How people affected by Chagas disease have struggled with their negligence: history, associative movement and World Chagas Disease Day.

It is well documented that Chagas disease (CD) can pose a public health problem to countries. As one of the World Health Organization Neglected Tropical Diseases undoubtedly calls for comprehensive healthcare, transcending a restricted biomedical approach. After more than a century since their discovery, in 1909, people affected by CD are still frequently marginalised and/or neglected. The aim of this article is to tell the story of their activism, highlighting key historical experiences and successful initiatives, from 1909 to 2019. The first association was created in 1987, in the city of Recife, Brazil. So far, thirty associations have been reported on five continents. They were created as independent non-profit civil society organisations and run democratically by affected people. Among the common associations' objectives, we notably find: increase the visibility of the affected; make their voice heard; build bridges between patients, health system professionals, public health officials, policy makers and the academic and scientific communities. The International Federation of Associations of People Affected by CD - FINDECHAGAS, created in 2010 with the input of the Americas, Europe and the Western Pacific, counts as one of the main responses to the globalisation of CD. Despite all the obstacles and difficulties encountered, the Federation has thrived, grown, and matured. As a result of this mobilisation along with the support of many national and international partners, in May 2019 the 72nd World Health Assembly decided to establish World Chagas Disease Day, on 14 April. The associative movement has increased the understanding of the challenges related to the disease and breaks the silence around Chagas disease, improving surveillance, and sustaining engagement towards the United Nations 2030 agenda.

Clinical validation of atlas-based auto-segmentation of pelvic volumes and normal tissue in rectal tumors using auto-segmentation computed system.

PURPOSE: To evaluate in two different settings - clinical practice and education/training - the reliability, time efficiency and the ideal sequence of an atlas-based auto-segmentation system in pelvic delineation of locally advanced rectal cancer. METHODS: Fourteen consecutive patients were selected between October and December 2011. The images of four were used as an atlas and 10 used for validation. Two independent operators participated: a Delineator to contour and a Reviewer to perform an independent check (IC). The CTV, pelvic subsites and organs at risk were contoured in four different sequences. These included A: manual; B: auto-segmentation; C: auto-segmentation + manual revision; and D: manual + auto-segmentation + manual revision. Contouring was performed by the Delineator using the same planning CT. All of them underwent an IC by a Reviewer. The time required for all the contours were recorded and overlapping evaluation was assessed using a Dice coefficient. RESULTS: In the clinical practice setting there have been 13 minutes time saved between sequences A versus sequences B (from 38 to 25 minutes, p = 0.002), a mean Dice coefficient in favor of sequences A for CTV and all subsites (p = 0.0195). In the educational/training setting there have been 35.2 minutes time saved between sequences C and D 8 (from 73.1 min to 37.9 min, p = 0.002). CONCLUSION: The preliminary data suggest that the use of an atlas-based auto-contouring system may help improve efficiencies in contouring in the clinical practice setting and could have a tutorial role in the educational/training setting.

Biopolymeric Fibrous Aerogels: The Sustainable Alternative for Water Remediation.

The increment in water pollution due to the massive development in the industrial sector is a worldwide concern due to its impact on the environment and human health. Therefore, the development of new and sustainable alternatives for water remediation is needed. In this context, aerogels present high porosity, low density, and a remarkable adsorption capacity, making them candidates for remediation applications demonstrating high efficiency in removing pollutants from the air, soil, and water. Specifically, polymer-based aerogels could be modified in their high surface area to integrate functional groups, decrease their hydrophilicity, or increase their lipophilicity, among other variations, expanding and enhancing their efficiency as adsorbents for the removal of various pollutants in water. The aerogels based on natural polymers such as cellulose, chitosan, or alginate processed by different techniques presented high adsorption capacities, efficacy in oil/water separation and dye removal, and excellent recyclability after several cycles. Although there are different reviews based on aerogels, this work gives an overview of just the natural biopolymers employed to elaborate aerogels as an eco-friendly and renewable alternative. In addition, here we show the synthesis methods and applications in water cleaning from pollutants such as dyes, oil, and pharmaceuticals, providing novel information for the future development of biopolymeric-based aerogel.

[Prevalence of american trypanosomiasis in pregnant women from a health area of Valencia, Spain: 2005-2007]. / Prevalencia de tripanomiasis americana en mujeres gestantes de un área de salud: Valencia, 2005-2007.

