Prognostic factors of unilateral prelemniscal radiations radiofrequency lesions: A surgical technique for the treatment of Parkinson's disease motor symptoms.

OBJECTIVE: A group of patients with Parkinson's disease (PD) were managed with unilateral prelemniscal radiation radiofrequency lesions (U-Raprl). The current study aims to evaluate prognostic factors that could influence clinical response. METHODS: Patients previously diagnosed with PD managed with U-Raprl were included in the study, classifying them into two groups according to their percentage of clinical response ( 1.5), Age (p < 0.0001, ∆ = 2.38), Evolution (p < 0.0001, ∆ = 2.38), and post-operative UPDRS (p < 0.01, ∆ = 1.38). The qualitative analysis of the distribution regarding the responder group shows that those patients with an age under 58 years, an evolution fewer than 7 years, and a preoperative HYS score smaller than 2, showed a response ≥ 50% according to the UPDRS-III in all cases. CONCLUSION: U-Raprl is a highly effective procedure with a 5-year persistence of improvement. The most relevant prognostic factors to consider for a clinical response according to UPDRS-III greater than 50% are age under 58 years, less than 7 years of PD evolution, and HYS less or equal to 3.

Prelemniscal Radiations as a Target for the Treatment of Parkinson Disease - Individual Variations in the Stereotactic Location of Fiber Components: A Probabilistic Tractography Study.

OBJECTIVE: Prelemniscal radiation (Raprl) lesions and deep brain stimulation effectively control motor symptoms of Parkinson disease, but individual variations in the stereotactic location of its fiber components constitute a significant concern. The objective of this study was to determine individual variations in the stereotactic location of fiber tracts composing Raprl. METHODS: Raprl fiber composition was determined in a group of 10 Parkinson patients and 10 matched controls using 3T magnetic resonance imaging, brain imaging processed for diffusion-weighted images, tract density imaging, and constrained spherical deconvolution. The stereotactic position of the point of maximal proximity (PMP), which is the point where the most significant number of fibers is concentrated in the smallest volume in the tractography, was evaluated in the right and left hemispheres of the same person, between individuals and between patients and controls for each tract in coordinates "x," "y," and "z." The stereotactic coordinates at which PMP of all tracts meet were statistically determined, representing the recommended aim for this target. RESULTS: Stereotactic coordinates of the 3 fiber tracts composing Raprl, cerebellar-thalamic-cortical, globus pallidus-peduncle-pontine nucleus, and mesencephalic-orbital frontal cortex, did not vary between right and left hemispheres in the same person and between patients and controls. In contrast, PMP variability between individuals was significant, mainly for the mesencephalic-orbitofrontal tract. Therefore, probabilistic tractography can better determine individual variations to plan electrode trajectories. CONCLUSIONS: Individual PMP variations for fiber tracts in Raprl, identified by probabilistic tractography, provide a platform for planning the stereotactic approach to conform volumes for deep brain stimulation and lesions.

Caracterización clínico-epidemiológica de pacientes con daño actínico crónico. Cochabamba, Bolivia / Clinical-epidemiological characterization of patients with chronic actinic damage. Cochabamba, Bolivia

RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).

ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).

Degradation of the residual textile mixture cetyltrimethylammonium bromide/remazol yellow gold RNL-150%/reactive blue BF-5G: evaluation photo-peroxidation and photo-Fenton processes in LED and UV-C photoreactors.

