Is the combination of immunotherapy with conventional chemotherapy the key to increase the efficacy of colorectal cancer treatment?

Colorectal cancer (CRC) is among the most prevalent and deadly neoplasms worldwide. According to GLOBOCAN predictions, its incidence will increase from 1.15 million CRC cases in 2020 to 1.92 million cases in 2040. Therefore, a better understanding of the mechanisms involved in CRC development is necessary to improve strategies focused on reducing the incidence, prevalence, and mortality of this oncological pathology. Surgery, chemotherapy, and radiotherapy are the main strategies for treating CRC. The conventional chemotherapeutic agent utilized throughout the last four decades is 5-fluorouracil, notwithstanding its low efficiency as a single therapy. In contrast, combining 5-fluorouracil therapy with leucovorin and oxaliplatin or irinotecan increases its efficiency. However, these treatments have limited and temporary solutions and aggressive side effects. Additionally, most patients treated with these regimens develop drug resistance, which leads to disease progression. The immune response is considered a hallmark of cancer; thus, the use of new strategies and methodologies involving immune molecules, cells, and transcription factors has been suggested for CRC patients diagnosed in stages III and IV. Despite the critical advances in immunotherapy, the development and impact of immune checkpoint inhibitors on CRC is still under investigation because less than 25% of CRC patients display an increased 5-year survival. The causes of CRC are diverse and include modifiable environmental factors (smoking, diet, obesity, and alcoholism), individual genetic mutations, and inflammation-associated bowel diseases. Due to these diverse causes, the solutions likely cannot be generalized. Interestingly, new strategies, such as single-cell multiomics, proteomics, genomics, flow cytometry, and massive sequencing for tumor microenvironment analysis, are beginning to clarify the way forward. Thus, the individual mechanisms involved in developing the CRC microenvironment, their causes, and their consequences need to be understood from a genetic and immunological perspective. This review highlighted the importance of altering the immune response in CRC. It focused on drugs that may modulate the immune response and show specific efficacy and contrasted with evidence that immunosuppression or the promotion of the immune response is the answer to generating effective treatments with combined chemotherapeutic drugs.

Multi-modality imaging of aggressive submural neoplasia of the hoof in two horses.

This case series presents a 20-year-old Quarter horse gelding and a 10-year-old Thoroughbred gelding with a histologic diagnosis of aggressive submural neoplasia, including an anaplastic sarcoma and a squamous cell carcinoma respectively. The current case series describes these neoplasias with radiography, computed tomography, magnetic resonance imaging and histopathology with immunohistochemistry. The purpose of this case series is to identify the clinical pattern of chronic reoccurring lameness in these cases and highlight the appearance of expansile osteolytic pathology of the distal phalanx with adjacent hoof wall abnormalities. Advanced imaging has the potential to assist with a differential diagnosis list and surgical planning in patients such as these however obtaining a cellular sample for histopathological examination remains necessary for definitive diagnosis.

Investigation of the value of precipitins in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with a positive marker for Aspergillus species.

Although a high prevalence of COVID-19-associated pulmonary aspergillosis has been reported, it is still difficult to distinguish between colonization with Aspergillus fumigatus and infection. Concomitantly, similarities between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hypersensitivity pneumonitis were suggested. The objective of this study was to investigate retrospectively if precipitin assays targeting A. fumigatus could have been useful in the management of SARS-CoV-2 patients hospitalized in an Intensive Care Unit (ICU) in 2020. SARS-CoV-2 ICU patients were screened for Aspergillus co-infection using biomarkers (galactomannan antigen, qPCR) and culture of respiratory samples (tracheal aspirates and bronchoalveolar lavage). For all these patients, clinical data, ICU characteristics and microbial results were collected. Electrosyneresis assays were performed using commercial A. fumigatus somatic and metabolic antigens. ELISA were performed using in-house A. fumigatus purified antigen and recombinant antigens.Our study population consisted of 65 predominantly male patients, with a median ICU stay of 22 days, and a global survival rate of 62%. Thirty-five patients had at least one positive marker for Aspergillus species detection. The number of arcs obtained by electrosyneresis using the somatic A. fumigatus antigen was significantly higher for these 35 SARS-CoV-2 ICU patients (P 0.01, Welch's t-test). Our study showed that SARS-CoV-2 ICU patients with a positive marker for Aspergillus species detection more often presented precipitins towards A. fumigatus. Serology assays could be an additional tool to assess the clinical relevance of the Aspergillus species in respiratory samples of SARS-CoV-2 ICU patients. LAY SUMMARY: This study showed retrospectively that precipitin assays, such as electrosyneresis, could be helpful to distinguish between colonization and infection with Aspergillus fumigatus during the management of severe acute respiratory syndrome Coronavirus-2 (SARS CoV-2) patients in an intensive care unit.

