Stratification of pregnancy care based on risk of pre-eclampsia derived from biophysical and biochemical markers at 19-24 weeks' gestation.

OBJECTIVE: We have proposed previously that all pregnant women should have assessment of risk for pre-eclampsia (PE) at 20 and 36 weeks' gestation and that the 20-week assessment should be used to define subgroups requiring additional monitoring and reassessment at 28 and 32 weeks. The objective of this study was to examine the potential improvement in screening at 19-24 weeks' gestation for PE with delivery at < 28, < 32, < 36 and ≥ 36 weeks' gestation by the addition of serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) to the combination of maternal demographic characteristics and medical history, uterine artery pulsatility index (UtA-PI) and mean arterial pressure (MAP). METHODS: This was a prospective, non-intervention study in women attending for an ultrasound scan at 19-24 weeks as part of routine pregnancy care. Patient-specific risks of delivery with PE at < 36 weeks' gestation were calculated using the competing-risks model to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics and medical history, with multiples of the median values of UtA-PI, MAP, PlGF and sFlt-1. Different risk cut-offs were used to vary the proportion of the population stratified into each of four risk categories (very high risk, high risk, intermediate risk and low risk) with the intention of detecting about 80%, 85%, 90% and 95% of cases of delivery with PE at < 28, < 32 and < 36 weeks' gestation. The performance of screening was assessed by plotting the detection rate against the screen-positive rate and calculating the areas under these curves, and by the proportion stratified into a given group for fixed detection rates. Model-based estimates of screening performance for these various combinations of markers were also produced. RESULTS: In the study population of 37 886 singleton pregnancies, there were 1130 (3.0%) that subsequently developed PE, including 160 (0.4%) that delivered at < 36 weeks' gestation. In both the modeled and empirical results, there was incremental improvement in the performance of screening with the addition of PlGF and sFlt-1 to the combination of maternal factors, UtA-PI and MAP. If the objective of screening was to identify about 90% of cases of PE with delivery at < 28, < 32 and < 36 weeks and the method of screening was a combination of maternal factors, UtA-PI and MAP, the respective screen-positive rates would be 3.1%, 8.5% and 19.1%. The respective values for screening by maternal factors, UtA-PI, MAP and PlGF were 0.2%, 0.7% and 10.6%, and for screening by maternal factors, UtA-PI, MAP, PlGF and sFlt-1 they were 0.1%, 0.4% and 9.5%. The empirical results were consistent with the modeled results. There was good agreement between the predicted risk and the observed incidence of PE at < 36 weeks' gestation for all three strategies of screening. Prediction of PE at ≥ 36 weeks was poor for all three screening methods, with the detection rate, at a 10% screen-positive rate, ranging from 33.2% to 38.4%. CONCLUSIONS: The performance of screening at 19-24 weeks' gestation for PE with delivery at < 28, < 32 and < 36 weeks' gestation achieved by a combination of maternal demographic characteristics and medical history, UtA-PI and MAP is improved by the addition of serum PlGF and sFlt-1. The performance of screening for PE at ≥ 36 weeks' gestation is poor irrespective of the method of screening at 19-24 weeks. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Oferta de programas para el desarrollo integral de la primera infancia en Chile: revisión exploratoria / Program offer for the integral development of early childhood in Chile: scoping review

OBJETIVO: Describir la oferta programática en primera infancia destinada a favorecer el desarrollo infantil integral en Chile. MÉTODO: Se realizó una revisión exploratoria siguiendo el marco método lógico del Joanna Briggs Institute. La búsqueda fue realizada por un investigador y los criterios de inclusión fueron: programas gubernamentales destinados al desarrollo integral en menores de 5 años en Chile. Los datos fueron organizados y sintetizados para describir características del programa y de la o las prestaciones que entrega. RESULTADOS: La búsqueda identificó 2060 documentos y 72 cumplieron los criterios de inclusión. Se describen 59 programas vigentes que abarcan la primera infancia, es tando principalmente a cargo de los Ministerio de Justicia, Educación, Salud y Desarrollo Social. Los programas están destinados en su mayoría a la promoción e intervención, se encuentran focalizados en población vulnerable, son intersectoriales y utilizan diversas estrategias para su implementación. CONCLUSIÓN: La oferta programática en Chile para la primera infancia presenta características sugeridas como efectivas para favorecer el desarrollo infantil.

