Absceso hepático en Cali, Colombia / Liver abscess in Cali, Colombia

INTRODUCCIÓN: El absceso hepático (AH) es el tipo mas común de abscesos viscerales. Se estima que el perfil epidemiológico de esta enfermedad ha cambiado con el aumento de la resistencia de los microorganismos y el uso de nuevos medicamentos. OBJETIVO: Describir las características demográficas y clínicas de los pacientes hospitalizados con diagnóstico de AH en un hospital universitario del suroccidente colombiano. MÉTODOS: Se realizó un estudio observacional retrospectivo, en la Fundación Valle del Lili, Cali, Colombia. Se incluyeron pacientes mayores de 18 años con diagnóstico de AH hospitalizados entre 2011-2020. RESULTADOS: Se incluyeron 182 pacientes. La mediana de edad fUe 56 años (rango intercuartílico, 45-67) y 62,1% fueron hombres. El microrganismo mas común fue Klebsiella pneumoniae (17,6%). La mayoría requirió drenaje percutáneo (58,2%). El 58,8% tuvo un absceso único y 54,4% fue manejado en cuidados intensivos. El 7,1% de los pacientes falleció. Al comparar los casos que fueron manejados en cuidados intensivos vs. aquellos que no lo fueron, hubo más hepatomegalia (28,3 vs. 11,0%, p = 0,004), derrame pleural derecho (48,5 vs. 28,1%, p = 0,010), cirugía (42,4 vs. 13,4%, p < 0,001), falla terapéutica (22,2 vs. 7,3%, p = 0,007) y muerte (12,1 vs. 1,2%, p = 0,005) en los atendidos en UCI. CONCLUSIÓN: Las Enterobacterales son la principal causa de AH en nuestra población. La mortalidad ha disminuido, pero la hospitalización en cuidados intensivos sigue siendo alta.

BACKGROUND: Liver abscess (LA) is the most common type of visceral abscess. It is estimated that the epidemiological profile of this disease has changed with the increase in resistance and the use of new drugs. AIM: To describe the demographic and clinical characteristics of hospitalized patients with a diagnosis of LA in a university hospital in the southwestern region of Colombia. METHODS: A. retrospective observational study was conducted at Fundación Valle del Lili, Cali, Colombia. Patients older than 18 years with a diagnosis of LA hospitalized between 2011-2020 were included. RESULTS: A total of 182 patients were included. The median age was 56 years (interquartile range, 45-67) and 62.1% were men. The most common microorganism was Klebsiella pneumoniae (17.6%). The majority required percutaneous drainage (58.2%). A 58.8% had a single abscess and 54.4% were treated in ICU. A 7.1% of the patients died. When comparing cases treated in the ICU vs. those who did not, there was more hepatomegaly (28.3 vs. 11.0%, p = 0.004), right pleural effusion (48.5 vs. 28.1%, p = 0.010), surgery (42.4 vs. 13.4%, p < 0.001), therapeutic failure (22.2 vs. 7.3%, p = 0.007) and death (12.1 vs. 1.2%, p = 0.005) in patients treated in ICU. CONCLUSION: Enterobacterales are the main cause of LA in our population. Mortality has decreased, but intensive care hospitalization remains high.

Safety and efficacy of endovascular versus microsurgical treatment of unruptured wide-necked middle cerebral artery aneurysms: a propensity score-matched analysis of the NeuroVascular Quality Initiative Quality Outcomes Database Cerebral Aneurysm Registry.

