Solid pseudopapillary tumor of the páncreas

Antecedentes: la neoplasia sólida pseudopapilar del páncreas es una entidad rara, que típicamente se presenta en mujeres jóvenes. Suele presentar síntomas abdominales inespecíficos. Es un tumor maligno de bajo grado de malignidad.Objetivos: el objetivo del siguiente informe de serie de casos es presentar 9 casos tratados en un centro y realizar una revisión bibliográfica del tema.Material y métodos: estudio retrospectivo descriptivo de los casos con diagnóstico anatomopatológico de neoplasia sólida pseudopapilar en el Servicio de Cirugía General, desde febrero de 2013 hasta septiembre de 2019. Se contemplaron como variables: edad, sexo, localización del tumor, tratamiento quirúrgico realizado, tiempo operatorio, complicaciones, estancia hospitalaria y seguimiento alejado.Resultados: fueron 9 casos, todos de sexo femenino con media de edad de 30 años (rango 20 a 70 años). La localización más frecuente fue en cola de páncreas en 4 casos (45%). Todas las pacientes fueron sometidas a cirugía, con abordaje laparoscópico en el 60% de los casos (n = 5); la resección pancreática distal con preservación esplénica fue la conducta más utilizada (n = 6). Se constataron tres complicaciones, de las cuales dos fueron colecciones abdominales como consecuencia de una fístula pancreática que se abordaron por vía percutánea, y la restante fue un retardo del vaciamiento gástrico por lo cual la paciente requirió internación prolongada.Conclusión: la neoplasia sólida pseudopapilar pancreática es una enfermedad poco frecuente, maligna pero con bajo riesgo de malignidad. Presenta buena sobrevida cuando se somete a cirugía de carácter curativo; la laparoscopia es la vía de abordaje de elección en centros con experiencia.Background: Solid pseudopapillary tumor of the pancreas is a rare condition that affects young women. The most common symptom is unspecific abdominal pain. It is a malignant tumor of low malignant potential. Objective: The aim of this study is to report a case series of patients treated in a single center and perform a bibliographic review. Material and methods: We conducted a retrospective study of the cases with pathological diagnosis of solid pseudopapillary tumor of the pancreas treated in the Department of General Surgery between February 2013 and September 2019. The following variables were analyzed; age, sex, tumor location, surgical treatment, operative time, complications, length of hospital stay and long-term follow-up. Results: Nine patients were included; all of them were women with mean age of 30 years (range: 20 - 70 years). The most common location of the tumor was the tail of the pancreas (n = 4; 45%). Surgery was performed in all the cases; five cases underwent video-assisted laparoscopy and spleen-preserving distal pancreatectomy was the technique more commonly used (n = 6). Three complications were recorded: two abdominal collections due to biliary leaks were trated by percutaneous approach and the other patient presented delayed gastric emptying and required prolonged hospitalization. Conclusion: Solid pseudopapillary tumor pf the pancreas is a rare low-grade malignant neoplasm. The prognosis is favorable after surgery and laparoscopy is the preferred approach in centers with experience.Fil: Montes, Leonardo Ezequiel. Fundación Favaloro; ArgentinaFil: Alaniz, Jimena. Fundación Favaloro; ArgentinaFil: Dieguez Palacios, Andres. Fundación Favaloro; ArgentinaFil: Varela, Estanislao. Fundación Favaloro; ArgentinaFil: Lobos, Fernando D.. Fundación Favaloro; ArgentinaFil: Fernandez, Florencia M.. Fundación Favaloro; ArgentinaFil: Farinelli, Pablo. Fundación Favaloro; ArgentinaFil: Ramisch, Diego. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentin

Multidisciplinary Collaboration in the Treatment of Patients With Type 2 Diabetes in Primary Care: Analysis Using Process Mining

