Chronic Venous Insufficiency as a Predisposing Factor for Basal Cell Carcinoma on Legs.

BACKGROUND: The main risk factor associated with basal cell carcinomas (BCCs) is believed to be exposure to ultraviolet radiation (UVR). In the case of lower limb BCC, the frequency is higher in women, possibly because of greater exposure of the leg to UVR. Chronic venous insufficiency (CVI), also more common in women, may have some association with leg BCCs. METHODS: We retrospectively evaluated the histopathological features of leg BCCs removed between 1993 and 2017 in a tertiary referral center. The patients' clinical data were obtained from medical records, considering, in particular, CVI. RESULTS: We selected 149 patients with leg BCCs, predominately occurring in elderly Caucasian women. Of those, 71 had a clinical diagnosis of CVI in whom the clinical tumor size and frequency of recurrences were significantly higher than patients without CVI. There was an association between clinical diagnosis of CVI and histological findings of (1) follicular induction in epidermis and (2) distal sweat duct hyperplasia. CONCLUSIONS: CVI, besides the already known UVR exposure, is probably associated with leg BCCs and may determine a worse BCC course.

Ubiquitous neurocognitive dysfunction in familial adenomatous polyposis: proof-of-concept of the role of APC protein in neurocognitive function.

BACKGROUND: Familial adenomatous polyposis (FAP) is an autosomal dominant disorder caused by germline mutations in the APC gene. Patients with FAP have multiple extraintestinal manifestations that follow a genotype-phenotype pattern; however, few data exist characterizing their cognitive abilities. Given the role of the APC protein in development of the central nervous system, we hypothesized that patients with FAP would show differences in cognitive functioning compared to controls. METHODS: Matched case-control study designed to evaluate cognitive function using the Test of Nonverbal Intelligence-4, the Bateria III Woodcock-Munoz, and the Behavior Rating Inventory of Executive Functions-Adult. Twenty-six individuals with FAP (mean age = 34.2 ± 15.0 years) and 25 age-gender and educational level matched controls (mean age = 32.7 ± 13.8 years) were evaluated. RESULTS: FAP-cases had significantly lower IQ (p = 0.005). Across all tasks of the Batería III Woodcock-Muñoz, FAP-cases performed significantly lower than controls, with all of the summary scores falling in the bottom quartile compared to controls (p < 0.0001). Patients with FAP scored within the deficient range for Long-Term Retrieval and Cognitive Fluency. CONCLUSION: APC protein has an important role in neurocognitive function. The pervasive nature of the observed cognitive dysfunction suggests that loss or dysfunction of the APC protein impacts processes in cortical and subcortical brain regions. Additional studies examining larger ethnically diverse cohorts with FAP are warranted.

Thalidomide modulates renal inflammation induced by brain death experimental model.

