Incidencia y factores de riesgo de las complicaciones biliares tras el trasplante hepático

RESUMEN Las complicaciones biliares (CB) son las que con más frecuencia aparecen tras el trasplante hepático (TH). Pueden afectar a la anastomosis biliar o al árbol biliar intrahepático, siendo ambos tipos diferentes en cuanto a los factores de riesgo, manejo y pronóstico. Existen múltiples factores de riesgo relacionados tanto con la técnica quirúrgica como con factores del donante o del receptor. Se suelen manejar con tratamiento endoscópico, reservando el tratamiento quirúrgico para los casos refractarios. OBJETIVO: Analizar la incidencia, tratamiento aplicado y factores de riesgo asociados a las complicaciones biliares en los pacientes sometidos a TH en la unidad de trasplantes del HCU Lozano Blesa de Zaragoza. MATERIAL Y METODOS: estudio retrospectivo analítico, mediante la revisión de historias clínicas, de los pacientes sometidos a TH durante el periodo comprendido entre Febrero de 2010 y Diciembre de 2014. RESULTADOS: Se realizaron 152 TH a 147 pacientes. El 37,5% de ellos presentaron alguna CB siendo la más frecuente (66,6%) la estenosis de la anastomosis (EA). Los factores que se relacionaron con un mayor riesgo de complicaciones biliares globales fueron el sexo femenino del receptor (40,4% vs .24,2%) p= 0,036; OR 2,18; IC 95% (1,04-4,29), la trombosis de la arteria hepática (TAH) (14% vs 2,1%) p=0,04; OR 7,592; IC95% (1,55-37,14) y el tiempo de isquemia(364,06 ±92,6 vs. 312,4±70,83) p= 0,01; IC 95% (22,53- 80,79). Los factores relacionados con complicaciones de la anastomosis fueron la presencia de rechazo (23,8% vs. 9,9%) p=0,029; OR 2,84; IC95% (1,08-7,46) y el tiempo de isquemia (361,69±94,31 vs. 314,65±70,41) p= 0,003; IC95% (16,39-77,67). El único factor asociado a estenosis no anastomótica (ENA) fue la TAH (66,7% vs. 2,8%); p= 0,00; OR: 69,5; IC 95% (12,67-382,53). CONCLUSIONES: Las complicaciones de la anastomosis biliar fueron las más frecuentes, resultando factores de riesgo la presencia de rechazo y el tiempo de isquemia. La mayoría se solucionaron con tratamiento endoscópico. La ENA se relacionó con TAH, y la totalidad de los pacientes que la presentaron precisaron un retrasplante

Methodological contributions of social sciences for the construction of youth Public policies in Quindío Colombia

La juventud en el departamento del Quindío, Colombia, es actualmente una de las poblacionesde esta región más vulnerables a las crisis económicas, a las coyunturas globales ambientalesy tecnológicas, y a los conflictos regionales y locales; generando cada vez más incertidumbre enlos procesos de autoconciencia del lugar sociopolítico que tienen en las sociedades a las quepertenecen. Esta fragilidad se manifiesta en las discontinuidades ejercidas en los mecanismos departicipación ciudadana propios de esta población, como lo son las políticas públicas de juventud.A partir de una revisión documental cualitativa, este artículo tiene el objetivo de analizar losdiversos aportes metodológicos de las ciencias sociales para el desarrollo y fortalecimiento de losenfoques participativos de construcción de las políticas públicas de juventud del departamento.Esta lectura devela la necesidad de plantear enfoques que garanticen los derechos humanos, la justicia social, la inclusión y la apropiación de las capacidades de agencia de los jóvenes para latransformación social. Lo que conlleva a considerar la legitimación de la acción científica comouna acción política, y las prácticas socioculturales como prácticas políticas.Youth in the department of Quindío, Colombia, is currently one of the most vulnerable populationsin this region to economic crises, global environmental and technological junctures, and regionaland local conflicts. Generating more uncertainty in the processes of self-awareness of thesocio-political role they have in the society to which they belong. This fragility is manifested inthe discontinuities exercised in the citizen participation mechanisms of this population, such aspublic youth policies. In this way this article aims to analyze the methodological contributions ofsocial sciences to strengthen and develop participatory approaches to the construction of publicpolicies of youth of the department, which guarantees human rights, social justice, inclusion andappropriation of the abilities of the youth to transform the society

