Cirugía de la hipertrofia benigna de próstata. Estándares de uso apropiado

El presente documento describe los estándares de uso apropiado de la cirugía de la Hipertrofia Benigna de Próstata (HBP). Estos estándares son el resultado de la aplicación del “método de uso apropiado”. El método fue desarrollado inicialmente por RAND y combina la evidencia científica con la opinión de un grupo de expertos. El propósito del método es establecer en qué circunstancias clínicas específicas la realización de un procedimiento puede ser apropiada, inapropiada, o dudosa. Los estándares de uso apropiado, se obtienen a partir de la evidencia científica, y del juicio de expertos cuando no existe evidencia o ésta es contradictoria. Esta es la primera vez que esta metodología se utiliza en nuestro país.Presentación, Prólogo, Resumen, Método, Estándares de uso, Retención Aguda de Orina, Retención Crónica de Orina, Hematuria, Infección uinaria, Litiasis, Divertículos, Sintomatología aislada, Conclusiones Anexo I. Revisión de la literatura de la hipertrofia benigna de próstata, Summary, Abstrac

Origin of the Breno and Esino dolomites in the western Southern Alps (Italy): Implications for a volcanic influence

The Esino Limestone of the western Southern Alps represents a differentiated Ladinian-Lower Carnian (?) carbonate platform comprised of margin, slope and peritidal inner platform facies up to 1000 m thick. A major regional subaerial exposure event lead to coverage by another peritidal Lower Carnian carbonate platform (Breno Formation). Multiphase dolomitization affected the carbonate sediments. Petrographic examinations identified at least three main generations of dolomites (D1, D2, and D3) that occur as both replacement and fracture-filling cements. These phases have crystal-size ranges of 3e35 mm (dolomicrite D1), 40e600 mm (eu-to subhedral crystals D2), and 200 mm to 5 mm (cavity- and fracture-filling anhedral to subhedral saddle dolomite D3), respectively. The fabric retentive near-micritic grain size coupled with low mean Sr concentration (76 \ub1 37 ppm) and estimated d18O of the parent dolomitizing fluids of D1 suggest formation in shallow burial setting at temperature ~ 45e50 C with possible contributions from volcanic-related fluids (basinal fluids circulated in volcaniclastics or related to volcanic activity), which is consistent with its abnormally high Fe (4438 \ub1 4393 ppm) and Mn (1219 \ub1 1418 ppm) contents. The larger crystal sizes, homogenization temperatures (D2, 108 \ub1 9 C; D3, 111 \ub1 14 C) of primary two-phase fluid inclusions, and calculated salinity estimates (D2, 23 \ub1 2 eq wt% NaCl; D3, 20 \ub1 4 eq wt% NaCl) of D2 and D3 suggest that they formed at later stages under mid-to deeper burial settings at higher temperatures from dolomitizing fluids of higher salinity, which is supported by higher estimated d18O values of their parent dolomitizing fluids. This is also consistent with their high Fe (4462 \ub1 4888 ppm; and 1091 \ub1 1183 ppm, respectively) and Mn (556 \ub1 289 ppm and 1091 \ub1 1183 ppm) contents, and low Sr concentrations (53 \ub1 31 ppm and 57 \ub1 24 ppm, respectively). The similarity in shale-normalized (SN) REE patterns and Ce (Ce/Ce*)SN and La (Pr/Pr*)SN anomalies of the investigated carbonates support the genetic relationship between the dolomite generations and their calcite precursor. Positive Eu anomalies, coupled with fluid-inclusion gas ratios (N2/Ar, CO2/CH4, Ar/He), high F concentration, high F/Cl and high Cl/Br molar ratios suggest an origin from diagenetic fluids circulated through volcanic rocks, which is consistent with the co-occurrence of volcaniclastic lenses in the investigated sequence

A narrow band neutrino beam with high precision flux measurements

The ENUBET facility is a proposed narrow band neutrino beam where lepton production is monitored at single particle level in the instrumented decay tunnel. This facility addresses simultaneously the two most important challenges for the next generation of cross section experiments: a superior control of the flux and flavor composition at source and a high level of tunability and precision in the selection of the energy of the outcoming neutrinos. We report here the latest results in the development and test of the instrumentation for the decay tunnel. Special emphasis is given to irradiation tests of the photo-sensors performed at INFN-LNL and CERN in 2017 and to the first application of polysiloxane-based scintillators in high energy physics.Comment: Poster presented at NuPhys2017 (London, 20-22 December 2017). 5 pages, 2 figure

