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Background Treating children with acute severe asthma (ASA) who fail to respond to first-line inhaled bronchodilators is problematic: use of intravenous agents is inconsistent and side-effects are common. High-flow humidified oxygen (HiFlo) has shown promise in other respiratory conditions and is increasingly used in ASA, but with little evidence. Methods We conducted a feasibility randomised controlled trial with deferred consent to assess early HiFlo in children aged 2–11 years with ASA not responding to “burst” therapy (high-dose inhaled salbutamol ± ipratropium). Children with Paediatric Respiratory Assessment Measure (PRAM) score 5+ after “burst” were randomised to commence HiFlo or follow standard care. Candidate primary outcomes assessed were treatment failure requiring escalation, and time to meeting hospital discharge criteria. Results The target was met despite coronavirus disease 2019 pandemic disruption: 56 children were randomised across four sites, with deferred consent received in 50 out of 56 (89%), and mean recruitment rate 1.1 per site per month. 28 were allocated early HiFlo and 22 standard care. Data collection was complete for both candidate primary outcomes. Treatment failure requiring escalation occurred in 18 of 28 children (64%) in the HiFlo arm and in 19 of 22 (86%) in the standard care arm. Median (interquartile range) time from randomisation to meeting discharge criteria was 29.3 h (21.8–43.7 h) in the HiFlo arm and 36.8 h (24.1–46.3 h) in the standard care arm. Conclusions HiFlo in childhood ASA is a potentially promising intervention whose use is increasing despite lack of evidence. A definitive randomised controlled trial to assess its effectiveness is required and appears to be feasible.

La pandemia por Covid-19 llegó a México en febrero de 2020. Las autoridades sanitarias promovieron medidas de prevención no farmacológicas para contrarrestar el avance de la epidemia y a finales del año se anunció la aplicación de las primeras vacunas. A nivel global y local, las vacunas marcaron un hito al erigirse como “balas mágicas”, sin em­bargo, enfrentaron diversas dificultades como la producción masiva, la logística de distribución, la efectividad, su aplicación escalonada que priorizó a grupos vulnerables, el rechazo y la baja percepción de riesgo por parte de algunos grupos de la población; por tanto, el énfasis sobre las medidas preventivas o “escudos sociales” se diluyó con el avance de la estrategia de vacunación. Este ensayo resalta la importancia de man­tener “los escudos sociales” como medidas fundamentales y complementarias a la aplicación de vacunas, puesto que, por sí solas, las “balas mágicas” presentan retos que podrían comprometer su eficacia.

Objetivo: Analizar las estrategias implementadas para mantener el proceso de enseñanza aprendizaje haciendo uso de las TIC desde la experiencia de una institución de educación superior. Método: Estudio de corte cualitativo, realizado en dos fases: documental y acercamiento con agentes educativos, haciendo uso de una plataforma virtual. El registro de información se hizo mediante notas, que fueron codificadas. El análisis de las fuentes primarias y secundarias fue de carácter general, es decir, se realizó un proceso inductivo y se buscó realizar un ejercicio de reducción y relación categorial para su triangulación con el contexto y la interpretación del equipo investigador. Resultados: Las estrategias efectuadas por la Universidad se clasificaron en tres categorías: infraestructura, corresponde a las acciones implementadas para asumir la virtualidad; la formación docente, se llevó a cabo un proceso de fortalecimiento en pedagogía haciendo uso de las TIC y bienestar estudiantil, las actividades realizadas para alcanzar desde la virtualidad el proceso enseñanza, aprendizaje. Discusión y Conclusiones: Se evidenció la brecha digital y su influencia en el uso de las TIC. La virtualidad en la educación superior implica retos para los cuales no se estaba preparada.