Estudio descriptivo de una cohorte de pacientes diagnosticadas de cáncer de ovario y portadoras de variante patogénica en BRCA 1/2

Este trabajo trata sobre cómo la realización del estudio genético de BRCA1 y BRCA2 puede influir en el manejo clínico del cáncer de ovario. Se trata de una cohorte de pacientes con cáncer de ovario muy seleccionada por subtipo tumoral. Desde que a finales de los años 90 comenzaron a realizarse los estudios genéticos de BRCA1 y BRCA2, los criterios de selección de pacientes se han ido modificando a lo largo del tiempo. Un ejemplo importante es el cáncer de ovario seroso de alto grado ya que es suficiente éste diagnóstico para indicar la realización del test, independientemente de la edad de diagnóstico (el cáncer hereditario suele presentarse a edades más jóvenes) y de la presencia o no de antecedentes familiares. La realización del test en estas pacientes es de gran importancia ya la frecuencia de detección de variantes patogénicas es elevada y además influye en las decisiones terapeúticas. También aporta información pronóstica y permite ofrecer medidas de diagnóstico precoz y reducción de riesgo de segundos tumores. Es un trabajo original y sobre un tema actual que evalúa en una cohorte de pacientes con cáncer de ovario seroso de alto grado cómo la realización del test influye en su manejo clínico

A Techno-Economic Appraisal of Green Diesel Generation through Hydrothermal Liquefaction, Leveraging Residual Resources from Seaweed and Fishing Sectors

[EN] This study examines the economic viability of an emerging technology for potential up- scaling and commercialization in a specific location: the village of New Stuyahok, Alaska. The proposed technology is hydrothermal liquefaction, which utilizes kelp macroalgae and fishing waste as feedstock. These materials were chosen due to their easy availability in the village and their alignment with the local economy. The economic evaluation is based on the net present value (NPV) and sensitivity models. Different feedstock ratios (on a dry basis), such as 100:0, 50:50, and 30:70 of kelp and fishing waste, respectively, were evaluated to determine the optimal combination. The results indicated that the process is economically viable only when a high proportion of fish- ing waste is used. This can be ascribed to the constrained output yield of the kelp biomass and the relatively negligible influence exerted by alginate production on the NPV. However, the ratio 50:50 appears to be economically promising if the costs can be reduced by at least 13.5% or the benefits can be increased by 12.1%. Nevertheless, government support could play a crucial role in expediting the implementation of this technology once it becomes market-ready. This means being practical, scalable, and economically viable, enabling reduced investments or increased benefits that signify its readiness. Utilizing such a tool offers valuable insights into the framework of the proposed technology and the use of local natural resource

Los ciclos económicos en ALALC o ALADI, CAN, CAFTA, MCCA : 1960-2008.

RESUMEN: El objetivo de este trabajo es analizar los ciclos económicos de los países que firman los tratados comerciales ALAC o ALADI, CAFTA, MCCA y CAN, con el fin de encontrar argumentos que demuestren o contradigan una posible sincronización de los ciclos económicos en Latinoamérica. Se realiza el análisis a través de dos metodologías, la primera, estudia las correlaciones del ciclo económico, para la cual, se hace uso del filtro de Hodrick y Prescott (HP) para extraer el componente de tendencia de las series y la segunda, por medio de una medida no paramétrica denominada índice de concordancia presentado por Harding y Pagan (1999). En síntesis, se encuentran relaciones interesantes entre algunos de sus miembros, pero sus vínculos no son lo suficientemente fuertes para hablar de un ciclo común, por esta razón se puede afirmar que no se presentan indicios de sincronización económica en los tratados analizados.ABSTRACT: The paper analyze the business cycles of countries that sign trade agreements of ALAC or ALADI, CAFTA, MCCA and CAN, it is order to find arguments to prove or contradict a possible synchronization of business cycles in Latin America. Analysis is performed through the study of business cycle correlations, for which use is made of the Hodrick-Prescott (HP) to extract the trend component of the series. After obtaining the cycle component of the series is an examination of the correlations between countries, it is analysis will find the degree of relationship between economies. In synthesis there are interesting relationships between some members, but their links are not strong enough to speak of a common cycle, therefore we can to say don’t show signs of economic synchronization

