Reconstrucción de neoglande con colgajo uretral para el tratamiento quirúrgico de calcifilaxis peniana

ResumenIntroducciónLa arteriolopatía urémica calcificante, también conocida como calcifilaxis, es una entidad caracterizada por la presencia de áreas de necrosis isquémica junto con extensas calcificaciones de la capa media de las arteriolas de la piel; la etiopatogenia es compleja, las formas de presentación y evolución son diversas. La calcifilaxis del pene es una entidad muy rara. El dolor y la ulceración del glande es una de sus manifestaciones clínicas iniciales, el diagnóstico en estas etapas es difícil de establecer y el manejo debe ser integral. El tratamiento médico seguido del manejo quirúrgico se establecerá de acuerdo a la etapa y evolución de la enfermedad.La reconstrucción aislada del glande se recomienda tras una amputación traumática o quirúrgica por alguna enfermedad benigna o maligna. El objetivo es conseguir una apariencia estética razonable, permitir una micción fisiológica y tratar de conservar la mayor cantidad de tejido eréctil. En pacientes con calcifilaxis peniana, el manejo quirúrgico convencional es radical y consiste en falectomía parcial o total según sea el caso. El manejo conservador ha sido reportado mediante la desbridación de las lesiones ulcerosas en pene, tratamiento local y vigilancia.Caso clínicoSe presenta el caso de un paciente masculino de 59 años de edad con insuficiencia renal crónica en tratamiento con hemodiálisis, hospitalizado por cuadro de 5 días de evolución con úlcera dolorosa en glande, refractaria a manejo analgésico. Se realizó biopsia escisional de la lesión con estudio histopatológico confirmando calcifilaxis. Se plantea a paciente falectomía parcial la cual rechaza por lo que se ofrece reconstrucción en un tiempo como opción terapéutica.ConclusiónUtilizar injertos o colgajos de piel para realizar la reconstrucción del pene en pacientes con calcifilaxis no representa una opción viable. Por su gran aporte vascular, la uretra representa una buena opción de reconstrucción en pacientes con calcifilaxis en etapa inicial. La selección y evaluación de los pacientes debe ser muy cautelosa para que los resultados estéticos y funcionales sean aceptables.AbstractIntroductionCalcific uremic arteriolopathy, also known as calciphylaxis, is an entity characterized by areas of ischemic necrosis with extensive calcifications of the middle layer of the skin arterioles. Its etiopathogenesis is complex and its forms of presentation and progression are diverse. Calciphylaxis of the penis is an extremely rare entity. Pain and ulceration of the glans penis are initial clinical manifestations and diagnosis at these stages is difficult. Management should be comprehensive. Medical treatment, followed by surgical management, is established according to disease stage and progression.Isolated reconstruction of the glans penis is recommended when there is traumatic amputation or a surgical one due to benign or malignant disease. The goal is to obtain a reasonably esthetic appearance, to have physiologic micturition, and to spare the greatest amount of erectile tissue possible. Conventional surgical management in patients with penile calciphylaxis is radical and consists of partial or total phallectomy, depending on the case. Conservative management through ulcerous penile lesion debridement, local treatment, and surveillance has been reported.Case reportA 59-year-old man with chronic renal insufficiency in hemodialysis treatment was hospitalized for symptoms of 5-day progression of a painful ulcer on the glans penis that was refractory to analgesics. An excisional biopsy of the lesion was taken and the histopathologic study confirmed calciphylaxis. Partial phallectomy was suggested to the patient, but he rejected it, and so single stage reconstruction was offered as a therapeutic option.ConclusionThe use of skin grafts or flaps for penile reconstruction in patients with calciphylaxis is not a viable option. Because of its large blood supply, the urethra is a good reconstruction option in patients with initial-stage calciphylaxis. Patient selection and evaluation must be carried out with great care in order to have acceptable functional and esthetic results

Dependencia emocional en estudiantes de Medicina

Objective: To determine the emotional dependence of students of medicine in a public university. Methods: A cross-sectional study was carried-out applying the 42-item scale of emotional dependence of Ancima, Caballero, Cirilo y Aguirre (2013) with dichotomous responses (yes/no); 332 five-year medical students were selected; a non- probabilistic sample of 303 students was finally recruited. Results: 183 (60.39%) were females: mean age was 24 years; only 2.98% were stables and 90.39% had a tendency for dependence. Conclusions: Five-year medical students had a marked tendency for dependence, especially female students.Objetivos: Identificar la dependencia emocional en los estudiantes de medicina de universidad pública. Material y métodos: Estudio cuantitativo, no experimental, exploratorio, descriptivo, transversal. Se aplicó la escala de dependencia emocional de Ancima, Caballero, Cirilo y Aguirre (2013) integrada por 42 ítems. Las respuestas se establecen dicotómicamente Si o no. La población se conformó por 332 estudiantes de medicina de quinto año de una universidad pública. La escala fue aplicada a 303 estudiantes una muestra no probabilística, por conveniencia. Resultados: De 303 estudiantes, 183 (60,39%) eran del género femenino y 120 (39,60%) masculino, con promedio de edad de 24 años, con una desviación estándar de 1,46. Solo el 2,98% fueron “estables” y el 90,39% con “tendencia a la dependencia”. Conclusiones: Los estudiantes de medicina presentan una marcada tendencia a la dependencia emocional. Siendo las mujeres las más dependientes

