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Context: Malva spp. have been widely used in the world as traditional remedies. In Ecuadorian markers Malva sylvestris and Malva pseudolavatera are the species most commercialized. However, the scientific information about M. pseudolavatera is little. Aims: To determine the chemical composition and antioxidant capacity of the aqueous extracts of the leaves of both species. Methods: Aqueous extracts were partitioned with butanol and the fractions obtained were analyzed by GC/MS. Total extracts were evaluated as antioxidants using FRAP, DPPH and ABTS assays. Results: Differences in the chemical composition were found between the extracts. Both extracts showed the presence of polysaccharides, phenolic acids and fatty acids, but in M. sylvestris were identified polyols, which there was not observed in M. pseudolavatera. The aqueous extracts showed free radical scavenging and ferric reducing power capacities in vitro assays, being M. sylvestris the most promissory antioxidant, possibly due to the presence of polyols in the extract. In the present research were reported 39 phytochemical compounds by first time for the specie M. pseudolavatera. Conclusions: Aqueous extracts of the leaves of M. sylvestris and M. pseudolavatera showed antioxidant capacity associated with the presence of phenolic acids, polysaccharides and flavonoids in the extracts.

Resumen: Introducción y objetivo: A pesar de que el término hepatocarcinoma se utiliza para designar tumores primarios hepáticos, su etiología, variación geográfica, comportamiento y asociación con alteraciones genéticas específicas hace de esta una enfermedad con elevada heterogeneidad. El objetivo de esta investigación es establecer características clínicas que permitan definir conglomerados homogéneos utilizando análisis de clúster. Materiales y métodos: Esta investigación desarrolló un análisis exploratorio de clúster utilizando el método K-means para subclasificar a 119 casos de pacientes con hepatocarcinoma de los cuales 62 cumplieron con criterios de inclusión y no de exclusión. Para el análisis de clúster se definió un espacio N dimensional donde N fue igual al número de variables incluidas en el estudio (N̊=̊17), las coordenadas espaciales correspondieron a cualquier magnitud posible entre el valor mínimo y el máximo de las variables incluidas (edad, volumen tumoral, AFP, AST, BD, Alb, Na, INR, Cr, HBV, OH, NASH, tumor Múltiple, Neo, HCV, Sexo, Cirrosis). Resultados: Se identificaron cuatro patrones con características clínicas homogéneas en los cuales la edad de presentación, el antecedente de infección por virus de hepatitis B, la alteración del perfil hepático con dominancia colestásica y los bajos niveles de albúmina se asociaron con un aparente peor pronóstico. Conclusión: Se demuestra cómo la heterogeneidad en hepatocarcinoma puede reducirse utilizando métodos de aprendizaje no supervisado para definir subgrupos específicos, en los cuales los mecanismos fisiopatológicos descritos puedan explicar mejor el comportamiento tumoral y definir determinantes pronósticos relacionados con los subgrupos. Abstract: Introduction and objective: Even though the term hepatocellular carcinoma designates the most common type of primary liver cancer, the disease has a high level of heterogeneity due to its etiology, geographic variation, behavior, and association with specific genetic alterations. The aim of the present study was to establish, through a cluster analysis, the clinical characteristics that enable homogeneous conglomerates to be defined. Materials and methods: An exploratory cluster analysis was developed utilizing the K-means method for sub-classifying 119 cases of patients with hepatocellular carcinoma. Sixty-two of those patients met the inclusion criteria, as well as none of the exclusion criteria. For the cluster analysis, an n-dimensional space was defined, in which n was equal to the number of variables included in the study (n = 17). The spatial coordinates corresponded to any possible magnitude between the minimum and maximum values of the variables analyzed (age, sex, tumor volume, AFP, AST, DB, Alb, Na, INR, Cr, HBV, HCV, OH, NASH, cirrhosis, multiple tumors, and neotumor). Results: Four patterns with homogeneous clinical characteristics were identified, in which age at presentation, history of hepatitis B virus infection, altered liver profile with cholestatic dominance, and low albumin levels were associated with an apparently worse outcome. Conclusion: How heterogeneity in hepatocellular carcinoma could be reduced was shown through utilizing an unsupervised learning method to define specific subgroups, in whom known pathophysiologic mechanisms could better explain tumor behavior and define the determining prognostic factors related to the subgroups.

Microstructural and fatigue behavior of Inconel 718 weldments performed using gas tungsten arc welding process (GTAW) were studied. Ti and Nb segregation tends to form brittle phases (Laves, NbC and TiC), which were identified in the interdendritic region of the weld metal (WM). The heat generated to weld Inconel 718 produced a microstructural transformation of the γ´´ (Ni3Nb), decreasing the microhardness in comparison to the base metal (BM). The welded joints were heat treated by a solubilization and aging treatment. Fatigue life behavior of the welded joints was measured. Curves of stress amplitude versus number of cycles to failure were obtained for the welded joints. Nevertheless, considering the difference in tensile properties of the welded joints and BM, similar fatigue life resistance was found. The fatigue crack initiation was located close to the WM, coinciding with softer zone as identified by microhardness. Fatigue crack growth rate da/dN as a function of stress intensity factor range ΔK was determined. The slower da/dN as a function of ΔK corresponds to the WM in the as-welded condition, followed by the HAZ, WM after the heat treatment, and finally the BM. This phenomenon was analyzed in terms of the crack closure effect induced by the plasticity zone ahead of the crack tip.

