Manejo anestésico en un paciente con feocromocitoma y paragangliomas

Introduction: Pheochromocytoma and paraganglioma are neuroendocrine tumors of chromaffin cells with a low incidence, these tumors can be in the adrenal glands and between 25% are located extra-adrenal and are called paraganglioma. Material and methods: A 56-year-old patient with a diagnosis of pheochromocytoma, with symptoms of paroxysmal arterial hypertension, tachycardia, sweating, anxiety and with an abdominal tomography report that reports: mass of 4 x 1.8 x 3.5 centimeters located by behind the inferior vena cava compatible with a paraganglioma or pheochromocytoma. She underwent resection of the tumor with a high risk of tearing the inferior vena cava, invasive monitoring was performed, and anesthetic depth is important, administration of vasoactive drugs with the aim of reducing the peaks of arterial hypertension, arterial hypotension, arrhythmias, avoiding complications and providing patient safety. Discussion: Anesthetic management is a challenge due to intraoperative hemodynamic instability characterized by arrhythmias, abrupt variability of blood pressure. Among the drugs recommended for greater success:  doxazosin, magnesium sulfate, which prevent the release of catecholamines, dexmedetomidine, due to its sympatholytic effects, produce a decrease in plasma levels of norepinephrine. Conclusions: Thanks to multidisciplinary work, advances in technology, medications, it is possible that the risk of surgery and anesthesia are safer.Introducción: La feocromocitoma y paraganglioma son tumores neuroendocrinos de células cromafines de baja incidencia, la mayor parte se localiza en las glándulas suprarrenales y entre un 25% se de localización extra adrenal denominándose paraganglioma. Material y métodos: Paciente de 56 años con el diagnóstico de feocromocitoma, con sintomatología de hipertensión arterial paroxística, taquicardia, sudoración, ansiedad y con un informe de tomografía abdominal que reporta: masa de 4 x 1,8 x 3,5 centímetros localizada por detrás de la VCI compatible con un paraganglioma o feocromocitoma. Es sometida a resección del tumor con alto riesgo de desgarro de la vena cava inferior, se realizó monitorización invasiva, profundidad anestésica, administración de drogas vasoactivas para disminuir los picos de hipertensión arterial, hipotensión arterial, arritmias evitando las complicaciones y otorgando seguridad al paciente. Discusión: El manejo anestésico es un desafío por la inestabilidad hemodinámica durante el intraoperatorio. Entre los medicamentos recomendados para mayor éxito: doxazosina, sulfato de magnesio los cuales previenen la liberación de catecolaminas, la dexmedetomidina por sus efectos simpaticolíticos producen disminución de los niveles plasmáticos de norepinefrina. Conclusiones: Gracias al trabajo multidisciplinario, al avance de la tecnología y medicamentos es posible que el riesgo de la cirugía y anestesia sean más segura

Precipitation comparison for the CFSR, MERRA, TRMM3B42 and Combined Scheme datasets in Bolivia

AbstractAn overwhelming number of applications depend on reliable precipitation estimations. However, over complex terrain in regions such as the Andes or the southwestern Amazon, the spatial coverage of rain gauges is scarce. Two reanalysis datasets, a satellite algorithm and a scheme that combines surface observations with satellite estimations were selected for studying rainfall in the following areas of Bolivia: the central Andes, Altiplano, southwestern Amazonia, and Chaco. These Bolivian regions can be divided into three main basins: the Altiplano, La Plata, and Amazon. The selected reanalyses were the Modern-Era Retrospective Analysis for Research and Applications, which has a horizontal resolution (~50km) conducive for studying rainfall in relatively small precipitation systems, and the Climate Forecast System Reanalysis and Reforecast, which features an improved horizontal resolution (~38km). The third dataset was the seventh version of the Tropical Rainfall Measurement Mission 3B42 algorithm, which is conducive for studying rainfall at an ~25km horizontal resolution. The fourth dataset utilizes a new technique known as the Combined Scheme, which successfully removes satellite bias. All four of these datasets were aggregated to a coarser resolution. Additionally, the daily totals were calculated to match the cumulative daily values of the ground observations. This research aimed to describe and compare precipitations in the two reanalysis datasets, the satellite-algorithm dataset, and the Combined Scheme with ground observations. Two seasons were selected for studying the precipitation estimates: the rainy season (December–February) and the dry season (June–August). The average, bias, standard deviation, correlation coefficient, and root mean square error were calculated. Moreover, a contingency table was generated to calculate the accuracy, bias frequency, probability of detection, false alarm ratio, and equitable threat score.All four datasets correctly depicted the spatial rainfall pattern. However, CFSR and MERRA overestimated precipitation along the Andes' eastern-facing slopes and exhibited a dry bias over the eastern Amazon; TRMM3B42 and the Combined Scheme depicted a more realistic rainfall distribution over both the Amazon and the Andes. When separating the precipitation into classes, MERRA and CFSR overestimated light to moderate precipitation (1–20mm/day) and underestimated very heavy precipitation (>50mm/day). TRMM3B42 and CoSch depicted behaviors similar to the surface observations; however, CoSch underestimated the precipitation in very intense systems (>50mm/day).The statistical variables indicated that CoSch's correlation coefficient was highest for every season and basin. Additionally, the bias and RMSE values suggested that CoSch closely represented the surface observations

