Algoritmos de derivación y confirmación diagnóstica de citología cervical atípica: desafíos para la actualización

Indexación: ScieloEl Programa Nacional de Pesquisa y Control del Cáncer Cervicouterino de Chile ha contribuido al descenso sostenido de la mortalidad por cáncer de cuello uterino. Para la reducción de esta mortalidad ha sido fundamental la citología exfoliativa del cérvix, la que no está exenta de resultados inciertos. En este sentido, los frotis clasificados como atípicos se consideran ambiguos por la presencia de anomalías celulares de difícil determinación, lo que se traduce en un diagnóstico de probabilidad incierta. En la literatura nacional como internacional, se manifiesta un notorio interés por unificar la nomenclatura citológica cervical y los algoritmos de derivación y confirmación diagnóstica, para el manejo clínico de las mujeres con anomalías citológicas cervicales y lesiones precursoras de cáncer cervicouterino. Por lo anterior, se considera relevante los estudios que proporcionen evidencia clínica epidemiológica actualizada, que permitan optimizar el cumplimiento del Programa Nacional de Cáncer Cervicouterino, conducentes al logro de los Objetivos Sanitarios del período 2011-2020.The National Research and Control of Cervical Cancer in Chile had contributed to the sustained decline in mortality from cervical cancer. The exfoliative cytology of the cervix has been to reduce this mortality, which is not without uncertain results. The smears classified as atypical are considered ambiguous by the presence of cellular abnormalities difficult to determine, resulting in a diagnosis of uncertain probability. The literature, both nationally and internationally, is widespread interest to unify the nomenclature cervical cytology and the support of the derivation algorithms for the clinical management of women with cytologic abnormalities cervical and cervical cancer precursor lesions. Therefore, it is relevant to perform studies the provide updated epidemiological clinical evidence, to optimize the performance of the National Program for the achievement of health objectives for the period 2011-2020.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-75262012000400015&nrm=is

A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study

__Background:__ Persistent hyperlactatemia is particularly difficult to interpret in septic shock. Besides hypoperfusion, adrenergic-driven lactate production and impaired lactate clearance are important contributors. However, clinical recognition of different sources of hyperlactatemia is unfortunately not a common practice and patients are treated with the same strategy despite the risk of over-resuscitation in some. Indeed, pursuing additional resuscitation in non-hypoperfusion-related cases might lead to the toxicity of fluid overload and vasoactive drugs. We hypothesized that two different clinical patterns can be recognized in septic shock patients through a multimodal perfusion monitoring. Hyperlactatemic patients with a hypoperfusion context probably represent a more severe acute circulatory dysfunction, and the absence of a hypoperfusion context is eventually associated with a good outcome. We performed a retrospective analysis of a database of septic shock patients with persistent hyperlactatemia after initial resuscitation. __Results:__ We defined hypoperfusion context by the presence of a ScvO2 < 70%, or a P(cv-a)CO2 ≥6 mmHg, or a CRT ≥4 s together with hyperlactatemia. Ninety patients were included, of whom seventy exhibited a hypoperfusion-related pattern and 20 did not. Although lactate values were comparable at baseline (4.8 ± 2.8 vs. 4.7 ± 3.7 mmol/L), patients with a hypoperfusion context exhibited a more severe circulatory dysfunction with higher vasopressor requirements, and a trend to longer mechanical ventilation days, ICU stay, and more rescue therapies. Only one of the 20 hyperlactatemic patients without a hypoperfusion context died (5%) compared to 11 of the 70 with hypoperfusion-related hyperlactatemia (16%). __Conclusions:__ Two different clinical patterns among hyperlactatemic septic shock patients may be identified according to hypoperfusion context. Patients with hyperlactatemia plus low ScvO2, or high P(cv-a)CO2, or high CRT values exhibited a more severe circulatory dysfunction. This provides a starting point to launch further prospective studies to confirm if this approach can lead to a more selective resuscitation strategy

Impairment of exogenous lactate clearance in experimental hyperdynamic septic shock is not related to total liver hypoperfusion

