Cross-leg flap after free flap failure: a case report

The cross-leg flap is a technique that has been used for a long time to address defects in the distal third of the leg. Currently, the gold standard for these defects is free flap reconstruction. However, the success of microsurgery is not always guaranteed due to a wide range of extrinsic and intrinsic factors. In this study, we present the use of a cross-leg flap as an alternative in the case of free flap failure, performed in the plastic and reconstructive surgery department of the General Hospital of Mexico. The cross-leg flap represents a reliable, simple, and effective alternative when free flaps are not suitable or as a rescue in case of their failure, either due to extrinsic or patient-related causes.

Malignant pheochromocytoma treated with minimally invasive surgery

Indexación: Web of Science; Scielo.Introducción: El Feocromocitoma es un tumor de células cromafines productor de catecolaminas. Su variedad maligna es muy poco frecuente. Objetivo: Describir 2 casos de Feocromocitoma maligno tratados con cirugía mínimamente invasiva. Casos clínicos: Presentamos 2 pacientes de sexo femenino, de 31 y 51 años respectivamente. La primera con historia de hipertensión arterial de larga data y uso de múltiples fármacos. La segunda paciente debuta con dolor abdominal. En ambos casos los estudios radiológicos y metabólicos confirmaron el diagnóstico de Feocromocitoma. A la primera paciente se le realizó un procedimiento laparoscópico puro, mientras que a la segunda paciente se le realizó un procedimiento laparoscópico asistido por robot. En ambos casos fue necesario realizar adrenalectomía en bloque con el riñón, por compromiso del hilio renal. No hubo complicaciones severas intra ni post-operatorias, como tampoco conversión a cirugía abierta. La histopatología confirmó el diagnóstico de Feocromocitoma maligno con metástasis ganglionares regionales y márgenes quirúrgicos negativos. Ambas se mantienen en control, sin evidencia de recurrencia. Conclusión: El Feocromocitoma maligno puede ser manejado de forma mínimamente invasiva, con morbilidad y resultados oncológicos comparables a cirugía abierta.Introduction: Pheochromocytoma is a tumor derived from chromaffin cells that produces cathecolamines. Malignant pheochromocytomas are extremely rare. Aim: To describe 2 cases of malignant Pheochromocytoma treated with pure laparoscopic and robot assisted surgery. Clinical cases: Two female patients, 31 and 51 years of age, presented with a history of high blood pressure and abdominal pain. Radiologic and metabolic studies confirmed the diagnosis of Pheochromocytoma in both patients. A pure laparoscopic approach was performed in the first patient while a robotic assisted laparoscopy was done in the second patient. In both cases, adrenalectomy with in bloc nephrectomy was performed due to compromise of the renal sinus. There were no complications or conversion to open surgery. Histopathology confirmed the diagnosis of malignant Pheochromocytoma with metastasis to regional nodes and negative surgical margins. At follow-up, there is no evidence of recurrence. Conclusion: Malignant Pheochromocytoma can be treated with minimally invasive surgery, with morbidity and oncological outcomes similar to open approach.http://ref.scielo.org/ksq86

Fooled by the cycle: Permanent versus cyclical improvements in social indicators

This paper studies the time series behavior of a set of widely-used social indicators and uncovers two important stylized facts. First, not all social indicators are created equal in terms of the importance of cyclical fluctuations. While some social indicators such as the unemployment rate and monetary poverty show large cyclical fluctuations, other social measures such as the Human Development Index are, by construction, dominated by long-run trends. Second, interestingly, yet not surprisingly, a large part of the cyclical fluctuations in social indicators can be explained by cyclical changes in income (proxied by real GDP per capita). For this reason, countries with large cyclical income volatility exhibit, in turn, large cyclical changes in some of these social indicators (particularly in those indicators that are more prone to cyclical fluctuations). Since cyclical income volatility is much larger in the developing world, these two critical stylized facts raise fundamental issues regarding the duration of improvements in social indicators (like the ones observed in many developing countries during the last commodity super-cycle). After a detailed conceptual and methodological discussion of these issues, and relying on a global sample of industrial and developing countries, we dig deeper into the importance of cyclical versus permanent components by extending the seminal contribution of Datt and Ravallion (1992). In particular, we show that more than 40 percent of the fall in monetary poverty observed in Latin America and the Caribbean during the so-called Golden Decade can be attributed to cyclical changes in income. While in principle universal, our concerns are particularly relevant in the developing world where, compared to developed countries, output volatility is larger and driven, to a large extent, by external factors (such as commodity prices)

