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In modern reproducible, hypothesis-driven plant research, scientists are increasingly relying on research data management (RDM) services and infrastructures to streamline the processes of collecting, processing, sharing, and archiving research data. FAIR (i.e., findable, accessible, interoperable, and reusable) research data play a pivotal role in enabling the integration of interdisciplinary knowledge and facilitating the comparison and synthesis of a wide range of analytical findings. The PLANTdataHUB offers a solution that realizes RDM of scientific (meta)data as evolving collections of files in a directory - yielding FAIR digital objects called ARCs - with tools that enable scientists to plan, communicate, collaborate, publish, and reuse data on the same platform while gaining continuous quality control insights. The centralized platform is scalable from personal use to global communities and provides advanced federation capabilities for institutions that prefer to host their own satellite instances. This approach borrows many concepts from software development and adapts them to fit the challenges of the field of modern plant science undergoing digital transformation. The PLANTdataHUB supports researchers in each stage of a scientific project with adaptable continuous quality control insights, from the early planning phase to data publication. The central live instance of PLANTdataHUB is accessible at (https://git.nfdi4plants.org), and it will continue to evolve as a community-driven and dynamic resource that serves the needs of contemporary plant science.
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Bases de Datos como Asunto , Difusión de la Información , PlantasRESUMEN
The pursuit for better skin health, driven by collective and individual perceptions, has led to the demand for sustainable skincare products. Environmental factors and lifestyle choices can accelerate skin aging, causing issues like inflammation, wrinkles, elasticity loss, hyperpigmentation, and dryness. The skincare industry is innovating to meet consumers' requests for cleaner and natural options. Simultaneously, environmental issues concerning waste generation have been leading to sustainable strategies based on the circular economy. A noteworthy solution consists of citrus by-product valorization, as such by-products can be used as a source of bioactive molecules. Citrus processing, particularly, generates substantial waste amounts (around 50% of the whole fruit), causing unprecedented environmental burdens. Hesperidin, a flavonoid abundant in orange peels, is considered to hold immense potential for clean skin health product applications due to its antioxidant, anti-inflammatory, and anticarcinogenic properties. This review explores hesperidin extraction and purification methodologies as well as key skincare application areas: (i) antiaging and skin barrier enhancement, (ii) UV radiation-induced damage, (iii) hyperpigmentation and depigmentation conditions, (iv) wound healing, and (v) skin cancer and other cutaneous diseases. This work's novelty lies in the comprehensive coverage of hesperidin's promising skincare applications while also demonstrating its potential as a sustainable ingredient from a circular economy approach.
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Citrus sinensis , Citrus , Hesperidina , Hiperpigmentación , Humanos , Hesperidina/farmacología , Flavonoides , AntioxidantesRESUMEN
During their first year of growth, overwintering biennial plants transport Suc through the phloem from photosynthetic source tissues to storage tissues. In their second year, they mobilize carbon from these storage tissues to fuel new growth and reproduction. However, both the mechanisms driving this shift and the link to reproductive growth remain unclear. During vegetative growth, biennial sugar beet (Beta vulgaris) maintains a steep Suc concentration gradient between the shoot (source) and the taproot (sink). To shift from vegetative to generative growth, they require a chilling phase known as vernalization. We studied sugar beet sink-source dynamics upon vernalization and showed that before flowering, the taproot underwent a reversal from a sink to a source of carbohydrates. This transition was induced by transcriptomic and functional reprogramming of sugar beet tissue, resulting in a reversal of flux direction in the phloem. In this transition, the vacuolar Suc importers and exporters TONOPLAST SUGAR TRANSPORTER2;1 and SUCROSE TRANSPORTER4 were oppositely regulated, leading to the mobilization of sugars from taproot storage vacuoles. Concomitant changes in the expression of floral regulator genes suggest that these processes are a prerequisite for bolting. Our data will help both to dissect the metabolic and developmental triggers for bolting and to identify potential targets for genome editing and breeding.
