Malformaciones venosas orofaciales de bajo flujo: esclerosis endoluminal con láser de diodo

ResumenIntroducciónLas anomalías vasculares son procesos frecuentes que se localizan en más del 50% de los casos en la región de la cabeza y el cuello. Las técnicas clásicas de tratamiento, tales como la cirugía y la esclerosis química, han dado paso a modernas técnicas menos invasivas, tales como el láser Nd:YAG. Por otra parte, se ha utilizado con éxito el láser de diodo (980 nm) para el tratamiento de varices mediante esclerosis endoluminal. Nuestra propuesta es la utilización del láser de diodo (λ 980 nm) para provocar una esclerosis por fotocoagulación intralesional de las malformaciones venosas de bajo flujo dada la capacidad de este láser de ser transmitido por fibra óptica.ObjetivoExponer nuestros resultados en el tratamiento de malformaciones venosas de bajo flujo (MVBF) orofaciales mediante la terapéutica de esclerosis endoluminal con láser de diodo.Material y métodosRevisamos 84 pacientes que presentaban MVBF orofaciales tratados con láser de diodo. Describimos la técnica de realización y se muestran los resultados postoperatorios a corto plazo.ResultadosTras un periodo de seguimiento no inferior a 12 meses se constató curación en el 95,24% aplicando una o dos sesiones y solamente en 4 casos se objetivó recidiva. Concluimos que la técnica de esclerosis endoluminal con láser de diodo de MVBF en el área orofacial se constituye como una nueva técnica de tratamiento, mínimamente invasiva, ambulatoria, y que permite la resolución de los casos sin tener que recurrir a cirugías más agresivas y con excelentes resultados funcionales y estéticos.AbstractBackgroundVascular anomalies are common processes that involve the head and neck region in more than 50% of the cases. Traditional treatment options such as surgery and chemical sclerosis have given way to modern less-invasive techniques, including Nd:YAG laser treatment. On the other hand, 980 nm laser diode has been successfully used for the endovenous sclerosis of varicose veins. Our proposal is the usage of diode laser (λ = 980 nm) to induce the sclerosis of low-flow venous malformations by intralesional photocoagulation, given this laser's ability to deliver the beam via a fiber optic cable.ObjectiveTo report our results in the treatment of orofacial low-flow venous malformations (LFVM) with diode laser endovenous sclerosis (DLES).Material and methods: The clinical records from 84 patients presenting with orofacial LFVM treated with DLES were collected. The technique used and short-term postoperative results were revised.ResultsAfter a follow-up period of at least 12 months after one or two DLES sessions, healing was observed in 95.24% of the cases. Only 4 cases showed relapse.ConclusionsThe DLES technique is a new therapeutic option for the treatment of orofacial LFVM, is minimally-invasive, allows an outpatient setting and achieves excellent functional and esthetic results avoiding more aggressive procedures

Real-World Multicenter Experience of Immunosuppression Minimization Among 661 Liver Transplant Recipients.

BACKGROUND Long-term morbidity and mortality in liver transplant recipients is frequently secondary to immunosuppression toxicity. However, data are scarce regarding immunosuppression minimization in clinical practice. MATERIAL AND METHODS In this cross-sectional, multicenter study, we reviewed the indications of immunosuppression minimization (defined as tacrolimus levels below 5 ng/mL or cyclosporine levels below 50 ng/mL) among 661 liver transplant recipients, as well as associated factors and the effect on renal function. RESULTS Fifty-three percent of the patients received minimized immunosuppression. The median time from transplantation to minimization was 32 months. The most frequent indications were renal insufficiency (49%), cardiovascular risk (19%), de novo malignancy (8%), and cardiovascular disease (7%). The factors associated with minimization were older age at transplantation, longer post-transplant follow-up, pre-transplant diabetes mellitus and renal dysfunction, and the hospital where the patients were being followed. The patients who were minimized because of renal insufficiency had a significant improvement in renal function (decrease of the median serum creatinine level, from 1.50 to 1.34 mg/dL; P=0.004). Renal function significantly improved in patients minimized for other indications, too. In the long term, glomerular filtration rate significantly decreased in non-minimized patients and remained stable in minimized patients. CONCLUSIONS Immunosuppression minimization is frequently undertaken in long-term liver transplant recipients, mainly for renal insufficiency. Substantial variability exists regarding the use of IS minimization among centers

Prevalence of vertebral fractures and their prognostic significance in the survival in patients with chronic kidney disease stages 3-5 not on dialysis

The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. 612 NDD 3-5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. VF were detected in 110patients(18%). Serumphosphatelevels(OR0.719,95%CI0.532to0.972,p = 0.032),ankle-brachial index 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009-3.898, p = 0.047) were an independent predictor of all-cause mortality. In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3-5 NDD-CKD patients. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis

Revisión bibliográfica de implantología bucofacial del año 2007

Se expone una revisión de la literatura científica publicada en revistas indexadas durante el año 2007 sobre Implantología Bucofacial. La escasez de tiempo de que disponen los profesionales para consultar las múltiples fuentes de información, ha motivado a los autores a resumir los artículos publicados y clasificarlos en los siguientes apartados: generalidades, pacientes especiales, superficies y diseños, tejidos blandos, implantes inmediatos, carga inmediata, complicaciones, elevación sinusal, técnicas avanzadas, plasma rico en plaquetas y factores de crecimiento, cirugía guiada, cirugía mínimamente invasiva y miniimplantes, con la intención de facilitar una puesta al día

