The origin and speciation of orchids.

Orchids constitute one of the most spectacular radiations of flowering plants. However, their origin, spread across the globe, and hotspots of speciation remain uncertain due to the lack of an up-to-date phylogeographic analysis. We present a new Orchidaceae phylogeny based on combined high-throughput and Sanger sequencing data, covering all five subfamilies, 17/22 tribes, 40/49 subtribes, 285/736 genera, and c. 7% (1921) of the 29 524 accepted species, and use it to infer geographic range evolution, diversity, and speciation patterns by adding curated geographical distributions from the World Checklist of Vascular Plants. The orchids' most recent common ancestor is inferred to have lived in Late Cretaceous Laurasia. The modern range of Apostasioideae, which comprises two genera with 16 species from India to northern Australia, is interpreted as relictual, similar to that of numerous other groups that went extinct at higher latitudes following the global climate cooling during the Oligocene. Despite their ancient origin, modern orchid species diversity mainly originated over the last 5 Ma, with the highest speciation rates in Panama and Costa Rica. These results alter our understanding of the geographic origin of orchids, previously proposed as Australian, and pinpoint Central America as a region of recent, explosive speciation.

Plastome phylogenomics reveals an early Pliocene North- and Central America colonization by long-distance dispersal from South America of a highly diverse bromeliad lineage.

Understanding the spatial and temporal frameworks of species diversification is fundamental in evolutionary biology. Assessing the geographic origin and dispersal history of highly diverse lineages of rapid diversification can be hindered by the lack of appropriately sampled, resolved, and strongly supported phylogenetic contexts. The use of currently available cost-efficient sequencing strategies allows for the generation of a substantial amount of sequence data for dense taxonomic samplings, which together with well-curated geographic information and biogeographic models allow us to formally test the mode and tempo of dispersal events occurring in quick succession. Here, we assess the spatial and temporal frameworks for the origin and dispersal history of the expanded clade K, a highly diverse Tillandsia subgenus Tillandsia (Bromeliaceae, Poales) lineage hypothesized to have undergone a rapid radiation across the Neotropics. We assembled full plastomes from Hyb-Seq data for a dense taxon sampling of the expanded clade K plus a careful selection of outgroup species and used them to estimate a time- calibrated phylogenetic framework. This dated phylogenetic hypothesis was then used to perform biogeographic model tests and ancestral area reconstructions based on a comprehensive compilation of geographic information. The expanded clade K colonized North and Central America, specifically the Mexican transition zone and the Mesoamerican dominion, by long-distance dispersal from South America at least 4.86 Mya, when most of the Mexican highlands were already formed. Several dispersal events occurred subsequently northward to the southern Nearctic region, eastward to the Caribbean, and southward to the Pacific dominion during the last 2.8 Mya, a period characterized by pronounced climate fluctuations, derived from glacial-interglacial climate oscillations, and substantial volcanic activity, mainly in the Trans-Mexican Volcanic Belt. Our taxon sampling design allowed us to calibrate for the first time several nodes, not only within the expanded clade K focal group but also in other Tillandsioideae lineages. We expect that this dated phylogenetic framework will facilitate future macroevolutionary studies and provide reference age estimates to perform secondary calibrations for other Tillandsioideae lineages.

New and noteworthy species of the genus Epidendrum (Orchidaceae, Laeliinae) from the Área de Conservación Privada La Pampa del Burro, Amazonas, Peru.

Fourteen species of the genus Epidendrum, recently collected in the Área de Conservación Privada La Pampa del Burro (ACPPB), five of them new to science (Epidendrumechinatiantherumsp. nov., E.imazaensesp. nov., E.parvireflexilobumsp. nov., E.rosulatumsp. nov., and E.ochrostachyumsp. nov.), are described and illustrated. The other species include a new record for Peru (E.acrobatesii) and four for the department of Amazonas (E.brachyblastum, E.forcipatum, E.mavrodactylon, and E.tridens). Epidendrumenantilobum is here considered a synonym of Epidendrumbrachyblastum. The type locality of Epidendrumcryptorhachis, originally stated as Ecuador, Guayabamba, is corrected to indicate that it refers to the valley of Guayabamba, Rodríguez de Mendoza, Amazonas, Peru. Our results show the need to continue conducting botanical exploration in the ACPPB as a baseline for subsequent studies, including a full inventory of the orchid diversity.

A new species of Liparis (Orchidaceae, Epidendroideae, Malaxidinae) from the Bosque de Protección Alto Mayo, San Martín, Peru.