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Beta vulgaris/fisiología , Floema/metabolismo , Proteínas de Plantas/metabolismo , Brotes de la Planta/metabolismo , Metabolismo de los Hidratos de Carbono , Dióxido de Carbono/metabolismo , Frío , Esculina/metabolismo , Perfilación de la Expresión Génica , Regulación de la Expresión Génica de las Plantas , Floema/genética , Fotosíntesis/fisiología , Proteínas de Plantas/genética , Raíces de Plantas/genética , Raíces de Plantas/metabolismo , Brotes de la Planta/genética , Sacarosa/metabolismo , Azúcares/metabolismo , Vacuolas/genética , Vacuolas/metabolismoRESUMEN
One line of enquiry in demographic research assesses whether climate affects fertility. We extend this literature by examining the ramifications of climate conditions on fertility over a period of public health crisis in a highly unequal, urban middle-income country. We use monthly data for Brazil's 5,564 municipalities and apply spatial fixed-effects models to account for unobserved municipal heterogeneity and spatial dependence. Findings suggest that increases in temperature and precipitation are associated with declines in births. We also show that changes in response to climate conditions became greater during the Zika epidemic, particularly in urban areas. Combined, findings highlight the value of understanding the intersections between climate and fertility across geographic boundaries and during this public health crisis. Epidemics have become more important in people's lives with the recurring emergence of novel infectious disease threats, such as Zika and Covid-19.
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Infección por el Virus Zika , Virus Zika , Humanos , Dinámica Poblacional , Demografía , Salud Pública , Países en Desarrollo , Fertilidad , Infección por el Virus Zika/epidemiología , Brasil/epidemiologíaRESUMEN
Collagen is the major structural protein in extracellular matrix present in connective tissues, including skin, being considered a promising material for skin regeneration. Marine organisms have been attracting interest amongst the industry as an alternative collagen source. In the present work, Atlantic codfish skin collagen was analyzed, to evaluate its potential for skincare. The collagen was extracted from two different skin batches (food industry by-product) using acetic acid (ASColl), confirming the method reproducibility since no significant yield differences were observed. The extracts characterization confirmed a profile compatible with type I collagen, without significant differences between batches or with bovine skin collagen (a reference material in biomedicine). Thermal analyses suggested ASColl's native structure loss at 25 °C, and an inferior thermal stability to bovine skin collagen. No cytotoxicity was found for ASColl up to 10 mg/mL in keratinocytes (HaCaT cells). ASColl was used to develop membranes, which revealed smooth surfaces without significative morphological or biodegradability differences between batches. Their water absorption capacity and water contact angle indicated a hydrophilic feature. The metabolic activity and proliferation of HaCaT were improved by the membranes. Hence, ASColl membranes exhibited attractive characteristics to be applied in the biomedical and cosmeceutical field envisaging skincare.
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Gadiformes , Gadus morhua , Animales , Bovinos , Materiales Biocompatibles/farmacología , Materiales Biocompatibles/análisis , Gadus morhua/metabolismo , Reproducibilidad de los Resultados , Piel/metabolismo , Colágeno/química , Gadiformes/metabolismoRESUMEN
BACKGROUND: DNA methylation is thought to influence the expression of genes, especially in response to changing environmental conditions and developmental changes. Sugar beet (Beta vulgaris ssp. vulgaris), and other biennial or perennial plants are inevitably exposed to fluctuating temperatures throughout their lifecycle and might even require such stimulus to acquire floral competence. Therefore, plants such as beets, need to fine-tune their epigenetic makeup to ensure phenotypic plasticity towards changing environmental conditions while at the same time steering essential developmental processes. Different crop species may show opposing reactions towards the same abiotic stress, or, vice versa, identical species may respond differently depending on the specific kind of stress. RESULTS: In this study, we investigated common effects of cold treatment on genome-wide DNA methylation and gene expression of two Beta vulgaris accessions via multi-omics data analysis. Cold exposure resulted in a pronounced reduction of DNA methylation levels, which particularly affected methylation in CHH context (and to a lesser extent CHG) and was accompanied by transcriptional downregulation of the chromomethyltransferase CMT2 and strong upregulation of several genes mediating active DNA demethylation. CONCLUSION: Integration of methylomic and transcriptomic data revealed that, rather than methylation having directly influenced expression, epigenetic modifications correlated with changes in expression of known players involved in DNA (de)methylation. In particular, cold triggered upregulation of genes putatively contributing to DNA demethylation via the ROS1 pathway. Our observations suggest that these transcriptional responses precede the cold-induced global DNA-hypomethylation in non-CpG, preparing beets for additional transcriptional alterations necessary for adapting to upcoming environmental changes.