This article presents a study on the degradation of a residual textile mixture composed of cationic surfactant cetyltrimethylammonium bromide (CTAB) and the remazol yellow gold RNL-150% and reactive blue BF-5G textile dyes. This was carried out by employing the photo-peroxidation and photo-Fenton processes in LED and UV-C photoreactors. The photo-Fenton process was the most efficient as regards the degradation of the CTAB and dye mixture, for both types of radiation. In the kinetic study, degradations of 99% were obtained in 180 min for the chromophore groups using both types of radiation. The degradation of the CTAB and aromatic groups was, meanwhile, an average of 25% when employing LED radiation. The behavior of the degradation reaction was pseudo-first-order. Toxicity tests indicated that the solutions were better able to grow seeds and bacteria after treatment with the photo-Fenton process, using both types of radiation. The photo-Fenton processes carried out by employing LED and UV-C photoreactors were able to degrade the CTAB and dye mixture, thus highlighting the efficiency of LED radiation when its power (three times smaller) is compared to that of UV-C radiation. This process, therefore, represents an alternative for use in textile wastewater treatment systems.

Inclusion of ionizing radiation in a mathematical model for photosynthesis.

Ionizing radiation of astrophysical origin might have played an important role in biological evolution during the long course of Earth's evolution. Several phenomena might have induced intense fluctuations in background ionizing radiation, such as highly energetic stellar explosions. There might also be anthropogenic causes for environmental radiation fluctuations, resulting from nuclear industry activities. The inclusion of these effects in a mathematical model for photosynthesis provides a useful tool to account for the damages of the above-mentioned phenomena in vegetal life. Mathematical models for photosynthesis typically only consider ultraviolet radiation and photosynthetically active radiation, as they have been a ubiquitous physical factor in the settlement of vegetal life. In this work a mathematical model for aquatic photosynthesis is modified, from first principles, to include the action of particulate ionizing radiation on the photosynthetic process. After assuming an ansatz allowing to separate damage/repair kinetics of ultraviolet and ionizing radiations, a treatable mathematical expression of the model is obtained. This generalized model is presented as a function of radiometric and photometric magnitudes, making it prone to calibration and useful to apply to aquatic ecosystems under radiational stress due to gamma-ray bursts, cosmic ray bursts, solar storms, or other sources of ionizing radiations.

Venom variation in Bothrops asper lineages from North-Western South America.

Bothrops asper is a venomous pitviper that is widely distributed and of clinical importance in Mesoamerica and northern South America, where it is responsible for 50-80% of all envenomations by Viperidae species. Previous work suggests that B. asper has a complex phylogeographic structure, with the existence of multiple evolutionarily distinct lineages, particularly in the inter-Andean valleys of north South America. To explore the impact of the evolutionary history of B. asper on venom composition, we have investigated geographic variation in the venom proteome of this species from the populations from the Pacific side of Ecuador and south-western Colombia. Among the 21 classes of venom components identified, proteins from mainly four major toxin families, snake venom metalloproteases (PI- and PII-SVMP), phospholipases A2 (K49- and D49-PLA2s), serine proteinases (SVSP), and C-type lectins-like (CTL) proteins are major contributors to the geographic variability in venom. Principal component analyses demonstrate significant differences in venom composition between B. asper lineages previously identified through combination of molecular, morphological and geographical data, and provide additional insights into the selection pressures modulating venom phenotypes on a geographic scale. In particular, altitudinal zonation within the Andean mountain range stands out as a key ecological factor promoting diversification in venom. In addition, the pattern of distribution of PLA2 molecules among B. asper venoms complements phylogenetic analysis in the reconstruction of the dispersal events that account for the current biogeographic distribution of the present-day species' phylogroups. Ontogenic variation was also evident among venoms from some Ecuadorian lineages, although this age-related variation was less extreme than reported in B. asper venoms from Costa Rica. The results of our study demonstrate a significant impact of phylogenetic history on venom composition in a pitviper and show how analyses of this variation can illuminate the timing of the cladogenesis and ecological events that shaped the current distribution of B. asper lineages. BIOLOGICAL SIGNIFICANCE: Bothrops asper, called "the ultimate pitviper" due to its defensive behavior, large body size, and medical importance, represents a species complex that is widely distributed from southern México southwards across north-western South America to north-western Perú. This work reports the characterization of the venom proteomes of B. asper lineages from the Pacific sides of Ecuador and south-western Colombia. Multivariate analyses indicate that variability in venom composition among the B. asper lineages is driven by proteins from four major toxin families, presumably in response to selection pressures created by recent and historical ecological conditions created by geological and climatic events from the Pliocene-Pleistocene to the present along the Central and South American Continental Divide. The emerging biogeographic pattern of venom variation, interpreted in the context of the current phylogenetic hypotheses, support and complement previously proposed evolutionary Plio-Pleistocene dispersal events that shaped the present-day distribution range of B. asper lineages. In addition, our venomics data indicate the occurrence of genetic exchange between Colombian and Pacific Costa Rican populations, which may have occurred during the second wave of B. asper migration into Mesoamerica. Our work represents a foundation for a future broader sampling and more complete "-omics" analyses to deepen our understanding of the patterns and causes of venom variation in this medically important pitviper.

