Towards a GDPR-compliant cloud architecture with data privacy controlled through sticky policies.

Data privacy is one of the biggest challenges facing system architects at the system design stage. Especially when certain laws, such as the General Data Protection Regulation (GDPR), have to be complied with by cloud environments. In this article, we want to help cloud providers comply with the GDPR by proposing a GDPR-compliant cloud architecture. To do this, we use model-driven engineering techniques to design cloud architecture and analyze cloud interactions. In particular, we develop a complete framework, called MDCT, which includes a Unified Modeling Language profile that allows us to define specific cloud scenarios and profile validation to ensure that certain required properties are met. The validation process is implemented through the Object Constraint Language (OCL) rules, which allow us to describe the constraints in these models. To comply with many GDPR articles, the proposed cloud architecture considers data privacy and data tracking, enabling safe and secure data management and tracking in the context of the cloud. For this purpose, sticky policies associated with the data are incorporated to define permission for third parties to access the data and track instances of data access. As a result, a cloud architecture designed with MDCT contains a set of OCL rules to validate it as a GDPR-compliant cloud architecture. Our tool models key GDPR points such as user consent/withdrawal, the purpose of access, and data transparency and auditing, and considers data privacy and data tracking with the help of sticky policies.

Landmarks for the hypoglossal nerve within the anterior cervical triangle / Topografía del nervio hipogloso en el triángulo cervical anterior

SUMMARY: Cranial nerve injury is one of the neurologic complications following carotid endarterectomy. The hypoglossal nerve is one of the most frequently injured nerves during carotid endarterectomy. Guidelines suggest that proper anatomic knowledge is crucial to avoid cranial nerve injury. The aim of the present study is to provide landmarks for the localization of the hypoglossal nerve during carotid endarterectomy. 33 anterior cervical triangles of formalin-fixed adult cadavers were dissected. The "carotid axis" was defined and measured, the level of the carotid bifurcation within the carotid axis was registered. "High carotid bifurcation" was considered for those carotid bifurcation found in the upper 25 mm of the carotid axis. The distance between the hypoglossal nerve and the carotid bifurcation was measured (length 1). The relationship between the hypoglossal nerve and the posterior belly of the digastric muscle was registered. For caudal positions, the distance between hypoglossal nerve and posterior belly of the digastric muscle was determined (length 2). Carotid axis range 88.3 mm-155.4 mm, average 125.8 mm. Level of the carotid bifurcation within the carotid axis range 75.3 mm-126.5 mm, mean 102.5 mm. High carotid bifurcation was found in 19 cases (57 %). Length 1 ranged from 1.6 mm to 38.1, mean 17.5. Finally, in 29 specimens (87.8 %) the hypoglossal nerve was caudal to posterior belly of the digastric muscle, whereas in 4 cases (12.2 %) it was posterior. Length 2 ranged from 1 mm to 17.0 mm, mean 6.9 mm. Distances between the hypoglossal nerve and nearby structures were determined. These findings may aid the surgeon in identifying the hypoglossal nerve during carotid endarterectomy and thus prevent its injury.

RESUMEN: La lesión de pares craneales es una de las complicaciones neurológicas posteriores a la endarterectomía carotídea. El nervio hipogloso es uno de los nervios lesionados más frecuentemente durante la endarterectomía carotídea. Las guías de actuación clínica sugieren que el conocimiento anatómico adecuado es crucial para evitar lesiones de los nervios craneales. El objetivo del presente estudio fue proporcionar puntos de referencia para la ubicación del nervio hipogloso durante la endarterectomía carotídea. Se disecaron 33 triángulos cervicales anteriores de cadáveres adultos fijados en solución a base de formaldehído. Se definió y midió el "eje carotídeo", se registró el nivel de la bifurcación carotídea dentro del eje carotídeo. Se consideró una "bifurcación carotídea alta" para aquellas bifurcaciones carotídeas encontradas en los 25 mm superiores del eje carotídeo. Se midió la distancia entre el nervio hipogloso y la bifurcación carotídea (longitud 1). Se registró la relación entre el nervio hipogloso y el vientre posterior del músculo digástrico. Para las posiciones caudales, se determinó la distancia entre el nervio hipogloso y el vientre posterior del músculo digástrico (longitud 2). Rango del eje carotídeo 88,3 mm-155,4 mm, media 125,8 mm. Rango del nivel de la bifurcación carotídea dentro del eje carotídeo 75,3 mm-126,5 mm, media 102,5 mm. Se encontró una bifurcación carotídea alta en 19 casos (57 %). La longitud 1 osciló entre 1,6 mm y 38,1, con una media de 17,5. Finalmente, en 29 muestras (87,8 %) el nervio hipogloso fue caudal al vientre posterior del músculo digástrico, mientras que en 4 casos (12,2 %) fue posterior. La longitud 2 osciló entre 1 mm y 17,0 mm, con una media de 6,9 mm. Se determinaron las distancias entre el nervio hipogloso y las estructuras cercanas. Estos hallazgos pueden ayudar al cirujano a identificar el nervio hipogloso durante la endarterectomía carotídea y así prevenir su lesión.