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Beta vulgaris , Beta vulgaris/genética , Metilación de ADN , Epigénesis Genética , Expresión Génica , Proteínas Tirosina Quinasas/genética , Proteínas Tirosina Quinasas/metabolismo , Proteínas Proto-Oncogénicas/genética , Azúcares/metabolismoRESUMEN
Shigella flexneri invades host cells by entering within a bacteria-containing vacuole (BCV). In order to establish its niche in the host cytosol, the bacterium ruptures its BCV. Contacts between S. flexneri BCV and infection-associated macropinosomes (IAMs) formed in situ have been reported to enhance BCV disintegration. The mechanism underlying S. flexneri vacuolar escape remains however obscure. To decipher the molecular mechanism priming the communication between the IAMs and S. flexneri BCV, we performed mass spectrometry-based analysis of the magnetically purified IAMs from S. flexneri-infected cells. While proteins involved in host recycling and exocytic pathways were significantly enriched at the IAMs, we demonstrate more precisely that the S. flexneri type III effector protein IpgD mediates the recruitment of the exocyst to the IAMs through the Rab8/Rab11 pathway. This recruitment results in IAM clustering around S. flexneri BCV. More importantly, we reveal that IAM clustering subsequently facilitates an IAM-mediated unwrapping of the ruptured vacuole membranes from S. flexneri, enabling the naked bacterium to be ready for intercellular spread via actin-based motility. Taken together, our work untangles the molecular cascade of S. flexneri-driven host trafficking subversion at IAMs to develop its cytosolic lifestyle, a crucial step en route for infection progression at cellular and tissue level.
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Disentería Bacilar , Shigella flexneri , Transducción de Señal , Vacuolas , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Disentería Bacilar/genética , Disentería Bacilar/metabolismo , Células HeLa , Humanos , Shigella flexneri/genética , Shigella flexneri/metabolismo , Shigella flexneri/patogenicidad , Vacuolas/genética , Vacuolas/metabolismo , Vacuolas/microbiología , Factores de Virulencia/genética , Factores de Virulencia/metabolismo , Proteínas de Unión al GTP rab/genética , Proteínas de Unión al GTP rab/metabolismoRESUMEN
Sucrose (Suc) is one of the most important types of sugars in plants, serving inter alia as a long-distance transport molecule, a carbon and energy storage compound, an osmotically active solute, and fuel for many anabolic reactions. Suc biosynthesis and degradation pathways are well known; however, the regulation of Suc intracellular distribution is poorly understood. In particular, the cellular function of chloroplast Suc reserves and the transporters involved in accumulating these substantial Suc levels remain uncharacterized. Here, we characterize the plastidic sugar transporter (pSuT) in Arabidopsis (Arabidopsis thaliana), which belongs to a subfamily of the monosaccharide transporter-like family. Transport analyses with yeast cells expressing a truncated, vacuole-targeted version of pSuT indicate that both glucose and Suc act as substrates, and nonaqueous fractionation supports a role for pSuT in Suc export from the chloroplast. The latter process is required for a correct transition from vegetative to reproductive growth and influences inflorescence architecture. Moreover, pSuT activity affects freezing-induced electrolyte release. These data further underline the central function of the chloroplast for plant development and the modulation of stress tolerance.
