Suicide victims and alcohol-related consumption in Brazil: An observational study and a narrative review of the literature.

Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evidence shows that the tendency to impulsive behavior is exacerbated after alcohol consumption. The relationship between alcohol and suicide is poorly described in the medical literature. The study aims to analyze the relationship between victims' blood alcohol levels and suicides in some municipalities in Greater São Paulo, Brazil. We reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo in Franco da Rocha, Brazil, from 2001 to 2017. The manner of death was established based on the result of police inquiry. Deaths due to suicide (n=41) were selected for the study. Descriptive statistics and Student t-test was applied when appropriate. The variables studied were sex, age, suicide mechanism, and blood alcohol level (BAC). In all cases we could not determine how much time the deceased consumed alcohol before suicide. Of the individuals analyzed, 85.36% were male, and 14.64% were female. The most prevalent age range for males was between 18 and 23 (19.5%). For females, it was between 12 and 23 years (33.2%). Most suicides (48.78%) were due to hanging, followed by self-poisoning (22.08%) and firearms (17.1%). 38 victims (92.68%) presented a positive BAC, over 0.3 mg/dl. The higher levels were in the group of suicide by hanging (2.3 mg/ml). Thus, alcohol intoxication is common among suicide victims, and it can contribute to the fatal outcome as a risk factor. Further studies are necessary for a better comprehension of the effect of alcohol on suicide victims.

Epidemiological profile, temporal analysis, and future projections of suicide cases in rural cities in the extreme south of Brazil.

The present study aimed to verify the time series (2000-2017) of death rates by suicide and its associated factors in 4 municipalities in the extreme south of Brazil. Data were obtained through the analysis of medical reports and police report bulletins at the Instituto Médico Legal, in the city of Rio Grande. The suicide rate in the Rio Grande region varied from 4 to 11 suicides per 100,000 inhabitants and it is estimated that by 2030 this rate could reach 16.5 suicides per 100,000 inhabitants. The rural cities of Santa Vitória do Palmar and Chuí present even higher suicide averages when compared to Rio Grande, the most populous city of the four. The death rate from suicide increased gradually in the period analyzed, with the prevalence rising among the youngest and the elderly population. A more comprehensive understanding of the influences of environmental issues on suicidal decisions constitutes an important action that needs to be taken, both because of regional vulnerabilities and the target population identified. Evidence indicates that knowledge of factors affecting individuals residing in this Brazilian region where increased suicide rates are recorded needs to be recognized as a priority.

Initial Characterization of 3D Culture of Yolk Sac Tissue.

The role of the yolk sac (YS) in miscarriage is not yet clear, largely due to ethical reasons that make in vivo studies difficult to conduct. However, 3D cultures could provide a solution to this problem by enabling cells to be arranged in a way that more closely mimics the structure of the YS as it exists in vivo. In this study, three domestic species (porcine, canine, and bovine) were chosen as models to standardize 3D culture techniques for the YS. Two techniques of 3D culture were chosen: the Matrigel® and Hanging-Drop techniques, and the 2D culture technique was used as a standardized method. The formed structures were initially characterized using scanning electron microscopy (SEM), immunohistochemistry (IHC), and quantitative real-time PCR (RT-qPCR). In general, the 3D culture samples showed better organization of the YS cells compared to 2D cultures. The formed structures from both 3D methods assemble the mesothelial layer of YS tissue. Regarding the IHC assay, all in vitro models were able to express zinc and cholesterol transport markers, although only 3D culture techniques were able to generate structures with different markers pattern, indicating a cell differentiation process when compared to 2D cultures. Regarding mRNA expression, the 3D models had a greater gene expression pattern on the Hemoglobin subunit zeta-like (HBZ) gene related to the YS tissue, although no significant expression was found in Alpha-fetoprotein (AFP), indicating a lack of endodermal differentiation in our 3D model. With the initial technique and characterization established, the next step is to maintain the cultures and characterize the diversity of cell populations, stemness, functions, and genetic stability of each 3D in vitro model.

Suicide rates in Ecuador: A nationwide study from 2011 until 2020.

