Handibox: software para la interacción humano-computador en base a reconocimiento de rostros para personas con discapacidad motora en las extremidades superiores

190 p.El uso de computadores ha pasado a formar parte de la cotidianeidad facilitando la creación y manipulación de la información para distintos fines, sin embargo, hay un segmento de la población que ve impedido su acceso a los equipos comunes debido a una serie de discapacidades que limitan o anulan sus capacidades motoras.¿Cómo una persona que tiene movimiento sólo en su cabeza puede interactuarcon los computadores comunes si estos no están diseñados para este tipo de usuarios? Actualmente existe en el mercado una serie de productos de software que pretenden solucionar esta problemática con la salvedad que no estan diseñadas ni pensadas en el contexto nacional y más específicamente el contexto regional en donde el acceso a la tecnología es aún limitado y la mayoría de las veces desconocido para las personas con discapacidad.Para suplir estas necesidades, se ha desarrollado un producto de software orientado a la accesibilidad de personas con este tipo de discapacidades que emula la funcionalidad de un mouse estándar, tomando como referencia los movimientos de la cabeza captados con una cámara frontal común, cubriendo las características y requerimientos que otros productos de software de su misma categoría no cubren adaptándose a la realidad de la región del Maule.Con el fin de lograr un producto de software de calidad, se opto por utilizar una metodología iterativa que contó con la retroalimentacion constante de los usuarios en todas sus etapas. Cada una de las etapas o iteraciones permitieron la generación de prototipos probados con los usuarios obteniendo un producto final desarrollado a la medida.El funcionamiento del producto de software Handibox se validó directamente con los alumnos, profesores, kinesiólogos y padres del Colegio Especial Enseña en Talca que atiende niños con discapacidades motoras y mentales.Palabras Claves: Accesibilidad, Discapacidad , Inclusión, Handibox./ABSTRACT The uses of computers has become part of our daily life and get easy the creation and manipulation of the different goals, however there in a segment of the population that are not able to access to the common equipment due to a lot of disabilities that limit or void their motors skill. How a person who has movement only in his head can interact with the ordinary computers, if those aren’t design it for these kind of users? Actually, exists offers with a lot of products of software which pretend give a solution but in nowadays this software aren’t design nor thought for the national context and more specifically in regional context where the access to the technology is still limited and the most of the time the uses are unknown for those people. Taking account for this problem, it has developed software oriented to the accessibility of the people with this kind of disabilities which emulate the functionality of a standard mouse with the head movement with a common frontal camera, finally the features and requirements are satisfied. To make a good software with the best quality, it chose to use the iterative methodology that counts with the constant feedback of every users in all of their levels. Each levels and iteration allow to generate a testing prototypes with the users and as a result getting a final product developed and adjusted. The function of the software Handibox was validated directly with the students, teachers, Chiropractic and parents from the “Colegio Especial Ense˜na”in Talca which attend kids with motors and mental disabilities.Keywords: Accessibility, Inclusion, Disability, Handibox

3D-PP: A tool for discovering conserved three-dimensional protein patterns

Discovering conserved three-dimensional (3D) patterns among protein structures may provide valuable insights into protein classification, functional annotations or the rational design of multi-target drugs. Thus, several computational tools have been developed to discover and compare protein 3D-patterns. However, most of them only consider previously known 3D-patterns such as orthosteric binding sites or structural motifs. This fact makes necessary the development of new methods for the identification of all possible 3D-patterns that exist in protein structures (allosteric sites, enzyme-cofactor interaction motifs, among others). In this work, we present 3D-PP, a new free access web server for the discovery and recognition all similar 3D amino acid patterns among a set of proteins structures (independent of their sequence similarity). This new tool does not require any previous structural knowledge about ligands, and all data are organized in a high-performance graph database. The input can be a text file with the PDB access codes or a zip file of PDB coordinates regardless of the origin of the structural data: X-ray crystallographic experiments or in silico homology modeling. The results are presented as lists of sequence patterns that can be further analyzed within the web page. We tested the accuracy and suitability of 3D-PP using two sets of proteins coming from the Protein Data Bank: (a) Zinc finger containing and (b) Serotonin target proteins. We also evaluated its usefulness for the discovering of new 3D-patterns, using a set of protein structures coming from in silico homology modeling methodologies, all of which are overexpressed in different types of cancer. Results indicate that 3D-PP is a reliable, flexible and friendly-user tool to identify conserved structural motifs, which could be relevant to improve the knowledge about protein function or classification. The web server can be freely utilized at https://appsbio.utalca.cl/3d-pp/.Peer ReviewedPostprint (published version

