Mir-21-Sox2 Axis Delineates Glioblastoma Subtypes with Prognostic Impact.

UNLABELLED: Glioblastoma (GBM) is the most aggressive human brain tumor. Although several molecular subtypes of GBM are recognized, a robust molecular prognostic marker has yet to be identified. Here, we report that the stemness regulator Sox2 is a new, clinically important target of microRNA-21 (miR-21) in GBM, with implications for prognosis. Using the MiR-21-Sox2 regulatory axis, approximately half of all GBM tumors present in the Cancer Genome Atlas (TCGA) and in-house patient databases can be mathematically classified into high miR-21/low Sox2 (Class A) or low miR-21/high Sox2 (Class B) subtypes. This classification reflects phenotypically and molecularly distinct characteristics and is not captured by existing classifications. Supporting the distinct nature of the subtypes, gene set enrichment analysis of the TCGA dataset predicted that Class A and Class B tumors were significantly involved in immune/inflammatory response and in chromosome organization and nervous system development, respectively. Patients with Class B tumors had longer overall survival than those with Class A tumors. Analysis of both databases indicated that the Class A/Class B classification is a better predictor of patient survival than currently used parameters. Further, manipulation of MiR-21-Sox2 levels in orthotopic mouse models supported the longer survival of the Class B subtype. The MiR-21-Sox2 association was also found in mouse neural stem cells and in the mouse brain at different developmental stages, suggesting a role in normal development. Therefore, this mechanism-based classification suggests the presence of two distinct populations of GBM patients with distinguishable phenotypic characteristics and clinical outcomes. SIGNIFICANCE STATEMENT: Molecular profiling-based classification of glioblastoma (GBM) into four subtypes has substantially increased our understanding of the biology of the disease and has pointed to the heterogeneous nature of GBM. However, this classification is not mechanism based and its prognostic value is limited. Here, we identify a new mechanism in GBM (the miR-21-Sox2 axis) that can classify ∼50% of patients into two subtypes with distinct molecular, radiological, and pathological characteristics. Importantly, this classification can predict patient survival better than the currently used parameters. Further, analysis of the miR-21-Sox2 relationship in mouse neural stem cells and in the mouse brain at different developmental stages indicates that miR-21 and Sox2 are predominantly expressed in mutually exclusive patterns, suggesting a role in normal neural development.

A Multiagent System for Coordinating Ambulances for Emergency Medical Services

To coordinate ambulances for emergency medical services, a multiagent system uses an auction mechanism based on trust. Results of tests using real data show that this system can efficiently assign ambulances to patients, thereby reducing transportation time. Emergency transportation on specialized vehicles is needed when a person's health is in risk of irreparable damage. A patient can't benefit from sophisticated medical treatments and technologies if she or he isn't placed in a proper healthcare center with the appropriate medical team. For example, strokes are neurological emergencies involving a limited amount of time in which treatment measures are effective

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Mild Cognitive Impairment and Early Detection of Alzheimer`s Disease. A Positron Emission Tomography Study

