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The potential clinical usefulness of electron density (ED) imaging, that can be directly estimated using dual-layer spectral computed tomography (CT), has been poorly investigated. We explored whether ED imaging might improve thrombus identification compared to conventional imaging in vitro. We evaluated mechanical thrombectomy material obtained from patients with acute ischemic stroke (AIS) treated in a tertiary level stroke center and immediately fixed in 10% neutral buffered formalin and stored in polystyrene test tubes. The test tubes were immersed in a bucket of water for evaluation by spectral CT, along with scattered control tubes. All images were obtained using a dual-layer detector CT scanner. Each tube was assessed using multiparametric side-by-side view of conventional CT (120 kVp), low monoenergetic imaging (40 keV), and ED images. Fifty-eight polystyrene tubes were analyzed, comprising 52 tubes with thrombectomy material of at least 1 mm2 size obtained from 52 AIS patients, and six control tubes filled with formalin. ED imaging identified accurately the presence of material in all tubes, whereas 2 (3%) of the tubes containing thrombus were not identified by conventional CT, leading to a very good agreement between observers for the presence of material using conventional CT and ED imaging (kappa =0.84, P<0.001). Using ED imaging, thrombus material showed a mean density of 108.8±2.9 percent ED relative to water (%EDW), water had a mean density of 100.0±0.3 %EDW, and formalin a mean density of 103.5±1.2 %EDW. Compared to conventional imaging and 40 keV monoenergetic, ED imaging had a significantly higher signal-to-noise ratio (conventional 10.4±7.0, vs. 40 keV 11.5±8.4, vs. ED 490.0±304.5, P<0.001) and contrast-to-noise ratio (CNR) (conventional 4.3±4.3, vs. 40 keV 5.7±11.2, vs. ED 37.8±29.1, P<0.001). In this in-vitro study, we demonstrated improved visualization of thrombus with ED imaging compared to conventional imaging and low monoenergetic imaging, with a significant increase in CNR.

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Genome editing in pigs for xenotransplantation has seen significant advances in recent years. This study compared three methodologies to generate gene-edited embryos, including co-injection of sperm together with the CRISPR-Cas9 system into oocytes, named ICSI-MGE (mediated gene editing); microinjection of CRISPR-Cas9 components into oocytes followed by in vitro fertilization (IVF), and microinjection of in vivo fertilized zygotes with the CRISPR-Cas9 system. Our goal was to knock-out (KO) porcine genes involved in the biosynthesis of xenoantigens responsible for the hyperacute rejection of interspecific xenografts, namely GGTA1, CMAH, and ß4GalNT2. Additionally, we attempted to KO the growth hormone receptor (GHR) gene with the aim of limiting the growth of porcine organs to a size that is physiologically suitable for human transplantation. Embryo development, pregnancy, and gene editing rates were evaluated. We found an efficient mutation of the GGTA1 gene following ICSI-MGE, comparable to the results obtained through the microinjection of oocytes followed by IVF. ICSI-MGE also showed higher rates of biallelic mutations compared to the other techniques. Five healthy piglets were born from in vivo-derived embryos, all of them exhibiting biallelic mutations in the GGTA1 gene, with three displaying mutations in the GHR gene. No mutations were observed in the CMAH and ß4GalNT2 genes. In conclusion, in vitro methodologies showed high rates of gene-edited embryos. Specifically, ICSI-MGE proved to be an efficient technique for obtaining homozygous biallelic mutated embryos. Lastly, only live births were obtained from in vivo-derived embryos showing efficient multiple gene editing for GGTA1 and GHR.

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Regulated systems for transgene expression are useful tools in basic research and a promising platform in biomedicine due to their regulated transgene expression by an inducer. The emergence of optogenetics expression systems enabled the construction of light-switchable systems, enhancing the spatial and temporal resolution of a transgene. The LightOn system is an optogenetic tool that regulates the expression of a gene of interest using blue light as an inducer. This system is based on a photosensitive protein (GAVPO), which dimerizes and binds to the UASG sequence in response to blue light, triggering the expression of a downstream transgene. Previously, we adapted the LightOn system to a dual lentiviral vector system for neurons. Here, we continue the optimization and assemble all components of the LightOn system into a single lentiviral plasmid, the OPTO-BLUE system. For functional validation, we used enhanced green fluorescent protein (EGFP) as an expression reporter (OPTO-BLUE-EGFP) and evaluated the efficiency of EGFP expression by transfection and transduction in HEK293-T cells exposed to continuous blue-light illumination. Altogether, these results prove that the optimized OPTO-BLUE system allows the light-controlled expression of a reporter protein according to a specific time and light intensity. Likewise, this system should provide an important molecular tool to modulate gene expression of any protein by blue light.