Suicide, suicide ideations, and psychiatric disorder rates tend to increase after natural disasters such as earthquake. In 2016 Ecuador experienced a 7.8Mw earthquake and, more recently, the Covid-19 confinement. Both events may have negatively affected the mental health of the Ecuadorian population. Therefore, the present study aimed to evaluate the suicide rates and choice of suicide method in the Ecuadorian population between January 2011 and December 2020. The dataset used is publicly available on the Ecuadorian National Institute of Statistics and Censuses. Multivariate logistic regression models were used to calculate adjusted odds ratios (OR) for potential sociodemographic factors associated with each suicide method compared to other reported suicide methods. There were 10,380 registered cases of suicide in Ecuador between 2011 and 2020. Significant suicide rates per provinces were seen in Napo with 12.63 and Azuay with 12.52, followed by Bolívar with 12.30, and Orellana with 11.36 suicides/100,000 habitants. Hanging accounted for 7082 cases (68.2 %). The mestizos (82 %) were the most prevalent ethnicity of all suicide cases. School-age children with 6-12 years (OR 8.83, 95 % CI 5.34-14.59) and adolescents with 13-19 years (OR 1.46, 95 % CI 1.29-1.66) were more likely to use hanging as method of suicide. In conclusion, we observed an increase of suicide rates from 8.15 per 100,000 in 2011 to 8.81 in 2020. The confinement of COVID-19 pandemic in the period evaluated did not significantly affect the suicide rates. An increased suicide rate was observed in the province hardest hit by the 2016 earthquake.

Cotransplantation of marginal mass allogeneic islets with 3D culture-derived adult human skin cells improves glycemia in diabetic mice

Islet transplantation represents a therapeutic option for type 1 diabetes (T1D). Long-term viability of transplanted islets requires improvement. Mesenchymal stromal cells (MSCs) have been proposed as adjuvants for islet transplantation facilitating grafting and functionality. Stem cell aggregation provides physiological interactions between cells and enhances the in situ concentration of modulators of inflammation and immunity. We established a hanging-drop culture of adult human skin fibroblast-like cells as spheroids, and skin spheroid-derived cells (SphCs) were characterized. We assessed the potential of SphCs in improving islet functionality by cotransplantation with a marginal mass of allogeneic islets in an experimental diabetic mouse model and characterized the secretome of SphCs by mass spectrometry-based proteomics. SphCs were characterized as multipotent progenitors and their coculture with anti-CD3 stimulated mouse splenocytes decreased CD4+ T cell proliferation with skewed cytokine secretion through an increase in the Th2/Th1 ratio profile. SphCs-conditioned media attenuated apoptosis of islets induced by cytokine challenge in vitro and importantly, intratesticular SphCs administration did not show tumorigenicity in immune-deficient mice. Moreover, SphCs improved glycemic control when cotransplanted with a marginal mass of allogeneic islets in a diabetic mouse model without pharmacological immunosuppression. SphCs' protein secretome differed from its paired skin fibroblast-like counterpart in containing 70% of up- and downregulated proteins and biological processes that overall positively influenced islets such as cytoprotection, cellular stress, metabolism, and survival. In summary, SphCs improved the performance of transplanted allogeneic islets in an experimental T1D model, without pharmacological immunosuppression. Future research is warranted to identify SphCs-secreted factors responsible for islets' endurance.

"Sitting-up vertigo as an expression of posterior semicircular canal heavy cupula and posterior semicircular canal short arm canalolithiasis".

Background: Vestibular symptoms on sitting-up are frequent on patients seen by vestibular specialists. Recently, a benign paroxysmal positional vertigo (BPPV) variant which elicits vestibular symptoms with oculomotor evidence of posterior semicircular canal (P-SCC) cupula stimulation on sitting-up was described and named sitting-up vertigo BPPV. A periampullar restricted P-SCC canalolithiasis was proposed as a causal mechanism. Objective: To describe new mechanisms of action for the sitting-up vertigo BPPV variant. Methods: Eighteen patients with sitting-up vertigo BPPV were examined with a pre-established set of positional maneuvers and follow-up until they resolved their symptoms and clinical findings. Results: All patients showed up-beating torsional nystagmus (UBTN) and vestibular symptoms on coming up from either Dix-Hallpike (DHM) or straight head-hanging maneuver. Sixteen out of 18 patients presented a sustained UBTN with an ipsitorsional component to the tested side on half-Hallpike maneuver (HH). A slower persistent contratorsional down-beating nystagmus was found in eleven out 18 patients tested on nose down position (ND). Conclusions: Persistent direction changing positional nystagmus on HH and ND positions indicative of P-SCC heavy cupula was found in 11 patients. A sustained UBTN on HH with the absence of findings on ND, which is suggestive of the presence of P-SCC short arm canalolithiasis, was found on 5 patients. All patients were treated with canalith repositioning maneuvers without success, but they resolved their findings by means of Brandt-Daroff exercises. We propose P-SCC heavy cupula and P-SCC short arm canalolithiasis as two new putative mechanisms for the sitting-up vertigo BPPV variant.

