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Patients after Fontan palliation represent a growing pediatric population requiring heart transplant (HTx) and often have lymphopenia (L) and/or hypogammaglobinemia that may be exacerbated by protein-losing enteropathy (PLE, P). The post-HTx effects of this altered immune phenotype are not well studied.In this study of the Pediatric Heart Transplant Society Registry, 106 Fontan patients who underwent HTx between 2005 and 2018 were analyzed. The impact of lymphopenia and PLE on graft survival, infection, rejection, and malignancy was analyzed at 1 and 5 years post-HTx.The following combinations of lymphopenia and PLE were noted: +L+P, n = 37; +L-P, n = 23; -L+P, n = 10; and -L-P, n = 36. Graft survival between the groups was similar within the first year after transplant (+L+P: 86%, +L-P: 86%, -L+P: 87%, -L-P: 89%, p = .9). Freedom from first infection post-HTx was greatest among -L-P patients compared to patients with either PLE, lymphopenia, or both; with a 22.1% infection incidence in the -L-P group and 41.4% in all others. These patients had a significantly lower infection rate in the first year after HTx (+L+P: 1.03, +L-P: 1, -L+P: 1.3, -L-P: 0.3 infections/year, p .001) and were similar to a non-single ventricle CHD control group (0.4 infections/year). Neither freedom from rejection nor freedom from malignancy 1 and 5 years post-HTx, differed among the groups.Fontan patients with altered immunophenotype, with lymphopenia and/or PLE, are at increased risk of infection post-HTx, although have similar early survival and freedom from rejection and malignancy. These data may encourage alternative immunosuppression strategies and enhanced monitoring for this growing subset of patients.

We report on a 10-year-old female who rapidly developed a left atrial (LA) mass two months after orthotopic heart transplant. Nine days prior to detection of the mass, she received high-dose corticosteroids for acute cellular rejection (grade 2). Despite negative echocardiogram five days prior to detection, a large echogenic mass was noted in the LA (18 x 12 x 24 mm); it was surgically resected after unsuccessful anticoagulation treatment. Pathogenesis of this LA thrombus remains uncertain, but immunosuppression, acute rejection, and high-dose steroid therapy may have contributed. Surgical thrombectomy is a safe and effective treatment option for LA thrombus.

Resumen Objetivo La interconsulta medica es una labor asistencial generalmente poco valorada y estudiada. El principal objetivo ha sido describir y analizar las interconsultas solicitadas a Dermatologia y los aspectos que inciden en su resolucion. Pacientes y metodos Estudio observacional retrospectivo en el que se recogieron las interconsultas de los pacientes ingresados durante 36 meses. Se analizaron variables con relacion al manejo de los pacientes y a la calidad asistencial. Resultados Se incluyo a 750 pacientes, con una edad media de 64,85 ± 20,23 anos. Los servicios medicos fueron los mas solicitantes y, principalmente, Medicina Interna (37,9%). Destacaron las dermatosis inflamatorias (36,2%). El diagnostico individual mas frecuente correspondio al exantema medicamentoso (8,1%). Conclusiones La actividad consultora conlleva un importante impacto en el manejo de los pacientes ingresados, implica una mejora en la calidad asistencial y una reduccion del coste sanitario, y conforma un valor formativo para los medicos residentes.

Objective Medical interconsultations are a healthcare task that is generally undervalued and understudied. The main objective of this study was to describe and analyse the interconsultations requested of dermatology departments and the aspects that are involve in resolving the interconsultations. Patients and methods We conducted an observational retrospective study that collected the interconsultations for patients hospitalised over a period of 36 months. We analysed variables related to the management of patients and the quality of the care. Results The study included 750 patients with a mean age of 64.85 (±20.23) years. The medical departments requested the most consultations, mainly internal medicine departments (37.9 %). The most common topic for the consultations was inflammatory dermatoses (36.2 %). The most common individual diagnosis was drug rash (8.1 %). Conclusions Consultation activities have a significant impact on the management of hospitalised patients, resulting in improved quality of care and reduced healthcare costs. These activities are also of training value for resident physicians.

