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Every surgeon starts the training with suturing, which can be very confusing as most of the senior surgeons have their own style, approach, tricks and different rules to follow. It is hard for residents and medical students to know what is an evidence-based rule that should be followed and what is a personal trick of their teacher that can be modified. We provide a review of current data on surgical suturing with all the reasons for specific techniques. Parameters of the correct skin suture, practical guide and all the complications are mentioned in the text.

Cada cirujano empieza su carrera profesional con el entrenamiento de la sutura cirúrgica. Dado que todos los cirujanos con experiencia tienen sus propios trucos, estilo y enfoque, la enseñanza y el aprendizaje de la técnica correcta pueden ser caóticos. Por esta razón, para los cirujanos residentes y los estudiantes de medicina les puede resultar difícil distinguir entre el enfoque de "evidence-based medicine" - el cuál ha de ser tomado, y los trucos personales de sus superiores, cuáles pueden ser modificados. Ofrecemos una revisión de los datos disponibles sobre la sutura cirúrgica, incluyendo las razones para el empleo de algunas técnicas especiales. En el texto presentamos los parámetros para la correcta sutura del piel, un guía práctico y las complicaciones que pueden surgir.

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PURPOSE: To retrospectively assess outcomes and to identify prognostic factors in patients diagnosed with intermediate-risk (IR) prostate cancer (PCa) treated with primary external beam radiotherapy (EBRT). MATERIALS AND METHODS: Data were obtained from the multi-institutional Spanish RECAP database, a population-based prostate cancer registry in Spain. All IR patients (NCCN criteria) who underwent primary EBRT were included. The following variables were assessed: age; prostate-specific antigen (PSA); Gleason score; clinical T stage; percentage of positive biopsy cores (PPBC); androgen deprivation therapy (ADT); and radiotherapy dose. The patients were stratified into one of three risk subcategories: (1) favourable IR (FIR; GS 6, ≤ T2b or GS 3 + 4, ≤ T1c), (2) marginal IR (MIR; GS 3 + 4, T2a-b), and (3) unfavourable IR (UIR; GS 4 + 3 or T2c). Biochemical relapse-free survival (BRFS), disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) were assessed. RESULTS: A total of 1754 patients from the RECAP database were included and stratified by risk group: FIR, n = 781 (44.5%); MIR, n = 252 (14.4%); and UIR, n = 721 (41.1%). Mean age was 71 years (range 47-86). Mean PSA was 10.4 ng/ml (range 6-20). The median radiotherapy dose was 74 Gy, with mean doses of 72.5 Gy (FIR), 73.4 Gy (MIR), and 72.8 Gy (UIR). Most patients (88%) received ADT for a median of 7.1 months. By risk group (FIR, MIR, UIR), ADT rates were, respectively, 88.9, 86.5, and 86.9%. Only patients with ≥ 24 months of follow-up post-EBRT were included in the survival analysis (n = 1294). At a median follow-up of 52 months (range 24-173), respective 5- and 10-year outcomes were: OS 93.6% and 79%; BRFS 88.9% and 71.4%; DFS 96.1% and 89%; CSS 98.9% and 94.6%. Complication rates (≥ grade 3) were: acute genitourinary (GU) 2%; late GU 1%; acute gastrointestinal (GI) 2%; late GI 1%. There was no significant association between risk group and BRFS or OS. However, patients with favourable-risk disease had significantly better 5- and 10-year DFS than patients with UIR: 98.7% vs. 92.4% and 92% vs. 85.8% (p = 0.0005). CSS was significantly higher (p = 0.0057) in the FIR group at 5 (99.7% vs. 97.3%) and 10 years (96.1% vs. 93.4%). On the multivariate analyses, the following were significant predictors of survival: ADT (BRFS and DFS); dose ≥ 74 Gy (BRFS); age (OS). CONCLUSIONS: This is the first nationwide study in Spain to report long-term outcomes of patients with intermediate-risk PCa treated with EBRT. Survival outcomes were good, with a low incidence of both acute and late toxicity. Patients with unfavourable risk characteristics had significantly lower 5- and 10-year disease-free survival rates. ADT and radiotherapy dose ≥ 74 Gy were both significant predictors of treatment outcomes.

