RESUMEN

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure, but it poses challenges in patients with surgically altered gastrointestinal anatomy (SAGA). Alternative techniques like single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or push enteroscopy (PE) have been used, albeit with potential complications. Limited Latin American data exists on ERCP complications in SAGA patients. Our goal is to describe complications of ERCP in SAGA at a national referral institution. METHODS: Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system. RESULTS: A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44 years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable. CONCLUSION: ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.

Asunto(s)

Colangiopancreatografia Retrógrada Endoscópica , Complicaciones Posoperatorias , Centros de Atención Terciaria , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Femenino , Masculino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anciano , Anastomosis en-Y de Roux/efectos adversos , América Latina/epidemiología , Gastrectomía/efectos adversos , Gastrectomía/métodos

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This article argues that to disrupt legal education in a radical sense, students need to become acquainted with the art of worldmaking and the view that law is a "way of worldmaking". First, I show that law is a cultural semiotic practice that requires decoding and, for that reason, demands a creative intervention by those that want to know, understand, and do things with law. Altogether this amounts to recognizing the different modes in which law creates, and is part of, worlds. Second, I propose that due to different features of their aesthetic form, comics are a particularly effective medium to place students before the myriad ways in which law and lawyers make and reproduce worlds. Third, I illustrate the argument by exploring how the Saga comic series, through its formal multimodality and narrative and cultural complexity, can make good on that challenge.

RESUMEN

AIM: By using the finite element method (FEM), this study aimed to evaluate the effect of different corticotomy formats on the distribution and magnitude of stress on the periodontal ligament (PDL) during retraction of the maxillary canine. MATERIALS AND METHODS: A geometric model of the left hemi-jaw was created from computed tomography scan images of a dry human skull and loads were administered during distalization movement of the canine. Three trials were performed: (1) without corticotomy, (2) box-shaped corticotomy and perforations in the cortical bone of the canine (CVC) and (3) CVC and circular-shaped corticotomy in the cortical bone of the edentulous space of the first premolar. RESULTS: There was no difference in stress distribution among the different corticotomy formats. CONCLUSION: Different corticotomy formats used to accelerate orthodontic tooth movement did not affect stress distribution in the PDL during canine retraction. CLINICAL SIGNIFICANCE: From a mechanical perspective, the present study showed that the stress distribution on the PDL during canine retraction was similar in all the corticotomy formats. When using the Andrews T2 bracket, the PDL presented the highest levels of stress in the middle third of the PDL, suggesting that the force was near the center of resistance. Also, as bone weakening by corticotomies did not influence stress distribution, the surgical procedure could be simplified to a less aggressive one, focusing more on inflammatory cellular stimulation than on bone resistance. A simpler surgical act could also be performed by most orthodontists in their practices, enhancing postoperative response and reducing patient costs.

Asunto(s)

Diente Canino , Análisis de Elementos Finitos , Maxilar , Ligamento Periodontal , Humanos , Modelos Anatómicos , Técnicas de Movimiento Dental

RESUMEN

Protein complexes involved in epigenetic regulation of transcription have evolved as molecular strategies to face environmental stress in plants. SAGA (Spt-Ada-Gcn5 Acetyltransferase) is a transcriptional co-activator complex that regulates numerous cellular processes through the coordination of multiple post-translational histone modifications, including acetylation, deubiquitination, and chromatin recognition. The diverse functions of the SAGA complex involve distinct modules that are highly conserved between yeast, flies, and mammals. In this review, the composition of the SAGA complex in plants is described and its role in gene expression regulation under stress conditions summarized. Some of these proteins are likely involved in the regulation of the inducible expression of genes under light, cold, drought, salt, and iron stress, although the functions of several of its components remain unknown.