BACKGROUND: Brain death (BD) is characterized by a complex inflammatory response, resulting in dysfunction of potentially transplantable organs. This process is modulated by cytokines, which amplify graft immunogenicity. We have investigated the inflammatory response in an animal model of BD and analyzed the effects of thalidomide, a drug with powerful immunomodulatory properties. METHODS: BD was induced in male Lewis rats. We studied three groups: Control (sham-operated rats) (n = 6), BD (rats subjected to brain death) (n = 6) and BD + Thalid (BD rats treated with one dose of thalidomide (200 mg/Kg), administered by gavage) (n = 6). Six hours after BD, serum levels of urea and creatinine, as well as systemic and renal tissue protein levels of TNF-α and IL-6, were analyzed. We also determined the mRNA expression of ET-1, and macrophage infiltration by immunohistochemistry. RESULTS: BD induced a striking inflammatory status, demonstrated by a significant increase of plasma cytokines: TNF-α (2.8 ± 4.3 pg/mL [BD] vs. 9.4 ± 2.8 pg/mL [Control]), and IL-6 (6219.5 ± 1380.6 pg/mL [BD] vs. 1854.7 ± 822.6 pg/mL [Control]), and in the renal tissue: TNF-α (2.5 ± 0.3 relative expression [BD] vs. 1.0 ± 0.4 relative expression [Control]; p < 0.05), and IL-6 (4.0 ± 0.4 relative expression [BD] vs. 1.0 ± 0.3 relative expression [Control]; p < 0.05). Moreover, BD increased macrophages infiltration (2.47 ± 0.07 cells/field [BD] vs. 1.20 ± 0.05 cells/field [Control]; p < 0.05), and ET-1 gene expression (2.5 ± 0.3 relative expression [BD] vs. 1.0 ± 0.2 relative expression [Control]; p < 0.05). In addition, we have observed deterioration in renal function, characterized by an increase of urea (194.7 ± 25.0 mg/dL [BD] vs. 108.0 ± 14.2 mg/dL [Control]; p < 0.05) and creatinine (1.4 ± 0.04 mg/dL [BD] vs. 1.0 ± 0.07 mg/dL [Control]; p < 0.05) levels. Thalidomide administration significantly reduced plasma cytokines: TNF-α (5.1 ± 1.4 pg/mL [BD + Thalid] vs. BD; p < 0.05), and IL-6 (1056.5 ± 488.3 pg/mL [BD + Thalid] vs. BD; p < 0.05), as well as in the renal tissue: TNF-α (1.5 ± 0.2 relative expression [BD + Thalid] vs. BD; p < 0.05), and IL-6 (2.1 ± 0.3 relative expression [BD + Thalid] vs. BD; p < 0.05). Thalidomide treatment also induced a significant decrease in the expression of ET-1 (1.4 ± 0.3 relative expression [BD + Thalid] vs. BD; p < 0.05), and macrophages infiltration (1.17 ± 0.06 cells/field [BD + Thalid] vs. BD; p < 0.05). Also thalidomide prevented kidney function failure by reduced urea (148.3 ± 4.4 mg/dL [BD + Thalid] vs. BD; p < 0.05), and creatinine (1.1 ± 0.14 mg/dL [BD + Thalid] vs. BD; p < 0.05). CONCLUSIONS: The immunomodulatory properties of thalidomide were effective in decreasing systemic and local immunologic response, leading to diminished renal damage, as reflected in the decrease of urea and creatinine levels. These results suggest that use of thalidomide may represent a potential strategy for treating in BD kidney organ donors.

Altered neural networks and cognition in a hereditary colon cancer.

Familial Adenomatous Polyposis (FAP) is an autosomal dominant disorder caused by mutation of the APC gene presenting with numerous colorectal adenomatous polyps and a near 100% risk of colon cancer. Preliminary research findings from our group indicate that FAP patients experience significant deficits across many cognitive domains. In the current study, fMRI brain metrics in a FAP population and matched controls were used to further the mechanistic understanding of reported cognitive deficits. This research identified and characterized any possible differences in resting brain networks and associations between neural network changes and cognition from 34 participants (18 FAP patients, 16 healthy controls). Functional connectivity analysis was performed using FSL with independent component analysis (ICA) to identify functional networks. Significant differences between cases and controls were observed in 8 well-established resting state networks. With the addition of an aggregate cognitive measure as a covariate, these differences were virtually non-existent, indicating a strong correlation between cognition and brain activity at the network level. The data indicate robust and pervasive effects on functional neural network activity among FAP patients and these effects are likely involved in cognitive deficits associated with this disease.

Enzyme mediated site-specific surface modification.

Stable tethering of bioactive peptides like RGD to surfaces can be achieved via chemical bonding, biotin streptavidin interaction, or photocross-linking. More challenging is the immobilization of proteins, since methods applied to immobilize peptides are either not specific or versatile enough or might even compromise the protein's bioactivity. To overcome this limitation, we have employed a scheme that by enzymatic (transglutaminase) reaction allows the site-directed and site-specific coupling of growth factors and other molecules to nonfouling poly(L-lysine)-graft-poly(ethylene glycol) (PLL-g-PEG) coated surfaces under physiological conditions. By our modular and flexible design principle, we are able to functionalize these surfaces directly with peptides and growth factors or precisely position poly(ethylene glycol) (PEG)-like hydrogels for the presentation of growth factors as exemplified with vascular endothelial growth factor (VEGF).