Odderon Exchange from Elastic Scattering Differences between pp and pp[over ¯] Data at 1.96 TeV and from pp Forward Scattering Measurements.

We describe an analysis comparing the pp[over ¯] elastic cross section as measured by the D0 Collaboration at a center-of-mass energy of 1.96 TeV to that in pp collisions as measured by the TOTEM Collaboration at 2.76, 7, 8, and 13 TeV using a model-independent approach. The TOTEM cross sections, extrapolated to a center-of-mass energy of sqrt[s]=1.96 TeV, are compared with the D0 measurement in the region of the diffractive minimum and the second maximum of the pp cross section. The two data sets disagree at the 3.4σ level and thus provide evidence for the t-channel exchange of a colorless, C-odd gluonic compound, also known as the odderon. We combine these results with a TOTEM analysis of the same C-odd exchange based on the total cross section and the ratio of the real to imaginary parts of the forward elastic strong interaction scattering amplitude in pp scattering for which the significance is between 3.4σ and 4.6σ. The combined significance is larger than 5σ and is interpreted as the first observation of the exchange of a colorless, C-odd gluonic compound.

Cutaneous botryomycosis in a free-living short-beaked echidna (Tachyglossus aculeatus).

Botryomycosis is a chronic bacterial infection of the skin and viscera caused by nonbranching bacteria such as Staphylococcus spp. It results in the formation of chronic, suppurative and often granulomatous lesions that may resemble multiple abscesses. It has been diagnosed worldwide in both humans and animals. It is a rare disease, usually requiring surgical excision combined with long-term antibiotics to achieve a good resolution. A wild echidna (Tachyglossus aculeatus) was presented with a soft tissue mass at the base of the right distal beak with multiple discharging fistulas arising from it. The mandible appeared to be shortened and deviated to the right, and the animal was unable to close its beak. The echidna was in poor body condition and was euthanased on welfare grounds. Histopathology of the lesions demonstrated the classical botryoid lesions with the characteristic Splendore-Hoeppli reaction surrounding the bacterial colonies, in a background of extensive granulation tissue. Radiographs revealed mild mandibular osteomyelitis, yet haematology and biochemistry results were nonspecific. This disease has not previously been reported in a wild monotreme.

Scale-up of electrokinetic permeable reactive barriers for the removal of organochlorine herbicide from spiked soils.

This work aims to shed light on the scale-up a combined electrokinetic soil flushing process (EKSF) with permeable reactive barriers (PRB) for the treatment of soil spiked with clopyralid. To do this, remediation tests at lab (3.45 L), bench (175 L) and pilot (1400 L) scales have been carried out. The PRB selected was made of soil merged with particles of zero valent iron (ZVI) and granular activated carbon (GAC). Results show that PRB-EKSF involved electrokinetic transport and dehalogenation as the main mechanisms, while adsorption on GAC was not as relevant as initially expected. Clopyralid was not detected in the electrolyte wells and only in the pilot scale, significant amounts of clopyralid remained in the soil after 600 h of operation. Picolinic acid was the main dehalogenated product detected in the soil after treatment and mobilized by electro-osmosis, mostly to the cathodic well. The transport of volatile compounds into the atmosphere was promoted at pilot scale because of the larger soil surface exposed to the atmosphere and the electrical heating caused by ohmic losses and the larger interelectrode gap.

Impact of sugar replacement by non-centrifugal sugar on physicochemical, antioxidant and sensory properties of strawberry and kiwifruit functional jams.

