Acerca de la historia reciente de la arqueología patagónica

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COLECISTECTOMÍA LAPAROSCÓPICA POR COLECISTITIS ALITIÁSICA EN PACIENTE CON SITUS INVERSUS TOTALIS

Introducción: La Incidencia de Situs Inversus Totalis (SIT) es de 1:400.000 nacidos vivos, caracterizada por error en la migración de órganos torácicos y abdominales durante el desarrollo embrionario, colocándose como una “imagen de espejo” con respecto al eje sagital de la posición anatómica normal, puede ser parte del síndrome de Kartagener, donde además existe infertilidad e infecciones respiratorias a repetición. La colecistitis o inflamación de la vesícula biliar, es una patología frecuente, que, asociado al SIT, presenta manifestaciones clínicas especiales por la ubicación del dolor en lado izquierdo del abdomen, lo que retrasa el diagnóstico y la resolución. Objetivo: Reportar un caso de Colecistitis alitiásica y Situs Inversus Totalis. Descripción del caso:  Paciente femenina de 72 años, que acudió a emergencias en varias ocasiones por dolor tipo cólico, en hipocondrio izquierdo, estudios como ecografía abdominal, ecocardiograma confirma la presencia de SIT y Colecistitis alitiásica. El laboratorio expresa leucocitosis. Se programa la Colecistectomía por vía laparoscópica, realizando el procedimiento quirúrgico con la distribución de los trócares en forma de espejo, mirando hacia el lado izquierdo del paciente. Evolución clínica: satisfactoria sin complicaciones. Se establece protocolo para descartar Síndrome de Kartagener, en vista de antecedentes respiratorios. Conclusiones: La colecistitis es una patología con una alta incidencia, pero en combinación con el SIT es poco frecuente. La mayoría de los pacientes con SIT, tienen una vida normal, su diagnóstico precoz orienta ante la presencia de patologías quirúrgicas agudas, con características clínicas especiales como la ubicación del dolor en el lado opuesto, retrasando el diagnóstico y la resolución quirúrgica con abordaje en modalidades especiales   Palabras clave: colecistitis alitiásica, colecistectomía, síndrome de Kartagener, situs inversus.   ABSTRACT Introduction: The incidence of Situs Inversus Totalis (SIT) is 1:400,000 live births, characterized by an error in the migration of thoracic and abdominal organs during embryonic development, positioning itself as a "mirror image" with respect to the sagittal axis of the normal anatomical position, it may be part of Kartagener's syndrome, where there is also infertility and recurrent respiratory infections. Cholecystitis or inflammation of the gallbladder is a frequent pathology, which, associated with SIT, presents special clinical manifestations due to the location of pain on the left side of the abdomen, which delays diagnosis and resolution. Objective: To report a case of acalculous cholecystitis and Situs Inversus Totalis. Description of the case: A 72-year-old female patient, who went to the emergency room on several occasions due to colicky pain in the left hypochondrium, studies such as abdominal ultrasound, echocardiogram confirmed the presence of SIT and acalculous cholecystitis. The laboratory expresses leukocytosis. Laparoscopic cholecystectomy is scheduled, performing the surgical procedure with the distribution of the trocars in the form of a mirror, looking towards the left side of the patient. Clinical evolution: satisfactory without complications. A protocol is established to rule out Kartagener's Syndrome, in view of a respiratory history. Conclusions: Cholecystitis is a pathology with a high incidence, but in combination with SIT it is rare. Most of the patients with SIT have a normal life, their early diagnosis guides the presence of acute surgical pathologies, with special clinical characteristics such as the location of the pain on the opposite side, delaying the diagnosis and surgical resolution with an approach in modalities specials   Keywords: acalculous cholecystitis, cholecystectomy, Kartagener syndrome, situs inversus

Rendimiento de la canal y ganancia de peso en vacas de descarte con inducción del anestro por vías quirúrgica versus mecánica

Orquera, M.L.; Pochon, D.O.; Flores, S.; Konrad, J.L.; Crudeli, G.A.: Rendimiento de la canal y ganancia de peso en vacas de descarte con inducción de anestro por vías quirúrgica versus mecánica. Rev. vet. 22: 1, 64–67, 2011. Palabras clave: vaca descarte, dispositivo intrauterino, castración quirúrgica, ganancia de peso, performance de canal

Longer and less overlapping food webs in anthropogenically disturbed marine ecosystems: confirmations from the past

