Estado actual de los estudios de conservación de las pinturas rupestres esquemáticas del Monte Valonsadero (Soria) y propuestas para su protección y salvaguarda

El primero de los autores reúne aquí su experiencia, de más de veinte años de estudio y seguimiento de las pinturas rupestres esquemáticas del Monte Valonsadero, con las síntesis —que él mismo traza y los demás autores anotan, corrigen o amplían— de los trabajos de estudio de la alteración de las areniscas que soportan los paneles pintados, de los análisis mineralógicos de sus pinturas y de la conservación y posible medidas para su protección, cuando se aproxima el año 2001, fecha en que este interesante núcleo de arte rupestre cumplirá cincuenta años de su descubrimiento. El interés de los autores está centrado en la necesidad de salvaguardar este tipo de manifestaciones, para lo cual entienden como prioritario el conocimiento de su estado de conservación y la llamada de atención a la Administración a fin de que ésta desarrolle sobre aquéllas cuantas actuaciones sean precisas para cumplir con la inexorable obligación de legarlas, al menos en su situación actual, a la posterioridad.The first one oí the authors assembles his experience of more than twenty-year-old study made of the schematic rock paintings in Monte Valonsadero, together with the syntheses —also made by him and later revised by the other authors— firstly of the studies of the alteration of the sandstone which support the paintings, secondly of the mineralogical analysis of the paint, and finally aiming to the preservation and possible actions for their protection. This article has an especial significance owing to the closeness of the year 2001, date on which the discovery of this interesting cave art nucleus will be fifty years of age. The main interest of tfie authors aims at the necessity of safeguarding tfiis type of paintings and ttiat is why they give priority to the knowledge of the preservation level in which the paintings are and, at the same time, they make a cali on the Authorities attention so that they could make any precise action to fulfil their inexorable duty to leave the paintings, at least as they are nowadays, to posterity

Neuroaxial anesthesia caused paraplegia: a case report

Patients who undergo; anesthesia, neuraxial analgesia, or some type of neuraxial blockage are exposed to multiple complications. 33-year-old male patient, suffers a femur fracture with a long oblique trace causing pain and functional limitation for movements. Surgical resolution is determined using neuraxial block at L2-L3 level, and intravenous sedation. During his postoperative follow-up, a decrease in strength was confirmed in the lower limbs with 0/5 on the Daniels scale, 100% sensitivity without sphincter control, steroids were prescribed along with magnetic resonance imaging and a neurosurgical evaluation was requested. The MRI shows bulging of the fibrous annulus that obliterates the epidural fat and makes contact with the thecal sac in the L5-S1 intervertebral disc level. The neurosurgery service prescribes rehabilitation sessions at home, electrostimulation and neuropathic medications. Patient was discharged with rehabilitation sessions at home and medical treatment. In his last consultation, an evaluation from the psychiatry department was requested for ideas of disability, hopelessness, fantasies of death without a suicide plan related to limitations and loss of functionality. Patient does not return to external follow-up, cannot be located

Interaction of 8He with 208Pb at near-barrier energies: 4He and 6He production

Angular distributions for the inclusive 4He and 6He production cross sections in the 8He+208Pb system at incident energies of 16 and 22 MeV measured at the SPIRAL facility of the GANIL laboratory are presented. Using a combination of kinematical arguments and distorted wave Born approximation (DWBA) calculations, neutron transfer reactions were inferred to be the dominant contributors to both inclusive cross sections. Model-dependent values for the ratios of two- to one-neutron stripping, s2n/s1n, were derived and compared with previous results for 8He and 6He projectiles incident on other heavy targets. Three- and four-neutron stripping were inferred to be the main processes leading to 4He production, although the exact mechanism remains to be elucidated.The authors would like to thank the staff of the GANIL accelerator facility for providing the high-quality 8He beam. This work was supported in part by Grants No. FPA-2010-22131-CO2-01 (FINURA) and No. FPA2013-47327-C2-1-R from the Spanish Ministry of Economy and Competitiveness, UNAM-PAPIIT IA103218 (Mexico); Grant No. N202 033637 from the Ministry of Science and Higher Education of Poland; the National Science Centre of Poland under Contracts No. 2013/08/M/ST2/00257 (LEA-COPIGAL) and No. 2014/14/M/ST2/00738 (COPIN-INFN Collaboration); and Grant No. EUI2009-04163432 (EUROGENESIS) from the European Science Foundation