BACKGROUND: The Chagas disease, an endemic illness in Latin America, is an emerging pathology due mainly to the increment of human migration. Prevalence increase, difficult diagnosis and therapeutic management turn Chagas into an important public health problem. Our objectives are first to analyse the seroprevalence and epidemiologic profile of Latin American pregnant women who were taken charge of in the area of Hospital Clinical University of Valencia (HCUV), and second, to determine the risk of vertical transmission from infected women to their children. METHOD: 400 Latin American pregnant women were analysed. They were assisted in HCUV from February 2005 to July 2007. The screening technique used was Immunoprecipitation ID-PaGIA_DiaMed, confirmed through Indirect Immunofluorescence (Immunofluor Chagas-Inverness Medical). For newborns whose mothers were seropositive, a microhematocrit and PCR was performed at birth, later IgG detection was performed at 6 and 12 months. RESULTS: 9.3% of pregnant women developed specific antibodies to the parasite. Trypanosomiasis illness in antecedents, living in rural areas and gastrointestinal symptomatology were the most outstanding risk markers among the epidemiological, sociodemographic and clinical variables analysed, especially when women were Bolivians. There was a case of seroconversion in an 8 months child with an incidence of 0.25%. CONCLUSIONS: The high proportion of pregnant Latin American women with latent Chagas disease, the epidemiological history and the risk of vertical transmission made advisable to include the detection of parasite antibodies in the health screenings of this group.

The INTERACT Trial: Long-term results of a randomised trial on preoperative capecitabine-based radiochemotherapy intensified by concomitant boost or oxaliplatin, for cT2 (distal)-cT3 rectal cancer.

BACKGROUND AND PURPOSE: Capecitabine-based radiochemotherapy (cbRCT) is standard for preoperative long-course radiochemotherapy of locally advanced rectal cancer. This prospective, parallel-group, randomised controlled trial investigated two intensification regimens. cT4 lesions were excluded. PRIMARY OBJECTIVE: pathological outcome (TRG 1-2) among arms. MATERIALS AND METHODS: Low-located cT2N0-2M0, cT3N0-2M0 (up to 12 cm from anal verge) presentations were treated with cbRCT randomly intensified by either radiotherapy boost (Xelac arm) or multidrug concomitant chemotherapy (Xelox arm). Xelac: concomitant boost to bulky site (45 Gy/1.8 Gy/die, 5 sessions/week to the pelvis, +10 Gy at 1 Gy twice/week to the bulky) plus concurrent capecitabine (1650 mg/mq/die). Xelox: 45 Gy to the pelvis + 5.4 Gy/1.8 Gy/die, 5 sessions/week to the bulky site + concurrent capecitabine (1300 mg/mq/die) and oxaliplatin (130 mg/mq on days 1,19,38). Surgery was planned 7-9 weeks after radiochemotherapy. RESULTS: From June 2005 to September 2013, 534 patients were analysed: 280 in Xelac, 254 in Xelox arm. Xelox arm presented higher G ≥ 3 haematologic (p = 0.01) and neurologic toxicity (p < 0.001). Overall, 98.5% patients received curative surgery. The tumour regression grade distribution did not differ between arms (p = 0.102). TRG 1+2 rate significantly differed: Xelac arm 61.7% vs. Xelox 52.3% (p = 0.039). Pathological complete response (ypT0N0) rates were 24.4 and 23.8%, respectively (p non-significant). Median follow-up:5.62 years. Five-year disease-free survival rate were 74.7% (Xelac) and 73.8% (Xelox), respectively (p = 0.444). Five-year overall survival rate were 80.4% (Xelac) and 85.5% (Xelox), respectively (p = 0.155). CONCLUSION: Xelac arm significantly obtained higher TRG1-2 rates. No differences were found about clinical outcome. Because of efficacy on TRG, inferior toxicity and good compliance, Xelac schedules or similar radiotherapy dose intensification schemes could be considered as reference treatments for cT3 lesions.

Fast cyclical-decellularized trachea as a natural 3D scaffold for organ engineering.

Commonly reported decellularization protocols for trachea may take up from several weeks to months in order to remove the cellular materials. Two years ago, we significantly reduced the time of decellularization trachea process using trypsin. Despite the positive outcome, the protocol was useful to produce 5 cm graft length, an unsuitable length graft for most patients with tracheal disorders. In this work we improved the decellularization procedure for longer sections up to 10 cm without considerable extension in the necessary time process (2 weeks). Herein, for the first time, we completely describe and characterize the process for pig tracheal bioactive scaffolds. Histological and molecular biology analysis demonstrated effective removal of cellular components and nuclear material, which was also confirmed by the Immunohistochemical (IHC) analysis of the major histocompatibility complexes (MHCs) and DNA stain by 4'-6-diamidino-2-phenylindole (DAPI). The images and data obtained from scanning electron microscopy (SEM) and thermal analysis showed conservation of the hierarchical structures of the tracheal extracellular matrix (ECM), the biomechanical tests showed that decellularization approach did not lead to a significant alteration on the mechanical properties. In this paper, we demonstrate that the proposed cyclical-decellularization protocol allowed us to obtain a non-immunological 10 cm natural tracheal scaffold according to the in vivo immunological assessment. Furthermore, the recellularization of the matrix was successfully achieved by demonstrating first-stage cellular differentiation from stem cells to chondrocytes expressed by the SOX9 transcription factor; this organ-engineered tracheal matrix has the potential to act as a suitable template for organ regeneration.