Alzheimer`s disease (AD) is characterised neuropathologically by the presence of extracellular amyloid plaques, intraneuronal neurofibrillary tangles, and cerebral neuronal loss. The pathological changes in AD are believed to start even decades before clinical symptoms are detectable. AD gradually affects episodic memory, cognition, behaviour and the ability to perform everyday activities. Mild cognitive impairment (MCI) represents a transitional state between normal aging and dementia disorders, especially AD. The predictive accuracy of the current and commonly used MCI criteria devide this disorder into amnestic (aMCI) and non-amnestic (naMCI) MCI. It seems that many individuals with aMCI tend to convert to AD. However many MCI individuals will remain stable and some may even recover. At present, the principal drugs for the treatment of AD provide only symptomatic and palliative benefits. Safe and effective mechanism-based therapies are needed for this devastating neurodegenerative disease of later life. In conjunction with the development of new therapeutic drugs, tools for early detection of AD would be important. In future one of the challenges will be to detect at an early stage these MCI individuals who will convert to AD. Methods which can predict which MCI subjects will convert to AD will be much more important if the new drug candidates prove to have disease-arresting or even disease–slowing effects. These types of drugs are likely to have the best efficacy if administered in the early or even in the presymptomatic phase of the disease when the synaptic and neuronal loss has not become too widespread. There is no clinical method to determine with certainly which MCI individuals will progress to AD. However there are several methods which have been suggested as predictors of conversion to AD, e.g. increased [11C] PIB uptake, hippocampal atrophy in MRI, low CSF A beta 42 level, high CSF tau-protein level, apolipoprotein E (APOE) ε4 allele and impairment in episodic memory and executive functions. In the present study subjects with MCI appear to have significantly higher [¹¹C] PIB uptake vs healthy elderly in several brain areas including frontal cortex, the posterior cingulate, the parietal and lateral temporal cortices, putamen and caudate. Also results from this PET study indicate that over time, MCI subjects who display increased [¹¹C] PIB uptake appear to be significantly more likely to convert to AD than MCI subjects with negative [¹¹C] PIB retention. Also hippocampal atrophy seems to increase in MCI individuals clearly during the conversion to AD. In this study [¹¹C] PIB uptake increases early and changes relatively little during the AD process whereas there is progressive hippocampal atrophy during the disease. In addition to increased [¹¹C] PIB retention and hippocampal atrophy, the status of APOE ε4 allele might contribute to the conversion from MCI to AD.

O papel atual do cirurgião no tratamento do GIST

Recent progress in gastrointestinal stromal tumor's (GIST) treatment were responsible for changing GIST's natural history. Knowlegde acquirement of molecular mechanism-based systemic therapy gave rise to the development of targeted antineoplastic drugs capable of reaching outcomes that had never been reached before. The introduction of imatinib in the clinical practice not only changed GIST's patients survival but also shifted paradigms. However, besides all these new advances and the improved results with imatinib, the surgeon still plays a pivotal role in the management of the primary GIST tumor and even in the metastatic setting.

Flexible multibody dynamics and intelligent control of a hydraulically driven hybrid redundant robot machine

The assembly and maintenance of the International Thermonuclear Experimental Reactor (ITER) vacuum vessel (VV) is highly challenging since the tasks performed by the robot involve welding, material handling, and machine cutting from inside the VV. The VV is made of stainless steel, which has poor machinability and tends to work harden very rapidly, and all the machining operations need to be carried out from inside of the ITER VV. A general industrial robot cannot be used due to its poor stiffness in the heavy duty machining process, and this will cause many problems, such as poor surface quality, tool damage, low accuracy. Therefore, one of the most suitable options should be a light weight mobile robot which is able to move around inside of the VV and perform different machining tasks by replacing different cutting tools. Reducing the mass of the robot manipulators offers many advantages: reduced material costs, reduced power consumption, the possibility of using smaller actuators, and a higher payload-to-robot weight ratio. Offsetting these advantages, the lighter weight robot is more flexible, which makes it more difficult to control. To achieve good machining surface quality, the tracking of the end effector must be accurate, and an accurate model for a more flexible robot must be constructed. This thesis studies the dynamics and control of a 10 degree-of-freedom (DOF) redundant hybrid robot (4-DOF serial mechanism and 6-DOF 6-UPS hexapod parallel mechanisms) hydraulically driven with flexible rods under the influence of machining forces. Firstly, the flexibility of the bodies is described using the floating frame of reference method (FFRF). A finite element model (FEM) provided the Craig-Bampton (CB) modes needed for the FFRF. A dynamic model of the system of six closed loop mechanisms was assembled using the constrained Lagrange equations and the Lagrange multiplier method. Subsequently, the reaction forces between the parallel and serial parts were used to study the dynamics of the serial robot. A PID control based on position predictions was implemented independently to control the hydraulic cylinders of the robot. Secondly, in machining, to achieve greater end effector trajectory tracking accuracy for surface quality, a robust control of the actuators for the flexible link has to be deduced. This thesis investigates the intelligent control of a hydraulically driven parallel robot part based on the dynamic model and two schemes of intelligent control for a hydraulically driven parallel mechanism based on the dynamic model: (1) a fuzzy-PID self-tuning controller composed of the conventional PID control and with fuzzy logic, and (2) adaptive neuro-fuzzy inference system-PID (ANFIS-PID) self-tuning of the gains of the PID controller, which are implemented independently to control each hydraulic cylinder of the parallel mechanism based on rod length predictions. The serial component of the hybrid robot can be analyzed using the equilibrium of reaction forces at the universal joint connections of the hexa-element. To achieve precise positional control of the end effector for maximum precision machining, the hydraulic cylinder should be controlled to hold the hexa-element. Thirdly, a finite element approach of multibody systems using the Special Euclidean group SE(3) framework is presented for a parallel mechanism with flexible piston rods under the influence of machining forces. The flexibility of the bodies is described using the nonlinear interpolation method with an exponential map. The equations of motion take the form of a differential algebraic equation on a Lie group, which is solved using a Lie group time integration scheme. The method relies on the local description of motions, so that it provides a singularity-free formulation, and no parameterization of the nodal variables needs to be introduced. The flexible slider constraint is formulated using a Lie group and used for modeling a flexible rod sliding inside a cylinder. The dynamic model of the system of six closed loop mechanisms was assembled using Hamilton’s principle and the Lagrange multiplier method. A linearized hydraulic control system based on rod length predictions was implemented independently to control the hydraulic cylinders. Consequently, the results of the simulations demonstrating the behavior of the robot machine are presented for each case study. In conclusion, this thesis studies the dynamic analysis of a special hybrid (serialparallel) robot for the above-mentioned special task involving the ITER and investigates different control algorithms that can significantly improve machining performance. These analyses and results provide valuable insight into the design and control of the parallel robot with flexible rods.