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The present study evaluates the response to betahistine in patients who presented vestibular drops attacks in the context of Ménière's disease (MD) and the factors that can predict an unfavorable response to it. A total of 43 patients were analyzed, out of which 33 were diagnosed with MD. This is a descriptive, cross-sectional study with retrospective data collection. Data as regards age, accompanying symptoms, etiological diagnosis and response to MD treatment were collected. A statistical analysis was carried out, and we found that the disease evolution time and specific alterations in the vestibulospinal and oculomotor physical examination present an unfavorable response to betahistine. Failures for betahistine were treated with intratympanic gentamicin, with which symptomatic control was achieved in all cases.

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Objetivo: Analizar la percepción de los residentes a factores de riesgos psicosociales a los que se enfrentan a lo largo de su formación académica relacionados con los dominios de control y recompensas del trabajo. Materiales y métodos: Estudio cualitativo con metodología fenomenológica, que utilizó la entrevista a profundidad como técnica de obtención de los datos a partir de los elementos contemplados en la Batería de Instrumentos para la Evaluación de Factores de Riesgo Psicosocial del Ministerio de Protección Social de Colombia. Se entrevistó a 42 residentes de 8 especialidades médicas en Barranquilla. El análisis de la información obtenida se interpretó a partir de la teoría sociológica de Schütz. Resultados: Se observó relación de la carga de trabajo, tiempo y organización con el poco reconocimiento al esfuerzo. Además, existe poco apego con las instituciones y no hay vínculo profesional y emocional estable debido a la baja percepción de autorrealización en el ejercicio de su trabajo. Conclusiones: Los dominios "control" y "recompensas" se conjeturan como problemáticas frecuentes en el ámbito de las residencias médicas. Si no hay control de las funciones, participación en la toma de decisiones y en el funcionamiento de la institución, y si existen pocas oportunidades de demostrar el dominio en las responsabilidades adquiridas, la percepción de bienestar se ve implicada.

Objective: To analyze the perception of residents to psychosocial risk factors they face throughout their academic training related to the domains of control and work rewards. Materials and Methods: Qualitative study with phenomenological methodology, which used in-depth interview as a technique to obtain data from the elements contemplated in the Battery of Instruments for the Evaluation of Psychosocial Risk Factors of the Ministry of Social Protection of Colombia. Forty-two residents from 8 medical specialties in Barranquilla were interviewed. The analysis of the information obtained was interpreted based on Schütz's sociological theory. Results: A relationship was observed between workload, time and organization, with little recognition of effort. In addition, there is little attachment to the institutions and there is no stable professional and emotional bond due to the low perception of self-fulfillment in the exercise of their work. Conclusions: The control and reward domains are conjectured as frequent problems in the field of medical residencies. If there is no control of the functions, participation in decision making and in the functioning of the institution, and if there are few opportunities to demonstrate mastery in the acquired responsibilities, the perception of well-being is implicated.

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Introducción: La formación académica en las especialidades médicas es un proceso continuo de entrenamiento teórico y práctico en el que las y los residentes interactúan constantemente con los coordinadores del programa, con residentes de diferentes programas y las y los trabajadores de los escenarios de prácticas. Se investigó por medio de entrevistas las relaciones que se presentan en diferentes especialidades. Objetivo: Conocer las vivencias y experiencias de la jerarquía de las y los residentes durante su proceso de formación en los escenarios de prácticas. Método: Estudio cualitativo de corte fenomenológico que aplicó entrevistas semi-estructuradas a 42 estudiantes de especialidades médico-quirúrgicas como: cirugía plástica, ginecología, medicina crítica, medicina interna, neurología, pediatría y psiquiatría, revisando de la batería de riesgo psicosocial el dominio de relaciones sociales y liderazgo. Resultados: Las y los entrevistados expresaron 195 referencias relacionadas con sus experiencias en las que el liderazgo de los coordinadores del programa es descrito como una interacción significativa que genera malestar psicológico o protección, junto con 158 referencias de estilo de retroalimentación en algunas vivencias, escaso o centrado en una nota cuantitativa, y 156 referencias de cómo veían la relación con sus residentes mayores desde una perspectiva jerárquica. Conclusiones: Las características de la jerarquía durante la residencia están determinadas por el estilo de liderazgo del coordinador del programa y los residentes replican el mismo modelo con sus compañeros de mismo año, superiores y residentes menores.