Stereotactic ablative radiation therapy as a potential curative treatment in duodenal adenocarcinoma: a case report.

PURPOSE: One of the rarest gastrointestinal neoplasm is small bowel cancer. Experience with its treatment modalities is limited. Stereotactic ablative radiation therapy (SABR) has improved, with image-guided radiation therapy becoming a curative option in many tumors. Especially when surgery cannot be performed due to comorbidities, SABR provides a good toxicity profile and an excellent tumor control rate owing to its specific schedule: high dose on a limited and well-defined area. METHODS: An 83-year-old man had arterial hypertension and congestive cardiomyopathy, with recent history of upper abdominal pain, weight loss over 10 kg, and progressive severe fatigue. The patient underwent endoscopy that showed a large mass partially obstructing the second part of the duodenum; a biopsy revealed a moderately differentiated adenocarcinoma. A staging CT scan confirmed localized disease. Due to the patient's age and comorbidities, a SABR was proposed as the preferred treatment. In order to localize the tumor during radiotherapy sessions, surgical clips were placed endoscopically next to the lesion as fiducial markers. The patient received 25 Gy in 5 fractions on alternate days. RESULTS: Resolution of duodenal obstruction and bleeding lasted for 14 months. The patient died of myocardial infarction. CONCLUSIONS: This case suggests that SABR could have a role in the palliative treatment of small bowel cancers, with good toxicity profile, particularly in patients for whom surgical treatment is not a viable option.

How people affected by Chagas disease have struggled with their negligence: history, associative movement and World Chagas Disease Day

It is well documented that Chagas disease (CD) can pose a public health problem to countries. As one of the World Health Organization Neglected Tropical Diseases undoubtedly calls for comprehensive healthcare, transcending a restricted biomedical approach. After more than a century since their discovery, in 1909, people affected by CD are still frequently marginalised and/or neglected. The aim of this article is to tell the story of their activism, highlighting key historical experiences and successful initiatives, from 1909 to 2019. The first association was created in 1987, in the city of Recife, Brazil. So far, thirty associations have been reported on five continents. They were created as independent non-profit civil society organisations and run democratically by affected people. Among the common associations' objectives, we notably find: increase the visibility of the affected; make their voice heard; build bridges between patients, health system professionals, public health officials, policy makers and the academic and scientific communities. The International Federation of Associations of People Affected by CD - FINDECHAGAS, created in 2010 with the input of the Americas, Europe and the Western Pacific, counts as one of the main responses to the globalisation of CD. Despite all the obstacles and difficulties encountered, the Federation has thrived, grown, and matured. As a result of this mobilisation along with the support of many national and international partners, in May 2019 the 72nd World Health Assembly decided to establish World Chagas Disease Day, on 14 April. The associative movement has increased the understanding of the challenges related to the disease and breaks the silence around Chagas disease, improving surveillance, and sustaining engagement towards the United Nations 2030 agenda.

When can a drug be considered synergic with radiotherapy?

The combination of radiotherapy with chemotherapy is now considered the standard treatment for a number of tumors. However frequently, within radiotherapy as well as medical oncology, considerable skepticism has been expressed about the real impact of this therapeutic modality, in spite of the improvement in terms of outcome seen in numerous trials concerning head and neck, lung, esophageal cancer and tumors of the anal canal, the uterine cervix and pancreas. Considering the evident clinical advantages achieved in the last 2-3 decades, a close collaboration between basic, preclinical and clinical research is desirable to further optimize the outcomes based on the present radiobiological knowledge. As for the preclinical evaluation different methods should be concomitantly used to analyze the pharmacokinetics and mechanism of action; the method of tumor growth delay should be used especially in neoadjuvant clinical settings; the method of tumor control should be used when chemoradiation is aimed at the local cure of the patient independently of subsequent surgery.

[Mexican ceramic material for skin healing]. / Cerámicas mexicanas para cicatrización de piel.

