Implementación de una plataforma informática avanzada que sirva de soporte a los procesos que intervienen en la gestión de equipos médicos en establecimientos de salud peruanos

El modelo de la actual estructura de la gestión de los establecimientos de salud del país no tiene desarrollado el aspecto tecnológico. Debido a lo anterior, existe un riesgo de que las inversiones realizadas se pierdan debido a la poca capacidad de manejo tecnológico actual. La problemática afecta directamente a los pacientes debido a la baja efectividad clínica, aumento de la morbilidad y uso del presupuesto en áreas no críticas. Por lo anterior, se busca tener un método que permita cuantificar las pérdidas y sobrecostos que se generan por no tener un modelo organizacional que incluya la gestión de equipos médicos, una mejora en la calidad de los servicios (los cuales repercutirán positivamente en los pacientes) y una mejora en la disposición de residuos ambientales provenientes de los mantenimientos realizados. La gestión de tecnología en salud es un nuevo enfoque integral de gestión especializada basada en los fundamentos de ingeniería clínica, la gestión y la economía que sigue los lineamientos generales de organizaciones mundiales como la Organización Mundial de la Salud desde el 2009. Teniendo en cuenta lo anterior, se propone la implementación de una plataforma informática que permite dar soporte a la gestión de los equipos médicos en los establecimientos de salud en el país. Esta implementación se realizará en función a los procesos previamente diseñados por el equipo de bioingeniería de la PUCP pertenecientes al proyecto financiado por Innóvate Perú con código 209-FINCYT-IA- 2013, en base a los estándares y normas internacionales de la Gestión de las Tecnologías de la Salud de la OMS.Tesi

Crossover from coherent to incoherent scattering in spin-orbit dominated Sr2IrO4

Strong spin-orbit interaction in the two dimensional compound Sr2IrO4 leads to the formation of Jeff=1/2 isospins with unprecedented dynamics. In Raman scattering a continuum attributed to double spin scattering is observed. With higher excitation energy of the incident Laser this signal crosses over to an incoherent background. The characteristic energy scale of this cross over is identical to that of intensity resonance effects in phonon scattering. It is related to exciton-like orbital excitations that are also evident in resonant X-Ray scattering. The crossover and evolution of incoherent excitations are proposed to be due to their coupling to spin excitations. This signals a spin-orbit induced entanglement of spin, lattice and charge degrees of freedoms in Sr2IrO4.Comment: 20 pages, 7 figure

Virological characterization of the 2022 outbreak-causing monkeypox virus using human keratinocytes and colon organoids

ヒトiPS細胞由来大腸オルガノイドおよびヒトケラチノサイトを用いたmpoxウイルス2022年株の解析. 京都大学プレスリリース. 2023-06-07.The outbreak-causing monkeypox virus of 2022 (2022 MPXV) is classified as a clade IIb strain and phylogenetically distinct from prior endemic MPXV strains (clades I or IIa), suggesting that its virological properties may also differ. Here, we used human keratinocytes and induced pluripotent stem cell-derived colon organoids to examine the efficiency of viral growth in these cells and the MPXV infection-mediated host responses. MPXV replication was much more productive in keratinocytes than in colon organoids. We observed that MPXV infections, regardless of strain, caused cellular dysfunction and mitochondrial damage in keratinocytes. Notably, a significant increase in the expression of hypoxia-related genes was observed specifically in 2022 MPXV-infected keratinocytes. Our comparison of virological features between 2022 MPXV and prior endemic MPXV strains revealed signaling pathways potentially involved with the cellular damages caused by MPXV infections and highlights host vulnerabilities that could be utilized as protective therapeutic strategies against human mpox in the future

Phototoxicity of indocyanine green and brilliant blue G under continuous fluorescent illumination on cultured human retinal pigment epithelial cells,”