Resumen Las drusas del nervio optico son concreciones acelulares de calcio localizadas en el parenquima de la cabeza del nervio optico, descritas como la causa mas frecuente de pseudopapiledema, lo cual las hace dificil de diferenciar de un verdadero edema del disco optico. A pesar de su poca frecuencia, las drusas del nervio optico y el papiledema secundario a una hipertension intracraneal idiopatica pueden coexistir en el mismo paciente. Reportamos el caso de una mujer de 34 anos de vida remitida al servicio de oftalmologia con molestias visuales, cefalea, y tinnitus pulsatil de dos meses de evolucion; al examen fisico se encontro borramiento del margen del disco optico de manera bilateral sin pulsacion venosa espontanea. El diagnostico de hipertension intracraneal idiopatica se realizo por una puncion lumbar con medicion de la presion de apertura, y por los hallazgos de resonancia magnetica cerebral y de orbitas. Se observo incidentalmente las drusas del nervio optico en una tomografia de coherencia optica con angiografia, que luego se confirmarian con una ecografia ocular. Este es el primer caso reportado en America Latina de la coexistencia de drusas del nervio optico y papiledema secundario a hipertension intracraneal idiopatica para nuestro conocimiento.

Optic nerve drusen are acellular concretions of calcium located in the parenchyma of the optic nerve head described as the most common cause of pseudo-papilloedema, which makes it difficult to differentiate from a true optical disc oedema. Despite it being rare optic nerve drusen and the papilloedema secondary to idiopathic intracranial hypertension can coexist in the same patient. We present a case of a 34-year-old woman referred to the Ophthalmology Department with visual discomfort, headaches, and pulsatile tinnitus of two months onset. In the physical examination there was bilateral blurring of the optic disc margin with absence of spontaneous venous pulsation. The diagnosis of idiopathic intracranial hypertension was made by lumbar puncture with the measurement of the opening pressure, and due to the findings of the magnetic resonance scan of the brain and orbits. The optic nerve drusen was an incidental finding in an optical coherence tomography angiography, which would later be confirmed with an eye ultrasound. To our knowledge, this the first case reported in Latin America of the coexistence of optic nerve drusen and papilloedema secondary to idiopathic intracranial hypertension.

INTRODUCTION Uninsured trauma patients are at higher risk of mortality, limited access to postdischarge resources, and catastrophic health expenditure. Hospital Presumptive Eligibility (HPE), enacted with the 2014 Affordable Care Act, enables uninsured patients to be screened and acquired emergency Medicaid at the time of hospitalization. We sought to identify factors associated with successful acquisition of HPE insurance at the time of injury, hypothesizing that patients with higher Injury Severity Score (ISS) (ISS >15) would be more likely to be approved for HPE. METHODS We identified Medicaid and uninsured patients aged 18 to 64 years with a primary trauma diagnosis (International Classification of Diseases, Tenth Revision) in a large level I trauma center between 2015 and 2019. We combined trauma registry data with review of electronic medical records, to determine our primary outcome, HPE acquisition. Descriptive and multivariate analyses were performed. RESULTS Among 2,320 trauma patients, 1,374 (59%) were already enrolled in Medicaid at the time of hospitalization. Among those uninsured at arrival, 386 (40.8%) acquired HPE before discharge, and 560 (59.2%) remained uninsured. Hospital Presumptive Eligibility patients had higher ISS (ISS >15, 14.8% vs. 5.7%; p < 0.001), longer median length of stay (2 days [interquartile range, 0-5 days] vs. 0 [0-1] days, p < 0.001), were more frequently admitted as inpatients (64.5% vs. 33.6%, p < 0.001), and discharged to postacute services (11.9% vs. 0.9%, p < 0.001). Patient, hospital, and policy factors contributed to HPE nonapproval. In adjusted analyses, Hispanic ethnicity (vs. non-Hispanic Whites: aOR, 1.58; p = 0.02) and increasing ISS (p ≤ 0.001) were associated with increased likelihood of HPE approval. CONCLUSION The time of hospitalization due to injury is an underused opportunity for intervention, whereby uninsured patients can acquire sustainable insurance coverage. Opportunities to increase HPE acquisition merit further study nationally across trauma centers. As administrative and trauma registries do not capture information to compare HPE and traditional Medicaid patients, prospective insurance data collection would help to identify targets for intervention. LEVEL OF EVIDENCE Economic, level IV.

Objective To report the ocular manifestations in patients with leukaemia. Methods This is a retrospective, descriptive and observational study in patients with ocular manifestations of leukaemia. Results A total of 14 eyes were evaluated corresponding to 8 patients (5 women and 3 men) with ocular manifestations of leukaemia. The mean age at diagnosis was 43 years (31–76 years). Six eyes corresponded to patients with Acute Myeloid Leukaemia (AML), four eyes to Acute Lymphoid Leukaemia (ALL), two eyes to Chronic Myeloid Leukaemia (CML), and the remaining two belonged to patients with Hairy Cell Leukaemia (HCL). The primary ocular findings were choroidal invasion in 12 eyes (85.7%), retinal infiltration in 4 eyes (28.6%), and neuro-ophthalmic disorders in 4 eyes (28.6%). The mean visual acuity improved from 0.689 to 0.449 (logMAR) (P = .012) after the systemic and intrathecal chemotherapy. Of the eight patients, four died from systemic complications of the underlying disease. Conclusions This is the first report of multiple ocular manifestations secondary to leukaemia in a Colombian population. It is important to keep in mind that this disease is included within the masquerade syndromes and that the ophthalmological findings that, while subtle, can also be devastating and be signs of a life-threatening disease.