Raw cane sugars have been claimed to be rich in natural phenolic compounds which, in contrast to refined sugar, may increase the nutritional value of foods and contribute to the development of healthier foods and diets. The use of non-refined cane sugars in food formulation seems an interesting option since they provide natural antioxidants with sucrose still being the major sugar present, minimizing the loss of technological properties. However, substitution of refined sugar could imply an undesired impact on physicochemical and sensory properties, conditioning consumer's acceptance. Functional jams (strawberry and kiwifruit) with a larger fruit to sugar ratio than conventional ones, in which white sugar was replaced by granulated jaggery (0, 15, 30, 45, 60 y 75 % w/w) were obtained. Impact of sugar replacement was assessed by evaluating physicochemical properties (moisture, water activity, pH, total soluble sugars, sugar profile (glucose, fructose, sucrose), and optical, rheological, mechanical and antioxidant properties). Sensory properties and microbiological stability were also determined. Jaggery improved the antioxidant properties of jams (total phenolic content, total flavonoid content, antiradical activity by the DPPH and ABTS methods), proportionally to the amount of cane sugar incorporated and more significantly in the case of kiwifruit. Other physicochemical properties were not significantly affected by jaggery, except for color. However, these differences were not crucial in the acceptability tests, since acceptance of jams containing jaggery was generally good, very good when intermediate replacement percentages were used. Conclusions of the present work suggest that granulated jaggery can be used to formulate sugar-rich food products such as jams in order to increase their nutritional value, with little impact on physicochemical properties and good consumer acceptance.

[Hot tub lung: A retrospective analysis of 14 cases]. / Poumon de jacuzzi : analyse rétrospective de 14 cas.

INTRODUCTION: Hot tub lung (HTL) is a hypersensitivity pneumonitis (HP) related to inhalation of non-tuberculous mycobacteria (NTM) when exposed to ejected jet droplets from a jacuzzi. The aetiological debate is not completely settled in the literature. METHOD: An observational study of 14 cases of HTL, diagnosed at the University Hospital of Besançon, France, between 2004 and 2018 according to the diagnostic criteria used in the clinic. RESULTS: This cohort corresponds to type I HP (inflammatory), with one case of type II HP. Decrease of lung transfer for carbon monoxide was present in 86% of examinations (n=12/14). In total, 84% of bronchoalveolar lavages showed a lymphocytic cellular pattern≥30% (n=11/13). The environmental survey enabled the identification of NTM in 93% of cases (n=13/14), mainly Mycobacterium avium. Serum precipitins directed against NTM were found in 10% of the cases (n=2/20). Three cases received corticosteroid therapy and none received antibiotics. Antigenic eviction has improved the symptomatology in all cases. CONCLUSIONS: Our cohort supports the hypothesis that HTL is predominantly a type I HP. Avoidance of the agent involved (NTM) is necessary. The diagnosis is difficult because serum precipitins against NTM are not easily demonstrable. An environmental survey could facilitate the identification of the NTM. Prevention of HTL depends on education of the clinician and the patient.

Use of STAT6 Phosphorylation Inhibitor and Trimethylglycine as New Adjuvant Therapies for 5-Fluorouracil in Colitis-Associated Tumorigenesis.

Colorectal cancer (CRC) is one of the most widespread and deadly types of neoplasia around the world, where the inflammatory microenvironment has critical importance in the process of tumor growth, metastasis, and drug resistance. Despite its limited effectiveness, 5-fluorouracil (5-FU) is the main drug utilized for CRC treatment. The combination of 5-FU with other agents modestly increases its effectiveness in patients. Here, we evaluated the anti-inflammatory Trimethylglycine and the Signal transducer and activator of transcription (STAT6) inhibitor AS1517499, as possible adjuvants to 5-FU in already established cancers, using a model of colitis-associated colon cancer (CAC). We found that these adjuvant therapies induced a remarkable reduction of tumor growth when administrated together with 5-FU, correlating with a reduction in STAT6-phosphorylation. This reduction upgraded the effect of 5-FU by increasing both levels of apoptosis and markers of cell adhesion such as E-cadherin, whereas decreased epithelial-mesenchymal transition markers were associated with aggressive phenotypes and drug resistance, such as ß-catenin nuclear translocation and Zinc finger protein SNAI1 (SNAI1). Additionally, Il-10, Tgf-ß, and Il-17a, critical pro-tumorigenic cytokines, were downmodulated in the colon by these adjuvant therapies. In vitro assays on human colon cancer cells showed that Trimethylglycine also reduced STAT6-phosphorylation. Our study is relatively unique in focusing on the effects of the combined administration of AS1517499 and Trimethylglycine together with 5-FU on already established CAC which synergizes to markedly reduce the colon tumor load. Together, these data point to STAT6 as a valuable target for adjuvant therapy in colon cancer.