Measuring HIV felt stigma: a culturally adapted scale targeting PLWHA in Puerto Rico.

The objective of this study was to culturally adapt and validate a scale to measure HIV-related felt stigma in a group of People living with HIV/AIDS (PLWHA) in Puerto Rico. The researchers conducted a two-phase cross-sectional study with 216 participants (60, first phase; 156, second phase). The first phase consisted of the cultural adaptation of the scale; the second evaluated its psychometric properties. After conducting a factor analysis, a 17-item scale, the HIV Felt-Stigma Scale (HFSS), resulted. Participants completed the Puerto Rico Comprehensive Center for the Study of Health Disparities Socio-demographic Questionnaire, the HFSS, the Beck Depression Inventory-II, and the Sexual Abuse dimension of the History of Abuse Questionnaire; the case managers completed the Case Manager Stigma Guide with subjects. The HFSS measures four dimensions: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. The alpha and Pearson correlation coefficients (0.91 and 0.68, respectively) indicated satisfactory validity and reliability; the scale suggested adequate convergent validity. The HFSS is a culturally sensitive instrument that fills the existing gap in the measurement of felt stigma in Spanish-speaking PLWHA.

Altered Resting State Brain Networks and Cognition in Familial Adenomatous Polyposis.

Familial Adenomatous Polyposis (FAP) is an autosomal dominant disorder caused by mutation of the APC gene presenting with numerous colorectal adenomatous polyps and a near 100% risk of colon cancer. Preliminary research findings from our group indicate that FAP patients experience significant deficits across many cognitive domains. In the current study, fMRI brain metrics in a FAP population and matched controls were used to further the mechanistic understanding of reported cognitive deficits. This research identified and characterized any possible differences in resting brain networks and associations between neural network changes and cognition from 34 participants (18 FAP patients, 16 healthy controls). Functional connectivity analysis was performed using FSL with independent component analysis (ICA) to identify functional networks. Significant differences between cases and controls were observed in 8 well-established resting state networks. With the addition of an aggregate cognitive measure as a covariate, these differences were virtually non-existent, indicating a strong correlation between cognition and brain activity at the network level. The data indicate robust and pervasive effects on functional neural network activity among FAP patients and these effects are likely involved in cognitive deficits associated with this disease.

Smart Hydrogels for the Augmentation of Bone Regeneration by Endogenous Mesenchymal Progenitor Cell Recruitment.

The treatment of bone defects with recombinant bone morphogenetic protein-2 (BMP-2) requires high doses precluding broad clinical application. Here, a bioengineering approach is presented that strongly improves low-dose BMP-2-based bone regeneration by mobilizing healing-associated mesenchymal progenitor cells (MPCs). Smart synthetic hydrogels are used to trap and study endogenous MPCs trafficking to bone defects. Hydrogel-trapped and prospectively isolated MPCs differentiate into multiple lineages in vitro and form bone in vivo. In vitro screenings reveal that platelet-derived growth factor BB (PDGF-BB) strongly recruits prospective MPCs making it a promising candidate for the engineering of hydrogels that enrich endogenous MPCs in vivo. However, PDGF-BB inhibits BMP-2-mediated osteogenesis both in vitro and in vivo. In contrast, smart two-way dynamic release hydrogels with fast-release of PDGF-BB and sustained delivery of BMP-2 beneficially promote the healing of bone defects. Collectively, it is shown that modulating the dynamics of endogenous progenitor cells in vivo by smart synthetic hydrogels significantly improves bone healing and holds great potential for other advanced applications in regenerative medicine.

Functionalized self-assembling peptide hydrogel enhance maintenance of hepatocyte activity in vitro.