Diamond-Based Thin Film Bulk Acoustic Wave Resonator for Biomedical Applications

Nowadays it is in constant growing the development of thin film bulk acoustic resonators. If the piezoelectric material is going to be implanted in the human body, an important requirement is the biocompatibility of the implant. In this regard, Aluminum Nitride (AlN) has emerged as an attractive alternative for use in biomedical MicroElectroMechanical Systems. Ultrananocrystalline Diamond (UNCD) is a promising material to be used in biomedical applications, due to its extraordinary mulifunctionality; it is exceptional for implantable medical devices requiring stringent biological performance. Since both UNCD and AlN films can be processed via photolithography processes used in microfabrication, the integration of UNCD and AlN films provides the bases for developing a new generation of biocompatible Bio-MEMS/NEMS. Research and development was conducted to produce implantable MEMS devices: Pt/piezoelectric AlN/Pt layer heterostructure was grown and patterned on the UNCD membrane with a Ti adhesion layer. By applying voltages between the top and bottom Pt electrodes layers the piezoelectric AlN layer is energized. The feasibility of the fabrication of biocompatible AlN/diamond-based FBAR structure has been demonstrated.Fil: Zalazar, Martin. Universidad Nacional de Entre Rios. Facultad de Ingenieria. Departamento de Bioingenieria; ArgentinaFil: Guarnieri, Fabio Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico. Centro de Investigación de Métodos Computacionales; Argentina. Universidad Nacional de Entre Rios. Facultad de Ingenieria. Departamento de Bioingenieria; Argentin

Molecular Analysis of Microbial Communities in Endotracheal Tube Biofilms

Ventilator-associated pneumonia is the most prevalent acquired infection of patients on intensive care units and is associated with considerable morbidity and mortality. Evidence suggests that an improved understanding of the composition of the biofilm communities that form on endotracheal tubes may result in the development of improved preventative strategies for ventilator-associated pneumonia. (n = 5). DGGE profiling of the endotracheal biofilms revealed complex banding patterns containing between 3 and 22 (mean 6) bands per tube, thus demonstrating the marked complexity of the constituent biofilms. Significant inter-patient diversity was evident. The number of DGGE bands detected was not related to total viable microbial counts or the duration of intubation.Molecular profiling using DGGE demonstrated considerable biofilm compositional complexity and inter-patient diversity and provides a rapid method for the further study of biofilm composition in longitudinal and interventional studies. The presence of oral microorganisms in endotracheal tube biofilms suggests that these may be important in biofilm development and may provide a therapeutic target for the prevention of ventilator-associated pneumonia

Treatment regimen determines whether an HIF-1 inhibitor enhances or inhibits the effect of radiation therapy

Hypoxia-inducible factor-1 (HIF-1) has been reported to promote tumour radioresistance; therefore, it is recognised as an excellent target during radiation therapy. However, the inhibition of HIF-1 in unsuitable timing can suppress rather than enhance the effect of radiation therapy because its anti-angiogenic effect increases the radioresistant hypoxic fraction. In this study, we imaged changes of HIF-1 activity after treatment with radiation and/or an HIF-1 inhibitor, YC-1, and optimised their combination. Hypoxic tumour cells were reoxygenated 6 h postirradiation, leading to von Hippel-Lindau (VHL)-dependent proteolysis of HIF-1α and a resultant decrease in HIF-1 activity. The activity then increased as HIF-1α accumulated in the reoxygenated regions 24 h postirradiation. Meanwhile, YC-1 temporarily but significantly suppressed HIF-1 activity, leading to a decrease in microvessel density and an increase in tumour hypoxia. On treatment with YC-1 and then radiation, the YC-1-mediated increase in tumour hypoxia suppressed the effect of radiation therapy, whereas on treatment in the reverse order, YC-1 suppressed the postirradiation upregulation of HIF-1 activity and consequently delayed tumour growth. These results indicate that treatment regimen determines whether an HIF-1 inhibitor enhances or inhibits the therapeutic effect of radiation, and the suppression of the postirradiation upregulation of HIF-1 activity is important for the best therapeutic benefit