[EN] Background: Public health in several countries is characterized by a shortage of professionals and a lack of economic resources. Monitoring and redesigning processes can foster the success of health care institutions, enabling them to provide a quality service while simultaneously reducing costs. Process mining, a discipline that extracts knowledge from information system data to analyze operational processes, affords an opportunity to understand health care processes. Objective: Health care processes are highly flexible and multidisciplinary, and health care professionals are able to coordinate in a variety of different ways to treat a diagnosis. The aim of this work was to understand whether the ways in which professionals coordinate their work affect the clinical outcome of patients. Methods: This paper proposes a method based on the use of process mining to identify patterns of collaboration between physician, nurse, and dietitian in the treatment of patients with type 2 diabetes mellitus and to compare these patterns with the clinical evolution of the patients within the context of primary care. Clustering is used as part of the preprocessing of data to manage the variability, and then process mining is used to identify patterns that may arise. Results: The method is applied in three primary health care centers in Santiago, Chile. A total of seven collaboration patterns were identified, which differed primarily in terms of the number of disciplines present, the participation intensity of each discipline, and the referrals between disciplines. The pattern in which the three disciplines participated in the most equitable and comprehensive manner had a lower proportion of highly decompensated patients compared with those patterns in which the three disciplines participated in an unbalanced manner. Conclusions: By discovering which collaboration patterns lead to improved outcomes, health care centers can promote the most successful patterns among their professionals so as to improve the treatment of patients. Process mining techniques are useful for discovering those collaborations patterns in flexible and unstructured health care processes.This paper was partially funded by the National Commission for Scientific and Technological Research, the Formation of Advanced Human Capital Program and the National Fund for Scientific and Technological Development (CONICYT-PCHA/Doctorado Nacional/2016-21161705 and CONICYT-FONDECYT/1150365; Chile). The authors would like to thank Ancora UC primary health care centers for their help with this research. The founding sponsors had no role in the design of the study in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.Conca, T.; Saint Pierre, C.; Herskovic, V.; Sepulveda, M.; Capurro, D.; Prieto, F.; Fernández Llatas, C. (2018). Multidisciplinary Collaboration in the Treatment of Patients With Type 2 Diabetes in Primary Care: Analysis Using Process Mining. JOURNAL OF MEDICAL INTERNET RESEARCH. 20(4). https://doi.org/10.2196/jmir.8884S204Chen, C.-C., Tseng, C.-H., & Cheng, S.-H. (2013). Continuity of Care, Medication Adherence, and Health Care Outcomes Among Patients With Newly Diagnosed Type 2 Diabetes. Medical Care, 51(3), 231-237. doi:10.1097/mlr.0b013e31827da5b9International Diabetes FederationIDF20152018-03-19IDF Diabetes Atlas 7th Edition (2015) https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/13-diabetes-atlas-seventh-edition.htmlMinisterio de Salud de Chileminsal.cl20102018-03-23Encuesta Nacional de Salud ENS Chile 2009-2010 http://www.minsal.cl/estudios_encuestas_salud/Ministerio de Salud de Chileminsal.cl20102018-03-20Guía Clinica Diabetes Mellitus Tipo 2 http://www.minsal.cl/portal/url/item/72213ed52c3e23d1e04001011f011398.pdfSapunar Z., J. (2016). EPIDEMIOLOGÍA DE LA DIABETES MELLITUS EN CHILE. Revista Médica Clínica Las Condes, 27(2), 146-151. doi:10.1016/j.rmclc.2016.04.003World Health Organizationwho.int2018-03-20Global Report on Diabetes http://www.who.int/diabetes/global-report/en/Poblete, F., Glasinovic, A., Sapag, J., Barticevic, N., Arenas, A., & Padilla, O. (2015). Apoyo social y salud cardiovascular: adaptación de una escala de apoyo social en pacientes hipertensos y diabéticos en la atención primaria chilena. Atención