Introduction: Academic training in medical specialties is a continuous process of theoretical and practical training where residents constantly interact with program coordinators, residents of different programs and workers in internship scenarios; the relationships that occur in different residences were investigated through interviews. Objective: To know the life experiences of the hierarchy of resident doctors during their training process in the practice settings. Method: Qualitative phenomenological study that uses semi-structured interviews with 42 students of medical-surgical specialties such as: plastic surgery, gynecology, critical medicine, internal medicine, neurology, pediatrics and psychiatry, reviewing the psychosocial risk battery domain of social relations and leadership. Results: The interviewees expressed 195 references related to their experiences where the leadership of the program coordinators is described as a significant interaction generating psychological or protective discomfort, along with 158 references of feedback style in some experiences, scarce or focused on a quantitative note and 156 references of how they saw the relationship with their older residents from a hierarchical perspective. Conclusions: The characteristics of the hierarchy in the residence are determined by the leadership style of the program coordinator and the residents replicate the same model with their peers of the same year, superiors and minor residents.

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Introducción: el objetivo de este estudio fue analizar la relación entre los valores de IL13 y su pronóstico en pacientes con artritis reumatoidea (AR) y enfermedad pulmonar intersticial (EPI). Materiales y métodos: estudio de cohorte prospectiva. Se midió IL13 en suero y se dividió la cohorte en dos grupos con la mediana de IL13 como punto de corte. Se estudió el tiempo hasta una caída de la capacidad vital forzada (CVF) mayor o igual al 5% con el método de Kaplan Meier (KM) y regresión de Cox. Resultados: se incluyeron 47 pacientes. La media (DE) de tiempo de seguimiento fue de 12,7 (12,5) meses. El estimador de KM a 15 meses fue de 0,48 (IC 95% 0,13-0,76) en el grupo con valores elevados de IL13 y de 0,86 (IC 95% 0,54-0,93) en el otro grupo (p=0,037). En el análisis de Cox multivariado los valores elevados de IL13 se asociaron con una caída de la CVF mayor o igual al 5% en el seguimiento (HR 17.64 (IC 95% 1,89-164,1) p=0,012). Conclusiones: los valores elevados de IL13 se asociaron con peor evolución funcional en esta cohorte prospectiva de pacientes con AR y EPI.

Introduction: the aim of our study was to analyze the relationship between the concentrations of IL13 in serum and the prognosis of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. Materials and methods: we conducted a prospective cohort study. We measured IL13 levels in serum. Patients were divided in two groups using the median of IL13 value as cut off point. Time to a decline of 5% or more in FVC% from basal measurement was estimated using Kaplan Meier method. Univariate and multivariate Cox models were applied. Results: we included 47 patients. The mean (SD) time of follow-up was 12.7 (12.5) months. The Kaplan Meier estimator at 15 months was 0.48 (CI 95% 0.13-0.76) in the group with higher values of IL13, and 0.86 (CI95% 0.54-0.93) in the other group (p=0.037). In the Cox multivariate analysis, the values of IL13 were significantly associated with a decline of 5% or more in FVC% in the follow-up (HR 17.64 (CI 95% 1.89-164.1) p=0.012). Conclusions: our results indicate that patients with higher values of IL13 in serum presented higher decline in FVC% during their follow-up.

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Resumen La ecografía pulmonar (EP) ha demostrado ser una herramienta útil para detectar el grado de compromiso pulmonar en neumonía y síndrome de distrés respiratorio agudo. El presente estudio evalúa la asociación entre la puntuación de EP de 12 regiones y el ingreso de terapia intermedia a terapia intensiva en pacientes con neumonía por COVID-19. Se incluyó un total de 115 pacientes con diagnóstico de neumonía confirmada por radiografía de tórax, por SARS-CoV-2, se realizó una EP junto con la evaluación de laboratorio que incluyó la medición de marcadores inflamatorios (linfocitos, proteína C reactiva, Dímero D, procalcitonina, ferritina, lactato deshidrogenasa y pro péptido natriurético de tipo B). Se utilizó una puntuación ecográfica pul monar que caracteriza el grado de afección pulmonar como leve, moderado y grave, y se comparó el resultado con los marcadores inflamatorios de laboratorio. En el análisis univariado se observó una asociación entre la puntuación de la EP, los niveles elevados de procalcitonina y péptido natriurético cerebral y el ingreso a terapia intensiva. En el análisis multivariado solo la puntuación de EP fue un predictor independiente de requerimiento de terapia intensiva.

Abstract Lung ultrasound (LUS) has shown to be a useful tool to detect the degree of pulmonary involvement in patients with pneumonia and acute respiratory distress syndrome. The present study evaluates the association of the 12-region lung ultrasound score and the requirements of intensive care unit, in patients with COVID-19 infection who were admitted to intermediate care in a specialized hospital; 115 patients with a diagnosis of pneumonia confirmed by chest radiography secondary to SARS-CoV-2 were included, LUS was performed together with the laboratory evaluation that included the measurement of inflammatory biomarkers (lymphocytes, C-reactive protein, D-dimer, procalcitonin, ferritin, lactate dehydrogenase, and pro B-type natriuretic peptide). Lung ultrasound score was used, characterizing the degree of lung involvement as mild, moderate, and severe, and the results were compared with inflammatory biomarkers. In the univariate analysis, an association was observed between the lung ultrasound score, elevated levels of procalcitonin and brain natriuretic peptide, and the admission to intensive care. In the multivariate analysis, only the lung ultrasound score was an independent predictor of need for intensive therapy.

