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Appendiceal mucinous lesions' classification and nomenclature has been modified several times along the last decades, reflecting their great heterogeneity and making difficult to compare results and draw conclusions. Despite its nearby origin, appendiceal mucinous lesions have a distinctive behaviour compared to colorectal cancer, including their molecular and genetic markers. Due to their low frequency, their management is not well standardised. However, surgery is considered the cornerstone of treatment. Their indolent behaviour has encouraged surgeons to apply more aggressive treatments, such as cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), that may extend overall survival. Chemotherapy is reserved for unresectable and/or disseminated disease and could play a role in the adjuvant and neoadjuvant setting. Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is recently emerging as a possible alternative for treatment in advanced disease although its results in long-term survival are lacking Hereby, we review the available evidence in the management of appendiceal mucinous lesions, including localised and disseminated disease, with a special emphasis on the oncological perspective, focusing on the lights and shadows of the systemic treatments.
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Leukemia is a common neoplasia that, in its progress, can have ocular involvement due to direct infiltration or secondary to hematological alterations typical of the disease. These findings are consistent with an involvement of the central nervous system and are thus related to the prognosis. Despite the existing systemic therapies, there needs to be more literature that shows the treatment in the ocular involvement of this disease. A case report of a child with ocular involvement due to treatment-refractory acute lymphoblastic leukemia, successfully managed with intravitreal methotrexate, is presented.
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El shunt portosistémico congénito es una anomalía vascular venosa que comunica circulación portal y sistémica, por la que se deriva el flujo sanguíneo, salteando el paso hepático. Es una entidad poco frecuente, cuya incidencia varía entre 1/30 000 y 1/50 000 recién nacidos. Puede cursar de forma asintomática o presentarse con complicaciones en la edad pediátrica o, menos frecuente, en la edad neonatal. Ante el diagnóstico, se deberá definir la necesidad de intervención quirúrgica o intravascular para el cierre. Esta decisión depende de las características anatómicas de la malformación, de las manifestaciones clínicas y complicaciones presentes. Se presenta el caso de un paciente de un mes de vida derivado a nuestro centro para estudio de hepatitis colestásica neonatal, con diagnóstico de shunt portosistémico extrahepático. Se realizó cierre intravascular de la lesión con mejoría significativa posterior.
Congenital portosystemic shunt is a venous vascular abnormality that connects portal and systemic circulation, resulting in diversion of the blood flow, bypassing the hepatic passage. It is a rare malformation; its incidence varies from 1:30 000 to 1:50 000 newborns. It may be asymptomatic or present with complications in the pediatric age or, less frequently, in the neonatal age. Upon diagnosis, the need for a surgical or an intravascular intervention for closure should be defined. This decision depends on the malformation anatomical characteristics, clinical manifestations, and complications. We present the case of a 1-month-old patient referred to our center for the study of neonatal cholestatic hepatitis, with a diagnosis of extrahepatic portosystemic shunt. Intravascular closure of the defect was performed with significant subsequent improvement.
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Humanos , Masculino , Recém-Nascido , Derivação Portossistêmica Transjugular Intra-Hepática , Malformações Vasculares/complicações , Procedimentos Endovasculares , Hepatite/diagnóstico , Hepatite/etiologia , Veia Porta/anormalidadesRESUMO
Congenital portosystemic shunt is a venous vascular abnormality that connects portal and systemic circulation, resulting in diversion of the blood flow, bypassing the hepatic passage. It is a rare malformation; its incidence varies from 1:30 000 to 1:50 000 newborns. It may be asymptomatic or present with complications in the pediatric age or, less frequently, in the neonatal age. Upon diagnosis, the need for a surgical or an intravascular intervention for closure should be defined. This decision depends on the malformation anatomical characteristics, clinical manifestations, and complications. We present the case of a 1-month-old patient referred to our center for the study of neonatal cholestatic hepatitis, with a diagnosis of extrahepatic portosystemic shunt. Intravascular closure of the defect was performed with significant subsequent improvement.
El shunt portosistémico congénito es una anomalía vascular venosa que comunica circulación portal y sistémica, por la que se deriva el flujo sanguíneo, salteando el paso hepático. Es una entidad poco frecuente, cuya incidencia varía entre 1/30 000 y 1/50 000 recién nacidos. Puede cursar de forma asintomática o presentarse con complicaciones en la edad pediátrica o, menos frecuente, en la edad neonatal. Ante el diagnóstico, se deberá definir la necesidad de intervención quirúrgica o intravascular para el cierre. Esta decisión depende de las características anatómicas de la malformación, de las manifestaciones clínicas y complicaciones presentes. Se presenta el caso de un paciente de un mes de vida derivado a nuestro centro para estudio de hepatitis colestásica neonatal, con diagnóstico de shunt portosistémico extrahepático. Se realizó cierre intravascular de la lesión con mejoría significativa posterior.