Long-Term Improvement of Parkinson Disease Motor Symptoms Derived From Lesions of Prelemniscal Fiber Tract Components.

BACKGROUND: Prelemniscal radiations (Raprl) are composed of different fiber tracts, connecting the brain stem and cerebellum with basal ganglia and cerebral cortex. In Parkinson disease (PD), lesions in Raprl induce improvement of tremor, rigidity, and bradykinesia in some patients, while others show improvement of only 1 or 2 symptoms, suggesting different fiber tracts mediate different symptoms. OBJECTIVE: To search for correlations between improvements of specific symptoms with surgical lesions of specific fiber tract components of Raprl in patients with PD. METHODS: A total of 10 patients were treated with unilateral radiofrequency lesions directed to Raprl. The improvement for tremor, rigidity, bradykinesia, posture, and gait was evaluated at 24 to 33 mo after operation through the Unified Parkinson's Disease Rating Scale (UPDRS) score, and the precise location and extension of lesions through structural magnetic resonance imaging and probabilistic tractography at 6 to 8 mo postsurgery. Correlation between percentage of fiber tract involvement and percentage of UPDRS-III score improvement was evaluated through Spearman's correlation coefficient. RESULTS: Group average improvement was 86% for tremor, 62% for rigidity, 56% for bradykinesia, and 45% for gait and posture. Improvement in global UPDRS score correlated with extent of lesions in fibers connecting with contralateral cerebellar cortex and improvement of posture and gait with fibers connecting with contralateral deep cerebellar nuclei. Lesion of fibers connecting the globus pallidum with pedunculopontine nucleus induced improvement of gait and posture over other symptoms. CONCLUSION: Partial lesion of Raprl fibers resulted in symptom improvement at 2-yr follow-up. Lesions of selective fiber components may result in selective improvement of specific symptoms.

The Retrochiasmal Optic Pathway: A Link in Jeopardy.

The case of an intraventricular meningioma is presented and the visual complication incurred by its surgical resection is discussed. The importance of selecting the most optimal surgical approach and the basis for that selection are highlighted.

Acoplamiento de métodos prospectivos y reactivos para análisis de riesgo en medicina con radiaciones ionizantes / Matching between prospective and reactive methods for risk analysis in ionizing radiation medicine

Resumen Entre los enfoques prospectivos más empleados a nivel mundial para la medicina con radiaciones ionizantes está la matriz de riesgo y los análisis de modos y efectos de fallo. Por otra parte, existen varios sistemas reconocidos a nivel mundial para análisis de riesgo reactivo en estas prácticas, destacándose ROSIS, SAFRON y ARIR. En la investigación se persigue desarrollar y aplicar una metodología de integración de los métodos referidos para el análisis de riesgo en la medicina con radiaciones ionizantes. Su informatización se realizó con el código cubano SECURE-MR-FMEA versión 3.0. Se propuso una taxonomía para la base de datos de incidentes (BDI) acoplada al software y se programó el análisis de correspondencia de los modelos estudiados de radioterapia para facilitar su selección por criterios de expertos. Los resultados de este acoplamiento permiten validar los modelos de estudios prospectivos empleados, analizando su cobertura y representatividad en la BDI, así como para el análisis de las causas raíces o básicas. Dentro de los patrones de riesgo más representados están los del acelerador lineal y cobaltoterapia. Los estudios realizados en este ámbito han sido comparados con algunos similares reportados, demostrándose la coherencia de los resultados. La BDI ha sido enriquecida con la consulta de reportes publicados sobre medicina nuclear y el transporte de material radiactivo, para poder aplicar las facilidades creadas. Esta investigación facilita la toma de decisiones más eficaz y efectiva, para la mejora de la seguridad y calidad de la medicina con radiaciones ionizantes.