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Introduction: Ergotism is a vasospasm that affects visceral and peripheral muscle arteries. Classically, symmetrical involvement of lower limb arteries is described, and is often associated with a history of chronic consumption of ergotamine derived medications (Cafergot). Case report: A 22 year-old healthy man with infectious mononucleosis syndrome, who presented with a sudden onset of paraesthesias in the lower limbs, as well as livedo reticularis. The initial diagnosis was a medium-sized vessel vasculitis (polyarteritis nodosa). The symptoms were preceded by the administration of Cafergot for headache treatment, and resolved spontaneously. The magnetic resonance angiography (MRA) of the lower limbs showed occlusion of peroneal arteries, with filiform distal flow. Other infectious, autoimmune and cardiovascular origins were ruled out. Discussion: Ergotism is an important differential diagnosis in the study of the patient with vasculitis, especially in acute onset presentations. Its treatment is the suspension of the causal drug, with vasodilator and surgical vascular procedures, if necessary. Conclusions: Ergotism is an imitator of vasculitis, especially in young patients with a history of difficult to control migraine. The concomitant administration of CYP3A4 inhibitors (mainly, protease inhibitors and macrolides) enhances the toxic effects of ergot. RESUMEN Introducción: El ergotismo es un vasoespasmo que afecta las arterias musculares periféricas y viscerales. Clásicamente se describe la afectación simétrica de las arterias de las extremidades inferiores, a menudo asociada con el consumo crónico de medicamentos derivados de ergotamina (Cafergot®). Caso clínico: Varón sano de 22 anos con síndrome de mononucleosis, presentó parestesias en las extremidades inferiores y livedo reticularis de forma súbita, el diagnóstico inicial fue una vasculitis de mediano vaso (poliarteritis nodosa). Los síntomas fueron precedidos por la administración de Cafergot® para el tratamiento de cefalea, y se resolvieron espontáneamente. La angiografía por resonancia magnética (ARM) de las extremidades inferiores mostró oclusión de las arterias peroneas, con flujo distal filiforme. Se descartaron otras etiologías infecciosas, autoinmunes y cardiovasculares. Discusión: Los ergotismos son un diagnóstico diferencial importante en el estudio del paciente con vasculitis, especialmente en presentaciones de inicio agudo. Su tratamiento es la suspensión del fármaco causal, vasodilatadores y procedimientos vasculares quirúrgicos, si es necesario. Conclusiones: El ergotismo es un imitador de vasculitis, especialmente en pacientes jóvenes con antecedentes de migrana de difícil control. La administración concomitante de inhibidores del CYP3A4 (principalmente, inhibidores de proteasa y macrólidos) potencia los efectos tóxicos del ergot.

We report the case of a 22 year-old male with a clinical picture of 4 months onset of headaches, deafness, and a decrease of vision in the left eye. His mother mentioned he also had changes in behaviour and mood. The magnetic resonance scan of the brain showed multiple hyper-intense lesions in the knee of the corpus callosum. The hearing test reported a neurosensory deafness. In the ophthalmoscopy, a retinal infarction was observed in the nerve fibre layer in the left eye, which was confirmed using optical coherence tomography. The fluorescein angiography showed multiple foci of hyperfluorescence of the arteriole walls, arteriole filling defects, and regional ischaemia foci of the choroid. These findings confirmed the presumed diagnosis of a Susac syndrome. This is one of the few cases reported in the literature of a Susac syndrome in a young man with the complete diagnostic triad, and the first in Colombia.

Resumen Presentamos el caso de un joven de 22 anos con 4 meses de cefalea, hipoacusia y disminucion de la vision izquierdos. Su madre refirio ademas cambios del comportamiento y del estado de animo. La resonancia magnetica cerebral mostro multiples lesiones hiperintensas en la rodilla del cuerpo calloso. La audiometria documento una hipoacusia neurosensorial. En la oftalmoscopia se observo un infarto retiniano de la capa de fibras nerviosas en el ojo izquierdo, el cual fue confirmado con una tomografia de coherencia optica; la angiografia fluoresceinica mostro multiples focos de hiperfluorescencia de la pared de las arteriolas, defectos del llenado de las arteriolas, y regiones focales de isquemia de la coroides. Estos hallazgos confirman el diagnostico presuntivo de un sindrome de Susac. Este es uno de los pocos casos publicados en la literatura de un sindrome de Susac en un hombre joven con la triada diagnostica completa, y el primero en Colombia.

Partially aged 6061 aluminum plates were welded by the gas metal arc welding process. During the welding process, a cooling system to act as a heat sink was used to extract the heat coming out from the welding process. To determine the experimental weld thermal cycles, K type thermocouples were placed at the heat affected zone. Finite element was used to compute the thermal distribution and isothermal sections generated by welding. The temperature measurements, Vickers microhardness profiles and tensile tests were observed to be related with the microstructural β″ to β′ phase transformation. The over-aging of the heat affected zone tends to diminish when the heat sink is used as compared with the reference welding condition. An increase on tensile strength (about 5.8%) and ductility (close to 29%), for welds performed in partial aging materials with respect to the welds with artificial aging condition (6061-T6 alloy) was also observed.

