Circadian disruption promotes tumor-immune microenvironment remodeling favoring tumor cell proliferation.

Circadian disruption negatively affects physiology, posing a global health threat that manifests in proliferative, metabolic, and immune diseases, among others. Because outputs of the circadian clock regulate daily fluctuations in the immune response, we determined whether circadian disruption results in tumor-associated immune cell remodeling, facilitating tumor growth. Our findings show that tumor growth rate increased and latency decreased under circadian disruption conditions compared to normal light-dark (LD) schedules in a murine melanoma model. Circadian disruption induced the loss or inversion of daily patterns of M1 (proinflammatory) and M2 (anti-inflammatory) macrophages and cytokine levels in spleen and tumor tissues. Circadian disruption also induced (i) deregulation of rhythmic expression of clock genes and (ii) of cyclin genes in the liver, (iii) increased CcnA2 levels in the tumor, and (iv) dampened expression of the cell cycle inhibitor p21WAF/CIP1 , all of which contribute to a proliferative phenotype.

Changes on the Structural Architecture and Growth Factor Release, and Degradation in Equine Platelet-Rich Fibrin Clots Cultured Over Time.

The aims of the present study were (1) to describe the microscopic and ultrastructural appearance of equine platelet-rich fibrin (PRF) clots and (2) to determine the release and degradation of transforming growth factor beta 1 (TGF-ß1) and insulin-like growth factor type I (IGF-I) from PRF clots incubated over 14 days. Whole blood from six horses was collected into plain tubes and centrifuged at 240 g for 8 minutes. Clots were evaluated by histology and by both transmission and scanning electronic microscopy (TEM and SEM). Growth factor concentrations were measured by ELISA at 48-hour intervals over 14 days and analyzed by one-way repeated-measures ANOVA. Histology showed a clot composed by a fibrin layer and a cellular layer with platelets and leukocytes. Scanning electron microscopy showed the cells trapped by an incipient fibrin network at 1 hour. At day 8, these cells were embedded by an incipient fibrin network. At day 14, the leukocytes and platelet aggregates from the clot were imbibed in an organized web of fibrin fibrils. TEM exhibited platelets with preserved cytoplasm and alpha granules randomly scattered at day 8, and damaged platelets with interrupted cytoplasm and organelle emigration to the periphery at day 14. TGF-ß1 and IGF-I concentrations showed a progressive increase until day 14. TGF-ß1 was released from PRF clots in a gradual and controlled manner, and increasing its concentration for two weeks, which supports TEM findings indicating that platelets began disintegrating by day 14. Furthermore, IGF-I production and release from PRF clots is sustained over time.

Patología oculoplástica: experiencia de 7 años en Hospital del Sistema de Salud Público de Chile / Oculoplastic Pathology: experience of 7 years in Hospital of the Public Health System of Chile

INTRODUCCIÓN: La cirugía oculoplástica estudia y trata los trastornos de párpados, órbita y vías lagrimales. Entre las patologías más importantes por frecuencia e impacto tenemos: ptosis palpebral, blefarochalasis, ectropión y entropión. OBJETIVO: Analizar la experiencia del Hospital El Pino en cuanto al manejo de patología oculoplástica en manos de un cirujano plástico. MATERIALES Y MÉTODO: Estudio descriptivo y retrospectivo. Se revisaron fichas de pacientes operados con diagnóstico de blefarochalasis, ptosis palpebral, ectropión y entropión entre los años 2010 y 2017. Se analizaron datos como edad, sexo, comorbilidades, causa del defecto, cirugía oculoplástica, tipo de anestesia, complicación posoperatoria, tiempo de seguimiento y resultados. RESULTADOS: Entre los años 2010 y 2017 se operaron 79 pacientes con patología oculoplástica, 17 por ptosis palpebral, 42 por blefarochalasis, 14 por ectropión y 6 por entropión, siendo la principal causa senil (93,7%). Las cirugías realizadas fueron: pexia del elevador para Ptosis palpebral, blefaroplastía para blefarochalasis y para ectropión-entropión tarsal strip. La principal técnica anestésica utilizada fue anestesia local + sedación (54,4%). Entre el total de complicaciones posoperatorias tenemos: lagoftalmo (2 casos), ectropión residual (3 casos), conjuntivitis (3 casos), dehiscencia de herida (2 casos) y hematoma palpebral (1 caso). Se reintervinieron 6 pacientes por complicaciones. Los resultados obtenidos según la evaluación subjetiva del cirujano plástico y pacientes fueron regular (5 casos), bueno (20 casos) y muy bueno (54 casos). CONCLUSIÓN: El manejo de la patología oculoplástica requiere en su mayoría de cirugías ambulatorias con buenos resultados y poca morbilidad, lo cual es factible de realizar en un hospital público. Creemos necesario el uso de algún instrumento objetivo para evaluar de mejor manera los defectos palpebrales y su corrección.