Abstract The most useful prospective methods to risk analysis in ionizing radiation medicine are the risk matrix and the failure mode and effect analysis. In another hand, at the world level developed various systems for reactive risk analysis, for example ROSIS, SAFRON and ARIR. In the research will follow to development and use an integration methodology of these methods. This approach was introduced in the Cuban code SECURE MR-FMEA version 3.0. A specific taxonomy for the incident data base (IDB) coupled with the code was developed and it was created the correspondence analysis of studied models for radiotherapy for allows the selection by expert criteria. The result of this matching allows the validation of the risk patterns by risk matrix or FMEA approach, through the coverage or representative studies in the incident data base. The most representative risk patterns in the incident data base are the linear accelerator and cobalt therapy. The comparison between the results of the investigation and other similar studies are available in the paper. The IDB incorporated de radionuclide therapy and transport of radioactive materials events.This research facilitates the decision-making in improvements of safety and culture in the ionizing radiation medicine.

Phylogenomics and biogeography of the world's thrushes (Aves, Turdus): new evidence for a more parsimonious evolutionary history.

To elucidate the relationships and spatial range evolution across the world of the bird genus Turdus (Aves), we produced a large genomic dataset comprising ca 2 million nucleotides for ca 100 samples representing 53 species, including over 2000 loci. We estimated time-calibrated maximum-likelihood and multispecies coalescent phylogenies and carried out biogeographic analyses. Our results indicate that there have been considerably fewer trans-oceanic dispersals within the genus Turdus than previously suggested, such that the Palaearctic clade did not originate in America and the African clade was not involved in the colonization of the Americas. Instead, our findings suggest that dispersal from the Western Palaearctic via the Antilles to the Neotropics might have occurred in a single event, giving rise to the rich Neotropical diversity of Turdus observed today, with no reverse dispersals to the Palaearctic or Africa. Our large multilocus dataset, combined with dense species-level sampling and analysed under probabilistic methods, brings important insights into historical biogeography and systematics, even in a scenario of fast and spatially complex diversification.

Diagnóstico y el tratamiento del cáncer en Cuba / Diagnosis and treatment of cancer in Cuba

RESUMEN El cáncer constituye un serio problema de salud para la humanidad y se estima que se incrementará rápidamente en los próximos años. En Cuba las enfermedades malignas pasaron a ocupar la primera causa de muerte en el 2012 y cada año se diagnostican aproximadamente entre 30 y 36 mil casos nuevos. Teniendo en cuenta la importancia que tienen para nuestro sistema social la asistencia médica y la calidad de vida del paciente, el gobierno cubano y el Ministerio de Salud Pública diseñaron un proyecto de Introducción de tecnologías para el diagnóstico y el tratamiento del cáncer en Cuba, el cual incluye la introducción de cinco tecnologías: dos para el diagnóstico del cáncer y tres para el tratamiento de esta enfermedad. Para el diseño de las demandas técnicas, la planificación del proceso de introducción tecnológica y la formación de los recursos humanos se crearon grupos de trabajo compuestos por especialistas de hospitales, los centros reguladores y el Ministerio de Salud Pública, con el fin de garantizar que se tuviera en cuenta la necesidad de equipamiento, las regulaciones vigentes y los mecanismos de formación del personal requeridos para la asimilación de las diferentes tecnologías. En estos momentos ya han sido instaladas tres de estas tecnologías y se prevé que a fines de 2017 haya concluido el proceso de instalación tecnológica, el cual tendrá un relevante impacto social, tanto en el diagnóstico temprano de las enfermedades malignas, como en el control de las mismas, en todos los grupos de edades.