Crustal structure across the Costa Rican Volcanic Arc

Author Posting. © American Geophysical Union, 2013. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry, Geophysics, Geosystems 14 (2013): 1087–1103, doi:10.1002/ggge.20079.Island arcs are proposed to be essential building blocks for the crustal growth of continents; however, island arcs and continents are fundamentally different in bulk composition: mafic and felsic, respectively. The substrate upon which arcs are built (oceanic crust versus large igneous province) may have a strong influence on crustal genesis. We present results from an across-arc wide-angle seismic survey of the Costa Rican volcanic front which test the hypothesis that juvenile continental crust is actively forming at this location. Travel-time tomography constrains velocities in the upper arc to a depth of ~15 km where average velocities are <6.5 km/s. The upper 5 km of crust is constrained by velocities between 4.0 and 5.5 km/s, which likely represent sediments, volcaniclastics, flows, and small intrusions. Between 5 and 15 km depth, velocities increase slowly from 5.5 to 6.5 km/s. Crustal thickness and lower crustal velocities are roughly constrained by reflections from an inferred crust-mantle transition zone. Crustal thickness beneath the volcanic front in Costa Rica is ~40 km with best-fit average lower-crustal velocities between 6.8 and 7.1 km/s. Overall, velocities across the arc in central Costa Rica are at the high-velocity extreme of bulk continental crust velocities and are lower than modern island arc velocities, suggesting that continental compositions are created at this location. These data suggest that preexisting thick crust of the Caribbean Large Igneous Province has a measurable effect on bulk composition. This thickened arc crust may be a density filter for mafic material and thereby support differentiation toward continental compositions.Funding was provided by the NSF-MARGINS and ODP programs, under NSF grant OCE-0405654 and project Nº 113- A4-408 from the University of Costa Rica.2013-10-2

PLAN DE ACCIÓN PARA LA CONSERVACIÓN DEL AGUARÁ GUAZÚ EN SANTA FE VERSIÓN 01 PERÍODO 2009 – 2014

El presente plan fue realizado usando de base los capítulos 1, 2, 3 y 4 del trabajo: Estado  de  conocimiento  y  conservación  del  aguará  guazú  (Chrysocyon  brachyurus)  en  la  provincia  de Santa Fe, Argentina. . Se tomó como base orientaciones generales de Margoluis y Salafsky (1998) y en la estructura general se siguió de modelo práctico a Jiménez Pérez (2006). Para asignar la prioridad se utilizaron las categorías desarrolladas por el Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis (Baz Hughes, et al. 2006), estas son: Esencial: una actividad específica cuyo cumplimiento es necesario para evitar una declinación de las poblaciones que pueda llevar a la extinción de la especie en la naturaleza y/o en cautiverio. Alta: una actividad específica cuyo cumplimiento es necesario para evitar una declinación poblacional de más del 20% de una población en 20 años o menos. Media: una actividad específica cuyo cumplimiento es necesario para evitar una declinación poblacional de hasta el 20% de una población en 20 años o menos. Baja: una actividad específica cuyo cumplimiento es necesario para prevenir declinaciones poblacionales  locales o que se estima que dicha acción apenas tiene un pequeño impacto sobre las poblaciones en un área grande. Se trata de una planificación para cinco años pues la experiencia indica que a Santa Fe le falta mucho  trabajo  y experiencia para  fortalecer  su  forma de  ver  y de actuar en  la  recuperación de  las especies amenazadas.  Por ejemplo muchas de  las amenazas  indirectas (generadoras de amenazas directas) que afectan a esta especie son producto de  la  falta de coordinación, compromiso, metas y objetivos comunes entre  los profesionales de  la conservación, sea sociedad civil u organismos estatales. Es así como se pretende en un corto plazo y monitoreando constantemente, las acciones y sus resultados, lograr un plan a futuro de mediano y largo plazo.Fil: Biassati, R. Secreataría de Medio Ambiente de Santa Fe; ArgentinaFil: Larriera, Alejandro. Secretaría de Medio Ambiente de Santa Fe; ArgentinaFil: Mosso, E.. Secretaría de Medio Ambiente de Santa Fe; ArgentinaFil: Rozztti, J.C.. Secretaría de Medio Ambiente de Santa Fe; ArgentinaFil: Moggia, L.. Secretaría de Medio Ambiente, Santa Fe; ArgentinaFil: Pautasso, A.. Museo de Cs Naturales Florentino Ameghino; ArgentinaFil: Nebozuk, M. A.. Museo Provincial de Ciencias Naturales Ángel Gallardo; ArgentinaFil: Walker, C.. Universidad Nacional del Litoral; ArgentinaFil: Ramirez, C.. Universidad Nacional del Litoral; ArgentinaFil: Mirol, P.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Raimondi, Vanina Belén. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Beldomenico, Pablo Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - CONICET - Santa Fe. Instituto de Ciencias Veterinarias del Litoral; Argentina. Laboratorio de Ecología de Enfermedades; ArgentinaFil: Eberhardt, María Ayelen Teresita. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - CONICET - Santa Fe. Instituto de Ciencias Veterinarias del Litoral; Argentina. Laboratorio de Ecología de Enfermedades; ArgentinaFil: Manzzoli, D.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - CONICET - Santa Fe. Instituto de Ciencias Veterinarias del Litoral; Argentina. Laboratorio de Ecología de Enfermedades; ArgentinaFil: Correa, A.. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; ArgentinaFil: Terragona, E.. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; ArgentinaFil: Magni, C.. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; ArgentinaFil: Alvarado, S.. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; ArgentinaFil: Barengo, E.. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; Argentin