Sixty female Wistar rats were employed and divided into three experimental groups of 20 rats each. Groups were evaluated at 15, 30, and the last at 45 days after surgery. Each group was divided into four sets of five rats each. All rats were subjected to surgery; an incision of 2 x 2 cm was done on the back of each animal, removing tissue until reaching muscular fascia, where the material was applied. Nitro-furazone was employed as positive control. Test materials were AlPO added with 0.55% wt of Zn; 0.30% wt of Ca(OH)2, and AlPO added with 0.55% wt of Zn and 0.66% wt of Ca(OH)2. Finally, as negative control no material was used. The object of this work was in the first place obtension of test materials and to evaluate the healing skin process in rats using AlPO enriched with Zn and Ca(OH)2; as indicated previously. Obtained materials were characterized employing XRD. Histologic studies tested showed that best healing process of dermal tissue corresponded to rats treated with AlPO added with 0.55% wt of Zn and 0.30% wt of Ca(OH)2. Use of AlPO ceramics to repair skin has not been reported previously.

Effect of Ions Released and pH of Two Glass Ionomer Cements in Human Gingival Fibroblasts / Efecto de la liberación de iones y pH de dos cementos de ionómero de vidrio en fibroblastos gingivales humanos

Abstract 20. Conventional glass ionomer cements are used as dental provisional restorative materials, which present several advantages such as adhesion to the tooth mineral phase among others. On the other hand, the knowledge about biological property of glass ionomers shows various approaches and results. In this work, it was studied the in vitro biological response of human gingival fibroblasts in contact with commercial cements of glass ionomer: Mirafil® and Ionglass® and with their extracts, according to ISO 10993. The extracts of the cements, in which the cells were cultured, were adjusted at different concentrations ranging 0.1% to 100%. The cellular metabolic activity of gingival fibroblasts was measured using the Alamar Blue® reagent. The results showed a significant effect on the cellular metabolic activity correlated with the concentration of liberated ions (Al³+ and Ca²+) for both ionomers, as well as the pH variations of the culture media. This could mean that the cellular metabolic activity is substantially influenced by ions and pH of the cell culture.

Resumen 24. Los cementos de ionómero de vidrio convencionales se utilizan como materiales de restauración provisional para uso dental, los cuales presentan varias ventajas como la adhesión a la fase mineral de los dientes. Por otro lado, las propiedades biológicas de los ionómeros de vidrio muestran diversos enfoques y resultados. En éste trabajo se estudió la respuesta biológica in vitro de fibroblastos gingivales humanos en contacto con cementos comerciales de ionómero de vidrio: Mirafil® e Ionglass® y con sus respectivos extractos según la norma ISO 10993. Los extractos de los cementos en los que se cultivaron las células estaban en diferentes concentraciones: de 0.1% a 100%. La actividad metabólica celular se midió usando el reactivo Alamar Blue®. Los resultados mostraron un efecto significativo sobre la actividad metabólica celular correlacionada con la concentración de iones liberados (Al³+ y Ca²+) para ambos ionómeros, así como las variaciones de pH de los medios de cultivo. Ello podria explicar la influencia por los iones y el pH del cultivo celular en la actividad metabólica celular.

Is two-dimensional field definition sufficient for pelvic node coverage in rectal cancer compared to technical three-dimensional definition?

BACKGROUND AND AIM: To assess the effectiveness of the potential advantages with 3-dimensional-based treatment planning versus 2-dimensional pelvic bone-based treatment planning in patients with rectal cancer, controlled for clinical stage. METHODS AND MATERIALS: Areas at risk from computed tomography in 30 patients were delineated: mesorectum, presacral, internal iliac, obturator and external iliac nodes. Two planning target volumes per patient were created: PTV_T3 (M + PSN + ON + IIN) and PTV_T4 (M + PSN + ON + IIN + EIN). Two- and 3-dimensional treatment plans for each planning target volume were calculated. Three analyses were performed: 1) mean volume receiving doses >95% and >105%; according to the percentage of prescribed dose to cover at least 95% of the planning target volume, the treatment plan was defined as optimal dose >95%, acceptable dose between 95% and 90%, inferior dose <90%; 2) comparison of the percentage of volume covered by the dose for 2- vs 3-dimensional; 3) determination of the doses at which the lack of volume coverage started to decrease significantly. RESULTS: For PTV_T3, the following was seen: 1) 2D vs 3D comparison showed optimal PTV_T3 coverage in 76.7% and 96.7%, respectively; 2) 2D vs 3D TP coverage difference was significant between 29%-95% of the total dose; 3) the lack of volume coverage started at 30% for 2D and 89% for 3D. For PTV_T4, the following was seen: 1) 2D vs 3D comparison showed an optimal PTV_T4 coverage in 33.3% and 86.7%, respectively; 2) 2D vs 3D TP coverage difference was significant between 7%-97% of the total dose; 3) the lack of volume coverage started at 7% for 2D and 87% for 3D. CONCLUSIONS: The 3D treatment planning was superior to 2D treatment planning in covering areas at risk for pelvic recurrence in patients treated for rectal cancer. The areas with suboptimal coverage may lead to an increased risk of recurrence and should be correlated with the patterns of recurrence.

Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials.

PURPOSE: The purpose of this study was to develop accurate models and nomograms to predict local recurrence, distant metastases, and survival for patients with locally advanced rectal cancer treated with long-course chemoradiotherapy (CRT) followed by surgery and to allow for a selection of patients who may benefit most from postoperative adjuvant chemotherapy and close follow-up. PATIENTS AND METHODS: All data (N = 2,795) from five major European clinical trials for rectal cancer were pooled and used to perform an extensive survival analysis and to develop multivariate nomograms based on Cox regression. Data from one trial was used as an external validation set. The variables used in the analysis were sex, age, clinical tumor stage stage, tumor location, radiotherapy dose, concurrent and adjuvant chemotherapy, surgery procedure, and pTNM stage. Model performance was evaluated by the concordance index (c-index). Risk group stratification was proposed for the nomograms. RESULTS: The nomograms are able to predict events with a c-index for external validation of local recurrence (LR; 0.68), distant metastases (DM; 0.73), and overall survival (OS; 0.70). Pathologic staging is essential for accurate prediction of long-term outcome. Both preoperative CRT and adjuvant chemotherapy have an added value when predicting LR, DM, and OS rates. The stratification in risk groups allows significant distinction between Kaplan-Meier curves for outcome. CONCLUSION: The easy-to-use nomograms can predict LR, DM, and OS over a 5-year period after surgery. They may be used as decision support tools in future trials by using the three defined risk groups to select patients for postoperative chemotherapy and close follow-up (http://www.predictcancer.org).

Que no tengan miedo de nosotros:el Chagas según los propios protagonistas / Não tenham medo de nós: a doença de Chagas segundo os protagonistas / Do not be afraid of us: Chagas disease as explained by people affected by it

El artículo da cuenta de un estudio internacional realizado entre octubre de 2011 y enero de 2012, como fundamento para el diseño y elaboración de un material audiovisual (spot) con el objeto de sensibilizar y visibilizar la problemática del Chagas. La investigación, de carácter cualitativo, recogió los datos de 38 encuestas, respondidas por personas afectadas y especialistas en la temática. La información para cada grupo se ordenó según aspectos que las personas asociaban con la palabra Chagas, y dificultades, retos, desafíos y logros vinculados. Para cada punto se presenta un análisis de las respuestas, relatos y anécdotas relacionadas. Las conclusiones refuerzan la necesidad de conocer y dar a conocer las dificultades que viven las personas afectadas por el Chagas, considerando que se trata de una realidad que tiene diversas manifestaciones dependiendo del contexto...

O artigo apresenta um estudo internacional realizado entre outubro de 2011 e janeiro de 2012, no qual se baseou o desenho e elaboração de um vídeo (spot) que tinha como objetivo a sensibilização e promoção da visibilidade da problemática vinculada à doença de Chagas. A pesquisa, de caráter qualitativo, analisou a informação recolhida por meio de 38 questionários respondidos por pessoas afetadas e especialistas sobre a doença. A informação, para cada um dos dois grupos, foi classificada de acordo com os aspectos que as pessoas associavam com a palavra Chagas, e as dificuldades, adversidades, desafios e conquistas vinculadas com a doença. Para cada um dos referidos aspectos, apresenta-se uma análise das respostas, relatos e anedotas. As conclusões reforçam a necessidade de se conhecer e divulgar as dificuldades vividas pelas pessoas afetadas pela doença de Chagas, tendo em mente que se trata de uma realidade que se manifesta de forma diversa dependendo do contexto...

This paper presents an international study that was conducted between October 2011 and January 2012, in which a video (spot) to boost awareness and raise the profile of Chagas disease issues was designed and developed. This study was of qualitative nature and analyzed information that was gathered from 38 questionnaires that had been answered by individuals affected by the disease and by specialists on this disease. The information from each group was classified according to factors that they associated with the word Chagas, along with the difficulties, adversities, challenges, objectives and achievements relating to the disease. The responses, reports and anecdotes relating to each of these factors were analyzed. The conclusions emphasize the need to know and make known the difficulties that people affected by Chagas disease experience, bearing in mind that the realities are manifested differently depending on the context...