ABSTRACT Cancer is a serious health problem for humanity and is expected to increase rapidly in the coming years. In Cuba, malignancies became the leading cause of death in 2012 and each year about 30 to 36 thousand new cases are diagnosed. Given the importance to our social system for medical care and the quality of life of patients, the Government and the Ministry of Health designed a project to introduce five new technologies for the diagnosis and treatment of cancer in Cuba. Two technologies are for diagnosing cancer and three for the treatment of this disease. In order to guarantee the technical requirements of this project, the planning of the introduction process of the new technology and training of human resources, working groups, made up by experts from hospitals, regulatory bodies and the Ministry of Public Health (MINSAP) were created. These working groups shall take into account the needed equipment, the regulations in force as well as staff training required by the new technologies. At present three of these technologies are already installed and by the end of 2017, the introduction of all the new technology is expected to be completed, which will have a significant social impact both on the early diagnosis of malignant diseases, and on their control in all age groups.

Fractional anisotropy of the optic radiations correlates with the visual field after epilepsy surgery.

PURPOSE: This study assessed whether optic radiations (OR) microstructure after temporal lobe epilepsy (TLE) surgery correlated with visual field defects (VFD). METHODS: Patients were subjected to diffusion tensor imaging (DTI) tractography of the OR and Humphrey perimetry after TLE surgery. We used Spearman's test to verify correlations between tractographic parameters and perimetry mean deviation. Tractographic variables were compared between patients with VFD or intact perimetry. Multiple logistic regression was applied between DTI and perimetry values. DTI sensitivity and specificity were assessed with a receiver operating characteristic (ROC) curve to evaluate VFD. RESULTS: Thirty-nine patients had reliable perimetry and OR tractography. There was a significant correlation between (1) fractional anisotropy (FA) and both total (rho = 0.569, p = 0.0002) and quadrant (rho = 0.453, p = 0.0037) mean deviation and (2) radial diffusivity and total mean deviation (rho = - 0.350, p = 0.0286). There was no other significant correlation. Patients with VFD showed a significantly lower FA compared with patients with normal perimetry (p = 0.0055), and a 0.01 reduction in FA was associated with a 44% increase in presenting VFD after surgery (confidence interval, CI = 1.10-1.88; p = 0.0082). Using a FA of 0.457, DTI tractography showed a specificity of 95.2% and a sensitivity of 50% to detect VFD after surgery (area under the curve = 0.7619, CI = 0.6020-0.9218). CONCLUSION: The postoperative OR microstructure correlated with visual loss after epilepsy surgery. DTI postoperative OR tractography may be helpful in evaluating VFD.

Ecomorphological convergence in Eleutherodactylus frogs: a case of replicate radiations in the Caribbean.

Replicate radiations, the repeated multiplication of species associated with ecological divergence, have attracted much attention and generated as much debate. Due to the few well-studied cases, it remains unclear whether replicate radiations are an exceptional result of evolution or a relatively common example of the power of adaptation by natural selection. We examined the case of Eleutherodactylus frogs, which radiated in the Caribbean islands resulting in more than 160 species that occupy very diverse habitats. A time-calibrated phylogeny revealed that these frogs independently diversified on all larger islands producing species that occupy a broad range of microhabitats in different islands. Using phylogenetic comparative methods, we found an association between morphological traits and particular microhabitats, and for most microhabitats detected significant morphological convergence. Our results indicate Caribbean Eleutherodactylus are a novel example of replicate radiations, and highlight the predictability of evolutionary processes, as similar ecological opportunities can lead to similar outcomes.