Preliminary observations on carcass traits and meat yield of five types of Brahman-influenced grass-fed bulls

Benefiting from interventions of the savanna ecosystem, breeders in Los Llanos of Apure State (Venezuela) are exploring the opportunity to improve cattle genetics by implementing crossbreeding programs.  Fifty yearling bulls of five types of Brahman influence [ST-Brahman (n = 10), F1 Angus x Brahman (F1-Angus; n = 10), F1 Chianina x Brahman (F1-Chianina; n = 10), F1 Romosinuano x Brahman (F1-Romosinuano; n = 10), and F1 Simmental x Brahman (F1-Simmental; n = 10)] were selected to be compared in carcass performance (linear measurements, quality and quantity indicators, Venezuelan and U.S. grades, and cutability) at a desirable conformation endpoint with a suitable market weight of 480 kg.  Shorter ST-Brahman carcasses exhibited the most abundant finish, significantly different from the longer F1-Simmental and F1-Romosinuano counterparts.  All carcasses fell into the A youngest maturity and were eligible for the USDA "Bullock “class designation; 62% reached the top Venezuelan quality grade, 96% graded US Standard and 64% reached the US yield grade 1, indicating superior cutability. Significant differences in yield of individual cuts (ribeye + strip loin, and cuts from the round) were detected between F1-Romosinuano and St-Brahman, F1-Angus and F1-Chianina counterparts.  F1-Chianina bulls had slight but significant advantages in yield of high-valued boneless cuts as compared to those of F1-Romosinuano and F1-Simmental counterparts. Conversely, F1-Romosinuano outperformed F1-Chianina in 1.73 percentage points of medium-valued boneless cuts (P < 0.05).  Under the sample selection criteria and harvest endpoint, slight changes in carcass performance can be expected from crossbreeding.Con intervenciones del ecosistema sabana y aplicando un manejo adecuado de los pastos, ganaderos de Los Llanos del Estado Apure (Venezuela) estan explorando mejorar la genética del ganado con programas de cruzamiento.  Cincuenta machos enteros añosos de cinco tipos raciales con influencia Brahman [Brahman puro (n = 10), F1 Angus x Brahman (F1-Angus; n = 10), F1 Chianina x Brahman (F1-Chianina; n = 10), F1 Romosinuano x Brahman (F1-Romosinuano; n = 10) y F1 Simmental x Brahman (F1-Simmental; n = 10)] se compararon en desempeño de la canal (mediciones lineales, indicadores de calidad y cantidad, categorías de clasificación y rendimiento carnicero) a un punto final de conformación deseable con un peso corporal aproximado de 480 kg.  Canales más cortas de Brahman puros exhibieron acabado más abundante, diferente (P<0.05) de las contrapartes más largas F1-Simmental y F1-Romosinuano.  Todas las canales cayeron en la madurez más joven (A) y fueron elegibles para la designación de clase "Bullock" del USDA; el 62% alcanzó el grado de calidad superior venezolano (categoría A), el 96% calificó en el grado de calidad Standard y el 64% alcanzó el grado máximo de rendimiento carnicero (grado 1 USDA).  Los toretes F1-Chianina tuvieron ventajas leves pero significativas en rendimiento en cortes deshuesados de alto valor, en comparación con los de F1-Romosinuano y F1-Simmental.  Por el contrario, F1-Romosinuano superó a F1-Chianina en 1,73 puntos porcentuales de cortes deshuesados de valor medio (P <0.05).  Bajo los criterios de selección de la muestra y el punto final de la cosecha, no se pueden esperar grandes cambios en el rendimiento carnicero a partir del cruzamiento.Com o uso de tecnologias em um ecossistema de savana e aplicando um manejo adequado das pastagens, os criadores de Los Llanos do Estado de Apure (Venezuela) estão tentando melhorar a genética do gado através da utilização de programas de cruzamento.  Cinquenta bovinos machos não castrados, com peso de abate de ~480 kg, de cinco cruzamentos com Brahman [Brahman puro (n = 10), F1 Angus x Brahman (F1-Angus; n = 10), F1 Chianina x Brahman (F1-Chianina; n = 10), F1 Romosinuano x Brahman (F1-Romosinuano; n = 10) e F1 Simental x Brahman (F1-Simental; n = 10)], foram comparados quanto às características (medidas lineares, indicadores de qualidade e quantidade e rendimento de desossa) y tipificacao de carcaça.    Carcaças de Brahman puros apresentaram maior cobertura de gordura do que carcaças de animais F1-Simmental e F1-Romosinuano (P<0.05).  Todas as carcaças foram com maturidade “A” (jovem / Bullock), sendo que 96% se qualificaram no grau de qualidade USDA “Standard” e 64% alcançaram o grau máximo de rendimento de desossa (grau 1).  Pelo padrão venezuelano, 62% das carcaças alcançaram o grau de qualidade superior (categoria A).  Diferenças significativas foram detectadas no rendimento de cortes individuais (filé de costela e contrafilé e cortes do coxão) entre carcaças de F1-Romosinuano e F1-Simental e F1-Angus e F1-Chianina. Carcaças de F1-Chianina apresentaram maiores rendimentos em cortes desossados de alto valor em comparação com F1-Romosinuano e F1-Simmental.  Carcaças de F1-Romosinuano tiveram 1,73 pontos percentuais a mais de rendimento em cortes desossados de valor intermediário, que carcaças de F1-Chianina (P <0,05). Segundo os critérios de seleção da amostra e o ponto final de abate, não se podem esperar grandes mudanças na qualidade e rendimento das carcaças de diferentes cruzamentos. &nbsp

