El conjunto arqueológico de Saqsaywaman (Cusco): una aproximación a su arquitectura

Saqsaywaman is the most extensive archaeological complex of the ancient imperial capital of Cuzco. Despite the excavations carried out in the last 70 years, it lacks even an architectural and functional interpretation that claimed its extraordinary importance in the context of Inca architecture. This paper presents an architectural study of the sector of Muyukmarca as a result of the training seminar on «Archaeology of architecture» held in Cusco between the years 2010 and 2011. The examination of material remains and of information gathered by colonial chroniclers indicates that the most important spaces had religious functions, agreeing on the idea that Saqaywaman was the great Sun House of Hanan Qusqu, built as a counterpoint to Coricancha in the unitary design of the city decided by the great Pachacuti.Saqsaywaman es el conjunto arqueológico más extenso que se ha conservado de la antigua capital imperial del Cusco. A pesar de las grandes excavaciones realizadas en los últimos 70 años, carecemos aún de interpretaciones arquitectónicas y funcionales que reivindiquen su extraordinaria importancia en el contexto de la arquitectura inca. Presentamos en estas páginas el estudio arquitectónico del sector de Muyukmarca como resultado del seminario didáctico sobre «Arqueología de la Arquitectura» realizado en el Cusco entre los años 2010 y 2011. El examen de los restos y las noticias recogidas por los cronistas coloniales permiten afirmar que Saqsaywaman era la gran Casa del Sol de Hanan Qusqu, construida como contrapunto del Coricancha en el diseño unitario de la ciudad decidido por el gran Pachacuti

Tyrannobdella rex N. Gen. N. Sp. and the Evolutionary Origins of Mucosal Leech Infestations

BACKGROUND: Leeches have gained a fearsome reputation by feeding externally on blood, often from human hosts. Orificial hirudiniasis is a condition in which a leech enters a body orifice, most often the nasopharyngeal region, but there are many cases of leeches infesting the eyes, urethra, vagina, or rectum. Several leech species particularly in Africa and Asia are well-known for their propensity to afflict humans. Because there has not previously been any data suggesting a close relationship for such geographically disparate species, this unnerving tendency to be invasive has been regarded only as a loathsome oddity and not a unifying character for a group of related organisms. PRINCIPAL FINDINGS: A new genus and species of leech from Perú was found feeding from the nasopharynx of humans. Unlike any other leech previously described, this new taxon has but a single jaw with very large teeth. Phylogenetic analyses of nuclear and mitochondrial genes using parsimony and Bayesian inference demonstrate that the new species belongs among a larger, global clade of leeches, all of which feed from the mucosal surfaces of mammals. CONCLUSIONS: This new species, found feeding from the upper respiratory tract of humans in Perú, clarifies an expansion of the family Praobdellidae to include the new species Tyrannobdella rex n. gen. n. sp., along with others in the genera Dinobdella, Myxobdella, Praobdella and Pintobdella. Moreover, the results clarify a single evolutionary origin of a group of leeches that specializes on mucous membranes, thus, posing a distinct threat to human health

La imagen del Cusco inka en la historia: apuntes sobre arquitectura y arqueología para su reinterpretación