OBJECTIVE: To describe the program offering designed to promote comprehensive early childhood de velopment in Chile. METHOD: A scoping review was carried out following the Joanna Briggs Institute's methodological framework. A researcher conducted the review considering as inclusion criteria go vernment programs aimed at the comprehensive development of children under 5 years of age in Chile. The data were organized and synthesized to describe the characteristics of the program and the service(s) it provides. RESULTS: The search identified 2.060 documents and 72 met the inclusion crite ria. 59 current programs are covering early childhood, which are mainly managed by the Ministries of Justice, Education, Health, and Social Development. Most of the programs are aimed at promotion and intervention, focusing on vulnerable populations, are cross-sectoral, and use different strategies for their implementation. CONCLUSION: The program offering in Chile for early childhood has charac teristics suggested as effective to promote child development.

[Program offer for the integral development of early childhood in Chile: Scoping review]. / Oferta de programas para el desarrollo integral de la primera infancia en Chile: Revisión exploratoria.

OBJECTIVE: To describe the program offering designed to promote comprehensive early childhood de velopment in Chile. METHOD: A scoping review was carried out following the Joanna Briggs Institute's methodological framework. A researcher conducted the review considering as inclusion criteria go vernment programs aimed at the comprehensive development of children under 5 years of age in Chile. The data were organized and synthesized to describe the characteristics of the program and the service(s) it provides. RESULTS: The search identified 2.060 documents and 72 met the inclusion crite ria. 59 current programs are covering early childhood, which are mainly managed by the Ministries of Justice, Education, Health, and Social Development. Most of the programs are aimed at promotion and intervention, focusing on vulnerable populations, are cross-sectoral, and use different strategies for their implementation. CONCLUSION: The program offering in Chile for early childhood has charac teristics suggested as effective to promote child development.

Lesiones musculares deportivas: correlación entre anatomía y estudio por imágenes / Muscle injuries in sports: imaging study

Un gran segmento de la población participa en actividades deportivas. Las lesiones musculares corresponden a aproximadamente un tercio de las lesiones deportivas. Las demandas recreacionales y profesionales de la sociedad moderna exigen un diagnóstico precoz y preciso, para un adecuado tratamiento y seguimiento, dadas las implicancias económicas y mediáticas, especialmente en deportistas de elite. La imagenología tiene un rol fundamental en la evaluación de estas lesiones. Permite evaluar localización, extensión, severidad y estimar pronóstico, así como también el seguimiento para determinar el retorno deportivo. En este artículo se revisa la anatomía microscópica y macroscópica muscular, la fisiología, los tipos de lesiones y su representación en imágenes, tanto en ultrasonido (US), como en resonancia magnética (RM). Se mencionan distintas clasificaciones descritas en la literatura y se propone una nueva nomenclatura y descripción, basada principalmente en la anatomía muscular, la localización y cuantificación de las lesiones.

A large segment of the population participates in sporting activities. Muscle injuries account for approximately one-third of the injuries. The recreational and professional demands of modern society require an early and precise diagnosis of these, for an adequate treatment and follow-up, given the economic and media implications, especially in elite athletes1. Imaging plays a fundamental role in the evaluation of these lesions. It allows evaluation location, extent, severity and estimations of prognosis, as well as the follow-up to determine the return to sport. This article reviews the microscopic and macroscopic muscle anatomy, the physiology, types of lesions and their representation in images, both in ultrasound (US) and magnetic resonance (MRI). Different classifications described in the literature are mentioned and a nomenclature and description is proposed, based mainly on the muscle anatomy, localization and type of injury.

Epidermal growth factor receptor and epididymis invasion as prognostic biomarkers in clinical stage I testicular germ cell tumours.