Resumen El ectropion o eversion del parpado, es la malposicion palpebral mas frecuente. Al alterar la funcion protectora palpebral puede causar epifora, lagoftalmos, queratinizacion, irritacion cronica, dolor o ulceracion. Se distinguen 5 tipos de ectropion en funcion de su mecanismo causal: congenito, paralitico, involutivo, cicatricial y mecanico. Lo mas habitual en dermatologia, es la presencia de ectropion de tipo mixto, con elementos involutivos y mecanico-traccionales. Existen varias tecnicas reparadoras de ectropion cuya indicacion dependera del componente patogenico principal. Revisamos la anatomia basica palpebral y exponemos la tecnica exploratoria que nos permitira analizar el riesgo de ectropion para prevenir su aparicion o determinar la patogenia del ectropion ya establecido para definir la tecnica reparadora mas apropiada.

Ectropion, or eyelid eversion, is the most common form of eyelid malposition. By impairing the eyelid's protective function, ectropion can cause epiphora, lagophthalmos, keratinization, chronic irritation, pain, and ulceration. There are 5 types of ectropion, each with a different cause: congenital, paralytic, involutional, cicatricial, and mechanical. The most common presentation in dermatology is involutional eversion with a mechanical or tractional element. Several options exist for the surgical repair of ectropion and choice of technique will depend on the main pathogenic component. We review the basic anatomy of the eyelid and describe examination techniques for assessing risk and preventing ectropion and for identifying the main pathogenic component in order to select the most suitable repair technique.

International audience; Real-time 3-D ultrasound imaging with matrix arrays remains a challenge in Non-Destructive Testing (NDT) due to the time-consuming reconstruction algorithms based on delay-and-sum operations. Other algorithms operating in the Fourier domain have lower algorithmic complexities and therefore higher frame rates at the cost requiring more storage space, which may limit the number of reconstruction points. In this paper, we present a 3-D real-time implementation of the Total Focusing Method (TFM) and the Plane Wave Imaging (PWI), as well as of their Fourier-domain counterparts, referred to as k-TFM and k-PWI. For both acquisition types, the Fourier-domain algorithms are used to increase frame rates, and they are compared to the time-domain TFM and PWI in terms of image quality, frame rates and memory requirements. In order to greatly reduce their memory requirements, a new implementations of k-TFM and k-PWI are proposed. The four imaging methods are then evaluated in real time on a block of stainless steel made by additive layer manufacturing using a laser powder bed fusion process and containing a 3-D network of spherical porosities.

In 1993, Law 100 introduced major reforms to Colombia’s health system and regulated the health care industry. We analyzed the structure of the social space of Colombia’s health system and the trans...

In this research, a methodology based on the development of numerical simulations is proposed to analyze the physical behavior of centrifugal pumps such as a turbine. Numerical simulations were carried out using OpenFOAM software. For the validation of the numerical model, the construction of an experimental test bench was carried out. The analysis carried out involves the evaluation of performance parameters of the pump as a turbine, such as head, power, and efficiency. Additionally, the effect of the rotation speed on the previous parameters is evaluated. From the results obtained, it was shown that the maximum relative error was 4%, 3.4%, and 3.8% for the head, power, and efficiency parameters, respectively. In general, it was evidenced that the proposed numerical simulation has the ability to describe the real trends of the pump as a turbine for different flow conditions. In addition, an 11% increase in rotational speed was shown to cause a 12%, 1.9%, and 3% increase in head, power, and maximum efficiency. The proposed methodology is considered an adequate tool to analyze performance and identify the best efficiency point of pump systems such as a turbine. In this way, greater energy use is guaranteed.