Abstract Background In healthy subjects fibrinogen γ/γ‘ circulates at 8–15% of the total plasma fibrinogen concentration. Elevated levels of this variant have been associated with arterial thrombosis, and its diminution with venous thrombosis. The aims of the present work were to analyze the structure of the fibrin network formed on the top of human dermal microvascular endothelial cells (HMEC-1) at different fibrinogen γ/γ‘ concentrations, as well as its influence on the secretion of fibrinolytic components. The kinetics of fibrin polymerization on top of HMEC-1 cells with 3, 10, and 30% fibrinogen γ/γ‘ was followed at 350 nm. The secretion of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor type 1 (PAI 1) by HMEC-1 were measured in the supernatant and cell lysates, after incubation with 1 nM thrombin, fibrin with 3, and 30% fibrinogen γ/γ‘, using commercial kits. The influence of fibrinogen γ/γ‘ on fibrin structure on the surface of the HMEC-1 was followed with laser scanning confocal microscopy (LSCM). Results The kinetics of fibrin formation on HMEC-1 with 3 and 10% fibrinogen γ/γ‘ were similar. However, with 30% fibrinogen γ/γ‘ both the slope and final turbity were approximately 50% less. The LSCM images showed the dramatic effects of increasing fibrinogen γ/γ‘ from 3 to 30%. The uPA and PAI 1 concentrations in culture supernatants HMEC-1 cells treated with thrombin or 30% γ/γ‘ fibrin were two-fold increased as compared to basal culture supernatants and 3% γ/γ‘ fibrin-treated HMEC-1. In all stimulatory conditions the intracellular concentration of uPA was higher than in supernatants. In contrast, the intracellular PAI 1 concentration was decreased as compared to that measured in the supernatant, including the basal condition. Conclusion A concentration of 30% fibrin γ/γ‘ alter drastically fibrin structure on the cell surface and affects the secretion of uPA and PAI 1 through its capacity to bind thrombin.

Introduction: Pyogenic granuloma (PG) is a reactive inflammatory vascular lesion of the skin and mucous membranes, characterised by the presence of enlarged venules and seamed and seamless capillaries with plump endothelial cells (EC), and numerous macrophages. EC activation upregulates the synthesis of galectins and induces their translocation to the EC surface promoting angiogenesis and lymphangiogenesis, particularly galectin-1 (Gal-1), Gal-3 and Gal-8. However, the presence and distribution of Gal-1, -3 and -8, as well as their implications in the pathogenesis of PG, has not been considered. Materials and methods: Eight biopsies from patients diagnosed with PG were selected. The presence of PECAM-1/CD31, IL-1β, VEGF-C, VEGFR-2, VEGFR-3, integrin β1, CD44, fibronectin and Gal-1, -3 and -8 was assessed by immunofluorescence staining using confocal laser scanning microscopy. Results and Discussion: Immunostaining revealed that these molecules were present in the enlarged venules with plump ECs, in some macrophages and other immune cells. We propose that macrophages release VEGF-A and VEGF-C inducing VEGFR-2/VEGFR-3 expression and activation, leading macrophages to transdifferentiate into plump ECs that might integrate into pre-existing venules, contributing to the formation of enlarged venules with transluminal bridges and capillaries. EC activation, induced by certain cytokines, has been shown to stimulate galectin expression and changes in the cellular localisation through association and activation of specific EC surface glycoproteins. Therefore, it is plausible that Gal-1, -3 and -8, acting in a concerted manner, could be mediating the transdifferentiation of macrophages into plump ECs and facilitating their migration and incorporation into the new vessels. Lay Summary In this study, immunostaining of pyogenic granuloma (PG) tissue sections showed immunoreactivity for PECAM-1/CD31, IL-1β, VEGF-C, VEGFR-2 and VEGFR-3, and galectin-1, -3 and -8 in enlarged venules with plump endothelial cells (EC), as well as in some macrophages and other immune cells. Interestingly, enlarged and thin-walled transient vessels lined by PECAM-1/CD31 and VEGFR-2 immunopositive ECs that form from pre-existing normal venules in response to VEGF-A (called ‘mother’ vessels [MV]) and that undergo intraluminal bridging evolving into various types of capillaries (called ‘daughter’ vessels [DV]) have been observed in benign and malignant tumours, in physiological and pathological angiogenesis as well as in vascular malformations, suggesting an important role for VEGF-A and VEGFR-2 in such a process. However, it is not only the mechanisms by which the MVs evolve in different types of DVs that remains to be elucidated, but also whether the cells that form intraluminal bridges proceed from locally activated ECs or whether they are derived from bone marrow precursors or from resident macrophages. Given that the formation of homodimers by Gal-1 and Gal-8 and pentamers by Gal-3 to generate gal–glycan lattices at the cell surface and in the extracellular space has been shown, it is possible that in PG tissue Gal-1, -3 and -8, through their binding partners, form a supramolecular structure at the surface of ECs and plump ECs, macrophages and in the extracellular space that might be mediating the transdifferentiation of macrophages into plump ECs and facilitating the migration and incorporation of these cells into the pre-existing venules, thus contributing to the formation of MVs and DVs.