Prelemniscal Lesion for Selective Improvement of Parkinson Disease Tremor.

BACKGROUND: Selective improvement of symptoms may be required when treating Parkinson disease (PD) patients with a predominantly monosymptomatic clinical picture. OBJECTIVE: To define a target in prelemniscal radiation fibers (Raprl) related to the physiopathology of tremor evidenced by tractography. CASE REPORT: We report a patient with predominant unilateral rest and postural tremor, diagnosed as PD based on 80% improvement induced by the administration of L-DOPA/carbidopa, subsequently complicated by motor fluctuations, L-DOPA dyskinesia, and a reduced ON period. A stereotactic radiofrequency lesion was made for tremor control, and postoperative diffusion-weighted imaging (DWI) demonstrated the precise location and extension of the lesioned tract. RESULTS: Perfect control of the tremor was achieved with the patient OFF medication; this has lasted for 5 years, without hypotonia in the treated extremities. DWI revealed a 3.0-mm lesion at the base of the nucleus ventralis intermedius (Vim) interrupting cerebellar-Vim fibers sparing the cerebellar ventralis oralis posterior nucleus component. CONCLUSION: Selective improvement of symptoms is feasible in patients with a predominantly monosymptomatic PD clinical presentation.

Chloroplast and ITS phylogenies to understand the evolutionary history of southern South American Azorella, Laretia and Mulinum (Azorelloideae, Apiaceae).

Azorella, Laretia and Mulinum are taxonomically complex, and good candidates to study evolutionary radiations in the Andes and the importance of hybridizations. Previous phylogenetic studies of subfamily Azorelloideae agree that Azorella and Mulinum as currently conceived are not monophyletic, and hence a revision of their circumscription is necessary. However, these phylogenies were based only on chloroplast DNA sequence data. Here, phylogenetic relationships within Azorelloideae were inferred using sequence data from five chloroplast DNA (rps16 intron, trnQ-rps16, rps16-trnKUUU 5' -exon, trnGGCC-trnSGCU and rpL32-trnLUAG), and from nuclear rDNA ITS regions to assess the monophyly of Azorella and Mulinum and discuss generic re-circumscriptions, determine hybridization and radiation events, identify and characterize important lineages, and propose hypotheses on evolution of key morphological characters. In total, 121 accessions of Azorelloideae were analyzed. Phylogenetic analyses of the different genomes were conducted separately and combined, with and without indels, using maximum parsimony, maximum likelihood, and Bayesian methods. To analyze the incongruence between plastid and nuclear-derived trees a consensus network from strongly supported nodes from cpDNA and ITS trees was constructed. Internode certainty values were calculated to evaluate the reliability of the relationships estimated from the individual cpDNA and ITS data sets and to examine the degree of conflict within the total evidence data set. Azorella and Mulinum were confirmed as not monophyletic. Except three Azorella species, the remaining azorellas, all species of Mulinum, and Laretia form a monophyletic group, designated here as Andean-Patagonian. The three species of Azorella that are not part of the Andean-Patagonian lineage are grouped together with Huanaca and Schizeilema in another lineage, designated here as Austral. Within the Andean-Patagonian clade, three major lineages can be recognized: Diversifolia, Trifurcata, and Spinosum. Each of these lineages have different leaf morpho-anatomies, Diversifolia species being more mesomorphic compared to species of Trifurcata, and species of Spinosum being the most xeromorphic. Hybridizations have been important in the evolution of the group, especially within Diversifolia, with at least six reticulation events resulting in putative homoploid and allopolyploid hybrid species. Evidence from branch lengths and low sequence divergences suggest a rapid radiation in the Spinosum group, probably associated with the acquisition of wings in the fruits.