Aplicación para prevenir comportamientos de riesgo para pacientes en régimen nutritivo, implementación en plataforma Android

155 p.El sobrepeso y obesidad no son problemas aislados, en el mundo un 65% de la población vive en paí ses donde las enfermedades asociadas al sobrepeso y obesidad tienen un í ndice de mortandad y mortalidad mayor que las enfermedades asociadas a la malnutrici on [24]. Dentro de estas podemos encontrar: alta presión arterial, condiciones card íacas, diabetes, aumento de probabilidad en distintos tipos de cáncer, baja autoestima y disminución de calidad de vida.El estilo de vida actual tiene directa relación con el problema planteado anteriormente; un ritmo apresurado y falta de educación nutricional llevan a dietas mal balanceadas y aumentan las conductas de riesgo de la población [24], tales como las tentaciones de comidas r ápidas altas en grasas y az úcares, la presi ón social, falta de tiempo dedicado a actividades f ísicas, entre otras. Las tecnologí as de información y comunicación (TICs) actualmente se encuentran profundamente ligadas a la vida de sus usuarios, es por medio de estas tecnologías que se pretende alcanzar un punto de entrada para dar soporte en tratamientos que busquen anticipar y modi car las conductas de riesgo de las personas. Como resultado de lo descrito anteriormente, la computació ubicua (es decir,las TIC presentes en la vida del usuario hasta el punto de que no es consciente de su existencia) se utilizó como plataforma para promover cambios en el comportamiento de individuos. Con este fin se desarroll o Geonut, un software para teléfonos Android que utiliza tecnologías de posicionamiento global (GPS, wifi y / o redes teléf onicas) para identi car las áreas de riesgo y proporcionar alertas en tiempo real, dando un consejo saludable para el usuario. Este software ha sido probado con los estudiantes en Ingenierí a en Bioinform ática y Nutrición, como resultado de estas pruebas es evidente la relaci ón directa del comportamiento del usuario con el n úmero de alertas generadas. Finalmente, con el desarrollo de la presente memoria de titulo se encuentra disponible una plataforma ubicua, con proyecciones para el futuro desarrollo en torno a la aplicación de las tecnolog ías m óviles como apoyo para tratamientos médicos./ABSTRACT: Overweight and obesity are not isolated problems in the world a 65 % of the population lives in countries where the diseases associated with overweight and obesity have a mortality rate greater than diseases associated with malnutrition [24]. Among these we nd: high blood pressure, heart conditions, diabetes, increased probability of cancer types, low self-esteem and decreased quality of life. The current lifestyle is directly related to the problem previously exposed, a fast pace and lack of nutritional education lead to unbalanced diets and increased risk behavior population [24], such as fast food temptations, high in fats and sugars, social pressure, lack of time devoted to physical activities, among others. The information and communication technologies (ICTs) are now deeply linked to the life of its users, it is through these technologies that will achieve a point of entry for support in treatments that look for anticipate and modify risk behaviors of individuals. As a result of the previously described, ubiquitous computing (ie ICT present in the user's life to the point that he is not aware of its existence) was used as platform to promote changes in the behavior of individuals . For this purpose was developed Geonut, a software for Android phones which use global positioning technologies (GPS, wi and / or telephone networks) for identify risk areas and provide real-time alert, giving a healthy advice for the user. This software was tested with students in Bioinformatics Engineering and Nutrition, as a result of these tests is evident the direct relationship of user behavior with the number of alerts generated. Finally, with the development of this work is available a ubiquitous platform, with projections for further development around the application of mobile technologies as a support for medical treatments

Software para la monitorización y asistencia durante actividades en exterior para los pacientes con el mal de Alzheimer: Implementación en plataforma Android