BACKGROUND: Inguinal orchiectomy is curative in 70-80% of clinical stage I testicular germ cell tumours (CS I TGCT). The identification of patients who are at low risk of relapse is critical to avoid unnecessary treatment. The aim of this study is to explore EGFR, hMLH-1/hMSH-2 and microsatellite instability (MSI) as potential prognostic factors of recurrence in CS I TGCT. METHODS: Fifty-six CS I TGCT patients who underwent inguinal orchiectomy were included in this study. We analysed the relationship between clinicopathological and molecular factors with survival. Analysis of hMLH1, hMSH2 and EGFR expression was carried out by immunohistochemistry. Methylation status of the hMLH1 promoter was determined by pyrosequencing analysis in selected cases. EGFR exons 19, 20, 21 were analysed by PCR labeled-fragments and MSI status was determined using standard Multiplex MSI assays. RESULTS: Classical pathological factors such as lymphovascular invasion, high percentage of embryonal carcinoma, rete testis invasion or tumour size ≥4 cm showed a significant relationship with a higher risk of relapse. Additionally, it was found that an epididymis invasion proved to be a significant independent poor prognostic factor of recurrence (p = 0.001). hMLH1 or hMSH2 expression showed no significant association with risk of relapse and no MSI was found. EGFR expression was observed in 30.4% of samples and its expression was associated with higher risk of relapse (HR 3.5; 95% CI 1.3-9.8; p = 0.016). None of the cases presented EGFR kinase domain mutations. CONCLUSIONS: Epididymis invasion and EGFR expression, but not hMLH-1/hMSH-2 or MSI, could be potentially useful as new prognostic factors of recurrence for CS I TGCT.

Analysis of Olig2 and YKL-40 expression: a clinicopathological/immunohistochemical study for the distinction between subventricular zone II and III glioblastomas.

Glioblastomas (GBs) are the most common and lethal primary brain tumors in the adults. Glioblastomas originates either from astrocytes that have accumulated mutations and de-differentiated or from neural stem cells within the subventricular zone (SVZ) in close contact with the vasculature. Recently, several studies have hypothesized that gliomagenesis occurs in perivascular niches with highly invasive peripheral proliferating zones. The purpose of our study was to investigate the pathological and clinical significance of Olig2 and YKL40 immunoexpression in 152 GBs in relationship to the SVZ II and III. Olig2 expressions were successfully detected in 12 (15.58%) of 77 SVZ type II GBs and 16 (21.3%) of 75 SVZ type III GBs, respectively. YKL-40 expression was observed in 45 (58.4%) of 77 SVZ type II GBs and in 17 (22.6%) of 75 SVZ type III GBs, respectively. Stepwise multivariate Cox proportional hazards models were used, and the prognostic factors to significantly impact OS were: PFS < 54 weeks (HR: 5.86; CI: 3.02-11.33; p = 0.00); radiotherapy (HR: 0.34; CI: 0.18-0.60; p = 0.00); radio- and chemotherapy (HR: 0.05; CI: 0.03-0.10; p = 0.0), and YKL-40+ GBs (HR: 1.61; CI: 1.28-2.31; p = 0.01).

Prognostic significance of the markers IDH1 and YKL40 related to the subventricular zone.

Glioblastoma multiforme (GBM), a highly aggressive brain cancer characterized by uncontrolled proliferation, resistance to cell death, angiogenesis, and vascular edema, remains one of the deadliest types of cancer. The subventricular zone (SVZ) harbors cells with great proliferative potential, and the microenvironment within the SVZ is permissive to growth and proliferation. This neurogenic niche is suspected to be a vulnerable site for the origin of subtypes of GBM. The aim of our study was to determine the immunohistochemical expression of mIDH1 and YKL40 in relationship to the SVZ of GBMs. YKL40, also known as chitinase-like protein 1, is included as a mesenchymal marker and associated with a poor prognosis. The protein is a secreted inflammatory molecule with no chitinolytic activity. However, the mutation of IDH1 (mIDH1) has been found in the cytoplasm and peroxisomes of 70-80% of secondary GBMs. In our study we found that YKL40-positive GBM is significantly linked to SVZ types IV and V (p < 0.0001). Our results show the diversity among GBMs related to the SVZ, which should be considered in the design of future targeted therapies. There was a significant impact of patient age, mIDH1 positivity, SVZ type III, and chemoradiotherapy on overall survival.