Liparisaltomayoënsissp. nov. is described, illustrated, and tentatively assigned to the Neotropical section Decumbentes on the basis of its branching, prostrate rhizomes and upright stems bearing several leaves. Vegetatively, the new species is distinguished by its short, upward stems bearing 3-6 leaves, these with undulate, translucent margins and reticulate, prominent veining on the upper surface. Florally, it is distinctive in the labellum with fleshy basal one-half provided with a central, rounded cavity limited on each side by a prominent, bilobulate ridge and apically by a lunate ridge, and membranaceous, trilobulate apical one-half deflexed ca. 90°. In contrast with other species of section Decumbentes, in which fruit formation is infrequent, in L.altomayoënsis a high proportion (⁓50-100%) of flowers develop into a fruit; in some flowers the pollinaria rotate and contact the stigma, apparently resulting in at least facultative self-pollination. The main differences among the six species of L.sectionDecumbentes hitherto known are contrasted in a dichotomous key. The new species is known only from three populations located in the Bosque de Protección Alto Mayo, on the Amazonian slope of the Andes in northeastern Peru but appears to be under no foreseeable threats.

ResumenLiparisaltomayoënsissp. nov. es descrita, ilustrada y asignada tentativamente a la sección neotropical Decumbentes con base en sus rizomas postrados, ramificados y tallos ascendentes portando varias hojas. Vegetativamente, la nueva especie se distingue por sus tallos ascendentes cortos con 3­6 hojas, éstas con márgenes undulados, translúcidos y venación reticulada prominente en la superficie superior. Floralmente, es distintivo su labelo con la mitad basal carnosa, provista de una cavidad central redondeada que está limitada a cada lado por una cresta bilobulada prominente y apicalmente por una cresta lunada, y la mitad apical del labelo membranácea, trilobulada y deflexa ca. 90°. En contraste con otras especies de la sección Decumbentes, en las que la producción de frutos es infrecuente, en L.altomayoënsis una alta proporción (⁓50­100%) de las flores produce fruto; en algunas flores los polinarios rotan y contactan el estigma, aparentemente resultando en autopolinización al menos facultativa. Las diferencias principales entre las seis especies de L. sección Decumbentes conocidas hasta ahora se contrastan en una clave dicotómica. La nueva especie se conoce solamente de tres poblaciones localizadas en el Bosque de Protección Alto Mayo, en la vertiente amazónica de los Andes en el noreste de Perú, pero no parece estar sujeta a amenazas previsibles.

Sperm calcium flux and membrane potential hyperpolarization observed in the Mexican big-eared bat Corynorhinus mexicanus.

Mammalian sperm capacitation involves biochemical and physiological changes, such as an increase in intracellular calcium ion concentration ([Ca2+]i), hyperpolarization of the plasma membrane potential and sperm hyperactivation, among others. These changes provide sperm with the ability to fertilize. In the bat Corynorhinus mexicanus, there is an asynchrony between spermatogenesis and sperm storage in the male with the receptivity of the female. For instance, in C. mexicanus, spermatogenesis occurs before the reproductive season. During the reproductive period, sperm are stored in the epididymis for a few months and the testis undergoes a regression, indicating low or almost null sperm production. Therefore, it is unclear whether the elements necessary for sperm fertilization success undergo maturation or preparation during epididymis storage. Here, we characterized pH-sensitive motility hyperactivation and Ca2+ influx in sperm, regulated by alkalinization and progesterone. In addition, by electrophysiological recordings, we registered currents that were stimulated by alkalinization and inhibited by RU1968 (a CatSper-specific inhibitor), strongly suggesting that these currents were evoked via CatSper, a sperm Ca2+-specific channel indispensable for mammalian fertilization. We also found hyperpolarization of the membrane potential, such as in other mammalian species, which increased according to the month of capture, reaching the biggest hyperpolarization during the mating season. In conclusion, our results suggest that C. mexicanus sperm have functional CatSper and undergo a capacitation-like process such as in other mammals, particularly Ca2+ influx and membrane potential hyperpolarization.

Validación de un instrumento para evaluar el nivel de conocimiento en la aplicación de fórceps obstétrico / Validation of an instrument to assess the level of knowledge about the application of obstetric forceps

Resumen OBJETIVO: Diseñar y validar un instrumento para evaluar el nivel de conocimiento en la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, tipo validación de un instrumento. El primer constructo se desarrolló con base en el marco teórico; el cuestionario fue objeto de análisis por parte de un grupo de expertos que se basaron en la metodología Delphi. Se obtuvo un constructo de 20 preguntas y se emprendió un estudio para evaluar la pertinencia del instrumento. La confiabilidad se evaluó con el coeficiente de Kuder-Richardson, prueba Kaiser-Meyer-Olkin y de esfericidad de Bartlett. Los datos se procesaron en el programa SPSS versión 21. RESULTADOS: El instrumento se aplicó a 66 médicos residentes con media de edad de 28.5 ± 0.7 años. El coeficiente de Kuder-Richardson fue 0.608. Las pruebas de Kaiser-Meyer-Olkin y Bartlett mostraron que se trató de un instrumento multidimensional. CONCLUSIONES: Se obtuvo un instrumento válido, confiable y multidimensional para determinar el nivel de conocimientos en relación con la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia.