There is a major challenge in maintaining functional hepatocytes in vivo as these cells rapidly lose their metabolic properties in culture. In this work we have developed a bioengineered platform that replaces the use of the collagen I--in the traditional culture sandwich technique--by a defined extracellular matrix analogue, the self-assembling peptide hydrogel RAD16-I functionalized with biologically active motifs. Thus, after examining side by side the two culture systems we have found that in both cases hepatocytes acquired similar parenchymal morphology, presence of functional bile canaliculi structures, CYP3A2 induction by dexamethasone, urea production, secretion of proteins such as apolipoprotein (class A1, E, J), alpha(1)-microglobulin, alpha(1)-macroglobulin, retinol binding protein, fibronectin, alpha(1)-inhibitor III and biotin-dependent carboxylases. Interestingly, by assessing in more detail some other hepatic markers, one of the functionalized matrix analogues--carrying the 67 kD laminin receptor ligand--enhanced the gene expression of albumin, HNF4-alpha, MDR2 and tyrosine aminotransferase. We conclude that the use of a synthetic culture system with designed matrix functionalization has the advantage in controlling specific cellular responses.

The effect of sympathy on discriminatory attitudes toward persons living with HIV/AIDS in Puerto Rico: a hierarchical analysis of women living in public housing.

As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Puerto Rico, it becomes increasingly important to address the issues of stigma and other discriminatory attitudes. Therefore, the objective of the present study is to examine the attitudes toward PLWHA of a large sample of women living in public housing in Puerto Rico, including sympathy and support for PLWHA in the workplace and in school. A total of 1138 women completed a self-administered 218-item survey made up of questions that measured HIV-related knowledge, attitudes and behaviors. Levels of sympathy varied depending upon the target group, with HIV-infected drug users receiving the least sympathy. Most women reported that HIV-positive teachers should be allowed to teach and that HIV-positive children should be allowed to attend school. However, a significantly lower percentage reported that HIV-infected nurses should be allowed to continue working. Women who were more sympathetic toward PLWHA were more tolerant of PLWHA in the workplace and school, while those with inaccurate knowledge concerning HIV transmission were less tolerant. Also, those who knew a PLWHA were more tolerant. Levels of discriminatory attitudes in Puerto Rico are high and warrant both individual- and societal-level interventions.

HIV testing practices among women living in public housing in Puerto Rico.

OBJECTIVE: The objective of our study was to examine HIV testing practices among a large sample of women living in public housing in Puerto Rico and the relationships among HIV testing, sociodemographic variables, and HIV-related behaviors. METHODS: A total of 1138 women were surveyed between April and August 2006 using a self-administered survey instrument. RESULTS: Eighty-two percent of the women in the sample group reported a history of HIV testing. Hierarchical logistic regression analyses revealed that those adults who were at least 25 years of age and those who perceived some risk of HIV were more likely to report previous HIV testing. Also, those who had attended an HIV/AIDS education workshop or discussion and those who reported knowing persons living with HIV/AIDS were more likely to report previous testing. CONCLUSIONS: A large percentage of the women in our study have been tested for HIV; it is imperative, however, that appropriate HIV education and prevention messages be given to them when they receive their results. Client-initiated HIV testing to learn HIV status provided through counseling and testing remains critical to the effectiveness of HIV prevention. It is unwise to underestimate the importance of being tested. One of the first steps in self-protection from HIV is to be informed of one's HIV status, which allows one to make appropriate and responsible sexual decisions. Future success in decreasing the number of new infections among women will result from targeting women who may be at high risk, although not because of sex work or drug use. Increasing knowledge of HIV serostatus and the implications of these results, especially among those who are infected, can serve as a gateway to sustained behavioral risk reduction intervention, as well as to care and treatment. Considering the fact that both the actual and estimated numbers of HIV/AIDS cases among women in Puerto Rico continue to increase, it is clear that effective, targeted, and aggressive strategies are urgently needed to prevent both primary and secondary HIV transmission.

National Health Care Network for children with oral clefts: organization, functioning, and preliminary outcomes. / Red nacional para la atención de niños/as con fisuras orales: organización, funcionamiento y primeros resultados.

