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Many of the current synthetic methodologies utilized within academic and industrial laboratories require knowledge of how to safely handle air- and moisture-sensitive reagents and work under inert atmospheres. As a result, the ACS Committee on Professional Training recommends incorporating synthetic methods that make use of these inert atmospheres into curricula for the development of students with career aspirations in science. However, incorporation of these methods into the curricula at primarily undergraduate institutions is challenging due to access to limited resources and infrastructure. This article reports a semester long, multistep laboratory synthesis of the tripodal bis[2-(2,3-dihydroxyphenyl)-6-pyridylmethyl](2-pyridylmethyl)amine (BCATTPA) compound involving metal halogen exchange, chlorine transfer, nucleophilic substitution, Suzuki cross-coupling, and Lewis acid dealkylation steps that was successfully carried out by sophomore or junior undergraduate researchers enrolled in a Mentored Research in Chemistry course at Fairleigh Dickinson University. Using routine laboratory characterization techniques such as 1H NMR and FT-IR spectroscopies as well as GC-MS, students were able to identify and assess the purities of their resulting products. The disclosed laboratory synthesis enabled students to get formal training in air- and moisture-free Schlenk-line techniques such as syringe and cannula transfers in a controlled learning environment that they could use in future research activities in organic, inorganic, analytical, physical, or biochemistry laboratories.

Introducción: El proceso de enfermería es el método que nos permite administrar los cuidados a personas con enfermedades crónicas a través de sus etapas: valoración, razonamiento diagnóstico, plan de cuidados de enfermería y evaluación. Objetivo: Evaluar un plan de cuidados de enfermería a una adulta mayor con diabetes mellitus tipo 2 y osteoporosis con enfoque a la educación para la salud terapéutica. Metodología: Estudio de caso clínico, observacional, descriptivo y longitudinal, a paciente de 63 años con diabetes mellitus y osteoporosis; para la valoración se empleó el instrumento de Marjory Gordon, para el razonamiento diagnóstico, planeación, ejecución y evaluación se utilizó el lenguaje estandarizado de enfermería. Bajo los principios bioéticos es una investigación de riesgo mínimo, se protege la privacidad y datos del adulto mayor. Resultados: Se encontró alteración en el patrón percepción / mantenimiento de la salud, nutricional / metabólico, actividad ejercicio y afrontamiento del estrés; estableciendo actividades para el control de su glucosa, se priorizó en dieta prescrita, ejercicio, adherencia al tratamiento y afrontamiento al estrés. Se logró aceptación de la enfermedad, aprendizaje de toma de glucosa capilar y control glucémico, además del apego a dieta y ejercicio prescrito. Conclusiones: La educación para la salud terapéutica logró el apego al tratamiento farmacológico y no farmacológico, así como la aceptación del estado de salud le permite adquirir el autocontrol de su enfermedad, es importante el seguimiento continuo y a largo plazo por el avance patológico, edad y deterioro general de la paciente.

Introduction: Values are crucial in decision-making, including processes related to science and technology, despite scientists often being unaware of them. Because a goal of science, technology, engineering, and mathematics (STEM) is to foster innovation, values have become fundamental in directing science and technology policies and shaping organizational cultures to leverage innovation. However, most research on STEM education has focused on improving performance or access to STEM education while overlooking its axiological configuration. This study analyzes the different value systems emerging in the current literature on STEM higher education and identifies the relevant stakeholders. Method: In this systematic review and ethical meta-analysis, we aimed to assess the most prominent studies on STEM education and its core values. We followed a Ricoeur-inspired hermeneutical methodology using Atlas ti 8.4.4. Values are identified and classified using a systematic approach to integrate axiological landscapes. Results: The literature does not explicitly discuss the value of STEM education for innovation. However, social values appear to be at the intersection and the cornerstone of basic, economic, aesthetic, and epistemic values, as most social values also manifest these four systems. The most common manifestation of the value system is the capability approach to justice, followed by the beauty of recognition and success and, in third place, racism and social disparities. The analyzed literature emphasizes STEM education's social, political, and economic determinants. However, there is an epistemic gap in the indispensable value of innovating and assessing STEM education. Conclusions: We propose an organizational culture model for STEM education that considers the goals, ends, values, and behaviors of students, teachers, educational institutions, and the government. This model can help fill the axiological gaps in STEM education.