Abstract OBJECTIVE: To design and validate an instrument to assess the level of knowledge of Salinas forceps application in Gynecology and Obstetrics residents. MATERIALS AND METHODS: Descriptive, cross-sectional, validation-type study of an instrument. The first construct was developed based on the theoretical framework; the questionnaire was analyzed by a group of experts based on the Delphi methodology. A construct of 20 questions was obtained and a study was undertaken to assess the relevance of the instrument. Reliability was evaluated with the Kuder-Richardson coefficient, Kaiser-Meyer-Olkin test and Bartlett's sphericity test. The data were processed in SPSS version 21. RESULTS: The instrument was applied to 66 resident physicians with a mean age of 28.5 ± 0.7 years. The Kuder-Richardson coefficient was 0.608. The Kaiser-Meyer-Olkin and Bartlett tests showed that it was a multidimensional instrument. CONCLUSIONS: A valid, reliable and multidimensional instrument was obtained to determine the level of knowledge in relation to the application of Salinas forceps in Gynecology and Obstetrics residents.

A Community-based study on the prevalence and predisposing factors of Parkinson's disease in Barangay Mangilag Sur, Quezon Province, Philippines.

Introduction: Prevalence of Parkinson's Disease (PD) in the Philippines has been estimated to be < 1 % based on a 2007 nationwide survey conducted by the Philippine Neurological Association, but without case ascertainment. Since there is still paucity of data, we aim to determine the prevalence of PD in a rural community and the possible predisposing factors on the development of the disease. Methods: This is a two-phase descriptive study which investigated the prevalence of PD and associated risk factors in a randomly selected rural community in Candelaria, Quezon Province. A validated screening questionnaire was utilized, and case ascertainment was done in eligible respondents. Results: A total of 365 respondents aged ≥ 20 years were randomly surveyed from 2016 to 2017. Two cases of PD aged ≥ 60 years were reported. Thus, the prevalence of PD in the community was 0.55 %. Age-specific prevalence of PD among individuals ≥ 60 years was 4.35 %.Insecticide use was infrequent in the community and was recorded in one PD patient. Protective factors like smoking and drinking tea were not observed in both cases whereas coffee intake was reported in one PD patient. Conclusion: This community-based epidemiologic study on PD is consistent with a nationwide study. The study portrayed certain demographic and environmental features inherent in a community, which are potential confounding variables in PD development. Future larger population studies be recommended to establish PD in the advancing age and to further support the link of various factors with PD.

New plastome structural rearrangements discovered in core Tillandsioideae (Bromeliaceae) support recently adopted taxonomy.

Full plastome sequences for land plants have become readily accessible thanks to the development of Next Generation Sequencing (NGS) techniques and powerful bioinformatic tools. Despite this vast amount of genomic data, some lineages remain understudied. Full plastome sequences from the highly diverse (>1,500 spp.) subfamily Tillandsioideae (Bromeliaceae, Poales) have been published for only three (i.e., Guzmania, Tillandsia, and Vriesea) out of 22 currently recognized genera. Here, we focus on core Tillandsioideae, a clade within subfamily Tillandsioideae, and explore the contribution of individual plastid markers and data categories to inform deep divergences of a plastome phylogeny. We generated 37 high quality plastome assemblies and performed a comparative analysis in terms of plastome structure, size, gene content and order, GC content, as well as number and type of repeat motifs. Using the obtained phylogenetic context, we reconstructed the evolution of these plastome attributes and assessed if significant shifts on the evolutionary traits' rates have occurred in the evolution of the core Tillandsioideae. Our results agree with previously published phylogenetic hypotheses based on plastid data, providing stronger statistical support for some recalcitrant nodes. However, phylogenetic discordance with previously published nuclear marker-based hypotheses was found. Several plastid markers that have been consistently used to address phylogenetic relationships within Tillandsioideae were highly informative for the retrieved plastome phylogeny and further loci are here identified as promising additional markers for future studies. New lineage-specific plastome rearrangements were found to support recently adopted taxonomic groups, including large inversions, as well as expansions and contractions of the inverted repeats. Evolutionary trait rate shifts associated with changes in size and GC content of the plastome regions were found across the phylogeny of core Tillandsioideae.