This paper presents the implementation and design features of a gravimetric-based fuel consumption system. The proposed system comprises a gravimetric balance with serial output, a fuel pump, and a control valve that are integrated into a complete engine test bench via Arduino UNO®. The study implements an instrumentation methodology to minimize measurement disturbance and error propagation, which represents a major concern in engine experimental testing. Moreover, an interactive virtual environment is developed to reinforce user interaction via LabView™. Results demonstrated that the proposed measurement system features robust and reliable operation while maintaining negligible disturbance and overall uncertainty ranging from 0.010-0.23 g/s. Additionally, it was evidenced that the measurement system allows the analysis of key parameters to evaluate engine performance. The study of the fuels blends shows that the ethanol content causes a 6.8% increase in brake specific fuel consumption and a 4% decrease in the brake thermal efficiency. Due to the low cost of the developed measurement system can be easily adapted to test bench laboratories to promote a better learning process and in industrial sectors for better energy management.

Medical consultations are a healthcare task that is generally undervalued and understudied. The main objective of this study was to describe and analyse the consultations requested of dermatology departments and the aspects that are involve in resolving the consultations.We conducted an observational retrospective study that collected the consultations for patients hospitalised over a period of 36 months. We analysed variables related to the management of patients and the quality of the care.The study included 750 patients with a mean age of 64.85 (±20.23) years. The medical departments requested the most consultations, mainly internal medicine departments (37.9%). The most common topic for the consultations was inflammatory dermatoses (36.2%). The most common individual diagnosis was drug rash (8.1%).Consultation activities have a significant impact on the management of hospitalised patients, resulting in improved quality of care and reduced healthcare costs. These activities are also of training value for resident physicians.

Ectropion, or eyelid eversion, is the most common form of eyelid malposition. By impairing the eyelid's protective function, ectropion can cause epiphora, lagophthalmos, keratinization, chronic irritation, pain, and ulceration. There are 5 types of ectropion, each with a different cause: congenital, paralytic, involutional, cicatricial, and mechanical. The most common presentation in dermatology is involutional eversion with a mechanical or tractional element. Several options exist for the surgical repair of ectropion and choice of technique will depend on the main pathogenic component. We review the basic anatomy of the eyelid and describe examination techniques for assessing risk and preventing ectropion and for identifying the main pathogenic component in order to select the most suitable repair technique.

Vehicle congestion is a phenomenon that affects the world due to the potential increase in its population. Consequently, the capacity and level of service of Norte de Santander, Colombia, main avenue was analyzed, being the epicenter of the problem. This article was carried out using the highway capacity manual 2000, in addition to collecting information by means of vehicle gauges, conceptualizing the causes and critical points of the sector to diagnose the vehicle situation, proceeding to classify and process according to the highway capacity manual 2000. It is concluded that currently the system is with a level of service D and E, being these unstable, with tolerable speeds in some specific hours, but an incident on the road would cause little mobility, long queues and high waiting times for its narrow road space.

There are different factors that can cause a vehicular accident, starting with the carelessness of the driver or pedestrian, putting in risk his life and the life of third parties; by roads in bad conditions and lack of signaling, without warning him of the adversities that continue in the road, for this reason, the research work was developed on the causes of road accidents in four sectors, compiling information on the roads corresponding to the proposed streets and avenues, followed by defining the possible causes of the problems in the critical sites and thus defining the potential factors of an accident. Finally, solutions are proposed to reduce the percentages of vehicle accidents at the critical points found, decreasing the indicators of accident and mortality in this vehicle sector, giving people peace of mind when leaving their homes.

Colombia is an exporting country of quality coffee in the world; divergent factors in the short and long term, such as inclement weather, geographic changes, and socio-political development, are some of the factors that influence the price of this product. Knowing the future behavior of this phenomenon is one of the most important studies for economists, academics, coffee growers, entrepreneurs, and exporters. Brownian motion, a physical phenomenon that describes the irregular movement of some particles suspended in a fluid, was described by the probability of finding a particle in a position at a specific time. Fractional Brownian motion describes the random fluctuation of a stochastic process continuous in time and is characterized by the Hurst coefficient to observe persistence and volatility in a time series. The percentage of volatility that changes in the price of coffee present allows generating strategies to maintain the quality of the product and, therefore, its positioning in the market. In this work it was found that the series of data on coffee prices is persistent and that its volatility is 43.77%.