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Procedimentos Endovasculares , Hepatite , Derivação Portossistêmica Transjugular Intra-Hepática , Malformações Vasculares , Recém-Nascido , Humanos , Criança , Lactente , Veia Porta/anormalidades , Hepatite/diagnóstico , Hepatite/etiologia , Malformações Vasculares/complicaçõesRESUMO
Introducción. La cirugía bariátrica es efectiva para inducir una rápida pérdida del exceso de peso, pero existen dudas sobre la duración de este efecto a largo plazo. Este estudio buscaba identificar la proporción de pacientes operados que presentaron una pérdida insuficiente o una ganancia significativa de peso y los posibles factores relacionados. Métodos. Estudio de cohorte retrospectivo en pacientes adultos sometidos a cirugía bariátrica. Se describieron variables demográficas y clínicas. Se realizó un análisis multivariado para identificar factores relacionados con un peso fuera de metas posterior a la cirugía. Resultados. Se incluyeron 187 pacientes, 117 con baipás gástrico y 70 con manga gástrica. La mediana de índice de masa corporal preoperatorio fue 41,3 kg/m2 y postoperatorio de 28,8 kg/m2. El 94,7 % de los pacientes en ambos grupos logró una adecuada pérdida del exceso de peso. La ganancia de peso mayor del 20 % se presentó en el 43,5 % de los pacientes, siendo mayor en el grupo de manga gástrica (p<0,004). Los factores independientes para ganancia de peso fueron el sexo masculino (OR 5,5), cirugía tipo manga gástrica (OR 3,4), síndrome de apnea del sueño (OR 2,9) y enfermedad mental medicada (OR 2,8). Conclusión. La cirugía bariátrica produce una pérdida del exceso de peso suficiente en casi la totalidad de los pacientes, pero un buen número recuperan peso luego de 3 años. Los principales factores asociados a ganancia de peso son el sexo masculino y la cirugía tipo manga gástrica
Introduction. Bariatric surgery is highly effective in inducing rapid excess body weight loss but there are doubts about its effect on long-term. This study seeks to identify the number of patients that underwent bariatric surgery who present insufficient weight loss or significant weight gain and the possible related factors. Methods. Retrospective cohort study of adult patients who underwent bariatric surgery. Demographic and clinical variables are described. A multivariate analysis was performed to identify factors related to patient weight outside the set goals postoperatively. Results. 187 patients were included (117 gastric bypass, 70 gastric sleeve). The median preoperative body mass index was 41m/kg2 and 28.8m/kg2 postoperatively. 94.7% of the patients in both groups achieved adequate excess body weight loss. Weight gain (>20%) occurred in 43.5% of the patients, with the probability being higher in the gastric sleeve group (p<0.004). Independent factors for weight gain were male gender (OR 5.5), gastric sleeve surgery (OR 3.4), sleep apnea syndrome (OR 2.9), and mental illness under treatment (OR 2.8). Conclusions. Bariatric surgery produces sufficient loss of excess weight in almost all patients, but a good number of them regain weight after 3 years. The main factors associated with weight gain are male gender and gastric sleeve surgery
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Humanos , Derivação Gástrica , Cirurgia Bariátrica , Obesidade Mórbida , Gastroplastia , Redução de PesoRESUMO
Blunt abdominal trauma is associated with a bladder injury in 1.6% of cases. The patient's conditions and the specific diagnosis determine the best surgical approach, be it open, laparoscopic or robotic surgery. We present the diagnosis and laparoscopic management of a 31-year-old patient with intraperitoneal bladder rupture due to a traffic accident.
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Mining has had a great influence on human societies permeating the riches of the soil and culture in equal proportion. This has led to profound changes in the individuals dedicated to this work and the locations where it takes place. In this historical review, we describe the socio-cultural and health characteristics, as well as the diseases associated with gold mining in Marmato (Caldas) during the 19th century. Poor salubrity conditions and tropical and infectious diseases were constant during the whole century.