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Proteínas de Arabidopsis/metabolismo , Arabidopsis/fisiología , Respuesta al Choque por Frío/fisiología , Flores/fisiología , Simportadores/metabolismo , Proteínas de Arabidopsis/química , Proteínas de Arabidopsis/genética , Cloroplastos/metabolismo , Regulación de la Expresión Génica de las Plantas , Técnicas de Inactivación de Genes , Proteínas de Transporte de Membrana/genética , Proteínas de Transporte de Membrana/metabolismo , Proteínas de Transporte de Monosacáridos/genética , Proteínas de Transporte de Monosacáridos/metabolismo , Mutación , Plantas Modificadas Genéticamente , Plastidios/metabolismo , Dominios Proteicos , Saccharomyces cerevisiae/genética , Sacarosa/metabolismo , Simportadores/química , Simportadores/genéticaRESUMEN
Most cellular sucrose is present in the cytosol and vacuoles of plant cells; however, little is known about the effect of this sucrose compartmentation on plant properties. Here, we examined the effects of altered intracellular sucrose compartmentation in Arabidopsis thaliana leaves by heterologously expressing the sugar beet (Beta vulgaris) vacuolar sucrose loader BvTST2.1 and by generating lines with reduced vacuolar invertase activity (amiR vi1-2). Heterologous expression of BvTST2.1 led to increased monosaccharide levels in leaves, whereas sucrose levels remained constant, indicating that vacuolar invertase activity in mesophyll vacuoles exceeds sucrose uptake. This notion was supported by analysis of tobacco (Nicotiana benthamiana) leaves transiently expressing BvTST2.1 and the invertase inhibitor NbVIF. However, sucrose levels were strongly elevated in leaf extracts from amiR vi1-2 lines, and experiments confirmed that sucrose accumulated in the corresponding vacuoles. The amiR vi1-2 lines exhibited impaired early development and reduced seed weight. When germinated in the dark, amiR vi1-2 seedlings were less able to convert sucrose into monosaccharides than the wild type. Cold temperatures strongly down-regulated both VI genes, but the amiR vi1-2 lines showed normal frost tolerance. These observations indicate that increased vacuolar sucrose levels fully compensate for the effects of low monosaccharide concentrations on frost tolerance.
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Arabidopsis , Arabidopsis/genética , Arabidopsis/metabolismo , Regulación de la Expresión Génica de las Plantas , Homeostasis , Desarrollo de la Planta , Semillas/metabolismo , Sacarosa , Vacuolas/metabolismo , beta-Fructofuranosidasa/genética , beta-Fructofuranosidasa/metabolismoRESUMEN
The plasma membrane transporter SOS1 (SALT-OVERLY SENSITIVE1) is vital for plant survival under salt stress. SOS1 activity is tightly regulated, but little is known about the underlying mechanism. SOS1 contains a cytosolic, autoinhibitory C-terminal tail (abbreviated as SOS1 C-term), which is targeted by the protein kinase SOS2 to trigger its transport activity. Here, to identify additional binding proteins that regulate SOS1 activity, we synthesized the SOS1 C-term domain and used it as bait to probe Arabidopsis thaliana cell extracts. Several 14-3-3 proteins, which function in plant salt tolerance, specifically bound to and interacted with the SOS1 C-term. Compared to wild-type plants, when exposed to salt stress, Arabidopsis plants overexpressing SOS1 C-term showed improved salt tolerance, significantly reduced Na+ accumulation in leaves, reduced induction of the salt-responsive gene WRKY25, decreased soluble sugar, starch, and proline levels, less impaired inflorescence formation and increased biomass. It appears that overexpressing SOS1 C-term leads to the sequestration of inhibitory 14-3-3 proteins, allowing SOS1 to be more readily activated and leading to increased salt tolerance. We propose that the SOS1 C-term binds to previously unknown proteins such as 14-3-3 isoforms, thereby regulating salt tolerance. This finding uncovers another regulatory layer of the plant salt tolerance program.
