temprana de la crisis así como la administración oportuna del tratamiento específico tiene implicaciones en el desenlace del paciente, siendo las posibles dificultades en la reconstitución del dantroleno un punto crítico donde se pueden generar retrasos o errores prevenibles si hay familiaridad con el proceso de preparación y administración del medicamento. El desarrollo de un modelo de simulación que permite conocer este proceso ofrece la posibilidad de adquirir una de las destrezas requeridas para afrontar una crisis de hipertermia maligna. El elevado costo de los viales y en ocasiones el difícil acceso a estos debido a la no disponibilidad del medicamento en muchas de las instituciones hace atractiva la opción de simular la reconstitución del dantroleno para familiarizar al equipo quirúrgico con el manejo del medicamento. En este escenario proponemos un modelo de simulación con el cual es posible conocer el proceso de preparación del dantroleno en un ambiente controlado.

Resistencia a fármacos antirretrovirales en la Clínica de VIH del Hospital de Especialidades Carlos Andrade Marín / Antiviral Drug Resistance in the HIV Clinic, Carlos Andrade Marín Specialities Hospital

Introducción. La resistencia a los fármacos antirretrovirales es un problema de importancia mundial. El tratamiento antirretroviral procura disminuir la carga viral y permitir la reconstitución inmune, logrando la máxima supresión viral por el mayor tiempo posible, con un mínimo impacto en las actividades del paciente. Objetivo. Evaluar la prevalencia de resistencia antiviral en pacientes sometidos a la prueba de resistencia viral. Material y métodos. Para el estudio se recolectaron muestras de plasma de 41 pacientes de la clínica de VIH del Hospital de Especialidades Carlos Andrade Marín con sospecha clínica de resistencia a antirretrovirales y fallo virológico. Todas las muestras se almacenaron a -80°C hasta su uso y se procesaron de acuerdo a las condiciones del fabricante en cuanto a extracción de ARN y secuenciación. Los resultados fueron analizados con el software DeepChek®, específico para detectar resistencia antirretroviral de VIH. Resultados. Cuarenta y un pacientes fueron seleccionados para el análisis de resistencia antirretroviral, más del 85% (35/41) de los pacientes estudiados presentaron resistencia a algún fármaco antirretroviral. La mayoría de pacientes (71%; 29/41) resultaron tener algún tipo de resistencia a inhibidores de nucleósidos de la transcriptasa inversa (NRTI) e inhibidores de no nucleósidos de la transcriptasa inversa (NNRTI) conjuntamente. Conclusiones. El problema de resistencia viral es evidente en los pacientes contagiados por VIH, en nuestro caso se observa alta resistencia a NRTI y NNRTI. Se pudieron identificar pacientes con resistencia primaria y resistencia secundaria, generando inquietud en la importancia de la adherencia del paciente al tratamiento, con el fin de tener supresión antiviral efectiva.

Introduction. Resistance to antiviral drugs is a major problem worldwide. Antiretroviral therapy seeks to reduce viral load and allows for immune reconstitution, achieving viral suppression for as long as possible, with minimum impact on patient activities. Objective. To evaluate the prevalence of antiviral resistance in patients subjected to viral resistance test. Resistance to antiretrovirals has clinical, virological and immunological implications, so monitoring resistance in case of virological failure optimizes therapeutic scheme selection, to minimize costs and obtain greater treatment success. Materials and methods. Plasma samples with clinical suspicion of antiretroviral resistance and virological failure were collected from 41 patients at the HIV Clinic, Carlos Andrade Marín Specialties Hospital. All samples were stored at -80°C until processed, following Manufacturer conditions for RNA extraction and sequencing. Results were analyzed using DeepChek® for the detection of HIV antiretroviral resistance. Results. Over 85% of patients studied had resistance to a antiretroviral drug. Most patients (71%) were found to have some type of combined resistance to NRTI and NNRTI. Conclusions. The problem of viral resistance is evident in patients infected with HIV. We observed high resistance to NRTI and NNRTI. Patients with primary and secondary resistance were identified, raising concerns about the importance of patient adherence to treatment, to achieve effective antiviral suppression.

Análisis de los factores radio-patológicos y terapéuticos del cáncer de mama triple negativo y su influencia en la recidiva y supervivencia libre de enfermedad / Analysis of the radiopathological and therapeutic factors in triple-negative breast cancer and their influence on relapse and disease-free survival