La minería ha tenido una gran influencia en las sociedades humanas, permeando por igual las riquezas del suelo y la cultura, lo que ha tenido profundas implicaciones para los individuos dedicados a esta labor y para los lugares en los que se lleva a cabo. En el presente artículo, se describen las características socioculturales y de sanidad, así como las enfermedades más frecuentes en las minas de oro de Marmato (Caldas) durante el siglo XIX. Las precarias condiciones de salubridad y las enfermedades tropicales infecciosas persistieron en la población durante todo el siglo.
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Doenças Transmissíveis , Peste , Varíola , Ouro , História do Século XIX , História do Século XX , Humanos , Mineração , Peste/epidemiologiaRESUMO
Resumen | La minería ha tenido una gran influencia en las sociedades humanas, permeando por igual las riquezas del suelo y la cultura, lo que ha tenido profundas implicaciones para los individuos dedicados a esta labor y para los lugares en los que se lleva a cabo. En el presente artículo, se describen las características socioculturales y de sanidad, así como las enfermedades más frecuentes en las minas de oro de Marmato (Caldas) durante el siglo XIX. Las precarias condiciones de salubridad y las enfermedades tropicales infecciosas persistieron en la población durante todo el siglo.
Abstract | Mining has had a great influence on human societies permeating the riches of the soil and culture in equal proportion. This has led to profound changes in the individuals dedicated to this work and the locations where it takes place. In this historical review, we describe the socio-cultural and health characteristics, as well as the diseases associated with gold mining in Marmato (Caldas) during the 19th century. Poor salubrity conditions and tropical and infectious diseases were constant during the whole century.
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Salubridade Ambiental , História , Medicina Tropical , Mineração , Doenças ProfissionaisRESUMO
Resumen Introducción: la diabetes mellitus tipo 2 (DM2) es el tipo más común de diabetes la cual ocurre generalmente en adultos, sin embargo, hay reportes que la describen en adolescentes y adultos jóvenes. Objetivo: describir las características clínicas y el tratamiento de la diabetes tipo 2 en adultos jóvenes en un hospital colombiano. Material y métodos: estudio de corte transversal entre el 2017 y 2019, que incluyó pacientes adultos jóvenes entre 18 y 40 años con DM2, que fueron atendidos en el Hospital Santa Mónica de Dosquebradas, Colombia. La unidad de análisis fueron las historias clínicas. Se incluyeron variables sociodemográficas, clínicas, farmacológicas y control metabólico (HbAlc < 7.0%). Se realizaron análisis descriptivos y se aplicó una regresión logística binaria (p< 0.05). Resultados: se identificaron 124 pacientes de los cuales 83 (70.0%) cumplieron criterios de inclusión, con una edad media de 33.7 ± 5.3 años. Unos 28 pacientes eran obesos (33.7%). Además, 21 pacientes (25.3%) presentaron control metabólico. Los fármacos más usados fueron metformina en 64 pacientes (77.1%), seguido de las insulinas en 46 pacientes (55.4%). Se estableció que 51 de estos (61.4%) presentaron adherencia al tratamiento. No hubo pacientes con terapia triple como estrategia terapéutica. Los pacientes con retinopatía diabética presentaban una probable asociación con tener control de la enfermedad en el momento del estudio (P=0.048, OR:0.130; IC95%:0.017-0.987). Conclusiones: los pacientes adultos jóvenes presentan pobre control metabólico y uso frecuente de insulinas. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1902).
Abstract Introduction: type 2 diabetes mellitus (T2DM) is the most common type of diabetes, generally occurring in adults. However, there are reports which describe it in adolescents and young adults. Objective: to describe the clinical characteristics and treatment of type 2 diabetes in young adults in a Colombian hospital. Materials and methods: a cross-sectional study from 2017 to 2019 which included young adult patients between 18 and 40 years old with T2DM who were seen at Hospital Santa Mónica in Dosquebradas, Colombia. The unit of analysis was the medical charts. Sociodemographic, clinical, pharmacological and metabolic control (HbA1c < 7.0%) variables were included. Descriptive analyses were performed, and binary logistic regression was applied (p<0.05). Results: 124 patients were identified, 83 (70.0%) of whom met the inclusion criteria, with a mean age of 33.7 ± 5.3 years. Some 28 patients were obese (33.7%). In addition, 21 patients (25.3%) had metabolic control. The most frequently used medications were metformin in 64 patients (77.1%), followed by insulin in 46 patients (55.4%). It was determined that 51 of these patients (61.4%) were compliant with treatment. No patients received triple therapy as a therapeutic strategy. Patients with diabetic retinopathy had a probable association with having the disease controlled at the time of the study (P=0.048, OR:0.130; 95%CI:0.017-0.987). Conclusions: young adult patients have poor metabolic control and frequent use of insulins. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1902).
