El financiamiento a través de la Factura Negociable. O el nuevo intento del legislador de superar el fracaso de la Factura Conformada

El 07.12.2010 se publicó la Ley Nº 29623, Ley que promueve el financiamiento a través de la Factura Comercial (LFN) con la cual se pretende incrementar las opciones de financiamiento de quienes realizan transacciones comerciales y prestaciones de servicios a través de facturas comerciales y recibos por honorarios. Para ello, el legislador ha creado un nuevo título valor, la Factura Negociable. En el presente artículo se analizará la viabilidad, en tanto título valor, de dicho documento. Con este fin se realizará un estudio previo de la Factura Conformada y las modificaciones que esta ha sufrido desde que entró en vigencia; luego, apoyados en la experiencia comparada realizaremos un análisis de la LFN intentando determinar si se trata en realidad de un mecanismo que aporta nuevas alternativas de financiamiento como se pretende o si, con un nombre distinto, regula los mismos supuestos de hecho que la Factura Conformada

Global gene expression analysis provides insight into local adaptation to geothermal streams in tadpoles of the Andean toad Rhinella spinulosa

Indexación: Web of Science; Scopus.The anuran Rhinella spinulosa is distributed along the Andes Range at altitudes that undergo wide daily and seasonal variation in temperature. One of the populations inhabits geothermal streams, a stable environment that influences life history traits such as the timing of metamorphosis. To investigate whether this population has undergone local adaptation to this unique habitat, we carried out transcriptome analyses in animals from two localities in two developmental stages (prometamorphic and metamorphic) and exposed them to two temperatures (20 and 25 degrees C). RNA-Seq, de novo assembly and annotation defined a transcriptome revealing 194,469 high quality SNPs, with 1,507 genes under positive selection. Comparisons among the experimental conditions yielded 1,593 differentially expressed genes. A bioinformatics search for candidates revealed a total of 70 genes that are highly likely to be implicated in the adaptive response of the population living in a stable environment, compared to those living in an environment with variable temperatures. Most importantly, the population inhabiting the geothermal environment showed decreased transcriptional plasticity and reduced genetic variation compared to its counterpart from the non-stable environment. This analysis will help to advance the understanding of the molecular mechanisms that account for the local adaptation to geothermal streams in anurans.https://www.nature.com/articles/s41598-017-01982-

Role of surface microgeometries on electron escape probability and secondary electron yield of metal surfaces

The influence of microgeometries on the Secondary Electron Yield (SEY) of surfaces is investigated. Laser written structures of different aspect ratio (height to width) on a copper surface tuned the SEY of the surface and reduced its value to less than unity. The aspect ratio of microstructures was methodically controlled by varying the laser parameters. The results obtained corroborate a recent theoretical model of SEY reduction as a function of the aspect ratio of microstructures. Nanostructures - which are formed inside the microstructures during the interaction with the laser beam - provided further reduction in SEY comparable to that obtained in the simulation of structures which were coated with an absorptive layer suppressing secondary electron emission

Revisión de los criterios audiométricos en el tratamiento de la hipoacusia neurosensorial mediante audífonos y prótesis auditivas implantables

Sensorineural hearing loss has a high incidence in our population; as a matter of fact, 50 % of people above 75 years of age suffer this impairment. Due to the advances in the devices to alleviate this condition and their verified efficacy, it is now appropriate to review the indications for these devices and provide a detailed description of the audioprosthetic systems used. These systems can be classified as external non-implantable devices (hearing aids) and implantable prostheses. The latter can be sub-divided into active implants in the external ear or middle ear, cochlear implants, and auditory brainstem implants (ABI). Indications for each group are determined by the type and location of the underlying condition as well as by the anatomic, functional, and social characteristics of each patient. It must be stressed that the selection and monitoring of the treatment is up to the specialist. Generally speaking, an attempt is made to facilitate the integration of the hypoacusic patients to their sound setting by enhancing their understanding of the spoken word and restoring binaurality, while at the same time, seeking to retain the plasticity of central auditory routes through the stimulation provided by any of these systems. In the course of this review, we refer to newly-emerging indications in both the field of cochlear implants (bimodal stimulation, implantation in patients with residual hearing, bilateral implants, etc) and in the area of ABI in patients with tumoural disease previously treated with radiosurgery or patients with non-tumour pathologies presenting malformations or bilateral cochlear ossification