Se analiza la relación entre las variables competencia digital y actitud hacia el cambio en el contexto de universidades nacionales de Lima, a partir de el enfoque interaccionista, con el fin de destacar efectos del uso de la tecnología en la transformación cultural. Se implementó un diseño no experimental. Los resultados arrojan que el 57.06% determinó que la variable competencia digital es “alta” en lo que respecta a la variable actitud hacia el cambio, superando ésta el 58.3% en el nivel “buena”. Además, el 38.65% percibe la competencia digital como “media” y solo un 4.9% como “baja”, relacionándose con un bajo nivel de actitud al cambio. Se analizan los resultados desde los aportes de Goffman (desde el contexto de la llamada Escuela de Palo Alto), pudiendo interpretarse como un impacto de las nuevas interacciones figura/fondo promovidas por la tecnología en el desarrollo de competencias y en las nuevas representaciones sociales en general.

The sandfish Holothuria (Metriatyla) scabra, is a high-value tropical sea cucumber harvested from wild stocks for over four centuries in multi-species fisheries across its Indo-Pacific distribution, for the global bêche-de-mer (BDM) trade. Within Southeast Asia, the Philippines is an important centre of the BDM trade, however overharvesting and largely open fishery management have resulted in declining catch volumes. Sandfish mariculture has been developed to supplement BDM supply and assist restocking efforts; however, it is heavily reliant on wild populations for broodstock supply. Consequently, to inform fishery, mariculture, germplasm and translocation management policies for both wild and captive resources, a high-resolution genomic audit of 16 wild sandfish populations was conducted, employing a proven genotyping-by-sequencing approach for this species (DArTseq). Genomic data (8,266 selectively-neutral and 117 putatively-adaptive SNPs) were used to assess fine-scale genetic structure, diversity, relatedness, population connectivity and local adaptation at both broad (biogeographic region) and local (within-biogeographic region) scales. An independent hydrodynamic particle dispersal model was also used to assess population connectivity. The overall pattern of population differentiation at the country level for H. scabra in the Philippines is complex, with nine genetic stocks and respective management units delineated across 5 biogeographic regions: (1) Celebes Sea, (2) North and (3) South Philippine Seas, (4) South China and Internal Seas and (5) Sulu Sea. Genetic connectivity is highest within proximate marine biogeographic regions (mean Fst=0.016), with greater separation evident between geographically distant sites (Fst range=0.041–0.045). Signatures of local adaptation were detected among six biogeographic regions, with genetic bottlenecks at 5 sites, particularly within historically heavily-exploited locations in the western and central Philippines. Genetic structure is influenced by geographic distance, larval dispersal capacity, species-specific larval development and settlement attributes, variable ocean current-mediated gene flow, source and sink location geography and habitat heterogeneity across the archipelago. Data reported here will inform accurate and sustainable fishery regulation, conservation of genetic diversity, direct broodstock sourcing for mariculture and guide restocking interventions across the Philippines.

La mega secuencia sedimentaria del Cretácico Superior de la cuenca Oriente en Ecuador se compone por las formaciones Hollín, Napo y Tena, que ha sido ampliamente estudiada debido a su interés económico en la industria petrolera. No obstante, la escasa información acerca de las características petrográficas y geoquímicas de las rocas fuente de la Formación Tena en el centro y sur de la zona Subandina ha generado incertidumbre en el modelo de evolución geológica regional, particularmente en el intervalo Maastrichtiano a Paleoceno. La sección del río Anzu, al noroeste de Puyo, proporciona la oportunidad de analizar la procedencia de la Formación Tena, exhibiendo de forma completa y continua su secuencia estratigráfica. Con el propósito de definir la fuente detrítica de la Formación Tena, esta investigación detalla la litoestratigrafía, petrografía, geoquímica y asociación de minerales pesados en la sección del río Anzu. El análisis petrográfico revela que las areniscas de la Formación Tena son litoareniscas feldespáticas, arcosas líticas y sublitarenitas, originadas a partir de fuentes sedimentarias ricas en cuarzo, con influencia ígnea y metamórfica. Las asociaciones de minerales pesados, junto con las concentraciones de elementos mayores, traza y tierras raras, indican que estas areniscas provienen principalmente de provincias sedimentarias recicladas, con influencia de provincias ígneas ácidas y metamórficas. Estas fuentes estarían vinculadas a regiones andinas que exhumaron y asimilaron bloques o cuñas tectónicas de la cuenca Oriente durante el inicio de la orogenia Andina a finales del Cretácico Superior e inicio del Paleoceno; la erosión de estos bloques controló el detrito disponible para la sedimentación de la Formación Tena en la zona de estudio.