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BACKGROUND: The purpose of this study was to identify nerves at risk when using a minimally invasive plate osteosynthesis precontoured long proximal humerus locking plate and to evaluate the risk of injury to deltoid insertion and brachialis muscle. METHODS: Ten cadaveric upper limb specimens were used. A transdeltoid anterolateral approach was performed proximally and a second anterior approach was performed distally. A 14-hole "low" long precountored ALPS locking plate (Biomet Trauma; Zimmer Biomet, Warsaw, IN, USA) was used. Subsequently, anatomic dissection to measure the anatomic relationship of the plate with the deltoid insertion, with the brachialis muscle, and with the axillary, radial, and musculocutaneous nerves was performed. RESULTS: The mean humeral length was 302 mm (standard deviation 52.3, 99% confidence interval: 259.3-344.6). In 6 specimens, the axillary nerve was located at the level of the third row of holes of the plate; in 3 specimens, at the level of the fourth row; and in one specimen, at the level of the second row. The distance between the plate and the musculocutaneous nerve was on average 10.2 mm (standard deviation 4, 99% confidence interval: 6.9-13.5) and between the plate and the radial nerve was on average 7.9 mm (standard deviation 4.7, 99% confidence interval: 4-11.8). The plate pierced the anterior distal fibers of the deltoid in all specimens. In 8 specimens, no brachialis muscle fibers were located under the plate. CONCLUSIONS: The use of the long precontoured 14-hole ALPS locking plate with the minimally invasive plate osteosynthesis technique, previously identifying the axillary and musculocutaneous nerves, is feasible; however, the distances between the plate and the nerves remain low, so caution should be maintained. Despite the curved design of the plate, the deltoid insertion is partially compromised in all cases.
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La trombosis en recién nacidos (RN) es una patología infrecuente que se asocia principalmente a catéter venoso central. Su presentación clínica puede ser la de un RN asintomático o con sintomatología variable, según la ubicación y tamaño de la trombosis. El diagnóstico generalmente se realiza con ecografía doppler y exámenes específicos según sea la presentación clínica. Con respecto al manejo, actualmente no existe mucha evidencia en RN, pero se suele utilizar trombolíticos/fibrinolíticos extrapolando las investigaciones de adultos. En esta revisión se detalla sobre epidemiología, fisiopatología, factores de riesgo, presentaciones clínicas, diagnóstico y tratamiento. Existe falta de estudios sobre epidemiología nacional y tratamiento en RN, se plantea la necesidad de estos.
Thrombosis in newborns is an infrequent pathology which is mainly associated with a central venous catheter. Its clinical presentation may be that of an asymptomatic newborn or with variable symptoms, depending on the location and size of the thrombosis. The diagnosis is generally made with Doppler ultrasound and specific examinations depending on the clinical presentation. Regarding management, currently there is not much evidence in newborns, but thrombolytics / fibrinolytics are usually used extrapolating from adult investigations. This review details epidemiology, pathophysiology, risk factors, clinical presentations, diagnosis and treatment. There is a lack of studies on national epidemiology and treatment in newborns, the need for these arises.
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Humanos , Recém-Nascido , Trombose/diagnóstico , Trombose/tratamento farmacológico , Trombose/fisiopatologia , Trombose/epidemiologia , Fatores de Risco , Anticoagulantes/uso terapêuticoRESUMO
RESUMEN La tuberculosis es una enfermedad infecciosa y frecuente en países en vía de desarrollo. Esta puede causar una amplia variedad de complicaciones y presentaciones atípicas con alta morbimortalidad. De la forma genitourinaria se sospechada muy poco, razón por la cual su diagnóstico se hace, usualmente, de forma tardía o no se realiza. Esto conlleva a consecuencias muy graves en los pacientes, por ejemplo, la enfermedad renal crónica terminal. A continuación, se presenta un reporte de caso de una paciente con la anterior enfermedad, secundaria a una tuberculosis renal bilateral diagnosticada tardíamente y se realiza una revisión de la literatura sobre este tema.
SUMMARY Tuberculosis is a common infectious disease in developing countries, which can cause a variety of complications and atypical manifestations with high morbidity and mortality. The urogenital form is rarely suspected, resulting in delayed diagnosis or even no diagnosis, which can have serious consequences for the patients, such as chronic end-stage renal disease. We report on a patient with chronic end-stage renal failure caused by a delayed diagnosis of bilateral renal tuberculosis and a literature review on this topic.