Although with a not so old past, the historical American cities have developed the same pat- terns of historical overlap as the European ones. The problems are similar and throughout the 20th century they have led the development of a «his- torical archeology» with its own characteristics. In the last forty years, the archaeological study of historical centers has been develo- ped in practically all the countries of Ameri- ca, and is a viable model in the Latin Ameri- can tradition of management of historic cities. The reconstruction of the urban layout of Cusco as capital and center of the Tawantinsuyu is, in many aspects, an archaeological task still pending. In spite of the important studies carried out until now, there is no consensus on the form that the old city had and, consequently, the images of the Incas spaces inclu- ded in popular editions, popular books and tourist guides are incomplete and sometimes distorted. The study cites chronological, historical refe- rences, written, archaeological and architectural sources for reinterpretation through the appli- cation of the urban methodology of the inka tra- ce of the city of Cusco, describing important works and incidents carried out in recent decades. Finally understand the keys to a balanced and sustainable development for the archaeologi- cal future of historic cities. It go through to re- cover and enhance the old idea of multidisci- plinary teams, from the desirable perspective of cooperation between architects, engineers, archaeologists, anthropologists and historians.Aunque con un pasado no tan antiguo, las ciudades históricas americanas han desarrollado las mismas pautas de superposición histórica que las euro- peas. Los problemas son similares y a lo largo del siglo XX han protagonizado el desarrollo de una «arqueología histórica» con características propias. En los últimos cuarenta años, el estudio arqueo- lógico de los centros históricos se ha desarro- llado en prácticamente todos los países de América y es un modelo viable en la tradición la- tinoamericana de gestión de ciudades históricas. La reconstrucción de la traza urbana del Cusco como capital y centro del Tawantinsuyu es, en mu- chos aspectos, una tarea arqueológica todavía pen- diente. A pesar de los importantes estudios realiza- dos hasta ahora, no existe consenso sobre la forma que tenía la antigua ciudad y, en consecuencia, las imágenes de los espacios inkas incluidas en edicio- nes populares, libros de divulgación y guías para turistas son incompletas y a veces distorsionadas. El estudio cita referencias cronológicas, históricas, fuentes escritas, arqueológicas y arquitectónicas para la reinterpretación a través de la aplicación de la metodología urbana de la traza inka de la ciudad de Cusco, describiendo trabajos importan- tes e incidentes realizados en los últimos decenios. Finalmente, se busca entender las claves de un desarrollo equilibrado y sostenible para el futuro arqueológico de las ciudades históricas. Este pasa por recuperar y potenciar la vieja idea de los equi- pos pluridisciplinares desde la perspectiva desea- ble de la cooperación entre arquitectos, ingenie- ros, arqueólogos, antropólogos e historiadores

¿El descortezamiento de un árbol medicinal impacta en su estructura poblacional-espacial? El caso de Hintonia latiflora en México

The population structure and the patterns of spatial distribution and correlation among developmental stages of Hintonia latiflora, a species threatened in Mexico by the commercial harvest of its bark, are documented. Six plots (three in harvested sites and three in not harvested ones) of 20 m × 100 m were established for the census of all plants and they were categorized into three stages of development based on the total height and basal diameter; all individuals were located by their cartesian coordinates. The population structure was analyzed by a density histogram; whereas bias and kurtosis were used to determine the harvest effect on size categories. Univariate and bivariate spatial patterns were determined using Ripley's L(t) and L12(t) functions, respectively, and the statistical significance was 99% using Monte Carlo simulations. Density between harvested sites vs. not harvested was statistically different (p 0), whereas the spatial correlation in populations subject to debarking reflected a combination between independence and spatial attraction at different distances. This information provides a basis for the sustainable management of H. latiflora and represents the first study in Mexico that analyzes the debarking of a medicinal resource on its population-spatial structure.Se documenta la estructura poblacional y el patrón de distribución y correlación espacial entre etapas de desarrollo de Hintonia latiflora, especie amenazada en México por la cosecha comercial de su corteza. Se establecieron seis unidades de muestreo (tres cosechadas y tres no cosechadas) de 20 m × 100 m para el censo de todas las plantas y se categorizaron en tres etapas de desarrollo con base en la altura total y diámetro basal; todos los individuos fueron ubicados por sus coordenadas cartesianas. La estructura poblacional se analizó mediante un histograma de densidad; , mientras que el sesgo y la curtosis se usaron para determinar el efecto del aprovechamiento sobre las categorías de tamaño. Los patrones espaciales univariantes y bivariantes se determinaron usando la función L1(t) y L12(t) de Ripley, respectivamente, y la significancia estadística fue a 99% mediante simulaciones Monte Carlo. La densidad entre sitios cosechados vs. no cosechados fue estadísticamente diferente (p 0), mientras que la correlación espacial en poblaciones sujetas a descortezamiento reflejó una combinación entre independencia y atracción espacial a diferentes distancias. Esta información aporta bases para el manejo sostenible de H. latiflora y representa el primer estudio en México que analiza el impacto del descortezamiento de un recurso medicinal sobre su estructura poblacional-espacial

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research