Merkel cell carcinoma and Merkel cell polyomavirus: a systematic review and meta-analysis.

Several observational studies have assessed the correlation between Merkel cell carcinoma and Merkel cell polyomavirus with variable results. The objective of this systematic review was to determine whether there is a correlation between Merkel cell carcinoma and Merkel cell polyomavirus. Studies assessing the relationship between Merkel cell carcinoma and Merkel cell polyomavirus from January 2008 to August 2014 were pooled from Medline, Embase, PubMed, Cochrane Database of Systemic Reviews and Google Scholar. From each study we collected the first author's last name, publication year, country of origin, type of study design, characteristics of participants, possible variables incorporated into the multivariable analyses and the risk ratio (RR) for Merkel cell carcinoma associated with Merkel cell polyomavirus combined with the corresponding 95% confidence interval (CI). Methodological assessment of the study was evaluated using the Newcastle-Ottawa scale. Crude RR was calculated from the data provided in each article. Meta-analyses for the global RR and for the proportion of positives in both case and control samples were performed. In addition, in order to explore the sources of heterogeneity among the studies, meta-regression and sensitivity analyses are also provided. A total of 22 studies were identified for the analysis. The pooled RR from random-effects analysis was determined to be 6.32 (95% CI, 4.02-9.93). Global proportions of positive samples were 0.79 (95% CI, 0.72-0.84) and 0.12 (95% CI, 0.08-0.19) in the case and control groups, respectively. The findings support the association between Merkel cell carcinoma and Merkel cell polyomavirus. However, a non-negligible percentage of positive results have been identified in controls. Some caution must be taken in the interpretation of these results because heterogeneity between studies was found.

Molecular biology of neuroendocrine tumors: from pathways to biomarkers and targets.

Neuroendocrine tumors (NETs) represent a heterogeneous group of diseases with varied natural history and prognosis depending upon the organ of origin and grade of aggressiveness. The most widely used biomarker to determine disease burden and monitor response to treatment is chromogranin A (CgA), but it is far from being the optimal predictive and prognostic biomarker in NETs. Biological understanding and derived treatment options for NETs have changed markedly in recent years. Over the last decade, the genomic landscape of these tumors has been extensively investigated. This has resulted in the discovery of mutations and expression anomalies in genes and pathways such as the PI3K/Akt/mTOR, DAXX/ATRX, and MEN1, which are promising predictive and prognostic biomarkers and future candidates for targeted therapies. Additionally, the study of tumor stroma and environment are one of the most promising fields for discovery of potential new targets and biomarkers.

Estudios por imágenes en reumatismo / Imaging studies in reumatology

En reumatología los estudios por imágenes juegan un papel fundamental en el diagnóstico y seguimiento de los pacientes. Si bien la radiografía convencional es el examen de primera línea en el estudio, el desarrollo de técnicas como el Ultrasonido (US), la Resonancia Magnética (RM) y la Densitometría ósea posibilitan realizar diagnósticos en etapas más precoces, lo que permite modificar el curso de la enfermedad a través de tratamientos más tempranos y controlar en forma más precisa la respuesta al tratamiento. Los grandes avances tecnológicos de la última década han mejorado la calidad y cantidad de información que las distintas técnicas aportan, especialmente la RM; esto hace vislumbrar un cambio significativo en el diagnóstico por imágenes, ya que en el futuro no solo estará basado en los cambios morfológicos en órganos y tejidos; las imágenes obtenidas aportarán información bioquímica, molecular y fisiológica de los procesos patológicos facilitando su diagnóstico aún más precoz.

Imaging studies in Rheumatology play fundamental role in the patients diagnosis and follow-up. While conventional radiography is the first line examination, development of other techniques such as US, MRI and bone densitometry make possible earlier diagnosis which can modify the disease course through earlier treatment and controlling more precisely the response to it. The great technological advances of the last decade have improved the quality and quantity of information that different techniques provide, especially MRI, this makes glimpse a significant change in diagnostic imaging, since in the future not only will be based on the morphological changes in organs and tissues, the obtained images will provide biochemical, molecular and physiological information of the pathological processes, allowing earlier diagnosis.