Se realizó el estudio en veinte perros a los que se les practicó autotrasplante pulmonar izquierdo, dividiéndoseles en dos grupos de 10 cada uno; en el primer grupo el autotransplante se practic´ó siguiendo la técnica convencional, es decir sin conservación e las estructuras peribronquiales, mientras que en el segundo grupo se conservó las arterias bronquiales. En todos ellos se practicaron estudios broncoscópicos, broncoespirométricos, radiológicos (radiografías simples y broncografías) tanto en el pre como en el post-operatorio inmediato, al mes, a los dos y a los tres meses; finalmente, los perros sobrevivientes más de 90 días, fueron sacrificados practicándoseles la necropsia, al igual que a los que fallecieron antes de cumplir este período. Se detalla la técnica quirúrgica seguida, así como los métodos empleados para realizar las broncoscopías, broncografías, radiografías y broncoespirometrías. De los veinte animales, once llegaron al final del experimento, correspondiente 4 al Grupo I y 7 de Grupo II, habiéndose observado que la mayor letalidad en el Grupo I se produjo en las tres primeras semanas, siendo la causa en dos de ellos bronconeumonía; en dos infarto pulmonar y en uno disrupción de la anastomosis bronquial. En el Grupo II, la mayor letalidad se produjo durante la octava semana y fue debida en los tres casos a sobredosis anestésica, dada con el objeto de realizar los exámenes rutinarios. La evaluación clínica, radiográfica y broncoscópica muestran resultados muy favorables en el grupo en que se conservó la arteria bronquial en relación con el grupo en que no se conservó. En cuanto a los datos broncoespirométricos obtenidos, podemos decir que la irrigación bronquial no tendría efectos significativos directos sobre la funcionalidad del pulmón reimplantado.

Introducción: La forma clínica cardiaca es la principal causa de morbimortalidad de la enfermedad de Chagas, y su patogenia estaría relacionada con alteraciones del sistema nervioso autónomo que afectarían la fisiología cardiovascular. Objetivos: Comparar los valores de frecuencia cardiaca, presión arterial y las alteraciones electrocardiográficas de pobladores infectados con T. cruzi y sujetos control. Material y métodos: estudio analítico, observacional, transversal; realizado en el valle de Vítor de Arequipa en el período 2004-2005. Se estudiaron 75 voluntarios mayores de 15 años de edad, distribuidos en 25 seropositivos y 50 seronegativos para T. cruzi, pareados por edad y sexo. Se midió frecuencia cardiaca, presión arterial y se realizó electrocardiografía estándar, comparándose los resultados en ambos grupos. Resultados: Los valores de frecuencia cardiaca y presión arterial fueron similares entre los sujetos infectados con T. cruzi y los controles, al igual que la presencia de bradicardia sinusal, hipotensión e hipertensión arterial. En 40% de los sujetos seropositivos hubo alteraciones electrocardiográficas, y en sujetos control en 26% diferencia estadísticamente no significativa. Las alteraciones más frecuentes en ambos grupos fueron los cambios inespecíficos de repolarización, bradicardia sinusal, hemibloqueo anerior izquierdo, extrasistolias supraventriculares. Se presentó bloqueo completo de rama derecha y hemibloqueo anterior izquierdo en personas infectadas con T. cruzi menores de 40 años. Conclusiones: La prevalencia de alteraciones cardiovasculares fue similar en población infectada con T. cruzi y sujetos control. Las alteraciones al EKG más frecuentes no son las típicamente descritas en enfermedad de Chagas.

Introducción: La demencia por deficiencia de vitamina B12 es una causa de demencia reversible que se presenta principalmente en adultos mayores. Casos clínicos: Presentamos tres pacientes quienes fueron diagnosticados de demencia, con niveles séricos bajos de vitamina B12 y recibieron tratamiento de reposición con hidroxicobalamina. Dos pacientes tuvieron mejoría clínica y uno, solo normalizó los niveles séricos de vitamina B12 sin mejoría clínica, posiblemente por una coexistencia con enfermedad de Alzheimer.