Dysfunction of neurovascular/metabolic coupling in chronic focal epilepsy

In this study, we aim to evaluate the mechanisms underlying the neuro-vascular/metabolic coupling in the epileptogenic cortices of rats with chronic focal epilepsy. To that end, we first analyzed intracranial recordings (electrophysiology, laser Doppler flowmetry and optical imaging) obtained from the seizure onset zones during ictal periods and then used these data to fit a metabolically-coupled balloon model. This biophysical model is an extension of the standard balloon model with modulatory effects of changes in tissue oxygenation, capillary dynamics and variable O2 extraction fraction. As previously reported using acute seizure models, we found that there is a significant higher contribution from high local field potential frequency bands to the cerebral blood flow (CBF) responses in the epileptogenic cortices during ictal neuronal activities. The hemodynamic responses associated with ictal activities were distance-dependent with regard to the seizure focus, though varied in profiles from those obtained from acute seizure models. Parameters linking the CBF and relative concentration of deoxy-hemoglobin to neuronal activity in the biophysical model were significantly different between epileptic and normal rats. In particular, we found that the coefficient associated with the strength of the functional hyperemic response was significantly larger in the epileptogenic cortices, although changes in hemoglobin concentration associated with ictal activity reflected the existence of a significantly higher baseline for oxygen metabolism in the epileptogenic cortices

Energía gastada en el primer ciclo de histéresis como parámetro de selección de un biomaterial