Suicidios en el Perú: Descripción epidemiológica a través del Sistema Informático Nacional de Defunciones (SINADEF) en el periodo 2017-2021 / Suicides in Perú: Epidemiological description through SINADEF in the period 2017-2021

RESUMEN Objetivo: Descripción de características epidemiológicas de suicidios ocurridos en el Perú durante el periodo 2017-2021. Material y Métodos: Estudio de tipo descriptivo-comparativo, basado en la revisión del Sistema Informático Nacional de Defunciones entre los años 2017-2021; la muestra final incluyó un total de 2579 suicidios. Resultados: El 69,5% de los suicidios ocurrieron en el género masculino, el promedio de edad fue 34,87 años, 79,5% solteros y 26,6% con instrucción secundaria completa. Los departamentos con mayor frecuencia de suicidio fueron Lima (20,3%), Arequipa (19,2%), Cusco (9,5%) y Junín (7,8%). Según CIE-10 la causa principal de muerte fue edema cerebral (20,06%) y el domicilio, el lugar más frecuente (63,4%). Las modalidades utilizadas fueron ahorcamiento (56,6%), envenenamiento (29,2%), arma de fuego (4,0%), precipitación (3,1%) y arma blanca (1,7%). Se pudo establecer diferencias significativas con un p < 0,05 entre tipo de suicidio y género, identificando un 74% de casos por ahorcamiento en el sexo masculino; entre tipo de suicidio y región natural: 60% de ahorcamientos en la costa; entre rango etario y tipo de suicidio: ahorcamiento 10-19 años (27,7%) y envenenamiento 20-29 años (26,5%), La mayoría (70,7%) cometió suicidio por ahorcamiento en su domicilio, seguida por envenenamiento en establecimientos de salud (56,9%) y por precipitación en la vía pública (16,8%). Conclusiones: El tipo más frecuente de suicidio fue por ahorcamiento, en personas jóvenes-adultas de sexo masculino y por envenenamiento en personas de sexo femenino.

SUMMARY Objectives: Description of epidemiological features of suicides in Peru between the years 2017-2021. Material and Methods: Descriptive-comparative study based on the review of the national computerized registry of SINADEF deaths between the years 2017-2021; the final sample included a total of 2579 suicides. Results: Male gender reached 69.5%, average age 34.87 years, 79.5% were single, and 26.6% had complete secondary education. The departments with highest frequency of suicides were Lima (20.3%), Arequipa (19.2%), Cusco (9.5%) and Junín (7.8%). According to ICD-10, the main cause of death was cerebral edema (22.71%), and place of death at home (63.4%). Suicide modalities included hanging (56.6%), poisoning (29.2%), firearm (4%), precipitation (3.1%), and knife (1.7%). It was possible to establish significant differences with a p<0.05 value in: type of suicide and gender, 74% of hangings among males; type of suicide and natural region: hanging in the coast (60%); type of suicide and age range: hanging 10-19 years (27.7%) and poisoning 20-29 years (26.5%). A majority (70.7%) died at home by hanging, followed by poisoning in health facilities (56.9%), and by precipitation (16.8%) on public roads. Conclusions: The most frequent type of suicide was by hanging in young-adult males, and poisoning among females.

Análisis comparativo de casos de suicidio por ahorcadura, precipitación e intoxicación atendidos en la Morgue Judicial en la provincia de Ancón, Panamá de marzo del 2019 a febrero de 2020 y marzo del 2020 a febrero de 2021 / Comparative analysis of suicide by hanging, precipitation and intoxication cases attended at the Judicial Morgue in the province of Ancón, Panama from March 2019 to February 2020 and March 2020 to February 2021