Snail nuclear expression parallels higher malignancy potential in neuroendocrine lung tumors.

INTRODUCTION: The aim of our study was to determine the integrity of the cell-cell adhesion E-cadherin-beta-catenin complex in neuroendocrine lung tumors (NELTs) and the possible involvement of Snail in its deregulation. METHODS: The studied series consisted of formalin-fixed-paraffin-embedded tissue samples from 70 patients diagnosed with NELT (2000-2006) including tumors of low malignancy potential (3 tumorlets, 33 typical carcinoids), intermediate malignancy potential (3 atypical carcinoids) and tumors of high malignancy potential (10 large cell neuroendocrine carcinomas-LCNEC and 21 small cell carcinoma-SCLC). E-cadherin, beta-catenin and Snail expression were immunohistochemically evaluated and mRNA levels were assessed by Q-RT-PCR for E-cadherin and Snail. RESULTS: Nuclear Snail signal was high in 46% tumors with the strongest level observed in high malignancy tumors. Furthermore, Snail levels correlated with tumor size, lymph node involvement and tobacco consumption. E-cadherin expression was downregulated in 24% cases and it was absent from the membrane in 31%, all of them cases of high malignancy potential. High E-cadherin levels and a membrane pattern were associated with tumor-free lymph node patients and inversely proportional to Snail protein expression. beta-catenin levels were weak in 43% and absent from the membrane in 59% cases. Interestingly, among high malignancy potential tumors, beta-catenin levels were significantly higher in LCNEC than in SCLC. The integrity of the E-cadherin-beta-catenin complex was retained in 37% cases, most of them carcinoid tumors, and correlated with low Snail levels, low malignancy potential and free lymph nodes. CONCLUSION: Snail nuclear expression and loss of integrity of cell adhesion complex E-cadherin/beta-catenin parallels higher malignancy potential in NELTs.

Estudio de imágenes de articulación patelofemoral: ¿en qué estamos?: [revisión] / Imaging studies of the patellofemoral joint: current reality: [review]

La disfunción patelofemoral (DPF) es causa frecuente de consulta clínica y se refiere, a grandes rasgos, a una patología en la cual la patela falla en la correcta entrada en la tróclea. Es un tema en el que la terminología suele ser ambigua y confusa, debido entre otras cosas a la discrepancia entre la clínica y la imaginología. Además, la etiología de la DPF es multifactorial, incluyendo factores anatómicos locales, rotacionales y dinámicos, no existiendo tampoco claridad acerca de su real influencia. Desde el punto de vista imaginológico, existen innumerables publicaciones, con diferentes clasificaciones y mediciones descritas para las distintas técnicas, sin embargo, no hay un consenso amplio en relación a cuáles son las alteraciones anatómicas o los valores normales que el reporte imaginológico debiera incluir. Se realiza una revisión de la literatura existente y se propone para los pacientes con DPF, un estudio radiológico que considera los factores etiológicos anatómicos y un estudio tomográfico de segunda línea, que incluye estudio rotacional de extremidades inferiores, sistematizando las mediciones y puntos relevantes en una plantilla de informe.

Patellofemoral dysfunction (PFD) is a common cause for medical consultation and in a broad sense it refers to a condition in which the patella fails to engage securely in the trochlear groove. This is a topic in which terminology is often ambiguous and confusing due, inter alia, to the discrepancy between symptomatology, imaging findings and physical examination. In addition, PFD has a multifactorial etiology that includes local anatomical, rotational and dynamic factors, with no certainty about its real influence. From the imaging point of view, there are countless publications proposing different classifications and measurements obtained trough different imaging techniques; however, there is no consensus regarding what are the anatomical alterations or the normal values that imaging reports should include. A review of the existing literature is performed and we propose that patients with PFD should undergo both a radiological study comprising etiologic and anatomic factors and a second-line tomographic exploration including lower extremity rotational profiles. From the radiological and clinical viewpoints, relevant issues to be considered as well as assessments performed should be systematized and recorded in a report sheet.