Introduction: Gastric cancer is one of the most prevalent types of cancer worldwide. The World Health Organization (WHO), the International Agency for Research on Cancer (IARC), and the Global Cancer Statistics (GLOBOCAN) reported an age standardized global incidence rate of 9.2 per 100,000 individuals for gastric cancer in 2022, with a mortality rate of 6.1. Despite considerable progress in precision oncology through the efforts of international consortia, understanding the genomic features and their influence on the effectiveness of anti-cancer treatments across diverse ethnic groups remains essential.Methods: Our study aimed to address this need by conducting integrated in silico analyses to identify actionable genomic alterations in gastric cancer driver genes, assess their impact using deleteriousness scores, and determine allele frequencies across nine global populations: European Finnish, European non-Finnish, Latino, East Asian, South Asian, African, Middle Eastern, Ashkenazi Jewish, and Amish. Furthermore, our goal was to prioritize targeted therapeutic strategies based on pharmacogenomics clinical guidelines, in silico drug prescriptions, and clinical trial data.Results: Our comprehensive analysis examined 275,634 variants within 60 gastric cancer driver genes from 730,947 exome sequences and 76,215 whole-genome sequences from unrelated individuals, identifying 13,542 annotated and predicted oncogenic variants. We prioritized the most prevalent and deleterious oncogenic variants for subsequent pharmacogenomics testing. Additionally, we discovered actionable genomic alterations in the ARID1A, ATM, BCOR, ERBB2, ERBB3, CDKN2A, KIT, PIK3CA, PTEN, NTRK3, TP53, and CDKN2A genes that could enhance the efficacy of anti-cancer therapies, as suggested by in silico drug prescription analyses, reviews of current pharmacogenomics clinical guidelines, and evaluations of phase III and IV clinical trials targeting gastric cancer driver proteins.Discussion: These findings underline the urgency of consolidating efforts to devise effective prevention measures, invest in genomic profiling for underrepresented populations, and ensure the inclusion of ethnic minorities in future clinical trials and cancer research in developed countries.

Phyllodes Tumor is a rare fibroepithelial neoplasm that represents 0.3 to 1% of all breast neoplasms. According to histopathologic classification, 12 to 26% are borderline type and approximately 15% of these tumors recur after surgical excision. The recommended treatment for all types of Phyllodes Tumor is surgical excision, and in the case of giant tumors, the treatment should be multidisciplinary. We present the case of a 46-year-old woman with a Phyllodes Tumor in the left breast that recurred 4 years after surgical excision. The anatomopathological study qualified it as a giant tumor and the histopathological study reported a Borderline Phyllodes Tumor. She underwent surgical excision with a left mastectomy and breast reconstruction employing a latissimus dorsi flap plus fat graft. The patient presented a favorable evolution without recurrence. In conclusion, the Recurrent Giant Borderline Phyllodes tumor is rare and its surgical management represents a challenge both in breast excision and reconstruction.

Neurofibromatosis type 1 (NF1) is an inherited neurocutaneous disorder in which tumors form in the nervous system (neurofibromas). Neurofibromas are the most common benign tumors in NF1. The type, size, number, and location of the neurofibromas should be considered for the choice of treatment. We present a case of NF1, in which a wide scalp resection was performed due to the presence of multiple neurofibromas. Associated with this, reconstruction was performed with advancement flaps plus partial skin autograft with favorable results and good coverage of the areas where the tumors were removed.

Epigenetic modifications, characterized by changes in gene expression without altering the DNA sequence, play a crucial role in the development and progression of cancer by significantly influencing gene activity and cellular function. This insight has led to the development of a novel class of therapeutic agents, known as epigenetic drugs. These drugs, including histone deacetylase inhibitors, histone acetyltransferase inhibitors, histone methyltransferase inhibitors, and DNA methyltransferase inhibitors, aim to modulate gene expression to curb cancer growth by uniquely altering the epigenetic landscape of cancer cells. Ongoing research and clinical trials are rigorously evaluating the efficacy of these drugs, particularly their ability to improve therapeutic outcomes when used in combination with other treatments. Such combination therapies may more effectively target cancer and potentially overcome the challenge of drug resistance, a significant hurdle in cancer therapy. Additionally, the importance of nutrition, inflammation control, and circadian rhythm regulation in modulating drug responses has been increasingly recognized, highlighting their role as critical modifiers of the epigenetic landscape and thereby influencing the effectiveness of pharmacological interventions and patient outcomes. Epigenetic drugs represent a paradigm shift in cancer treatment, offering targeted therapies that promise a more precise approach to treating a wide spectrum of tumors, potentially with fewer side effects compared to traditional chemotherapy. This progress marks a step towards more personalized and precise interventions, leveraging the unique epigenetic profiles of individual tumors to optimize treatment strategies.