Resumen Introducción: La crisis por la Covid-19, en muchas maneras, podría exacerbar ciertas dimensiones del proceso suicida a través de su impacto psicológico, social, económico o, incluso, biológico. El estudio comparará los casos de suicidio por ahorcadura, precipitación e intoxicación atendidos en la morgue judicial de la provincia de Panamá, entre marzo del 2019 a febrero del 2020 y marzo del 2020 a febrero del 2021. Material y métodos: Se trata de un estudio descriptivo, transversal y retrospectivo; cuya población de análisis comprende todas las autopsias médico-legales realizadas en la Morgue Judicial de Panamá por casos de ahorcadura, precipitación e intoxicación, de marzo del 2019 a febrero del 2021. Resultados: En el estudio se registró un total de 117 casos. De estos, 73 practicados de marzo del 2019 a febrero del 2020, de los cuales el 78 % (n=57) correspondió al sexo masculino, con una media de 41 años, y el 22 % (n=16) al sexo femenino, con una media de 36 años; mientras que, en el lapso de marzo del 2020 a febrero del 2021 la muestra fue de 44 casos, lo que representó el 93 % (n=41), de sexo masculino, con una media de 42 años y el 7 % (n=3) de sexo femenino, con una media de 47 años. Conclusión: Durante el año posterior al inicio de la pandemia y la aplicación de las medidas de cuarentena en la provincia de Panamá hubo una disminución de la frecuencia de los casos de suicidios por ahorcadura e intoxicación en comparación con el año previo y un aumento en cuanto a los casos por precipitación.

Abstract Introduction: The Covid-19 crisis in many ways could exacerbate certain dimensions of the suicidal process through its psychological, social, economic or even biological impact. In this study we will compare the cases of suicide by hanging, precipitation and intoxication carried out in the Judicial Morgue of Ancon from March 2019 to February 2020 and from March 2020 to February 2021. Materials and methods: This is a descriptive, cross-sectional and retrospective study; the population studied will be all the medicolegal autopsies performed in the Judicial Morgue of Panama, due to hanging, precipitation and intoxication in the period from March 2019 to February 2021. Results: A total of 117 cases were recorded in this period studied; 73 cases from March 2019 to February 2020 of which 78% (n=57) corresponded to the male sex, with an average of 41 years and 22% (n=16) to the female sex, with an average of 36; while, in the period from March 2020 to February 2021, of the sample of 44 cases 93% (n=41) corresponded to the male sex, with an average of 42 and 7% (n=3) to the female sex, with an average of 47 years. Conclusión: During the year after the beginning of the pandemic and the quarantine measures in the Province of Panama, there was a decrease in the frequency of suicide cases by hanging, precipitation and intoxication compared to the previous year.

Development of 3D cultures of zebrafish liver and embryo cell lines: a comparison of different spheroid formation methods.

Fish cell spheroids are promising 3D culture models for vertebrate replacement in ecotoxicology. However, new alternative ecotoxicological methods must be adapted for applications in industry and for regulatory purposes; such methods must be cost-effective, simple to manipulate and provide rapid results. Therefore, we compared the effectiveness of the traditional hanging drop (HD), orbital shaking (OS), and HD combined with OS (HD+OS) methods on the formation of zebrafish cell line spheroids (ZFL and ZEM2S). Time in HD (3-5 days) and different 96-well plates [flat-bottom or ultra-low attachment of round-bottom (ULA-plates)] in OS were evaluated. Easy handling, rapid spheroid formation, uniform-sized spheroids, and circularity were assessed to identify the best spheroid protocol. Traditional HD alone did not result in ZFL spheroid formation, whereas HD (5 days)+OS did. When using the OS, spheroids only formed on the ULA-plate. Both HD+OS and OS were reproducible in size (177.50 ± 2.81 µm and 225.62 ± 19.20 µm, respectively) and circularity (0.83 ± 0.02 and 0.80 ± 0.01, respectively) of ZFL spheroids. Nevertheless, HD+OS required a considerable time to completely form spheroids (10 days) and intensive handling, whereas the OS was fast (5 days of incubation) and simple. OS also yielded reproducible ZEM2S spheroids in 1 day (226.23 ± 0.57 µm diameter and 0.80 ± 0.01 circularity). In conclusion, OS in ULA-plate is an effective and simple spheroid protocol for high-throughput ecotoxicity testing. This study contributes to identify a fast, reproducible, and simple protocol of single piscine spheroid formation in 96-well plates and supports the application of fish 3D model in industry and academia.

A Combined "Hanging Liver Maneuver" and "Intrahepatic Extra-Glissonian Approach" for Anatomical Right Hepatectomy: Technique Standardization, Results, and Correlation With Portal Pedicle Anatomy.