Characterization of By-products with High Fat Content Derived from the Production of Bovine Gelatin [version 2; peer review: 2 approved]

Background: Gelatin is a protein obtained by partial hydrolysis of collagen contained in skins, connective tissue and/or animal bones, which are by-products of the meat industry. The main raw material to produce bovine gelatin is the dermis of the skin, but there is a variation in fat and moisture content depending on the bovine skin origin. As a contribution to the circular economy and sustainability, these by-products with high fat content and the fat released from them during the gelatin production process can be managed for food industries, mainly in the development or formulation of animal feed. Methods: For the initial physicochemical characterization, moisture, fat, protein and ashes content were determined. Once the by-products with high fat content were identified, alteration parameters such as acidity, peroxide and saponification indexes were evaluated. Additionally, thermal, rheological and fatty acid composition characterization was carried out in order to study the possible applications of the by-products. Results and Discussion: The results showed that certain by-products have a fat content of less than 15%, so the viability of their use is limited. On the other hand, some by-products have a fat content exceeding 30%; however, their extraction can only be done manually, resulting in a low efficiency process. By-products removed from the supernatant in the extractors presented fat percentages of 99.9 and 98.9%, and there exists the possibility of implementing a mechanical method for their extraction. The analysis of alteration and oxidation parameters, thermal and rheological characterization, fatty acid profile and solid fat content were exclusively conducted on these high-fat content by-products. Based on the characterization, these by-products could be valued and incorporated into animal feed formulations. Nevertheless, certain limitations exist for their use in applications such as biodiesel production or the food industry

NUTRARET: Effect of 2-Year Nutraceutical Supplementation on Redox Status and Visual Function of Patients With Retinitis Pigmentosa: A Randomized, Double-Blind, Placebo-Controlled Trial

Oxidative stress plays a major role in the pathogenesis of retinitis pigmentosa (RP). The main goal of this study was to evaluate the effect of 2-year nutritional intervention with antioxidant nutraceuticals on the visual function of RP patients. Secondly, we assessed how nutritional intervention affected ocular and systemic redox status. We carried out a randomized, double-blind, placebo-controlled study. Thirty-one patients with RP participated in the study. RP patients randomly received either a mixture of nutraceuticals (NUT) containing folic acid, vitamin B6, vitamin A, zinc, copper, selenium, lutein, and zeaxanthin or placebo daily for 2 years. At baseline and after 2- year of the nutritional supplementation, visual function, dietetic-nutritional evaluations, serum concentration of nutraceuticals, plasma and aqueous humor concentration of several markers of redox status and inflammation were assessed. Retinal function and structure were assessed by multifocal electroretinogram (mfERG), spectral domain-optical coherence tomography (SD-OCT) and automated visual field (VF) tests. Nutritional status was estimated with validated questionnaires. Total antioxidant capacity, extracellular superoxide dismutase (SOD3), catalase (CAT), and glutathione peroxidase (GPx) activities, protein carbonyl adducts (CAR) content, thiobarbituric acid reactive substances (TBARS) formation (as indicator of lipid peroxidation), metabolites of the nitric oxide (NOX) and cytokine (interleukin 6 and tumor necrosis factor alpha) concentrations were assessed by biochemical and immunological techniques in aqueous humor or/and blood. Bayesian approach was performed to determine the probability of an effect. Region of practical equivalence (ROPE) was used. At baseline, Bayesian analysis revealed a high probability of an altered ocular redox status and to a lesser extent systemic redox status in RP patients compared to controls. Twenty-five patients (10 in the treated arm and 15 in the placebo arm) completed the nutritional intervention. After 2 years of supplementation, patients who received NUT presented better retinal responses (mfERG responses) compared to patients who received placebo. Besides, patients who received NUT showed better ocular antioxidant response (SOD3 activity) and lower oxidative damage (CAR) than those who received placebo. This study suggested that long-term NUT supplementation could slow down visual impairment and ameliorate ocular oxidative stress.This work was supported by the Spanish Ministry of Economy, Industry, and Competitiveness (MINECO) Carlos III Health Institute (ISCIII) (Grant numbers: PI15/00052 and PI18/00252) and co-funded by the European Regional Development Fund (FEDER)/European Social Fund “A way to make Europe”/”Investing in your future.” It was also supported by the IIS La Fe-UV PROGRAMA VLC-BIOMED-I (NUTRARET) and by RETINA COMUNIDAD VALENCIANA. LO-G had an ISCIIIMedicin