Fracturas de las espinas tibiales en el niño y en el adulto

Presentamos una serie de 29 fracturas de las espinas tibiales en 27 pacientes, 11 niños y 16 adultos. Para su estudio hemos seguido la clasificación de Meyers y McKeever, siendo las fracturas tipo II las más frecuentes. Se registraron las lesiones asociadas de la rodilla, y la más frecuente fue la del ligamento lateral interno; encontramos 2 fracturas de Segond en niños. El tratamiento fue conservador en 7 casos y quirúrgico en los 22 restantes. Para evaluar el resultado final estudiamos el desplazamiento de la fractura, movilidad y laxitudes residuales de la rodilla y fuerza muscular. Usamos las escalas de Lysholm y de Tegner para la valoración funcional. Un estudio radiológico con 3 proyecciones se llevó a cabo en todos los pacientes. El tiempo medio de seguimiento fue de 9,7 años para el grupo de niños y de 8,2 para los adultos. Los resultados globales, de acuerdo con la escala de Lysholm, fueron excelentes, pero se registraron 11 laxitudes anteroposteriores y 4 laterales, aunque 11 de estos 15 pacientes permanecen asintomáticos. Muchas de estas laxitudes aparecen en fracturas anatómicamente reducidas. Sugerimos que debe realizarse estudio artroscópico en estos pacientes para detectar lesiones asociadas que empeoran el resultado.A series of 29 fractures of the tibial spine in 27 patients, 11 children and 16 adults. We followed Meyers and McKeever to classify the fractures, tipe II being the most frecuent. Associated injuries of the knee were registered, being medial collateal ligament the most frecuent. We found 2 Segond fractures in young patients. The treatment was conservative in 7 cases and surgical in the remaining 22. To evaluate the final result we studied the displacement of the fracture, mobility of the knee, anteroposterior and lateral inestabilities, muscle strength. We used the Lysholm and the Tegner rating systems to evaluate the functional result. A complete radiological evaluation (three views) was made in all the patients. The average follow-up times was 9.7 years for the children group, and 8.2 years for the adult group. The overall results according to the Lysholm rating scale were excellent, but 11 anteroposterior and 4 lateral laxities were registered, though 11 of the 15 cases remains asymptomatic. Many of theese laxities appeared in anatomically reduced fractures. We suggest that an arthroscopic study of the patients must be done to detect associated injuries that produces a worse final result

Reconstrucción ósea acetabular con cotilos no cementados y aporte de aloinjerto en la artroplastia total de cadera : estudio de 35 casos

Se han revisado 35 arlroplastias realizadas en 29 pacientes portadores de algún tipo de defecto óseo en el cotilo por fallo de prótesis total de cadera. En el presente estudio incluimos sólo las reconstrucciones acetabulares efectuadas con implantes no cementados. La edad media fue de 60 años (29/79), siendo 19 mujeres y 10 varones. Clasificamos los defectos óseos siguiendo a D'Antonio en segmentarios, cavitarios y mixtos, y para la reparación de dichos defectos utilizamos aloinjerto criopreservado en todos los casos excepto uno, tratado con injerto liofilizado. Valoramos los resultados desde un punto de vista clínico, subjetivo y objetivo (escala de Harris). Desde un punto de vista radiológico se analizaron las migraciones del implante acetabular, la existencia de zonas de radiolucencia, las osificaciones periarticulares y la incorporación o no del injerto óseo utilizado. Desde el punto de vista clínico obtuvimos un 60% de resultados excelentes y buenos, frente a un 40% de regulares y malos. Desde cualquier punto de vista el índice de aflojamiento del componente acetabular fue mucho mayor que el que puede obtenerse con cotilos no defectuososThirty five revision hip arthroplasties performed in 29 patients with acetabular bone defects were reviewed. In this series we only include the acetabular reconstruction performed using non cemented acetabular implants. The mean age of the patients was 60 years (29-79), 19 were female and 10 male. We classified the acetabular bone defects according to D'Antonio, in segmentary, cavitary and combined. To repair these defects, we used criopreserved allograft, except one case in which a liofilized allograft was used. The results were evaluated clinically (modified Harris hip score) and radiographically, looking for acetabular migrations, radiolucent lines, periarticular ossifications and bone graft incorporation. We obtained 60% of excellent and good results. There was 40% of poor and fair results. The acetabular loosening rate was higher than in revision hip arthroplasty without acetabular bone defects