Manejo anestésico en hepatectomia parcial por hemangioma

Introduction: A giant hepatic hemangioma is a benign vascular tumor more frequent in females, when the tumor measures more than 10 centimeters it is considered giant and can cause symptoms such as abdominal pain, anemia, thrombocytopenia, Kasabach-Merritt syndrome under these criteria they become candidates for surgery. Material and methods: A 33-year-old female patient who has an abdominal tomography report which informed giant hepatic hemangioma in segments II, III and IV of 21x10x13.8 centimeters, without portal hypertension criteria. It is scheduled for left hepatectomy (liver segments II and III). In the first and second phase of surgery, the objective was to maintain a central venous pressure of 1 mmHg and a mean arterial pressure pressure greater than 70 mmHg, starting continuous infusion of Nitroglycerin 5-15 µg/min, norepinephrine 0.05 µg/kg/min, remifentanil 0.5 µg/kg/hour, dexmedetomidine 0.6 µg/kg/hour these doses were modified according to blood pressure and central venous pressure throughout the surgery. Vascular hemi-pringle was performed with duration of 15 minutes; blood loss in the second phase was approximately 4000 milliliters, replacing with transfusion of blood products. Discussion: There are several strategies to minimize intraoperative complications such as maintaining low central venous pressure, normovolemic hemodilution, fluid restriction, administration of furosemide, nitroglycerin, phenylephrine and dexmedetomidine. Conclusion: The role of the anesthesiologist is a challenge because there must be extensive knowledge about the surgical technique, the risks and complications involved during hepatectomy, however, a balance must be made between an anesthetic technique that allows the protection of organs and provide hemodynamic stability.Introducción: Un hemangioma hepático gigante es un tumor benigno vascular, más frecuente en el sexo femenino, cuando el tumor mide más de 10 centímetros es considerado gigante y puede ocasionar sintomatología como dolor abdominal, anemia, trombocitopenia síndrome de Kasabach-Merritt bajo estos criterios se convierten en candidatos para cirugía. Material y métodos: Paciente femenina de 33 años quien cuenta con un informe de tomografía abdominal que reporto hemangioma hepático gigante en segmentos II, III y IV de 21x10x13.8 centímetros, sin criterios de hipertensión portal. Se programa para hepatectomia izquierda (segmentos hepáticos II y III). En la primera y segunda fase de la cirugía el objetivo fue mantener una presión venosa central de 1 mmHg y una presión arterial media mayor a 70 mmHg iniciando infusión continua de Nitroglicerina 5-15 µg/min, noradrenalina 0.05 µg/kg/min, remifentanil 0.5 µg/kg/hora, dexmedetomidina 0,6 µg /kg/hora modificando las dosis según presión arterial y presión venosa central durante toda la cirugía. Se realizó hemi-pringle vascular con una duración de 15 minutos, la perdida sanguínea en la segunda fase fue 4000 mililitros aproximadamente reponiendo con transfusión de hemoderivados. Discusión: Existen varias estrategias para minimizar las complicaciones intraoperatoria como mantener presión venosa central baja, hemodilución normovolémica, restricción de líquidos, administración de furosemida, nitroglicerina, fenilefrina y dexmedetomidina. Conclusión: El rol del anestesiólogo es un reto porque se debe tener un amplio conocimiento sobre la técnica quirúrgica, los riesgos y complicaciones que implica durante la hepatectomia, sin embargo, se debe realizar un equilibrio entre una técnica anestésica que permita la protección de órganos y brindar estabilidad hemodinámica