El estudio se realizó en el ciclo 2014-2015, en una huerta de toronja (Citrus paradisi Macf.) variedad Rio Red, del Municipio de General Terán, N.L. México. El objetivo fue evaluar la concentración de fructosa en frutos de toronja en desarrollo procedentes de árboles de producción elevada («on») y producción escasa («off»), en un ciclo de producción en respuesta a la aplicación de ácido giberélico (Acigib 10% de GA3 , 25 ppm), urea foliar (1 kg 100 L-1) y anillado de ramas. La fructosa fue cuantificada en frutos de toronja a los 30, 60 y 90 dda (días después de antesis). El análisis de fructosa se realizó mediante Cromatografía Líquida de Alta Presión (HPLC). A los 30 dda, las aplicaciones de urea foliar y GA3 en árboles «on» resultaron en los valores más altos en la concentración de fructosa en frutos. A los 60 dda no se presentaron diferencias estadísticas entre los tratamientos. A los 90 dda los frutos de árboles «on» con urea foliar y con anillado se comportaron estadísticamente diferentes al resto de los tratamientos, con menor concentración de fructosa. El comportamiento de la concentración de fructosa en frutos de toronja entre muestreos fue de un incremento en todos los tratamientos de árboles «on» y «off». Abstract This research was conducted during the production year 2014- 15 on a 18-year in a grapefruit (Citrus paradasi Macf.) grove, Rio Red variety in the municipality of General Teran, N.L. Mexico. The objective was to evaluate the concentration of fructose in small fruits from trees with a high production year («on») and others with a low production year («off») throughout the whole productive cycle, as a result of the application of gibberellic acid (Acigib 10% of GA3 , 25 ppm), foliar urea (1 kg 100 L-1) and girdling. Fructose was quantified in fruits of grapefruit at 30, 60 and 90 days after anthesis (DDA). Fructose analysis was done by High Pressure Liquid Chromatography (HPLC). According with the results, application of foliar urea and GA3 on trees «on» at 30 DDA, resulted in the highest values in the concentration of fructose in fruit. Treatments applied at 60 DDA resulted in not statistically differences for fructose concentration in fruits. Fruit fructose concentration from samples at 90 DDA showed statistical differences in trees «on» treated with foliar urea and girdling obtained the lowest concentration of fructose. The behavior of the concentration of fructose between samples was increased in all treatments of trees «on» and «off». Keywords: Girdling, carbohydrates, citrus, gibberellic acid, foliar urea.