The relation between hypoxia-inducible factor (HIF)-1alpha expression with p53 expression and outcome in surgically treated supraglottic laryngeal cancer.

OBJECTIVE: The purpose of this study was to examine whether a relationship exists between HIF-1alpha expression and the pro-apoptotic protein p53 in supraglottic laryngeal squamous cell carcinomas (SCCs), which could provide information concerning patient prognosis. METHODS: The study population was composed of 106 previously untreated men with SCC of the supraglottic larynx. All the patients underwent surgical resection of the tumor and bilateral neck dissection. Immunohistochemical analysis of HIF-1alpha and p53 protein expression was performed in relation with clinicopathological parameters and prognosis. RESULTS: HIF-1alpha nuclear expression was detected in 71% of primary carcinomas and 55% of the paired lymph node metastases. There was a significant positive correlation between HIF-1alpha and T-classification but no associations were observed with other clinicopathological variables and with prognosis. There was no correlation between the expression of HIF-1alpha and p53. HIF-1alpha overexpression in combination with p53 immunostaining was not associated with disease recurrence or survival. CONCLUSION: The data suggest that HIF-1alpha expression does not have a prognostic value in surgically treated supraglottic laryngeal SCC, and that immunohistochemical determination of p53 does not allow improving the clinical significance of HIF-1alpha.

Estudio por imágenes de los gangliones musculoesqueleticos / Imaging study of musculokeletal ganglia

The ganglion is a pseudo cyst that appears as a well defined nodule of firm consistence, formed by fibrous tissue walls and a layer of discontinuous pseudosynovial cells, with thick mucinous content, usually located near a joint a tendon sheath. According to location, different types of cysts, histologically similar, can be found. Their clinical manifestations may vary depending on location and size. They can evolve as an expansive process, displacing or compressing adjacent structure; sometimes they can be an asymptomatic entity that generates patients some embarracement from an aesthetic point of view, or just constitute an incidental radiological. Finding. Therefore, we attach great importance to knowing not only cysts imaging features but also their most common sites and the most appropriate examination techniques to be performed in each specific case. We present a review of the different types of ganglia and the imaging method of choice, according to the literature and to our clinical experience.

El ganglion es un pseudoquiste que se presenta como un nodulo bien definido, de consistencia firme, formado por paredes de tejido fibroso y una capa de células discontinuas pseudosinovlales, con contenido mucinoso espeso y que frecuentemente está cerca de una articulación o una vaina tendínea. Dependiendo de su ubicación, existen varios tipos histológicamente similares. Las manifestaciones clínicas varían dependiendo de su localización y tamaño: pueden comportarse como proceso expansivo, desplazando o comprimiendo estructuras vecinas, ser asintomáticos y a veces provocar una molestia estética al paciente o, ser un hallazgo radiológico incidental. Estimamos importante conocer sus características imaginológicas, localizaciones más frecuentes y el método de examen más útil acorde a su ubicación, para lo cual presentamos una revisión de los distintos tipos de gangliones y el estudio imaginológico de elección en cada caso, de acuerdo a la literatura y a nuestra experiencia clínica.

Longitud del canal cervical uterino como factor de riesgo de parto prematuro en pacientes sintom¨¢ticas / Cervical length as a risk factor of preterm delivery