Translation and Validation of the Spanish Version of the SARC-F Questionnaire to Assess Sarcopenia in Older People.

OBJECTIVES: The revised European consensus on sarcopenia definition and diagnosis (EWGSOP2) includes the SARC-F questionnaire, the most valid and consistent sarcopenia screening tool, as the mandatory first step. Our aim was the translation, cross-cultural adaptation, and validation of the SARC-F questionnaire as a culturally-responsive Spanish-language version for the European population. STUDY DESIGN: Cross-sectional descriptive study, applying the two-step WHO methodology for translation and cross-cultural adaptation of health questionnaires, and harmonization with the Mexican-Spanish version. European Union Geriatric Medicine Society recommendations for SARC-F validation in European languages were considered. PARTICIPANTS: Outpatient clinics of a university hospital. INCLUSION CRITERIA: stable, ambulatory (including aids), community-dwelling population ≥65 years old. MAIN OUTCOME MEASURES: The self-reported 5-item SARC-F questionnaire was administered; scores ≥4 indicated sarcopenia. Sensitivity, specificity, accuracy-likelihood ratios, predictive values, and kappa statistics were calculated and consecutively compared with European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2 criteria. RESULTS: This Spanish version, administered in an average 70s, has adequate internal consistency (Cronbach alpha=0.779). For the validation study, 90 (43.3%) of 208 potentially eligible subjects (81.4 ± 5.9 years old, 75.6% women) were included. SARC-F identified 51 (56.7%) subjects with sarcopenia and 39 (43.3%) without the disease. Prevalence was 17.8% per EWGSOP and 25.6% per EWGSOP2 (58% accuracy and fair agreement: sensitivity, 78.3%; specificity, 50.8%). CONCLUSIONS: SARC-F is a feasible tool, suitable for bedside assessment in community-dwelling older patients. Wide diffusion of this culturally-responsible SARC-F Spanish version is expected as EWGSOP2 is adopted and sarcopenia assessment is broadly implemented in Spain.

Non-Conjugated Chitosan-Based Nanoparticles to Proteic Antigens Elicit Similar Humoral Immune Responses to Those Obtained with Alum.

Biodegradables Chitosan-based Nanoparticles (CS NPs) have been extensively studied as delivery system for therapeutic molecules and as efficient carriers or adjuvants in experimental vaccination. Physicochemical association between CS NPs and antigens is a key step for the biological function as carrier devices. However, for the adjuvant CS NPs property, it is not well known if coupling with vaccine antigens is required or not to potentiate the immune response. To address this issue, in this work, we evaluated the potential adjuvant effect of CS NPs by simply mixing with two different antigens such as Bovine Serum Albumin (BSA) or E protein from Dengue Virus serotype 2 (E protein DENV2). Thus the CS NPs were prepared by ionic gelation with sodium tripolyphosphate, resulting particles among 68 and 188 nm of size. Immunization of 6­8 week old female BALB/c mice, were carried out by intraperitoneal route with a simple combination of CS NPs either with BSA (CS NPs-BSA) at 10 µg or with E protein DENV2 (CS NPs-Protein E) at 5 µg. Combinations with the above antigens with CS NPs elicited robust specific primary and secondary humoral responses comparable to alum, a well-known adjuvant. BSA-specific IgG titers were detectable by day 14 after priming with the CS NPs-BSA formulation, with titers that ranged from 102 to 103 EU ml-. After a second immunization, the anti-BSA titers ranged around 104 EU ml-. In contrast, in the group of mice immunized with the protein alone, BSA-specific serum IgG titers were undetectable at day 14 and 28. For the immunizations with the CS NPs-E protein formulation, we observed also a remarkable specific-antibody production in the primary response, with titers reaching 103 EU ml-. After the booster immunization the anti-E protein DENV2 antibodies titers reached peak values around 104 EU ml-. Interestingly, for both antigens, the combination with CS NPs polarized the immune response to a Th2-like profile, which is characterized mainly by the production of the IgG1 Isotype, confirming that CS NPs can enhance and modulate the humoral immune responses against different antigens independently of physicochemical conjugation. This could represent a simplification in the use of CS NPs as adjuvants in vaccination.