Chronic venous insufficiency: a review

Chronic venous insufficiency (CVI) comprises a complete spectrum of morphological and functional abnormalities of the venous system1 including any long-term functional and morphological alteration. CVI accounts for several abnormalities of the venous system. It is a highly prevalent disease that causes serious economic consequences, a decrease in the quality of life and can lead to serious complications. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to chronic venous insufficiency. The pathophysiology of chronic venous insufficiency begins with chronic venous hypertension and the dilation of the vessel, this leads to a series of pathological changes in the venous wall and surrounding tissues, in advanced stages of CVI, skin lesions are associated with an increased proliferation of skin capillaries and microcirculatory abnormalities that may be the result of an altered level of factors responsible for the angiogenic response, such as vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2) and angiostatin. In this review, updates on pathophysiology, clinic, diagnosis, classification and treatment of this disease are analyzed, with special emphasis on therapeutic options. Chronic venous insufficiency is a disease that affects the patient at several levels, mainly diminishing his/her quality of life. Currently there are various treatments ranging from habit modifications, pharmacological, to endovenous and surgical treatment.

Familial hypercholesterolaemia: A study of 36 cases with a phenotype of homozygous familiar hypercholesterolaemia

La hipercolesterolemia familiar homocigótica (HFHo) se caracteriza por niveles muy elevados de cLDL y por enfermedad aterosclerótica temprana. Aunque la frecuencia es baja (1/300.000), las complicaciones son muy severas y pueden ser evitadas. Encontrar y tratar esta población de manera temprana podría reducir la mortalidad. Se describen 36 casos en Colombia, en donde se calcula que haya entre 160 y 200 casos. Resultados Un total de 36 pacientes con fenotipo sugestivo de HFHo fueron identificados y tratados en un período de observación de cuatro años. La media de edad fue 27 años (24 mujeres). 34 pacientes tuvieron un puntaje según la Red de Clínicas de Lípidos de Holanda (RCLH) mayor de 8 (diagnóstico definitivo) y los restantes 2 tenían puntaje equivalente a diagnóstico probable. Un cuarto de los casos procedían de la costa norte colombiana. En las pruebas genéticas, 14 fueron homocigóticos verdaderos para mutación del gen que codifica para el receptor de LDL (LDLR), 12 heterocigóticos compuestos, 2 heterocigóticos dobles y uno autosómico recesivo (LDLRAP1); 5 pacientes fueron heterocigóticos simples (LDLR) y 2 pacientes no autorizaron la prueba. En los homocigóticos verdaderos, la variante más frecuente encontrada fue la c.11G>A. 14 pacientes cursaron con enfermedad coronaria, 9 con estenosis carotídea, 8 con estenosis aórtica y 2 tuvieron ataques cerebrovasculares (ACV). 34 pacientes recibían estatinas (24 rosuvastatina), 30 recibían ezetimibe, 2 recibían evolocumab y 20 recibían lomitapide (dosis promedio 12,7mg). Ninguno recibió aféresis de cLDL. Los medicamentos, en general, fueron bien tolerados y la reducción promedio de cLDL con la terapia fue de 533,7mg/dl a 245,1mg/dl (54%). Conclusiones Todos los pacientes recibieron tratamiento hipolipemiante y se encontraron alteraciones genéticas diagnósticas en todos aquellos que autorizaron el examen. Los niveles elevados de cLDL conllevan tanto riesgo que el tratamiento debe establecerse aún sin conocer el diagnóstico genético.Homozygous familial hypercholesterolemia (HoFH) is characterized for very high levels of cLDL and early cardiovascular disease. Although incidence is low (1/300 000), complications are very severe and can be avoided. Finding and treating this population promptly could reduce mortality. We describe 36 cases in Colombia, where 160 to 200 cases are expected. Results 36 patients with phenotype of HoHF were identified and treated in a follow-up of 4 years. The mean age was 27 years (24 women). 34 of them had at least 8 points in the FH Dutch Lipid Clinic Criteria (definitive diagnosis) and two had probable diagnosis. A quarter of the cases came from the Colombian North Coast. In molecular tests, 14 were true homozygous for LDLR, 12 were compound heterozygous for LDLR, 2 double heterozygous and one was autosomal recessive; 5 were heterozygous and 2 patients did not authorized genetic test. In true homozygous subjects, the most frequent variant was c.11G>A. 14 patients had coronary disease, 9 carotid stenosis, 8 aortic stenosis and 2 had stroke. 34 patients were on statins (25 rosuvastatin), 30 were receiving ezetimibe, 2 were receiving a PSCK9 inhibitor (evolocumab) and 20 were on lomitapide with mean doses of 12.7mg. None received lipoprotein apheresis. Medications were very well tolerated. Changes in cLDL after therapy was from 533.7 mg/dL to 245 mg/dL, (54%). Conclusions Treatment was started in all patients. We found genetic mutations in all patients with genetic tests. The high levels of cLDL mean such a high risk that treatment must be started promptly, even without a genetic test