Perturbation of Mouse Retinal Vascular Morphogenesis by Anthrax Lethal Toxin

Lethal factor, the enzymatic moiety of anthrax lethal toxin (LeTx) is a protease that inactivates mitogen activated protein kinase kinases (MEK or MKK). In vitro and in vivo studies demonstrate LeTx targets endothelial cells. However, the effects of LeTx on endothelial cells are incompletely characterized. To gain insight into this process we used a developmental model of vascularization in the murine retina. We hypothesized that application of LeTx would disrupt normal retinal vascularization, specifically during the angiogenic phase of vascular development. By immunoblotting and immunofluorescence microscopy we observed that MAPK activation occurs in a spatially and temporally regulated manner during retinal vascular development. Intravitreal administration of LeTx caused an early delay (4 d post injection) in retinal vascular development that was marked by reduced penetration of vessels into distal regions of the retina as well as failure of sprouting vessels to form the deep and intermediate plexuses within the inner retina. In contrast, later stages (8 d post injection) were characterized by the formation of abnormal vascular tufts that co-stained with phosphorylated MAPK in the outer retinal region. We also observed a significant increase in the levels of secreted VEGF in the vitreous 4 d and 8 d after LeTx injection. In contrast, the levels of over 50 cytokines other cytokines, including bFGF, EGF, MCP-1, and MMP-9, remained unchanged. Finally, co-injection of VEGF-neutralizing antibodies significantly decreased LeTx-induced neovascular growth. Our studies not only reveal that MAPK signaling plays a key role in retinal angiogenesis but also that perturbation of MAPK signaling by LeTx can profoundly alter vascular morphogenesis

Structural Analysis to Determine the Core of Hypoxia Response Network

The advent of sophisticated molecular biology techniques allows to deduce the structure of complex biological networks. However, networks tend to be huge and impose computational challenges on traditional mathematical analysis due to their high dimension and lack of reliable kinetic data. To overcome this problem, complex biological networks are decomposed into modules that are assumed to capture essential aspects of the full network's dynamics. The question that begs for an answer is how to identify the core that is representative of a network's dynamics, its function and robustness. One of the powerful methods to probe into the structure of a network is Petri net analysis. Petri nets support network visualization and execution. They are also equipped with sound mathematical and formal reasoning based on which a network can be decomposed into modules. The structural analysis provides insight into the robustness and facilitates the identification of fragile nodes. The application of these techniques to a previously proposed hypoxia control network reveals three functional modules responsible for degrading the hypoxia-inducible factor (HIF). Interestingly, the structural analysis identifies superfluous network parts and suggests that the reversibility of the reactions are not important for the essential functionality. The core network is determined to be the union of the three reduced individual modules. The structural analysis results are confirmed by numerical integration of the differential equations induced by the individual modules as well as their composition. The structural analysis leads also to a coarse network structure highlighting the structural principles inherent in the three functional modules. Importantly, our analysis identifies the fragile node in this robust network without which the switch-like behavior is shown to be completely absent

Multiple Invasions into Freshwater by Pufferfishes (Teleostei: Tetraodontidae): A Mitogenomic Perspective

Pufferfishes of the Family Tetraodontidae are the most speciose group in the Order Tetraodontiformes and mainly inhabit coastal waters along continents. Although no members of other tetraodontiform families have fully discarded their marine lives, approximately 30 tetraodontid species spend their entire lives in freshwaters in disjunct tropical regions of South America, Central Africa, and Southeast Asia. To investigate the interrelationships of tetraodontid pufferfishes and thereby elucidate the evolutionary origins of their freshwater habitats, we performed phylogenetic analysis based on whole mitochondrial genome sequences from 50 tetraodontid species and closely related species (including 31 newly determined sequences). The resulting phylogenies reveal that the family is composed of four major lineages and that freshwater species from the different continents are independently nested in two of the four lineages. A monophyletic origin of the use of freshwater habitats was statistically rejected, and ancestral habitat reconstruction on the resulting tree demonstrates that tetraodontids independently entered freshwater habitats in different continents at least three times. Relaxed molecular-clock Bayesian divergence time estimation suggests that the timing of these invasions differs between continents, occurring at 0–10 million years ago (MA) in South America, 17–38 MA in Central Africa, and 48–78 MA in Southeast Asia. These timings are congruent with geological events that could facilitate adaptation to freshwater habitats in each continent