Primaria, 47(8), 523-531. doi:10.1016/j.aprim.2014.10.010Tuligenga, R. H., Dugravot, A., Tabák, A. G., Elbaz, A., Brunner, E. J., Kivimäki, M., & Singh-Manoux, A. (2014). Midlife type 2 diabetes and poor glycaemic control as risk factors for cognitive decline in early old age: a post-hoc analysis of the Whitehall II cohort study. The Lancet Diabetes & Endocrinology, 2(3), 228-235. doi:10.1016/s2213-8587(13)70192-xGamiochipi, M., Cruz, M., Kumate, J., & Wacher, N. H. (2016). Effect of an intensive metabolic control lifestyle intervention in type-2 diabetes patients. Patient Education and Counseling, 99(7), 1184-1189. doi:10.1016/j.pec.2016.01.017Wagner, E. H. (2001). Effect of Improved Glycemic Control on Health Care Costs and Utilization. JAMA, 285(2), 182. doi:10.1001/jama.285.2.182McDonald, J., Jayasuriya, R., & Harris, M. F. (2012). The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus. BMC Health Services Research, 12(1). doi:10.1186/1472-6963-12-63Gucciardi, E., Espin, S., Morganti, A., & Dorado, L. (2016). Exploring interprofessional collaboration during the integration of diabetes teams into primary care. BMC Family Practice, 17(1). doi:10.1186/s12875-016-0407-1Caron, F., Vanthienen, J., Vanhaecht, K., Limbergen, E. V., De Weerdt, J., & Baesens, B. (2014). Monitoring care processes in the gynecologic oncology department. Computers in Biology and Medicine, 44, 88-96. doi:10.1016/j.compbiomed.2013.10.015Rothman, A. A., & Wagner, E. H. (2003). Chronic Illness Management: What Is the Role of Primary Care? Annals of Internal Medicine, 138(3), 256. doi:10.7326/0003-4819-138-3-200302040-00034Organisation for Economic Co-operation and DevelopmentOECD20162018-03-20OECD Health Policy Overview: Health Policy in Chile http://www.oecd.org/els/health-systems/health-policy-in-your-country.htmRojas, E., Munoz-Gama, J., Sepúlveda, M., & Capurro, D. (2016). Process mining in healthcare: A literature review. Journal of Biomedical Informatics, 61, 224-236. doi:10.1016/j.jbi.2016.04.007Fernandez-Llatas, C., Lizondo, A., Monton, E., Benedi, J.-M., & Traver, V. (2015). Process Mining Methodology for Health Process Tracking Using Real-Time Indoor Location Systems. Sensors, 15(12), 29821-29840. doi:10.3390/s151229769Mans, R. S., van der Aalst, W. M. P., & Vanwersch, R. J. B. (2015). Process Mining in Healthcare. SpringerBriefs in Business Process Management. doi:10.1007/978-3-319-16071-9Van der Aalst, W. M. P. (2011). Process Mining. doi:10.1007/978-3-642-19345-3Kim, E., Kim, S., Song, M., Kim, S., Yoo, D., Hwang, H., & Yoo, S. (2013). Discovery of Outpatient Care Process of a Tertiary University Hospital Using Process Mining. Healthcare Informatics Research, 19(1), 42. doi:10.4258/hir.2013.19.1.42Harper, P. R., Sayyad, M. G., de Senna, V., Shahani, A. K., Yajnik, C. S., & Shelgikar, K. M. (2003). A systems modelling approach for the prevention and treatment of diabetic retinopathy. European Journal of Operational Research, 150(1), 81-91. doi:10.1016/s0377-2217(02)00787-7Rebuge, Á., & Ferreira, D. R. (2012). Business process analysis in healthcare environments: A methodology based on process mining. Information Systems, 37(2), 99-116. doi:10.1016/j.is.2011.01.003Ferreira, D., Zacarias, M., Malheiros, M., & Ferreira, P. (2007). Approaching Process Mining with Sequence Clustering: Experiments and Findings. Business Process Management, 360-374. doi:10.1007/978-3-540-75183-0_26Cheong, L. H., Armour, C. L., & Bosnic-Anticevich, S. Z. (2013). Multidisciplinary collaboration in primary care: through the eyes of patients. Australian Journal of Primary Health, 19(3), 190. doi:10.1071/py12019Boyle, E., Saunders, R., & Drury, V. (2016). A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners. Journal of Clinical Nursing, 25(13-14), 1977-1986. doi:10.1111/jocn.13219UddinSHossainLEffects of Physician Collaboration Network on Hospital Outcomes2012Fifth Australasian Workshop on Health Informatics and Knowledge Management (HIKM 2012)2012Melbourne, AustraliaBorgermans, L., Goderis, G., Van Den Broeke, C., Verbeke, G., Carbonez, A., Ivanova, A., … Grol, R. (2009). Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project. 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The ocean sampling day consortium.