Urges to Move and Other Motivation States for Physical Activity in Clinical and Healthy Populations: A Scoping Review Protocol

[EN] Motivation for bodily movement, physical activity and exercise varies from moment to moment. These motivation states may be “affectively-charged,” ranging from instances of lower tension (e.g., desires, wants) to higher tension (e.g., cravings and urges). Currently, it is not known how often these states have been investigated in clinical populations (e.g., eating disorders, exercise dependence/addiction, Restless Legs Syndrome, diabetes, obesity) vs. healthy populations (e.g., in studies of motor control; groove in music psychology). The objective of this scoping review protocol is to quantify the literature on motivation states, to determine what topical areas are represented in investigations of clinical and healthy populations, and to discover pertinent details, such as instrumentation, terminology, theories, and conceptual models, correlates and mechanisms of action. Iterative searches of scholarly databases will take place to determine which combination of search terms (e.g., “motivation states” and “physical activity”; “desire to be physically active,” etc.) captures the greatest number of relevant results. Studies will be included if motivation states for movement (e.g., desires, urges) are specifically measured or addressed. Studies will be excluded if referring to motivation as a trait. A charting data form was developed to scan all relevant documents for later data extraction. The primary outcome is simply the extent of the literature on the topic. Results will be stratified by population/condition. This scoping review will unify a diverse literature, which may result in the creation of unique models or paradigms that can be utilized to better understand motivation for bodily movement and exercise.GA was supported by a fellowship from the Office of Academic Affiliations at the United States Veterans Health Administration, a Robert E. Leet and Clara Guthrie Patterson Trust Mentored Research Award, Bank of America, N.A., Trustee, and American Heart Association Grant #852679 (GA, 2021–2024).We would like to thank Melissa Eden, Ph.D. (Hanover College, IN) for her valuable assistance in refining aspects of the search strategy. Khristdman Cavalcanti helped with technical aspects of the study. Sunao Akashi Slayton, PharmD BCOP (Smilow Cancer Hospital, Yale – New Haven Hospital, CT) evaluated clinical information and provided nomenclatur

Evidence for Interhemispheric Mercury Exchange in the Pacific Ocean Upper Troposphere

Even though anthropogenic mercury (Hg) emissions to the atmosphere are ∼2.5 times higher in the Northern Hemisphere (NH) than in the Southern Hemisphere (SH), atmospheric Hg concentrations in the NH are only ∼1.5 times higher than in the SH. Global Hg models attribute this apparent discrepancy to large SH oceanic Hg emissions or to interhemispheric exchange of Hg through the atmosphere. However, no observational data set exists to serve as a benchmark to validate whether these coarse-resolution models adequately represent the complex dynamics of interhemispheric Hg exchange. During the 2015–2016 El Niño, we observed at mount Chacaltaya in the tropical Andes a ∼50% increase in ambient Hg compared to the year before, coinciding with a shift in synoptic transport pathways. Using this event as a case study, we investigate the impact of interhemispheric exchange on atmospheric Hg in tropical South America. We use HYSPLIT to link Hg observations to long-range transport and find that the observed Hg increase relates strongly to air masses from the tropical Pacific upper troposphere (UT), a region directly impacted by interhemispheric exchange. Inclusion of the modeled seasonality of interhemispheric air mass exchange strengthens this relationship significantly. We estimate that interhemispheric exchange drives Hg seasonality in the SH tropical Pacific UT, with strongly enhanced Hg between July and October. We validate this seasonality with previously published aircraft Hg observations. Our results suggest that the transport of NH-influenced air masses to tropical South America via the Pacific UT occurs regularly but became more detectable at Chacaltaya in 2015–2016 because of a westward shift in air mass origin