OBJECTIVE: Unruptured, wide-necked middle cerebral artery (WN-MCA) aneurysms have traditionally been considered ideal candidates for microsurgery (MS), although endovascular treatment (EVT) has dramatically increased in popularity with the advent of novel devices such as intrasaccular flow disruptors. The purpose of this study was to evaluate the safety and efficacy of MS versus EVT for unruptured WN-MCA aneurysms. METHODS: The NeuroVascular Quality Initiative Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry, a multiinstitutional, prospectively collected procedural database, was queried for cases of unruptured WN-MCA aneurysms treated with MS or EVT between 2015 and 2022. A wide neck was defined as an aneurysm neck ≥ 4 mm or a dome/neck ratio ≤ 2. Demographics and aneurysm characteristics were queried. Propensity score matching (PSM) was utilized to match aneurysm size, number of aneurysms treated, patient age, and aneurysm status. Safety outcomes were evaluated including intraoperative and postoperative complication rates. Aneurysm occlusion status and clinical outcomes using the modified Rankin Scale (mRS) score at discharge and the last follow-up were also assessed. RESULTS: Of 671 unruptured MCA aneurysms, 319 were wide necked. Thirty cases were excluded, as the aneurysm had been previously treated. Two hundred eighty-nine operations (203 EVT, 86 MS) in 282 patients satisfied inclusion criteria. After PSM, there were 86 operations in each group for analysis. The mean aneurysm width was 5.0 (EVT) versus 4.9 mm (MS; p = 0.285). Safety data showed similar intraoperative (7.0% EVT vs 3.5% MS, p = 0.496) and postoperative (4.7% vs 7%, p = 0.746) complication rates. The MS patients were more likely to have complete aneurysm occlusion at discharge (90.4% vs 58.8%, p < 0.001). In a limited subset of patients (52.9%) for whom outcome data were available, the EVT patients were more likely to have an mRS score 0 at discharge (50/59 [84.7%] vs 29/54 [53.7%], p < 0.0003] and at the last follow-up (36/55 [65.5%] vs 13/36 [36.1%], p = 0.006). CONCLUSIONS: This study describes a large, modern cohort of propensity score-matched patients who underwent treatment of unruptured WN-MCA aneurysms. Safety data on intraoperative and postoperative complication rates were similar in both treatment groups. MS was more likely to result in complete aneurysm occlusion at discharge. In a subset of patients with available outcome data, EVT was associated with better functional outcomes at discharge and the last follow-up. Given the lack of complete follow-up data and rates of retreatment, these results should be interpreted cautiously.

Urinary bladder retention secondary to intranasal administration of oxymetazoline "Afrin" for intra-arterial chemotherapy.

Selective ophthalmic artery infusion of chemotherapy (SOAIC) has emerged as the standard of care for retinoblastoma (RB). Intranasal oxymetazoline (INO), Afrin, is often intraoperatively administered adjunctively to optimize flow to the orbit. There has been one report to date that suggests the adjunctive use of INO has led to systemic side effects. To our knowledge, this is the first documented case of INO causing urinary retention in a patient undergoing SOAIC, and the recommended treatment.

Review and Proposal for a Classification System of Soft Robots Inspired by Animal Morphology.

The aim of this article is to propose a bio-inspired morphological classification for soft robots based on an extended review process. The morphology of living beings that inspire soft robotics was analyzed; we found coincidences between animal kingdom morphological structures and soft robot structures. A classification is proposed and depicted through experiments. Additionally, many soft robot platforms present in the literature are classified using it. This classification allows for order and coherence in the area of soft robotics and provides enough freedom to expand soft robotics research.

Cluster Amplitudes and Their Interplay with Self-Consistency in Density Functional Methods.

The front cover artwork is provided by the Mosquera group at Montana State University, Bozeman. The image shows theoretical elements involved in the density-functional calculations that are free of spurious fractional charges. Read the full text of the Research Article at 10.1002/cphc.202200592.

A Proposal of Bioinspired Soft Active Hand Prosthesis.

Soft robotics have broken the rigid wall of interaction between humans and robots due to their own definition and manufacturing principles, allowing robotic systems to adapt to humans and enhance or restore their capabilities. In this research we propose a dexterous bioinspired soft active hand prosthesis based in the skeletal architecture of the human hand. The design includes the imitation of the musculoskeletal components and morphology of the human hand, allowing the prosthesis to emulate the biomechanical properties of the hand, which results in better grips and a natural design. CAD models for each of the bones were developed and 3D printing was used to manufacture the skeletal structure of the prosthesis, also soft materials were used for the musculoskeletal components. A myoelectric control system was developed using a recurrent neural network (RNN) to classify the hand gestures using electromyography signals; the RNN model achieved an accuracy of 87% during real time testing. Objects with different size, texture and shape were tested to validate the grasping performance of the prosthesis, showing good adaptability, soft grasping and mechanical compliance to object of the daily life.

Cluster Amplitudes and Their Interplay with Self-Consistency in Density Functional Methods.