FabLab en Educación: propuesta formativa y práctica para la creación de recursos didácticos dirigida a la docencia del profesorado universitario

El proyecto de innovación docente FabLab (laboratorios de fabricación digital) en educación pretende dotar al profesorado de una serie de competencias tecnológicas y pedagógicas que le permita ofrecer al alumnado una formación mucho más rica, integradora de contenidos, inclusiva, y que facilite el empoderamiento del alumnado para el emprendimiento profesional. El objetivo principal del proyecto es promover un cambio pedagógico en el profesorado para que sea capaz de adaptarse a las exigencias de una sociedad cada vez más tecnológica y en la que se demanda unos tipos de competencias que claramente no pueden adquirirse en la Universidad si no se tiene acceso, mínimamente, a unos recursos y dispositivos tecnológicos. En este sentido, la creación del FabLab permite crear un espacio creativo y productivo relacionado con la tecnología que favorece el acceso a ella y la adquisición de unas competencias tecnológicas y didácticas que, por la salida profesional del alumnado, permitiría acercar las materias denominadas STEM a las chicas de las etapas educativas no universitarias para que continúen estudios superiores relacionadas con estas asignaturas. El proyecto se articula en torno a cuatro fases: formación y sensibilización, diseño y desarrollo de materiales docentes, implementación en el estudiantado y la evaluación. Para el desarrollo del mismo se ha necesitado dos cursos académicos en los que el profesorado ha recibido una formación tanto virtual como presencial por diferentes especialistas. Para la formación y asesoramiento se ha contado con dos profesores de centros de secundaria de Granada que ya manejan algunos de los recursos y dispositivos tecnológicos en sus aulas. Además, han recibido formación sobre la gamificación de la docencia y el diseño de insignias para cuando se las tengan que otorgar al alumnado. Se han conseguido realizar diversos proyectos tecnológicos utilizando la placa Arduino y los diferentes componentes y accesorios como, por ejemplo, un vehículo sigue líneas con sensores de proximidad y un ascensor de vehículos automatizado al detectar el vehículo en el interior. También se ha elaborado un material digital con Inkscape, GIMP y Tinkercad para la para la impresión en 3D de ficha para la gamificación de diversos juegos elaborados para el aprendizaje de, por ejemplo, los mitos griegos. Para la docencia habitual, la formación recibida, así como los dispositivos utilizados y los materiales realizados, son un elemento innovador que les permite al profesorado ofrecer unos recursos atractivos para los aprendizajes de los contenidos de las diferentes materias que imparten.The FabLab (digital fabrication laboratories) teaching innovation project in education aims to provide teachers with a series of technological and pedagogical skills that will enable them to offer students a much richer, more inclusive and inclusive education that integrates content and facilitates the empowerment of students for professional entrepreneurship. The main objective of the project is to promote a pedagogical change in the teaching staff so that they are able to adapt to the demands of an increasingly technological society that demands certain types of skills that clearly cannot be acquired at the University if they do not have access, minimally, to technological resources and devices. In this sense, the creation of the FabLab makes it possible to create a creative and productive space related to technology that favours access to it and the acquisition of technological and didactic skills that, due to the students' professional opportunities, would bring STEM subjects closer to girls in non-university educational stages so that they can continue higher studies related to these subjects. The project is structured around four phases: training and awareness-raising, design and development of teaching materials, implementation among students and evaluation. It has taken two academic years to develop the project, during which the teaching staff have received both virtual and face-to-face training from different specialists. Two teachers from secondary schools in Granada, who already use some of the technological resources and devices in their classrooms, have been involved in the training and assessment. In addition, they have received training on the gamification of teaching and the design of badges for when they have to award them to students. They have managed to carry out various technological projects using the Arduino board and the different components and accessories, such as a vehicle that follows lines with proximity sensors and an automated vehicle lift when it detects the vehicle inside. Digital material has also been developed with Inkscape, GIMP and Tinkercad for the 3D printing of cards for the gamification of various games developed for the learning of, for example, Greek myths. For regular teaching, the training received, as well as the devices used and the materials produced, are an innovative element that allows teachers to offer attractive resources for learning the contents of the different subjects they teach.Unidad de Calidad, Innovación Docente y Prospectiva de la Universidad de Granad