241 p.La principal causa de demencia es la enfermedad de Alzheimer, que afecta principalmente a personas mayores a 45 a˜nos. Este mal produce el deterioro de los procesos cognitivos de los pacientes existiendo m´as de 26 millones de personas con Alzheimer en el mundo. En la mayorıa de los casos los familiares asumen los cuidados en sus propios hogares, o simplemente las personas son llevadas a hogares de acogida. El cuidado de las personas que padecen esta enfermedad es una tarea que en algunos casos puede volverse un trabajo engorroso debido a los comportamientos que puede presentar el paciente, llegando incluso a provocar severos casos de stress tanto en el cuidador como el paciente. Actualmente el mal de Alzheimer no tiene cura por lo que los esfuerzos estan orientados al retardo de esta enfermedad, a trav´es de la estimulaci´on de los procesos cognitivos mediante de actividades que no implican la utilizaci´on de medicamentos. Las caminatas y las actividades que se realizan fuera del hogar, son tareas recomendadas por especialistas que estimulan los procesos cognitivos y mantienen la calidad de vida del paciente, logrando retardar la enfermedad. La necesidad de una herramienta capaz de proporcionar la posibilidad de supervisar y ayudar a un paciente con Alzheimer en tareas que realice fuera del hogar, es una alternativa viable al momento de priorizar la calidad de vida del enfermo. Al monitorizar caminatas, le brinda independencia al paciente por cierta cantidad de tiempo, adem´as de proporcionar a los cuidadores breves descansos, para que las tareas de vigilancia y supervisi´on no se vuelvan tediosas. Es por estas razones y en base del paradigma de la computacion ubicua que mediante la utilizacion de dispositivos moviles se desarrollo el presente producto de software que consta de una aplicacion implementada en la plataforma Android, la cual realiza la monitorizacion a traves de la utilizacion de la localizacion vıa GPS y entrega informacion util de lugares(previamente almacenados en el sistema) que el paciente recorre durante una caminata, y registra informacion en un se vicio web. El servicio web es el encargado de guardar la informacion de manera persistente en una base de datos y almacena la informacion de la localizacion del paciente en tiempo real, a la cual se puede acceder mediante una aplicacion web que proporciona las herramientas para visualizar la ubicacion en un mapa. Una de las principales caracterısticas del producto de software es la generacion de rutas programadas con lugares conocidos por el paciente,con el fin de situarlo en una situaci´on donde debera interpretar la informacion dada para cumplir las metas que se le pediran durante el recorrido, estimulando su raciocinio y con estos sus procesos cognitivos. En otras palabras el producto de software es capaz de: • Almacenar informacion de pacientes y monitores. • Almacenar informacion georreferenciada de lugares para la identificacion de Hitos y Obstaculos. • Almacenar recorridos para realizar caminatas en ambientes externos. • Localizacion de paciente mediante tecnologıa GPS. • Almacenar informaci´on de localizacion en tiempo real. • Aplicaci´on web para el servicio de monitorizacion. El producto de software fue desarrollado mediante la metodologıa de desarollo iterativo con objetos acoplados, con el fin de desarrollar una arquitectura modular y reusable, bajo el paradigma de la orientacion a objetos./ The principal cause of dementia is the Alzheimer’s disease, mainly affecting people over 45. This disease causes the deterioration of cognitive processes of patients, existing more than 26 million people with Alzheimers in the world. In most cases the family takes care in their own houses, or just the patients are taken to foster homes. The care of people that are suffering this disease is a job that in some cases can become a cumbersome work, because the behaviors that the patient can present even causing severe cases of stress on both persons, the caregiver and the patient.Actually the Alzheimers disease has no cure, so the efforts are oriented to delay the disease through the stimulation of cognitive processes through activities that do not involve the use of drugs. The walks and the activities take place outside the house, task are recommended by specialists for stimulate the cognitive processes and keep the quality of life of the patient in delaying the disease. The need of a tool able to provide the possibility to monitoring and assist a patient with Alzheimer’s in tasks that he realize outside the house, is a viable alternative to prioritize the quality of life of the patient. Monitoring the walks gives independence to the patient for an amount of time, also providing short breaks for caretakers, for that the task of monitoring and supervision do not become tedious. For this reasons and based on the paradigm of ubiquitous computing using mobile devices was developed this product of software consisting in a deployed application on the Android plataform, that made the monitoring through the use of the location by GPS and provides helpful information of places (previously stored in the system) the patient goes for a walk and records information on a web service. The web service is responsible of storing information persistently in a database and store the information of the location of the patient in real time, wich can be accessed through a web application that provides the tools to visualize the location in a map. One of the principal characteristics of the software product is the generation of scheduled routes with places known by the patient, to put him on a situation where he must interpret the information given to meet the goals that might be asked during the tour, stimulating his reasoning and cognitive processes. In others words the product of software is able to: • Lay up information of patients and monitors.The principal cause of dementia is the Alzheimer’s disease, mainly affecting people over 45. This disease causes the deterioration of cognitive processes of patients, existing more than 26 million people with Alzheimer’s in the world. In most cases the family takes care in their own houses, or just the patients are taken to foster homes. The care of people that are suffering this disease is a job that in some cases can become a cumbersome work, because the behaviors that the patient can present, even causing severe cases of stress on both persons, the caregiver and the patient. Actually the Alzheimer’s disease has no cure, so the efforts are oriented to delay the disease through the stimulation of cognitive processes through activities that do not involve the use of drugs. The walks and the activities take place outside the house, task are recommended by specialists for stimulate the cognitive processes and keep the quality of life of the patient in delaying the disease. The need of a tool able to provide the possibility to monitoring and assist a patient with Alzheimer’s in tasks that he realize outside the house, is a viable alternative to prioritize the quality of life of the patient. Monitoring the walks gives independence to the patient for an amount of time, also providing short breaks for caretakers, for that the task of monitoring and supervision do not become tedious. For this reasons and based on the paradigm of ubiquitous computing using mobile devices was developed this product of software consisting in a deployed application on the Android plataform, that made the monitoring through the use of the location by GPS and provides helpful information of places (previously stored in the system) the patient goes for a walk and records information on a web service. The web service is responsible of storing information persistently in a database and store the information of the location of the patient in real time, wich can be accessed through a web application that provides the tools to visualize the location in a map. One of the principal characteristics of the software product is the generation of scheduled routes with places known by the patient, to put him on a situation where he must interpret the information given to meet the goals that might be asked during the tour, stimulating his reasoning and cognitive processes. In others words the product of software is able to: • Lay up information of patients and monitors.• Lay up georeferenced information of places for the identification of Hitos and Obstacles. • Lay up tours to realize walks outside the house. • Localization of the patient through GPS tecnology. • Lay up information of the localization in real time. • Web aplication for the monitoring service. The software product was developed using iterative methodology with coupled objects in order to develop a modular architecture and reusable , in the paradigm of object orientation