Experiencia en el tratamiento endovascular de pseudoaneurismas arteriales infecciosos: presentación de tres casos / Endovascular treatment experience on arterial pseudoaneurysms: a presentation of three cases

En los últimos años con la llegada del tratamiento endovascular, se ha visto una importante disminución de la morbimortalidad de pacientes con pseudoaneurismas arteriales. Continúa siendo controversial su uso en un contexto de infección. El objetivo de este trabajo es reportar la experiencia del servicio en el manejo endovascular de pseudoaneurismas arteriales infecciosos (PAI).Un estudio retrospectivo y observacional, incluye pacientes con diagnóstico de pseudoaneurisma infeccioso arterial tratados de forma endovascular en nuestro centro en un periodo de dos años, de junio 2016 a junio 2018.(AU)

In last few years, with the arrival of endovascular treatments, we have seen an important decrease of morbimortality in patients with arterial pseudoaneurysms. Its use is still controversial in an infectious context. The main objective of the present article is to report our experience of endovascular management of infectious arterial pseudoaneurysms (IAP).A retrospective and observational study, it includes patients with a diagnosis of infectious arterial pseudoaneurysms treated with endovascular procedures in our centre between June 2016 and June 2018.(AU)

Colocación de catéter de hemodiálisis transceldas de stent en paciente con agotamiento de acceso venoso / Trans-cells of stent hemodialysis catheter placement in patients with exhausted central venous Access

INTRODUCCIÓN: el agotamiento vascular es un problema sanitario significativo, sobre todo en pacientes renales que no sean aptos para otro tipo de terapia de sustitución renal (trasplante o diálisis peritoneal). Se describen distintas alternativas para estos pacientes, de acuerdo a las posibilidades. CASO CLÍNICO: exponemos el caso de una mujer de 37 años, con enfermedad renal terminal desde hace más de treinta años por esclerohialinosis focal y segmentaria de variante colapsante y agotamiento del capital venoso central. Acude a nuestro centro con infección de Splithcath III(R) (MedComp), que se retira para colocar dos catéteres venosos simples de 6 Fr a nivel del tronco innominado vía yugular interna izquierda, al fallar en una navegación más central. Se destaca que la paciente presenta una vena yugular, vena subclavia y tronco innominado derechos ocluidos, con oclusión larga en el sitio donde se colocó un stent Palmaz(R) (Genesis Medical Group) en contexto de confección de fístula protésica, que cruza completamente la vena cava superior impidiendo el paso desde las venas izquierdas. Se optó por la implantación de un catéter de larga duración a través de las celdas del stent, llevada a cabo con éxito, con síndrome de vena cava superior de resolución posterior como complicación. DISCUSIÓN: lo más significativo de esta presentación es el implante a través de las celdas de un stent de catéteres de diálisis. Hasta ahora, encontramos descrita solo la colocación endoluminal y no esta técnica. Creemos que se trata de una alternativa válida en casos puntuales, como el analizado

INTRODUCTION: exhausted vascular access in chronic renal disease patients represents a significant issue for national health systems all around. It is fundamentally worse for those patients who have already surpassed or have no indication for other methods (renal transplant, peritoneal dilalysis). Different alternatives are assessed for each of these patients according to individual history. CASE REPORT: we assess the case of a 37 year old female patient with end-stage renal disease secondary to focal esclerohialinosis. Said patient has exhausted vascular access, as a consult for infected Splithcath III(R) (MedComp) for retrieval. Two simple 6Fr standard venous catheters were placed instead through the left jugular vein, with their tips in the left innominate vein lumen for a fail in mor central navigation. Patient concomitantly presented right jugular, subclavian and innominate veins obstructed, treated with a Palmaz(R) (Genesis Medical Group) metallic stent prior to right arteriovenous graft confection. That stent was across the lumen of the superior vena Cava. We opted for the implantation of a long-lasting dialysis catheter through the cells of the mentioned stent, which was successful despite complicaciones (superior vena cava syndrome). DISCUSSION: the most relevant topic of this case is the trans-stent cell implant of dialysis catheters. Research finds evidence only of transluminal stent central vein catheters implanted. We believe it constitutes a valid alternative in special cases such as the one being exposed

Annular pancreas: case report and review of the literature

Annular pancreas is defined as a pancreatic ring which encircles the descending portion of the duodenum. Since its first description in 1818, attention has been paid to this variation due to its clinical manifestations, which may appear in the first days of life or even in adulthood, and usually require surgical treatment. Although an infrequent variation, more and more reports have been published due to new and improved diagnostic techniques, which include magnetic resonance cholangiopancreatography, endoscopic ultrasonography, and endoscopic retrograde cholangiopancreatography. A case of annular pancreas found during routine abdominal dissection of an adult female cadaver is reported here. It consisted of a complete pancreatic ring which surrounded the descending part of the duodenum. The duodenum was clearly distended proximally. After careful dissection, the ring presented a duct with a circumferential direction emptying into the pancreatic duct. The presence of this variation is associated with the embryology of the ventral pancreatic anlage. Clinical, diagnostic and therapeutic implications of this variation are discussed in this article

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