Miomectomía durante el embarazo: leiomioma gigante con degeneración / Miomectomy during pregnancy: giant leiomyoma with degeneration

Resumen ANTECEDENTES: Los leiomiomas son los tumores pélvicos más comunes, con múltiples presentaciones clínicas a lo largo de la vida de la mujer. Es inusual que aparezcan durante el embarazo y que ameriten tratamiento quirúrgico, sobre todo por abdomen agudo secundario a degeneración. OBJETIVO: Aportar y exponer el proceso de diagnóstico, tratamiento quirúrgico y desenlace obstétrico en una paciente con un leiomioma gigante con degeneración asociado al embarazo. CASO CLÍNICO: Paciente de 34 años, primigesta, con 22.1 semanas de embarazo. Acudió a Urgencias con abdomen agudo, fiebre y daño ventilatorio secundario a un leiomioma gigante que ocupaba la totalidad del abdomen y comprimía las estructuras abdominales y torácicas. Debido al deterioro clínico se decidió la intervención quirúrgica para extraer los dos miomas: el mayor de 35 x 20 cm y 9150 g. La evolución posoperatoria fue favorable lo mismo que el control prenatal. La finalización del embarazo fue por cesárea electiva a las 38.1 semanas, sin complicaciones maternas ni perinatales. CONCLUSIÓN: La miomectomía durante el embarazo es un procedimiento seguro para disminuir la morbilidad y la mortalidad materna y fetal en casos seleccionados.

Abstract BACKGROUND: Leiomyomas are the most common pelvic tumors, with multiple clinical presentations throughout a woman's life. It is unusual for them to appear during pregnancy and to merit surgical treatment, especially for acute abdomen secondary to degeneration. OBJECTIVE: To provide and expose the process of diagnosis, surgical treatment and obstetric outcome in a patient with a giant leiomyoma with pregnancy-associated degeneration. CLINICAL CASE: A 34-year-old primigravida patient, 22.1 weeks pregnant. She came to the emergency department with acute abdomen, fever and ventilatory impairment secondary to a giant leiomyoma that occupied the entire abdomen and compressed abdominal and thoracic structures. Due to the clinical deterioration, surgery was decided to remove the two fibroids: the larger one measuring 35 x 20 cm and weighing 9150 g. The postoperative evolution was favorable. The postoperative evolution was favorable as well as the prenatal control. The pregnancy was terminated by elective cesarean section at 38.1 weeks, without maternal or perinatal complications. CONCLUSION: Myomectomy during pregnancy is a safe procedure to reduce maternal and fetal morbidity and mortality in selected cases.

A new species and a new record of Liparis sect. Decumbentes (Malaxidinae, Orchidaceae) from Peru.

A new species of Liparis sect. Decumbentes, Liparis sessilis Damián, Salazar & Rimarachín, sp. nov is described and illustrated from Amazonas (Perú), including color photographs, a detailed comparison and an identification key to all the species of Liparis sect. Decumbentes. In addition, we report Liparis brachystalix Rchb.f. for the first time for the orchid flora of Peru, and select a lectotype for its synonym, L. commelinoides Schltr.

ResumenUna nueva especie de Liparis sect. Decumbentes, Liparis sessilis Damián, Salazar & Rimarachín, sp. nov se describe e ilustra de Amazonas (Perú), incluyendo fotografías a color, una comparasion detallada y una clave de identificación de todas las especies de Liparis sect. Decumbentes. Ademas, reportamos Liparis brachystalix Rchb.f. por primera vez para la orquiflora del Perú, y seleccionamos un lectótipo para uno de sus sinónimos, L. commelinoides Schltr.

Target Nuclear and Off-Target Plastid Hybrid Enrichment Data Inform a Range of Evolutionary Depths in the Orchid Genus Epidendrum.