Desde tiempos remotos, la diplomacia ha constituido un instrumento de política exterior de los agentes gubernamentales para el cumplimiento de sus objetivos nacionales. No obstante, la incursión de nuevos actores en el escenario internacional, asociado a los procesos de globalización, y al desarrollo de las nuevas tecnologías y el comercio, ha conllevado a la necesidad de una ampliación del alcance de la forma tradicional del arte de ejercer la política. En este contexto, aparece la diplomacia académica como un término relativamente nuevo, sobre el cual aún no existe una definición consensuada entre la comunidad científica nacional e internacional. Algunos autores, asocian esta palabra con otras formas de diplomacia, como la científica, la cultural y la del conocimiento. Mientras que otros, incorporan su uso como complemento de las actuales experiencias de internacionalización de la Educación Superior. En consecuencia, el presente trabajo se propone analizar los fundamentos teóricos de la diplomacia académica en función del cumplimiento de los objetivos de política exterior. Para esto, se utiliza una perspectiva cualitativa desde un enfoque dialéctico-materialista. Las técnicas de investigación empleadas son el fichaje bibliográfico, el análisis de contenido y las entrevistas estandarizadas. Como resultado, el término objeto de estudio se identifica como una modalidad de diplomacia pública que involucra la utilización de instrumentos tradicionales. A su vez, representa un concepto clave para comprender y propiciar la internacionalización de la Educación Superior.

Summary: To meet the high energy demands of brain function, cerebral blood flow (CBF) parallels changes in neuronal activity by a mechanism known as neurovascular coupling (NVC). However, which neurons play a role in mediating NVC is not well understood. Here, we identify in mice and humans a specific population of cortical GABAergic neurons that co-express neuronal nitric oxide synthase and tachykinin receptor 1 (Tacr1). Through whole-tissue clearing, we demonstrate that Tacr1 neurons extend local and long-range projections across functionally connected cortical areas. We show that whisker stimulation elicited Tacr1 neuron activity in the barrel cortex through feedforward excitatory pathways. Additionally, through optogenetic experiments, we demonstrate that Tacr1 neurons are instrumental in mediating CBF through the relaxation of mural cells in a similar fashion to whisker stimulation. Finally, by electron microscopy, we observe that Tacr1 processes contact astrocytic endfeet. These findings suggest that Tacr1 neurons integrate cortical activity to mediate NVC.

This study forms part of a classroom teaching experiment on the development of a group of 25 9-10 years old students' algebraic thinking. More specifically, it explored their reasoning while solving word problems built around functional relationships to determine how they generalized through questions posed using natural language, drawn figures or the keyword 'many'. Their written and oral answers to those questions were analyzed qualitatively to determine which approach most effectively supported the expression of their generalization. The results reveal the benefits of posing questions about the general case in different ways while teaching students to use conventional algebraic representations. According to these findings, representing indeterminate quantities with the keyword 'many' induces generalization more successfully than representing them with letters. The use of letters prompts students to seek meaning for the letters, either conventionally, as an unknown or variable quantity, or otherwise, as a label or specific values assigned according to their own criteria. Identifying the most effective procedures may help teachers and curriculum designers formulate mathematical tasks that encourage students to express the generality they perceive in particular cases. Determining the communication demands of each approach is likewise highly useful.

Pooling the opinions of the decision makers about premier alternative from a list of given choices is the most crucial phenomenon theory of decision making. The MSM operator is an effective approach and can identify the collective connection among various input viewpoints. So, tacking the fully benefit of MSM operator, this paper presents a new novel in depth investigation of MSM in context of Neutrosophic fuzzy variables. Initially we developed the structure of One-dimension uncertain linguistic interval valued neutrosophic fuzzy variables, deliberate their fundamental properties along with meaningful laws. Moreover, we encompass the MSM operator to the extent of one dimensional uncertain-linguistic Neutrosophic fuzzy variables and introduced some novel aggregations operators including one-dimensional uncertain linguistic interval-valued Neutrosophic fuzzy, weighted fuzzy and ordered weighted fuzzy McLaurin symmetric mean operator. The practical utilization of the proposed aggregation operators in business analytic are also included in the paper. In last comparison is made between current vs old studies which proved solidity and reliability of the new operator’s vs existing operators in the literature.