Background: The hanging liver maneuver and intrahepatic extra-Glissonian approach are distinct modalities to facilitate safe anatomical liver resections. This study reports a standardized combination of these techniques focusing on safety, results and correlation with portal pedicle anatomy in oncological patients. Method: Combined hanging liver maneuver and intrahepatic extra-Glissonian approach for anatomic right hepatectomy was described stepwise. Portal pedicle anatomy was correlated with the Glissonian approach failure and complications. Clinical characteristics of patients, perioperative outcomes, short and long-term survival rates were analyzed. Results: Thirty colorectal liver metastases patients submitted to the combined approach were evaluated. Anatomical variations of the right portal pedicle were present in 26.6%. Hanging liver maneuver was feasible in 100%, and Glissonian approach in 96.7% despite portal pedicle variations. Mean operative time was 326 min. Mean blood loss was 507 ml. Mean hospital stay was 8 days. There was no 90-day operative mortality and no significant morbidity. Oncological surgical margins were free. Overall and disease-free 5-year survival were 59 and 37%. Conclusion: Regardless of frequent anatomical variations of the right portal pedicle, the hanging liver maneuver, and intrahepatic extra-Glissonian approach can be combined, being useful for anatomical right hepatectomies in a safe and reproducible way in most patients.

Lesiones laringotraqueales por ahorcamiento fallido / Laryngotracheal lesions by near-hanging

Introducción: La lesión por ahorcamiento se inscribe dentro del traumatismo cerrado de la tráquea cervical. Objetivo: Presentar seis enfermos tratados por secuelas de un intento fallido de ahorcamiento y revisión la literatura sobre los métodos diagnósticos y terapéuticos. Métodos: Se realizó un estudio descriptivo de seis pacientes tratados entre 1989 y 2011 en el Hospital "Hermanos Ameijeiras". Todos fueron remitidos de diferentes hospitales, con una traqueostomía para el control de la vía respiratoria. Las variables estudiadas fueron: sexo, edad, diagnóstico definitivo, técnicas quirúrgicas empleadas, evolución posoperatoria, complicaciones y mortalidad. Resultados: Todos los pacientes fueron del sexo masculino, con edad entre 16 y 66 años (mediana 28,5). Cuatro tenían menos de 30 años, uno 38 y el último 66. El diagnóstico se hizo mediante traqueoscopia flexible y tomografía axial computarizada. La lesión se localizó en subglotis (2) y tráquea (4). Dos pacientes fueron operados antes de la remisión: resección traqueal (1) y laringotraqueal (1). El tratamiento definitivo, en nuestro centro, consistió en resección traqueal (4) y subglótica (2). No se presentaron complicaciones ni fallecidos. Durante el seguimiento postoperatorio (7 a 26 meses), cinco lesionados tuvieron resultados excelentes y uno satisfactorio, asociado con voz débil. Conclusiones: El traumatismo traqueal por ahorcamiento fallido es muy raro. El tratamiento oportuno y adecuado puede reducir las complicaciones y la mortalidad. Un equipo quirúrgico con experiencia puede lograr resultados satisfactorios en un grupo importante de lesionados. La traqueostomía, con anestesia local, es el método de elección para controlar la VR en pacientes con traumatismo cervical(AU)

Introduction: The hanging injury is considered a closed trauma of the cervical trachea. Objective: To present the cases of six patients treated for sequelae after failed hanging attempt, and to review the literature about diagnostic and therapeutic methods. Methods: A descriptive study was carried out of six consecutive patients treated between 1989 and 2011 at Hermanos Ameijeiras Hospital. All were referred from different hospitals, with a tracheostomy for controlling the airway. The variables studied were sex, age, definitive diagnosis, surgical techniques used, postoperative evolution, complications and mortality. Results: All patients were male, aged between 16 and 66 years (median: 28.5). Four were less than 30 years old; one, 38; and the last, 66. The diagnosis was made by flexible tracheoscopy and computerized axial tomography. The injury was located in the subglottis (2) and the trachea (4). Two patients were operated on before referral, through tracheal (1) and laryngotracheal (1) resection. Definitive treatment in our center consisted of tracheal (4) and subglottic (2) resection. There were no complications or deaths. During the postoperative follow-up (7-26 months), five injured patients had excellent outcomes and one had satisfactory outcomes, associated with a weak voice. Conclusions: Tracheal trauma after failed hanging is very rare. Timely and appropriate managment can reduce complications and mortality. An experienced surgical team can achieve satisfactory outcomes in a large group of injured people. Tracheostomy, under local anesthesia, is the method of choice for controlling the airways in patients with cervical trauma(AU)

Ahorcamiento con soga. Presentación de un caso atípico / Hanging with rope. Presentation of an atypical case