Objectives: The definition of circulatory impairment in the premature infant is controversial. Current research suggests overdiagnosis and overtreatment. We aimed to analyse which biomarkers move clinicians to initiate cardiovascular treatment (CVT). The prognostic capacity for adverse outcome (death and/or moderate-severe brain damage by cranial ultrasound at term equivalent) of these biomarkers was evaluated.Study Design: Retrospective data analysis from preterm infants enrolled in a placebo-controlled trial on dobutamine for low superior vena cava (SVC) flow, who showed normal SVC flow within the first 24 h (not randomized). Five positive biomarkers were considered: MABP < gestational age (GA)-1 mmHg; MABP < GA-5 mmHg; lactate > 4 mmol/L; BE < −9 mmol/L; SVC flow 4 mmol/L were the most prevalent biomarkers at start of treatment. Low BE, high serum lactate and low SVC flow at first echocardiography showed a trend toward being associated with adverse outcome, although not statistically significant.Conclusions: Low blood pressure and high lactate are the most prevalent biomarkers used for CVT prescription. Lactic acidosis and low SVC flow early after birth showed a trend toward being associated with adverse outcome. These findings support using a combination of biomarkers for inclusion in a placebo-controlled trial on CVT during transitional circulation.

This paper examines the relationship between national investment and saving in Colombia during the period 1925-2011. Consistent with Cardenas and Escobar (1998), an Error Correction Model is used to examine short and long run effects. The results provide evidence that investment and saving are co-integrated during the study period. The results for the co-integration vector, with and without structural breaks, indicate that capital mobility was low, which is consistent with the Feldstein – Horioka [1980] paradox. The results imply that increases in domestic saving rates reduce the mobility of financial capital in Colombia.

The causative agent of cholera, Vibrio cholerae, can enter into a viable but non-culturable (VBNC) state in response to unfavorable conditions. The aim of this study was to evaluate the in situ survival of V. cholerae in an aquatic environment of the Southern Caribbean Sea, and its induction and resuscitation from the VBNC state. V. cholerae non-O1, non-O139 was inoculated into diffusion chambers placed at the Cuare Wildlife Refuge, Venezuela, and monitored for plate, total and viable cells counts. At 119 days of exposure to the environment, the colony count was < 10 CFU/mL and a portion of the bacterial population entered the VBNC state. Additionally, the viability decreased two orders of magnitude and morphological changes occurred from rod to coccoid cells. Among the aquatic environmental variables, the salinity had negative correlation with the colony counts in the dry season. Resuscitation studies showed significant recovery of cell cultivability with spent media addition (p < 0.05). These results suggest that V. cholerae can persist in the VBNC state in this Caribbean environment and revert to a cultivable form under favorable conditions. The VBNC state might represent a critical step in cholera transmission in susceptible areas.

The accumulation of shavings of ultra-high molecular weight polyethylene (UHMWPE), a product used for manufacturing machine elements, creates serious problems in production plants. In order to promote a possible reuse of this waste and thus reduce the environmental impact they generate, blends with UHMWPE and two different grades of high density polyethylene (HDPE) were prepared in a twin-screw extruder and followed by compression molding. Rheological and mechanical (tensile and abrasion) properties for the blends prepared were evaluated, and its morphology using scanning electron microscopy was observed. Results showed that all HDPE blends exhibited an increase in abrasion resistance, little variations in tensile properties and an increase in complex viscosity and storage and loss modulus when the UHMWPE proportion increases. It should also be noted that the new material (HDPE, injection molding grade/UHMWPE, 80/20) may replace the HDPE, blow molding grade in similar applications because both materials have similar tensile properties and rheological behavior.

Se prepararon compuestos de poli (ácido láctico) (PLA) usando sepiolita y montmorillonita como cargas. Se estudió la influencia de la degradación del PLA durante el procesado y de incorporar dos tipos de agentes surfactantes a una sepiolita en las propiedades de estos compuestos. Para ello se emplearon las técnicas de viscosimetría en solución, difracción de rayos X, análisis termo-gravimétrico (TGA), calorimetría diferencial de barrido (DSC) y microscopía electrónica de barrido y transmisión. También se determinaron las propiedades mecánicas bajo tracción. Durante el procesado en el estado fundido se produjo la degradación termo-mecánica de la fase PLA que se manifestó como una disminución considerable de su peso molecular. Los resultados mostraron similares valores de resistencia a la tracción y módulos de elasticidad de los compuestos PLA/sepiolita modificadas que aquellos del PLA puro y los valores más bajos de propiedades mecánicas los arrojó el nanocompuesto de PLA/montmorillonita. A su vez, la estabilidad térmica medida mediante análisis termogravimétrico (TGA) de los compuestos con las sepiolitas modificadas, antes y después de someterlas a degradación hidrolítica, mostró los menores valores. Estos resultados permiten abrir nuevas posibilidades de aplicaciones para los nanocompuestos de PLA con sepiolita con un alto carácter de biodegradabilidad (mayor que la del PLA puro) y buenas propiedades de tracción