Computational models for and from biology : simple gene assembly and reaction systems

The advancement of science and technology makes it clear that no single perspective is any longer sufficient to describe the true nature of any phenomenon. That is why the interdisciplinary research is gaining more attention overtime. An excellent example of this type of research is natural computing which stands on the borderline between biology and computer science. The contribution of research done in natural computing is twofold: on one hand, it sheds light into how nature works and how it processes information and, on the other hand, it provides some guidelines on how to design bio-inspired technologies. The first direction in this thesis focuses on a nature-inspired process called gene assembly in ciliates. The second one studies reaction systems, as a modeling framework with its rationale built upon the biochemical interactions happening within a cell. The process of gene assembly in ciliates has attracted a lot of attention as a research topic in the past 15 years. Two main modelling frameworks have been initially proposed in the end of 1990s to capture ciliates’ gene assembly process, namely the intermolecular model and the intramolecular model. They were followed by other model proposals such as templatebased assembly and DNA rearrangement pathways recombination models. In this thesis we are interested in a variation of the intramolecular model called simple gene assembly model, which focuses on the simplest possible folds in the assembly process. We propose a new framework called directed overlap-inclusion (DOI) graphs to overcome the limitations that previously introduced models faced in capturing all the combinatorial details of the simple gene assembly process. We investigate a number of combinatorial properties of these graphs, including a necessary property in terms of forbidden induced subgraphs. We also introduce DOI graph-based rewriting rules that capture all the operations of the simple gene assembly model and prove that they are equivalent to the string-based formalization of the model. Reaction systems (RS) is another nature-inspired modeling framework that is studied in this thesis. Reaction systems’ rationale is based upon two main regulation mechanisms, facilitation and inhibition, which control the interactions between biochemical reactions. Reaction systems is a complementary modeling framework to traditional quantitative frameworks, focusing on explicit cause-effect relationships between reactions. The explicit formulation of facilitation and inhibition mechanisms behind reactions, as well as the focus on interactions between reactions (rather than dynamics of concentrations) makes their applicability potentially wide and useful beyond biological case studies. In this thesis, we construct a reaction system model corresponding to the heat shock response mechanism based on a novel concept of dominance graph that captures the competition on resources in the ODE model. We also introduce for RS various concepts inspired by biology, e.g., mass conservation, steady state, periodicity, etc., to do model checking of the reaction systems based models. We prove that the complexity of the decision problems related to these properties varies from P to NP- and coNP-complete to PSPACE-complete. We further focus on the mass conservation relation in an RS and introduce the conservation dependency graph to capture the relation between the species and also propose an algorithm to list the conserved sets of a given reaction system.

