Estudio retrospectivo en pacientes con Cáncer de Colon etapa III. ¿El tratamiento adyuvante es iniciado de forma oportuna?

Introducción: En Chile, el Cáncer colorrectal (CC) abarca el 11,5% de todas las neoplasias malignas. La cirugía es la piedra angular del tratamiento del cáncer de colon, y en pacientes en etapa III, la quimioterapia adyuvante forma parte del tratamiento estándar. Materiales y Métodos: Estudio descriptivo retrospectivo transversal, de centro único, de pacientes con cáncer de colon en estadio III patológico. Objetivo principal de este estudio es conocer si, en pacientes con cáncer de colon etapa III, la quimioterapia adyuvante se entrega de manera oportuna. Resultados: En el período comprendido entre abril de 2016 y abril de 2021 se operaron 35 pacientes con cáncer de colon en estadio III patológico. Se realizó quimioterapia adyuvante en un 80%, y en siete pacientes durante las primeras ocho semanas poscirugía. La dehiscencia de anastomosis ocurrió en un 11,4%, aumentando la mediana de hospitalización en 2,2 veces. Discusión: En nuestro estudio, la adyuvancia en cáncer de colon etapa III se administró a un alto porcentaje de los pacientes (80%), pero observamos un retraso importante, ya que sólo en un 25% se inició el tratamiento durante las primeras 8 semanas poscirugía, lo cual puede ser explicado por múltiples factores, siendo la dehiscencia de anastomosis un punto importante a considerar. Conclusión: En estadio III de CC la adyuvancia puede verse retrasada por múltiples factores, lo que puede repercutir en la sobrevida de los pacientes, por lo tanto, conocer las causas de este retraso podría ayudar a instaurar nuevas estrategias, como la neoadyuvancia, para mejorar los resultados oncológicos.

Introduction: In Chile, colorectal cancer covers 11.5% of all malignant neoplasms. Surgery is the cor- nerstone of colon cancer treatment and in stage III patients adjuvant chemotherapy is part of standard treatment. Materials and Methods: A descriptive, retrospective, cross-sectional study, single center, of patients with pathological stage III colon cancer. Main objective of this study is to know if in patients with stage III colon cancer adjuvant chemotherapy is delivered in a timely manner. Results: Between April 2016 and April 2021, 35 patients with pathological stage III colon cancer were operated on. Adjuvant chemotherapy was performed in 80%, and in seven patient during the first eight weeks after surgery. Anastomotic dehiscence occurred in 11.4%, the median hospitalization increased by 2.2 times. Discussion: In this study, adjuvant stage III colon cancer was administered to a high percentage of patients (80%), but we observed a significant delay, since only 25% began treatment during the first 8 weeks post-surgery, which can be explained by multiple factors, with anastomotic dehiscence being an important point to consider. Conclusion: In stage III CC, adjuvant treatment can be delayed by multiple factors, which may affect patient survival; therefore, knowing the causes of this delay could help to establish new strategies, such as neoadjuvant therapy, to improve oncological results.

Versatility of Tunneled Island Flaps for the Reconstruction of Facial Defects. / Versatilidad del «colgajo en isla tunelizado¼ para la reconstrucción de defectos faciales.

BACKGROUND AND OBJECTIVE: Tunneled island flaps that transfer skin from a site adjacent to the wound are an effective way to reconstruct defects. These flaps provide good aesthetic and functional results and can be completed during a single surgical session, thus reducing complications. The procedure consists of taking an island of skin about the size of the surgical defect and moving it through a subcutaneous tunnel to cover the wound. We aimed to exemplify the use of these flaps in different regions of the face. MATERIAL AND METHODS: Retrospective descriptive study of 12 cases in which tunneled island flaps were used after removal of malignant tumors in different facial regions. RESULTS: The tumors, all of which were basal cell carcinomas, were removed by means of conventional surgery from 9 patients and Mohs micrographic surgery from 3 patients. Histology demonstrated tumor-free margins after excision in all cases. None of the tumors recurred during a mean follow-up period of 25 months. All complications were minor and transient. There were 3 cases of trapdoor effect and 2 each of postsurgical bleeding, transient superficial flap necrosis, and slight protrusion of the pedicle. The final cosmetic and functional outcome was satisfactory in all cases. CONCLUSIONS: Tunneled island flaps are particularly useful for repairing defects in the center of the face, where several anatomical structures converge. These flaps, which use donor skin that is similar to skin in the receptor site, can be used to close large defects in one-step procedures with only slight alteration of the facial architecture.