Density functional theory (DFT) provides convenient electronic structure methods for the study of molecular systems and materials. Regular Kohn-Sham DFT calculations rely on unitary transformations to determine the ground-state electronic density, ground state energy, and related properties. However, for dissociation of molecular systems into open-shell fragments, due to the self-interaction error present in a large number of density functional approximations, the self-consistent procedure based on the this type of transformation gives rise to the well-known charge delocalization problem. To avoid this issue, we showed previously that the cluster operator of coupled-cluster theory can be utilized within the context of DFT to solve in an alternative and approximate fashion the ground-state self-consistent problem. This work further examines the application of the singles cluster operator to molecular ground state calculations. Two approximations are derived and explored: i) A linearized scheme of the quadratic equation used to determine the cluster amplitudes. ii) The effect of carrying the calculations in a non-self-consistent field fashion. These approaches are found to be capable of improving the energy and density of the system and are quite stable in either case. The theoretical framework discussed in this work could be used to describe, with an added flexibility, quantum systems that display challenging features and require expanded theoretical methods.

Slippery Paraelectric Transition-Metal Dichalcogenide Bilayers.

Traditional ferroelectrics undergo thermally induced phase transitions whereby their structural symmetry increases. The associated higher-symmetry structure is dubbed paraelectric. Ferroelectric transition-metal dichalcogenide bilayers have been recently shown to become paraelectric, but not much has been said of the atomistic configuration of such a phase. As discovered through numerical calculations that include molecular dynamics here, their paraelectricity can only be ascribed to a time average of ferroelectric phases with opposing intrinsic polarizations, whose switching requires macroscopically large areas to slip in unison.

Theoretical quantum model of two-dimensional propagating plexcitons.

When plasmonic excitations of metallic interfaces and nanostructures interact with electronic excitations in semiconductors, new states emerge that hybridize the characteristics of the uncoupled states. The engendered properties make these hybrid states appealing for a broad range of applications, ranging from photovoltaic devices to integrated circuitry for quantum devices. Here, through quantum modeling, the coupling of surface plasmon polaritons and mobile two-dimensional excitons such as those in atomically thin semiconductors is examined with emphasis on the case of strong coupling. Our model shows that at around the energy crossing of the dispersion relationships of the uncoupled species, they strongly interact and polariton states-propagating plexcitons-emerge. The temporal evolution of the system where surface plasmon polaritons are continuously injected into the system is simulated to gain initial insight on potential experimental realizations of these states. The results show a steady state that is dominated by the lower-energy polariton. The study theoretically further establishes the possible existence of propagating plexcitons in atomically thin semiconductors and provides important guidance for the experimental detection and characterization of such states for a wide range of optoelectronic technologies.

Thermal properties of single-layer MoS2-WS2 alloys enabled by machine-learned interatomic potentials.

Two-dimensional (2D) quantum materials are poised to transform conventional electronics for a wide spectrum of applications that will encompass chemical sciences. For the study of thermal transport in single-layer (1L) or multi-layer transition metal dichalcogenides (TMDs), this work explores the combination of density functional theory (DFT) and algorithmic training for the generation of a moment tensor potential (MTP) that models 1L-MoS2, 1L-WS2 and their alloys, and demonstrates a synergy of theoretical techniques that is anticipated to play an important role in the field. From a high-performance computing perspective, these yield very convenient inter-atomic (or inter-molecular in other contexts) potentials that are useful to predict the response of quantum materials to thermal perturbations, or other driving forces. We show that our trained MTP functions successfully describe vibrational properties of the systems, and their thermal conductivities. The trained potential displays consistent agreement with DFT calculations, as well as the Stillinger-Weber (SW) potential. We also find that the thermal conductivity of the 2D alloys is little affected by sulfur vacancies. This is a behavior that may aid the fine-tuning of material's thermal properties for heat management and energy storage and conversion applications.

Understanding the Origin of Enhanced Piezoelectric Response in PVDF Matrices with Embedded ZnO Nanoparticles, from Polarizable Molecular Dynamics Simulations.

The pervasive use of portable electronic devices, powered from rechargeable batteries, represents a significant portion of the electricity consumption in the world. A sustainable and alternative energy source for these devices would require unconventional power sources, such as harvesting kinetic/potential energy from mechanical vibrations, ultrasound waves, and biomechanical motion, to name a few. Piezoelectric materials transform mechanical deformation into electric fields or, conversely, external electric fields into mechanical motion. Therefore, accurate prediction of elastic and piezoelectric properties of materials, from the atomic structure and composition, is essential for studying and optimizing new piezogenerators. Here, we demonstrate the application of harmonic-covalent and reactive force fields (FF), Dreiding and ReaxFF, respectively, coupled to the polarizable charge equilibration (PQEq) model for predicting the elastic moduli and piezoelectric response of crystalline zinc oxide (ZnO) and polyvinylidene difluoride (PVDF). Furthermore, we parametrized the ReaxFF atomic interactions for Zn-F in order to characterize the interfacial effects in hybrid PVDF matrices with embedded ZnO nanoparticles (NPs). We capture the nonlinear piezoelectric behavior of the PVDF-ZnO system at different ZnO concentrations and the enhanced response that was recently observed experimentally, between 5 and 7 wt % ZnO concentrations. From our simulation results, we demonstrate that the origin of this enhancement is due to an increase in the total atomic stress distribution at the interface between the two materials. This result provides valuable insight into the design of new and improved piezoelectric nanogenerators and demonstrates the practical value of these first-principles based modeling methods in materials science.