The main purpose of this study consisted in the implementation of neutrosophic logic as the central axis for the creation of a neutrosophic model, supported by the AHP method, for the allocation of beds in the Intensive Care Unit (ICU) of an emergency room located in the city of Babahoyo. The principles and contributions of neutrosophic logic are introduced and applied to effectively deal with the uncertainty and ambiguity inherent to resource allocation in a highly complex hospital environment. The synergy between the AHP methodology and the approaches proposed by neutrosophy has allowed the formulation of a model that enables informed and equitable decision-making in circumstances characterized by a shortage of ICU beds. This model ensures not only the provision of optimal care to patients but also the effective management of available resources. The results of this study not only confirm the effectiveness of neutrosophic logic in the scientific field for solving complex problems but also highlight its relevance in clinical practice in the hospital context.

Summary: Background & Aims: Overweight and obesity in children are a public health problem worldwide. There are few studies about nutritional interventions with different diet macronutrient distribution and their potential application in regulating food consumption in this age group. This study aimed to assess the impact of a high protein diet over satiety, energy intake, and body composition in children diagnosed with overweight (Ov) or obesity (Ob). Methods: School-age children (6–10 years) diagnosed Ov or Ob were randomized to receive three different dietary interventions for two months: standard diet (SD), high protein (HP) diet, and HP diet with calcium caseinate (HPC); BMI (Z-score and percentiles), body composition, indirect calorimetry (REEIC), energy intake (24-h recall questionnaire) and satiety (visual analog scale) were evaluated before and two-months after intervention. Results: Sixty-four children diagnosed with overweight (12.5%) and obesity (87.5%) were evaluated. There were no changes in the perception of satiety between groups (p>0.05). There was a tendency for a reduction in waist circumference in the HPC group after treatment (p=0.05). There were no significant differences in body composition, and children's growth was homogeneous between groups. However, intragroup Z-score values for BMI were significantly reduced in all groups (p

Alexandra Arias-Mendoza,1 Jorge A Ortega-Hernández,1 Diego Araiza-Garaygordobil,1 Héctor González-Pacheco,1 Mireya Martínez-García,2 Enrique Hernández-Lemus,3 Rodrigo Gopar-Nieto,1 Tomás Tadeo Sandoval-Aguilar,1 Daniel Sierra-Lara Martinez,1 Salvador Mendoza-García,1 Alfredo Altamirano-Castillo,1 José Luis Briseño-de-la-Cruz,1 Midori Alondra Ortega-Hernández,4 Luis Alejandro Soliz-Uriona,1 Jorge Gaspar-Hernández5 1Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; 2Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; 3Computational Genomics, Instituto Nacional de Medicina Genómica, Mexico City, Mexico; 4Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico; 5Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, MexicoCorrespondence: Alexandra Arias-Mendoza, Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano, Sección XVI, 14080, Tlalpan, Mexico City, Mexico, Tel +52-55- 54852219, Fax +52-55-54852219, Email aariasm@yahoo.comPurpose: While pharmacoinvasive strategy (PI) is a safe and effective approach whenever access to primary percutaneous intervention (pPCI) is limited, data on each strategy’s economic cost and impact on in-hospital stay are scarce. The objective is to compare the cost-effectiveness of a PI with that of pPCI for the treatment of ST-elevation myocardial infarction (STEMI) in a Latin-American country.Patients and Methods: A total of 1747 patients were included, of whom 470 (26.9%) received PI, 433 (24.7%) pPCI, and 844 (48.3%) NR. The study’s primary outcome was the incremental cost-effectiveness ratio (ICER) for PI compared with those for pPCI and non-reperfused (NR), calculated for 30-day major cardiovascular events (MACE), 30-day mortality, and length of stay.Results: For PI, the ICER estimates for MACE showed a decrease of $– 35.81/per 1% (95 confidence interval, – 114.73 to 64.81) compared with pPCI and a decrease of $– 271.60/per 1% (95% CI, – 1086.10 to – 144.93) compared with NR. Also, in mortality, PI had an ICER decrease of $– 129.50 (95% CI, – 810.57, 455.06) compared to pPCI and $– 165.27 (– 224.06, – 123.52) with NR. Finally, length of stay had an ICER reduction of − 765.99 (− 4020.68, 3141.65) and − 283.40 (− 304.95, − 252.76) compared to pPCI and NR, respectively.Conclusion: The findings of this study suggest that PI may be a more efficient treatment approach for STEMI in regions where access to pPCI is limited or where patient and system delays are expected.Keywords: pharmacoinvasive, cost-effectiveness, STEMI, Latin-America

