Challenges and opportunities for sarcoma care and research in Latin America: a position paper from the LACOG sarcoma group.

As a developing region, Latin America faces unique cancer control and prevention challenges, which are intensified when considering rare cancers, including sarcomas. Sarcomas are a group of malignancies that arise in the connective tissues of the body-such as muscle, fat, nerves, blood vessels, and bones-accounting for a diverse range of tumours that, although rare, require specialized attention. Sarcoma care and research in Latin America require a comprehensive approach that includes deeper epidemiologic knowledge, diagnostic capacity building, access to innovative treatments, increased patient advocacy, and strengthening of clinical research capacity. This article will review current challenges and opportunities for treating patients with sarcoma in Latin America and outline a pathway toward improvement for regional collaborative groups.

Merkel cell carcinoma: epidemiology, clinical features, diagnosis and treatment of a rare disease

Abstract Merkel cell carcinoma is a rare skin cancer with neuroendocrine differentiation. The risk factors include sun exposure, advanced age, immunosuppression (such as transplant recipients, patients with lymphoproliferative neoplasms, or patients with HIV), and Merkel cell polyomavirus infection. Clinically, Merkel cell carcinoma appears as a cutaneous or subcutaneous plaque or nodule, but this tumor diagnosis is rarely made clinically. Therefore, histopathology and immunohistochemistry are usually necessary. Primary tumors without evidence of metastases are treated with complete surgical excision and appropriate surgical margins. The presence of occult metastasis in a lymph node is frequent and a sentinel lymph node biopsy should be performed. Postoperative adjuvant radiotherapy increases local tumor control. Recently, agents that block the PD-1/PD-L1 pathway have shown objective and durable tumor regression in patients with advanced solid malignancies. The first anti-PD-L1 antibody used in patients with Merkel cell carcinoma was avelumab, but pembrolizumab and nivolumab have also shown efficacy. This article describes the current state of knowledge of the epidemiology, diagnosis, and staging of Merkel cell carcinoma, as well as new strategies for its systemic treatment.

Merkel cell carcinoma: epidemiology, clinical features, diagnosis and treatment of a rare disease.

Merkel cell carcinoma is a rare skin cancer with neuroendocrine differentiation. The risk factors include sun exposure, advanced age, immunosuppression (such as transplant recipients, patients with lymphoproliferative neoplasms, or patients with HIV), and Merkel cell polyomavirus infection. Clinically, Merkel cell carcinoma appears as a cutaneous or subcutaneous plaque or nodule, but this tumor diagnosis is rarely made clinically. Therefore, histopathology and immunohistochemistry are usually necessary. Primary tumors without evidence of metastases are treated with complete surgical excision and appropriate surgical margins. The presence of occult metastasis in a lymph node is frequent and a sentinel lymph node biopsy should be performed. Postoperative adjuvant radiotherapy increases local tumor control. Recently, agents that block the PD-1/PD-L1 pathway have shown objective and durable tumor regression in patients with advanced solid malignancies. The first anti-PD-L1 antibody used in patients with Merkel cell carcinoma was avelumab, but pembrolizumab and nivolumab have also shown efficacy. This article describes the current state of knowledge of the epidemiology, diagnosis, and staging of Merkel cell carcinoma, as well as new strategies for its systemic treatment.

Administration of PGF2α at the moment of timed-AI using sex-sorted or conventional semen in suckled nelore cows with different intensity of estrus behavior.