Background: A high prevalence of Helicobacter pylori in the esophageal mucosa of dyspeptic Venezuelan patients has been reported. We aimed to assess the genetic composition of the cag genotypes of H. pylori and its relation to histopathological outcomes in the gastroesophageal mucosa. Methods: The presence of cagA, cagE, and virB11 cag pathogenicity island (PAI) genes was detected by PCR in 80 of 150 H. pylori-positive dyspeptic patients in both mucosae. Alterations of the gastroesophageal mucosa were assessed by histological techniques. Results: The frequency of intact, partial, and deleted cag-PAI genes in the stomach of dyspeptic patients was found to be 57.5%, 21.3%, and 21.3%, respectively, whereas in the esophagus, frequencies were 33.8%, 33.8%, and 32.5% respectively. The genetic composition in the stomach was 57.5% cagA-positive, 20.0% cagA-negative, 75.0% cagE, and 77.5% virB11, whereas in the esophagus the distribution was 36.3% cagA-positive, 30.0% cagA-negative, 61.3% cagE, and 63.8% virB11. The gene with the largest difference between the two mucosae was cagA, with 58.8% in the stomach and 37.5% in the esophagus; cagE and virB11 were less variable. The correlation among single and/or mixed cag genotypes with histopathological outcomes in both mucosae from the same patient was higher for intact single cag-PAI genotypes, showing severe alterations. Conclusions: H. pylori may coexist in similar proportions without dominance of one cag genotype, suggesting a heterogeneous distribution in the esophagus. The cagE and virB11 genes can be used as markers of cag-PAI in the esophagus. The single cag-PAI genotype in both mucosae confers an increased risk of developing histological damage.

La acupuntura es una antigua técnica terapéutica desarrollada en China, que ha evidenciado ser efectiva en síntomas como las náuseas, vómito y dolor dentario. A pesar del sustento fisiológico que posibilitaría un uso efectivo en otras patologías, incluyendo el campo de las adicciones, los estudios son contradictorios, posiblemente por la diferencias de visión entre la medicina oriental y la occidental. El consumo de psicoactivos es un problema de salud pública en Colombia y en el mundo que genera grandes costos tangibles e intangibles, los cuales, en países desarrollados, puede llegar hasta el 1,6 % del PIB. En contraste, el beneficio económico del tratamiento de las adicciones, según las Naciones Unidas Contra la Droga y el Delito (UNODC), está entre 1:3 a 1:13; por lo tanto, cualquier esfuerzo que se realice en favor de los consumidores es una ganancia. Con base en estos datos, los organismos internacionales han generado políticas que ayudan a aminorar estos efectos. Colombia, como integrante de estos organismos, ha realizado varios compromisos para llevar a cabo dichas metas. Los tratamientos con auriculoterapia, como el protocolo NADA (National Acupuncture Detoxification Association), son los métodos más usados para las adicciones en el mundo, y aunque no se ha logrado evidenciar su efectividad, por su costo, facilidad y el poco riesgo de efectos adversos se hace viable en un país con pocos recursos económicos como Colombia.