INTRODUCTION: Oral clefts are major congenital anomalies that may affect the lip and/or palate, and that may also involve the nose and nostrils. In Argentina, their prevalence is approximately 15 per 10 000 births. In 2015, the Ministry of Health of Argentina created a national health care network for children with oral clefts in Argentina through the joint work with the National Registry of Congenital Anomalies (Red Nacional de Anomalías Congénitas, RENAC) (coordinating center for the national network) and the SUMAR Program. The objective of this study was to describe the health care network and its preliminary outcomes. POPULATION AND METHODS: A total of 61 centers that provided a comprehensive treatment for oral clefts or in collaboration with other centers were identified and accredited. Maternity centers were connected with treating centers grouped in health care network nodes. RESULTS: In the period between March 2015 and February 2016, 550 newborn infants who were exclusively covered by the public health care system were identified. Among these, 18% had a cleft lip; 62%, cleft lip and palate; and 20%, cleft palate only; 75% were isolated cases and 25%, in association with other congenital anomalies. CONCLUSION: Approximately 70% of children were assessed by a certified treating institution and are receiving treatment. The network seeks to improve data systematization, include the largest number of centers possible, strengthen interdisciplinary team work, and promote high-quality standards for treatments.

INTRODUCCIÓN: Las fisuras orales son anomalías congénitas mayores que comprometen la integridad del labio y/o paladar, y pueden también afectar la nariz y las fosas nasales. La prevalencia enArgentina esde, aproximadamente, 15 afectados cada 10 000 nacimientos. El Ministerio de Salud de la Nación implemento, a partir del año 2015, una red nacional para la atención de niños/as con fisuras orales en Argentina a través de un trabajo conjunto entre la Red Nacional de Anomalías Congénitas (RENAC) (centro coordinador de la red nacional) y el Programa SUMAR. El objetivo de este trabajo es describir la red de atención y sus primeros resultados. POBLACIÓN Y MÉTODOS: Se identificaron y acreditaron 61 instituciones que realizaban el tratamiento de fisuras orales de manera integral o articuladamente con otras instituciones. Se conectaron las maternidades con las instituciones tratantes, que se agruparon en nodos de la red de atención. RESULTADOS: En el período entre marzo de 2015 y febrero de 2016, se identificaron 550 recién nacidos con cobertura exclusiva del sector público de salud. De ellos, un 18% presentó fisura de labio; 62%, fisura de labio y paladar; y 20%, fisura de paladar únicamente; en un 75% se presentaron de forma aislada y, en un 25%, asociadas a otras anomalías congénitas. CONCLUSIÓN: Un 70% de los niños fue evaluado por una institución tratante acreditada y se encuentran en tratamiento. Se busca mejorar la sistematización de los datos, incorporar mayor cantidad de instituciones, fortalecer el trabajo interdisciplinario de los equipos y promover estándares de calidad para los tratamientos.

Primer reporte en Cuba de Anisakis spp. en muestras de pescado en conserva / First report in Cuba of Anisakis spp. in samples of canned fish

Introducción: Las especies de Anisakis representan uno de los grupos parasitarios patógenos transmitidos por alimentos más importantes en relación con sus capacidades zoonóticas y pueden producir una enfermedad emergente llamada anisakiosis. En Cuba, no existen reportes de la enfermedad como tampoco publicaciones sobre la detección del parásito en muestras de productos pesqueros. Objetivo: Identificar larvas de Anisakis spp. en muestras de productos pesqueros. Métodos: Se realizó un estudio para la búsqueda de larvas de Anisakis spp. en muestras de productos pesqueros en conserva recibidos en el Laboratorio de Parasitología de los alimentos del Instituto Nacional de Higiene, Epidemiología y Microbiología de Cuba. Se recibieron 96 muestras de dos marcas diferentes. A cada marca se le asignó las letras A o B para proteger la identidad del fabricante. Las larvas recuperadas fueron previamente aclaradas con lactofenol e identificadas morfológicamente por microscopía. Se utilizaron las claves de identificación para larvas de Anisakis spp. descritas en la literatura. Resultados: El 38,5 por ciento del total de muestras de pescado en conserva analizadas estuvieron parasitadas con larvas de Anisakis spp., con una frecuencia media de 1,2 larvas por cada submuestra. Las larvas fueron clasificadas de tercer estadio y de tipo I. Conclusiones: Por primera vez se identificó en Cuba larvas de Anisakis spp. en muestras de pescado en conserva y se proporcionó datos de interés a las autoridades sanitarias para el fortalecimiento de políticas públicas relacionadas con la calidad e inocuidad de los alimentos(AU)