Effect of surface oxidation on the electronic transport properties of phosphorene gas sensors: a computational study.

The potential for phosphorene-based devices has been compromised by the material's fast degradation under ambient conditions. Its tendency to fully oxidize under O2-rich and humid environments, leads to the loss of its appealing semiconducting properties. However, partially-oxidized phosphorene (po-phosphorene), has been demonstrated to remain stable over significantly longer periods of time, thereby enabling its use in sensing applications. Here, we present a computational study of po-phosphorene-based gas sensors, using the Density-Functional-based Tight Binding (DFTB) method. We show that DFTB accurately predicts the bandgap for the pristine material and po-phosphorene, the electronic transport properties of po-phosphorene at different surface oxygen concentrations, and the appropriate trends in Density-of-States (DOS) contributions caused by adsorbed gas molecules, to demonstrate its potential application in the development of gas sensors. Results are compared against the more traditional and expensive Density Functional Theory (DFT) method using generalized gradient approximation (GGA) exchange-correlation functionals, which significantly underestimates the material's bandgap.

Evolutionary Computation for Parameter Extraction of Organic Thin-Film Transistors Using Newly Synthesized Liquid Crystalline Nickel Phthalocyanine.

In this work, the topic of the detrimental contact effects in organic thin-film transistors (OTFTs) is revisited. In this case, contact effects are considered as a tool to enhance the characterization procedures of OTFTs, achieving more accurate values for the fundamental parameters of the transistor threshold voltage, carrier mobility and on-off current ratio. The contact region is also seen as a fundamental part of the device which is sensitive to physical, chemical and fabrication variables. A compact model for OTFTs, which includes the effects of the contacts, and a recent proposal of an associated evolutionary parameter extraction procedure are reviewed. Both the model and the procedure are used to assess the effect of the annealing temperature on a nickel-1,4,8,11,15,18,22,25-octakis(hexyl)phthalocyanine (NiPc6)-based OTFT. A review of the importance of phthalocyanines in organic electronics is also provided. The characterization of the contact region in NiPc6 OTFTs complements the results extracted from other physical-chemical techniques such as differential scanning calorimetry or atomic force microscopy, in which the transition from crystal to columnar mesophase imposes a limit for the optimum performance of the annealed OTFTs.

Partially-oxidized phosphorene sensor for the detection of sub-nano molar concentrations of nitric oxide: a first-principles study.

The development of new techniques or instruments for detecting and accurately measuring biomarker concentrations in living organisms is essential for early diagnosis of diseases, and for tracking the effectiveness of treatments. In chronic diseases, such as asthma, precise phenotyping can help predict the response of patients to treatments and reduce the risk of complications. Fractional exhaled nitric oxide (FeNO) is a positive biomarker for eosinophilic asthma in humans, and it can be directly detected in the respiratory tract, at very low and volatile concentrations, which makes real-time measurement a challenge. This work describes the first-principles design and characterization of a molecular- and back-gated electronic field-effect transistor device for the detection and measurement of ultra-low FeNO concentrations (pM-nM) from a person' s exhaled breath, as a cost-efficient alternative to the slower and more expensive techniques based on off-line sputum characterization via mass spectrometry. The proposed device uses a partially oxidized phosphorene semiconducting channel material for FeNO detection, allowing nM L-1 concentration measurements of this analyte in an array configuration with an effective sensing surface area of 8.775 µm2, which results in a predicted limit of detection (LOD) of 19 nM L-1. In spite of the limited stability of phosphorene in oxygen-rich and humid environments, the proposed device would be practical for mobile applications with disposable sensors.

Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization.