Bora phosphorylation substitutes in trans for T-loop phosphorylation in Aurora A to promote mitotic entry.

Polo-like kinase 1 (Plk1) is instrumental for mitotic entry and progression. Plk1 is activated by phosphorylation on a conserved residue Thr210 in its activation segment by the Aurora A kinase (AURKA), a reaction that critically requires the co-factor Bora phosphorylated by a CyclinA/B-Cdk1 kinase. Here we show that phospho-Bora is a direct activator of AURKA kinase activity. We localize the key determinants of phospho-Bora function to a 100 amino acid region encompassing two short Tpx2-like motifs and a phosphoSerine-Proline motif at Serine 112, through which Bora binds AURKA. The latter substitutes in trans for the Thr288 phospho-regulatory site of AURKA, which is essential for an active conformation of the kinase domain. We demonstrate the importance of these determinants for Bora function in mitotic entry both in Xenopus egg extracts and in human cells. Our findings unveil the activation mechanism of AURKA that is critical for mitotic entry.

B regulatory cells associated with changes in biochemical and inflammatory parameters in normal-glycemic individuals, pre-diabetes and T2DM patients.

AIM: To determine the percentages of (CD19 + CD24 + CD38+, CD19 + CD24 + CD27+, CD19 + IL-10+)-Breg cells, IL-17 single and IL-17+/IFN-γ double producers T cells and IFN-γ+ T cells, in normal-glycemic individuals, prediabetes and T2DM patients, and to analyze the association of Breg cells with metabolic parameters of T2DM. METHODS: percentages of Breg cells, IL-17+ and IL-17 + IFN-γ+ T cells, IFN-γ+ T cells and IL-10 were determined by flow cytometry. IL-6 levels were evaluated by ELISA assay. RESULTS: increased IL-6 levels, IL-17+ and IL-17 + IFN-γ+ T cells and a diminution of IL-10 levels and CD19 + IL-10+ cells in T2DM patients were observed. We found that CD19 + CD24 + CD27+ cells and CD19 + CD24 + CD38+ cells were increased in T2DM patients. The percentages of CD19 + CD24 + CD38+ cells were associated with HOMA-B, TyG index, HDL and cholesterol values. In normal-glycemic individuals, CD19 + CD24 + CD27+ cells were inversely associated to triglycerides and TyG index. In prediabetes patients, CD19 + CD24 + CD38+ cells were inversely related with cholesterol and LDL. Finally, CD19 + CD24 + CD38+ cells were inversely related with HDL values in T2DM patients. CONCLUSION: Our results suggest that increased percentages of IL-17 single and IL-17/IFN-γ double producers T cells in T2DM patients may be a consequence of the initial CD19 + IL-10+ cells reduction. Furthermore, dyslipidemia could play an important role in percentages and activity of B regulatory cells.

Teledermatology before, during, and after the COVID-19 pandemic. / Teledermatología en tiempos de pandemia: El antes, el durante y el después.

The use and acceptance of teledermatology increased more in the last 2 months of the recent lockdown owing to coronavirus disease 2019 than in the preceding 20 years. This sudden popularity -even among the greatest skeptics- was driven by the need to offer solutions to patients in both public and private settings who suddenly found themselves unable to access in-person dermatological care. Even departments already offering an asynchronous, store-and-forward teledermatology service were obliged to create new systems to support direct interaction between specialists and patients (the direct-to-consumer model). This article suggests some practical ways to implement TD safely and to expedite and optimize teleconsultations; these ideas are not just applicable to a pandemic situation.

[Epidemiology, treatment and mortality in infection by carbapenemase-producing Enterobacteriaceae: retrospective study]. / Epidemiología, tratamiento y mortalidad en pacientes infectados por enterobacterias productoras de carbapenemasas: estudio retrospectivo.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome. OBJECTIVE: To assess the epidemiology, treatment and mortality in patients with infection due to CPE. MATERIAL AND METHODS: A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015. RESULTS: A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment. DISCUSSION: Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.

Reconstructing Ear Defects Using the Revolving Door Island Flap: A Case Series. / Reconstrucción de defectos auriculares mediante el «colgajo en isla en puerta giratoria¼. Serie de casos.