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Proteínas 14-3-3/metabolismo , Proteínas de Arabidopsis/metabolismo , Arabidopsis/metabolismo , Membrana Celular/metabolismo , Tolerancia a la Sal/genética , Intercambiadores de Sodio-Hidrógeno/metabolismo , Arabidopsis/genética , Proteínas de Arabidopsis/genética , Biomasa , Citosol/metabolismo , Flores/genética , Flores/crecimiento & desarrollo , Flores/metabolismo , Regulación de la Expresión Génica de las Plantas/genética , Hojas de la Planta/metabolismo , Prolina/metabolismo , Unión Proteica , Dominios Proteicos/genética , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , Proteínas Recombinantes , Sodio/metabolismo , Intercambiadores de Sodio-Hidrógeno/genética , Almidón/metabolismo , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Regulación hacia ArribaRESUMEN
Prior research in Western countries (mostly the US, Canada and northern Europe) indicates that mothers' representations are associated with mother-infant interaction quality and their child's attachment security later in the first year. Fewer studies, however, have evaluated whether these associations hold for mother-infant dyads in other countries, such as Brazil and Portugal. Although these countries share a similar language and culture, they differ on societal dimensions that may affect parenting attitudes and mother-infant relationships, such as economic stress, social organisation, social policy, and the availability of services for young families. In this longitudinal study, we followed two independent samples of Brazilian and Portuguese mother-infant dyads from the perinatal period to 12 months post-partum. We assessed mothers' perinatal representations using semi-structured interviews in the first 48 hours after the infant's birth, and evaluated the associations of these representations with mother interaction quality at 9 months and infant attachment at 12 months. Results were similar in each country, corroborating prior research in single Western countries: Mothers with more positive perinatal representations were more sensitive to their infants during free play at 9 months and were more likely to have infants classified as securely attached at 12 months.
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Relaciones Madre-Hijo/psicología , Adulto , Brasil , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Apego a Objetos , Portugal , Embarazo , Adulto JovenRESUMEN
Rib fractures are frequent in trauma patients, being most of them managed on a non-surgical way. However, in selected cases, it is advocated. Chest wall stabilization (CWS) only recently has been best characterized. Available data shows plenty of benefits related to CWS versus non-surgical treatment in selected cases. Even though, it is only performed in a small number of patients according to some national databases. There are lots of topics to define concerning CWS such as the subgroups that benefit most, the time of surgery, which ribs should be stabilized and which incision should be performed. Most of these subjects need to be tailored for each patient. So far, no guidelines for CWS are available, although some algorithms have been proposed based on a combination of clinical experience and risk factors. In high-volume trauma centers it has become a common procedure. The complexity of some cases demands a careful evaluation, especially in the context of multiple injuries, and it should be taken into account in the decision.
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Traumatismos Torácicos , Procedimientos Quirúrgicos Torácicos , Pared Torácica , Humanos , Traumatismos Torácicos/cirugía , Heridas no PenetrantesRESUMEN
Inflammatory myofibroblastic tumours (IMTs) are rare lesions. We report a case of a 55 year-old male, admitted with a pneumonia. Further investigation revealed a left lower lobe mass and enlarged mediastinal lymph nodes. Cytology of the bronchoalveolar lavage suggested a squamous cell carcinoma. He received four cycles of chemotherapy followed by a left lower lobectomy. Pathological analysis was compatible with IMT. Three months after surgery, a new IMT nodule located in the lingula was excised. Four months later,endobronchial involvement and the presence of liver nodules were detected.Ten months after the first surgery a CT revealed a sacrum lesion. Histology was compatible with undifferentiated sarcoma and a sarcomatous transformation was assumed.
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Granuloma de Células Plasmáticas , Neoplasias Pulmonares , Sarcoma , Humanos , Pulmón , Masculino , Persona de Mediana EdadRESUMEN
Male, 71 years old, active smoker. Referred to our outpatient clinic due to right upper lobe nodule with 4 year follow-up, which increased in size and metabolic uptake during the last year. CT scan also revealed multiple pleural plaques with a diffuse pattern. The patient underwent a right upper VATS lobectomy and mediastinal lymphadenectomy after intraoperative pathology consultation was positive for malignancy. Intraoperative with evidence of multiple hyline pleural plaques and aberrant neoformative lesions, mimicking teeth, on the diaphragm and parietal costal pleura, probably related to asbestos exposure.
