The Evolution of Triamcinolone Acetonide Therapeutic Use in Retinal Diseases: From Off-Label Intravitreal Injection to Advanced Nano-Drug Delivery Systems.

Ophthalmic drug delivery to the posterior segment of the eye has been challenging due to the complex ocular anatomy. Intravitreal injection of drugs was introduced to deliver therapeutic doses in the posterior segment. Different posterior segment diseases including age-related macular degeneration, diabetic macular edema, retinal vein occlusions, uveitis, and cystoid macular edema, among others, have been historically treated with intravitreal corticosteroids injections, and more recently with intravitreal corticosteroids drug implants. Triamcinolone acetonide (TA) is the most frequently used intraocular synthetic corticosteroid. Using nanoparticle-based TA delivery systems has been proposed as an alternative to intravitreal injections in the treatment of posterior segment diseases. From these novel delivery systems, topical liposomes have been the most promising strategy. This review is oriented to exhibit triamcinolone acetonide drug evolution and its results in treating posterior segment diseases using diverse delivery platforms.

Abdominal wound dehiscence and incisional hernia prevention in midline laparotomy: a systematic review and network meta-analysis.

BACKGROUND: Incisional hernia (IH) is the main complication after laparotomy. In an attempt to reduce this complication, mesh techniques and studies in which the closure technique is modified have been proposed. Both types are characterized by comparison with the closure described as standard or conventional: 1 × 1, mass, and continuous closure. For this study, modified closure techniques (MCTs) were considered as those techniques in which an extra suture is placed (reinforced tension line (RTL), retention), the closure point is modified in distance (small bites) or shape (CLDC, Smead Jones, interrupted, Cardiff point) and which aim to reduce these complications. The objective of this network meta-analysis (NMA) was to evaluate the effectiveness of MCTs for reducing the incidence of IH and abdominal wound dehiscence (AWD) to provide objective support for their recommendation. METHODS: An NMA was performed according to the PRISMA-NMA guidelines. The primary objective was to determine the incidence of IH and AWD, and the secondary objective was to determine the incidence of postoperative complications. Only published clinical trials were included. The risk of bias was analyzed, and the random-effects model was used to determine statistical significance. RESULTS: Twelve studies comparing 3540 patients were included. The incidence of HI was lower in RTL, retention suture, and small bites, these techniques showed statistical differences with pooled ORs (95% CI) of 0.28 (0.09-0.83), 0.28 (0.13-0.62), and 0.44 (0.31-0.62), respectively. Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, MCTs did not increase the risk of surgical site infection. CONCLUSION: Small bites, RTL, and retention sutures decreased the prevalence of IH. RTL and retention suture decreased the prevalence of AWD. RTL was the best technique as it reduced both complications (IH and AWD) and had the best SUCRA and P-scores, and the number needed to treat (NNT) for net effect was 3. REGISTRATION: This study was prospectively registered in the PROSPERO database under registration number CRD42021231107.

Optical Detection of Cancer Cells Using Lab-on-a-Chip.

The global need for accurate and efficient cancer cell detection in biomedicine and clinical diagnosis has driven extensive research and technological development in the field. Precision, high-throughput, non-invasive separation, detection, and classification of individual cells are critical requirements for successful technology. Lab-on-a-chip devices offer enormous potential for solving biological and medical problems and have become a priority research area for microanalysis and manipulating cells. This paper reviews recent developments in the detection of cancer cells using the microfluidics-based lab-on-a-chip method, focusing on describing and explaining techniques that use optical phenomena and a plethora of probes for sensing, amplification, and immobilization. The paper describes how optics are applied in each experimental method, highlighting their advantages and disadvantages. The discussion includes a summary of current challenges and prospects for cancer diagnosis.

Asociación entre obesidad y síntomas de depresión en adolescentes en Querétaro, México

Objetivo: Identificar la asociación entre obesidad y síntomas de depresión en adolescentes atendidos en una unidad de salud familiar. Materiales y Métodos: Estudio observacional, transversal comparativo en adolescentes mexicanos de 10 a 19 años, se integraron dos grupos de comparación, adolescentes con obesidad y sin obesidad. El tamaño de la muestra fue de 97 adolescentes por cada grupo, se empleó muestreo no probabilístico por cuota. La depresión se evaluó con la versión revisada de la Escala de Depresión del Centro de Estudios Epidemiológicos (CESD-R). El análisis estadístico incluyó promedios, porcentajes, desviaciones estándar, prueba chi cuadrado, razón de momios (RM), e intervalos de confianza para RM. Resultados: En el grupo de adolescentes con obesidad 48,5% presentaron síntomas depresivos y en el grupo de adolescentes sin obesidad 33% también presentaron síntomas depresivos (p=0,02), RM de 1,90 (IC 95%: 1,06-3,41). Conclusiones: Se encontró asociación entre obesidad y síntomas de depresión en adolescentes.