BACKGROUND AND OBJECTIVES: Defects of the anterior region of the pinna pose a reconstruction challenge owing to the complex topography and difficult access. We report our experience using the revolving door island flap (RDIF) to reconstruct pinna defects and present the surgical results. MATERIAL AND METHODS: Retrospective descriptive study of patients undergoing ear reconstruction using RDIF at different sites of the anterior region after resection of malignant tumors. RESULTS: Seventeen patients underwent surgery between 2011 and 2019 for squamous cell carcinoma (n=7) and basal cell carcinoma (n=10). Conventional histology showed disease-free surgical margins in all the resected tissue specimens. The mean follow-up period was 40 months. One local recurrence of squamous cell carcinoma was observed, which responded well to radiation therapy; all patients were free of disease at the end of follow-up. Only 3 patients presented minor complications (depression of the flap surface in 1 case and retraction of the ear toward the mastoid process in 2 cases). Subjective rating scales were used to evaluate cosmetic and functional outcomes as assessed by both the dermatologist and the patient. The normal contour of the pinna was conserved in all patients and no patients required additional corrective surgery. CONCLUSIONS: Reconstruction of the pinna using RDIF allowed for satisfactory repair following complete resection of the tumors, while conserving structure and functionality. RDIF has been reported to be a very good option for reconstruction of the pinna. It is a simple technique that makes it possible to repair large defects with minimal risk of necrosis. In our series, the cosmetic results were excellent and recurrence rates were very low. RDIF provided optimal results in repairing lesions in the concha and in other regions, such as the antihelix, triangular fossa, and scapha.

Epidemiología, tratamiento y mortalidad en pacientes infectados por enterobacterias productoras de carbapenemasas: estudio retrospectivo / Epidemiology, treatment and mortality in infection by carbapenemase-producing Enterobacteriaceae: retrospective study

Resumen Introducción: Las enterobacterias productoras de carbapenemasas (EPC) suponen un reto para la salud pública y la práctica clínica. Objetivo: Analizar la epidemiología, el tratamiento y la mortalidad en pacientes infectados por EPC. Material y Métodos: Análisis retrospectivo de 163 pacientes infectados por EPC en un hospital universitario desde julio de 2013 a octubre de 2015. Resultados: Klebsiella pneumoniae fue aislada en 95,1% de los casos, y la mayoría de las carbapenemasas pertenecían al grupo OXA-48 (93%). La adquisición fue nosocomial en 124 casos (77%), asociada a cuidados sanitarios en 30 (18,6%), y 7 (4,3%) fueron de adquisición comunitaria. Las infecciones más frecuentes fueron las del tracto urinario (48,4%) y las respiratorias (19,5%). Aproximadamente, la mitad de los pacientes recibieron monoterapia antimicrobiana. La tasa de mortalidad a los 30 días fue de 23,3%. El análisis multivariante identificó que la presencia de shock séptico al diagnóstico (OR 4,2; IC 95% 1,5-11) estaba asociada de manera independiente con mayor mortalidad en el primer mes, sin lograr identificar asociación con el tratamiento antimicrobiano inapropiado. Discusión: Son necesarios más estudios para aclarar si el tratamiento antimicrobiano de las infecciones por EPC debe ser combinado o si podría ser suficiente la monoterapia en infecciones leves.

Abstract Background: Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome. Objective: To assess the epidemiology, treatment and mortality in patients with infection due to CPE. Material and Methods: A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015. Results: A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment. Discussion: Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.

Functional Surgery for Malignant Subungual Tumors: A Case Series and Literature Review. / Cirugía funcional en tumores malignos subungueales. Serie de casos y revisión de la literatura.