[Bone loss treatment, pseudoarthrosis, arthrodesis and benign tumors using xenoimplant: clinical study].

BACKGROUND: Bone loss as a result of arthrodesis, pseudarthrosis, benign tumors and bone defects was treated using a xenoimplant (Nukbone). METHODS: The effectiveness of the material was evaluated through a longitudinal and observational study at the Hospital Regional "General Ignacio Zaragoza" (HRGIZ) ISSSTE. The Mexican xenoimplant is a patent of the National Autonomous University of Mexico (UNAM). RESULTS: Fifty two patients were considered regardless of age or gender. Of these patients, 28 were male and 24 female. Average age of the patients was 47.7 years (9-84 years). Twenty eight patients had arthrodesis, 16 were treated with pseudarthrosis, three patients had benign tumors and five patients presented bone defects, which were implanted with Nukbone at the site and was the correct treatment for the problem. The xenoimplant is fully integrated during a period of 3-18 months, depending on the size of the pathology and the region where it was placed. Fracture healing was evaluated radiographically according to the classification of Montoya. No patient had clinical signs of rejection. CONCLUSIONS: In Mexico, bony xenoimplants (osseous) have been used, all of foreign origin due to the high degree of technological dependence in this country. In this study we describe the use, for the first time, of a Mexican xenoimplant with a patent from the Universidad Nacional Autónoma de México (UNAM). The Mexican xenoimplant is biocompatible and can be adapted to treat pathologies where bony (osseous) material is needed.

Infusional 5-fluorouracil and ZD1839 (Gefitinib-Iressa) in combination with preoperative radiotherapy in patients with locally advanced rectal cancer: a phase I and II Trial (1839IL/0092).

PURPOSE: To report the final data of a Phase I and II study (1839IL/0092) on the combination of an anti-epidermal growth factor receptor drug (gefitinib), infusional 5-fluorouracil, and preoperative radiotherapy in locally advanced, resectable rectal cancer. METHODS AND MATERIALS: Patients received 45 Gy in the posterior pelvis plus a boost of 5.4 Gy on the tumor and corresponding mesorectum. Infusional 5-fluorouracil (5-FU) and gefitinib (250 and 500 mg/day) were delivered during all radiotherapy course. An IORT boost of 10 Gy was allowed. The main endpoints of the study were to establish dose-limiting toxicity (DLT) and to evaluate the rate of pathologic response according to the tumor regression grade (TRG) Mandard score. RESULTS: A total of 41 patients were enrolled. The DLT was not reached in the 6 patients enrolled in the dose-escalation part of the study. Of the 33 patients in the Phase II, TRG 1 was recorded in 10 patients (30.3%) and TRG 2 in 7 patients (21.2 %); overall 17 of 33 patients (51.5%) had a favorable endpoint. Overall, Grade 3+ toxicity was recorded in 16 patients (41%); these included Grade 3+ gastrointestinal toxicity in 8 patients (20.5%), Grade 3+ skin toxicity in 6 (15.3%), and Grade 3+ genitourinary toxicity in 4 (10.2%). A dose reduction of gefitinib was necessary in 24 patients (61.5%). CONCLUSIONS: Gefitinib can be associated with 5-FU-based preoperative chemoradiation at the dose of 500 mg without any life-threatening toxicity and with a high pCR (30.3%). The relevant rate of Grade 3 gastrointestinal toxicity suggests that 250 mg would be more tolerable dose in a neaoadjuvant approach with radiotherapy and infusional 5-FU.

Ipanosomiasis americana en mujeres gestantes de un área de salud. Valencia, 2005-2007 / Prevalence of american tripanosomiasis in pregnant women from a health area of Valencia, Spain. 2005-2007