Urges to Move and Other Motivation States for Physical Activity in Clinical and Healthy Populations: A Scoping Review Protocol

Motivation for bodily movement, physical activity and exercise varies from moment to moment. These motivation states may be "affectively-charged," ranging from instances of lower tension (e.g., desires, wants) to higher tension (e.g., cravings and urges). Currently, it is not known how often these states have been investigated in clinical populations (e.g., eating disorders, exercise dependence/addiction, Restless Legs Syndrome, diabetes, obesity) vs. healthy populations (e.g., in studies of motor control; groove in music psychology). The objective of this scoping review protocol is to quantify the literature on motivation states, to determine what topical areas are represented in investigations of clinical and healthy populations, and to discover pertinent details, such as instrumentation, terminology, theories, and conceptual models, correlates and mechanisms of action. Iterative searches of scholarly databases will take place to determine which combination of search terms (e.g., "motivation states" and "physical activity"; "desire to be physically active," etc.) captures the greatest number of relevant results. Studies will be included if motivation states for movement (e.g., desires, urges) are specifically measured or addressed. Studies will be excluded if referring to motivation as a trait. A charting data form was developed to scan all relevant documents for later data extraction. The primary outcome is simply the extent of the literature on the topic. Results will be stratified by population/condition. This scoping review will unify a diverse literature, which may result in the creation of unique models or paradigms that can be utilized to better understand motivation for bodily movement and exercise

Tropical tropospheric aerosol sources and chemical composition observed at high altitude in the Bolivian Andes

The chemical composition of PM10 and non-overlapping PM2.5 was studied at the summit of Mt. Chacaltaya (5380 m a.s.l., lat. −16.346950°, long. −68.128250°) providing a unique long-term record spanning from December 2011 to March 2020. The chemical composition of aerosol at the Chacaltaya Global Atmosphere Watch (GAW) site is representative of the regional background, seasonally affected by biomass burning practices and by nearby anthropogenic emissions from the metropolitan area of La Paz–El Alto. Concentration levels are clearly influenced by seasons with minima occurring during the wet season (December to March) and maxima occurring during the dry and transition seasons (April to November). Ions, total carbon (EC + OC), and saccharide interquartile ranges for concentrations are 558–1785, 384–1120, and 4.3–25.5 ng m−3 for bulk PM10 and 917–2308, 519–1175, and 3.9–24.1 ng m−3 for PM2.5, respectively, with most of the aerosol seemingly present in the PM2.5 fraction. Such concentrations are overall lower compared to other high-altitude stations around the globe but higher than Amazonian remote sites (except for OC). For PM10, there is dominance of insoluble mineral matter (33 %–56 % of the mass), organic matter (7 %–34 %), and secondary inorganic aerosol (15 %–26 %). Chemical composition profiles were identified for different origins: EC, NO3-, NH4+, glucose, and C2O42- for the nearby urban and rural areas; OC, EC, NO3-, K+, acetate, formate, levoglucosan, and some F− and Br− for biomass burning; MeSO3-, Na+, Mg2+, K+, and Ca2+ for aged marine emissions from the Pacific Ocean; arabitol, mannitol, and glucose for biogenic emissions; Na+, Ca2+, Mg2+, and K+ for soil dust; and SO42-, F−, and some Cl− for volcanism. Regional biomass burning practices influence the soluble fraction of the aerosol between June and November. The organic fraction is present all year round and has both anthropogenic (biomass burning and other combustion sources) and natural (primary and secondary biogenic emissions) origins, with the OC/EC mass ratio being practically constant all year round (10.5 ± 5.7, IQR 8.1–13.3). Peruvian volcanism has dominated the SO42- concentration since 2014, though it presents strong temporal variability due to the intermittence of the sources and seasonal changes in the transport patterns. These measurements represent some of the first long-term observations of aerosol chemical composition at a continental high-altitude site in the tropical Southern Hemisphere.</p

A community resource for paired genomic and metabolomic data mining

Genomics and metabolomics are widely used to explore specialized metabolite diversity. The Paired Omics Data Platform is a community initiative to systematically document links between metabolome and (meta)genome data, aiding identification of natural product biosynthetic origins and metabolite structures