Association of breast and gut microbiota dysbiosis and the risk of breast cancer: a case-control clinical study

We would like to thank M Luisa Puertas-Martin and Isabel Manzano-Jimenez, nurses at the Unit of Mammary Pathology, General Surgery Service, San Cecilio University Hospital (Granada), without whose enthusiasm the enrolment of participants in Granada would still be stalled. We are indebted to all the women taking part in the study.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Trial registration ClinicalTrials.gov NCT03885648, 03/25/2019. Retrospectively registered.Background Breast cancer ranks first in women, and is the second cause of death in this gender. In addition to genetics, the environment contributes to the development of the disease, although the factors involved are not well known. Among the latter is the influence of microorganisms and, therefore, attention is recently being paid to the mammary microbiota. We hypothesize that the risk of breast cancer could be associated with the composition and functionality of the mammary/gut microbiota, and that exposure to environmental contaminants (endocrine disruptors, EDCs) might contribute to alter these microbiota. Methods We describe a case-control clinical study that will be performed in women between 25 and 70 years of age. Cases will be women diagnosed and surgically intervened of breast cancer (stages I and II). Women with antecedents of cancer or advanced tumor stage (metastasis), or who have received antibiotic treatment within a period of 3 months prior to recruitment, or any neoadjuvant therapy, will be excluded. Controls will be women surgically intervened of breast augmentation or reduction. Women with oncological, gynecological or endocrine history, and those who have received antibiotic treatment within a period of 3 months prior to recruitment will also be excluded. Blood, urine, breast tissue and stool samples will be collected. Data regarding anthropometric, sociodemographic, reproductive history, tumor features and dietary habits will be gathered. Metabolomic studies will be carried out in stool and breast tissue samples. Metagenomic studies will also be performed in stool and breast tissue samples to ascertain the viral, fungal, bacterial and archaea populations of the microbiota. Quantitation of estrogens, estrogen metabolites and EDCs in samples of serum, urine and breast tissue will also be performed. Discussion: This is the first time that the contribution of bacteria, archaea, viruses and fungi together with their alteration by environmental contaminants to the risk of breast cancer will be evaluated in the same study. Results obtained could contribute to elucidate risk factors, improve the prognosis, as well as to propose novel intervention studies in this disease.This work is funded by grants PI-0538-2017 (Junta de Andalucía, Spain, to LF) and Biomedical Research Networking Center-CIBER de Epidemiología y Salud Pública (CIBERESP) of the Institute of Health Carlos III -supported by European Regional Development Fund/FEDER (FIS-PI16/01812) (to MFF)

Nuevas terapias dirigidas para el tratamiento del cáncer

El cáncer es el término que se utiliza para englobar un conjunto de enfermedades que se caracterizan por el crecimiento descontrolado de células alteradas molecularmente por mutaciones o modificaciones epigenéticas.En la presente revisión describimos algunas terapias dirigidas que se están utilizando actualmente en clínic