Identity of the commune of Hualpen and some of its main urban-populational elements

Before being created in 2003, the commune of Hualpén was foreseeing as a large neighbourhood of the commune of Talcahuano, and its name was related semantically to the area of Hualpencillo.Hualpén’s urban development, initiated in the middle of the twentieth century with the creation of Hualpencillo’s airport as one of the few of the country, can be understood as a sum of neighbourhood settlements that were randomly arranged in the urban communal territory and that are still undergoing a process of consolidation.This article reviews some of the most relevant and recognisable urban elements that form part of the current inter-communal conurbation Concepción- Talcahuano, that for its size and population represents one of the focal points of one of the main metropolitan areas of Chile.La actual comuna de Hualpén, antes de ser creada en el año 2003, se vislumbraba como un gran barrio de la comuna de Talcahuano y se relacionaba su nombre semánticamente como el sector de Hualpencillo.El desarrollo urbanístico de Hualpén, que se inicia a mediados del siglo XX con la instalación del Aeródromo de Hualpencillo como uno de los pocos del país, se puede entender como una sumatoria de asentamientos poblacionales que fueron dispuestos en forma aleatoria en el territorio urbano comunal y que aún se encuentra en proceso de consolidación.En este trabajo, se reconocen algunos de los principales y más reconocibles elementos urbanos que conforman parte de la actual conurbación de la intercomuna Concepción-Talcahuano y que por su extensión y población la convierten en un área neurálgica de una de los principales áreas metropolitanas de Chile

Small bowel obstruction due to laparoscopic barbed sutures: An unknown complication?

Background: In recent years there has been an increasing uptake in the use of barbed sutures, particularly in minimally invasive and laparoscopic procedures where they may reduce operating time and improve surgical efficiency. However, little is known about the adverse events associated with these new materials and concerns have arisen regarding their safety in certain procedures. Methods: We performed a search of electronic databases (PubMed, EMBASE, and Cochrane Database). We reveal up to 15 cases of small bowel obstruction (SBO) complicating laparoscopic pelvic surgery that have been reported to date adding two cases of SBO in our own practice following the use of barbed sutures in laparoscopic operations, both requiring surgical re-intervention in the early post-operative period. Results: Fifteen similar cases of small bowel obstruction were identified, all of which occurred in patients undergoing surgery below the transverse colon. Surgical re-intervention was required in all cases although 60% of these were performed laparoscopically. Conclusions: These cases highlight that although barbed sutures provide an attractive means to allow easier and faster laparoscopic suturing, they should be used carefully in inframesocolic surgery and the suture end cut and buried to avoid inadvertent attachment to the small bowel or its mesentery. Barbed suture entanglement should be considered as an uncommon yet potentially serious differential cause for SBO presenting in the early period after laparoscopic surgery where a barbed suture has been used

Multi-institutional expert update on the use of laparoscopic bile duct exploration (LBDE) in the management of choledocholithiasis: lesson learned from 3950 procedures

Background: Recently there has been a growing interest in the laparoscopic management of common bile duct stones with gallbladder in situ (LBDE), which is favoring the expansion of this technique. Our study identified the standardization factors of LBDE and its implementation in the single-stage man agement of choledocholithiasis. Methods: A retrospective multi-institutional study among 17 centers with proven experience in LBDE was performed. A cross-sectional survey consisting of a semi-structured pretested questionnaire was distributed covering the main aspects on the use of LBDE in the management of choledocholithiasis. Results: A total of 3950 LBDEs were analyzed. The most frequent indication was jaundice (58.8%). LBDEs were performed after failed ERCP in 15.2%. The most common approach used was the transcystic (63.11%). The overall series failure rate of LBDE was 4% and the median rate for each center was 6% (IQR, 4.5-12.5). Median operative time ranged between 60-120 min (70.6%). Overall morbidity rate was 14.6%, with a postoperative bile leak and complications ≥3a rate of 4.5% and 2.5%, respectively. The operative time decreased with experience (P = .03) and length of hospital stay was longer in the presence of a biliary leak (P = .04). Current training of LBDE was defined as poor or very poor by 82.4%. Conclusion: Based on this multicenter survey, LBDE is a safe and effective ap proach when performed by experienced teams. The generalization of LBDE will be based on developing training programs

Gene expression analysis of aberrant signaling pathways in meningiomas

Examining aberrant pathway alterations is one method for understanding the abnormal signals that are involved in tumorigenesis and tumor progression. In the present study, expression arrays were performed on tumor-related genes in meningiomas. The GE Array Q Series HS-006 was used to determine the expression levels of 96 genes that corresponded to six primary biological regulatory pathways in a series of 42 meningiomas, including 32 grade I, four recurrent grade I and six grade II tumors, in addition to three normal tissue controls. Results showed that 25 genes that were primarily associated with apoptosis and angiogenesis functions were downregulated and 13 genes frequently involving DNA damage repair functions were upregulated. In addition to the inactivation of the neurofibromin gene, NF2, which is considered to be an early step in tumorigenesis, variations of other biological regulatory pathways may play a significant role in the development of meningiomaThis study was partially supported by Fondo de Investigaciones Sanitarias, Ministerio de Ciencia e Innovación, Spain, Grants PI‑08/1849 and PI‑10/1972; and by grant PI‑10‑045 from the Fundación Sociosanitaria de Castilla‑La Mancha, Spai

Malformations of the craniocervical junction (chiari type I and syringomyelia: classification, diagnosis and treatment)