Academic productivity is an increasingly important asset for trainees pursuing academic careers. Medical schools and graduate medical education programs offer structured research programs, but providing longitudinal and individualized health services research education remains challenging. Whereas in basic science research, members at multiple training levels support each other within a dedicated community (the laboratory), health services research projects frequently occur within individual faculty-trainee relationships. An optimal match of expertise, availability, and interest may be elusive for an individual mentor-mentee pair. We aimed to share our experience building Surgeons Writing about Trauma (SWAT), a trainee-led research community that propels academic productivity by facilitating peer collaboration and opportunities to transition into independent researchers. We highlight challenges of health services research for trainees, present how structured mentorship and a peer community can address this challenge, and detail SWAT's operational structure to guide replication at peer institutions.

This article describes the effect on the efficiency of a fully aqueous dye-sensitized solar cell (DSSC) after the anchoring of the hydrophobic and halogen-free ionic liquid (IL) trioctylmethyl ammonium dodecanedioate (DTMA) on its titanium oxide (TiO2) photo-anode surface. In comparison with nontreated DTMA DSSCs, efficiency increments of 137% and 176% were observed when azo dye Red Reactive 2 and N3 dye were employed as sensitizers, respectively. Since V OC and I SC were increased, it was concluded that DTMA reinforced the dye-TiO2 anchoring, shifted negatively the levels of photo-anode conduction bands, improved electron injection, and reduced recombination losses.

Resumen: Este artículo presenta varias metodologías analíticas para investigar el colapso de un muro de mampostería de ladrillo no reforzada sujeta a flexión fuera del plano debido a los vientos moderados presentes en Medellín, Colombia. Los modelos analíticos incluyen un modelo rígido de mampostería en voladizo, modelos en voladizo y pórtico de concreto reforzado considerando o excluyendo la contribución de la mampostería, y un modelo de elementos finitos que incorpora explícitamente los pórticos de concreto, las unidades de mampostería y aperturas en los paneles. Las demandas por viento se estimaron por interpolación espacial de las mediciones reales de la velocidad del viento cercanas al sitio. La comparación de los resultados se realiza en términos de las deflexiones máximas en la parte superior del muro, así como en las razones de la demanda a la capacidad, de fuerzas y esfuerzos en los pórticos de concreto y en la mampostería, respectivamente. Se demuestra que la distribución de presiones de viento, los efectos P-Delta, la interacción y contribución relativa a la resistencia fuera del plano de los pórticos y elementos de mampostería con flexión en una o dos direcciones, son los parámetros principales que afectan los resultados, además de la selección del modelo analítico. A pesar de las diferencias sustanciales entre los modelos analíticos, los parámetros y suposiciones recomendadas resultaron en la correcta determinación del colapso inminente del muro bajo las fuerzas de viento estimadas.

Dual phase steel DP980 sheets were joined by resistance spot welding (RSW) process. Mechanical resistance of the welds was characterized by microhardness, tensile shear and fatigue tests. A significant hardness decreases was observed in the RSW lap joints with respect to the base material, which was attributed to phase transformations during the heating and cooling of the steel. Fatigue Wohler curves using a fixed load ratio of 0.1 were obtained. It was found that the spot weld at the nugget interface close to the fusion zone induced a critical stress concentration factor, which decreased the fatigue life of the joints in the as-welded condition. Failure of the welds was initiated at the interface between welded sheets. Two predominant fatigue fracture modes were observed associated with mode I/III cyclic loading, which were correlated with the fatigue crack initiation and propagation stages. Compressive residual stresses were induced by a loading-unloading cycle on the spot welds, which tends to increase the fatigue life of the joints when compared to the as-welded condition.

Heat moving source models along with transient heat analysis by finite element method were used to determine weld thermal cycles and isothermal sections obtained from the application of a gas tungsten arc welding beads on Inconel 718 plates. Analytical (Rosenthal's thick plate model) and finite element results show an acceptable approximation with the experimental weld thermal cycles. The isothermal sections determined by numerical simulation show a better approximation with the experimental welding profile for double-ellipse model heat distribution than Gauss model. To analyze the microstructural transformation produced by different cooling rates in the fusion and heat affected zones, Vickers microhardness measurements (profile and mapping representation) were conducted. A hardness decrement for the heat affected zone (∼200 HV0.2) and fusion zone (∼240 HV0.2) in comparison with base material (∼350 HV0.2) was observed. This behavior has been attributed to the heterogeneous solubilization process of the γ″ phase (nickel matrix), which, according to the continuous-cooling−transformation curve, produced the Laves phase, δ and MC transition phases, generating a loss in hardness close to the fusion zone.

The fatigue and crack growth behavior of Inconel 718 and AL6XN alloys joined with an ERNiFeCr-2 filler by the gas tungsten arc welding process was evaluated. A comparison between Wohler curves for the monolithic IN718 and AL6XN alloys and the IN718-AL6XN dissimilar welded joint were obtained. Although Vickers microhardness profiles revealed the presence of a soft region in the heat affected zone of the IN718 base material, the fatigue crack nucleated at the fusion zone near to the AL6XN and propagated across the weld bead. The welded joint and the AL6XN base material presented a similar high cycle fatigue behavior despite the presence of an unmixed zone at the AL6XN/weld metal interface. The results of the fatigue crack growth test indicated that the weld metal has the highest growing rate owing to the presence of brittle secondary phases such as Laves and NbC. The fatigue crack growth rates obtained from experimental data were compared with measurements of the distance between striations on the fracture surfaces, both were very close.