Objective: To identify the association between obesity and depression symptoms in adolescents attended in a family health center. Materials and Methods: An observational, cross-sectional, comparative study of Mexican adolescents aged 10 to 19 years integrated two comparison groups, adolescents with obesity and without obesity. The sample size was 97 adolescents per group, non-probabilistic sampling per quota was used. Depression was evaluated with the revised version of the Center for Epidemiological Studies (CESD-R) Depression Scale. The statistical analysis included averages, percentages, standard deviations, chi square test, odds ratio (OR), and confidence intervals for OR. Results: In the group of adolescents with obesity 48,5% presented depressive symptoms and in the group of adolescents without obesity 33% also presented depressive symptoms (p=0,02), RM was 1,90 (95%CI; 1,06-3,41). Conclusions: We found an association between obesity and depression symptoms in adolescents.

Nail Cancer: Review of the Two Main Types of an Underestimated Disease.

Neoplastic lesions (benign or malignant) in the nail region are rare when compared to lesions in the rest of the skin. Despite advances in diagnostic modalities, their diagnosis is frequently delayed or overlooked for days, months, or even years when they are misrecognized or when their approach is not appropriate. Undoubtedly, malignant tumors are the most important lesions since an inopportune diagnosis or treatment can drastically change the patient's prognosis. A review of all the scientific evidence on the two main malignant neoplasms of the nail apparatus (melanoma and squamous cell carcinoma) was carried out using the PubMed search engine from 2003 to 2022, in order to expose the appropriate diagnostic approach and treatment of these nail lesions to avoid delays that obscure the prognosis of patients. This review does not include reconstruction modalities after lesion resection, but the emphasis is placed on the great functional impact they produce. Surgical treatment in the early stages is the most important when talking about prognosis and emphasizing it; systemic oncological management of advanced stages is not so deep.

Transcriptional Regulation of Metabolic and Cellular Processes in Durum Wheat (Triticum turgidum subsp. durum) in the Face of Temperature Increasing.

The Yaqui Valley, Mexico, has been historically considered as an experimental field for semiarid regions worldwide since temperature is an important constraint affecting durum wheat cultivation. Here, we studied the transcriptional and morphometrical response of durum wheat at an increased temperature (+2 °C) for deciphering molecular mechanisms involved in the thermal adaptation by this crop. The morphometrical assay showed a significant decrease in almost all the evaluated traits (shoot/root length, biovolume index, and dry/shoot weight) except in the dry root weight and the root:shoot ratio. At the transcriptional level, 283 differentially expressed genes (DEGs) were obtained (False Discovery Rate (FDR) ≤ 0.05 and |log2 fold change| ≥ 1.3). From these, functional annotation with MapMan4 and a gene ontology (GO) enrichment analysis with GOSeq were carried out to obtain 27 GO terms significantly enriched (overrepresented FDR ≤ 0.05). Overrepresented and functionally annotated genes belonged to ontologies associated with photosynthetic acclimation, respiration, changes in carbon balance, lipid biosynthesis, the regulation of reactive oxygen species, and the acceleration of physiological progression. These findings are the first insight into the regulation of the mechanism influenced by a temperature increase in durum wheat.

Topical Triamcinolone Acetonide-Loaded Liposome Formulation Used as an Adjuvant to Intravitreal Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration.

Novel strategies have been developed to reduce or avoid intravitreal injections (IVTs) of the antiangiogenic (ranibizumab (RBZ)) and anti-inflammatory (triamcinolone acetonide (TA)) agents used to treat vitreoretinal diseases. One of the strategies includes liposomes. This study evaluated the safety and efficacy of a topical triamcinolone-loaded liposome formulation (TALF) as an adjuvant to intravitreal RBZ therapy in treatment- naïve patients with neovascular age-related macular degeneration (nAMD). Subjects were randomly assigned to the RBZ-TALF or the RBZ-pro re nata (RBZ-PRN) groups. Patients from the RBZ-TALF group were instructed to apply TALF for 12 months after a single dose of RBZ. Patients from the RBZ-PRN group received three monthly RBZ-IVTs. Retreatment with RBZ was considered in the case of nAMD reactivation. Regarding safety, non-ocular abnormalities were observed during TALF therapy. Concerning efficacy, non-significant differences were identified in terms of visual acuity or central foveal thickness when the RBZ-PRN and RBZ-TALF groups were compared. It is worth noting that the average number of RBZ injections was significantly lower in the RBZ-TALF group (2.5 ± 1.4 vs. 6.1 ± 1.3 IVTs; p = 0.0004). Therefore, TALF used as an adjuvant to RBZ reduces the need for RBZ-IVT retreatment with optimal visual and anatomic results.