The effect of simulated inflammatory conditions on the surface properties of titanium and stainless steel and their importance as biomaterials.

This work compares the surface modifications induced by the immersion in solutions that simulate inflammatory conditions of pure titanium (cpTi) and medical grade stainless steel (SS). The inflammatory conditions were simulated using a mixture of Hartman solution and 50mM of hydrogen peroxide (H2O2) at pH=5.2. The samples were immersed by 7days refreshing the solution every day to keep the reactivity of the H2O2. The surface characteristics that were investigated were: elemental composition by X-ray photoelectron spectroscopy (XPS); topography by atomic force microscopy (AFM) and profilometry; wettability and surface energy by sessile drop contact angle and point of zero charge by titration. Moreover, the variations in the electrochemical response were evaluated by open circuit potential (OCP), electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (PP) performed before and after the treatment using the Hartman solution as the electrolyte. The XPS results indicated that for both metallic samples, oxidation of the surface was promoted and/or the oxide layer was thicker after the immersion. The roughness and the solid-liquid surface energy were increased; the samples showed a more hydrophilic character after the treatment. However, the surface energy of the solid estimated using the Van Oss-Chaudhury-Good approach showed different trends between the cpTi and the SS surfaces; the polar component decreased for cpTi, while it increased for SS. Finally, the electrochemical results indicated that the corrosion resistance (Rcor) and the pore resistance (Rpo) significantly decreased for cpTi, while both resistances were not significantly different for the SS. This is indicative of a higher dissolution of the cpTi compared to SS and the lower Rpo means that the species are easily transported through the surface layer, which can be explained in terms of the formation of a porous TiOx layer, not observed on the SS. The cpTi surface suffered from a dissolution/oxidation process that allows its integration with the surrounding media, while the SS remained completely passive and this different response might be related to their distinguished clinical outcome.

Home management of acute medical complications in cancer patients: a prospective pilot study.

BACKGROUND: The development of reliable alternatives to conventional hospitalization in patients with cancer would have great clinical and economical value. The aim of the present study was to assess the feasibility of a home-based nursing intervention model as a safe alternative for the management of acute medical complications in cancer patients who would otherwise require conventional hospitalization. PATIENTS AND METHODS: From October 2013 to October 2014, we prospectively evaluated the outcomes of consecutive acute medical episodes treated at home under the home-based intervention program named the Bridge Project (BP). Episodes were classified as "avoided hospitalization in outpatients" (AHO) vs. "reduced hospitalization in inpatients" (RHI). The primary end-point was to assess the rate and causes of BP intervention failure (unplanned hospital readmission or death). RESULTS: Two hundred and forty-six consecutive episodes (52 % AHO and 48 % RHI) involving 203 patients (55 % male; mean age 63 years) were enrolled. The main conditions managed at home were non-neutropenic infections (40 %), febrile neutropenia (20 %), and cancer-related complications (28 %). The median duration of the BP intervention was 5 days (range 1-16 days). No deaths were reported at home. Unplanned hospital readmissions occurred in 9 % of episodes (14 % in AHO vs. 4 % in RHI; p = 0.001). Five of the 22 readmitted patients (22.7 % of the BP failures; 2.5 % of the whole series) died during hospitalization. The BP intervention burden was 1353 days, representing a potential saving of 14 % of days of hospitalization during the study period. CONCLUSIONS: The BP is a safe intervention which can potentially avoid or reduce the length of hospitalization in selected cancer patients with acute medical complications. Our findings support further development of innovative home-based clinical approaches to promote potentially avoidable hospitalization in this setting.