A new strategy for multitarget drug discovery/repositioning through the identification of similar 3D amino acid patterns among proteins structures: The case of Tafluprost and its efects on cardiac ion channels

The identification of similar three-dimensional (3D) amino acid patterns among different proteins might be helpful to explain the polypharmacological profile of many currently used drugs. Also, it would be a reasonable first step for the design of novel multitarget compounds. Most of the current computational tools employed for this aim are limited to the comparisons among known binding sites, and do not consider several additional important 3D patterns such as allosteric sites or other conserved motifs. In the present work, we introduce Geomfinder2.0, which is a new and improved version of our previously described algorithm for the deep exploration and discovery of similar and druggable 3D patterns. As compared with the original version, substantial improvements that have been incorporated to our software allow: (i) to compare quaternary structures, (ii) to deal with a list of pairs of structures, (iii) to know how druggable is the zone where similar 3D patterns are detected and (iv) to significantly reduce the execution time. Thus, the new algorithm achieves up to 353x speedup as compared to the previous sequential version, allowing the exploration of a significant number of quaternary structures in a reasonable time. In order to illustrate the potential of the updated Geomfinder version, we show a case of use in which similar 3D patterns were detected in the cardiac ions channels NaV1.5 and TASK-1. These channels are quite different in terms of structure, sequence and function and both have been regarded as important targets for drugs aimed at treating atrial fibrillation. Finally, we describe the in vitro effects of tafluprost (a drug currently used to treat glaucoma, which was identified as a novel putative ligand of NaV1.5 and TASK-1) upon both ion channels’ activity and discuss its possible repositioning as a novel antiarrhythmic drug.This research was funded by the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT) grants numbers 1191133, 1170662 and from Spanish Ministry of Economy and Competitiveness (projects SEV-2015-0493 and TIN2015-65316-P, grant BES-2016-078046), and from Generalitat de Catalunya (contracts 2017-SGR-1414 and 2017-SGR-1328). The financial support by DICYT-USACH grant 5392102RP-ACDicyt is also acknowledged. The web-server is hosted in the cluster obtained with the grant CONICYT-FONDEQUIP-EQM160063.Peer ReviewedPostprint (published version