RESUMEN Las asfixias mecánicas son aquellas que resultan de un impedimento mecánico a la penetración del aire en las vías respiratorias. Suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina, y a su modo de actuar. El ahorcamiento no es más que la constricción del cuello, ejercida por un lazo sujeto a un punto fijo, sobre el cual ejerce tracción el propio peso del cuerpo. La muerte, según las circunstancias del caso, puede ocurrir por un mecanismo asfíctico, circulatorio, inhibitorio o por lesión medular (caso raro de presentación). El presente trabajo constituyó un caso atípico de ahorcamiento. El ciudadano que resultó fallecido, al dejarse caer bruscamente del balcón de su vivienda, con el dogal en el cuello (soga) y quedar pendiendo el cuerpo, ocasionó un traumatismo raquimedular severo; lo que trajo como consecuencia que se produjera una fractura de la 3ra vértebra cervical, y una contusión medular que lo llevó a la muerte de forma instantánea por el shock medular ocasionado. Para la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, y el examen del cadáver externa e internamente.

ABSTRACT Mechanical asphyxias are those resulting from a mechanical interruption of air penetration to the respiratory tract. They are usually classified according to the nature of the mechanical mean originating them and the way they perform. Hanging is no more that the neck constriction, executed by a lace attached to a fixed point, on which the proper weight of the body applies traction. Death, according to the circumstances of the case, may occur by an asphyxiating, circulatory, inhibitory mechanism or by medullar lesion (a rare case of presentation). The current work reports a case of atypical hanging. The person who died, when abruptly jumped down the balcony of his house with the rope around the neck and the body was left pending, suffered a severe spinomedullar trauma, causing a fracture of the 3rd cervical vertebra, and a medullar contusion causing an instantaneous death due to the medullar shock. To discuss the case, the authors took into account elements of the location where it took place, and the external and internal examination of the body.

The disease burden of suicide in Ecuador, a 15 years' geodemographic cross-sectional study (2001-2015).

BACKGROUND: Suicide affects people from different backgrounds, ethnical groups, socio-economic status and geographical locations. In Latin America, suicide reports arescarce, specially in Andean countries. In Ecuador, very few reports have partially described this phenomenon, nonetheless, estimation of the burden of disease (BoD) hasnever been reported in the country. METHODS: A country-wide comparison was performed using the Ministry of Public Health's national databases of overall mortality, Hospital Discharges Database, and the Population Census of the National Institute of Census and Statistics (INEC). The study variables analyzed were age, geographical distribution to provincial level, sex, means of suicide, educational attainment, marital status and mortality. Linear Regression and relative Risk analysis were used to predict outcome and the likelihood that suicide occur among study variables. RESULTS: In the last 15 years, 13,024 suicides were officially reported. Men were 3 times more likely than women to die by suicide. The overall age-adjusted suicide ratio in Ecuador corresponds to 7.1 per 100,000 per year. The sex-specific rates were 5.3 in women and 13.2 in men. The primary mean of suicide was hanging X70 (51.1%), followed by self-poisoning X68-X69 (35.2%) and firearms X72-X74 (7.6%). Provinces located at higher altitude reported higher rates than those located at sea level (9 per 100,000 vs 4.5 per 100.000). The total economic loss due to suicide was estimated to be $852.6 million during the 15 years' analysis. CONCLUSIONS: This is the first geodemographic study exploring the complete burden of suicide in Ecuador and one of the very few in Latin-America. In the last 15 years of available data, Ecuador ranks above the regional average with an adjusted suicide rate of 7.1 per 100,000 inhabitants. An important finding is that Suicide affects rather younger populations, adding more than 10,000 years of premature years of life lost (YYL) between 2001 and 2015, becoming the first and fourth leading cause of death among adolescent women and men respectively. Suicide affects people from different backgrounds, socioeconomic status and educational attainment. The mean of suicide changed over time showing that gun and pesticides related deaths decreased significantly since 2001, while hanging and suffocation increased in more than 50%.

Comparative Analysis of 3D Bladder Tumor Spheroids Obtained by Forced Floating and Hanging Drop Methods for Drug Screening.