La enfermedad cerebrovascular constituye una de las principales causas de muerte a nivel mundial. Múltiples factores desencadenan los accidentes vasculares encefálicos isquémicos, entre ellas los tumores cardiacos, como el mixoma auricular. Se presenta el caso de una paciente femenina de 32 años, que al examen físico mostró afasia motora, hemiplejia fascio-braquio-crural derecha y discreta paresia de la mirada vertical con nistagmos. Se realizaron estudios de imagen (tomografía de cráneo, ecocardiograma transtorácico y angiotomografía de vasos de cuello) sugerentes de embolización sistémica en el territorio de la carótida izquierda, secundarios a la fragmentación de un tumor cardiaco. Se decide derivar a la paciente a cirugía cardiovascular para endarectomía carotídea con exéresis del tumor cardiaco, el cual evolucionó satisfactoriamente. Persistió el daño neurológico debido al tiempo transcurrido entre el diagnóstico y el tratamiento. Teniendo en cuenta la baja frecuencia del mixoma cardiaco y la posibilidad de asociarse con ictus isquémico se decide presentar este caso.

Multiple endocrine neoplasias encompass a series of syndromes characterized by their genetic origin and the involvement of one or more glands. A 23-years-old male patient with a health history of nesidioblastosis diagnosed at 16 years of age, who attended the Ambato General Teaching Hospital with tonic-clonic seizures and severe hypoglycemia with subsequent epileptic status, is described. Laboratory studies showed primary hyperparathyroidism, and imaging identified lesions suggestive of parathyroid adenoma and insulinoma of the head of the pancreas. After analyzing the case, two criteria were identified to suggest multiple endocrine neoplasia type 1: presence of insulinoma and primary hyperparathyroidism. In addition to treatment with bisphosphonate, consultation with the Genetics service was planned for study of the patient and family members; and with General Surgery, for scheduling surgical resolution. Due to the infrequency of this disease, it is of interest to describe the case, with the aim of exposing the main clinical manifestations and conduct to follow. Diagnosing its cause in each patient is a priority.

Foundation: the association between mental disorders and diabetes mellitus has had growing interest in medical research and clinical practice. Understanding of the relationship between these two conditions has expanded in recent years and a bidirectional relationship between them has been recognized. Objective: analyze and synthesize the opinions and perspectives of experts in relation to the association between mental illnesses and diabetes mellitus. Method: a descriptive study was carried out by applying the expert Delphi method. A total of 12 experts on this topic, specialists in psychiatry, endocrinology or clinical psychology, whose competence was evaluated, were consulted. For the purposes of the study, two questionnaires were developed. A qualitative assessment of the responses was carried out and the cut-off points and their respective indicator scales were calculated; inverse standard normal values were used. A 4-point Likert scale was used and inverse standard values were assigned to the cumulative probabilities. The Cut Points were estimated as the average of the values of the inverse standard function for each scale. The Limit N value was determined to delimit the ranges of each category. Cronbach's alpha correlation coefficient was used to examine the relationship between responses in different topic areas. A detailed report was prepared describing the method and results. Results: a characterization of the main mental illnesses associated with diabetes mellitus was obtained, a synthesis of the risk factors for diabetes mellitus in patients with mental illnesses and practical recommendations for the prevention, diagnosis and treatment of these comorbid disorders. Conclusions: the approach to this topic through the compilation of expert criteria allowed us to obtain a complete and enriching understanding of the underlying factors and clinical implications of this bidirectional association, which contributes to developing more effective strategies for early identification. the integrated management and appropriate care of patients with mental illnesses and diabetes mellitus.

Abstract Mycelium cultivation plays an important role in mushroom production and in various biotechnological studies. Submerged fermentation has received much attention as a promising alternative for the efficient production of mushroom biomass and active metabolites. For the following research, bioreactors were constructed to obtain pure mycelium from Pleurotus ostreatus and Agaricus brunnescens mushrooms using the Honey technique. This method is based on using honey as the main nutrient for the growth of microorganisms on an industrial scale. In the beginning, spore impressions were extracted by the dry chamber method and inoculated into the honey broth. The bioreactors were dimensioned with a 2.5 L culture chamber, 2 L production, controlled temperature of 28○C, pH = 4, and agitation of 120 revolutions per minute. Conidia/milliliter was quantified every three days with a Neubauer chamber, and the Kjeldahl method was used to identify protein as the main bioactive metabolite of the mycelium. Finally, the mycelium obtained was evaluated on three types of substrates comparing their colonization time. The use of bioreactors in mycelium cultivation is efficient as better mycelium quality, higher biomass yield, and more dispersion on substrates are obtained. It also has the benefits of much better oxygen mass transfer and culture homogeneity. With this technique, physical, chemical, and biological factors can be controlled to produce mushrooms in a much shorter time.