Fundamento: La enfermedad de Chagas es una patologíaemergente en nuestro medio debido principalmente al incrementode las migraciones. La prevalencia y el difícil manejoterapéutico hacen del Chagas un problema de salud públicacreciente. Pretendemos analizar la prevalencia y perfil epidemiológicode mujeres gestantes latinoamericanas atendidas enel área de influencia del Hospital Clínico de Valencia (HCUV)y estimar el riego de transmisión vertical.Métodos: Se estudió a 383 mujeres gestantes asistidas enel HCUV entre febrero de 2005 y julio de 2007. Utilizamospara el cribado la técnica de inmunoprecipitación ID-PaGIADiaMed,confirmada mediante Inmunofluorescencia Indirecta(IFI) - Inmunoflour Chagas-Inverness Medical. En hijos demujeres positivas: Microhematocrito, PCR y detección de anticuerposIgM por IFI, al nacer, e IgG, a los 6 y 12 meses.Resultados: El 9,7% de las mujeres presentaban anticuerposespecíficos del parásito. De ellas el 54,1% eran bolivianas,el 13,5% argentinas y 8,1 % colombianas. 81,1% vivieron enzonas rurales y casas de adobe, el 89,2% tenía antecedentesfamiliares y el 100% conocían la enfermedad y el vector. Laseroconversión en un niño de 8 meses supuso una transmisiónvertical del 2,7% y una incidencia en mujeres procedentes dezona endémica del 0,3%.Conclusiones: La prevalencia de enfermedad de Chagasen mujeres gestantes latinoamericanas es elevada y supone unriesgo de transmisión vertical importante que obliga a detectaranticuerpos frente al parásito en los exámenes de salud de estecolectivo. En el cribado son factores de riesgo los antecedentesfamiliares de tripanosomiasis y la residencia previa enhábitat rural(AU)

Background: The Chagas disease, an endemic illness inLatin America, is an emerging pathology due mainly to theincrement of human migration. Prevalence increase, difficultdiagnosis and therapeutic management turn Chagas into animportant public health problem. Our objectives are first toanalyse the seroprevalence and epidemiologic profile of LatinAmerican pregnant women who were taken charge of in thearea of Hospital Clinical University of Valencia (HCUV), andsecond, to determine the risk of vertical transmission frominfected women to their children.Method: 400 Latin American pregnant women wereanalysed. They were assisted in HCUV from February 2005 toJuly 2007. The screening technique used wasImmunoprecipitation ID-PaGIA_DiaMed, confirmed throughIndirect Immunofluorescence (Immunofluor Chagas-InvernessMedical). For newborns whose mothers were seropositive, amicrohematocrit and PCR was performed at birth, later IgGdetection was performed at 6 and 12 months.Results: 9.3% of pregnant women developed specificantibodies to the parasite. Trypanosomiasis illness in antecedents,living in rural areas and gastrointestinal symptomatology were themost outstanding risk markers among the epidemiological,sociodemographic and clinical variables analysed, especiallywhen women were Bolivians. There was a case of seroconversionin an 8 months child with an incidence of 0.25%.Conclusions: The high proportion of pregnant LatinAmerican women with latent Chagas disease, theepidemiological history and the risk of vertical transmissionmade advisable to include the detection of parasite antibodiesin the health screenings of this group(AU)

Tratamiento de pérdidas óseas, pseudoartrosis, artrodesis y tumores óseos benignos con un xenoimplante mexicano (estudio clínico) / Bone loss treatment, pseudoarthrosis, arthrodesis and benign tumors using xenoimplant: clinical study

Objetivo: Se trataron pérdidas óseas, artrodesis, pseudoartrosis, tumores benignos y defectos óseos con un xenoimplante. Material y métodos: Se evaluó la eficacia del material mediante un estudio observacional y longitudinal en el Hospital Regional “General Ignacio Zaragoza” del ISSSTE. Resultados: Fueron considerados 52 pacientes, 28 masculinos y 24 femeninos, de los cuales a 28 se les practicó artrodesis, 16 fueron tratados por pseudoartrosis, tres presentaron tumores óseos benignos y cinco defectos óseos, a los cuales se les colocó el xenoimplante en el sitio y forma adecuada según el problema por tratar. El promedio de edad de los pacientes fue de 47.7 años, con un rango de nueve a 84 años. Se presentó consolidación ósea entre los tres y ocho meses después de la cirugía; el xenoimplante se integró totalmente en un periodo de tres a 18 meses dependiendo del tamaño de la patología y la región donde fue colocado. La consolidación ósea fue valorada radiográficamente de acuerdo con la clasificación de Montoya. Ningún paciente presentó signos clínicos de rechazo. Conclusiones: En México se han empleado xenoimplantes óseos de origen extranjero debido a la gran dependencia tecnológica del país. Por primera vez se utiliza un xenoimplante producido en el país y cuya patente es de la Universidad Nacional Autónoma de México. El xenoimplante Nukbone® fue biocompatible y resultó adecuado para tratar patologías donde se requiere aporte óseo.