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Humanos , Tuberculose Urogenital , Falência Renal CrônicaRESUMO
The title ferrocene derivative, [Fe(C5H5)2(C8NO2)], including an alkyne bonded to a para-nitro-phenyl substituent, which was synthesized from a copper-free Sonogashira cross-coupling reaction between ethynylferrocene and 4-bromo-1-nitro-benzene, crystallizes in the P21/n space group. In the ferrocene unit, the penta-dienyl (Cps) rings are in an eclipsed conformation. The angle of rotation between the substituted cyclo-penta-dienyl ring and the p-nitro-phenyl group is 6.19â (10)°, yielding a quasi-linear extension of the ferrocenyl substitution. Important inter-molecular inter-actions arise from π-π stacking between the Cp rings and the p-nitro-phenyl, from corners of the Cp rings that are perpendicularly aligned, and between the O atoms from the nitro substituent and carbons at the corners of the Cp rings, propagating along all three crystallographic axes.
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BACKGROUND: Neurocysticercosis (NCC) is the most common parasitic infection involving the central nervous system in endemic areas. Notably, spinal involvement occurs in only 0.7%-3% of patients. CASE DESCRIPTION: A 58-year-old female presented with progressive spinal cord compression attributed to multiple cystic intradural extramedullary thoracic lesions. She underwent laminectomy at two separate thoracic levels; this involved excision of the upper T4-T6, and just exploration of the lower T9-T11 lesions. One year postoperatively, she exhibited a residual paraparesis. CONCLUSION: Spinal NCC must be considered among the differential diagnostic considerations for patients presenting with spinal intramedullary or subarachnoid/extramedullary cystic lesions. Although they are typically found in endemic regions, those who have traveled to these locations are also susceptible. Even though it is considered a benign condition, spinal NCC may cause permanent and irreversible neurological damage. Public health policies should, therefore, be developed to help control the spread and transmission of NCC.
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Choroid plexus papilloma is a low-frequency entity in both the adult and pediatric populations. Its clinical presentation is very variable as it depends on its location and length. We must always do the differential diagnosis between papilloma and other intraventricular pathologies. This article is about a case report of a pediatric patient with a Choroid plexus papilloma located in the fourth ventricle, a location that is atypical for the pediatric population.
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The poor fertility of ram semen stored chilled for long periods has encouraged the development of protocols designed to improve the kinetic vigour and cervical barrier-crossing capacity of sperm. The present work evaluated the effect of sperm selection with Sephadex filtration and the supplementation of 2% glycerol (GLY) to extenders based on ultra-heat-treated skimmed milk (UHT) or Tris-Tes-Glucose (TEST) on ram sperm kinetic parameters, plasma membrane integrity, acrosome integrity, mitochondrial function and fertilizing ability, over long chilling times. The results showed that for non-filtered semen, values for progressive sperm motility (%PSM), straight line velocity (VSL, µm/s) and the percentage of sperm with an intact plasma membrane/intact acrosome/a high mitochondrial function index (%IPIAHM) at all times up to 96â¯h of chilling were higher when the UHT extender (Pâ¯<â¯0.01) was used compared to TEST extender irrespective of the presence of GLY. When semen was previously filtered with Sephadex, the addition of GLY to the UHT extender improved total motility (%TM), the %PSM and the VSL at 96â¯h compared to all other treatments (Pâ¯<â¯0.01). The best results of all were obtained with non-filtered semen and UHT either with or without GLY. Heterologous IVF using zona-intact bovine oocytes was used to assess the fertilizing capacity of non-filtered fresh (FS0), chilled-for-24â¯h (CS24) or chilled-for-48â¯h (CS48) ram semen diluted in UHT extender (GLY-free). Heterologous IVF showed that ram sperm, either FS0, CS24 or CS48, were equally capable of penetrating zona pellucida intact bovine oocytes, leading to pronuclear formation and hybrid embryo cleavage (46.3⯱â¯3.2; 48.8⯱â¯3.2; and 43.3⯱â¯3.5, respectively). No differences were seen with respect to fresh sperm in terms of sperm binding, penetration, polyspermy, pronucleus formation or cleavage rates (Pâ¯>â¯0.05). In conclusion, neither Sephadex filtration nor addition of glycerol provided extra benefits to ram sperm chilled up to 96â¯h. Chilled, non-filtered sperm extended with UHT without GLY showed better sperm functionality than did similar sperm extended with TEST extenders. Indeed, sperm diluted in UHT extender, maintained fertilizing ability up to 48â¯h.