Vibrio cholerae represents a significant threat to human health in developing countries. This pathogen forms biofilms which favors its attachment to surfaces and its survival and transmission by water or food. This work evaluated the in vitro biofilm formation of V. cholerae isolated from clinical and environmental sources on stainless steel of the type used in food processing by using the environmental scanning electron microscopy (ESEM). Results showed no cell adhesion at 4 h and scarce surface colonization at 24 h. Biofilms from the environmental strain were observed at 48 h with high cellular aggregations embedded in Vibrio exopolysaccharide (VPS), while less confluence and VPS production with microcolonies of elongated cells were observed in biofilms produced by the clinical strain. At 96 h the biofilms of the environmental strain were released from the surface leaving coccoid cells and residual structures, whereas biofilms of the clinical strain formed highly organized structures such as channels, mushroom-like and pillars. This is the first study that has shown the in vitro ability of V. cholerae to colonize and form biofilms on stainless steel used in food processing.

La presente investigación se centró en el estudio de la influencia de la degradación durante el procesado en la morfología y en las propiedades de tracción de mezclas ricas en poli (ácido láctico) (PLA) premezclado con una nano-carga (montmorillonita), y un polietileno de baja densidad como fase dispersa. Como  agentes compatibilizantes se emplearon polímeros funcionalizados con anhídrido maleico. Las mezclas se prepararon en un mezclador interno a 200°C y se caracterizó la fase PLA mediante viscosimetría capilar en solución, espectroscopía infrarroja, y microscopía electrónica de barrido y de transmisión. El procesado del PLA produjo la degradación termo-mecánica del poliéster y una abrupta disminución de su peso molecular en las mezclas mencionadas. Los elevados tamaños de partícula de la fase dispersa en las mezclas sin carga y los bajos valores en las propiedades de tracción se atribuyen a esta degradación. Las mayores elongaciones y esfuerzos a la ruptura fueron obtenidos en las mezclas sin carga independientemente del tipo de compatibilizante usado. Las mezclas con montmorillonita mostraron menores valores en las propiedades de tracción que las mezclas sin carga debido posiblemente a la degradación durante el procesado y al tipo de morfología obtenida.   Â

La presente investigación se centró en el estudio de la influencia de la degradación durante el procesado en la morfología y en las propiedades de tracción de mezclas ricas en poli (ácido láctico) (PLA) premezclado con una nano-carga (montmorillonita), y un polietileno de baja densidad como fase dispersa. Como agentes compatibilizantes se emplearon polímeros funcionalizados con anhídrido maleico. Las mezclas se prepararon en un mezclador interno a 200°C y se caracterizó la fase PLA mediante viscosimetría capilar en solución, espectroscopía infrarroja, y microscopía electrónica de barrido y de transmisión. El procesado del PLA produjo la degradación termo-mecánica del poliéster y una abrupta disminución de su peso molecular en las mezclas mencionadas. Los elevados tamaños de partícula de la fase dispersa en las mezclas sin carga y los bajos valores en las propiedades de tracción se atribuyen a esta degradación. Las mayores elongaciones y esfuerzos a la ruptura fueron obtenidos en las mezclas sin carga independientemente del tipo de compatibilizante usado. Las mezclas con montmorillonita mostraron menores valores en las propiedades de tracción que las mezclas sin carga debido posiblemente a la degradación durante el procesado y al tipo de morfología obtenida.