Veinticuatro muestras de pericardio de ternera estabilizado, material similar al utilizado en la fabricación de velos de bioprótesis cardiacas, fueron sometidas a una prueba de esfuerzo a fatiga. Tras seis bloques de 100 ciclos a 1 MPa de presión máxima se rompieron 12 muestras, el 50%. La energía media gastada en este primer ciclo, en las muestras que sobrevivieron, fue de 0.16J, un valor inferior a la energía gastada en las muestra que terminaron rompiendo, 0.28J (p=0.005). Utilizando el cociente entre la energía disipada en el primer ciclo y el espesor medio de la muestra, con un valor de corte de 0.48J/mm para la selección de las mejores muestras, se obtiene un índice de validez del 87.5%, y un área bajo la curva ROC de 0.917. Este método no destructivo debe ayudar a los métodos ópticos en el reconocimiento y selección de las muestras más resistentes y en la obtención del material biológico más homogéne

Targeted Next-Generation Sequencing in a Large Cohort of Genetically Undiagnosed Patients with Neuromuscular Disorders in Spain

This article belongs to the Special Issue Genetic Advances in Neuromuscular Disorders: From Gene Identification to Gene Therapy.The term neuromuscular disorder (NMD) includes many genetic and acquired diseases and differential diagnosis can be challenging. Next-generation sequencing (NGS) is especially useful in this setting given the large number of possible candidate genes, the clinical, pathological, and genetic heterogeneity, the absence of an established genotype-phenotype correlation, and the exceptionally large size of some causative genes such as TTN, NEB and RYR1. We evaluated the diagnostic value of a custom targeted next-generation sequencing gene panel to study the mutational spectrum of a subset of NMD patients in Spain. In an NMD cohort of 207 patients with congenital myopathies, distal myopathies, congenital and adult-onset muscular dystrophies, and congenital myasthenic syndromes, we detected causative mutations in 102 patients (49.3%), involving 42 NMD-related genes. The most common causative genes, TTN and RYR1, accounted for almost 30% of cases. Thirty-two of the 207 patients (15.4%) carried variants of uncertain significance or had an unidentified second mutation to explain the genetic cause of the disease. In the remaining 73 patients (35.3%), no candidate variant was identified. In combination with patients’ clinical and myopathological data, the custom gene panel designed in our lab proved to be a powerful tool to diagnose patients with myopathies, muscular dystrophies and congenital myasthenic syndromes. Targeted NGS approaches enable a rapid and cost-effective analysis of NMD- related genes, offering reliable results in a short time and relegating invasive techniques to a second tier.This study was granted by FIS PI15/01898, funded by ISCIII and FEDER, ‘Una manera de hacer Europa’ and by Fundación Mutua Madrileña in the “Convocatoria de ayudas a la Investigación en Salud 2015”. It was also funded by an ACCI grant from CIBERER. Daniel Natera-de Benito is the recipient of a grant from the Instituto de Salud Carlos III (Contrato Rio Hortega, CM17/00044)

Infectious Diseases, Social, Economic and Political Crises, Anthropogenic Disasters and Beyond: Venezuela 2019 – Implications for Public Health and Travel Medicine

During last months, there have been a significant increase in the evidences showing the catastrophic health situation in Venezuela. There are multiple epidemics, increase in emerging and reemerging infectious, tropical and parasitic diseases as consequences of the social, economic and political crises, which would be considered today a clearly anthropogenic disaster. Venezuela is facing in 2019, the worse sanitary conditions, with multiple implications for public health and travel medicine. So far, from a global perspective, this situation will be an impediment for the achievement of the sustainable development goals (SDG) in 2030. In this multiauthor review, there is a comprehensive analysis of the situation for infectious diseases, non-communicable diseases, their impact in the Americas region, given the migration crisis as well as the comparative status of the SDG 2030. This discussion can provide input for prioritizing emerging health problems and establish a future agenda