Universal angiosperm enrichment probe sets designed to enrich hundreds of putatively orthologous nuclear single-copy loci are increasingly being applied to infer phylogenetic relationships of different lineages of angiosperms at a range of evolutionary depths. Studies applying such probe sets have focused on testing the universality and performance of the target nuclear loci, but they have not taken advantage of off-target data from other genome compartments generated alongside the nuclear loci. Here we do so to infer phylogenetic relationships in the orchid genus Epidendrum and closely related genera of subtribe Laeliinae. Our aims are to: 1) test the technical viability of applying the plant anchored hybrid enrichment (AHE) method (Angiosperm v.1 probe kit) to our focal group, 2) mine plastid protein coding genes from off-target reads; and 3) evaluate the performance of the target nuclear and off-target plastid loci in resolving and supporting phylogenetic relationships along a range of taxonomical depths. Phylogenetic relationships were inferred from the nuclear data set through coalescent summary and site-based methods, whereas plastid loci were analyzed in a concatenated partitioned matrix under maximum likelihood. The usefulness of target and flanking non-target nuclear regions and plastid loci was assessed through the estimation of their phylogenetic informativeness. Our study successfully applied the plant AHE probe kit to Epidendrum, supporting the universality of this kit in angiosperms. Moreover, it demonstrated the feasibility of mining plastome loci from off-target reads generated with the Angiosperm v.1 probe kit to obtain additional, uniparentally inherited sequence data at no extra sequencing cost. Our analyses detected some strongly supported incongruences between nuclear and plastid data sets at shallow divergences, an indication of potential lineage sorting, hybridization, or introgression events in the group. Lastly, we found that the per site phylogenetic informativeness of the ycf1 plastid gene surpasses that of all other plastid genes and several nuclear loci, making it an excellent candidate for assessing phylogenetic relationships at medium to low taxonomic levels in orchids.

Drenaje biliar transparietohepático: experiencia en el Hospital Universitario y Centro Médico de Caracas / Transhepatic Biliary Drainage: University Hospital and Medical Center of Caracas experience

Introducción: El drenaje biliar transparietohepático (DTPH) es un procedimiento terapéutico, temporal o definitivo, mediante el cual se cateteriza la vía biliar para descomprimirla. Indicaciones: Imposibilidad de resolver la patología biliar por otros métodos (CPRE), tratar la vía biliar en anastomosis bilioentéricas (estenosis), localización y tratamiento de fístulas biliares o patología maligna. Objetivos: Evaluar la experiencia de la Unidad de Radiología Intervencionista del Hospital Universitario de Caracas (HUC) y Centro Medico de Caracas (CMC) en el manejo de DTPH. Método: Estudio retrospectivo, analítico, de corte transversal, con muestreo no probabilístico e intencional. Se procesó estadísticamente la casuística obtenida de la combinación de pacientes atendidos en el CMC entre 2002 y 2017, y en el HUC entre 2010 y 2017, en una población de 528 pacientes, de los cuales 174 fueron reintervenidos, para un total de 702 casos de ambas instituciones. Se utilizó el equipo de arco en "C" fluoroscopia. Se procesaron datos en IBM SPSS 22.0. Resultados: 702 casos, promedio de edad 54±2. El 58,7 %, mujeres (n = 310). Principal incidencia de etiología de patología maligna n = 329 pacientes (62,3 %), seguido por patología benigna encabezada por estenosis posquirúrgica biliodigestiva en n = 191 pacientes (36,1 %). La patología maligna en mayor porcentaje la constituye el ADC de páncreas con n = 156 (29,5 %). En los procedimientos realizados se obtuvo un mayor porcentaje de drenaje interno-externo 48 % (n = 254).Conclusiones: El DTPH constituye una técnica efectiva con poco índice de complicaciones para tratamiento de ictericia obstructiva. La experiencia evaluada ha resultado estadísticamente óptima con buenos resultados.

Introduction: Biliary transparietohepatic drainage (BTHD) is a therapeutic element, temporary or definitive, through which the biliary path is accessed, being able toleave a catheter to decompress it. Indications: Impossibility of resolving biliary pathology by other methods (ERCP), treating the biliary tract in biliary-enteric anastomosis (stenosis), location and treatment of biliary fistulas or malignant pathology. Objectives: evaluate the experience of the interventional radiology unit of the University Hospital of Caracas (UHC) and Medical Center of Caracas (MCC) in the management of BTHD. Method: Retrospective, descriptive, cross-sectional study, with non-probabilistic and intentional sampling. The casuistry from the combination of patients in MCC period 2002 to 2017, and UHC from 2010 to 2017 was statistically processed. 528 patients were obtained, of which 174 were operated on, making 702 cases performed in both institutions. Arc equipment fluoroscopy was used. Data was processed in IBM SPSS 22.0. Results: 702 cases, average age 54 ± 2. 58.7% of female patients n = 310. Main incidence of malignant pathological etiology n = 329 patients (62.3%), followed by benign pathology headed by postsurgical stenosis of biliodigestive in n = 191 patients (36.1%). The malignant pathology with highest percentage is pancreatic ADC with n = 156 (29.5%). Procedures performed obtained a greater percentage of internal external drainage 48% n = 254. Conclusions: BTHD is an effective technique with a low rate of complications for the treatment of obstructive jaundice. Our experience has been statistically optimal with good results.

A pilot study applying the plant Anchored Hybrid Enrichment method to New World sages (Salvia subgenus Calosphace; Lamiaceae).