Ocean Sampling Day was initiated by the EU-funded Micro B3 (Marine Microbial Biodiversity, Bioinformatics, Biotechnology) project to obtain a snapshot of the marine microbial biodiversity and function of the world's oceans. It is a simultaneous global mega-sequencing campaign aiming to generate the largest standardized microbial data set in a single day. This will be achievable only through the coordinated efforts of an Ocean Sampling Day Consortium, supportive partnerships and networks between sites. This commentary outlines the establishment, function and aims of the Consortium and describes our vision for a sustainable study of marine microbial communities and their embedded functional traits

The ocean sampling day consortium

Ocean Sampling Day was initiated by the EU-funded Micro B3 (Marine Microbial Biodiversity, Bioinformatics, Biotechnology) project to obtain a snapshot of the marine microbial biodiversity and function of the world’s oceans. It is a simultaneous global mega-sequencing campaign aiming to generate the largest standardized microbial data set in a single day. This will be achievable only through the coordinated efforts of an Ocean Sampling Day Consortium, supportive partnerships and networks between sites. This commentary outlines the establishment, function and aims of the Consortium and describes our vision for a sustainable study of marine microbial communities and their embedded functional traits

De las aulas a los ambientes naturales... Conservamos nuestro patrimonio natural

El presente trabajo es resultado del proyecto de extensión UNNE res. 109/18 C.S., en el cual participaron integrantes de la FaCENA (UNNE), EBCo (MACN- CONICET), docentes y estudiantes de distintos niveles educativos de la provincia de Corrientes, guardaparques del Parque Pcial San Cayetano (PPSC, San Cayetano, Corrientes) y guías del Aluseo de Ciencias Naturales Amado Bonpland y de Casa Iberá (Corrientes, Corrientes). El objetivo principal fue fortalecer valores ambientales relacionados a temas de biodiversidad y conservación, principalmente mamíferos y sus ambientes naturales. Entre ellos, se trató aquellas especies bajo protección como los monumentos naturales de la provincia (aguará guazú, lobito de río, ciervo de los pantanos, venados de las pampas y oso hormiguero), y otras de importancia ecológica, cultural y/o económica como monos carayá, guazunchos, zorros, carpinchos y tatiíes. Esta experiencia fue un punto de partida para la integración didáctica entre los conocimientos científicos generados en la EBCo y la UNNE y los contenidos del Diseño Curricular de Corrientes, siendo la metodología talleres de educación no formal en las aulas y visitas guiadas al PPSC, Museo de Cs. Naturales Bonpland y/o Casa Iberá. Esta interacción permitió a la comunidad involucrada, el desarrollo de habilidades, actitudes y conocimientos en espacios generados para favorecer el reconocimiento, la reflexión, la valoración, el respeto de su Patrimonio Natural como un elemento clave hacia una mejor calidad de vida a futuro.Fil: Romero, Verónica Lorena. Universidad Nacional del Nordeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kowalewski, Miguel Martin. Universidad Nacional del Nordeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: Cespedez, Jorge Abel. Universidad Nacional del Nordeste; ArgentinaFil: Godoy, Angelina M.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: Obregon, Cesar A.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: Romero, Barbara G.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: Fernandez, Patricia M.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: Alegre, Rocío A.. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas y Naturales y Agrimensura; ArgentinaFil: Bay, Rodrigo. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas y Naturales y Agrimensura; ArgentinaFil: Landi, Mauricio A.. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas y Naturales y Agrimensura; ArgentinaFil: Mayer, Joaquin. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas y Naturales y Agrimensura; ArgentinaFil: Pucheta, Daniela. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas y Naturales y Agrimensura; ArgentinaFil: Quijano, Romina Florencia. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas y Naturales y Agrimensura; ArgentinaFil: Romero, Marta I. G.. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas y Naturales y Agrimensura; Argentin

Phosphorylation of Chromosome Core Components May Serve as Axis Marks for the Status of Chromosomal Events during Mammalian Meiosis

Meiotic recombination and chromosome synapsis between homologous chromosomes are essential for proper chromosome segregation at the first meiotic division. While recombination and synapsis, as well as checkpoints that monitor these two events, take place in the context of a prophase I-specific axial chromosome structure, it remains unclear how chromosome axis components contribute to these processes. We show here that many protein components of the meiotic chromosome axis, including SYCP2, SYCP3, HORMAD1, HORMAD2, SMC3, STAG3, and REC8, become post-translationally modified by phosphorylation during the prophase I stage. We found that HORMAD1 and SMC3 are phosphorylated at a consensus site for the ATM/ATR checkpoint kinase and that the phosphorylated forms of HORMAD1 and SMC3 localize preferentially to unsynapsed chromosomal regions where synapsis has not yet occurred, but not to synapsed or desynapsed regions. We investigated the genetic requirements for the phosphorylation events and revealed that the phosphorylation levels of HORMAD1, HORMAD2, and SMC3 are dramatically reduced in the absence of initiation of meiotic recombination, whereas BRCA1 and SYCP3 are required for normal levels of phosphorylation of HORMAD1 and HORMAD2, but not of SMC3. Interestingly, reduced HORMAD1 and HORMAD2 phosphorylation is associated with impaired targeting of the MSUC (meiotic silencing of unsynapsed chromatin) machinery to unsynapsed chromosomes, suggesting that these post-translational events contribute to the regulation of the synapsis surveillance system. We propose that modifications of chromosome axis components serve as signals that facilitate chromosomal events including recombination, checkpoint control, transcription, and synapsis regulation

Innate partnership of HLA-B and KIR3DL1 subtypes against HIV-1

Allotypes of the natural killer (NK) cell receptor KIR3DL1 vary in both NK cell expression patterns and inhibitory capacity upon binding to their ligands, HLA-B Bw4 molecules, present on target cells. Using a sample size of over 1,500 human immunodeficiency virus (HIV)+ individuals, we show that various distinct allelic combinations of the KIR3DL1 and HLA-B loci significantly and strongly influence both AIDS progression and plasma HIV RNA abundance in a consistent manner. These genetic data correlate very well with previously defined functional differences that distinguish KIR3DL1 allotypes. The various epistatic effects observed here for common, distinct KIR3DL1 and HLA-B Bw4 combinations are unprecedented with regard to any pair of genetic loci in human disease, and indicate that NK cells may have a critical role in the natural history of HIV infection