Introduction: Although the prognostic value of persistent hyperlactatemia in septic shock is unequivocal, its physiological determinants are controversial. Particularly, the role of impaired hepatic clearance has been underestimated and is only considered relevant in patients with liver ischemia or cirrhosis. Our objectives were to establish whether endotoxemia impairs whole body net lactate clearance, and to explore a potential role for total liver hypoperfusion during the early phase of septic shock. Methods: After anesthesia, 12 sheep were subjected to hemodynamic/perfusion monitoring including hepatic and portal catheterization, and a hepatic ultrasound flow probe. After stabilization (point A), sheep were alternatively assigned to lipopolysaccharide (LPS) (5 mcg/kg bolus followed by 4 mcg/kg/h) or sham for a three-hour study period. After 60 minutes of shock, animals were fluid resuscitated to normalize mean arterial pressure. Repeated series of measurements were performed immediately after fluid resuscitation (point B), and one (point C) and two hours later (point D). Monitoring included systemic and regional hemodynamics, blood gases and lactate measurements, and ex-vivo hepatic mitochondrial respiration at point D. Parallel exogenous lactate and sorbitol clearances were performed at points B and D. Both groups included an intravenous bolus followed by serial blood sampling to draw a curve using the least squares method. Results: Significant hyperlactatemia was already present in LPS as compared to sham animals at point B (4.7 (3.1 to 6.7) versus 1.8 (1.5 to 3.7) mmol/L), increasing to 10.2 (7.8 to 12.3) mmol/L at point D. A significant increase in portal and hepatic lactate levels in LPS animals was also observed. No within-group difference in hepatic DO2, VO2 or O2 extraction, total hepatic blood flow (point D: 915 (773 to 1,046) versus 655 (593 to 1,175) ml/min), mitochondrial respiration, liver enzymes or sorbitol clearance was found. However, there was a highly significant decrease in lactate clearance in LPS animals (point B: 46 (30 to 180) versus 1,212 (743 to 2,116) ml/min, P <0.01; point D: 113 (65 to 322) versus 944 (363 to 1,235) ml/min, P <0.01). Conclusions: Endotoxemia induces an early and severe impairment in lactate clearance that is not related to total liver hypoperfusion

Turbulence and hypoxia contribute to dense biological scattering layers in a Patagonian fjord system

The aggregation of plankton species along fjords can be linked to physical properties and processes such as stratification, turbulence and oxygen concentration. The goal of this study is to determine how water column properties and turbulent mixing affect the horizontal and vertical distributions of macrozooplankton along the only northern Patagonian fjord known to date, where hypoxic conditions occur in the water column. Acoustic Doppler current profiler moorings, scientific echo-sounder transects and in situ plankton abundance measurements were used to study macrozooplankton assemblages and migration patterns along Puyuhuapi Fjord and Jacaf Channel in Chilean Patagonia. The dissipation of turbulent kinetic energy was quantified through vertical microstructure profiles collected throughout time in areas with high macrozooplankton concentrations. The acoustic records and in situ macrozooplankton data revealed diel vertical migrations (DVM) of siphonophores, chaetognaths and euphausiids. In particular, a dense biological backscattering layer was observed along Puyuhuapi Fjord between the surface and the top of the hypoxic boundary layer ( ∼ 100&thinsp;m), which limited the vertical distribution of most macrozooplankton and their DVM, generating a significant reduction of habitat. Aggregations of macrozooplankton and fishes were most abundant around a submarine sill in Jacaf Channel. In this location macrozooplankton were distributed throughout the water column (0 to  ∼ 200&thinsp;m), with no evidence of a hypoxic boundary due to the intense mixing near the sill. In particular, turbulence measurements taken near the sill indicated high dissipation rates of turbulent kinetic energy (ε ∼ 10−5&thinsp;W&thinsp;kg−1) and vertical diapycnal eddy diffusivity (Kρ ∼ 10−3&thinsp;m2&thinsp;s−1). The elevated vertical mixing ensures that the water column is well oxygenated (3–6&thinsp;mL&thinsp;L−1, 60&thinsp;%–80&thinsp;% saturation), creating a suitable environment for macrozooplankton and fish aggregations. Turbulence induced by tidal flow over the sill apparently enhances the interchange of nutrients and oxygen concentrations with the surface layer, creating a productive environment for many marine species, where the prey–predator relationship might be favored.</p