Resultados a largo plazo de la patelectomía total

Desde el año 1981 hemos realizado 19 patelectomías totales, 9 por artrosis femoropatelar, 8 por dolor anterior de rodilla y 2 por fracturas conminutas. La edad media en el momento de la intervención era de 48 años (25-80); todos los pacientes con dolor anterior habían sido operados previamente. Con una evolución media de 7,8 años (3-14), hemos realizado una revisión clínica y radiológica. Según la escala de la Sociedad Internacional de Rodilla obtuvimos un 58% de resultados excelentes y buenos, resaltando que continúan con dolor todos los pacientes operados por artrosis y el 50% de los intervenidos por dolor anterior. La patelectomía total es una técnica cada vez menos utilizada, limitándose sus indicaciones a fracturas muy conminutas, artrosis femoropatelar en pacientes en los que estaría contraindicada la artroplastia total y en cuadros de dolor anterior de rodilla rebeldes a otros tratamientosNineteen total patelectomies were performed since 1981. The indication was femoropatellar osteoarthritis in nine cases, anterior knee pain syndrome in eight, and conminute fractures in two. The mean age of the group at the time of operation was 48 years (25-80). A1l the patients with anterior knee pain syndrome had been operated previously. With an average followup time of 7.8 years (3-14), vve reviewed our patients clinically and radiographically. We used the International Knee Society rating scale and found 58% of excellent and good results; 100% of the patients operated because of osteoarthritis and 50% of those operated because an anterior knee pain syndrome have pain at review. Total patellectomy is not a frequent technique. Today, the sole indications are very conminute fractures of the patella, femoropatellar osteoarthritis in those patients in which total knee arthroplasty is not indicated and in the anterior knee pain syndrome not improved with other treatments

Experiencia y resultados preliminares en el uso de cilindros intersomáticos para la artrodesis lumbar

El dolor lumbar crónico es una patología que puede llegar a ser incapacitante y en la que a menudo fracasan los tratamientos conservadores. Como alternativa entre las cirugías que pretenden atajar este problema mediante una artrodesis está la fusión intersomática con cilindros, que presenta algunas ventajas respecto a otras técnicas de fijación. Esta técnica ha sido introducida recientemente en nuestro país. Se presentan los primeros resultados obtenidos tras esta cirugía en los primeros 16 pacientes operados. Desde 1997 a diciembre de 2000 se han implantado 11 cilindros BAK y 5 LIFEC. Diez pacientes tenían un seguimiento mínimo de 1 año y éstos constituyen la serie evaluada. Siete pacientes (70%) no presentaban dolor. Cuatro pacientes (40%) se habían incorporado a sus trabajos respectivos. Seis pacientes (60%) no precisaban tratamiento médico. Los buenos resultados obtenidos hasta el momento nos invitan a pensar que esta técnica, de menor agresividad y que no cierra la puerta a otros tipos de instrumentación, es una opción válida para el tratamiento del dolor lumbar crónico.Chronic low back pain is a medical cause of disability in which conservative management is often not effective. As an alternative, interbody fusion with cylinders offers several advantages as compared to other surgical methods of fusion. This technique has been recently introduced in our Country. The preliminary results of 16 patients managed in our Department are shown. From 1997 to December 2000, eleven BAK devices and 5 LIFEC have been implanted. Ten patients had a minimum follow-up of 1 year and these constitute the series evaluated. Seven patients (70%) were free of pain. Four patients (40%) returned to their previous job. Six patients (60%) did not need medical treatment. The good results with this technique encourage us and suggest that these devices are a valid option for the management of chronic low back pain

Serum C-reactive protein on the prognosis of oncology patients with acute renal failure: an observational cohort study

We undertook this study to evaluate the significance of the C-reactive protein level (CRP) as a prognostic factor in oncology patients with acute renal failure (ARF) during nephrology consultation. METHODS: The study was comprised of a cohort of 375 consecutive oncology patients who had been admitted to a university-affiliated hospital between March 1998 and April 2006 and had been diagnosed with ARF. One hundred and fifty nine patients with ARF who matched at least one of the RIFLE criteria on increased serum creatinine were included for subsequent analysis. We used a Cox proportional hazard model. RESULTS: Clinical pathological variables were compared among patients with serum CRP levels > or =8 mg/dL (exposed group; cut-off point: median) and patients with serum CRP level <8 mg/dL (control group). In-hospital mortality rates associated with CRP levels were 53.8% for > or =8 mg/dL and 21.5% for <8 mg/dL (p <0.001). After adjusted analysis, the presence of a CRP level > or =8 mg/dL was significantly associated with an increased in-hospital mortality (HR 2.10; 95% CI: 1.17-3.78) than in those patients with similar Liano scoring, the same RIFLE classes, and the same treatment for ARF. In addition, each increment of 1 mg/dL of serum CRP was associated with an adjusted 4% increment of in-hospital mortality (HR 1.04, 95% CI: 1.01-1.06). CONCLUSIONS: CRP levels at nephrology consultation were an independent predictor of death in this cohort of oncology patients with ARF. Patients with levels > or =8 mg/dL may be considered at higher risk of death