Investigations into the determination of polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) by capillary gas chromatography

Factors involved in the determination of PAHs (16 priority PAHs as an example) and PCBs (10 PCB congeners, representing 10 isomeric groups) by capillary gas chromatography coupled with mass spectrometry (GC/MS, for PAHs) and electron capture detection (GC/ECD , for PCBs) were studied, with emphasis on the effect of solvent. Having various volatilities and different polarities, solvent studied included dichloromethane, acetonitrile, hexan e, cyclohexane, isooctane, octane, nonane, dodecane, benzene, toluene, p-xylene, o-xylene, and mesitylene. Temperatures of the capillary column, the injection port, the GC/MS interface, the flow rates of carrier gas and make-up gas, and the injection volume were optimized by one factor at a time method or simplex optimization method. Under the optimized conditions, both peak height and peak area of 16 PAHs, especially the late-eluting PAHs, were significantly enhanced (1 to 500 times) by using relatively higher boiling point solvents such as p-xylene and nonane, compared with commonly used solvents like benzene and isooctane. With the improved sensitivity, detection limits of between 4.4 pg for naphthalene and 30.8 pg for benzo[g,h,i]perylene were obtained when p-xylene was used as an injection solvent. Effect of solvent on peak shape and peak intensity were found to be greatly dependent on temperature parameters, especially the initial temperature of the capillary column. The relationship between initial temperature and shape of peaks from 16 PAHs and 10 PCBs were studied and compared when toluene, p-xylene, isooctane, and nonane were used as injection solvents. If a too low initial temperature was used, fronting or split of peaks was observed. On the other hand, peak tailing occurred at a too high initial column temperature. The optimum initial temperature, at which both peak fronting and tailing were avoided and symmetrical peaks were obtained, depended on both solvents and the stationary phase of the column used. On a methyl silicone column, the alkane solvents provided wider optimum ranges of initial temperature than aromatic solvents did, for achieving well-shaped symmetrical GC peaks. On a 5% diphenyl: 1% vinyl: 94% dimethyl polysiloxane column, when the aromatic solvents were used, the optimum initial temperature ranges for solutes to form symmetrical peaks were improved to a similar degree as those when the alkanes were used as injection solvents. A mechanism, based on the properties of and possible interactions among the analyte, the injection solvent, and the stationary phase of the capillary column, was proposed to explain these observations. The effect of initial temperature on peak height and peak area of the 16 PAHs and the 10 PCBs was also studied. The optimum initial temperature was found to be dependent on the physical properties of the solvent used and the amount of the solvent injected. Generally, from the boiling point of the solvent to 10 0C above its boiling point was an optimum range of initial temperature at which cthe highest peak height and peak area were obtained.

Hydrosilylation and hydroboration catalyzed by imido-hydride complexes of molybdenum (IV)