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Objective: Impulsiveness has been the subject of much research, but little is known about the possible relationship between craniofacial anatomy and impulsiveness. The present study was designed to investigate the relationship between one aspect of craniofacial structure (the angle of inclination of the forehead) and impulsiveness. Method: Photographs in profile were obtained from 131 volunteers who had been fined for driving at high speed and were undergoing a court-mandated driving license point-recovery course. They completed the Barratt Impulsiveness Scale (BIS-11), the Impulsive Behavior Scale (UPPS-P), and Zuckerman's Sensation Seeking Scale (V). The angle of the slant of the forehead was measured with a photographic support and a protractor. Results: High positive concordance was found between forehead inclination and 14 out of the 15 impulsiveness factors studied. Conclusions: The angle of inclination of the forehead was significantly associated with self-reported impulsiveness in this sample of traffic violators.

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OBJECTIVE: Impulsiveness has been the subject of much research, but little is known about the possible relationship between craniofacial anatomy and impulsiveness. The present study was designed to investigate the relationship between one aspect of craniofacial structure (the angle of inclination of the forehead) and impulsiveness. METHOD: Photographs in profile were obtained from 131 volunteers who had been fined for driving at high speed and were undergoing a court-mandated driving license point-recovery course. They completed the Barratt Impulsiveness Scale (BIS-11), the Impulsive Behavior Scale (UPPS-P), and Zuckerman's Sensation Seeking Scale (V). The angle of the slant of the forehead was measured with a photographic support and a protractor. RESULTS: High positive concordance was found between forehead inclination and 14 out of the 15 impulsiveness factors studied. CONCLUSIONS: The angle of inclination of the forehead was significantly associated with self-reported impulsiveness in this sample of traffic violators.

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Septic arthritis usually occurs as an acute joint process that can cause a rapid destruction of the cartilage, if the necessary therapeutic measures were not taken. Rarely, Staphylococcus warneri may be the cause of this pathology although due to its diagnostic difficulty we can make mistakes in its treatment. We present the case of a patient with septic arthritis of the knee by this germ and we intend to remark what are the diagnostic measures and recommendations to consider for this osteoarticular infection.

La artritis séptica suele presentarse como un proceso articular agudo que puede provocar una rápida destrucción del cartílago, si no se toman las medidas terapéuticas necesarias. De manera poco frecuente, el Staphylococcus warneri puede ser la causa de esta patología aunque por su dificultad diagnóstica podemos cometer errores en su tratamiento. Presentamos el caso de un paciente con artritis séptica de rodilla por este germen y pretendemos remarcar cuáles son las medidas diagnósticas y recomendaciones a tener en cuenta para esta infección osteoarticular.

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PURPOSE: To compare adjuvant radiotherapy (ART) to salvage radiotherapy (SRT) after radical prostatectomy (RP) in a cohort of prostate cancer (PCa) patients. The primary aim was to comparatively assess 2- and 5-year biochemical relapse-free survival (BRFS). A secondary aim was to identify predictors of survival. PATIENTS AND METHODS: Data were acquired from the RECAP database, a population-based prostate cancer registry in Spain. Inclusion criteria included RP (with or without lymphadenectomy) followed by ART or SRT. A total of 702 patients were analyzed. Pre-RT PSA values (>0.5 vs. ≤0.5 ng/ml), pathological stage (T1-2 vs. T3-4), post-surgical Gleason score (≤7 vs. 8-10), margin status (positive vs. negative), hormonal treatment (yes vs. no), and RT dose (≤66 Gy vs. >66 Gy) were evaluated to assess their impact on BRFS. RESULTS: The mean patient age in the ART and SRT groups, respectively, was 64 years (range 42-82) and 64.8 years (range 42-82). Median follow-up after RT in the whole sample was 34 months (range 3-141). A total of 702 patients were included: 223 (31.8%) received ART and 479 (68.2%) SRT. BRFS rates (95% CI) in the ART and SRT groups at months 24 and 60 were, respectively: 98.1% (95.9-100.0%) vs. 91.2% (88.2-94.2%) and 84.5% (76.4-92.6%) vs. 74.0% (67.4-80.7%) (p = 0.004). No significant differences in OS were observed (p = 0.053). The following variables were significant predictors of biochemical recurrence in the SRT group: (1) positive surgical margin status (p = 0.049); (2) no hormonotherapy (p = 0.03); (3) total prostate dose ≤66 Gy (p = 0.004); and pre-RT PSA ≥0.5 ng/ml (p = 0.013). CONCLUSIONS: This is the first nationwide study in Spain to evaluate a large cohort of PCa patients treated with RP followed by postoperative RT. ART yielded better 2- and 5-year BRFS rates, although OS was equivalent. These findings are consistent with most other published studies and support ART in patients with adverse prognostic characteristics after radical prostatectomy. Prospective trials are needed to compare immediate ART to early SRT to better determine their relative benefits.