The aim of this work was to evaluate pregnancy rates (PR) and ovulatory characteristics of Nelore cows receiving PGF2α at the time of AI (artificial insemination) in a progesterone(P4)/estradiol-based timed-AI protocol. We also compared the effects of PGF2α treatment at AI in cows inseminated with conventional or sex-sorted semen, with the absence or expression of estrus. In experiment 1, a total of 701 suckled, multiparous Nelore cows from two commercial beef farms were submitted to the same protocol. All cows received a 12.5 mg (IM) injection of dinoprost tromethamine (Dinoprost; Lutalyse®; PGF treatment) at days 7 and 9 of a timed-AI protocol. Following P4 device removal (day 11; D11), AI was performed 48 h later with conventional or sex-sorted semen from two different sires. At AI, cows received an additional dose of 12.5 mg (IM) of Dinoprost (PGF treatment) or 2.5 mL (IM) of sterile saline (Control). Estrus behavior was determined at D11 by activation of an estrus detection device (Estrotect®). The overall PR was 32.8% (n = 348) at Farm 1 and 42.3% (n = 353) at Farm 2 (P = 0.01). Despite PR differences between farms, the same factors affected PR at Farms 1 and 2. Body condition score (P = 0.02), estrus behavior (P = 0.01), and type of semen (P < 0.001) were factors affecting PR. Conventional semen had a 2.73x greater chance of successful pregnancy than sex-sorted semen. Cows displaying estrus had a 2.5x greater chance of successful pregnancy than cows that did not display estrus. No treatment effect (P = 0.67) was detected in cows receiving conventional or sex-sorted semen. However, there was a tendency (P = 0.08) for an interaction between treatment (PGF or control) and estrus behavior (estrus or no estrus). PGF2α at the time of AI tended to increase PR of cows that did not display estrus (P < 0.10). In experiment 2, 29 suckled, multiparous Nelore cows were compared using B-mode and Doppler ultrasongraphy to assess the ovulatory characteristics of cows receiving the 12.5 mg (IM) injection of Dinoprost (PGF treatment) or saline solution (control) at D11. No significant effects of PGF2α treatment at D11 were observed in follicular characteristics and/or ovulation performance. It was concluded that fertility of sex-sorted semen was lower than conventional semen, regardless of the PGF2α treatment. The 12.5 mg treatment of Dinoprost at AI did not accelerate the occurrence of ovulation; however, it was interesting to note that PGF2α treatment at timed-AI appeared to increase the fertility of cows that did not display estrus, independent of semen type.

Administering an additional prostaglandin F2α injection to Bos indicus beef cows during a treatment regimen for fixed-time artificial insemination.

Two experiments were conducted to evaluate if an additional prostaglandin F2α (PG) injection during an estradiol-based estrous synchronization treatment regimen affects pregnancy rates resulting from fixed-time artificial insemination (FTAI) in Nelore cows. In Experiment 1, 1039 cows were administered estradiol benzoate and an intravaginal progesterone releasing device (CIDR) on d -11, an injection of PG on d -4, with CIDR removal and administration of estradiol cypionate and eCG occurring on d -2, and FTAI on d 0. Cows were administered an additional injection of PG (PG2) or saline (PG1) on d -2. Percentage pregnancy per FTAI on d 30 was greater (P = 0.01) in cows of the PG2 than PG1 group (54.5 % and 46.6 %, respectively). In Experiment 2, there was use of the same treatment regimen for estrous synchronization of 934 cows as that for Experiment 1 followed by FTAI, with there being diagnosis of whether cows had or did not have a corpus luteum on d -4. Response to estrous synchronization, largest follicle diameter at FTAI, and pregnancy per FTAI were greater (P ≤ 0.05) in cows of the PG2 than PG1 group with a body condition score (BCS) < 5.0 at FTAI (81.2 % and 72.6 %, 11.9 and 11.2 mm, 55.5 and 45.6 %; respectively). These treatment responses did not differ (P ≥ 0.18) in cows with BCS ≥ 5.0. Collectively, results indicate that treatment with PG2 increased pregnancy per FTAI in B. indicus cows deficient in body energy reserves, by enhancing follicle development and estrous synchronization response.

Sire contribution to pregnancy loss and pregnancy-associated glycoprotein production in Nelore cows.