This thesis describes the synthesis, structural studies, stoichiometric and catalytic reactivity of novel Mo(IV) imido hydride complexes (Cp)(ArN)Mo(H)(PMe3) (1) and (Tp )(ArN)Mo(H)(PMe3) (2). Both 1 and 2 catalyze hydrosilylation of a variety of carbonyls. Detailed kinetic and DFT studies found that 1 reacts by an unexpected associative mechanism, which does not involve Si-H addition either to the imido group or the metal. Despite 1 being a d2 complex, its reaction with PhSiH3 proceeds via a a-bond metathesis mechanism giving the silyl derivative (Cp )(ArN)Mo(SiH2Ph)(PMe3). In the presence of BPh3 reaction of 1 with PhSiH3 results in formation of (Cp)(ArN)Mo(SiH2Ph)(H)2 and (Cp)(ArN)Mo(SiH2Ph)2(H), the first examples ofMo(VI) silyl hydrides. AI: 1 : 1 reaction between 2, PhSiD3 and carbonyl substrate established that hydrosilylation is not accompanied by deuterium incorporation into the hydride position of the catalyst, thus ruling out the conventional mechanism based on carbonyl insertion carbonyl. As 2 is nomeactive to both the silane and ketone, the only mechanistic alternative we are left with is that the metal center activates the carbonyl as a Lewis acid. The analogous nonhydride mechanism was observed for the catalysis by (ArN)Mo(H)(CI)(PMe3), (Ph3P)2(I)(O)Re(H)(OSiMe2Ph) and (PPh3CuH)6. Complex 2 also catalyzes hydroboration of carbonyls and nitriles. We report the first case of metal-catalyzed hydroboration of nitriles as well as hydroboration of carbonyls at very mild conditions. Conversion of carbonyl functions can be performed with high selectivities in the presence of nitrile groups. This thesis also reports the first case of the HlH exchange between H2 and Si-H of silanes mediated by Lewis acids such as Mo(IV) , Re(V) , Cu(I) , Zn(II) complexes, B(C6Fs)3 and BPh3.

Développement de tensioactifs à base d’acides biliaires pegylés pour des applications pharmaceutiques

Les acides biliaires sont reconnus comme des tensioactifs d’origine biologique potentiellement applicables dans le domaine pharmaceutique. Leurs structures en font une plateforme idéale pour l’obtention de nouvelles architectures polymères. Des composés synthétisés par polymérisation anionique de dérivés d’oxirane comme l’oxyde d’éthylène, offre des dérivés amphiphiles pegylés démontrant des propriétés d’agrégation intéressantes en vue d’une amélioration de la biocompatibilité et de la capacité d’encapsulation médicamenteuse. Une large gamme d’acides biliaires pegylés (BA(EGn)x) a été préparée avec comme objectif premier leurs applications dans la formulation de principes actifs problématiques. Pour cela, une caractérisation rigoureuse du comportement de ces dérivés (modulation de la longueur (2 < n < 19) et du nombre de bras (2 < x < 4) de PEG) en solution a été réalisée. Dans le but d’améliorer la biodisponibilité de principes actifs lipophiles (cas de l’itraconazole), des nanoémulsions spontanées, composées de BA(EGn)x et d’acide oléique, ont été développées. L’évaluation in vitro, de la toxicité (cellulaire), et de la capacité de solubilisation des systèmes BA(EGn)x, ainsi que les paramètres pharmacocinétiques in vivo (chez le rat), suggèrent une livraison contrôlée par nos systèmes auto-assemblés lors de l’administration orale et intraveineuse. Aussi, la synthèse de copolymères en blocs en étoile à base d’acide cholique pegylés a été effectuée par polymérisation anionique par addition d’un second bloc au caractère hydrophobe de poly(éther d’allyle et de glycidyle) (CA(EGn-b-AGEm)4). Selon le ratio de blocs hydrophiles-hydrophobes CA(EGn-b-AGEm)4, des réponses thermiques en solution (LCST) ont été observées par un point de trouble (Cp) entre 8 oC et 37 oC. Un mécanisme de formation d’agrégats en plusieurs étapes est suggéré. La thiolation des allyles des PAGE permet une fonctionnalisation terminale à haute densité, comparable aux dendrimères. Les caractérisations physico-chimiques des CA(EGn-b-AGEm-NH2)4 et CA(EGn-b-AGEm-COOH)4 indiquent la formation de structures auto-assemblées en solution, sensibles à la température ou au pH. Cette fonctionnalisation élargie le domaine d’application des dérivés d’acides biliaires pegylés en étoile vers la transfection d’ADN, la livraison de siRNA thérapeutiques ou encore à une sélectivité de livraison médicamenteux (ex. sensibilité au pH, greffage ligands).