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PURPOSE: To report treatment outcomes in a cohort of extreme-risk prostate cancer patients and identify a subgroup of patients with worse prognosis. MATERIALS AND METHODS: Extreme-risk prostate cancer patients were defined as patients with at least one extreme-risk factor: stage cT3b-cT4, Gleason score 9-10 or PSA > 50 ng/ml; or patients with 2 or more high-risk factors: stage cT2c-cT3a, Gleason 8 and PSA > 20 ng/ml. Overall survival (OS), cause-specific survival (CSS), clinical-free survival (CFS), and biochemical non-evidence of disease (bNED) survival are the four outcomes of interest in a population of 1341 patients. RESULTS: With a median follow-up of 71.5 months, 5- and 10-year bNED survival, CFS, CSS and OS for the entire cohort were 77.1 % and 57.0, 89.2 and 78.9 %, 97.4 and 93.6 %, and 92.0 and 71.3 %, respectively. On multivariate analysis, PSA and clinical stage were associated with bNED survival. PSA and Gleason score predicted for CFS, whereas only Gleason score predicted for OS. When a simplified model was performed using the "number of risk factors" variable, this model provided the best distinction between patients with ≥2 extreme-risk factors and patients with 2 high-risk factors, showing a hazard ratio (HR) of 1.737 (p = 0.0003) for bNED survival, HR 1.743 (p = 0.0448) for OS and an HR of 3.963 (p = 0.0039) for the CSS endpoint. CONCLUSIONS: Patients presenting at diagnosis with two extreme-risk criteria have almost fourfold higher risk for prostate cancer mortality. Such patients should be considered for more aggressive multimodal treatments.

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Cannabinoids are key regulators of vascular tone, some of the mechanisms involved include the activation of cannabinoid receptor types 1 and 2 (CB); the transient receptor potential cation channel, subfamily V, member 1 (TRPV1); and non-(CB(1))/non-CB2 receptors. Here, we used the potent, selective CB(1) agonist arachidonylcyclopropylamide (ACPA) to elucidate the mechanism underlying vascular tone regulation. Immunohistochemistry and confocal microscopy revealed that CB(1) was expressed in smooth muscle and endothelial cells in rat aorta. We performed isometric tension recordings in aortic rings that had been pre-contracted with phenylephrine. In these conditions, ACPA caused vasorelaxation in an endothelium-independent manner. To confirm that the effect of ACPA was mediated by CB(1) receptor, we repeated the experiment after blocking these receptors with a selective antagonist, AM281. In these conditions, ACPA did not cause vasorelaxation. We explored the role of K(+) channels in the effect of ACPA by applying high-K(+) solution to induce contraction in aortic rings. In these conditions, the ACPA-induced vasorelaxation was about half that observed with phenylephrine-induced contraction. Thus, K(+) channels were involved in the ACPA effect. Furthermore, the vasorelaxation effect was similarly reduced when we specifically blocked calcium-activated potassium channel subunit alpha-1 (KCa1.1) (MaxiK; BKCa) prior to adding ACPA. Finally, ACPA-induced vasorelaxation was also diminished when we specifically blocked the calcium channel, voltage-dependent, L type, alpha 1C subunit (Ca(v)1.2). These results showed that ACPA activation of CB(1) in smooth muscle caused vasorelaxation of aortic rings through a mechanism involving the activation of K(Ca)1.1 and the inhibition of Ca(v)1.2.