INTRODUCTION: The oculoplastic surgery studies and treats disorders of the eyelids, orbit and lacrimal ways. Among the most important pathologies by frequency and impact are: palpebral ptosis, blepharochalasis, ectropion and entropion. AIM: Analyze the experience of El Pino Hospital regarding the management of oculoplastic pathology in the hands of a plastic surgeon. MATERIALS AND METHOD: Descriptive and retrospective study. We reviewed files of patients operated with diagnosis of blepharochalasis, palpebral ptosis, ectropion and entropion between the years 2010 and 2017. Data were analyzed as age, sex, comorbidities, cause of the defect, oculoplastic surgery, type of anesthesia, postoperative complication, follow-up time and results. RESULTS: Between the years 2010 and 2017, 79 patients with oculoplastic pathology operated, 17 for palpebral ptosis, 42 for blefarochalasis, 14 for ectropion and 6 for entropion, being the main senile cause (93,7%). The surgeries performed were: elevator pexis for palpebral ptosis, blepharoplasty for blefarochalasis and for ectropion-entropion tarsal strip. The main anesthetic technique used was local anesthesia + sedation (54,4%). Among the total postoperative complications, we have: lagophthalmos (2 cases), residual ectropion (3 cases), conjunctivitis (3 cases), wound dehiscence (2 cases) and palpebral hematoma (1 case). Six patients were reoperated due to complications. The results obtained according to the subjective evaluation of the plastic surgeon were regular (5 cases), good (20 cases) and very good (54 cases). CONCLUSION: Management of oculoplastic pathology requires mostly ambulatory surgeries with good results and low morbidity, which is feasible to perform in a public hospital. We believe it is necessary to use some objective instrument to better evaluate the palpebral defects and their correction.

Reconstrucción mamaria con colgajo musculocutáneo de recto abdominal con isla transversa de piel (TRAM): experiencia de 12 años en Hospital El Pino / Breast reconstruction with musculocutaneous flap of abdominal rectus with transverse skin island (TRAM): 12 years of experience at Hospital El Pino

Objetivos: Analizar los resultados de reconstrucción mamaria con colgajo musculocutáneo de recto abdominal con isla transversa de piel (TRAM) en el Servicio de Cirugía del Hospital El Pino. Materiales y Métodos: Estudio retrospectivo de pacientes sometidas a mastectomía por cáncer de mama y posterior reconstrucción con colgajo TRAM pediculado en los últimos 12 años (2005-2017). Resultados: Se realizaron 12 reconstrucciones mamarias, 6 fueron con colgajo TRAM pediculado. La mayoría de las pacientes recibieron tratamiento adyuvante con radioterapia (1 caso), quimioterapia (1 caso), quimioterapia + radioterapia (2 casos). El tiempo transcurrido entre la mastectomía y reconstrucción mamaria fue en promedio de 2,5 años. Se produjeron 4 complicaciones (66,7%) que necesitaron reintervención: hematoma posoperatorio precoz, infección y necrosis grasas de colgajo, dehiscencia de sutura abdominal, necrosis grasa + fibrosis de colgajo TRAM. La evaluación de los resultados fue subjetiva obteniéndose muy buenos resultados en el 66,7% de los casos. No hubo complicaciones en sitio donante. Discusión: El colgajo TRAM pediculado es el tejido autólogo más utilizado en reconstrucción mamaria. Su tasa de complicación es de 26% muy por debajo a lo obtenido en nuestra experiencia. Las principales complicaciones son fibrosis y necrosis grasa de colgajo, pérdida de colgajo, seroma e infección siendo la necrosis grasa la más frecuente en nuestra serie. El uso de colgajo TRAM otorga mayor satisfacción con apariencia, tamaño y sensación del seno. Debido a los resultados obtenidos creemos que el colgajo TRAM pediculado es una excelente alternativa de reconstrucción mamaria en nuestro hospital.