The Effect of Nanoparticles on Amyloid Aggregation Depends on the Protein Stability and Intrinsic Aggregation Rate

Nanoparticles interfere with protein amyloid formation. Catalysis of the process may occur due to increased local protein concentration and nucleation on the nanoparticle surface, whereas tight binding or a large particle/protein surface area may lead to inhibition of protein aggregation. Here we show a clear correlation between the intrinsic protein stability and the nanoparticle effect on the aggregation rate. The results were reached for a series of five mutants of single-chain monellin differing in intrinsic stability toward denaturation, for which a correlation between protein stability and aggregation propensity has been previously documented by Szczepankiewicz et al. [Mol. Biosyst 2010 7 (2), 521-532]. The aggregation process was monitored by thioflavin T fluorescence in the absence and presence of copolyrneric nanoparticles with different hydrophobic characters. For mutants with a high intrinsic stability and low intrinsic aggregation rate, we find that amyloid fibril formation is accelerated by nanoparticles. For find the opposite-a retardation of amyloid fibril formation by nanoparticles. Moreover, both catalytic and inhibitory effects are most pronounced with the least hydrophobic nanoparticles, which have a larger surface accessibility of hydrogen-bonding groups in the polymer backbone

Extrinsic Magnetotransport Phenomena in Ferromagnetic Oxides

This review is focused on extrinsic magnetotransport effects in ferromagnetic oxides. It consists of two parts; the second part is devoted to an overview of experimental data and theoretical models for extrinsic magnetotransport phenomena. Here a critical discussion of domain-wall scattering is given. Results on surfacial and interfacial magnetism in oxides are presented. Spin-polarized tunnelling in ferromagnetic junctions is reviewed and grain-boundary magnetoresistance is interpreted within a model of spin-polarized tunnelling through natural oxide barriers. The situation in ferromagnetic oxides is compared with data and models for conventional ferromagnets. The first part of the review summarizes basic material properties, especially data on the spin-polarization and evidence for half-metallicity. Furthermore, intrinsic conduction mechanisms are discussed. An outlook on the further development of oxide spin-electronics concludes this review.Comment: 133 pages, 47 figures, submitted to Rep. Prog. Phy

Molecular characterization of occult hepatitis B virus infection in patients with end-stage liver disease in Colombia.

ABSTARCT: Hepatitis B virus (HBV) occult infection (OBI) is a risk factor to be taken into account in transfusion, hemodialysis and organ transplantation. The aim of this study was to identify and characterize at the molecular level OBI cases in patients with end-stage liver disease. METHODS: Sixty-six liver samples were obtained from patients with diagnosis of end-stage liver disease submitted to liver transplantation in Medellin (North West, Colombia). Samples obtained from patients who were negative for the surface antigen of HBV (n = 50) were tested for viral DNA detection by nested PCR for ORFs S, C, and X and confirmed by Southern-Blot. OBI cases were analyzed by sequencing the viral genome to determine the genotype and mutations; additionally, viral genome integration events were examined by the Alu-PCR technique. RESULTS: In five cases out of 50 patients (10%) the criteria for OBI was confirmed. HBV genotype F (subgenotypes F1 and F3), genotype A and genotype D were characterized in liver samples. Three integration events in chromosomes 5q14.1, 16p13 and 20q12 affecting Receptor-type tyrosine-protein phosphatase T, Ras Protein Specific Guanine Nucleotide Releasing Factor 2, and the zinc finger 263 genes were identified in two OBI cases. Sequence analysis of the viral genome of the 5 OBI cases showed several punctual missense and nonsense mutations affecting ORFs S, P, Core and X. CONCLUSIONS: This is the first characterization of OBI in patients with end-stage liver disease in Colombia. The OBI cases were identified in patients with HCV infection or cryptogenic cirrhosis. The integration events (5q14.1, 16p13 and 20q12) described in this study have not been previously reported. Further studies are required to validate the role of mutations and integration events in OBI pathogenesis