Variable stars in the VVV globular clusters. II. NGC6441, NGC6569, NGC6626 (M28), NGC6656 (M22), 2MASS-GC02, and Terzan10

© ESO 2021. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1051/0004-6361/202140546Context. The Galactic globular clusters (GGCs) located in the inner regions of the Milky Way suffer from high extinction that makes their observation challenging. High densities of field stars in their surroundings complicate their study even more. The VISTA Variables in the Via Lactea (VVV) survey provides a way to explore these GGCs in the near-infrared where extinction effects are highly diminished. Aims. We conduct a search for variable stars in several inner GGCs, taking advantage of the unique multi-epoch, wide-field, near-infrared photometry provided by the VVV survey. We are especially interested in detecting classical pulsators that will help us constrain the physical parameters of these GGCs. In this paper, the second of a series, we focus on NGC 6656 (M 22), NGC 6626 (M 28), NGC 6569, and NGC 6441; these four massive GGCs have known variable sources, but quite different metallicities. We also revisit 2MASS-GC 02 and Terzan 10, the two GGCs studied in the first paper of this series. Methods. We present an improved method and a new parameter that efficiently identify variable candidates in the GGCs. We also use the proper motions of those detected variable candidates and their positions in the sky and in the color-magnitude diagrams to assign membership to the GGCs. Results. We identify and parametrize in the near-infrared numerous variable sources in the studied GGCs, cataloging tens of previously undetected variable stars. We recover many known classical pulsators in these clusters, including the vast majority of their fundamental mode RR Lyrae. We use these pulsators to obtain distances and extinctions toward these objects. Recalibrated period-luminosity-metallicity relations for the RR Lyrae bring the distances to these GGCs to a closer agreement with those reported by Gaia, except for NGC 6441, which is an uncommon Oosterhoff III GGC. Recovered proper motions for these GGCs also agree with those reported by Gaia, except for 2MASS-GC 02, the most reddened GGC in our sample, where the VVV near-infrared measurements provide a more accurate determination of its proper motions.Peer reviewe

Young Stellar Clusters Containing Massive Young Stellar Objects in the VVV Survey

This is an author-created, un-copyedited version of an article published in The Astronomical Journal. IOP Publishing is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at: at doi: https://doi.org/10.3847/0004-6256/152/3/74. © 2016. The American Astronomical Society. All rights reserved. IOPScience PublishingThe purpose of this research is to study the connection of global properties of eight young stellar clusters projected in the Vista Variables in the Via Lactea (VVV) ESO Large Public Survey disk area and their young stellar object population. The analysis in based on the combination of spectroscopic parallax-based reddening and distance determinations with main sequence and pre-main sequence ishochrone fitting to determine the basic parameters (reddening, age, distance) of the sample clusters. The lower mass limit estimations show that all clusters are low or intermediate mass (between 110 and 1800 Mo), the slope Gamma of the obtained present-day mass functions of the clusters is close to the Kroupa initial mass function. On the other hand, the young stellar objects in the surrounding cluster's fields are classified by low resolution spectra, spectral energy distribution fit with theoretical predictions, and variability, taking advantage of multi-epoch VVV observations. All spectroscopically confirmed young stellar objects (except one) are found to be massive (more than 8 Mo). Using VVV and GLIMPSE color-color cuts we have selected a large number of new young stellar object candidates, which are checked for variability and 57% are found to show at least low-amplitude variations. In few cases it was possible to distinguish between YSO and AGB classification on the basis of the light curves.Peer reviewedFinal Accepted Versio

Aportes al conocimiento del sistema productivo de cultivo de la mora (Rubus glaucus Benth) en Colombia