The system of porticoes resistant to moments of reinforced concrete is a set of beams and columns connected by means of knots that allows the generation of adequate spaces with facility before changes by the same users, whereas the industrialized system of structural walls of reinforced concrete, they are used for numerous, repetitive and of low price real estate, but they are completely immobile and in some occasions with problems of segregation and anthills. In this research work, a comparative study of the costs and budgets of the two proposed structural systems of the building was carried out in order to determine the structural system with the lowest costs and execution times, showing the results in explanatory graphs.

The selection of suitable materials for a construction defines the costs and characteristics that can contribute to the building, being of vital importance to make a correct choice. Lightening is an element to reduce costs and optimize resources, adding a better index of resistance against earthquakes, being of vital importance the good choice of this: concrete, clay or EPS. In this investigation a comparison of costs and incidence of the three types of lighteners that are used in the construction of three levels houses with reinforced concrete portico based on the requirements of NSR-10 was made by means of statistical samples/data, graphs and tables of data analysis, on the quotations and information collected from different studies on lightening costs in structures.

The need to improve people’s living conditions starts from the reality of the durability of rural road constructions, which have a short useful life and have a negative impact on the inhabitants of these regions. This project aims to improve access to rural areas, rural economic development and thus improve the quality of life of people in the sector; taking into account that at the moment of building a rural road, has a better resistance and durability in time, this was done by analyzing the properties of the clay mixture of low plasticity in the dosage of soil-cement that were tested by tests to determine the liquid limit of soils, determination of the plastic limit, plasticity index, moisture test, classification of soil by sieving, granulometric analysis, unit weight-humidity relations in soils, soil support relationship in the laboratory; in order to find the best dosage that provides greater strength, long-term durability and risk reduction. The results indicate that this type of clay requires an improvement with cement, due to its bearing capacity of 2% and 4%, which gives it a very poor quality to be used in the construction of rural roads.

Traditionally a limb that has suffered a fracture, rupture or dislocation is immobilized with plaster, a procedure that generates discomfort in the patient to take a shower, besides producing excessive itching and sweating, stimulating the growth of the bacteria and leading to an odorous form, unhygienic and difficult to keep clean of treatment. On the other hand, if the plaster remains for a long period, it can cause injuries in joints and ligaments. This project describes a methodology of manufacturing a prototype of orthosis for upper limb printed in 3D, through additive manufacturing and reverse engineering, technology that is presented as an excellent alternative to solve the problems of traditional plaster molds. The model of the orthosis is obtained through the Meshmixer software and the structural viability of the design is studied using methods of finite element analysis and biomimetics, to guarantee the best possible mechanical properties. The realization of this work provides a custom-made prototype orthosis, a more comfortable, hygienic and aesthetically pleasing solution, which in turn allows the reduction of the time of use of the plaster molds.

Light and temperature are major drivers in the ecology and biogeography of symbiotic dinoflagellates living in corals and other cnidarians. We examined variations in physiology among 11 strains comprising five species of clade A Symbiodinium. We grew cultures at 26°C (control) and 32°C (high temperature) over a duration of 18 days while measuring growth and photochemical efficiency (Fv/Fm). Responses to thermal stress ranged from susceptible to tolerant across species and strains. Most strains exhibited a decrease in cell densities and Fv/Fm when grown at 32°C. Tolerance to high temperature (T32) was calculated for all strains, ranging from 0 (unable to survive at high temperature) to 1 (able survive at high temperature). There was substantial variation in thermotolerance across species and among strains. One strain had a T32 close to 1, indicating that growth was not reduced at 32°C for only this one strain. To evaluate the combined effect of temperature and light on physiological stress, we selected three strains with different levels of thermotolerance (tolerant, intermediate and susceptible) and grew them under five different light intensities (65, 80, 100, 240 and 443 μmol quanta m−2 s−1) at 26 and 32°C. High irradiance exacerbated the effect of high temperature, particularly in strains from thermally sensitive species. This work further supports the recognition that broad physiological differences exist not only among species within Symbiodinium clades, but also among strains within species demonstrating that thermotolerance varies widely between species and among strains within species.