Objetivo. Analizar la asociación entre la densidad mamográfica, la invasión linfovascular, la adenosis microglandular y el estado ganglionar de los tumores triples negativos (TN) con la recidiva tumoral y la supervivencia libre de enfermedad. Estudiar si la perfusión tumoral en las RM de estadificación se correlaciona con la recidiva tumoral, la supervivencia libre de enfermedad o los valores de restricción a la difusión. Analizar si la administración de quimioterapia neoadyuvante (QTN) o el tipo de tratamiento quirúrgico (cirugía conservadora o mastectomía) se asocian a un peor pronóstico. Pacientes y métodos. Estudio retrospectivo de las mamografías y de las RM pretratamiento de 122 pacientes con tumores TN entre los años 2007 y 2014. Se valoró la densidad mamaria en estudios mamográficos realizados en el momento del diagnóstico. El estado ganglionar se analizó en muestras de biopsia o quirúrgicas, mientras que la invasión linfovascular y la adenosis microglandular se estudió únicamente en muestras quirúrgicas. Resultados. La densidad mamográfica y los factores anatomo-patológicos no se asociaron con la recidiva tumoral. Los valores de realce máximo en la secuencia dinámica eran más altos en las pacientes sin recidiva tumoral (p=0,028), sin demostrar relación con la restricción a la difusión. Conclusiones. Los tumores con valores más altos de realce interno en RM de estadificación presentan un menor índice de recidivas. No se demostró correlación entre los valores de realce interno tumoral y de restricción a la difusión. Y no se observó asociación pronóstica con el resto de factores radio-patológicos (AU)

Objective. To analyse the association between breast density, lymphovascular invasion, microglandular adenosis and the axillary node status of triple-negative tumours (TN) with tumour recurrence and disease-free survival. To study whether tumour perfusion in MRI staging correlates with tumour recurrence, disease-free survival or diffusion restriction. To analyse whether the administration of neoadjuvant chemotherapy (NC) or the type of surgical treatment (breast-conserving surgery or mastectomy) are associated with a worse prognosis. Patients and methods. A retrospective study of mammograms and staging MRIs was performed from 2007 to 2014, including 122 women with TN breast cancer. Breast density was assessed in mammographic studies performed at the time of diagnosis. Lymph node status was analysed in biopsy or surgical specimens, whereas lymphovascular invasion and microglandular adenosis were studied only in surgical specimens. Results. Breast density and histopathological factors were not associated with tumour recurrence. The maximum enhancement values in the dynamic sequence were higher in patients without tumour recurrence (P=.028), without demonstrating a relationship with diffusion restriction. Conclusions. Tumours with higher values of internal enhancement showed less tumour recurrence. There was no correlation between the values of internal tumour enhancement and diffusion restriction. No prognostic association was observed with the remaining radiopathological factors (AU)

Tratamento de fratura de assoalho orbital com cartilagem conchal / Treatment of orbital floor fracture with conchal cartilage

Introdução: A reconstrução dos defeitos no assoalho orbital após fraturas constitui um desafio ao cirurgião plástico, pois além da expectativa estética e reconstrutora do paciente, cabe o tratamento de possíveis complicações funcionais, como diplopia e parestesias faciais. O objetivo é demonstrar uma série de casos utilizando cartilagem auricular conchal para reposição volumétrica orbital e estrutural do assoalho. Métodos: Foram avaliados 24 pacientes, operados pelo autor deste trabalho no período de 2013 a 2016, por motivo de fraturas de assoalho orbital pura (blow-out) ou impura (conjugadas a lesões de margem orbital, como zigoma e maxila). A técnica de estruturação do assoalho utilizou enxerto cartilaginoso autólogo conchal em todos os casos. Os pacientes foram catalogados quanto à presença de queixas pré-operatórias, como parestesia e diplopia, e sintomas, como enoftalmia, assim como resultados pós-operatórios. Resultados: A presença de lesões concomitantes como fratura de complexo zigomático e fratura maxilar pode influenciar no sucesso da reconstrução, assim como as fraturas com maior área de descontinuidade no assoalho orbital. Poucos pacientes apresentaram queixas pós-operatórias e somente dois casos (9,2%) necessitaram de nova abordagem cirúrgica. Conclusão: A cartilagem conchal auricular autóloga é um material adequado à reconstrução de defeitos no assoalho orbital pós-fratura, apresentando como vantagens a fácil obtenção, baixa morbidade, cicatriz inconspícua, excelente adaptação ao formato do assoalho da órbita e consequente reposição volumétrica.

Introduction: The reconstruction of defects in the orbital floor after fractures poses a challenge to the plastic surgeon because besides the patient's aesthetic and reconstructive expectations, possible functional complications such as diplopia and facial paresthesia must be treated. This study aimed at reporting a series of cases in which conchal auricular cartilage was used for volumetric orbital and structural replacement of the floor. Methods: Twenty-four patients, with surgery performed by the author, between 2013 and 2016, for pure (blow-out) or impure (conjugated to orbital margin injuries, such as zygoma and maxilla) orbital floor fractures, were evaluated. The repair technique involved autologous conchal cartilage graft in all cases. Patients were classified for the presence of preoperative complaints, including paresthesia and diplopia, and symptoms such as enophthalmia, as well as postoperative outcomes. Results: The existence of concomitant lesions, such as zygomatic complex and maxillary fracture, as well as fractures with greater discontinuity in the orbital floor, may influence the success of reconstruction. Few patients exhibited postoperative complaints and only two (9.2%) required a new surgical approach. Conclusion: Autologous conchal auricular cartilage is a suitable material for reconstruction of defects in the post-fracture orbital floor, possessing various advantages, including ease of attainment, low morbidity, inconspicuous scar, and excellent adaptation to the shape of the orbital floor and consequent volumetric replacement.