Automated Classification of Severity in Cardiac Dyssynchrony Merging Clinical Data and Mechanical Descriptors

Cardiac resynchronization therapy (CRT) improves functional classification among patients with left ventricle malfunction and ventricular electric conduction disorders. However, a high percentage of subjects under CRT (20%-30%) do not show any improvement. Nonetheless the presence of mechanical contraction dyssynchrony in ventricles has been proposed as an indicator of CRT response. This work proposes an automated classification model of severity in ventricular contraction dyssynchrony. The model includes clinical data such as left ventricular ejection fraction (LVEF), QRS and P-R intervals, and the 3 most significant factors extracted from the factor analysis of dynamic structures applied to a set of equilibrium radionuclide angiography images representing the mechanical behavior of cardiac contraction. A control group of 33 normal volunteers (28 ± 5 years, LVEF of 59.7% ± 5.8%) and a HF group of 42 subjects (53.12 ± 15.05 years, LVEF < 35%) were studied. The proposed classifiers had hit rates of 90%, 50%, and 80% to distinguish between absent, mild, and moderate-severe interventricular dyssynchrony, respectively. For intraventricular dyssynchrony, hit rates of 100%, 50%, and 90% were observed distinguishing between absent, mild, and moderatesevere, respectively. These results seem promising in using this automated method for clinical follow-up of patients undergoing CRT

Análisis del interactoma de la proteína KCTD5 mediante la plataforma web PPI-MASS

53 p.Existe una gran cantidad de enfermedades humanas que han sido vinculadas a interacciones proteína-proteína (PPIs). El interactoma humano se compone de más de 600.000 complejos proteicos, los cuales se asocian a una gran diversidad de procesos celulares fundamentales para el correcto funcionamiento y desarrollo del organismo. Un caso de especial interés es el interactoma de la proteína KCTD5, la cual ha mostrado regular canales iónicos y estar asociada con cáncer de mama y la formación de ciertos tumores. Una manera de estudiar proteínas que regulan la función de KCTD5 es mediante ensayos de espectrometría de masas (MS); sin embargo, el post-procesamiento de datos resultantes de MS no es trivial y actualmente existen limitadas herramientas informáticas que brinden al usuario flexibilidad y transparencia para manejar e interpretar los datos. En este sentido, el presente proyecto de tesis describe el desarrollo de una plataforma web para el análisis de datos obtenidos a través de experimentos de MS, integrando información de diferentes bases de datos biológicas y permitiendo al usuario emplear determinados filtros para identificar complejos proteína-proteína con potencial farmacológico. El desempeño de la plataforma PPI-MASS, ha sido inicialmente evaluado usando como parámetros de entrada datos de MS vinculados a la proteína KCTD5. Sin embargo, se prevé su uso para el análisis y detección de cualquier conjunto de PPIs proveniente de experimentos de MS. Cabe señalar, que la detección de PPIs es fundamental para el diseño de fármacos basado en estructura, por lo tanto, se espera que esta plataforma sea un gran aporte en el área biomédica. //ABSTRACT: A large number of human diseases have been linked to protein-protein interactions (PPIs). The human interactome comprises over 600.000 protein complexes, which are associated with a wide variety of cell processes essential for the correct function and development of the human organism. One case of particular interest is the KCTD5 protein interactome. KCTD5 has been shown to regulate ion channels and to be associated with breast cancer and the formation of certain tumors. One way of studying the proteins that regulate the function of KCTD5 is through mass-spectrometry assays (MS); however, the post-processing of the resulting data is not a trivial task. Moreover, there are currently few computational tools that give the user flexibility and transparency to manage and interpret the data. In that regard, this thesis project describes the development of a web platform for the analysis of data obtained through MS assays, incorporating information from different biological databases and allowing the user to employ specific filters to identify protein-protein complexes with pharmaceutical potential. The performance of the PPI-MASS platform has been initially evaluated using MS data associated with the KCTD5 protein as input. However, we expect its use to analyze and detect any set of PPIs from MS assays. It is important to note that the detection of PPIs is essential for structure-based drug design and, because of this, we expect that this platform will be of great assistance in the biomedical field