Photostimulated luminescence detection and radiation effects on cinnamon (Cinnamomum zeylanicum) spice.

The increase of disease borne pathogens in foods has promoted the use of new technologies in order to eliminate these pathogen microorganisms and extend the shelf-life of the foodstuffs. In particular, Cinnamon (Cinnamomum zeylanicum) contains an important number of pathogen microorganisms and it is frequently sterilized by gamma radiation. However, it is important to develop the detection methods for irradiated food in order to keep the dose control and also to analyze the radiation effects in their chemical property. This work reports (i) the photostimulated luminescence (PSL) detection of irradiated cinnamon and thermoluminescence (TL) detection of the inorganic polymineral fraction separated from this spice, and (ii) the proximate chemical analysis carried out on fat, protein and dietetic fiber contents. The detection limits using the PSL and TL methods were 500 Gy and 10 Gy, respectively, and the fat content was increased significantly with the gamma dose that could be related to the lipid oxidation in the cinnamon.

Progresión de la respuesta inflamatoria sistémica en pacientes con apendicitis / Progression of the systemic inflammatory response in patients with appendicitis

Introduction: The systemic inflammatory response has been described in patients with appendicitis. However, its progression from the onset of symptoms to diagnosis has not been characterized. The purpose of this study was to describe and characterize the systemic inflammatory response to appendicitis. Patients and Methods: A descriptive study was conducted. One-hundred eighty-three patients were studied divided into four groups from onset of symptoms to diagnosis. Primary outcome measure was to determine the systemic inflammatory response to appendicitis according to the established groups of time intervals. Secondary outcome measure was the analysis of C-reactive protein for the same purpose. Results: The systemic inflammatory response variables according to diagnostic intervals showed non-significant differences on white blood cells count. Temperature and heart rate rises constantly after 48 h reaching their peak after 72 h (p = 0.001); the respiratory rate rises after 73 h (p < 0.0001). After 73 h most patients had 3 or 4 systemic inflammatory response criteria (p < 0.0001). C-reactive protein levels rise progressively showing higher levels after 48 hours (p = 0.005). Conclusions: The inflammatory response to appendicitis is progressive, being more marked along the timeline from onset of symptoms to diagnosis.

Introducción: La progresión de la respuesta inflamatoria sistémica en pacientes con apendicitis desde el inicio de los síntomas hasta el diagnóstico no ha sido caracterizada. Los objetivos del presente estudio son describir y caracterizar la respuesta inflamatoria sistémica a la apendicitis. Pacientes y Métodos: Se realizó un estudio descriptivo. Ciento ochenta y tres pacientes fueron estudiados y divididos en cuatro grupos de acuerdo al tiempo transcurrido entre el inicio de los síntomas y el diagnóstico. El objetivo principal fue determinar la respuesta inflamatoria sistémica a la apendicitis de acuerdo a los grupos de tiempo establecidos. El objetivo secundario fue el análisis de la proteína C reactiva para el mismo propósito. Resultados: La variable leucocitosis de la respuesta inflamatoria sistémica de acuerdo con los períodos de evolución no mostró diferencias significativas. La temperatura y la frecuencia cardíaca se elevan constantemente después de 48 h llegando a su nivel máximo después de las 72 h (p = 0,001). La frecuencia respiratoria aumenta después de 73 h de evolución (p < 0,0001). Después de las 73 h desde el inicio de los síntomas, la mayoría de los pacientes presentan 3 ó 4 variables del síndrome de respuesta inflamatoria sistémica. La proteína C reactiva se eleva progresivamente mostrando sus valores máximos después de 48 h (p = 0,005). Conclusiones: La respuesta inflamatoria sistémica a la apendicitis es progresiva y más marcada a lo largo del tiempo desde el inicio de los síntomas hasta el diagnóstico.