Made available in DSpace on 2021-06-25T10:30:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-26 The effects of respiratory inhibitors, quinone analogues and artificial substrates on the membrane-bound electron transport system of the fastidious β-proteobacterium Eikenella corrodens grown under O2-limited conditions were studied. NADH respiration in isolated membrane particles were partially inhibited by rotenone, dicoumarol, quinacrine, flavone, and capsaicin. A similar response was obtained when succinate oxidation was performed in the presence of thenoyltrifluoroacetone and N,N'-dicyclohexylcarbodiimide. NADH respiration was resistant to site II inhibitors and cyanide, indicating that a percentage of the electrons transported can reach O2 without the bc1 complex. Succinate respiration was sensitive to myxothiazol, antimycin A and 2-heptyl-4-hydroxyquinoline-N-oxide (HQNO). Juglone, plumbagin and menadione had higher reactivity with NADH dehydrogenase. The membrane particles showed the highest oxidase activities with ascorbate-TCHQ (tetrachlorohydroquinone), TCHQ alone, and NADH-TMPD (N,N,N',N'-tetramethyl-p-phenylenediamine), and minor activity levels with ascorbate-DCPIP (2,6-dichloro-phenolindophenol) and NADH-DCPIP. The substrates NADH-DCPIP, NADH-TMPD and TCHQ were electron donors to cyanide-sensitive cbb' cytochrome c oxidase. The presence of dissimilatory nitrate reductase in the aerobic respiratory system of E. corrodens ATCC 23834 was demonstrated by first time. Our results indicate that complexes I and II have resistance to their classic inhibitors, that the oxidation of NADH is stimulated by juglone, plumbagin and menadione, and that sensitivity to KCN is stimulated by the substrates TCHQ, NADH-DCPIP and NADH-TMPD. Grupo de Investigación de Biomembranas (GIBIOM) Facultad Ciencias de La Salud Centro Seccional de Investigación (CIUL), Universidad Libre Campus Barranquilla Grupo de Micología Departamento de Microbiología Facultad de Medicina Universidad de Cartagena Campus Zaragocilla School of Agricultural and Veterinary Sciences Technology Department São Paulo State University (Unesp), Via de Acesso Prof. Paulo Donato Castellane s/n School of Agricultural and Veterinary Sciences Technology Department São Paulo State University (Unesp), Via de Acesso Prof. Paulo Donato Castellane s/n

Summary A pilot of co-produced fluid geothermal power generation has been implemented by Parex Resources in the Llanos Orientales sedimentary basin, Colombia’s largest oil producing region. This project represents the first generation of geothermal power in Colombia and demonstrates the viability of geothermal power production alongside oil and gas production in this setting. The pilot makes use of modular Organic Rankine Cycle (ORC) technology to convert the thermal energy from produced oilfield water to electrical power at temperatures below 100°C. Currently, the pilot generates 70kWe net of baseload, emissions-free power. Approximately 550 tonnes of carbon dioxide emissions per year will be eliminated through the operation of this pilot. This work highlights the importance of geothermal power as an energy efficiency measure in actively producing oilfields. Several technical and economic advantages of co-produced fluid oilfield geothermal in active oilfields are discussed, in comparison to the conversion of abandoned oilfield assets for geothermal power production.

This research carries out a systematic, descriptive, documentary study in the textile area focus on biodegradability in textile fibers to know in this first approach the processes that have detected the material obtained by biological action to change and lose its original properties and chemical level decreasing in as much as possible the damage environment, benefic to the areas: textile, construction, agriculture, livestock, fish farming, among others. 40 relevant articles or review articles of interest of factor-impact Q1, Q2, Q3 are selected: 22 selected articles are Q1, 17 articles are Q2 and 1 articles Q3 of the last 10 years, which answered the research question asked on impact investigations in this area.

Background Postdischarge convalescence after traumatic rib fractures remains unclear. We hypothesized that patients with rib fractures, even as an isolated injury, have associated poor quality of life (QoL) after discharge. Methods We prospectively enrolled adult patients at our level I trauma center with rib fractures between July 2019 and January 2020. We assessed QoL at 1 and 3 months after discharge using the Trauma-specific Quality-of-Life (T-QoL; 43-question survey evaluating five QoL domains on a 4-point Likert scale, where 4 indicates optimal and 1, worst QoL) and supplementary questionnaires. We used generalized estimating equations to assess T-QoL score trends over time and effect of age, sex, injury pattern, self-perceived injury severity, and Injury Severity Score. Results We enrolled 139 patients (108 completed the first and 93 completed both surveys). Three months after discharge, 33% of patients were not working at preinjury capacity, and 7% were still using opioid analgesia. Suffering rib fractures mostly impacted recovery and resilience (T-QoL score, mean [robust standard error] at 1 month, 2.7 [0.1]; 3 months, 3.0[0.1]) and physical well-being domains (1 month, 2.5 [0.1]; 3 months, 2.9[0.1]). Quality of life improved over time across all domains. Compared with patients who perceived their injuries as mild/moderate, patients who perceived their injuries as severe/very severe reported worse T-QoL scores across all domains. In contrast, Injury Severity Score did not affect QoL. Patients 65 years or older (-0.6 [0.1]) and women (-0.6 [0.2]) reported worse functional engagement compared with those 65 years or older and men, respectively. Conclusion We found that patients with traumatic rib fractures experience suboptimal QoL after discharge. Quality of life improved over time, but even 3 months after discharge, patients reported challenges performing activities of daily living, slower-than-expected recovery, and not returning to work at preinjury capacity. Perception of injury severity had a large effect on QoL. Patients with rib fractures may benefit from close short-term follow-up. Level of evidence Prognostic and epidemiological, level III.