We conducted a pilot study using Anchored Hybrid Enrichment to resolve relationships among a mostly Neotropical sage lineage that may have undergone a recent evolutionary radiation. Conventional markers (ITS, trnL-trnF and trnH-psbA) have not been able to resolve the relationships among species nor within portions of the backbone of the lineage. We sampled 12 representative species of subgenus Calosphace and included one species of Salvia's s.l. closest relative, Lepechinia, as outgroup. Hybrid enrichment and sequencing were successful, yielding 448 alignments of individual loci with an average length of 704bp. The performance of the phylogenomic data in phylogenetic reconstruction was superior to that of conventional markers, increasing both support and resolution. Because the captured loci vary in the amount of net phylogenetic informativeness at different phylogenetic depths, these data are promising in phylogenetic reconstruction of this group and likely other lineages within Lamiales. However, special attention should be placed on the amount of phylogenetic noise that the data could potentially contain. A prior exploration step using phylogenetic informativeness profiles to detect loci with sites with disproportionately high substitution rates (showing "phantom" spikes) and, if required, the ensuing filtering of the problematic data is recommended. In our dataset, filtering resulted in increased support and resolution for the shallow nodes in maximum likelihood phylogenetic trees resulting from concatenated analyses of all the loci. Additionally, it is expected that an increase in sampling (loci and taxa) will aid in resolving weakly supported, short deep internal branches.

Sex and the Catasetinae (Darwin's favourite orchids).

Two sexual systems are predominant in Catasetinae (Orchidaceae), namely protandry (which has evolved in other orchid lineages as well) and environmental sex determination (ESD) being a unique trait among Orchidaceae. Yet, the lack of a robust phylogenetic framework for Catasetinae has hampered deeper insights in origin and evolution of sexual systems. To investigate the origins of protandry and ESD in Catasetinae, we sequenced nuclear and chloroplast loci from 77 species, providing the most extensive data matrix of Catasetinae available so far with all major lineages represented. We used Maximum Parsimony, Maximum Likelihood and Bayesian methods to infer phylogenetic relationships and evolution of sexual systems. Irrespectively of the methods used, Catasetinae were monophyletic in molecular phylogenies, with all established generic lineages and their relationships resolved and highly supported. According to comparative reconstruction approaches, the last common ancestor of Catasetinae was inferred as having bisexual flowers (i.e., lacking protandry and ESD as well), and protandry originated once in core Catasetinae (comprising Catasetum, Clowesia, Cycnoches, Dressleria and Mormodes). In addition, three independent gains of ESD are reliably inferred, linked to corresponding loss of protandry within core Catasetinae. Thus, prior gain of protandry appears as the necessary prerequisite for gain of ESD in orchids. Our results contribute to a comprehensive evolutionary scenario for sexual systems in Catasetinae and more generally in orchids as well.

[Caesarean section: History, epidemiology, and ethics to diminish its incidence]. / Operación cesárea. Una visión histórica, epidemiológica y ética para disminuir su incidencia.

Cesarean section has become the most performed surgery and it has been enhanced with the use of antibiotics and improvement in surgical techniques. The aim of this systematic review is to describe and clarify some historical and ethical characteristics of this surgery, pointing out some aspects about its epidemiological behavior, becoming a topic that should be treated globally, giving priority to the prevention and identification of factors that may increase the incidence rates. Today, this "epidemic" reported rates higher than fifty percent, so it is considered a worldwide public health problem. Consequently, in Mexico strategies aimed at its reduction have been implemented. However, sociocultural, economic, medicolegal and biomedical factors are aspects that may difficult this goal. As we decrease the percentage of cesarean section in nulliparous patients, we diminish the number of iterative cesarean and its associated complications. This aim must be achieved through the adherence to the guidelines which promote interest in monitoring and delivery care in health institutions of our country.

La operación cesárea es la cirugía mayor más frecuentemente practicada, y ha sido perfeccionada con el uso de antibióticos y mejores técnicas quirúrgicas. El objetivo de esta revisión sistemática es describir y precisar diversas características históricas y éticas con relación a esta intervención quirúrgica, señalando algunos aspectos inherentes a su comportamiento epidemiológico, siendo este último una problemática de actualidad y de suma importancia que debe tratarse de forma integral, dando prioridad a la prevención e identificación de los factores que hacen posible el aumento en las tasas de incidencia. Hoy en día, esta "epidemia" reporta tasas que superan el cincuenta por ciento, por lo que se ha considerado un problema de salud pública a nivel mundial. Consecuentemente, en México se han implementado estrategias tendentes a su disminución, no obstante, los factores socioculturales, económicos, médico-legales y biomédicos son aspectos que dificultan dicho objetivo. En la proporción en que se disminuya el porcentaje de cesárea en pacientes primigestas, disminuirá secundariamente el número de cesáreas iterativas y sus complicaciones asociadas, meta que debe alcanzarse mediante el apego a las guías que promueven el interés por la vigilancia y atención del parto en las instituciones de salud de nuestro país.