BackgroundAcute severe asthma (ASA) is a leading cause of hospital attendance in children. Standard first-line therapy consists of high-dose inhaled bronchodilators plus oral corticosteroids. Treatment for children who fail to respond to first-line therapy is problematic: the use of intravenous agents is inconsistent, and side effects are frequent. High-flow humidified oxygen (HiFlo) is widely used in respiratory conditions and is increasingly being used in ASA, but with little evidence for its effectiveness. A well-designed, adequately powered randomized controlled trial (RCT) of HiFlo therapy in ASA is urgently needed, and feasibility data are required to plan such an RCT. In this study, we describe the protocol for a feasibility study designed to fill this knowledge gap. ObjectiveThis study aims to establish whether a full RCT of early HiFlo therapy in children with ASA can be conducted successfully and safely, to establish whether recruitment using deferred consent is practicable, and to define appropriate outcome measures and sample sizes for a definitive RCT. The underlying hypothesis is that early HiFlo therapy in ASA will reduce the need for more invasive treatments, allow faster recovery and discharge from hospital, and in both these ways reduce distress to children and their families. MethodsWe conducted a feasibility RCT with deferred consent to assess the use of early HiFlo therapy in children aged 2 to 11 years with acute severe wheeze not responding to burst therapy (ie, high-dose inhaled salbutamol with or without ipratropium). Children with a Preschool Respiratory Assessment Measure score ≥5 after burst therapy were randomized to commence HiFlo therapy or follow standard care. The candidate primary outcomes assessed were treatment failure requiring escalation and time to meet hospital discharge criteria. Patient and parent experiences were also assessed using questionnaires and telephone interviews. ResultsThe trial was opened to recruitment in February 2020 but was paused for 15 months owing to the COVID-19 pandemic. The trial was reopened at the lead site in July 2021 and opened at the other 3 sites from August to December 2022. Recruitment was completed in June 2023. ConclusionsThis feasibility RCT of early HiFlo therapy in children with ASA recruited to the target despite major disturbances owing to the COVID-19 pandemic. The data are currently being analyzed and will be published separately. Trial RegistrationInternational Standard Randomised Controlled Trial Number Registry ISRCTN78297040; https://www.isrctn.com/ISRCTN78297040 International Registered Report Identifier (IRRID)DERR1-10.2196/54081

La presente investigación tiene como objetivo principal indagar el nivel de conocimiento sobre el tema de cambio climático en los estudiantes que están culminando la educación básica regular (EBR) de la I.E. José Jaime Heredia Neyra y de la I.E. Horacio Zeballos Gámez. La finalidad fue tanto corroborar el logro de las exigencias planteadas en el perfil del egresado del Currículo Nacional de la EBR como identificar, a través de los resultados, las debilidades y las fortalezas de los estudiantes en el área de Ciencias Sociales, ya que, en ellas, se estudia todo lo relacionado con temas ambientales. Primero se aplicó una prueba sobre los contenidos relacionados con el clima, calentamiento global, causas y consecuencias del cambio climático; luego se pasó a procesar la información; finalmente, se presentó las discusiones, conclusiones y recomendaciones.

The mechanism of cerebral blood flow autoregulation can be of great importance in diagnosing and controlling a diversity of cerebrovascular pathologies such as vascular dementia, brain injury, and neurodegenerative diseases. To assess it, there are several methods that use changing postures, such as sit-stand or squat-stand maneuvers. However, the evaluation of the dynamic cerebral blood flow autoregulation (dCA) in these postures has not been adequately studied using more complex models, such as non-linear ones. Moreover, dCA can be considered part of a more complex mechanism called cerebral hemodynamics, where others (CO2 reactivity and neurovascular-coupling) that affect cerebral blood flow (BF) are included. In this work, we analyzed postural influences using non-linear machine learning models of dCA and studied characteristics of cerebral hemodynamics under statistical complexity using eighteen young adult subjects, aged 27 ± 6.29 years, who took the systemic or arterial blood pressure (BP) and cerebral blood flow velocity (BFV) for five minutes in three different postures: stand, sit, and lay. With models of a Support Vector Machine (SVM) through time, we used an AutoRegulatory Index (ARI) to compare the dCA in different postures. Using wavelet entropy, we estimated the statistical complexity of BFV for three postures. Repeated measures ANOVA showed that only the complexity of lay-sit had significant differences.