Introducción de tecnologías para el diagnóstico y el tratamiento del cáncer en Cuba / Introduction of technologies for the diagnosis and treatment of cancer in Cuba

El cáncer constituye un serio problema de salud para la humanidad y se estima que se incrementará rápidamente en los próximos años. En Cuba las enfermedades malignas pasaron a ocupar la primera causa de muerte en el 2012 y cada año se diagnostican aproximadamente entre 30 y 36 mil casos nuevos. Teniendo en cuenta la importancia que tienen para nuestro sistema social la asistencia médica y la calidad de vida del paciente, el gobierno cubano y el Ministerio de Salud Pública diseñaron un proyecto de Introducción de tecnologías para el diagnóstico y el tratamiento del cáncer en Cuba, el cual incluye la introducción de cinco tecnologías: dos para el diagnóstico del cáncer y tres para el tratamiento de esta enfermedad. Para el diseño de las demandas técnicas, la planificación del proceso de introducción tecnológica y la formación de los recursos humanos se crearon grupos de trabajo compuestos por especialistas de hospitales, los centros reguladores y el Ministerio de Salud Pública, con el fin de garantizar que se tuviera en cuenta la necesidad de equipamiento, las regulaciones vigentes y los mecanismos de formación del personal requeridos para la asimilación de las diferentes tecnologías. En estos momentos ya han sido instaladas tres de estas tecnologías y se prevé que a fines de 2017 haya concluido el proceso de instalación tecnológica, el cual tendrá un relevante impacto social, tanto en el diagnóstico temprano de las enfermedades malignas, como en el control de las mismas, en todos los grupos de edades

Cancer is a serious health problem for humanity and is expected to increase rapidly in the coming years. In Cuba, malignancies became the leading cause of death in 2012 and each year about 30 to 36 thousand new cases are diagnosed. Given the importance to our social system for medical care and the quality of life of patients, the Government and the Ministry of Health designed a project to introduce five new technologies for the diagnosis and treatment of cancer in Cuba. Two technologies are for diagnosing cancer and three for the treatment of this disease. In order to guarantee the technical requirements of this project, the planning of the introduction process of the new technology and training of human resources, working groups, made up by experts from hospitals, regulatory bodies and the Ministry of Public Health (Minsap) were created. These working groups shall take into account the needed equipment, the regulations in force as well as staff training required by the new technologies. At present three of these technologies are already installed and by the end of 2017, the introduction of all the new technology is expected to be completed, which will have a significant social impact both on the early diagnosis of malignant diseases, and on their control in all age groups

Radiaciones ultravioletas como factor de riesgo vinculado a la génesis del pterigión en trabajadores expuestos / UV radiations as a risk factor associated to pterygium genesis in exposed workers

Introducción: las radiaciones ultravioletas representan un factor de riesgo para los trabajadores que por razones de su oficio deben laborar a cielo abierto. Objetivos: relacionar las radiaciones ultravioletas como factor de riesgo relacionado con la génesis del pterigión en personas expuestas laboralmente. Métodos: estudio descriptivo correlacional, retrospectivo, diseño documental; realizado en una población 98 trabajadores dedicados, en su mayoría, a actividades a cielo abierto. La recogida de datos se hizo mediante análisis de registros ocupacionales en la Institución prestadora de servicios de Salud Ocupacional, CERINPROS. El análisis estadístico se realizó mediante correlación de Pearson y odd ration. Resultados: la distribución por sexo muestra el 83,67 por ciento de sexo masculino y 16,33 por ciento sexo femenino, con una media de edad de 35,3 años, con significancia estadística de exposición de radiaciones ultravioletas como factor de riesgo en la generación de pterigión de 4,56, para un índice de confianza de 95 por ciento. Correlación positiva entre actividad/exposición y edad/exposición. Conclusiones: en el presente estudio, las radiaciones ultravioletas representaron un factor de riesgo para la producción de pterigión(AU)