Pregnancy loss is a major contributing factor to reproductive inefficiency in both the beef and dairy industries. Sires can have a significant influence on the amount of pregnancy loss; however, this relationship is still poorly investigated. The primary objective of this study was to identify sires associated with high or low incidence of pregnancy loss (between d 30 and 100 of gestation) and investigate their effect on concentration of circulating pregnancy-associated glycoproteins (PAGs). Postpartum multiparous Nelore cows were inseminated artificially at a fixed time (FTAI, d 0) after synchronization of ovulation. A total of 736 cows were assigned randomly to be inseminated with semen from either of 6 Angus sires, whereas a separate subset of 492 cows were inseminated randomly with semen from either of 3 Nelore (n = 235) or either of 2 Angus sires (n = 257). Estrus expression was evaluated on d 0 using Estrotect Heat Detector patches. Blood samples were collected on d 30 of gestation for quantification of PAGs and pregnancy diagnosis was performed by ultrasound on d 30 and 100 after FTAI. Cows diagnosed pregnant at the first examination but not pregnant at the second were defined to have pregnancy loss. Overall pregnancy rate at d 30 was 54% (660/1,228) and pregnancy loss was 6.21% (41/660). Cows receiving semen from Nelore sires had greater (P < 0.001) pregnancy rate, greater (P = 0.014) pregnancy loss, and lesser (P = 0.002) PAG concentrations at d 30 of gestation compared with cows receiving Angus semen. Circulating PAG concentrations were lower (P = 0.008) in cows that had pregnancy loss (9.76 ± 0.25 vs. 7.41 ± 1.02 ng/mL). Angus sires were retrospectively classified according to percentage of pregnancy loss as either high pregnancy loss (mean of 7.25% or 67% of total) or low pregnancy loss (mean of 3.93% or 33% of total). Cows receiving semen from high pregnancy loss sires had 1.9 times greater (P = 0.123) rate of pregnancy loss and had lower (P = 0.059) PAG concentrations at d 30 of gestation compared with cows mated to low pregnancy loss sires. In summary, PAG concentrations reflected probability of pregnancy maintenance and were influenced by both sire and sire breed used at FTAI. Variation in the incidence of pregnancy loss was detected among sires that could not be predicted with standard semen fertility evaluations. Exploring the relationship of sire and PAG production might be promising to improve sire selection with regard to pregnancy loss.

[Sequence of unusual Chagas infection transmissions in the same family: mother by blood transfusion and child congenitally, with a treatment-resistant strain of Trypanosoma cruzi]. / Seqüência de transmissões não habituais da infecção chagásica em uma mesma família: transfusional para a mãe e congênita para o filho, de cepa de Trypanosoma cruzi resistente ao tratamento.

The authors present two cases of unusual transmission of Chagas infection in the same family: the mother by blood transfusion and her second child across the placenta. The child was diagnosed by chance and etiological treatment for both the mother and the child was ineffective in eradicating the parasitemia. At present, they continue to present the indeterminate form of the disease.

Seqüência de transmissões não habituais da infecção chagásica em uma mesma família: transfusional para a mãe e congênita para o filho, de cepa de Trypanosoma cruzi resistente ao tratamento / Sequence of unusual Chagas infection transmissions in the same family: mother by blood transfusion and child congenitally, with a treatment-resistant strain of Trypanosoma cruzi

Os autores apresentam dois casos de transmissão não habitual da infecção chagásica em uma mesma família: a mãe, por transfusão sangüínea e seu segundo filho, via transplacentária. O diagnóstico da criança foi acidental e a resposta ao tratamento etiológico, em ambos, foi ineficaz em erradicar a parasitemia. Atualmente, mãe e filho permanecem em forma indeterminada da doença.

The authors present two cases of unusual transmission of Chagas infection in the same family: the mother by blood transfusion and her second child across the placenta. The child was diagnosed by chance and etiological treatment for both the mother and the child was ineffective in eradicating the parasitemia. At present, they continue to present the indeterminate form of the disease.