PURPOSE. We compared the phototoxicity of indocyanine green (ICG) and Brilliant Blue G (BBG) in cultured RPE cells under fluorescent lamp illumination imitating ambient light. METHODS. Cultured human RPE line cells were stained with ICG or BBG solution at concentrations of clinical use, and cultured in a colorless medium for 24 hours in the dark or under illumination from a fluorescent lamp. After culture, cell morphology and TUNEL-positive apoptotic cells were observed. Cell viability and cell death rate were evaluated. Absorption spectral changes of BBG before and after incubation were measured. RESULTS. ICG-stained cells cultured under illumination changed to an oval morphology with increased number of apoptotic cells, whereas ICG-stained cells cultured in the dark, and BBGstained cells cultured under illumination and dark conditions maintained a flat morphology without increase in apoptotic cells. Cell viability decreased and cell death rate increased only in cells stained by ICG followed by culture under illumination. Staining cells with ICG at one-tenth concentration of clinical usage induced no cytotoxicity after culture under illumination. Approximately 30% of total BBG retained in the stained cells was released into the culture supernatant after incubation for 24 hours. The absorption spectrum of BBG did not change after fluorescent light irradiation. CONCLUSIONS. Illumination with a fluorescent lamp caused cell death via apoptosis in ICG-exposed, but not in BBG-exposed cultured RPE cells. BBG may be a safer dye than ICG because of low light-induced cytotoxicity and rapid elution from stained cells. (Invest Ophthalmol Vis Sci. 2012;53:7389-7394) DOI: 10.1167/iovs.12-10754 P eeling of the internal limiting membrane (ILM) is performed in vitrectomy for macular hole, 1-4 epiretinal membrane, 12-20 Moreover, a metaanalysis indicates that treatment of macular hole with ICG results in worse functional outcomes than treatment without ICG. 21-23 Thus, intravitreal ICG injection remains controversial. Use of safer dyes other than ICG for ILM staining and the conditions of clinical ICG administration have been investigated. Recently, Brilliant Blue G (BBG) has been reported to be a useful and safe dye for visualization of ILM. 13 In the present study, we used RPE cells because RPE is in direct contact with the vital dye at a high concentration in macular hole surgery with ILM peeling, and RPE injury is considered to affect visual prognosis. We compared phototoxicity of ICG and BBG retained in cultured RPE cells under ambient light illumination. Under visible light irradiation, we found that illumination equivalent to conventional fluorescence lamp light induced cytotoxicity in ICG-stained RPE cells but not in BBG-stained cells. MATERIALS AND METHODS Cells and Culture Medium The human RPE cell line ARPE-19 (American Type Culture Collection, Manassas, VA) was cultured in 1:1 mixture of Dulbecco's modified Eagle's medium and Ham's F12 medium (DMEM/F12; Sigma-Aldrich, Poole, UK) supplemented with 100 U/mL penicillin, 100 lg/mL streptomycin and 10% fetal bovine serum (FBS; JRH Bioscience, Lenexa, KS) at 378C in a humidified atmosphere of 5% CO 2 and 95% air. From th

Influence of renal function and demographic data on intrarenal Doppler ultrasonography

Intrarenal Doppler ultrasonography is a non-invasive method to evaluate the renal blood flow in patients with renal arterial stenosis as well as chronic kidney diseases (CKD). Until recently, the relationship between ultrasonography findings and CKD stage has not been fully understood. Overall, 162 patients with CKD without apparent renal arterial stenosis were included in this study, and the pulsed-wave Doppler ultrasonography findings were evaluated in terms of the following parameters: peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) at the renal arterial trunk, hilum, segmental, and interlobar regions. Age showed a significant negative correlation with the estimated glomerular filtration rate (eGFR), kidney size, and aortic PSV. Additionally, age showed a significant positive correlation with RI in all 4 regions. The eGFR showed a positive correlation with the aortic PSV and kidney size, but a negative correlation with RI. Both age and eGFR were found to be independently associated with aortic blood flow. On the intrarenal ultrasound, EDV and RI showed stronger correlations with eGFR than PSV, suggesting that the former indices would be better markers of renal function. In particular, the interlobar EDV was found to be the best index that reflects renal function. Although the RI is also a good marker of renal function, it is confounded by age; thus, its utility would be weaker than that of the EDV. In conclusion, intrarenal pulsed-wave Doppler ultrasonography is a useful tool to estimate and evaluate the renal function; the interlobar EDV may be the best index to estimate the effective perfusion and filtration of the kidneys

Nuclear Factor (Erythroid-Derived)-Related Factor 2-Associated Retinal Pigment Epithelial Cell Protection under Blue Light-Induced Oxidative Stress

Purpose. It is a matter of increasing concern that exposure to light-emitting diodes (LED), particularly blue light (BL), damages retinal cells. This study aimed to investigate the retinal pigment epithelium (RPE) damage caused by BL and to elucidate the role of nuclear factor (erythroid-derived)-related factor 2 (Nrf2) in the pathogenesis of BL-induced RPE damage. Methods. ARPE-19, a human RPE cell line, and mouse primary RPE cells from wild-type and Nrf2 knockout (Nrf2−/−) mice were cultured under blue LED exposure (intermediate wavelength, 450 nm). Cell death rate and reactive oxygen species (ROS) generation were measured. TUNEL staining was performed to detect apoptosis. Real-time polymerase chain reaction was performed on NRF2 mRNA, and western blotting was performed to detect Nrf2 proteins in the nucleus or cytoplasm of RPE cells. Results. BL exposure increased cell death rate and ROS generation in ARPE-19 cells in a time-dependent manner; cell death was caused by apoptosis. Moreover, BL exposure induced NRF2 mRNA upregulation and Nrf2 nuclear translocation in RPE. Cell death rate was significantly higher in RPE cells from Nrf2−/− mice than from wild-type mice. Conclusions. The Nrf2 pathway plays an important role in protecting RPE cells against BL-induced oxidative stress