Squamous Cell Carcinoma of the Nail, an Underdiagnosed and Underestimated Entity: A Series of Two Cases.

The nail apparatus is a complex area with great functional and cosmetic importance. The appearance of tumors is rare, frequently misdiagnosed with delaying the diagnosis. A series of cases is presented, where squamous cell carcinoma of nail apparatus underwent resection and reconstructive surgery in a relatively short time from their diagnosis, with a good oncological, functional, and cosmetic result.

Lipid-Based Nanocarriers as Topical Drug Delivery Systems for Intraocular Diseases.

Effective drug delivery to intraocular tissues remains a great challenge due to complex anatomical and physiological barriers that selectively limit the entry of drugs into the eye. To overcome these challenges, frequent topical application and regular intravitreal injections are currently used to achieve the desired drug concentrations into the eye. However, the repetitive installation or recurrent injections may result in several side effects. Recent advancements in the field of nanoparticle-based drug delivery have demonstrated promising results for topical ophthalmic nanotherapies in the treatment of intraocular diseases. Studies have revealed that nanocarriers enhance the intraocular half-life and bioavailability of several therapies including proteins, peptides and genetic material. Amongst the array of nanoparticles available nowadays, lipid-based nanosystems have shown an increased efficiency and feasibility in topical formulations, making them an important target for constant and thorough research in both preclinical and clinical practice. In this review, we will cover the promising lipid-based nanocarriers used in topical ophthalmic formulations for intraocular drug delivery.

Superior Vena Cava Syndrome Due to Thymic Carcinoma.

The superior vena cava syndrome (SVCS) is caused by a mechanical obstruction; 90% are of neoplasic etiology (lung cancer (LC) and non-Hodgkin lymphoma (NHL) mostly), epithelial neoplasms of the thymus (NET) is a rare cause, thymic carcinoma (TC) causing less than 1% of cases. A 56-year-old male presented with a four-month history of dyspnea, dysphonia, facial and cervical edema and bilateral cervical lymphadenopathy. The tomography showed bilateral, mediastinal, retroperitoneal lymphadenopathies, and obstruction of the internal jugular vein, right apical pulmonary nodules. A superficial adenopathy biopsy was taken, which is not conclusive, so it was decided to take an image-guided biopsy. During its evolution, it presents asymptomatic cardiovascular changes; in extension studies, systemic disease is evidenced. The definitive histopathological study reported thymic carcinoma. Systemic treatment with chemotherapy and radiation therapy was planned.

Intestinal Chloroma.

Chloromas are an atypical cellular infiltrate of immature granulocytic cells that can occur specially in patients with acute myelogenous leukemia (AML), but can be present in nonleukemic patients. Its clinical course will be dependent on its size and location, from asymptomatic to simulating a malignant gastrointestinal neoplasia. Definitive diagnosis is made upon an immunoprofile that is similar to that present in the blasts and precursor cells of acute myeloid leukemia. Endoscopic and CT images are variable being only part of the protocol panel. Treatment is the same as to AML, but surgery and radiation must be used in order to maintain low relapse and better overall survival.

Assessing delay and lag in sagittal trunk control using a tracking task.

Slower trunk muscle responses are linked to back pain and injury. Unfortunately, clinical assessments of spine function do not objectively evaluate this important attribute, which reflects speed of trunk control. Speed of trunk control can be parsed into two components: (1) delay, the time it takes to initiate a movement, and (2) lag, the time it takes to execute a movement once initiated. The goal of this study is to demonstrate a new approach to assess delay and lag in trunk control using a simple tracking task. Ten healthy subjects performed four blocks of six trials of trunk tracking in the sagittal plane. Delay and lag were estimated by modeling trunk control for predictable and unpredictable (control mode) trunk movements in flexion and extension (control direction) at movement amplitudes of 2°, 4°, and 6° (control amplitude). The main effect of control mode, direction, and amplitude of movement were compared between trial blocks to assess secondary influencers (e.g., fatigue). Only control mode was consistent across trial blocks with predictable movements being faster than unpredictable for both delay and lag. Control direction and amplitude effects on delay and lag were consistent across the first two trial blocks and less consistent in later blocks. Given the heterogeneity in the presentation of back pain, clinical assessment of trunk control should include different control modes, directions, and amplitudes. To reduce testing time and the influence of fatigue, we recommend six trials to assess trunk control.

Efficient OLEDs Fabricated by Solution Process Based on Carbazole and Thienopyrrolediones Derivatives.