Geochemical characteristics of surficial sediments in a tropical estuary, southwest India

Geochemical characteristics of surficial sediments in the Panangad region of Cochin estuary, the largest brackish-water humid ecosystem in the south-west coast of India, were analysed. Temporal variations in nutrient stoichiometry, seasonal characteristics of redox elements Fe and S, and the phosphorus geochemistry were employed for the purpose. The stoichiometric analysis pointed towards autochthonous origin of organic matter, possibility of nitrogen limitation, and allochthonous modification of redox conditions. Seasonal variations were not statistically significant for all the geochemical parameters, whereas significant spatial variations were observed with lower values at sandy stations, suggesting that the texture of the sediments is the main factor influencing the sediment geochemistry. Significant inter-relations between the geochemical parameters also suggest a common control mechanism. Based on these geochemical characteristics, the study region can be effectively categorized into two distinct zones, viz. (1) erosion and transportation and (2) deposition zones

Spontane Strukturbildung in Mehrschichtsystemen unter Verwendung Molekularer Gläser

Den Schwerpunkt dieser Dissertation bildet zum einen die Entwicklung eines theoretischen Modells zur Beschreibung des Strukturbildungsprozesses in organisch/anorganischen Doppelschichtsystemen und zum anderen die Untersuchung der Übertragbarkeit dieser theoretisch gewonnenen Ergebnisse auf reale Systeme. Hierzu dienen systematische experimentelle Untersuchungen dieses Phänomens an einem Testsystem. Der Bereich der selbstorganisierenden Systeme ist von hohem wissenschaftlichen Interesse, erlaubt er doch die Realisierung von Strukturen, die nicht den Begrenzungen heutiger Techniken unterliegen, wie etwa der Beugung bei lithographischen Verfahren. Darüber hinaus liefert ein vertieftes Verständnis des Strukturbildungsprozesses auch eine Möglichkeit, im Falle entsprechender technischer Anwendungen Instabilitäten innerhalb der Schichtsysteme zu verhindern und somit einer Degradation der Bauteile entgegenzuwirken. Im theoretischen Teil der Arbeit konnte ein Modell im Rahmen der klassischen Elastizitätstheorie entwickelt werden, mit dessen Hilfe sich die Entstehung der Strukturen in Doppelschichtsystemen verstehen läßt. Der hier gefundene funktionale Zusammenhang zwischen der Periode der Strukturen und dem Verhältnis der Schichtdicken von organischer und anorganischer Schicht, wird durch die experimentellen Ergebnisse sehr gut bestätigt. Die Ergebnisse zeigen, daß es technologisch möglich ist, über die Vorgabe der Schichtdicke in einem Materialsystem die Periodizität der entstehenden Strukturen vorzugeben. Darüber hinaus liefert das vorgestellte Modell eine Stabilitätsbedingung für die Schichtsysteme, die es ermöglicht, zu jedem Zeitpunkt die dominierende Mode zu identifizieren. Ein Schwerpunkt der experimentellen Untersuchungen dieser Arbeit liegt auf der Strukturbildung innerhalb der Schichtsysteme. Das Testsystem wurde durch Aufbringen einer organischen Schicht - eines sog. Molekularen Glases - auf ein Glassubstrat realisiert, als Deckschicht diente eine Siliziumnitrid-Schicht. Es wurden Proben mit variierenden Schichtdicken kontrolliert erwärmt. Sobald die Temperatur des Schichtsystems in der Größenordnung der Glasübergangstemperatur des jeweiligen organischen Materials lag, fand spontan eine Strukturbildung auf Grund einer Spannungsrelaxation statt. Es ließen sich durch die Wahl einer entsprechenden Heizquelle unterschiedliche Strukturen realisieren. Bei Verwendung eines gepulsten Lasers, also einer kreisförmigen Wärmequelle, ordneten sich die Strukturen konzentrisch an, wohingegen sich ihre Ausrichtung bei Verwendung einer flächenhaften Heizplatte statistisch verteilte. Auffällig bei allen Strukturen war eine starke Modulation der Oberfläche. Ferner konnte in der Arbeit gezeigt werden, daß sich durch eine gezielte Veränderung der Spannungsverteilung innerhalb der Schichtsysteme die Ausrichtung der Strukturen (gezielt) manipulieren ließen. Unabhängig davon erlaubte die Variation der Schichtdicken die Realisierung von Strukturen mit einer Periodizität im Bereich von einigen µm bis hinunter zu etwa 200 nm. Die Kontrolle über die Ausrichtung und die Periodizität ist Grundvoraussetzung für eine zukünftige technologische Nutzung des Effektes zur kontrollierten Herstellung von Mikro- bzw. Nanostrukturen. Darüber hinaus konnte ein zunächst von der Strukturbildung unabhängiges Konzept eines aktiven Sensors für die optische Raster-Nahfeld-Mikroskopie vorgestellt werden, das das oben beschriebene System, bestehend aus einem fluoreszierenden Molekularen Glas und einer Siliziumnitrid-Deckschicht, verwendet. Erste theoretische und experimentelle Ergebnisse zeigen das technologische Potential dieses Sensortyps.