The gametophytic morphology and development of Alsophila odonelliana (Alston) Lehnert, have been studied through in vitro cultures. This species grows in southern Bolivia and northwestern Argentina. The spores are uniform in structure, but not in size; a certain percentage being smaller than the average. 16 spores per sporangium were found. The germination is of the Cyathea type. It was found that spores stored at 4°C can maintain their viability for over two years. The maximum value of germination depends on spore age. The filamentous gametophytes are 4-16 cells long. Young gametophytes have 1-2 branches that give rise to new gametophytes. Male, female, bisexual and neuter gametophytes were found. Propagules were frequently found in neuter gametophytes, and female and bisexual gametophytes were found to have chlorophyll containing scales. The antheridia are made up of five cells and produce non-viable spermatozoids. The archegonia have necks formed by four columns with four cells each. Most of the gametophytic phase is documented with photomicrographs. © 2014 The Authors.

Polyethylene terephthalate (PET) currently occupies an important space in the manufacture of bottles for carbonated beverages and mineral water, however, its use has become another pollution problem in the world, due to the fact that most of them end up in landfills, increasing the volume of plastics waste. The present investigation focuses on the analysis of recycled polyethylene terephthalate (RPET) analyzing whether it is possible to modify the thermal behavior of this plastic, by adding flame retardant, with the aim of improving its thermal properties. The thermal properties of the mixture and the degradation were evaluated by thermogravimetric analysis (TGA) and Dynamic Thermal Analysis (DTA), characterizing its decomposition process in increase of temperature, showing the little variation of the behavior of the mixture of RPET and % of MCA as a flame retardant additive compared to virgin PET.

This work describes and compares morphogenesis of the gametophyte, or sexual phase, of three ferns, Pteris deflexa, P. denticulata and P. tristicula, through a palynological analysis of live spores. This study was conducted under laboratory conditions; observations and pictures were made using light and scanning electron microscopy. The pattern of spore germination corresponds to the Vittaria type and gametophytic development corresponds to the Ceratopteris type. We observed that the polymorphous spores of P. denticulata and P. tristicula are viable. Ultrastructural details of the gametophytes revealed that P. denticulata and P. tristicula form antheridia different from those of the remaining Pteris species; the archegonia have necks formed by 4 rows of 4 cells each. The type of reproduction is sexual and sporophytes arise 90 days after sowing.

Resumen El plano quirurgico es el plano de diseccion por el que podemos realizar la exeresis del tumor respetando la mayoria de las estructuras anatomicas neurovasculares. La mayoria de los tumores cutaneos se localizan en la cabeza y el cuello. Por tanto, es importante para el cirujano dermatologico tener un profundo conocimiento de la anatomia quirurgica de esta area. El temor a danar estructuras importantes puede llevarnos a no ser suficientemente eficaces en el tratamiento quirurgico, con el consiguiente riesgo de persistencia o recidiva tumoral. El conocimiento del sistema musculoaponeurotico superficial y sus relaciones con los puntos clave neurovasculares nos permitira planificar la ejecucion de la intervencion, guiarnos en la localizacion del plano adecuado y minimizar las complicaciones posquirurgicas. El objetivo de este articulo es revisar las caracteristicas anatomicas claves para el conocimiento de los planos de diseccion adecuados en la cabeza y el cuello, y con ello, asegurar la supervivencia de los colgajos e injertos.