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We performed a detailed investigation of the structural and optical properties of multi-layers of InP/GaAs quantum dots, which present a type II interface arrangement. Transmission electronic microscopy analysis has revealed relatively large dots that coalesce forming so-called quantum posts when the GaAs layer between the InP layers is thin. We observed that the structural properties and morphology affect the resulting radiative lifetime of the carriers in our systems. The carrier lifetimes are relatively long, as expected for type II systems, as compared to those observed for single layer InP/GaAs quantum dots. The interface intermixing effect has been pointed out as a limiting factor for obtaining an effective spatial separation of electrons and holes in the case of single layer InP/GaAs quantum-dot samples. In the present case this effect seems to be less critical due to the particular carrier wavefunction distribution along the structures.

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Despite its abundance in Latin America, and its remarkable ability to use tools, there are only a few myological studies on the capuchin monkey, Cebus libidinosus. In the present study, we dissected the forearm extensor muscles of six adult males and two adult females of this species. We describe these muscles and compare them with those of other primates dissected by us and by other authors. The forearm extensor muscles of Cebus monkeys are, in general, more similar to those of other platyrrhines than to distantly related taxa that use tools, such as chimpanzees and modern humans, with three main exceptions: contrary to most other platyrrhines, (1) in Cebus, chimpanzees and modern humans the extensor pollicis longus usually inserts onto Digit I, and not onto Digits I and II; (2) in Cebus the abductor pollicis longus has two separate tendons, as is the case in chimpanzees, and in modern humans (where one of these tendons is associated with a distinct belly, forming the muscle extensor pollicis brevis); (3) in Cebus, and in modern humans and chimpanzees, the extensor pollicis longus is not deeply blended with the extensor indicis. Therefore, the Cebus monkeys provide an illustrative example of how phylogenetic constrains and ecological adaptations have been combined to develop a specific myological configuration that, associated with their sophisticated neurological organization, allow them to easily navigate in their arboreal habitats and, at the same time, to finely manipulate objects in order to search for food and to prepare this food for ingestion.

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Syringomyelia is the condition in which cavities fulfilled with CSF are found within spinal cord. Syringes are caused by obstructions of CSF pathways of different causes. If we can not find a cause responsible for the blockage, we call it "idiopathic" syringomyelia. Drainage procedures have been widely used but results, especially long-term results, are not favourable and complication rate is high. Some authors prefer to restore CSF circulation instead to drain the syrinx. Results of this treatment modality are better in literature than drainage procedures. Adequate radiological studies help to identify problem location and to plan the approach. A case of "idiopathic" syringomyelia is presented. Treatment consisted on arachnoid webs dissection and dural plastia. Clinical and radiological response was good. Literature concerned about this kind of syringomyelia and treatment modalities are reviewed.

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In the present work, the effectiveness of styrene/ethylene-butylene/styrene rubbers grafted with maleic anhydride (MA) and a metallocene polyethylene (mPE) as toughening materials in binary and ternary blends with polypropylene and its nanocomposite as continuous phases was evaluated in terms of transmission electron microscopy (TEM), scanning electron microscopy (SEM), oscillatory shear flow and dynamic mechanical thermal analysis (DMA). The flexural modulus and heat distortion temperature values were determined as well. A metallocene polyethylene and a polyamide-6 were used as dispersed phases in these binary and ternary blends produced via melt blending in a corotating twin-screw extruder. Results showed that the compatibilized blends prepared without clay are tougher than those prepared with the nanocomposite of PP as the matrix phase and no significant changes in shear viscosity, melt elasticity, flexural or storage moduli and heat distortion temperature values were observed between them. However, the binary blend with a nanocomposite of PP as matrix and metallocene polyethylene phase exhibited better toughness, lower shear viscosity, flexural modulus, and heat distortion temperature values than that prepared with polyamide-6 as dispersed phase. These results are related to the degree of clay dispersion in the PP and to the type of morphology developed in the different blends.