A patient in her 60s presented to the emergency room with sudden-onset severe epigastric pain associated with nausea and emesis. The patient’s medical history was unremarkable; surgical history was notable only for a diagnostic laparoscopy without any additional intervention. Vital signs were within normal limits and physical examination was notable for abdominal distension and generalized tenderness without peritoneal signs. Laboratory values were notable for an elevated lactate of 2.9 mmol/L. On CT of the abdomen and pelvis, the patient was found to have a mesenteroaxial gastric volvulus with the markedly distended stomach causing mass effect on a very redundant colon (figure 1). There was concern for large bowel obstruction with a transition point at the splenic flexure. There was evidence of mesenteric edema, but no evidence of ischemia, pneumatosis, or pneumoperitoneum. Figure 1 Mesenteroaxial gastric volvulus. 1. Nasogastric tube …

Our patient initially presented to the Urology service for robotic-assisted right simple nephrectomy due to complications from a ureteral stricture and recurrent obstructive pyelonephritis. In the operating room, the patient was placed in right-side-up flank position and access was obtained using the Veress needle at approximately the midclavicular line at the level of the costal margin. The initial pass of the Veress was questionable for bilious aspirate and the Veress removed. One more Veress attempt was made prior to plans to convert to Hasson, this time slightly medial. At the time of insufflation, the patient became hemodynamically unstable and was unable to be ventilated. Transthoracic echocardiogram confirmed a CO2 embolism. The incidence of CO2 embolism during laparoscopy is estimated to be 1 out of every 60 000 cases.1 Management included aborting the planned procedure, placing the patient in Trendelenburg/left lateral decubitus position to sequester air at the apex of the right ventricle, and providing supportive care through oxygenation and ventilation. The Veress was removed and the patient was positioned and stabilized by the anesthesiologist. The patient transferred to the ICU where they were resuscitated. …

The gas metal arc welding (GMAW) process was used to weld 3003-H14 plates under restricted and unrestricted thermal expansion. Experimental and numerical analysis were conducted to determine the relation between weld thermal cycles and residual stresses. A customized data acquisition system with K-type thermocouples was used to measure the weld thermal cycles, while residual stresses were determined by the hole drilling method. Thermo-mechanical simulation models for the two restricted conditions were implemented from the experimental data obtained. A double ellipse heat distribution geometry was used to model the heat moving source by using the finite element method. Thermal rates and peak temperatures were approximated by the finite element model with 2% difference, with respect to the experimental weld thermal cycles. Longitudinal and transverse normal residual stresses determined by the finite element model showed a good comparison with experimental measurements. The larger residual stresses were in the transverse direction for both clamping conditions, which indicated that working loading paths along the lateral direction of the welded plate are more influenced by the post-welding residual stresses.

The patient is presented to the emergency department following the acute onset of abdominal pain, nausea and a painful mass in the right groin. This was following several months of experiencing a painless bulge in the groin that appeared only with heavy lifting or straining. Physical exam exam revealed normal vital signs, a diffusely tender abdomen and an irreducible, exquisitely tender 5 cm firm mass in the right inguinal crease. The white cell count was 15.7×109/ L and CT abdomen and pelvis with intravenous contrast showed an indirect right inguinal hernia containing a dilated appendix measuring 11 mm with wall enhancement, a 5 mm appendicolith and surrounding fat stranding (figure 1). Based on the physician exam, clinical presentation and imaging, the patient was diagnosed with incarcerated right indirect hernia containing an acutely inflamed appendix without rupture. This was consistent with an amyand hernia. Figure 1 CT abdomen pelvis showing the appendix within an indirect right inguinal hernia. The appendix measures up to 11 mm with wall enhancement, and there is a 5 mm appendicolith. There is mild fat …