Four low molecular weight compounds-three of them new, two of them with carbazole (Cz) as functional group and the other two with thienopyrroledione (TPD) group-were used as emitting materials in organic light emitting diodes (OLEDs). Devices were fabricated with the configuration ITO/PEDOT:PSS/emitting material/LiF/Al. The hole injector layer (HIL) and the emitting sheet were deposited by spin coating; LiF and Al were thermally evaporated. OLEDs based on carbazole derivatives show luminances up to 4130 cd/m², large current efficiencies about 20 cd/A and, cautiously, a very impressive External Quantum Efficiency (EQE) up to 9.5%, with electroluminescence peaks located around 490 nm (greenish blue region). Whereas, devices manufactured with TPD derivatives, present luminance up to 1729 cd/m², current efficiencies about 4.5 cd/A and EQE of 1.5%. These results are very competitive regarding previous reported materials/devices.

[Hyperbilirrubinemia as a predictive factor of perforated appendicitis]. / Hiperbilirrubinemia como factor predictivo de apendicitis perforada.

BACKGROUND: Recent studies considered hyperbilirubinemia as a marker to identify the presence of perforated appendix. The aim of the study is to verify that the presence of hyperbilirubinemia is a useful marker to identify the presence of perforated appendix before surgery, and thereby, provide early treatment to avoid progression of the disease and its complications. METHODS: This is a retrospective study, which identified 225 patients, who met the inclusion and exclusion criteria, from January 2012 to October 2014 at the IMSS General Hospital 29, taking into account laboratory results and postoperative, performing a univariate, bivariate and multivariate analysis. RESULTS: 56.9% showed bilirubin < 1, from which 16.4% presented perforation, while 43.1% showed bilirubin > 1, 62.88% presented perforated appendicitis. Hyperbilirubinemia increases 17 times the risk of perforated appendix (RMP: 17.63; IC 95%: 6.882-45.207; p < 0.001) which is statistically significant. CONCLUSIONS: Considering the limitations of this study, it can be inferred that hyperbilirubinemia is present in a great number of patients with perforated appendicitis, so it could be considered a relevant laboratory test to include within the protocol of appendicitis, which in turn, may determine a better planning for the surgical approach.

Introducción: en estudios recientes se considera la hiperbilirrubinemia como un marcador para identificar la presencia de apendicitis perforada. El objetivo del estudio es comprobar que la presencia de hiperbilirrubinemia es un marcador útil para identificar preoperatoriamente a los pacientes con presencia de perforación apendicular, y de esta manera proporcionar un tratamiento oportuno evitando la progresión de la patología y sus complicaciones. Métodos: estudio retrospectivo, con 225 pacientes, los cuales contaban con los criterios de inclusión y exclusión, del periodo de enero de 2012 a octubre del 2014 en el HGZ 29 del IMSS, tomando en cuenta resultados de laboratorio y posquirúrgico, realizando análisis univariado, bivariado y multivariado. Resultados: el 56.9% presentó bilirrubina < 1, de los cuales el 16.4% presentó perforación, mientras que el de 43.1% con bilirrubina > 1, el 62.88% presentó apendicitis perforada. La hiperbilirrubinemia incrementa 17 veces más el riesgo de presentar apendicitis perforada (RMP: 17.63; IC 95%: 6.882-45.207; p < 0.001), lo que resulta estadísticamente significativo. Conclusiones: considerando las limitaciones de este estudio, se puede inferir que la hiperbilirrubinemia está presente en un mayor número de pacientes con apendicitis perforada, por lo cual podría ser considerado como un estudio de laboratorio relevante para incluir dentro del protocolo de apendicitis, lo cual, a su vez, puede determinar una mejor planeación para el abordaje quirúrgico.

Light Emission Properties of a Cross-Conjugated Fluorene Polymer: Demonstration of Its Use in Electro-Luminescence and Lasing Devices.

Light emission properties of a fluorene cross-conjugated polymer (PF⁻1) based on the monomer 4,7-bis[2-(9,9-dimethyl)fluorenyl] benzo[1,2,5]thiadiazole are reported. This polymer exhibits solubility at high concentrations, good processability into thin solid films of good quality and a broad emission band with a fluorescence quantum yield of approximately 1. Based on these features, in this paper we implemented the use of PF⁻1 as an active layer in polymer light-emitting diodes (PLEDs) and as a laser gain medium in solution. To get insight on the conducting properties of PF⁻1, two different electron injectors, poly [(9,9-bis(3'-(N,N-dimethylamino) propyl)-2,7-fluorene)-alt-2,7-(9,9⁻dioctylfluorene)] (PFN) and lithium fluoride (LiF), were used in a simple PLED architecture. PLEDs with the PFN film were found to exhibit better performance with a maximum luminous efficiency of 40 cd/A, a turn-on voltage (Von) of approximately 4.5 V and a luminance maximum of 878 cd/m² at 5.5 V, with a current density of 20 A/m². For the lasing properties of PF⁻1, we found a lasing threshold of around 75 µJ and a tunability of 20 nm. These values are comparable with those of rhodamine 6G, a well-known laser dye.