Instilación intravesical de levobupivacaína para el manejo del dolor y síntomas urinarios en pacientes portadores de catéter doble J / Intravesical instillation of levobupivacaine for pain management andurinary symptoms in patients with ureteral double J stent

La instalación de catéteres ureterales tipo Doble J o “pigtail” es una práctica habitual en urología, el principal problema de su instalación radica en que gran parte de los pacientes presentan diferentes tipos de molestias en relación a su uso. Existen algunas alternativas de tratamiento médico que han probado ser efectivas en disminuir parcialmente estos síntomas; sin embargo, pocos estudios han evaluado la posibilidad de terapias locales, y estos reclutaron pocos pacientes por lo que no pudieron demostrar grandes diferencias.

The use of Double J ureteral stents or also called “pigtail” is common practice in urology; the main problem with its use is that a large number of patients develop discomfort with indwelling stents. To diminish them there are medical treatments that have been proven useful, however, few studies have assessed local therapies, and this studies include a small number of patients.

Estudio descriptivo del traumatismo máxilofacial en el Hospital de La Serena entre los años 2004-2011 / Maxillofacial injuries: experience in 343 patients

Background: Oral and Maxillofacial injuries are an important problem at public health services, due to the anatomical complexity of the involved areas and committed aesthetic factor. Aim: To determine and analyze the etiology, frequency, location and treatment of patients with maxillofacial trauma at a Chilean regional Hospital between 2004 and 2011. Material and Methods: Review of medical records of 343 patients aged 0 to 87 years (258 males) treated for maxillofacial trauma. Results: Physical aggression was the main etiologic factor in 35 percent of patients, followed by falls and sports injuries in 27 and 16 percent of cases respectively. The most commonly damaged structure was the dentoalveolar area in 43 percent of patients, followed by mandibular and malar lesions in 31 and 12 percent of cases. Twenty two percent of patients required an open reduction with osteosynthesis as treatment. Discussion: Maxillofacial trauma was more common in males. The main etiologic factor was physical aggression and the most affected damaged structure was the dentoalveolar area. Osteosynthesis was required for treatment in 22 percent of cases...

Introducción: Las lesiones máxilofaciales son un problema de relevancia dentro de los servicios hospitalarios dada la complejidad anatómica de las zonas que involucra y el factor estético que compromete. Objetivo: Determinar y analizar la etiología, frecuencia, localización y tratamientos de pacientes con traumatismo máxilofacial en un hospital regional de Chile entre los años 2004-2011. Metodología: En un estudio descriptivo de serie de casos se evaluó registros de 343 pacientes diagnosticados y tratados por trauma máxilofacial. Los datos obtenidos fueron ingresados y analizados en el programa Epi Info y se agruparon en tablas de distribución y gráficos. Resultados: El promedio de edad fue de 27 años y la relación hombre-mujer de 3: 1. L as agresiones se presentaron como la principal causa (3 5 por ciento) y las estructuras más afectadas fueron las dentoalveolares (43 por ciento). Discusión: La mayor proporción de traumatismos máxilofaciales se observó en las primeras décadas de vida y fueron más frecuentes en hombres. El principal factor etiológico fue la agresión y la estructura más dañada, la dentoalveolar, seguida por fracturas mandibulares y cigomáticas. El tratamiento de elección fue la reducción abierta y osteosíntesis con placas y tornillos...

Profilaxis de sangrado gastrointestinal en paciente crítico / Gastrointestinal bleeding prophylaxis in critically ill patients / Prevenção de hermorragias gastrointestinais em pacientes críticos

Las úlceras gástricas que se presentan en pacientes críticos generan un daño exponencial y constante en la mucosa \r\ngástrica, que aumenta la incidencia de hemorragias gastrointestinales clínicamente significativas, lo cual prolonga \r\nlos periodos de estancia hospitalaria en una unidad de cuidado intensivo (UCI) e incrementa el riesgo de muerte. \r\nPara prevenir este tipo de complicaciones, se pueden utilizar varias opciones farmacológicas; sin embargo, no existe \r\nun consenso que permita establecer cuál de todas las opciones existentes es la mejor decisión terapéutica para estos \r\npacientes, razón por la cual es pertinente realizar una revisión narrativa de la literatura que contribuya a la toma de \r\ndecisiones por parte de los médicos tratantes.