Objectives: To analyze the results of breast reconstruction with musculocutaneous flap of the rectus abdominis with transverse skin island (TRAM) in the Service of Surgery of El Pino Hospital. Materials and Methods: Retrospective study of patients undergoing mastectomy for breast cancer and subsequent reconstruction with pedicled TRAM flap in the last 12 years (2005-2017). Results: 12 mammary reconstructions were performed, 6 were with pedicled TRAM flap. The majority of patients received adjuvant treatment with radiotherapy (1 case), chemotherapy (1 case), chemotherapy + radiotherapy (2 cases). The time elapsed between the mastectomy and breast reconstruction was on average 2.5 years. There were 4 complications (66.7%) that required reintervention: early postoperative hematoma, infection and flap fat necrosis, abdominal suture dehiscence, fat necrosis + TRAM flap fibrosis. The evaluation of the results was subjective, obtaining very good results in 66.7% of the cases. There were no complications in the donor site. Discussion: The pedicled TRAM flap is the most used autologous tissue in breast reconstruction. Its complication rate is 26%, much lower than that obtained in our experience. The main complications are fibrosis and flap fat necrosis, flap loss, seroma and infection, with fat necrosis being the most frequent in our series. The use of TRAM flap gives greater satisfaction with appearance, size and sensation of the breast. Due to the results obtained, we believe that the pedicled TRAM flap is an excellent alternative for breast reconstruction in our hospital.

Translational Model of Zika Virus Disease in Baboons.

Zika virus (ZIKV) is an emerging mosquito-borne flavivirus with devastating outcomes seen recently in the Americas due to the association of maternal ZIKV infection with fetal microcephaly and other fetal malformations not previously associated with flavivirus infections. Here, we have developed the olive baboon (Papio anubis) as a nonhuman primate (NHP) translational model for the study of ZIKV pathogenesis and associated disease outcomes to contrast and compare with humans and other major NHPs, such as macaques. Following subcutaneous inoculation of adult male and nonpregnant female baboons, viremia was detected at 3 and 4 days postinfection (dpi) with the concordant presentation of a visible rash and conjunctivitis, similar to human ZIKV infection. Furthermore, virus was detected in the mucosa and cerebrospinal fluid. A robust ZIKV-specific IgM and IgG antibody response was also observed in all the animals. These data show striking similarity between humans and the olive baboon following infection with ZIKV, suggesting our model is a suitable translational NHP model to study ZIKV pathogenesis and potential therapeutics.IMPORTANCE ZIKV was first identified in 1947 in a sentinel rhesus monkey in Uganda and subsequently spread to Southeast Asia. Until 2007, only a small number of cases were reported, and ZIKV infection was relatively minor until the South Pacific and Brazilian outbreaks, where more severe outcomes were reported. Here, we present the baboon as a nonhuman primate model for contrast and comparison with other published animal models of ZIKV, such as the mouse and macaque species. Baboons breed year round and are not currently a primary nonhuman primate species used in biomedical research, making them more readily available for studies other than human immunodeficiency virus studies, which many macaque species are designated for. This, taken together with the similarities baboons have with humans, such as immunology, reproduction, genetics, and size, makes the baboon an attractive NHP model for ZIKV studies in comparison to other nonhuman primates.

[Jose Ingenieros and the amusias: the beginning of the neuropsychology in Argentina]. / Jose Ingenieros y las amusias, sobre los origenes de la neuropsicologia argentina.

The Argentine neuropsychological school is born of the hand of the European school and is part of the beginning of the Experimental Psychology. In 1896 Horacio Pinero creates the first Department of Psychology at the University of Buenos Aires and in 1898 the first laboratory of Experimental Psychology is annexed. Jose Ingeniero, psychiatrist, neurologist, politician and above all sociologist publishes in France his work about the musical aphasia, the first neuropsychological work with international significance. In the same redeems to Charcot instead of to Knoblauch like the first one to describe the amusias, it speaks of an intelligence instead of a musical language and proposes a new classification and a methodology of assessment with a neurological-psychiatric integrative perspective. This article gave rise to this book in French on the musical language and its hysterical alterations awarded by the Academy of Medicine of Paris.