A continuación se presentará un desarrollo teórico conceptual del nacionalismo y el perennialismo, para continuar con algunos de los aportes de Confucio al pensamiento colectivo a partir de sus enseñanzas y finalmente intentar evidenciar que la producción intelectual de Confucio permeó las fibras de la sociedad China al punto de continuar siendo replicadas en la actualidad. En ese sentido, podría considerarse a Confucio como el padre, o por lo menos, un personaje ampliamente influyente en la actual situación de la Nación China

Background: the incidence of lung cancer in the province of Sancti Spíritus is high and its diagnosis is usually made in advanced stages, for which surgical treatment is not always possible. Objective: to analyze the main characteristics and results of patients operated on for lung cancer. Methods: a cross-sectional descriptive observational study was carried out in the General Surgery service of the Camilo Cienfuegos General University Hospital in the Sancti Spiritus province in the period between January 1996 and December 2019. The universe consisted of 83 patients operated with lung cancer who underwent resection accompanied by mediastinal lymph node sampling. Results: the male sex predominated in the studied group. The most frequent age groups for both sexes were those from 51 to 60 years old and those over 60 years old. Smoking was present in most of the patients. The most frequent tumor location was in the upper lobes and lobectomy was the most performed technique. The pathological stages that predominated were lB and llB, followed by lllA. Squamous cell carcinoma was the predominant histological type. Atelectasis and respiratory infections were the most frequent complications. The deceased were few. Conclusions: the demographic characteristics of the patients studied correspond to other series of patients with lung cancer. Tumor location in the upper lobes, squamous cell carcinoma, as well as early stages, predominated in the series studied. Lobectomy was the most frequently used surgical technique and among complications, respiratory ones were the most frequent. DeCS: LUNG NEOPLASMS/surgery; LUNG NEOPLASMS/diagnosis; LUNG NEOPLASMS/complications; PNEUMONECTOMY/methods; CARCINOMA, SQUAMOUS CELL/complications.

Introduction: Bile duct malformations are extremely rare, and generally do not present complications that justify urgent surgical intervention. When it occurs, the clinical picture is similar to that of a patient with a gallbladder without congenital malformations. Objective: Describe a case of acute abdomen due to complicated gallbladder duplication. Clinical case: 46-year-old patient with a history of dyspepsia, who came the emergency with acute abdominal pain. Gallbladder gangrene is diagnosed, and surgical treatment is decided. During surgery, a double vesicular system was found, one area ofnecrosis and the other with chronic inflammatory changes. Cholecystectomy is performed on both organs. The evolution was favorable. Conclusions: The occurrence of an acute abdomen in a patient with gallbladder duplication is infrequent. The case is presented that contributes to deepen the knowledge about the course of action in this disease.

Fundamentación: En la provincia Sancti Spíritus no se reportan estudios sobre la supervivencia de pacientes con cáncer de pulmón sometidos a cirugía de resección con linfoadenectomía por muestreo. Objetivo: Evaluar la supervivencia de los pacientes con cáncer de pulmón sometidos a cirugía de resección pulmonar y linfadenectomía por muestreo. Metodología: Se realizó una investigación retrospectiva en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus, desde el 1 de enero del 1996 al 31 de diciembre del 2007. Fueron incluidos 48 pacientes a los que se les realizó cirugía de resección pulmonar con linfadenectomía por muestreo. Como variable principal fue considerada la supervivencia global a los 5 y 10 años. Otras variables fueron: edad, sexo, clasificación histológica y estadio patológico del tumor primario. Resultados: Predominaron los pacientes del sexo masculino, los mayores de 50 años y con estadio patológico IB. La estirpe histológica predominante fue el carcinoma epidermoide. La mediana de supervivencia fue superior para los estadios tempranos. La mayor supervivencia a los 5 años correspondió a los estadios IA y IIA. A los 10 años no hubo diferencias en la supervivencia de los pacientes. Conclusiones: La mayor supervivencia a los 5 años de los pacientes sometidos a cirugía de resección pulmonar y linfadenectomía por muestreo correspondió a los que se encontraban en estadios con menor extensión de la enfermedad. Entre los 5 y 10 años después de la cirugía hubo una estabilización en la sobrevida de todos los pacientes, indistintamente del estadio patológico inicial.