Chiari disease (or malformation) is in general a congenital condition characterized by an anatomic defect of the base of the skull, in which the cerebellum and brain stem herniate through the foramen magnum into the cervical spinal canal. The onset of Chiari syndrome symptoms usually occurs in the second or third decade (age 25 to 45 years). Symptoms may vary between periods of exacerbation and remission. The diagnosis of Chiari type I malformation in patients with or without symptoms is established with neuroimaging techniques. The most effective therapy for patients with Chiari type I malformation/syringomyelia is surgical decompression of the foramen magnum, however there are non-surgical therapy to relieve neurophatic pain: either pharmacological and non-pharmacological. Pharmacological therapy use drugs that act on different components of pain. Non-pharmacological therapies are primarly based on spinal or peripheral electrical stimulation

Prevalence of disability in a composite ≥75 year-old population in Spain: A screening survey based on the International Classification of Functioning

<p>Abstract</p> <p>Background</p> <p>The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF.</p> <p>Methods</p> <p>Nine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2^ndedition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100).</p> <p>Results</p> <p>The age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32).</p> <p>Conclusions</p> <p>Disability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.</p

Genetic Cross-Interaction between APOE and PRNP in Sporadic Alzheimer's and Creutzfeldt-Jakob Diseases

Alzheimer's disease (AD) and Creutzfeldt-Jakob disease (CJD) represent two distinct clinical entities belonging to a wider group, generically named as conformational disorders that share common pathophysiologic mechanisms. It is well-established that the APOE ε4 allele and homozygosity at polymorphic codon 129 in the PRNP gene are the major genetic risk factors for AD and human prion diseases, respectively. However, the roles of PRNP in AD, and APOE in CJD are controversial. In this work, we investigated for the first time, APOE and PRNP genotypes simultaneously in 474 AD and 175 sporadic CJD (sCJD) patients compared to a common control population of 335 subjects. Differences in genotype distribution between patients and control subjects were studied by logistic regression analysis using age and gender as covariates. The effect size of risk association and synergy factors were calculated using the logistic odds ratio estimates. Our data confirmed that the presence of APOE ε4 allele is associated with a higher risk of developing AD, while homozygosity at PRNP gene constitutes a risk for sCJD. Opposite, we found no association for PRNP with AD, nor for APOE with sCJD. Interestingly, when AD and sCJD patients were stratified according to their respective main risk genes (APOE for AD, and PRNP for sCJD), we found statistically significant associations for the other gene in those strata at higher previous risk. Synergy factor analysis showed a synergistic age-dependent interaction between APOE and PRNP in both AD (SF = 3.59, p = 0.027), and sCJD (SF = 7.26, p = 0.005). We propose that this statistical epistasis can partially explain divergent data from different association studies. Moreover, these results suggest that the genetic interaction between APOE and PRNP may have a biological correlate that is indicative of shared neurodegenerative pathways involved in AD and sCJD

Tratamiento laparoscópico en un episodio de la litiasis de la vía principal con vesícula in situ. La vía transductal, la vía transcística y la influencia de las nuevas tecnologías: técnica LABEL

[ES] Hipótesis: Clásicamente, antes de la CPRE, el tratamiento de la litiasis del colédoco con vesícula in situ se realizaba en un solo episodio con cirugía abierta. Desde el advenimiento de la CPRE en los años 80 el abordaje ha sido en dos episodios, primero una CPRE preoperatoria seguida de CL. En los últimos años y gracias a la cirugía laparoscópica se esta retomando el abordaje quirúrgico en un solo episodio: CLCIO± ELVB. Nuestra hipótesis se basa en que consideramos que el abordaje en un episodio es el más adecuado para tratar esta patología al requerir solo un ingreso, con ventajas económicas, logísticas, de morbilidad y probablemente, ayudado por las nuevas tecnologías (Láser, miniendoscopios) asociado a una menor tasa de fallo y menor incidencia de falsos positivos, dado que se trata de una exploración sincrónica de la vía biliar. Objetivos: - Objetivo principal. Evaluar la eficacia y seguridad del tratamiento de pacientes con coledocolitiasis y vesícula “in situ”, mediante la realización simultánea, por vía laparoscópica, de Colecistectomía + Colangiografía intraoperatoria ± Exploración de la Vía Biliar. - Objetivos secundarios. 1.-Analizar la efectividad y morbilidad de los distintos abordajes laparoscópicos de la vía biliar principal: El transductal y el transcístico. 2.- Evaluar los resultados, seguridad y complicaciones de la Técnica LABEL (Laser Assisted Bile duct Exploration by Laparoendoscopy) en nuestra serie. 3.- Evaluar la eficacia del acceso transinfundibular a la vía biliar principal, su efecto en el número de coledocotomías y la posible repercusión en el diagnóstico y tratamiento de los pacientes con síndrome de Mirizzi tipo 2. 4.- Evaluar la aplicabilidad, integración en vías clínicas y reproductibilidad de la técnica

Identidad urbana de la Comuna de Hualpén y algunos de sus principales elementos urbano poblacionales

La actual comuna de Hualpén, antes de ser creada en el año 2003, se vislumbraba como un gran barrio de la comuna de Talcahuano y se relacionaba su nombre semánticamente como el sector de Hualpencillo. El desarrollo urbanístico de Hualpén, que se inicia a mediados del siglo XX con la instalación del Aeródromo de Hualpencillo como uno de los pocos del país, se puede entender como una sumatoria de asentamientos poblacionales que fueron dispuestos en forma aleatoria en el territorio urbano comunal y que aún se encuentra en proceso de consolidación. En este trabajo, se reconocen algunos de los principales y más reconocibles elementos urbanos que conforman parte de la actual conurbación de la intercomuna Concepción-Talcahuano y que por su extensión y población la convierten en un área neurálgica de una de los principales áreas metropolitanas de Chile