Regulation of cell death receptor S-nitrosylation and apoptotic signaling by Sorafenib in hepatoblastoma cells

Nitric oxide (NO) plays a relevant role during cell death regulation in tumor cells. The overexpression of nitric oxide synthase type III (NOS-3) induces oxidative and nitrosative stress, p53 and cell death receptor expression and apoptosis in hepatoblastoma cells. S-nitrosylation of cell death receptor modulates apoptosis. Sorafenib is the unique recommended molecular-targeted drug for the treatment of patients with advanced hepatocellular carcinoma. The present study was addressed to elucidate the potential role of NO during Sorafenib-induced cell death in HepG2 cells. We determined the intra- and extracellular NO concentration, cell death receptor expression and their S-nitrosylation modifications, and apoptotic signaling in Sorafenib-treated HepG2 cells. The effect of NO donors on above parameters has also been determined. Sorafenib induced apoptosis in HepG2 cells. However, low concentration of the drug (10nM) increased cell death receptor expression, as well as caspase-8 and -9 activation, but without activation of downstream apoptotic markers. In contrast, Sorafenib (10 µM) reduced upstream apoptotic parameters but increased caspase-3 activation and DNA fragmentation in HepG2 cells. The shift of cell death signaling pathway was associated with a reduction of S-nitrosylation of cell death receptors in Sorafenib-treated cells. The administration of NO donors increased S-nitrosylation of cell death receptors and overall induction of cell death markers in control and Sorafenib-treated cells. In conclusion, Sorafenib induced alteration of cell death receptor S-nitrosylation status which may have a relevant repercussion on cell death signaling in hepatoblastoma cells.Instituto de Salud Carlos III PI13/00021Ministerio de Economía y Competitividad BFU2012-32056Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía BIO-0216Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía CTS-6264Consejería de Salud, Junta de Andalucía PI13/ 0002

Management of a ruptured epidural catheter, an anesthesiologist's dilemma: a case report

Epidural anesthesia is a widely used anesthetic technique in lower extremity surgeries although it is a relatively safe procedure, it can have complications, such as rupture of the epidural catheter. This is a 69-year-old male patient with a diagnosis of Wagner IV diabetic foot is presented, which was scheduled for left supracondylar amputation in which after epidural block, retention of the catheter tip in the epidural space at level L2-L3 was seen, so hemi laminectomy was performed in a second surgical stage in L2 and removal of the epidural catheter. Ideally a broken needle should be removed as soon as possible

Arte Rupestre en el Karst de Ojo Guareña (Merindad de Sotoscueva-Burgos) : trabajos de documentación y estudio en «La Sala de La Fuente»

La amplia nómina de autores que firman el presente artículo dan forma al equipo multidisciplinar que en 1995 inició un ambicioso proyecto, subvencionado por la Junta de Castilla y León, denominado «Trabajos de Documentación y Estudio del Arte Rupestre en el Karst de Ojo Guareña». El avance de sus primeros trabajos está recogido en el siguiente texto y fue presentado al Primer Congreso de Arqueología Burgalesa (1998), mas, al no haberse publicado éste, sigue aún inédito. Su interés, y de forma especial la continuidad de la investigación, aconseja a los autores su edición en Espacio, Tiempo y Forma con vistas a una mayor difusión del proyecto y, con ello, a un mejor conocimiento de la grafía rupestre de las galerías subterráneas del norte de la provincia de Burgos.The wide number of researchers who sign the present añide joined in the multi-discipline team that started an ambitious project, which was sponsored by the regional authority: Junta de Castilla y León, called «Records and Research on Cave Art at the karst in Ojo Guareña». The deveiopment of thelr first researches Is shown in the present Ítem and it was also presented in the First Burgos Archaeology Congress (1998), although it is still unavailable since it has never been published. Both, the Importance of its contents and specially the continuity of the research led its authors to publish this article in Espacio, Tiempo y Forma so that the project could be widely known and, at the same time, provide a better knowledge of rock graphics in the underground galleries which can be found in the north of Burgos province