Varios estudios que examinan el cultivo de la mora en Colombia muestran que esta actividad es realizada por pequeños y medianos agricultores. En muchas regiones constituye una de las principales fuentes de ingresos; generación de empleo rural; oferta de alimento y de agroindustria. En este trabajo se revisaron más de 180 documentos distribuidos entre artículos divulgativos, técnicos y científicos, publicados en boletines, manuales, cartillas, seminarios y cursos; además, resultados de trabajos de investigación, tesis de pregrado y artículos científicos publicados en revistas seriadas e indexadas. Este es resultado de la búsqueda la literatura de la agronomía del sistema productivo de la mora en la red, en la Biblioteca Agropecuaria de Colombia (BAC), en las bibliotecas de de la Universidad Nacional de Colombia y en las bibliotecas de los investigadores del CI La Selva de Corpoica. Para analizar la literatura sobre la agronomía y las prácticas de manejo agronómico de la mora (distribución espacial, trazado y siembra, propagación, tutorado, poda, entre otras). Del manejo agronómico se han escrito diversas publicaciones unas más profundas que otras, estas se caracterizan porque para la mayoría de las practicas agronómicas se carece de un sustento que las valide, para los diferentes ambiente y genotipos y muchas de ellas son el resultado de la observación, del sentido común y de adaptación de otro sistema productivo. Esta literatura surge en la década de 50’s, en la de los 70’ se dan las versiones más integrales del sistema productivo y durante la década de los 90’s, es el periodo dorado cuando se consolida y se presentan los trabajos mas completos, aun todavía faltando, la integralidad entre genotipo, ambiente y la interacción entre estos.Mora-Rubus ulmifoliu

Current tidal power technologies and their suitability for applications in coastal and marine areas

A considerable body of research is currently being performed to quantify available tidal energy resources and to develop efficient devices with which to harness them. This work is naturally focussed on maximising power generation from the most promising sites, and a review of the literature suggests that the potential for smaller scale, local tidal power generation from shallow near-shore sites has not yet been investigated. If such generation is feasible, it could have the potential to provide sustainable electricity for nearby coastal homes and communities as part of a distributed generation strategy, and would benefit from easier installation and maintenance, lower cabling and infrastructure requirements and reduced capital costs when compared with larger scale projects. This article reviews tidal barrages and lagoons, tidal turbines, oscillating hydrofoils and tidal kites to assess their suitability for small-scale electricity generation in shallow waters. This is achieved by discussing the power density, scalability, durability, maintainability, economic potential and environmental impacts of each concept. The performance of each technology in each criterion is scored against axial-flow turbines, allowing for them to be ranked according to their overall suitability. The review suggests that tidal kites and range devices are not suitable for small-scale shallow water applications due to depth and size requirements respectively. Cross-flow turbines appear to be the most suitable technology, as they have high power densities and a maximum size that is not constrained by water depth

Ruxolitinib in refractory acute and chronic graft-versus-host disease : a multicenter survey study

Graft-versus-host disease is the main cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. First-line treatment is based on the use of high doses of corticosteroids. Unfortunately, second-line treatment for both acute and chronic graft-versus-host disease, remains a challenge. Ruxolitinib has been shown as an effective and safe treatment option for these patients. Seventy-nine patients received ruxolitinib and were evaluated in this retrospective and multicenter study. Twenty-three patients received ruxolitinib for refractory acute graft-versus-host disease after a median of 3 (range 1-5) previous lines of therapy. Overall response rate was 69.5% (16/23) which was obtained after a median of 2 weeks of treatment, and 21.7% (5/23) reached complete remission. Fifty-six patients were evaluated for refractory chronic graft-versus-host disease. The median number of previous lines of therapy was 3 (range 1-10). Overall response rate was 57.1% (32/56) with 3.5% (2/56) obtaining complete remission after a median of 4 weeks. Tapering of corticosteroids was possible in both acute (17/23, 73%) and chronic graft-versus-host disease (32/56, 57.1%) groups. Overall survival was 47% (CI: 23-67%) at 6 months for patients with aGVHD (62 vs 28% in responders vs non-responders) and 81% (CI: 63-89%) at 1 year for patients with cGVHD (83 vs 76% in responders vs non-responders). Ruxolitinib in the real life setting is an effective and safe treatment option for GVHD, with an ORR of 69.5% and 57.1% for refractory acute and chronic graft-versus-host disease, respectively, in heavily pretreated patients