Gastric ulcers that occur in critically ill patients may \r\nproduce an exponential and constant damage to the \r\ngastric mucosa, by increasing the incidence of clinically \r\nsignificant gastrointestinal bleeding, which prolongs the \r\nperiods of hospitalization in intensive care units (ICU) \r\nand increases the risk of death. There are many pharma\r\n-\r\ncological options to avoid such complications; but there \r\nis no consensus in order to establish which of the options \r\nis the best choice of treatment for these patients, which is \r\nwhy it is appropriate to conduct a narrative review of the \r\nliterature that contributes to decision-making by atten\r\n-\r\nding physicians

Úlceras gástricas que ocorrem em pacientes criticamente \r\ndoentes geram danos constantes e exponenciais na \r\nmucosa gástrica, aumentando a incidência de sangra\r\n-\r\nmento gastrointestinal clinicamente significativo, o que \r\nprolonga os períodos de internação em unidade de terapia \r\nintensiva (UTI) e aumenta o risco de morte. Para evitar \r\ntais complicações pode ser usado várias opções farmaco\r\n-\r\nlógicas, mas não há consenso, a fim de estabelecer qual \r\ndas opções é a melhor de tratamento para estes pacientes, \r\nrazão pela qual é oportuno realizar uma revisão narrativa \r\nda literatura, que contribui para a tomada de decisões \r\npelos médicos.

Tumores testiculares: alternativas a la orquidectomia radical / Testicular tumors: alternatives to radical orchidectomy

Los tumores testiculares de células germinales (TCG) son poco frecuentes, corresponden al 2 por ciento de todos los cánceres masculinos. La incidencia de cáncer contralateral oscila entre 1por ciento a 5 por ciento, siendo los tumores metacrónicos mucho más comunes que los sincrónicos bilaterales. El tratamiento estándar en estos casos es la orquidectomía bilateral. Se han propuesto diferentes enfoques que buscan preservar la función testicular. Dentro de estas alternativas se describen en la literatura la Orquidectomía Parcial (OP), el Ultrasonido Focalizado de Alta Intensidad (HIFU por su sigla en inglés) y la radioterapia primaria. Nuestro objetivo es realizar una revisión de este tema y describir las alternativas de tratamiento a la orquidectomía radical, con la idea de preservar la función androgénica. Para esto nos enfocaremos en el manejo del paciente con masa testicular palpable, no palpable y sus alternativas terapéuticas.

Testicular germ cell tumors (GCT) are rare, corresponding to 2 percent of all male cancers. Contralateral cancer incidence ranges from 1 percent to 5 percent, metachronous tumors being more common than bilateral synchronous. Standard treatment in these cases is bilateral orchiectomy. Diferent approaches have been proposed that seek to preserve testicular function. Among these alternatives the literature describes Partial orchiectomy (OP), High Intensity Focused Ultrasound (HIFU for its acronym in English) and primary radiotherapy. Our goal is to review this issue and describe treatment alternatives to radical orchiectomy, with the idea of preserving androgenic function. We focus on the management of patients with palpable testicular mass, not palpable mass and it therapeutic alternatives.

Obese visceral adipose tissue grafted in lean mice can alter glucose homeostasis and energy efficiency.

Fat transplantation experiments have previously shown regulatory properties of lean adipose tissue on glucose homeostasis in the whole animal. In the current study, we addressed whether obese visceral white adipose tissue grafted in lean mice could alter glucose homeostasis. Obese visceral fat (VF) tissue was effective in increasing body weight gain and energy efficiency but not energy intake, when transplanted into the epididymal VF depot in lean recipient mice. These changes were accompanied by impaired glucose and insulin tolerance tests, showing altered glucose homeostasis. None of these effects were observed when transplants were grafted subcutaneously. These effects show that both physiologic state of donor VF (obese vs lean) and graft location (epididymal vs subcutaneous) in the recipient animal are critical to express deleterious effects of VF on glucose homeostasis in the whole organism.