Introduction: Cell-based assays using three-dimensional (3D) cell cultures may reflect the antitumor activity of compounds more accurately, since these models reproduce the tumor microenvironment better. Methods: Here, we report a comparative analysis of cell behavior in the two most widely employed methods for 3D spheroid culture, forced floating (Ultra-low Attachment, ULA, plates), and hanging drop (HD) methods, using the RT4 human bladder cancer cell line as a model. The morphology parameters and growth/metabolism of the spheroids generated were first characterized, using four different cell-seeding concentrations (0.5, 1.25, 2.5, and 3.75 × 104 cells/mL), and then, subjected to drug resistance evaluation. Results: Both methods generated spheroids with a smooth surface and round shape in a spheroidization time of about 48 h, regardless of the cell-seeding concentration used. Reduced cell growth and metabolism was observed in 3D cultures compared to two-dimensional (2D) cultures. The optimal range of spheroid diameter (300-500 µm) was obtained using cultures initiated with 0.5 and 1.25 × 104 cells/mL for the ULA method and 2.5 and 3.75 × 104 cells/mL for the HD method. RT4 cells cultured under 3D conditions also exhibited a higher resistance to doxorubicin (IC50 of 1.00 and 0.83 µg/mL for the ULA and HD methods, respectively) compared to 2D cultures (IC50 ranging from 0.39 to 0.43). Conclusions: Comparing the results, we concluded that the forced floating method using ULA plates was considered more suitable and straightforward to generate RT4 spheroids for drug screening/cytotoxicity assays. The results presented here also contribute to the improvement in the standardization of the 3D cultures required for widespread application.

Tratamiento conservador de la fractura diafisaria de húmero: presentación de un caso / Conservative treatment of the dyaphisial fracture of the humerus: presentation of a case

Uno de los pilares fundamentales en el tratamiento conservador de las fracturas diafisarias del húmero ha sido el uso del yeso colgante como método de inmovilización, por lo que se decició aplicar dicho tratamiento en un paciente después de haber realizado el diagnóstico de dicha afección. Se evaluó la eficacia del método empleado a través del seguimiento periódico de la evolución clínica e imaginológica de la lesión, obteniéndose la consolidación de la fractura sin que se apreciara complicación alguna, resultado que concuerda con la literatura mundial, la cual refiere la importancia y resultados positivos del método empleado. Teniendo en cuenta lo práctico, económico y útil que resulta el mismo los autores consideraron oportuno presentar esta experiencia con el objetivo de promover la extensión práctica del tratamiento conservador de la fractura diafisaria del húmero.

One of the main pillars of the humerus dyaphisial fracture conservative treatment has been the usage of the hanging plaster cast as an immobilization method, so we decided to use that treatment in a patient after diagnosing that condition. We evaluated the efficacy of the used method periodically following the clinical and imaging evolution of the lesion, obtaining the consolidation of the fracture without any complication, result agree with the international literature that refers the importance and positive outcomes of the used method. Taking into account its suitability, effectiveness, and usefulness we considered it opportune to present this experience with the objective of promoting the practical extension of the humerus dyaphisial fracture conservative treatment.

Functional characterization of fibrinolytic metalloproteinases (colombienases) isolated from Bothrops colombiensis venom.

UNLABELLED: Researchers trying to improve the safety and efficacy of fibrinolytic therapy have been isolating fibrinolytic enzymes from snake venoms. Two fibrinolytic enzymes, colombienases 1 and 2, with significant activity have been isolated from the venom of Bothrops colombiensis. METHODS: The colombienases were characterized for various biological activities which include hemorrhagic, fibrinogenolytic, proteolytic, hemolytic, edematogenic and cytotoxic. RESULTS: Colombienases directly acted on fibrin by degrading fibrinogen Aα and Bß chains without activating the fibrinolytic system (plasminogen/plasmin), additionally colombienase-2 degraded fibrinogen γ chains as well as the fibronectin molecule. Laminin and type IV collagen were colombienases resistant. Gelatin-zymogram activity was present in B. colombiensis venom (BcV) bands between 64 and 148 kDa. All activities were abolished by metalloproteinases inhibitors. Both enzymes lacked hemorrhagic, hemolytic, cytotoxic, plasminogen activator and coagulant activities. CONCLUSIONS: Both colombienases had direct fibrino(geno)lytic activity without other toxic side effects including in vivo hemorrhaging, which could be promising in terms of therapeutic potential as thrombolytic agents.

Muertes por suicidio en la ciudad de Constitución (Chile) entre los años 2001-2011: estudio de prevalencia acumulada / Prevalence of deaths by suicide in the city of Constitution (Chile) between the years 2001-2011