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Enfermedades Pleurales , Anciano , Amianto , Humanos , Escisión del Ganglio Linfático , Masculino , Pleura , Enfermedades Pleurales/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
A 19 years-old woman, on her 17th week of pregnancy presented to the emergency department with thoracic pain and vomiting. An empyema was diagnosed and she was transferred to a tertiary hospital for treatment. After drainage of the empyema a mediastinal mass was detected and a thoracic MRI revealed a multicystic lesion of the anterior mediastinum, causing cardiac and left lung compression, suggestive of a complicated teratoma. After a multidisciplinary discussion involving pulmonology, radiology, obstetrics and thoracic surgery, she was operated successfully by clamshell incision. A mature complicated teratoma was resected and a left pleurectomy/decortication performed. She was discharged on day 17 with no obstetrical or respiratory symptoms..
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Neoplasias del Mediastino , Complicaciones Neoplásicas del Embarazo , Teratoma , Cirugía Torácica , Dolor en el Pecho , Femenino , Humanos , Neoplasias del Mediastino/complicaciones , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/cirugía , Embarazo , Radiografía , Teratoma/complicaciones , Teratoma/diagnóstico por imagen , Teratoma/cirugía , Adulto JovenRESUMEN
INTRODUCTION: Colorectal cancer is the third most common malignancy, being associated with metastatic disease in 50% of cases. The lung is the second organ most affected by metastasis in colorectal cancer. In this study, we aim to review the cases submitted to resection of pulmonary colorectal metastasis at Hospital Pulido Valente, comprised in the period from the 1st of January to the 31st of December 2017. METHODS: Retrospective analysis. Data were collected from clinical records. RESULTS: There were 21 patients operated during this period, with a total of 22 surgeries performed, all with curative intent. Data were collected regarding age, gender, site of primary tumour, number of resected lesions, surgical approach, performed procedure, disease-free interval, presence of bilateral disease and existence of extra-pulmonary metastasis. CONCLUSION: Lung metastases are frequent in colorectal cancer. Pulmonary metastasectomy is currently accepted as a potentially curative therapy as part of a multimodal approach to metastatic colorectal cancer.
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Neoplasias Pulmonares/cirugía , Metastasectomía , Neumonectomía , Neoplasias Colorrectales/patología , Humanos , Neoplasias Pulmonares/secundario , Pronóstico , Estudios RetrospectivosRESUMEN
INTRODUCTION: We report a case of a patient with recurrent bilateral spontaneous pneumothorax presumably originating in a left bulla. METHODS: A 68 year old male, was admitted to the emergency department with shortness of breath and bilateral chest pain. He had had oesophageal cancer resection 2 years before, with a posterior mediastinal reconstruction using a gastric tube. Afterwards he had to be operated twice for hiatal hernia. RESULTS: Bilateral chest tubes were inserted, with complete resolution in 72 hours. He was readmitted 20 days later, with a bilateral recurrence. A pneumologist was called upon. The thoracic CT scan revealed large bulla in the left upper lobe. There was no evidence of pneumomediastinum or mediastinal fluid collections. Communication between the two pleura was suspected. After discussion with the surgeon responsible for the previous interventions only the left chest was drained with bilateral lung expansion after suction. A left VATS approach revealed a partially adherent left lung, in its mediastinal face. Inflated bulla could be partially observed firmly glued to the upper mediastinum. A leak could not be demonstrated within the left thorax. Due to the firm adhesions of a presumably nonruptured bula to the phrenic nerve, a decision was made not to dissect it. A pleurectomy was performed. In the 3 days that followed, the fistula persisted and increased, in spite of lung expansion. A left thoracotomy was then performed. The full extent of the anterior mediastinal face of then left lung was dissected by opening the bulla that were partially left on the mediastinal pleura. Resection was made using tristaple endoGIA staplers ®. The posterior mediastinum was manually dissected free up to the presumed gastric tube location. At the end of surgery, no major air leaks were documented. Communication with the right pleura could not be located, not even with the aid of a 30o camera, but a large amount of fluid (1000cc) missing, was recovered after turning the patient. The postoperative period was prolonged ut to the 16th day, by a small but persistent air leak. CONCLUSION: Although no visual proof of communication between the two pleural cavities could be found, the control of the right pneumotorax by contralateral drainage, the resolution of the case by left pleurectomy and bulla resection backup this theory. This is an unique case, not previously reported, resolved by a multidisciplinary discussion of all the specialists involved in the treatment.