A Multiagent System for Coordinating Ambulances for Emergency Medical Services

To coordinate ambulances for emergency medical services, a multiagent system uses an auction mechanism based on trust. Results of tests using real data show that this system can efficiently assign ambulances to patients, thereby reducing transportation time. Emergency transportation on specialized vehicles is needed when a person's health is in risk of irreparable damage. A patient can't benefit from sophisticated medical treatments and technologies if she or he isn't placed in a proper healthcare center with the appropriate medical team. For example, strokes are neurological emergencies involving a limited amount of time in which treatment measures are effective

Factores asociados al dolor crónico posoperatorio en pacientes llevados a herniorrafia inguinal

Introducción: La herniorrafia inguinal se asocia hasta en un 50% de los casos con dolor crónico posoperatorio (DCP), y en algunos puede ser incapacitante. En este estudio se evaluaron los factores asociados al DCP en pacientes llevados a herniorrafia inguinal. Métodología: Se realizó un estudio de cohorte multicéntrico. Se obtuvo información sociodemográfica y de antecedentes personales. Se determinó la presencia e intensidad de dolor agudo posoperatorio (DAP) y se evaluaron los factores asociados al DCP con seguimiento a los dos meses del posoperatorio. Se establecieron asociaciones con la prueba chi cuadrado. Mediante una regresión lineal se evaluó el papel de los factores de confusión. Resultados: Se analizaron 108 pacientes. 54.7% presentaron DCP. La edad menor de 40 años, el DAP no controlado, el DAP severo, y el dolor no controlado entre la primera y tercera semanas del POP se relacionaron con mayor riesgo de DCP. La edad mayor a 65, el uso de opioides intratecales, la visualización y preservación de los nervios durante la cirugía, y el uso de tres o más analgésicos intravenosos con bloqueo ilioinguinal/iliohipogástrico fueron factores protectores. Discusión: El DCP es frecuente en nuestro medio. La prevención y manejo eficientes del DAP utilizando analgesia multimodal, el uso de opioide intratecal, y la identificación y preservación de los nervios en el área quirúrgica ayudan a prevenir el desarrollo de DCP. Estudios de este tipo realizados a una escala más grande, permitirán identificar otros factores relacionados con esta patología. Palabras clave: Dolor crónico postoperatorio, herniorrafia inguinal, inguinodina, factores asociados.

La partición en vida y otras figuras similares: Protección judicial a los acreedores

El propósito del tema a desarrollar a través de este documento es el de analizar y comprender, bajo una óptica crítica y reflexiva, la institución jurídica de la partición en vida, su noción, regulación y efectos, con miras a determinar los posibles perjuicios que pueda generar la aplicación de esta figura a los acreedores de quien lleva a cabo la misma. Basados en dicho objetivo, se expone a la partición en vida como institución jurídica, analizando el fallo de la Corte Constitucional mediante el cual se declara su exequibilidad, y contrastándola con la partición por donación, usada en Argentina, como referente extranjero. Así mismo, son abordadas distintas instituciones jurídicas cuyo análisis permite denotar el alcance de la partición en vida en la práctica social colombiana, y a su vez, determinar cómo puede verse afectado el patrimonio de aquellos terceros que fungen como acreedores del partidor.