En la actualidad, Chile presenta una tasa de suicidios de 18,5 y 3,2 muertes entre hombres y mujeres, respectivamente, por cada 100.000 habitantes. En este estudio de prevalencia acumulada se revisaron todos los protocolos de autopsia realizadas en el Servicio Médico Legal de Constitución en que la causa de muerte fue suicidio, para describir su evolución entre los años 2001 y 2011. Se registró la información referente a métodos de suicidios, edades, sexos, temporalidad, sectores urbanos o rurales, estado civil y relación con tóxicos; los datos se analizaron mediante estadística descriptiva. El método por ahorcamiento fue el más prevalente, explicando el 83,3 por ciento de los suicidios, con mayor frecuencia los años 2007, 2008 y 2011, y mayor estacionalidad en marzo, octubre, noviembre y diciembre, preferentemente en personas entre los 13-22 años, hombres y solteros. Sólo el 44,55 por ciento se asoció al consumo de alcohol. El ahorcamiento sigue siendo el método de suicidio más común, y coincide con la tendencia mundial del suicidio infanto juvenil. Los meses de mayor frecuencia coinciden con una mayor luminosidad, de primavera o festivos, donde aumentan los trastornos del estado de ánimo. Es interesante que no existe una relación significativa con la ingesta de alcohol, ya que la literatura reporta una fuerte relación con el suicidio. Llama la atención que posterior al terremoto-maremoto de febrero del año 2010, no existe un incremento significativo de estos casos. En general, los datos muestran una tendencia coincidente a los del resto del país (Chile); sin embargo, en forma particular, Constitución muestra algunas diferencias, posiblemente por características población-específica.

Currently, Chile has a suicide rate of 18.5 and 3.2 deaths for men and women, respectively, per 100,000 inhabitants. In this cumulative prevalence study we reviewed all autopsies performed at the Forensic Service of Constitución city in which the cause of death was suicide, in order to describe their evolution between 2001 and 2011. We recorded information about methods of suicide, age, gender, temporality, urban or rural, marital status, and toxicology. Data were analyzed using descriptive statistics. The method by hanging was the most prevalent, accounting for 83.3 percent of suicides, occurring most often in the years 2007, 2008 and 2011, and showing increased seasonality in March, October, November and December, preferably in the 13 to 22 year-old age group and in unmarried men. Only 44.55 percent was associated with alcohol consumption. Hanging is still the most common method of suicide, and coincides with the global trend of child and adolescent suicide. The periods of greatest frequency coincide with brighter days, spring or holidays, in which mood disorders tend to increase. Interestingly, no significant relationship with alcohol intake was found, whereas the literature reports a strong relationship with suicide. It is noteworthy that after the earthquake-tsunami of February 2010, there was no significant increase in suicide rates. Overall, the data show a trend consistent with the rest of the country (Chile); however, Constitución deviates somewhat, possibly due to population-specific characteristics.

Optimization and comparison of two different 3D culture methods to prepare cell aggregates as a bioink for organ printing

The ultimate goal of tissue engineering is to design and fabricate functional human tissues that are similar to natural cells and are capable of regeneration. Preparation of cell aggregates is one of the important steps in 3D tissue engineering technology, particularly in organ printing. Two simple methods, hanging drop (HD) and conical tube (CT) were utilized to prepare cell aggregates. The size and viability of the aggregates obtained at different initial cell densities and pre-culture duration were compared. The proliferative ability of the cell aggregates and their ability to spread in culture plates were also investigated. In both methods, the optimum average size of the aggregates was less than 500 µm. CT aggregates were smaller than HD aggregates. 5,000 cells per drop HD aggregates showed a marked ability to attach and spread on the culture surface. The proliferative ability reduced when the initial cell density was increased. Comparing these methods, we found that the HD method having better size controlling ability as well as enhanced ability to maintain higher rates of viability, spreading, and proliferation. In conclusion, smaller HD aggregates might be a suitable choice as building blocks for making bioink particles in bioprinting technique.

Optimization and comparison of two different 3D culture methods to prepare cell aggregates as a bioink for organ printing

The ultimate goal of tissue engineering is to design and fabricate functional human tissues that are similar to natural cells and are capable of regeneration. Preparation of cell aggregates is one of the important steps in 3D tissue engineering technology, particularly in organ printing. Two simple methods, hanging drop (HD) and conical tube (CT) were utilized to prepare cell aggregates. The size and viability of the aggregates obtained at different initial cell densities and pre-culture duration were compared. The proliferative ability of the cell aggregates and their ability to spread in culture plates were also investigated. In both methods, the optimum average size of the aggregates was less than 500 Am. CT aggregates were smaller than HD aggregates. 5,000 cells per drop HD aggregates showed a marked ability to attach and spread on the culture surface. The proliferative ability reduced when the initial cell density was increased. Comparing these methods, we found that the HD method having better size controlling ability as well as enhanced ability to maintain higher rates of viability, spreading, and proliferation. In conclusion, smaller HD aggregates might be a suitable choice as building blocks for making bioink particles in bioprinting technique.(AU)