Ultrasonography-guided anterior approach for axillary nerve blockade: an anatomical study

Combined ultrasound-guided blockade of the suprascapular and axillary nerves has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or post-surgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the axillary nerve blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made post-surgical pain relief any better than an interscalene blockade, probably because articular branches of the axillary nerve are not blocked. Cephalic to caudal Methylene Blue injections were placed in the first segment of the axillary nerve of six Thiel-embalmed cadavers using an ultrasound-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral axillary nerve in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the axillary nerve. We found a good spread of the dye on the axillary nerve and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior axillary nerve blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. This article is protected by copyright. All rights reserved

ANÁLISIS DE FALLAS EN PROCESO INDUSTRIAL DE UNA ENLATADORA APLICANDO REDES COMPLEJAS (ANALYSIS OF FAILURES IN INDUSTRIAL PROCESS OF A CANNER APPLYING COMPLEX NETWORKS)

ResumenEn este trabajo se analiza la robustez de un sistema de enlatado ante cualquier falla aleatoria que pueden ocurrir en cualquier elemento o nodo, y ante fallas dirigidas que son aquellas donde se simula un mal funcionamiento en un nodo especifico, con la finalidad de proponer esquemas de monitoreo y protección sobre los elementos con alta vulnerabilidad. Se propone un modelo del sistema basado en el enfoque de la teoría de Redes Complejas (RC) y se analizan sus propiedades estructurales para determinar bajo el criterio de Molloy-Reed la robustez del sistema de la enlatadora. Con la teoría de redes complejas y el criterio de Molloy Reed se encontró que la red es robusta ante cualquier falla aleatoria pero es vulnerable ante fallas dirigidas.Palabras clave: Robustez, redes complejas, fallas múltiples. AbstractIn this work the robustness of a canning system is analyzed for any random failure that may occur in any element or node, and for directed failures that are those where a malfunction in a specific node is simulated, in order to propose schemes of monitoring and protection of the elements with high vulnerability. A system model based on the approach of the Complex Networks (RC) theory is proposed and its structural properties are analyzed to determine the robustness of the canner system under the Molloy-Reed criteria. With the theory of complex networks and the Molloy Reed criterion it was found that the network is robust to any random failure but is vulnerable to directed failures.Keywords: Robustness, complex networks, multiple failures

Exenteración pélvica en el cáncer avanzado de la vulva. Presentación de caso

Introducción: el carcinoma de la vulva es un tipo de cáncer raro que constituye entre 4 y 5 % de todos los cánceres ginecológicos. La Exenteración Pélvica les ofrece una última oportunidad de "curación" a algunas pacientes con enfermedad neoplásica ginecológica maligna, avanzada o recurrente. Sin embargo, la morbilidad de esta cirugía radical compleja es alta. Objetivo: presentar una paciente con cáncer avanzado de vulva y operada con la técnica de Exenteración Pélvica. Presentación del caso: se describen las características clínicas de la paciente; el resultado de los complementarios; estadio inicial, proceder terapéutico, resultado del estudio histopatológico, estadio postquirúrgico, la evolución postoperatoria, así como los datos del seguimiento. Conclusiones: postoperatorios satisfactorios a los 3 años de seguimiento; se presentó una sola complicación: edemas en ambos miembros inferiores en el primer año de operada que evolucionó adecuadamente. En la actualidad, mantiene relaciones sexuales satisfactorias por vagina. Palabras clave: carcinoma, exenteración pélvica, vulva. </p