TITLE: Jose Ingenieros y las amusias, sobre los origenes de la neuropsicologia argentina.La escuela neuropsicologica argentina nace de la mano de la escuela europea y forma parte del inicio de la psicologia experimental. En 1896, Horacio Pinero crea la primera catedra de psicologia de la Universidad de Buenos Aires, y en 1898 se anexa el primer laboratorio de psicologia experimental. Jose Ingenieros, psiquiatra, neurologo, politico y, sobre todo, sociologo publica en Francia su trabajo sobre afasias musicales, el primer estudio neuropsicologico argentino con trascendencia internacional. En el redime a Charcot y no a Knoblauch como el primero en describir la amusia, habla de una inteligencia y no de un lenguaje musical, y propone una clasificacion y una metodologia de evaluacion con una perspectiva integradora neurologica-psiquiatrica. Este articulo dio origen a su libro en frances sobre el lenguaje musical y sus alteraciones histericas, premiado por la Academia de Medicina de Paris.

Manejo anestésico para la realización de biosias transbronquiales guiadas por ecobroncoscopía: descripción de 9 casos y revisión de la literatura / Anesthetic management for performing endobronchial ultrasound-guided transbronchial biopsies: description of 9 cases and literature review

La realización de procedimientos broncoscópicos intervencionistas precisa en muchas ocasiones de la asistencia de anestesiólogos, debido al potencial compromiso de la vía aérea, a la patología asociada y a la complejidad de los procedimientos. Describimos el manejo anestésico de 9 casos de ecobroncoscopias para biopsias de ganglios en cáncer de pulmón, con anestesia intravenosa y sin la necesidad de utilizar dispositivos supraglóticos ni transglóticos, revisando a su vez la literatura al respecto...

Anesthesists are becoming increasingly involved in the performance of interventional bronchoscopies, because of the potential risk of compromising the patency of the airway, the presence of comorbidities ant the global complexity of the procedures. We describe in this paper the anesthetic management of 9 patients scheduled for nodal transbronchial ultrasound guided biopsy with intravenous agents and without the need of supraglotic or transglotic devices...

Hemorragia incoercible por trauma maxilofacial: experiencia del Hospital del Trabajador / Management of intractable bleeding facial trauma

Introduction: The aim of this paper is to show our experience in the management of intractable bleeding facial trauma during the past 10 years to determine its impact on our environment and outline the basic principles of treatment. Methods: A retrospective study of all patients with maxillofacial trauma and uncontrollable bleeding from 1999 to 2009. Inclusion criteria were oro-nasal bleeding secondary to maxi-llofacial trauma requiring emergency treatment by a specialist, without other associated lesions that could be a source of bleeding. We obtained demographic information, mechanism of injury, diagnosis of injury, hemodynamic status, type and timing of tamponade, definitive surgical treatment, results and evolution. Results: 21 patients in the study period, a true incidence of 0.002 percent. 7 patients (33.3 percent) with trauma naso-septal; 5 (23.8 percent) with panfacial fractures, and 7 (33.3 percent) with variable involvement of the upper and middle face. Nine patients (42.9 percent) had isolated facial injuries. Only 5 patients (23.8 percent) had hemodynamic compromise. Thirteen patients (61.9 percent) required posterior nasal packing with or without another procedure to control bleeding. Eight patients (38.1 percent) required early reduction and internal fixation as definitive treatment. Conclusions: Maxillofacial trauma uncontrollable bleeding is uncommon and rarely is the primary cause of hypovolemic shock. It should be suspected in patients with facial injuries from hours bleeding. The packing, suturing of wounds and reduce/OTS are the mainstays of early treatment.