Objetivo: Determinar si el acortamiento del cuello uterino en pacientes sintom¨¢ticas es predictor de parto prematuro en o antes de las 35 semanas y dentro de 7 d¨ªas. M¨¦todo: Se estudiaron 852 pacientes que consultaron por din¨¢mica uterina, a las que se midi¨® el cuello uterino al ingreso. Las pacientes fueron manejadas de acuerdo a las Gu¨ªas Cl¨ªnicas del Hospital. Se excluyeron las pacientes en trabajo de parto, con membranas rotas o con cerclaje. Resultados: La edad gestacional promedio al ingreso fue 31,5 semanas (rango: 24,0-34,9). Se present¨® parto prematuro a las 35 semanas o antes en 61 casos (7,2%), y dentro de los 7 d¨ªas del ingreso en 14 pacientes (1,6%). Fueron predictores independientes significativos (OR; IC95%) para un parto ¡Ü35 semanas las siguientes variables: antecedente de prematurez (2,03; 1,06-3,89), metrorragia (6,87; 2,83-16,65) y canal cervical <25 mm (3,31; 1,92-5,7). El an¨¢lisis con curvas ROC demostr¨® que el valor de corte que mejor predice un parto ¡Ü35 semanas y dentro de 7 d¨ªas de ingresada, es un cuello uterino <19,5 mm (p<0,05). Conclusiones: El acortamiento del canal cervical en pacientes sintom¨¢ticas, particularmente con un canal <20 mm, se asocia con un riesgo significativo de parto prematuro ¡Ü35 semanas y dentro de 7 d¨ªas de ingresada. La medici¨®n de canal cervical ayuda a distinguir a las pacientes en riesgo, con el fin de concentrar esfuerzos en ese grupo de embarazadas.

Objective: To determine if the shortening of cervical length (CL) in women with threatened preterm labor could predict delivery at or before 35 weeks´ gestation and within 7 days of presentation. Method: Sonographic measurement of CL was done in 852 women with singleton pregnancies presenting with painful uterine contractions. Women in labor, with ruptured membranes or those with cervical cerclage were excluded. Results: Median gestational age at presentation was 31.5 (range: 24.0-34.9) weeks and median cervical length was 31.5 (range: 3-61) mm. Delivery within 7 days occurred in 14 (1.6%) and delivery at or before 35 weeks, in 61 (7.2%) cases. Significant (OR; 95%CI) independent predictors of delivery at or before 35 weeks were vaginal bleeding (6.87; 2.83-16.65), cervical length (3.31; CI 1.92-5.70) and a history of preterm birth (2.03; 1.06-3.89). ROC curve analysis showed that a cervical length shorter than 19.5 mm (p<0.05) was the best cutoff value for predicting a delivery at or before 35 weeks´ gestation and within 7 days of presentation. Conclusions: Shortening of cervical length in threatened preterm labor, especially when shorter than 19.5 mm, is associated with a significant risk of preterm labor ¡Ü35 weeks¡¯ gestation and within 7 days of admission. Sonographic measurement of cervical length helps to recognize patients at risk for preterm birth, in order to focus interventions in that group of patients.

The receptor protein tyrosine phosphatase (RPTP)beta/zeta is expressed in different subtypes of human breast cancer.

Increasing evidence suggests mutations in human breast cancer cells that induce inappropriate expression of the 18-kDa cytokine pleiotrophin (PTN, Ptn) initiate progression of breast cancers to a more malignant phenotype. Pleiotrophin signals through inactivating its receptor, the receptor protein tyrosine phosphatase (RPTP)beta/zeta, leading to increased tyrosine phosphorylation of different substrate proteins of RPTPbeta/zeta, including beta-catenin, beta-adducin, Fyn, GIT1/Cat-1, and P190RhoGAP. PTN signaling thus has wide impact on different important cellular systems. Recently, PTN was found to activate anaplastic lymphoma kinase (ALK) through the PTN/RPTPbeta/zeta signaling pathway; this discovery potentially is very important, since constitutive ALK activity of nucleophosmin (NPM)-ALK fusion protein is causative of anaplastic large cell lymphomas, and, activated ALK is found in other malignant cancers. Recently ALK was identified in each of 63 human breast cancers from 22 subjects. We now demonstrate that RPTPbeta/zeta is expressed in each of these same 63 human breast cancers that previously were found to express ALK and in 10 additional samples of human breast cancer. RPTPbeta/zeta furthermore was localized not only in its normal association with the cell membrane but also scattered in cytoplasm and in nuclei in different breast cancer cells and, in the case of infiltrating ductal carcinomas, the distribution of RPTPbeta/zeta changes as the breast cancer become more malignant. The data suggest that the PTN/RPTPbeta/zeta signaling pathway may be constitutively activated and potentially function to constitutively activate ALK in human breast cancer.