BACKGROUND: Bone loss as a result of arthrodesis, pseudarthrosis, benign tumors and bone defects was treated using a xenoimplant (Nukbone). METHODS: The effectiveness of the material was evaluated through a longitudinal and observational study at the Hospital Regional "General Ignacio Zaragoza" (HRGIZ) ISSSTE. The Mexican xenoimplant is a patent of the National Autonomous University of Mexico (UNAM). RESULTS: Fifty two patients were considered regardless of age or gender. Of these patients, 28 were male and 24 female. Average age of the patients was 47.7 years (9-84 years). Twenty eight patients had arthrodesis, 16 were treated with pseudarthrosis, three patients had benign tumors and five patients presented bone defects, which were implanted with Nukbone at the site and was the correct treatment for the problem. The xenoimplant is fully integrated during a period of 3-18 months, depending on the size of the pathology and the region where it was placed. Fracture healing was evaluated radiographically according to the classification of Montoya. No patient had clinical signs of rejection. CONCLUSIONS: In Mexico, bony xenoimplants (osseous) have been used, all of foreign origin due to the high degree of technological dependence in this country. In this study we describe the use, for the first time, of a Mexican xenoimplant with a patent from the Universidad Nacional Autónoma de México (UNAM). The Mexican xenoimplant is biocompatible and can be adapted to treat pathologies where bony (osseous) material is needed.

Evaluación radiográfica de implantes de zinalco en fémur de perros / Radiographic evaluation of zinalco implants (80 percent Zn - 18 percent Al - 2 percent Cu), zinalco coated with titanium nitride and stainles steel 316L in dogs femur

Este trabajo es la búsqueda de nuevas alternativas para probar materiales con aplicaciones médicas. Se emplearon cuatro perros mestizos a los que se les implantaron cilindros de zinalco y acero 3l6L en los tercios proximal y distal del fémur izquierdo, respectivamente. El propósito fue evaluar la biocompatibilidad de estos materiales desde el punto de vista clínico, para lo cual se llevó a cabo el estudio radiográfico previo y posterior a la cirugía a los 30, 60, 90 y 120 días, evaluándose la densidad ósea, el rechazo al implante, signos de metalosis y reacción perióstica. En todos los casos hubo formación de hueso adyacente a los implantes, observada radiográficamente por reacción perióstica laminar, endostitis y esclerosis del canal medular. No se observaron reacciones periósticas severas e irregulares ni reabsorción ósea. No hubo evidencias de rechazo en los perros implantados a los 120 días de implantación de los materiales evaluados

Cerámicas mexicanas para cicatrización de piel / Mexican Ceramic Material for Skin Healing

Se utilizaron 60 ratas Wistar, que fueron evaluadas a los 15, 30 y 45 días después de la cirugía. Se quitó un cuadro de piel del lomo del animal, removiendo la epidermis y la dermis hasta alcanzar la fascia muscular donde se aplicó el material de experimentación. Se usó Nitrofurazona como control positivo y ningún material como control negativo. Los materiales a probar fueron fosfatos de aluminio a los que se agregó: 0.55% en peso de Zn y 0.30% en peso de Ca(0H)2 siendo éste el material A, y 0.55% en peso de Zn y 0.66% en peso de Ca(0H)2 el material B. Se trataron cinco ratas con cada material. Los objetivos del trabajo fueron la obtención de las cerámicas a probar y la evaluación de su efecto sobre el proceso de cicatrización de piel de ratas. Los materiales obtenidos fueron caracterizados con DRX. Estudios histopatológicos probaron que los mejores procesos de cicatrización de la piel se observaron en las ratas tratadas con el material A. El uso de las cerámicas AlPO para cicatrización de piel no ha sido reportado antes.

Sixty female Wistar rats were employed and divided into three experimental groups of 20 rats each. Groups were evaluated at 15, 30, and the last at 45 days after surgery. Each group was divided into four sets of five rats each. All rats were subjected to surgery; an incision of 2 x 2cm was done on the back of each animal, removing tissue until reaching muscular fascia, where the material was applied. Nitro-furazone was employed as positive control. Test materials were AlPO added with 0.55% wt of Zn; 0.30% wt of Ca(OH)2 and AlPO added with 0.55% wt of Zn and 0.66% wt of Ca(0H)2. Finally, as negative control no material was used. The object of this work was in the first place obtension of test materials and to evaluate the healing skin process in rats using AlPO enriched with Zn and Ca(0H)2; as indicated previously. Obtained materials were characterized employing XRD. Histologic studies tested showed that best healing process of dermal tissue corresponded to rats treated with AlPO added with 0.55% wt of Zn and 0.30% wt of Ca(OH)2. Use of AlPO ceramics to repair skin has not been reported previously.