BACKGROUND AND OBJECTIVES: Amputation is the conventional treatment for malignant subungual tumors (MSUTs), namely, subungual squamous cell carcinoma (SUSCC) and subungual melanoma (SUM). Functional surgery consisting of wide local excision (WLE) of the nail unit can preserve function without modifying prognosis in such cases. We present a series of MSUTs treated with WLE of the nail unit, describe the technique, and review its indications. MATERIAL AND METHODS: Retrospective observational study of MSUTs treated with WLE of the nail unit between 2008 and 2017. The technique consisted of en bloc supraperiosteal excision of the nail unit with a margin of 5mm followed by repair with a full-thickness graft. RESULTS: Eleven MSUTs were treated in the study period: 7 SUMs (4 in situ; mean thickness, 1.17mm; range, 0-4mm) and 4 SUSCCs (mean thickness, 3.4mm; range, 1.6-6mm). WLE of the nail unit was performed in 9 patients and amputation in 2 patients with invasive SUM. Mean follow-up was 39 months (range, 12-96 months) and no local or regional recurrences were detected. One of the 2 patients who underwent amputation developed metastasis to the brain and died. In our review of the literature, we identified 5 series of patients with SUSCC treated with WLE of the nail unit (105 patients) and 14 series of patients with SUM (243 patients). Based on an analysis of these cases and ours, it would appear that WLE of the nail unit is associated with a very low rate of local recurrence (<7%) and offers better functional and cosmetic outcomes than amputation. CONCLUSIONS: WLE of the nail unit is the treatment of choice for SUSCC without bone involvement and for thin noninvasive SUM (Breslow depth <1mm). It is also feasible in intermediate-thickness SUMs when detailed histologic examination of the margins confirms complete resection. Amputation, by contrast, is the treatment of choice for SUSCCs with bone involvement, very thick SUMs (>4mm), and recurrent tumors.

Progesterone suppresses the lipopolysaccharide-induced pro-inflammatory response in primary mononuclear cells isolated from human placental blood.

Progesterone is an essential hormone that induces deep immune adaptations favoring pregnancy maintenance. We aimed at evaluating the effects of progesterone on the synthesis of pro- and anti-inflammatory cytokines by mononuclear cells isolated from human placental blood stimulated with lipopolysaccharide, emulating an infection-inflammation environment. Mononuclear cells isolated form human placental blood were obtained from nine women undergoing elective cesarean delivery at term (not in labor), isolated by density gradient sedimentation, cultured and co-stimulated with lipopolysaccharide (500 ng/ml) from Escherichia coli in the presence or not of progesterone (0.01, 0.1, or 1.0 µM) for 24 h. Culture supernatants were assayed for pro-inflammatory (IL-1ß, TNFα, IL-6), anti-inflammatory (IL-10) cytokines, chemokines (IL-8, MIP-1α) and total MMP-9 by ELISA. In comparison with basal conditions, lipopolysaccharide treatment induced IL-1ß, TNFα, IL-6, IL-8, MIP-1α, and MMP-9 synthesis. lipopolysaccharide co-treatment with progesterone significantly decreased the bacterial endotoxin-induced IL-1ß, TNF-α, IL-6, IL-8, and MIP-1α secretion. In contrast, co-treatment with progesterone increased the level of IL-10 secreted to the culture medium. The present results support the concept that progesterone can modulate--partially--the inflammatory response of professional immune cells isolated from placental blood. Therefore, progesterone might be part of the natural compensatory mechanism that limits the cytotoxic effects associated with an intrauterine infection process during gestation.

Diffusion Model for Describing the Regional Spread of Huanglongbing from First-Reported Outbreaks and Basing an Area Wide Disease Management Strategy.

Huanglongbing (HLB), a recent worldwide spreading disease on citrus, was detected in July 2009 in Yucatan State of Mexico. The objective of this study was to evaluate the fit of diffusion and classic disease gradient models to large-scale HLB spatial data originated from initial foci to improve sampling, monitoring, and control strategies for Diaphorina citri, vector of Candidatus Liberibacter asiaticus (CLas), putative agent of HLB. Four transect routes were selected: Yuc-1, Yuc-2, QRoo-1, and QRoo-2, based on the directionality of the prevailing winds and foci location of HLB infected plants. In these routes, 35 sites, 5 to 20 km apart, were selected for monthly evaluation during a 12-month period. A 10-insect sample and disease incidence and severity of HLB, further confirmed by PCR, were assessed per site. Mexican lime was more vulnerable (67.5%) than sweet orange (14%). Also, leaf symptoms were mostly found with homogeneous distribution but rarely reaching 100% of the tree canopy during the 12-month period. The diffusion model provided the best fit among the family of time-gradient curves (r2 = 0.90 to 0.99) due to the flexibility of a three-parameter model. The gradients were well conformed to the model in a 25 to 82.6 km range, having the east-west direction the longest effect. Yuc-2 and QRoo-2 transects showed 82.6 and 43.9 km gradients with a diffusion coefficient (Do) of 0.15 and 0.09, respectively. This study constitutes the first quantitative evidence of the regional spread of CLas from a single focus and the application of a flexible model that improved the fit and allowed to better compare different gradients. These results are useful to determine the size of Regional Areas of Diaphorina citri Control (ARCO), a management program currently implemented in Mexico to combat HLB.