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Lung ultrasound (LUS) has shown to be a useful tool to detect the degree of pulmonary involvement in patients with pneumonia and acute respiratory distress syndrome. The present study evaluates the association of the 12-region lung ultrasound score and the requirements of intensive care unit, in patients with COVID-19 infection who were admitted to intermediate care in a specialized hospital; 115 patients with a diagnosis of pneumonia confirmed by chest radiography secondary to SARS-CoV-2 were included, LUS was performed together with the laboratory evaluation that included the measurement of inflammatory biomarkers (lymphocytes, C-reactive protein, D-dimer, procalcitonin, ferritin, lactate dehydrogenase, and pro B-type natriuretic peptide). Lung ultrasound score was used, characterizing the degree of lung involvement as mild, moderate, and severe, and the results were compared with inflammatory biomarkers. In the univariate analysis, an association was observed between the lung ultrasound score, elevated levels of procalcitonin and brain natriuretic peptide, and the admission to intensive care. In the multivariate analysis, only the lung ultrasound score was an independent predictor of need for intensive therapy.

La ecografía pulmonar (EP) ha demostrado ser una herramienta útil para detectar el grado de compromiso pulmonar en neumonía y síndrome de distrés respiratorio agudo. El presente estudio evalúa la asociación entre la puntuación de EP de 12 regiones y el ingreso de terapia intermedia a terapia intensiva en pacientes con neumonía por COVID-19. Se incluyó un total de 115 pacientes con diagnóstico de neumonía confirmada por radiografía de tórax, por SARS-CoV-2, se realizó una EP junto con la evaluación de laboratorio que incluyó la medición de marcadores inflamatorios (linfocitos, proteína C reactiva, Dímero D, procalcitonina, ferritina, lactato deshidrogenasa y pro péptido natriurético de tipo B). Se utilizó una puntuación ecográfica pulmonar que caracteriza el grado de afección pulmonar como leve, moderado y grave, y se comparó el resultado con los marcadores inflamatorios de laboratorio. En el análisis univariado se observó una asociación entre la puntuación de la EP, los niveles elevados de procalcitonina y péptido natriurético cerebral y el ingreso a terapia intensiva. En el análisis multivariado solo la puntuación de EP fue un predictor independiente de requerimiento de terapia intensiva.

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RESUMEN Objetivo Describir los factores psicosociales en las dimensiones demandas de trabajo en los residentes de especialidades médicas en Barranquilla. Métodos Estudio cualitativo con metodología fenomenológica en residentes de especialidades médicas adscritos a una institución de educación superior en Barranquilla. Mediante entrevistas en profundidad se recogieron las experiencias, vivencias y consideraciones manifestadas en su vida cotidiana y en su salud mental, frente a las situaciones que afrontan a diario en su formación en el contexto laboral en medio de la ejecución de sus responsabilidades operativas. Resultados En el dominio de demandas de trabajo se concentraron las cinco dimensiones más sobresalientes, con 266 testimonios-demandas de autocontrol emocional; seguidos de 237 en la dimensión demandas cuantitativa; 165, en demandas de carga mental; 152, en demandas ambientales y de esfuerzo físico; y 142, en exigencias de responsabilidad del cargo. Conclusiones Es importante revisar las cargas de las demandas de trabajo a lo largo del curso de la residencia de las especialidades medico quirúrgicas para disminuir los riesgos psicosociales en el desempeño de sus funciones.

ABSTRACT Objective To describe the psychosocial factors in the dimensions of work demands in the residents of medical specialties in Barranquilla. Methods A qualitative study with phenomenological methodology in residents of medical specialties assigned to an Institution of Higher Education in Barranquilla. Through the in-depth interviews, the experiences, experiences, and considerations manifested in their daily lives and mental health were collected, in the face of the situations, they face daily in their training in the work context amid the execution of their operational responsibilities. Results The five most outstanding dimensions were concentrated in the domain demands of work, with 266 testimonies demands of emotional self-control, followed by 237 in the dimension quantitative demands, 165 in demands of mental load, 152 in environmental demands and of physical effort, and 142 in demands of responsibility of the position. Conclusions It is important to review the burdens of work demands throughout the course of the residency of the medical-surgical specialties to reduce psychosocial risks in the performance of their functions.