Introducción: El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo de la hemorragia incoercible por trauma facial durante los últimos 10 años, para determinar su incidencia y delinear los principios básicos del tratamiento. Material y Método: Estudio retrospectivo de todos los pacientes con hemorragia incoercible por trauma maxilofacial entre 1999 y 2009. Criterios de inclusión fueron hemorragia oro-nasal secundaria a traumatismo maxilofacial, sin otras lesiones asociadas que pudieran ser fuente de hemorragia, que requirió de tratamiento de urgencia por un especialista. Se obtuvo información demográfica, mecanismo de injuria, diagnóstico del traumatismo, estado hemodinámico, tipo y momento del tratamiento especializado, tratamiento quirúrgico definitivo, resultados y evolución. Resultados: 21 pacientes en el período de estudio, con incidencia real de 0,002 por ciento. Destacan 7 pacientes (33,3 por ciento) con trauma nasoseptal, con o sin heridas faciales; 5 (23,8 por ciento) con fracturas panfaciales; 7 (33,3 por ciento) con compromiso variable del tercio superior y medio de la cara. Nueve pacientes (42,9 por ciento) presentaron lesiones faciales aisladas. 5 pacientes (23,8 por ciento) presentaron compromiso hemodinámico. Trece pacientes (61,9 por ciento) necesitaron un taponamiento nasal posterior, asociado o no a otro procedimiento para el control de la hemorragia. Ocho pacientes (38,1 por ciento) necesitaron reducción y osteosíntesis precoz como tratamiento definitivo. Conclusiones: La hemorragia incoercible por trauma maxilofacial es poco frecuente y rara vez es la causa primaria de shock hipovolémi-co. Se la debe sospechar especialmente en pacientes con lesiones faciales que llevan horas con sangrado, aún de poca cuantía, pero persistente. El taponamiento, sutura de heridas y reducción/OTS precoz son los pilares de su tratamiento.

Punción aspirativa con aguja fina de tiroides: valor diagnóstico: revisión de 28 años en el Hospital Ramón Barros Luco-Trudeau / Fine needle aspiration cytology in thyroid disease: diagnostic value: review of 28 years in the Ramon Luco-Trudeau Hospital

Entre 1975 y 2003 se intervinieron 1730 pacientes por patología tiroidea -tanto benigna como maligna- en el Servicio de Cirugía del Hospital Barros Luco-Trudeau. De estos pacientes, se revisaron para nuestro estudio un total de 899 pacientes, los cuales contaban con estudio de punción aspirativa con aguja fina (PAAF) y su resultado histopatológico diferido. Para determinar el valor diagnóstico de nuestras punciones, se calculó la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Para el análisis de los datos se consideraron los resultados de PAAF sospechosos de proceso neoplásico en conjunto con los positivos para neoplasia. Los resultados obtenidos fueron de una sensibilidad de 58,7 por ciento, especificidad de 83,7 por ciento, VPP de 5,38 y VPN de 84,9. Dentro de los falsos negativos de la histología preponderante correspondió a cáncer papilar de tiroides.

Water reuse in the Apatlaco River Basin (México): a feasibility study.

The aim of this work is to determine the technical and economic feasibility of implementing different reclamation and reuse projects that improve the quality of the Apatlaco river basin located in the central part of Mexico. A special methodology based on a decision support system was developed. This methodology allows to decide if it is convenient or not to finance a reclamation or reuse project for the most common water uses in the basin. This methodology is based on the net present value criteria (NPV) of the effective cash flow during the useful life of the project. The results obtained reveal a technical and economical feasibility for industrial reuse in Jiutepec and for agricultural reuse in Zacatepec and Emiliano Zapata. On the other hand, sanitation projects are not feasible in all cases analyzed. Therefore, Mexican Regulation (Ley Federal de Derechos en Materia de Agua) as currently implemented, does not promote and support this kind of projects.

Utilización de la llamada medicina tradicional en distintos níveles socioeconómicos y educacionales / Use of the called tradicional medicine in different socioeconomic and educacional levels

Este estudio identificó el uso de la medicina tradicional (MT) en una población con diferentes niveles educacionales y socioeconómicos. Se describen los agentes informales de la salud utilizados. Una encuesta previamente validada escrutó a adultos de 280 hogares del territorio elegido. Para el análisis se consideró un nivel de significancia de p<0,01. Los resultados caracterizaron al grupo con edad promedio de 41 años (18 a 82 años), 60 por ciento de hombres y 40 por ciento de mujeres. El 45,4 por ciento pertenecían al nivel socioeconómico C2, 43,2 por ciento al nivel C3 y 11,4 por ciento al nivel D. Un 60,7 por ciento de los encuestados tenía educación escolar básica incompleta. Casi 3 de cada 4 pobladores tenía algún grado de confianza en la MT; un 47,5 por ciento ha utilizado o utiliza sus servicios. Los agentes más usados fueron homeópatas (39,8 por ciento) y yerbateros (37,6 por ciento). Un 56,4 por ciento asiste a éstos por tradición familiar. Se demostró uso de MT significativamente mayor en bajos niveles educacionales (p<0,001) y socioeconómico (p=0,005). El trabajo mostró que el uso de la MT es una realidad no despreciable en esta población, con una clara influencia cultural y de tradiciones familiares