Abstract Background The metabolic reprogramming of mesenchymal stem/stromal cells (MSC) favoring glycolysis has recently emerged as a new approach to improve their immunotherapeutic abilities. This strategy is associated with greater lactate release, and interestingly, recent studies have proposed lactate as a functional suppressive molecule, changing the old paradigm of lactate as a waste product. Therefore, we evaluated the role of lactate as an alternative mediator of MSC immunosuppressive properties and its contribution to the enhanced immunoregulatory activity of glycolytic MSCs. Materials and methods Murine CD4+ T cells from C57BL/6 male mice were differentiated into proinflammatory Th1 or Th17 cells and cultured with either L-lactate, MSCs pretreated or not with the glycolytic inductor, oligomycin, and MSCs pretreated or not with a chemical inhibitor of lactate dehydrogenase A (LDHA), galloflavin or LDH siRNA to prevent lactate production. Additionally, we validated our results using human umbilical cord-derived MSCs (UC-MSCs) in a murine model of delayed type 1 hypersensitivity (DTH). Results Our results showed that 50 mM of exogenous L-lactate inhibited the proliferation rate and phenotype of CD4+ T cell-derived Th1 or Th17 by 40% and 60%, respectively. Moreover, the suppressive activity of both glycolytic and basal MSCs was impaired when LDH activity was reduced. Likewise, in the DTH inflammation model, lactate production was required for MSC anti-inflammatory activity. This lactate dependent-immunosuppressive mechanism was confirmed in UC-MSCs through the inhibition of LDH, which significantly decreased their capacity to control proliferation of activated CD4+ and CD8+ human T cells by 30%. Conclusion These findings identify a new MSC immunosuppressive pathway that is independent of the classical suppressive mechanism and demonstrated that the enhanced suppressive and therapeutic abilities of glycolytic MSCs depend at least in part on lactate production.

Studies on genetic variability amongst native and introduced species contribute to a better understanding of the genetic diversity of species along their autochthonous distribution and identify possible routes of introduction. Gonatodes caudiscutatus is a gecko native to western Ecuador and introduced to the Galapagos Islands. Despite being a successful species in human-modified habitats along its native and non-native ranges, neither the colonisation process nor the genetic diversity of this gecko is known. In this study, we analysed 55 individuals from 14 localities in western Ecuador and six localities in San Cristobal Island, Galapagos — the only island with a large, self-sustaining population. We amplified and analysed the genetic variability of two nuclear genes (Cmos and Rag2) and one mitochondrial gene (16S). Cmos and Rag2 sequences presented little to none genetic variability, while 16S allowed us to build a haplotype network. We identified nine haplotypes across mainland Ecuador, two of which are also present in Galapagos. Low genetic diversity between insular and continental populations suggests that the introduction of G. caudiscutatus on the Islands is relatively recent. Due to the widespread geographical distribution of mainland haplotypes, it was not possible to determine the source population of the introduction. This study represents the first exploration of the genetic diversity of Gonatodes caudiscutatus, utilising genetic tools to gain insights into its invasion history in the Galapagos.

Foundation: parkinson's disease is a chronic progressive disorder of the nervous system that mainly affects motor coordination and movement control. Quality of life in patients with Parkinson's disease can vary widely depending on the severity of symptoms and the effectiveness of treatment. Objective: to analyze the quality of life of patients with Parkinson's disease in terms of factors: depression, cognitive functioning, age, sex, duration of the disease and education. Methods: descriptive and correlational, cross-sectional study. 40 people diagnosed with idiopathic Parkinson's disease and members of the Association of People with Disabilities were surveyed. The Mini Mental State Examination was used to assess cognitive functioning, the Parkinson's Disease Quality of Life Questionnaire to assess quality of life, and the Beck Depression Scale to assess emotional status. A non-parametric analysis was used to analyze the correlation, by performing several significance tests in correspondence with the distribution of the variables. The results were presented in quantities and percentages. Results: somatic problems, motor capacity, daily living activity, cognitive functioning and emotional state are among the most affected areas of life. Support from family members and communication with the social environment were the least impaired. A significant correlation was observed between depression and quality of life. Conclusions: the results suggest that early recognition and adequate treatment of depression can improve quality of life and reduce some of the somatic alterations of patients with Parkinson's disease.