Eficacia y seguridad del taponamiento uterino para control de hemorragia y disminución de histerectomía obstétrica: cohorte histórica en Nuevo León, México, 2013 / Efficacy and safety of uterine tamponade to control bleeding and reduce obstetric hysterectomy: historic cohort in Nuevo León, México, 2013

Objetivo: realizar una aproximación a la eficacia y seguridad del taponamiento uterino para el control de la hemorragia obstétrica y reducir la necesidad de histerectomía obstétrica.Materiales y métodos: cohorte histórica de mujeres mayores de edad con diagnóstico de hemorragia obstétrica secundaria a atonía que no respondían a manejo inicial, con sangrado del lecho placentario secundario a placentación anormal o secundaria a aborto incompleto, a las cuales se les realizó taponamiento uterino, en la Unidad Médica de Alta Especialidad No. 23 de Ginecología y Obstetricia de la ciudad de Monterrey, hospital de concentración de tercer nivel de atención, ubicado en el estado de Nuevo León (México), de enero a diciembre de 2013. A partir del expediente clínico se registraron las características sociodemográficas y clínicas basales, los datos de laboratorio previo al evento obstétrico y posterior al taponamiento, así como el tiempo de taponamiento en horas, cantidad de insuflación del balón uterino, indicación para el procedimiento, cantidad de sangrado estimado durante el evento obstétrico y posterior a la colocación del balón, control de la hemorragia y necesidad de histerectomía. Se utilizó estadística descriptiva, medidas de dispersión y de tendencia central.Resultados: se incluyeron 161 pacientes con diagnóstico de hemorragia obstétrica, 147 posterior a parto o cesárea y 14 posterior al aborto, entre 16 y 42 años de edad. Se documentó un resultado satisfactorio en más del 95 % posterior al parto o la cesárea, y en más del 93 % posaborto. La permanencia del taponamiento para ambos casos tuvo una media de 20 horas.Conclusiones: este estudio soporta el uso de taponamiento uterino como medida terapéutica eficaz y segura para controlar la hemorragia y evitar una laparotomía o histerectomía, con una disminución de la morbilidad.

Objective: Examine the efficacy and safety of uterine tamponade for controlling obstetric bleeding and reducing the need for obstetric hysterectomy.Materials and methods: Historic cohort of adult women diagnosed with obstetric bleeding secondary to uterine atony that did not respond to the initial management, with bleeding of the placental bed secondary to abnormal placentation or to incomplete abortion, subjected to uterine tamponade at the Highly Specialized Gynaecology and Obstetrics Medical Unit No. 23, a Level III Hospital in the city of Monterrey, state of Nuevo Leon, Mexico, between January and December 2013. Information about social, demographic and baseline clinical characteristics, laboratory values before the obstetric event and after the tamponade procedure, as well as the inflation volume of the balloon, the indication of the procedure, the estimated amount of bleeding during the event and after placement of the tamponade balloon, control of bleeding, and need for hysterectomy, was derived from the clinical record. Descriptive statistics, scatter measurements, and central trends were used.Results: Overall, 161 patients between the ages of 16 and 42 years, with a diagnosis of obstetric haemorrhage were included, 147 following delivery or caesarean section, and 14 following miscarriage. A satisfactory result was documented in more than 95 % of cases after delivery or caesarean section, and in more than 93 % post abortion cases. The mean tamponade time for both groups was 20 hours.Conclusions: This study supports the use of uterine tamponade as an effective and safe therapeutic measure to control bleeding and avoid laparotomy or hysterectomy, and to reduce morbidity.

Use of antidepressants in the treatment of depression in Asia: guidelines, clinical evidence, and experience revisited.

Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients.

Molecular phylogenetics of the species-rich genus Habenaria (Orchidaceae) in the New World based on nuclear and plastid DNA sequences.