Introduction: UV radiations represent a risk factor to workers who labors on open-air spaces due to reasons of their jobs. Objective: Associate UV radiations as a risk factor related with pterygium genesis in work-exposed persons. Methods: Correlational, descriptive, retrospective study, and documental design, carried out in a target group of 98 workers dedicated mostly to open-air spaces activities. Data collection was performed by the analysis of occupational records in the institution providing occupational health care, CERINPROS. Statistical analysis was performed by odd ration and Pearson correlation coefficient. Results: Distribution by sex shows 83.67 percent of male sex and 16.22 percent of female sex, with a mean age of 35.3 years, with a 4.56 value of statistical significance of UV radiations exposition as a risk factor in pterygium genesis, for a confidence rate of 95 percent. There was a positive correlation between activity/exposition and age/exposition. Conclusions: In this study, UV radiations represented a risk factor for the production of genesis(AU)

Monitoreo dinámico de riesgo empleando matriz de riesgo en prácticas médicas con radiaciones ionizantes / Dynamic risk monitoring using risk matrix in medical practices with ionizing radiations

Las técnicas de control de riesgo, actualmente disponibles, no satisfacen la inmediatez necesaria para la vigilancia de los efectos, de los frecuentes fallos de equipos y errores humanos asociados a las prácticas de radioterapia. La metodología propuesta, en el artículo, integra las bases de datos sobre las secuencias accidentales posibles en prácticas médicas, con empleo de radiaciones ionizantes, con una herramienta desarrollada para la actualización dinámica del riesgo, en condiciones operacionales variables. Un resultado inmediato del análisis es el conocimiento de los nuevos escenarios de peligro en los que se trabaja, bajo cualquier combinación de indisponibilidades de contribuyentes al riesgo, el que se basa en múltiples capacidades de estudios detallados y mímicos de procesos y de secuencias accidentales. Estas capacidades garantizan el monitoreo dinámico del riesgo para cualquier estado de los escenarios de estudio.

The techniques of risk control at the moment available they don't satisfy the necessary speed to the surveillance of the effects from the equipment failures and human errors during practical of radiotherapy. The methodology proposed in this paper integrates databases on possible accident sequences in medical practices using ionizing radiation with a tool for dynamic updating of operational conditions risk variables. An immediate result of the analysis is the knowledge of the new scenarios of danger, under any combination of unavailability to the risk, based on multiple study capacities and mimics for the processes and sequences. These capacities guarantee the instantaneous risk monitoring for any state of the studied scenarios.

Unilateral Stimulation of Prelemniscal Radiations for the Treatment of Acral Symptoms of Parkinson's Disease: Long-Term Results.

BACKGROUND: Prelemniscal radiations (Raprl) have been proposed as a target for the treatment of Parkinson's disease. We evaluated effectiveness of this target through UPDRS-III in patients treated with Raprl deep brain stimulation (Raprl-DBS) and followed from 24 to 48 months. METHODS: Nineteen patients in Hoehn-Yahr stages II-III were implanted with tetrapolar deep brain stimulation electrodes in Raprl contralateral to the extremities with more prominent symptoms. Placement was assisted by MRI/CT/anatomical atlas fusion, microelectrode recording, and micro- and macro-stimulation. The effect on motor symptoms was evaluated in an open label protocol through specific items of the UPDRS-III score, applied pre-operatively and 6, 12, 24, and 48 months after the onset of stimulation in an OFF-medication/ON-stimulation condition. Changes in scores with regard to pre-operative condition were obtained for each symptom in both sides and statistical significance determined through double-tail Wilcoxon test. Influence of demographic variables on outcome was analyzed using linear regression testing. RESULTS: A greater than 80% decrease in UPDRS score for contralateral symptoms (classified as excellent results) occurred in 14 patients (73.7%), while in the other 5 it decreased from 33 to 79% (considered suboptimal results). These changes remained statistically significant up to 48 months (p < 0.01), while ipsilateral symptoms progressively increased. Suboptimal results were associated with selective improvement of only one symptom. CONCLUSION: Raprl-DBS induces a long-term, significant improvement of contralateral acral symptoms of Parkinson's disease.