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A 4.8-kb plasmid region carrying the four genes mcjABCD necessary for production of and immunity to the cyclic peptide antibiotic microcin J25 (MccJ25) has been sequenced. mcjA encodes the primary structure of MccJ25 as a precursor endowed with an N-terminal extension of 37 amino acids. The products of mcjB and mcjC are thought to be involved in microcin maturation, which implies cleavage of McjA and head-tail linkage of the 21-residue pro-MccJ25. The predicted McjD polypeptide, which is highly similar to several ABC exporters, was found to be required for MccJ25 secretion, thus explaining its ability to confer immunity to MccJ25.

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The limited success of the health unisectorial action for the solution of the nutritional problems of the population led to the recognition of the necessity of coordinating the work of many sectors. The most important responsibilities of the health sector in the process of the multisectorial food and nutrition planning are discussed: morail and technical leadership during the promotion and development of the process: diagnosis of the nutritional problems; definition of the biological reference terms; promotion and participation in the design, initiation, operation and evaluation of food and nutrition multisectorial systems; participation in the formulation of socio-economical development objectives; evaluation of the food and nutrition policies, and follow-up and evaluation of the projects they may generate; active participation and support of resources for the development of the process; implementation and execution of the sectoral activities; research; participation in nutritional planning aspects for disaster situations, and planning of the nutritional activities of the health sector.

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This paper addresses the interrelationship between the food and nutrition problem and population problems in Latin America within a global focus. A basic framework is presented which defines four demographic problems highly related with the food and nutrition situation: The underutilization of the labor force; the accelerated growth of the marginal population; the poor geographic distribution and rapid urbanization; and the high rates of infant and child mortality. Findings from the recent experience of demography in food and nutrition planning in the last four years in Central America and Panama are outlined, and strategies are recommended for the development of different types of programs and projects in population-nutrition. Finally, a list of applied research, basic information and direct action projects in population-nutrition that have been detected as needed by most of the Central American countries, is presented.

PIP: This paper explores various strategies for development of more effective integrated programs of nutrition and population, based on the study of the interrelationship between the 2 problems and the experience acquired in the application of population studies to the process of food and nutrition planning in Central America and Panama. An implicit consensus has been reached that the major problems which confront Latin American governments as a result of present demographic and social trends are urban concentration and metropolization, underutilization of the labor force, extreme poverty, and insufficient basic services. Many existing studies of the links between population, nutrition, and socioeconomic development have had perspectives that have been too global or too partial to support policymaking and planning. Some new lines of study of women, the family, basic needs and extreme poverty, on 1 side, and the elaboration of diagnostic tools, target groups, goals, primary health interventions, integral rural development, and their evaluation, on the other, represent advances in the integration of population and nutrition problems into development planning. A model of interrelationships between demographic policies, malnutrition, and socioeconomic development gives highest priority to 4 demographic problems affecting nutrition: underutilization of the labor force, which affects purchasing power and consumption; growth of the marginal sector, poor population distribution and rapid urbanization; and high mortality among children under 5. A project developed in Central America and Panama from 1977-79 on the sociodemographic dimensions of food and nutrition planning was largely intended to improve institutional planning capacity. An illustrative table identifies 4 conditioning factors of malnutrition, including lack of adequate planning, insufficient food production and poor distribution and underutilization of available food by the body; provides examples of nutritional programs directed toward the problems, and lists expected effects of the programs on demographic variables. Another table outlines conditioning factors of malnutrition and related demographic variables. 5 areas requiring research in Central America are seasonal migration and malnutrition; malnutrition and infant mortality; composition and stability of the family and intrafamily food distribution; urban women's role and lactation; and agricultural density, rural displacement, and home production.

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Population health and nutrition situations present different degrees of complexity which must be met with different degrees of technological complexity. This can be accomplished by organizing, in a progressive way, the resources of the health service system to constitute different levels of attention. In this paper, the concept of levels of attention of the health service system is analyzed on the basis of the aforementioned ideas, and comments are made on the increasing administrative complexity required to keep pace with the increasing technological complexity. Mention is made of the criteria which must be taken into account in order to select nutrition activities to be performed in the health sector and the way in which these activities must conform to the different levels, according to their degree of specialization and complexity. Special reference is made of experiences where the basic or primary level activities involving community participation are particularly important. Finally, the incorporation of nutrition as a part of the attention routine at the various levels is discussed; here, the importance of the necessary mechanisms for coordination and support among the various levels is stressed.