Introduction and aims: Even though the term hepatocellular carcinoma designates the most common type of primary liver cancer, the disease has a high level of heterogeneity due to its etiology, geographic variation, behavior, and association with specific genetic alterations. The aim of the present study was to establish, through a cluster analysis, the clinical characteristics that enable homogeneous conglomerates to be defined. Materials and methods: An exploratory cluster analysis was developed utilizing the K-means method for sub-classifying 119 cases of patients with hepatocellular carcinoma. Sixty-two of those patients met the inclusion criteria, as well as none of the exclusion criteria. For the cluster analysis, an n-dimensional space was defined, in which n was equal to the number of variables included in the study (n = 17). The spatial coordinates corresponded to any possible magnitude between the minimum and maximum values of the variables analyzed (age, sex, tumor volume, AFP, AST, DB, Alb, Na, INR, Cr, HBV, HCV, OH, NASH, cirrhosis, multiple tumors, and neotumor). Results: Four patterns with homogeneous clinical characteristics were identified, in which age at presentation, history of hepatitis B virus infection, altered liver profile with cholestatic dominance, and low albumin levels were associated with an apparently worse outcome. Conclusions: How heterogeneity in hepatocellular carcinoma could be reduced was shown through utilizing an unsupervised learning method to define specific subgroups, in whom known pathophysiologic mechanisms could better explain tumor behavior and define the determining prognostic factors related to the subgroups. Resumen: Introducción y objetivo: A pesar de que el término hepatocarcinoma se utiliza para designar tumores primarios hepáticos, su etiología, variación geográfica, comportamiento y asociación con alteraciones genéticas específicas hace de esta una enfermedad con elevada heterogeneidad. El objetivo de esta investigación es establecer características clínicas que permitan definir conglomerados homogéneos utilizando análisis de clúster. Materiales y métodos: Esta investigación desarrolló un análisis exploratorio de clúster utilizando el método K-means para subclasificar a 119 casos de pacientes con hepatocarcinoma de los cuales 62 cumplieron con criterios de inclusión y no de exclusión. Para el análisis de clúster se definió un espacio N dimensional donde N fue igual al número de variables incluidas en el studio (N = 17), las coordenadas espaciales correspondieron a cualquier magnitud posible entre el valor mínimo y el máximo de las variables incluidas (edad, volumen tumoral, AFP, AST, BD, Alb, Na, INR, Cr, HBV, OH, NASH, tumor Múltiple, Neo, HCV, Sexo, Cirrosis). Resultados: Se identificaron cuatro patrones con características clínicas homogéneas en los cuales la edad de presentación, el antecedente de infección por virus de hepatitis B, la alteración del perfil hepático con dominancia colestásica y los bajos niveles de albúmina se asociaron con un aparente peor pronóstico. Conclusiones: Se demuestra cómo la heterogeneidad en hepatocarcinoma puede reducirse utilizando métodos de aprendizaje no supervisado para definir subgrupos específicos, en los cuales los mecanismos fisiopatológicos descritos puedan explicar mejor el comportamiento tumoral y definir determinantes pronósticos relacionados con los subgrupos.

We report the case of a 22 year-old male with a clinical picture of 4 months onset of headaches, deafness, and a decrease of vision in the left eye. His mother mentioned he also had changes in behaviour and mood. The magnetic resonance scan of the brain showed multiple hyper-intense lesions in the knee of the corpus callosum. The hearing test reported a neurosensory deafness. In the ophthalmoscopy, a retinal infarction was observed in the nerve fibre layer in the left eye, which was confirmed using optical coherence tomography. The fluorescein angiography showed multiple foci of hyperfluorescence of the arteriole walls, arteriole filling defects, and regional ischaemia foci of the choroid. These findings confirmed the presumed diagnosis of a Susac syndrome. This is one of the few cases reported in the literature of a Susac syndrome in a young man with the complete diagnostic triad, and the first in Colombia.

Objective: To investigate the respiratory chain of Paraburkholderia tropica under limited oxygen conditions would allow us to better understand their functions in plant tissue. Methods: We first optimized the medium for P. tropica biomass production in static culture. Oxidase and Oxidoreductase activities were determined in absence and presence de inhibitors. Spectroscopic analysis of cytochromes was obtained at room and liquid nitrogen temperature. Findings: Isolated membranes showed respiratory oxidase activities with succinate, glucose, NADH and ascorbate-N,N,N′,N′-tetramethyl-p-phenylenediamine (TMPD). Succinate and glucose respiration were inhibited by 2-heptyl-4-hydroxyquinoline-N-oxide, antimycin A and myxothiazol, suggesting the presence of a bc1 complex.KCN inhibition curves in the presence of ascorbate-TMPD, succinate or glucose were biphasic, with KCN-sensitive and -resistant oxidases. Spectral analysis with physiological or artificial substrates revealed the presence of only cytochromes b and c, with remarkable cytochrome reduction by ascorbate alone. The CO difference and photodissociation spectra of glucosereduced membranes revealed one component with the spectral features of a cytochrome o´-like CO complex. Air-oxidation spectra of the cytochromes with KCN showed that cytochrome c is an obligate participant in the KCN-sensitive pathway and revealed the presence of a cyanide-resistant oxidase cytochrome bo. Novelty: The characterization of the electron transport system of P. tropica allowed us to propose the following components: 1. Dehydrogenases for succinate, glucose and NADH, 2. A ubiquinone, 3. A bc complex and 4. Two oxidases, cbb-type cytochrome c oxidase and bo-type quinol oxidase. Keywords: bc1 complex, cbb oxidase, Cytochromes, Paraburkholderia tropica, Quinol Oxidase, Respiration

This study aimed at developing a multiproduct biorefinery scheme for vinase valorization. It involved the extraction of trans-aconitic acid, its transformation into biopolymers using microwave irradiation and the use of the raffinated-vinasse for biogas production. Each technology was assessed individually, followed by a process integration at bench scale, from which a mass balance was calculated, supporting the feasibility of the approach. As a renewable source derived from a residue, these bioproducts can replace crude-oil-based materials in various chemical industrial processes; however, a detailed techno-economic and life-cycle analysis are required to defined the sustainability of the process.

