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El tratamiento de la extremidad inferior siempre ha sido una dura prueba para el cirujano plástico. La situación anatómica de la tibia, desprovista de protección muscular en su aspecto anterior, la hace altamente vulnerable ante cualquier traumatismo de la extremidad. Toda lesión a este nivel exige un tratamiento óseo y cutáneo adecuados, que deben realizarse primariamente y en forma conjunta. En el presente trabajo describimos 3 casos de pacientes con traumatismos de extremidad inferior, fracturas acompañadas de pérdida de sustancia, en los cuales se practicaron colgajos musculares para reconstruir las partes afectadas. Estos colgajos, en primera instancia se tomaron del músculo sóleo, pero encontramos el inconveniente del grosor exagerado que presentaba la cobertura a pesar de su atrofia posterior y del defecto estético desagradable que quedaba en la zona donante. Por todo ello realizamos una variante: en lugar de tomar la mitad del músculo como indica la técnica convencional, tomamos solo un cuadrante que sobrevivió a expensas de un solo pedículo vascular dominante. El cuadrante restante sirvió para hacer menos notorio el defecto de la zona donante. Los 3 casos tuvieron éxito y los pacientes están muy satisfechos con los resultados estéticos. Presentamos una alternativa quirúrgica innovadora de Colgajo de Sóleo que se puede aplicar satisfactoriamente para la cobertura de defectos de miembro inferior, al cual hemos llamado colgajo de So. Lower limb treatment has always been a headache to the plastic surgeon. Tibial anatomy, doesn´t has frontal muscle protection and it´s vulnerable in any trauma. Every lesion in the lower limb must be treated by traumatologyst and plastic surgeon. In this study we present 3 patients with lower limb trauma, fractures and soft tissue lost, treated with muscle flap to cover affected parts. First, we took the flaps from soleous muscle, but we had problems with flap thickness and with the disgusting defect crated in the donor site. So we have created a variety: instead of taking half of the muscle, we took just a quarter, which survived with only one dominant vessel. The other quarter improved de defect in the donor site. The 3 patients were successful and they are happy with the results. We present an innovative surgical variant in muscle Soleous flap that can be useful in lower limb reconstruction, and that we have denominated So flap.

We have proposed an adaptive procedure in order to estimate unknown parameters of a numerical model of a chaotic CO2 laser, which is observed through a time series that represents the output intensity of a laser. To do that, we consider a coupled system with the same functional form and adjustable parameters. The salient feature of the proposed technique is that accurate parameter estimation and identical synchronization can be jointly achieved by adaptively adjusting the desired parameters of the coupled system.

Nowadays, software industry demands high quality reusable artifacts that are easy to configure for developing new applications or modifying the existing ones at minimum cost. In this context several approaches have been proposed, as a result of this, libraries with a number of reusable functions and/or classes have been obtained. Such approaches have also proposed guidelines aimed to reuse most of the software developed by programmers. However this goal has not been achieved yet, mainly due to the lack of quality attributes of the reusable software components currently available. This paper introduces an approach known as SR2, which means software reengineering for reuse, it is based on a reengineering process whose input is legacy code written in C language and the output is an object-oriented framework in C++. In this work we employ the Gamma design patterns strategy and state to structure the framework generated by the reengineering process.

La aplasia cutis congénita es una condición caracterizada por la ausencia congénita de áreas de piel en zonas de localización variable. Es una entidad rara, que afecta por igual a ambos sexos y cuya etiología no está precisada. El cuero cabelludo es su localización más frecuente. Está constituida por un amplio espectro de alteraciones, con patrón de herencia variable, ocasionalmente asociados con otros defectos congénitos y síndromes malformativos. Se presentan cuatro casos clínicos y se hace referencia a los aspectos clínicos, etiopatogenia, evolución y tratamiento de la enfermedad. Congenital cutaneous aplasia is a condition characterized by congenital absence of skin areas that can occur in any location. It is a rare disease, affecting both the sexes equally and its aetiology is unclear. The disorder is seen most frequently on the scalp. It has a wide spectrum of clinical manifestations, with variable inheritance, sometimes associated to other congenital defects and malformations. We present 4 cases of aplasia cutis congenital and review the clinical findings, aetiopathogenesis, evolution and therapy of the disease.

Cardiac malfunction has been described in chronic alcoholics in the absence of clinical manifestations.In an unselected group of 25 chronic alcoholics, a low ejection time index was found as expected, but this index remained low after 2 weeks of abstinence. Since the ejection time index is primarily related to stroke volume, this observation could be explained on the basis of persistently depressed myocardial function.

Hepatocellular carcinoma (HCC) usually afflicts individuals in their maturity after a protracted liver disease. Contrasting with this pattern, the age structure of HCC in Andean people displays a bimodal distribution with half of the patients developing HCC in adolescence and early adulthood. To deepen our understanding of the molecular determinants of the disease in this population, we conducted an integrative analysis of gene expression and DNA methylation in HCC developed by 74 Peruvian patients, including 39 adolescents and young adults. While genome-wide hypomethylation is considered as a paradigm in human HCCs, our analysis revealed that Peruvian tumors are associated with a global DNA hypermethylation. Moreover, pathway enrichment analysis of transcriptome data characterized an original combination of signatures. Peruvian HCC forgoes canonical activations of IGF2, Notch, Ras/MAPK, and TGF-β signals to depend instead on Hippo/YAP1, MYC, and Wnt/β-catenin pathways. These signatures delineate a homogeneous subtype of liver tumors at the interface of the proliferative and non-proliferative classes of HCCs. Remarkably, the development of this HCC subtype occurs in patients with one of the four Native American mitochondrial haplogroups A-D. Finally, integrative characterization revealed that Peruvian HCC is apparently controlled by the PRC2 complex that mediates cell reprogramming with massive DNA methylation modulating gene expression and pinpointed retinoid signaling as a potential target for epigenetic therapy. © 2021 Cerapio et al.

ObjectiveTrained immunity (TI) is a de facto memory program of innate immune cells, characterized by immunometabolic and epigenetic changes sustaining enhanced production of cytokines. TI evolved as a protective mechanism against infections; however, inappropriate activation can cause detrimental inflammation and might be implicated in the pathogenesis of chronic inflammatory diseases. In this study, we investigated the role of TI in the pathogenesis of giant cell arteritis (GCA), a large-vessel vasculitis characterized by aberrant macrophage activation and excess cytokine production.MethodsMonocytes from GCA patients and from age- and sex-matched healthy donors were subjected to polyfunctional studies, including cytokine production assays at baseline and following stimulation, intracellular metabolomics, chromatin immunoprecipitation-qPCR, and combined ATAC/RNA sequencing. Immunometabolic activation (i.e. glycolysis) was assessed in inflamed vessels of GCA patients with FDG-PET and immunohistochemistry (IHC), and the role of this pathway in sustaining cytokine production was confirmed with selective pharmacologic inhibition in GCA monocytes.ResultsGCA monocytes exhibited hallmark molecular features of TI. Specifically, these included enhanced IL-6 production upon stimulation, typical immunometabolic changes (e.g. increased glycolysis and glutaminolysis) and epigenetic changes promoting enhanced transcription of genes governing pro-inflammatory activation. Immunometabolic changes of TI (i.e. glycolysis) were a feature of myelomonocytic cells in GCA lesions and were required for enhanced cytokine production.ConclusionsMyelomonocytic cells in GCA activate TI programs sustaining enhanced inflammatory activation with excess cytokine production.