Observation of Pulsed Gamma-rays Above 25 GeV from the Crab Pulsar with MAGIC

One fundamental question about pulsars concerns the mechanism of their pulsed electromagnetic emission. Measuring the high-end region of a pulsar's spectrum would shed light on this question. By developing a new electronic trigger, we lowered the threshold of the Major Atmospheric gamma-ray Imaging Cherenkov (MAGIC) telescope to 25 GeV. In this configuration, we detected pulsed gamma-rays from the Crab pulsar that were greater than 25 GeV, revealing a relatively high cutoff energy in the phase-averaged spectrum. This indicates that the emission occurs far out in the magnetosphere, hence excluding the polar-cap scenario as a possible explanation of our measurement. The high cutoff energy also challenges the slot-gap scenario.Comment: Slight modification of the analysis: Fitting a more general function to the combined data set of COMPTEL, EGRET and MAGIC. Final result and conclusion is unchange

First bounds on the high-energy emission from isolated Wolf-Rayet binary systems

High-energy gamma-ray emission is theoretically expected to arise in tight binary star systems (with high mass loss and high velocity winds), although the evidence of this relationship has proven to be elusive so far. Here we present the first bounds on this putative emission from isolated Wolf-Rayet (WR) star binaries, WR 147 and WR 146, obtained from observations with the MAGIC telescope.Comment: (Authors are the MAGIC Collaboration.) Manuscript in press at The Astrophysical Journal Letter

First bounds on the very high energy gamma-ray emission from Arp 220

Using the Major Atmospheric Gamma Imaging Cherenkov Telescope (MAGIC), we have observed the nearest ultra-luminous infrared galaxy Arp 220 for about 15 hours. No significant signal was detected within the dedicated amount of observation time. The first upper limits to the very high energy $\gamma$-ray flux of Arp 220 are herein reported and compared with theoretical expectations.Comment: Accepted for publication in Ap

MAGIC Upper Limits for two Milagro-detected, Bright Fermi Sources in the Region of SNR G65.1+0.6

We report on the observation of the region around supernova remnant G65.1+0.6 with the stand-alone MAGIC-I telescope. This region hosts the two bright GeV gamma-ray sources 1FGL J1954.3+2836 and 1FGL J1958.6+2845. They are identified as GeV pulsars and both have a possible counterpart detected at about 35 TeV by the Milagro observatory. MAGIC collected 25.5 hours of good quality data, and found no significant emission in the range around 1 TeV. We therefore report differential flux upper limits, assuming the emission to be point-like (<0.1 deg) or within a radius of 0.3 deg. In the point-like scenario, the flux limits around 1 TeV are at the level of 3 % and 2 % of the Crab Nebula flux, for the two sources respectively. This implies that the Milagro emission is either extended over a much larger area than our point spread function, or it must be peaked at energies beyond 1 TeV, resulting in a photon index harder than 2.2 in the TeV band.Comment: 8 pages, 3 figures, 1 tabl

MAGIC upper limits on the very high energy emission from GRBs

The fast repositioning system of the MAGIC Telescope has allowed during its first data cycle, between 2005 and the beginning of year 2006, observing nine different GRBs as possible sources of very high energy gammas. These observations were triggered by alerts from Swift, HETE-II, and Integral; they started as fast as possible after the alerts and lasted for several minutes, with an energy threshold varying between 80 and 200 GeV, depending upon the zenith angle of the burst. No evidence for gamma signals was found, and upper limits for the flux were derived for all events, using the standard analysis chain of MAGIC. For the bursts with measured redshift, the upper limits are compatible with a power law extrapolation, when the intrinsic fluxes are evaluated taking into account the attenuation due to the scattering in the Metagalactic Radiation Field (MRF).Comment: 25 pages, 9 figures, final version accepted by ApJ. Changet title to "MAGIC upped limits on the VERY high energy emission from GRBs", re-organized chapter with description of observation, removed non necessaries figures, added plot of effective area depending on zenith angle, added an appendix explaining the upper limit calculation, added some reference

Pathogenic mechanisms of SARS-CoV-2 infection and kidney disease: a clinical and molecular perspective

La infección por SARS-CoV-2 se ha convertido en un problema mundial de salud pública. Su presentación clínica es variada, desde benigna hasta un síndrome de distrés respiratorio agudo, afectación sistémica y fallo multiorgánico. La severidad del cuadro clínico depende de factores biológicos del virus y del huésped y de comorbilidades como la enfermedad renal. Además, la interacción entre el virus, la enzima convertidora de angiotensina 2 y la respuesta inmunológica exacerbada podría conducir al desarrollo de lesión renal aguda. Sin embargo, las implicaciones de la infección por SARSCoV-2 sobre las células renales, las repercusiones pronósticas en los pacientes con enfermedad renal crónica y su efecto a largo plazo sobre la función renal no están del todo claras. El objetivo es revisar el papel del SARSCoV-2 en la enfermedad renal aguda y crónica, y sus posibles mecanismos patogénicos en la afectación renal.The SARS-CoV-2 infection has become as a worldwide public health emergency. It exhibits a variety of clinical presentations, ranging from benign to acute respiratory distress syndrome, systemic involvement, and multiorganic failure. The severity of the clinical picture depends on host and virus biological features and the presence of comorbidities such as chronic kidney disease. In addition, the interaction between the virus, angiotensin-converting enzyme 2, and the exacerbated immune response could lead to the development of acute kidney injury. However, the implications of SARSCoV-2 infection on renal cells, the prognosis of patients with chronic kidney disease, and the long-term behavior of renal function are not entirely understood. This review aims to explore the role of SARS-CoV-2 in acute and chronic kidney disease and the possible pathogenic mechanisms of renal involvement