The modified indirect electric arc welding (MIEA) and the conventional gas metal arc welding (GMAW) processes were used to weld 7075-T651 aluminum alloy plates. The fatigue life behavior was studied for three different zones in the welded joints (base metal, heat affected zone and weld metal). Compact-type (CT) specimens manufactured from the 7075-T651 aluminum alloy welded plates were subjected to fatigue tests with constant amplitude cyclic loading. The CT specimens corresponding to MIEA weld metal shown the largest fatigue life (number of cycles to reach the stable crack propagation), which was four times larger than the weld metal obtained by GMAW. This improvement was attributed to the high tensile residual stresses induced by the application of three welding beads of the GMAW process in contrast with the stresses induced by the application of only one welding bead in the MIEA. The tensile residual stresses were of no consequence in terms of fatigue life for the heat affected zone (HAZ). At this zone, the microstructural transformation (soft zone formation in the HAZ) induces a similar fatigue life behavior. For the weld metal produced by the MIEA welding process, the fatigue crack growth tends to increase in comparison with the GMAW, whereas for the HAZ no difference was detected. Fracture surfaces of all materials were analyzed by using scanning electron microscopy to correlate the fatigue crack growth condition with the striations formation.

Gas tungsten arc welding (GTAW) was used to join plates of Inconel 718. The mechanical properties were determined by tensile, microhardness, and instrumented Charpy impact tests. An ERNiFeCr-2 filler metal fed by a semi-automatic mechanism was used. Partial dissolution of the strengthening phases, γ′ and γ″, induced a soft region (~ 225 HV1.0) in the heat-affected zone (HAZ) during welding. The yield strength (371.3 MPa) of the as-welded joint is approximately 45% of the base material in aged condition (822.7 MPa). The welds were subjected to a hardening recovery post weld heat treatment (HRPWHT). Impact testing of the hardened welds revealed a reduction of 17% in energy absorbed with respect the aged base material. Hardness measurements showed an increase to ~ 410 HV0.1 in the fusion zone; however, due to segregation of Nb and formation of carbides, the precipitation of γ″ is not fully completed, and the yield strength (719 MPa) of the heat-treated welded joint is lower than the base material in aged condition.

Objetivo: la responsabilidad ética del investigador obliga al monitoreo de la seguridad de los participantes a través del estudio y, por ende, se requiere de un comité de moni-toreo de datos, cuya tarea principal es el análisis interino que se refiere a la supervisión de variables como beneficios dramáticos, efectos adversos, mortalidad y futilidad, que lleven a la terminación temprana del estudio. El objetivo de esta investigación es de-terminar los métodos estadísticos más utilizados en el análisis interino en los ensayos clínicos aleatorizados y publicados en 2016 en una revista médica general de alto factor de impacto. Metodología: se realizó un estudio meta-epidemiológico descriptivo, constituido por ensayos clínicos aleatorizados publicados en el The New England Journal of Medicine, desde el 7 de enero hasta el 10 de noviembre de 2016. Resultados: se analizaron 104 artículos con una muestra promedio de 5 531 ± 762 pacientes y un tiempo de seguimiento promedio de 31 ± 45 meses. De los estudios evaluados se encontró que 88 (84.61%) realizaron análisis interino y 16 (15.38%) no lo realizaron. Los métodos estadísticos utilizados en los artículos fueron O’Brien-Fleming en 30 (34.09%), Haybittle-Peto en 13 (14.77%); otros métodos en dos (2.27%) y no especificado en 43 (48.86%) de ellos. Conclusiones: la mayoría de los ensayos clínicos aleatorizados realizó análisis interino y lo describen en su protocolo. Aproximadamente la mitad de los estudios no especificó el método estadístico; sin embargo, el método descrito más utilizado fue O’Brien-Fleming y, en segundo lugar, Haybittle-Peto y en ningún estudio se especificó el método de Pocock.

Thermal cycles and isothermal sections were determined analytically by using the Rosenthal thin plate model, as well as by means of finite element method. The simulation model provides an acceptable approximation to thermal cycles measured during the welding process. A discrepancy for the analytical model with respect to the experimental results was found. Due to the thermal effect a hardness decrement of 43% (60 HV 0.1 ) with respect to the base material (107 HV 0.1 ) at a distance of 18 mm from the center of the welding bead was observed. The weld thermal cycle measured experimentally at this distance traverses the C-curve for the β′ precipitation phase at a peak temperature of 380 °C, with a dwell-time of approximately 10 s. The presence of rod-shape β′ precipitates was observed on a transmission electron microscopy image. A correlation between isothermal sections and the hardness distribution for different zones of the welded joint was identified.

SAE4320H steel was characterized by photothermal radiometry spectroscopy, scanning electron microscopy, x-ray diffraction, and Vickers microhardness, to study metallurgical property changes as a result of the annealing heat treatment. Photothermal radiometry (PTR) images of hot forged and annealed SAE4320H steel were obtained to study the thermal changes, as a consequence of metallurgical microstructure changes that were produced by the heat treatment conditions. X-ray diffraction showed that the annealing process improves the crystalline quality of the SAE4320H steel and releases of any thermal stress. Widmanstatten microstructure was identified as a typical structure after the forging process. The Widmanstatten is a metallographic microstructure transformation to ferrite and pearlite which affected SAE4320H steel hardness and thermal properties. Vickers test showed that the hardness decreases as a result of the annealing process. A positive correlation between Vickers microhardness and PTR amplitude images was found, indicating that the annealing process increases the PTR signal. This methodology allows the determination of the changes in the Vickers microhardness from a non-contact and remote method as in PTR.