BACKGROUND: Endovascular treatment of large complex morphology aneurysms is challenging. High recanalization rates have been reported with techniques such as stent-assisted coiling and balloon-assisted coiling. Flow diverter devices have been introduced to improve efficacy outcomes and recanalization rates. Thromboembolic complications and in-device stenosis are certainly more worrisome when treatment of bilateral internal carotid arteries has been performed. This study aimed to report our experience with mid-term imaging follow-up of staged bilateral Pipeline embolization device placement for the treatment of bilateral internal carotid artery aneurysms. METHODS: We reviewed the clinical, angiographic, and follow-up imaging data in all consecutive patients treated with bilateral internal carotid artery aneurysms who underwent elective Pipeline embolization. RESULTS: Six female patients were treated, harboring a total of 13 aneurysms. Of these, 60% were asymptomatic. Diplopia and headache were the most common symptoms. The most common location was the paraclinoid segment (6/13), including by cavernous segment (4/13) and ophthalmic segment (2/13). Successful delivery of the device was achieved in 12 cases. Difficult distal access precluded the deployment of the device in one case. The treatment was always staged with at least eight weeks' difference between the two procedures. All aneurysm necks were covered completely. There were no periprocedural complications. Angiographic follow-up ranged between 3 and 12 months, and computed tomography angiogram follow-up ranged between 2 and 24 months. Complete aneurysm occlusion was achieved in all cases. CONCLUSION: In our series, Pipeline deployment for the treatment of bilateral internal carotid artery aneurysms in a staged fashion is safe and feasible. Mid-term imaging follow-up showed permanent occlusion of all the treated aneurysms.

Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis, a novel technique for malignant obstruction: A case report and review of literature.

For patients suffering from both biliary and duodenal obstruction, endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the treatment of choice. ERCP through an already existing duodenal prosthesis is an uncommon procedure and furthermore no studies have reported installing a covered metal stent onto an already existing bare metal stent in the common bile duct (CBD). We describe a rare case of a stent-in-stent dilatation of the CBD through an already existing self-expanding metal stent in the second part of duodenum for the patient presenting with jaundice in setting of biliary and duodenal obstruction from pancreatic adenocarcinoma. The biliary obstruction was relieved with a decrease in bilirubin levels post-stenting.

Off label use of lumen-apposing metal stent for persistent gastro-jejunal anastomotic stricture.

We are reporting a novel "off-label" use of lumen apposing metal stent (LAMS) for management of refractory gastro-jejunal (GJ) anastomotic stricture after Roux-en-y gastric bypass (RYGB). With increasing prevalence of obesity, bariatric surgery is performed more frequently than ever. RYGB is one of the most commonly performed bariatric procedures. GJ anastomotic stricture is a late complication of this procedure. Our patient, seven years after RYGB developed GJ anastomotic ulcer and subsequently a stricture not amendable to repeated pneumatic dilations. Instead of using the conventional fully covered self-expanding metal stent (fcSEMS) we deployed the relatively new LAMS keeping in mind its novel dumbbell shaped design. Our patient's symptoms were controlled successfully and she remained asymptomatic on follow-up. Despite initial approval for pancreatic pseudocyst drainage, LAMS has been used with increased frequency at various locations within gastrointestinal tract including GJ anastomotic strictures. Future randomized control trials are warranted to compare the efficacy of fcSEMS to LAMS.

Transverse venous sinus stenting for idiopathic intracranial hypertension: Safety and feasibility.

Purpose Transverse sinus stenosis is commonly seen in patients with idiopathic intracranial hypertension. It is not clear whether it is the cause or the result of idiopathic intracranial hypertension. Stenting for idiopathic intracranial hypertension has been carried out in several prior series. Our goal was to evaluate the clinical and imaging follow-up results of patients with idiopathic intracranial hypertension that underwent stenting for this condition at our center. Materials and Methods We reviewed the clinical, venographic and follow-up imaging data in patients who underwent elective transverse sinus stenting during the period from 2011 to 2017. Results In total, 18 patients with idiopathic intracranial hypertension were identified. The mean lumbar cerebrospinal fluid opening pressure recorded was 408 mmH20. Overall, 16 patients met the inclusion criteria and underwent transverse sinus stenting. At venography, the mean pressure gradient across the dominant transverse sinus stenosis was 21 mmHg. The pressure gradient immediately after stenting in all of those measured was negligible. Following stenting, headaches improved in 10 of the 16 cases, with persistent headaches in four patients, one of which had persistent baseline migraines. All cases showed resolution of the papilledema on follow up. Follow-up imaging with computed tomography venography showed that the stents remained widely patent. The follow up in clinic was done for a mean period of 35.5 months. Follow up with computed tomography venography was done for a mean of 10.3 months. Conclusion Venous sinus stenting is a safe and effective procedure. It relieves papilledema in all cases and improves headaches in most cases.