The human exploitation of marine resources is characterised by the preferential removal of the largest species. Although this is expected to modify the structure of food webs, we have a relatively poor understanding of the potential consequences of such alteration. Here, we take advantage of a collection of ancient consumer tissues, using stable isotope analysis and SIBER to assess changes in the structure of coastal marine food webs in the South-western Atlantic through the second half of the Holocene as a result of the sequential exploitation of marine resources by hunter-gatherers, western sealers and modern fishermen. Samples were collected from shell middens and museums. Shells of both modern and archaeological intertidal herbivorous molluscs were used to reconstruct changes in the stable isotopic baseline, while modern and archaeological bones of the South American sea lion Otaria flavescens, South American fur seal Arctocephalus australis and Magellanic penguin Spheniscus magellanicus were used to analyse changes in the structure of the community of top predators. We found that ancient food webs were shorter, more redundant and more overlapping than current ones, both in northern-central Patagonia and southern Patagonia. These surprising results may be best explained by the huge impact of western sealing on pinnipeds during the fur trade period, rather than the impact of fishing on fish populations. As a consequence, the populations of pinnipeds at the end of the sealing period were likely well below the ecosystem's carrying capacity, which resulted in a release of intraspecific competition and a shift towards larger and higher trophic level prey. This in turn led to longer and less overlapping food webs

Utilization of mechanical power and associations with clinical outcomes in brain injured patients. a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

BackgroundThere is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes.MethodsIn this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale <= 12 before intubation) who required mechanical ventilation (MV) >= 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS).ResultsWe included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22).ConclusionsExposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Effect of resource spatial correlation and Hunter-Fisher-Gatherer mobility on social cooperation in Tierra del Fuego

This article presents an agent-based model designed to explore the development of cooperation in hunter-fisher-gatherer societies that face a dilemma of sharing an unpredictable resource that is randomly distributed in space. The model is a stylised abstraction of the Yamana society, which inhabited the channels and islands of the southernmost part of Tierra del Fuego (Argentina-Chile). According to ethnographic sources, the Yamana developed cooperative behaviour supported by an indirect reciprocity mechanism: whenever someone found an extraordinary confluence of resources, such as a beached whale, they would use smoke signals to announce their find, bringing people together to share food and exchange different types of social capital. The model provides insight on how the spatial concentration of beachings and agents’ movements in the space can influence cooperation. We conclude that the emergence of informal and dynamic communities that operate as a vigilance network preserves cooperation and makes defection very costly.MICINN http://www.idi.mineco.gob.es/ CSD2010-00034 (SimulPast CONSOLIDER-INGENIO 2010) and HAR2009-06996; the government of Castilla y Leónhttp://www.jcyl.es/ GREX251-2009; the Argentine CONICET http://www.conicet.gov.ar/PIP-0706; and the Wenner-Gren Foundation for Anthropological Researchhttp://www.wennergren.org/ "Social Aggregation: A Yamana Society's Short Term Episode to Analyse Social Interaction, Tierra del Fuego, Argentina". The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip

Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Biallelic sequence and structural variants in RAX2 are a novel cause for autosomal recessive inherited retinal disease.

Purpose RAX2 encodes a homeobox-containing transcription factor, in which four monoallelic pathogenic variants have been described in autosomal dominant cone-dominated retinal disease. Methods Exome sequencing in a European cohort with inherited retinal disease (IRD) (n = 2086) was combined with protein structure modeling of RAX2 missense variants, bioinformatics analysis of deletion breakpoints, haplotyping of RAX2 variant c.335dup, and clinical assessment of biallelic RAX2-positive cases and carrier family members. Results Biallelic RAX2 sequence and structural variants were found in five unrelated European index cases, displaying nonsyndromic autosomal recessive retinitis pigmentosa (ARRP) with an age of onset ranging from childhood to the mid-40s (average mid-30s). Protein structure modeling points to loss of function of the novel recessive missense variants and to a dominant-negative effect of the reported dominant RAX2 alleles. Structural variants were fine-mapped to disentangle their underlying mechanisms. Haplotyping of c.335dup in two cases suggests a common ancestry. Conclusion This study supports a role for RAX2 as a novel disease gene for recessive IRD, broadening the mutation spectrum from sequence to structural variants and revealing a founder effect. The identification of biallelic RAX2 pathogenic variants in five unrelated families shows that RAX2 loss of function may be a nonnegligible cause of IRD in unsolved ARRP cases