Anticoncepción en la adolescencia: ¿opción informada según estrato socioeconómico-cultural? / Anticonception in adolescence: informed option by socioeconomic-cultural status?

Este estudio evaluó el uso de métodos anticonceptivos (MAC) por adolescentes que cursan sus últimos años de educación secundaria, en relación a edad, sexo, conocimientos del tema y estrato socioeconómico-cultural. Participaron 294 alumnos de 2 colegios estatales, de distinto estrato. Como instrumento se diseñó y validó una encuesta, contestada voluntaria y confidencialmente. Para el análisis se consideró un nivel de significancia de p

[Risk factors for asthenopia among computer terminal operators]. / Factores de riesgo para la astenopía en operadores de terminales de computadoras.

OBJECTIVE: To study the incidence of asthenopia among computer terminal operators as compared to unexposed administrative workers and to identify the risk factors associated with this condition. MATERIAL AND METHODS: A sample of 35 computer terminal operators and 70 unexposed administrative workers from eight computing centers at an educational institution were included in the study. The risk factors studied were: lighting, contrast, type of lighting, screen type, electrostatic field, eye to monitor distance, time and number of hours worked, age, use of corrective lenses, seniority and overtime. Asthenopia was clinically identified as the presence of at least one sign and symptom present in a given workday. RESULTS: Asthenopia was found in 68.5% of the exposed group and in 47.7% of the unexposed group (p < 0.05). Among the risk factors studied, working for more than four hours at the video display terminal was shown to have a significant association with asthenopia (p < 0.05). CONCLUSIONS: A recommendation is made to take breaks during the workday at computer terminals in order to avoid visual fatigue. Also, more extensive studies should be carried out in our population to establish safety criteria and to standardize work activities using computer terminals.

[Usefulness and risks of transtracheal aspiration in the diagnosis of pulmonary infections]. / Utilidad y riesgos del aspirado transtraqueal en el diagnóstico de infecciones pulmonares.

OBJECTIVE: To define the diagnostic usefulness and the risks of the transtracheal aspirate in a group of patients studied at the National Institute of Nutrition in Mexico City. DESIGN: It is a retrospective and descriptive analysis of a group of patients in whom a transtracheal aspiration (TTA) was performed due to suspicion of pulmonary infection. The study period was from 1983 to 1987. PATIENTS: On the study period 137 patients were submitted to a TTA; the clinical files of 126 of the cases were considered suitable for analysis. RESULTS: The procedure was performed because of a suspected bacterial pneumonia in 80% of the cases, and to study an interstitial infiltrate or pulmonary nodules in 14% and 6%, respectively. In the cases in which a bacterial pneumonia was suspected, the TTA had a sensitivity of 77% and a specificity of 95% when compared against a group of clinical, radiologic and microbiological data. Sensitivity increased to 84% when the patients who received antibiotics prior to the procedure were excluded. The specificity of the sputum's culture was sensibly less in this same group of patients. The TTA proved to be of value in five of nine pulmonary tuberculosis, two of three pulmonary mycoses and three of seven P. carinii pneumonias. Adverse events were noted in 6.3% of the cases; none of them was fatal, and specific corrective measures were necessary in only two patients. CONCLUSIONS: Our results agree with previous reports related to the usefulness of the TTA on patients with a suspected bacterial pneumonia. Our specificity is higher than that seen by other authors: we believe this is due to the low incidence of chronic respiratory diseases in the patients who attend our hospital. Transtracheal aspirate can be a valuable alternative in the diagnosis of non-bacterial pulmonary infections when the elective procedures cannot be performed. A modification on the technique is proposed to increase its usefulness in patients with interstitial pneumonia.