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Neoplasias Esofágicas , Neumotórax , Complicaciones Posoperatorias , Anciano , Dolor en el Pecho , Neoplasias Esofágicas/cirugía , Humanos , Masculino , Toracotomía , Tórax , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: 55 years old, male patient. History of heavy smoking (65 UMA) and COPD. Admitted to hospital due to a left pneumonia. Thoracic CT and PET-Scan, showed left lower lobe mass measuring 92x89 mm (SUVmax 49). Several mediastinal node groups presented increased uptake of FDG. A fiberoptic bronchoscopy was performed. Citology of the bronchoalveolar lavage suggested a squamous carcinoma. EBUS of node stations 4R, 4L e 7 without evidence of malignancy. METHODS: The case was taken to a multidisciplinary meeting staged as IIIA (T3N2M0). Neoadjuvant therapy (four cycles cysplatine and gemcitabine) was decided based on station 5, suspected disease. A left lower lobectomy was performed after a cervical mediastinoscopy excluded metastasis of node stations 4R and 4L. Histology of the specimen was compatible with inflammatory myofibroblastic tumor (IMT). No lymph node involvement was reported. It was restaged as IIB (ypT3N0M0). RESULTS: Three months after surgery one de novo nodule in the lingula with 12,7 of SUVmax was reported. The nodule was removed confirming a IMT metastasis. Four months after the nodule ressection a CT showed new lung and liver nodules. A total oclusion of the left main bronchus was documented and bronchoscopic debulking of the endobronchial mass again revealed IMT. Paliative radiotherapy was decided in the multidisciplinar group targeting the left main bronchus (five sessions of radiotherapy on a dose of 20Gy in 4Gy daily fractions). Ten months after surgery due to the onset of back pain, a CT revealed a sacrum lesion whose needle biopsy was suspicious for multiple myeloma. The patient was referred to another oncological center where previous non-surgical cases had been sent in the past. The patient is now proposed for histology reassessment and discussion by the hematology and pneumology medical teams. CONCLUSION: Inflammatory myofibrobastic tumors are considered benign or low-grade malignant tumors. The size of the tumour (cut-off of 3 cm) and secure surgical resection with free margins are the major determinants for recurrence and survival. There are some cases reported in the literature of distant metastasis and sarcomatous transformation after multiple recurrences. In our patient, the lesion was bigger than 3 cm and he underwent a complete resection. Nothing could foresee this aggressive metastatic behavior, especially when the recurrence did not show a sarcomatous transformation.
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Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Masculino , Mediastinoscopía , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de NeoplasiasRESUMEN
The initial manifestation of lung cancer as gastrointestinal tract metastasis is an extremely rare event. In most cases, these metastases are diagnosed after the primary lung tumor, when potentially life-threatening complications develop, often requiring emergency surgery. Regardless of treatment, these patients have a poor prognosis, due to the advanced stage of their disease. We report a clinical case of a gastrointestinal fistula arising from a small bowel non-small cell lung cancer (NSCLC) metastasis as a first manifestation of the disease, in a 43-years-old man. He underwent laparatomy with segmental small bowel and colon resection, followed by pulmonary lobectomy. A few months later the patient presented a cerebellum metastasis and was submitted to metastasectomy and holocranial radiation. After that event, systemic chemotherapy was prescribed, due to bone metastasis. Twenty-nine month after diagnosis, the patient is alive with a stable general condition. Aggressive surgical treatment of both primary and metastatic tumors can provide palliation and may improve short-term survival.