Habenaria is a large genus of terrestrial orchids distributed throughout the tropical and subtropical regions of the world. The integrity and monophyly of this genus have been under discussion for many years, and at one time or another, several genera have been either included in a broadly defined Habenaria or segregated from it. In this study, the phylogenetic relationships of the Neotropical members of the genus and selected groups of African Habenaria were investigated using DNA sequences from the nuclear internal transcribed spacer (ITS) region and the plastid matK gene sampled from 151 taxa of Habenaria from the Neotropics (ca. 51% of the total) as well as 20 species of Habenaria and Bonatea from the Old World. Bayesian and parsimony trees were congruent with each other, and in all analyses, the Neotropical species formed a highly supported group. African species of Habenaria in sections Dolichostachyae, Podandria, Diphyllae, Ceratopetalae and Bilabrellae, and the Neotropical clade formed a highly supported "core Habenaria clade", which includes the type species of the genus from the New World. The topology of the trees indicates an African origin for the Neotropical clade and the low sequence divergence among the Neotropical species suggests a recent radiation of the genus in the New World. Species of Bonatea and Habenaria sections Chlorinae and Multipartitae formed a well-supported clade that was sister to the "core Habenaria clade". The Neotropical clade consists of at least 21 well-supported subgroups, but all Neotropical sections of the current sectional classification are paraphyletic or polyphyletic and will need extensive revision and recircumscription. Most of the Neotropical subgroups formed morphologically uniform assemblage of species, but some cases of morphological divergence within subgroups and convergence between subgroups indicated that morphology alone can be misleading for inferring relationships within the genus. The genera Bertauxia, Kusibabella and Habenella, segregated from New World Habenaria, are not monophyletic and a revision of the sectional classification rather than a generic division seems most appropriate. Our results do not support an extensive generic fragmentation of Habenaria as previously suggested and will provide a framework for revising the infrageneric classification and investigating the patterns of morphological evolution and geographical distribution of the genus in the New World.

Factores de riesgo y consecuencias del cyberbullying en un grupo de adolescentes: Asociación con bullying tradicional / Risk factors and consequences of cyberbullying in teenagers: association with bullying

Introducción. En el cyberbullying se utilizan medios electrónicos para intimidar. El objetivo del presente trabajo fue determinar la prevalencia de cyberbullying, identificar algunas características, explorar asociación con el bullying y analizar factores de riesgo y consecuencias. Métodos. El estudio incluyó alumnos de secundaria. El cyberbullying se utilizó como variable de exposición y de resultado. Se aplicó estadística no paramétrica y regresión logística. Resultados. Se encuestaron 603 alumnos, con media de edad de 13.4 años (DE 0.98 años). Fueron más prevalentes las cibervíctimas. El teléfono celular fue la herramienta más utilizada para intimidar. El factor de riesgo más importante para cibervíctimas fue "sentirse inseguro en la escuela" (X²=6.485 p=0.011 OR=4.1 IC95% 1.30-11.2). Para ciberagresores, "usar la computadora a escondidas de los padres y a altas horas de la noche" (X²=14.584 p<0.05 OR=4.2 IC95% 2.10-16.30); para cibervíctimas-ciberagresores, "ser mujer" (X²=2.891 p>0.05 OR=3.50 IC95% 1.70-16.80). La mayor asociación con bullying fue para varones y entre los roles víctima-agresor tradicional y ciberagresor (X²=28.821 p<0.05 OR=7.37 IC95% 3.78-14.3). Al considerar al ciberbullying como variable de exposición, la principal consecuencia fue la cefalea para el rol de ciberagresor (X²=15.125 p<0.05 OR=7.91 IC95% 2.28-29.6). Conclusiones. La prevalencia de cyberbullying fue menor a otras investigaciones, pero los factores de riesgo y las consecuencias son relevantes.

Background. Cyberbullying uses electronic tools to intimidate. We undertook this study to determine the prevalence of cyberbullying and to identify its characteristics. We explored the association with bullying and analyzed consequences and risk factors. Methods. Junior-high-school students were included. Cyberbullying was used as exposure and outcome variable. Nonparametric statistic and logistic regression were applied. Results. Six hundred three students with a mean age of 13.4 years (SD 0.98 years) were included. Cybervictims were more prevalent. The cell phone was the most common tool used to intimidate. The most important risk factor for cybervictims was "feeling unsafe at school" (c² = 6.485 p = 0.011 OR = 4.1 95% CI 1.30-11.2); for cyberaggressors it was "to use the computer hidden from parents and late at night" (c² = 14.584 p <0.05 OR = 4.2 95% CI 2.10-16.30); for cybervictims-cyberaggressors it was "to be female" (c² = 2.891 p >0.05 OR = 3.50 95% CI 1.70-16.80). The strongest association with bullying was shown for males and between traditional victim-aggressor and cyberaggressor roles (c² = 28.821 p <0.05 OR = 7.37 95% CI 3.78-14.3). When cyberbullying was considered as the exposure variable, the most relevant outcome measure was "to have headaches" for cyberaggressors (c² = 15.125 p <0.05 OR=7.91 95% CI 2.28-29.6). Conclusions. The prevalence of cyberbullying was less than demonstrated in other studies, but the risk factors and consequences are relevant.