The surgical plane is a plane of dissection that can be used to excise a tumor while preserving most of the neurovascular structures. The majority of skin tumors are situated on the head and neck, and dermatologic surgeons should therefore have detailed knowledge of the surgical anatomy of this region. Fear of damaging important structures may result in insufficient efficacy of the surgical treatment, with consequent risk of persistence or recurrence of the tumor. Knowledge of the superficial musculoaponeurotic system and its relationship to key neurovascular structures enables the operation to be planned and will help us to locate the appropriate plane and minimize postoperative complications. The objective of this article is to review the key anatomical features defining suitable planes of dissection in the head and neck, the use of which will ensure survival of flaps and grafts.

Given that highly active antiretroviral therapy (HAART) has been demonstrated useful to restore immune competence in type-1 human immunodeficiency virus (HIV-1)-infected subjects, we evaluated the specific antibody response to influenza vaccine in a cohort of HIV-1-infected children on HAART so as to analyze the quality of this immune response in patients under antiretroviral therapy. Sixteen HIV-1-infected children and 10 HIV-1 seronegative controls were immunized with a commercially available trivalent inactivated influenza vaccine containing the strains A/H1N1, A/H3N2, and B. Serum hemagglutinin inhibition (HI) antibody titers were determined for the three viral strains at the time of vaccination and 1 month later. Immunization induced a significantly increased humoral response against the three influenza virus strains in controls, and only against A/H3N2 in HIV-1-infected children. The comparison of post-vaccination HI titers between HIV-1+ patients and HIV-1 negative controls showed significantly higher HI titers against the three strains in controls. In addition, post vaccination protective HI titers (defined as equal to or higher than 1:40) against the strains A/H3N2 and B were observed in a lower proportion of HIV-1+ children than in controls, while a similar proportion of individuals from each group achieved protective HI titers against the A/H1N1 strain. The CD4+ T cell count, CD4/CD8 T cells ratio, and serum viral load were not affected by influenza virus vaccination when pre- vs post-vaccination values were compared. These findings suggest that despite the fact that HAART is efficient in controlling HIV-1 replication and in increasing CD4+ T cell count in HIV-1-infected children, restoration of immune competence and response to cognate antigens remain incomplete, indicating that additional therapeutic strategies are required to achieve a full reconstitution of immune functions. COL0008639 COL0058784 COL0012444

Budd-Chiari syndrome is a rare disease characterized by hepatic outflow obstruction due to different causes. Hepatic nodules in patients with Budd-Chiari syndrome are rare and can be due to hepatocellular carcinoma and benign regenerative nodules. Imaging descriptions of regenerative nodules in cirrhotic livers are numerous, but the imaging findings of benign regenerative nodules associated with Budd-Chiari syndrome have only recently been reported. We present the computed tomographic and magnetic resonance features of benign regenerative hepatic nodules with copper accumulation in a patient with chronic Budd-Chiari syndrome.

Resumen Los meningiomas multiples intracraneales son procesos raros, generalmente benignos y con entidad propia. Suelen provocar escasos sintomas clinicos, resultando el diagnostico muchas veces casual y el tratamiento tardio. Presentamos tres casos de meningiomas multiples con diferente localizacion intracraneal, incluida la forma intraventricular. En uno de los pacientes los meningiomas estaban asociados a un schwannoma gigante del acustico. Revisamos la literatura para establecer un protocolo que contribuya a favorecer el diagnostico, pronostico tratamiento precoz de estos procesos.

Producción Científica, The aim of the study was to assess patterns of the use of medicines by the general population older than 0 years. The study was based on the information contained in the computerized database from the 1993 Spanish Household Health Survey. A representative sample of the population older than 0 was identi- ®ed, and a survey of 26,334 persons was carried out. Of the population 45.3% had taken some medicine in the last 2 weeks prior to the carrying out of the survey. The proportion was greater for women (50.6%) than for men (39.6%). With increasing age, the frequency and amount of medication use increased. A little over 20% of the medicines used were not prescribed by a doctor (self-medication). Data show the frequency of the use of medicines by the Spanish population. # 1997 by John Wiley & Sons, Ltd.