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Análise do Sêmen/veterinária , Preservação do Sêmen/veterinária , Ovinos , Espermatozoides/fisiologia , Animais , Fertilização , Filtração/veterinária , Glicerol , Inseminação Artificial/veterinária , Masculino , Preservação do Sêmen/métodosRESUMO
A complex network of chemokines can influence cancer progression with the recruitment and activation of hematopoietic cells, including macrophages to the supporting tumor stroma promoting carcinogenesis and metastasis. The aim of this study was to investigate the relation between tissue and plasma chemokine levels involved in macrophage recruitment with tumor-associated macrophage profile markers and clinicopathological features such as tumor-node-metastases stage, desmoplasia, tumor necrosis factor-α, and vascular endothelial growth factor plasma content. Plasma and tumor/healthy mucosa were obtained from Chilean patients undergoing colon cancer surgery. Chemokines were evaluated from tissue lysates (CCL2, CCL3, CCL4, CCL5, and CX3CL1) by Luminex. Statistical analysis was performed using Wilcoxon match-paired test ( p < 0.05). Macrophage markers (CD68, CD163, and iNOS) were evaluated by immunohistochemistry samples derived from colorectal cancer patients. Correlation analysis between chemokines and macrophage markers and clinicopathological features were performed using Spearman's test. Plasmatic levels of chemokines and inflammatory mediators' vascular endothelial growth factor and tumor necrosis factor-α were evaluated by Luminex. Tumor levels of CCL2 (mean ± standard deviation = 530.1 ± 613.9 pg/mg), CCL3 (102.7 ± 106.0 pg/mg), and CCL4 (64.98 ± 48.09 pg/mg) were higher than those found in healthy tissue (182.1 ± 116.5, 26.79 ± 22.40, and 27.06 ± 23.69 pg/mg, respectively p < 0.05). The tumor characterization allowed us to identify a positive correlation between CCL4 and the pro-tumor macrophages marker CD163 ( p = 0.0443), and a negative correlation of iNOS with desmoplastic reaction ( p = 0.0467). Moreover, we identified that tumors with immature desmoplasia have a higher CD163 density compared to those with a mature/intermediated stromal tissue ( p = 0.0288). Plasmatic CCL4 has shown a positive correlation with inflammatory mediators (tumor necrosis factor-α and vascular endothelial growth factor) that have previously been associated with poor prognosis in patients. In conclusion High expression of CCL4 in colon cancer could induce the infiltration of tumor-associated macrophages and specifically a pro-tumor macrophage profile (CD163+ cells). Moreover, plasmatic chemokines could be considered inflammatory mediators associated to CRC progression as well as tumor necrosis factor-α and vascular endothelial growth factor. These data reinforce the idea of chemokines as potential therapeutic targets or biomarker in CRC.
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Biomarcadores Tumorais/metabolismo , Quimiocina CCL2/metabolismo , Quimiocina CCL3/metabolismo , Quimiocina CCL4/metabolismo , Neoplasias Colorretais/patologia , Macrófagos/patologia , Microambiente Tumoral , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neoplasias Colorretais/metabolismo , Feminino , Seguimentos , Humanos , Macrófagos/metabolismo , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Every star-forming galaxy has a halo of metal-enriched gas that extends out to at least 100 kiloparsecs, as revealed by the absorption lines that this gas imprints on the spectra of background quasars. However, quasars are sparse and typically probe only one narrow beam of emission through the intervening galaxy. Close quasar pairs and gravitationally lensed quasars have been used to circumvent this inherently one-dimensional technique, but these objects are rare and the structure of the circumgalactic medium remains poorly constrained. As a result, our understanding of the physical processes that drive the recycling of baryons across the lifetime of a galaxy is limited. Here we report integral-field (tomographic) spectroscopy of an extended background source-a bright, giant gravitational arc. We can thus coherently map the spatial and kinematic distribution of Mg ɪɪ absorption-a standard tracer of enriched gas-in an intervening galaxy system at redshift 0.98 (around 8 billion years ago). Our gravitational-arc tomography unveils a clumpy medium in which the absorption strength decreases with increasing distance from the galaxy system, in good agreement with results for quasars. Furthermore, we find strong evidence that the gas is not distributed isotropically. Interestingly, we detect little kinematic variation over a projected area of approximately 600 square kiloparsecs, with all line-of-sight velocities confined to within a few tens of kilometres per second of each other. These results suggest that the detected absorption originates from entrained recycled material, rather than in a galactic outflow.