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Los distintos grados de complejidad que se presentan en las situaciones de nutricion y salud de las poblaciones, hacen necesario que la respuesta se de con diversos grados de complejidad tecnologica, por medio de una organizacion escalonada de los recursos del sistema de servicios de salud. En este sentido, se analiza el concepto de niveles de atencion de dicho sistema, y se comenta la creciente complejidad administrativa requerida conforme aumenta su complejidad tecnologica. Se mencionan los criterios a tomar en cuenta para seleccionar las actividades de nutricion a realizar y la forma en que tales actividades deben corresponder a los distintos niveles, segun su grado de especializacion y de complejidad. Se comentan experiencias en las que se destacan las actividades correspondientes al nivel basico o primario, en que participa la comunidad. Por ultimo, se discute la incorporacion de la nutricion -como parte de las rutinas de atencion en los distintos niveles- y se insiste en los mecanismos de articulacion necesarios para la coordinacion y el apoyo entre niveles

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Se analiza la interrelacion entre la problematica alimentaria-nutricional y la problematica demografica en America Latina, con un enfoque globalista. Se parte de un marco de referencia en el cual se definen cuatro problemas demograficos estrechamente relacionados con la situacion alimentaria-nutricional: la subutilizacion de la mano de obra; el crecimiento acelerado de la poblacion marginal; la mala distribucion geografica y rapida urbanizacion; y las altas tasas de mortalidad en ninos menores de cinco anos. Se presentan los resultados obtenidos al utilizar la demografia en la planificacion alimentaria-nutricional durante los ultimos cuatro anos en Centroamerica y Panama, y recomiendan estrategias a seguir para el desarrollo de diferentes tipos de programas y proyectos en poblacion-nutricion. Finalmente, se enumera una serie de proyectos de investigacion aplicada, de suministro util de informacion y de accion directa en materia de nutricion-poblacion, que han sido considerados como necesidades en la mayoria de los paises del Istmo Centroamericano

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El limitado exito de la accion unisectorial de salud en la solucion de los problemas nutricionales de la poblacion, ha llevado a reconocer la necesidad de coordinar la labor de numerosos sectores. En el presente trabajo se comentan las responsabilidades mas importantes del sector salud en el proceso de planificacion multisectorial de la alimentacion y nutricion: liderazgo moral y tecnico durante la promocion y el desarrollo del proceso; diagnostico de los problemas nutricionales; definicion de terminos de referencia biologicos; promocion y participacion en el diseno, puesta en marcha, funcionamiento y evaluacion de sistemas multisectoriales de vigilancia alimentaria-nutricional; participacion en la formulacion de objetivos de desarrollo economico-social; evaluacion de las politicas de alimentacion y nutricion, y seguimiento y evaluacion de los proyectos que generen; participacion activa y aporte de recursos para el desarrollo del proceso; aplicacion y ejecucion de las actividades que correspondan al sector; la investigacion; participacion en la planificacion de los aspectos nutricionales para enfrentar situaciones de desastre; y planificacion de las actividades de nutricion propias del sector salud

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The Project "Food and Nutrition Surveillance System (SVAN)" of Honduras, functions in a pilot area of the Department of El Paraíso, Honduras, with the participation of several national institutions involved in the food and nutrition problem. In accordance with the plan established in the Project, an evaluation of SVAN was carried out with the following purposes: a) determine the efficiency of the System in relation to the established objectives and goals; determine the obstacles and problems that have risen and the necessary methods and resources to solve them, and c) arrive to conclusions in regard to the Project until the moment of its evaluation, an express recommendations for its future development and extension. The formal aspects evaluated were: objectives, goals, strategies, organization and functioning of the SVAN, advisory services and supervision, personal training, equipment and materials, indicators, actions generated by the SVAN and resources used. To establish the effective value of the Project, informal aspects such as integration of multisectoral surveillance groups were included, as well as communication among the participating sectors in the System, as a result of the functioning of SVAN. Finally, conclusions derived from the evaluation process are presented in regard to: efficacy of the SVAN, costs in terms of invested resources, and feasibility of the System concerning its future extension, both in time and geographic coverage terms.

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