Background Factors Affecting Visual Acuity at Initial Visit in Eyes with Central Retinal Vein Occlusion : Multicenter Study in Japan

Purpose: To determine the baseline characteristics of patients with central retinal vein occlusion (CRVO) that were significantly associated with the best-corrected visual acuity (BCVA) at the initial examination. Methods: This was a retrospective multicenter study using the medical records registered in 17 ophthalmological institutions in Japan. Patients with untreated CRVO (≥20-years-of-age) who were initially examined between January 2013 and December 2017 were studied. The patients’ baseline factors that were significantly associated with the BCVA at the initial examination were determined by univariate and multivariate linear regression analyses. Results: Data from 517 eyes of 517 patients were analyzed. Univariate analyses showed that an older age (r = 0.194, p < 0.001) and the right eye (r = −0.103, p < 0.019) were significantly associated with poorer BCVA at the initial visit. Multivariate analyses also showed that an older age (β = 0.191, p < 0.001) and the right eye (β = −0.089, p = 0.041) were significantly associated with poorer BCVA at the initial visit. Conclusions: The results indicate that an older age, a known strong factor, and the right eye were significantly associated with poorer BCVA at the initial visit to the hospital. These results suggest that functional and/or anatomical differences between the right and left eyes may be involved in these results

Virological characteristics of the SARS-CoV-2 BA.2.86 variant

オミクロンBA.2.86株のウイルス学的特性の解明. 京都大学プレスリリース. 2024-01-30.A comprehensive systematic characterization of the SARS-CoV-2 strain BA.2.86. 京都大学プレスリリース. 2024-01-31.In late 2023, several SARS-CoV-2 XBB descendants, notably EG.5.1, were predominant worldwide. However, a distinct SARS-CoV-2 lineage, the BA.2.86 variant, also emerged. BA.2.86 is phylogenetically distinct from other Omicron sublineages, accumulating over 30 amino acid mutations in its spike protein. Here, we examined the virological characteristics of the BA.2.86 variant. Our epidemic dynamics modeling suggested that the relative reproduction number of BA.2.86 is significantly higher than that of EG.5.1. Additionally, four clinically available antivirals were effective against BA.2.86. Although the fusogenicity of BA.2.86 spike is similar to that of the parental BA.2 spike, the intrinsic pathogenicity of BA.2.86 in hamsters was significantly lower than that of BA.2. Since the growth kinetics of BA.2.86 are significantly lower than those of BA.2 both in vitro and in vivo, the attenuated pathogenicity of BA.2.86 is likely due to its decreased replication capacity. These findings uncover the features of BA.2.86, providing insights for control and treatment

Virological characteristics of the SARS-CoV-2 Omicron BA.2.75 variant

SARS-CoV-2オミクロンBA.2.75株（通称ケンタウロス）のウイルス学的性状の解明. 京都大学プレスリリース. 2022-10-12.The SARS-CoV-2 Omicron BA.2.75 variant emerged in May 2022. BA.2.75 is a BA.2 descendant but is phylogenetically distinct from BA.5, the currently predominant BA.2 descendant. Here, we show that BA.2.75 has a greater effective reproduction number and different immunogenicity profile than BA.5. We determined the sensitivity of BA.2.75 to vaccinee and convalescent sera as well as a panel of clinically available antiviral drugs and antibodies. Antiviral drugs largely retained potency but antibody sensitivity varied depending on several key BA.2.75-specific substitutions. The BA.2.75 spike exhibited a profoundly higher affinity for its human receptor, ACE2. Additionally, the fusogenicity, growth efficiency in human alveolar epithelial cells, and intrinsic pathogenicity in hamsters of BA.2.75 were greater than those of BA.2. Our multilevel investigations suggest that BA.2.75 acquired virological properties independent of BA.5, and the potential risk of BA.2.75 to global health is greater than that of BA.5

Rational Expectations Models with Higher Order Beliefs,” mimeo

Abstract This paper develops a general method of solving rational expectations models with higher order beliefs. Higher order beliefs are crucial in an environment with dispersed information and strategic complementarity, and the equilibrium policy depends on infinite higher order beliefs. It is generally believed that solving this type of equilibrium policy requires an infinite number of state variable