Introduction: Anisakis species represent one of the most important foodborne pathogenic parasitic groups in relation to their zoonotic capabilities, and can produce an emerging disease called anisakiosis. In Cuba, there are no reports of the disease and there are no publications on the detection of the parasite in samples of fishery products. Objective: To identify Anisakis spp. larvae in samples of fishery products. Methods: A study was conducted to search for Anisakis spp. larvae in samples of canned fish products received at the Laboratory of Food Parasitology of the National Institute of Hygiene, Epidemiology and Microbiology of Cuba. Ninety-six samples of two different brands were received. Each brand was assigned letter A or B to protect the identity of the manufacturer. The larvae recovered were previously rinsed with lactophenol and identified morphologically by microscopy. The identification keys for Anisakis spp. larvae described in the literature were used. Results: 38.5 percent of the total canned fish samples analyzed were parasitized with Anisakis spp. larvae, with a mean frequency of 1.2 larvae per subsample. The larvae were classified as third instar and type I. Conclusions: For the first time in Cuba, Anisakis spp. larvae were identified in canned fish samples and provided data of interest to health authorities to strengthen public policies related to food quality and safety(AU)

Strategies to increase the hygienic and economic value of fresh fish: Biopreservation using lactic acid bacteria of marine origin.

In this work we describe the development of a biopreservation strategy for fresh fish based on the use of bacteriocinogenic LAB of marine origin. For this purpose, two multibacteriocinogenic LAB strains, Lactobacillus curvatus BCS35 and Enterococcus faecium BNM58, previously isolated from fish and fish products were selected owing to their capability to inhibit the growth of several fish-spoilage and food-borne pathogenic bacteria. Two commercially important fish species were chosen, young hake (Merluccius merluccius) and megrim (Lepidorhombus boscii), and the specimens were acquired at the Marín (Pontevedra, Spain) retail fish market, after one night in the chilled hold of a near-shore fishing vessel. The biopreservation potential and the application strategies of these two LAB strains were first tested at a laboratory scale, where several batches of fresh fish were inoculated with: (i) the multibacteriocinogenic LAB culture(s) as protective culture(s); and/or (ii) their cell-free culture supernatant(s) as food ingredient(s), and (iii) the lyophilized bacteriocin preparation(s) as lyophilized food ingredient(s). All batches were stored in polystyrene boxes, permanently filled with ice at 0-2 °C, for 14 days. Microbiological analyses, as well as sensorial analyses, were carried out during the biopreservation trials. Subsequently, Lb. curvatus BCS35 was selected to up-scale the trials, and combinations of the three application methods were assayed. For this purpose, this strain was grown in a semi-industrial scale fermentor (150l) in modified MRS broth, and three batches of fresh fish were inoculated with the protective culture and/or food ingredient, and stored on ice in a chilled chamber at 0-2 °C at the Marín retail fish market for 14 days. Microbiological analyses were carried out during the storage period, showing that when Lb. curvatus BCS35 culture or the corresponding cell-free culture supernatant was used as protective culture or food ingredient, respectively, bacterial counts were significantly lower than those of the untreated control batches, both for young hake and megrim. In addition, the presence of Listeria spp. in megrim was inhibited in both analyses. The effect of protective culture or food ingredient on the sensory characteristics of fish was evaluated by an official fish appraiser from the Marín retail fish market, who concluded that all the biopreserved batches were worth a higher price in the fish market than the respective control batches, demonstrating that the multibacteriocinogenic strain of marine origin Lb. curvatus BCS35 may be considered as a suitable candidate for its application as fresh fish biopreservative.

Scleromyxedema: clinical diagnosis and autopsy findings.

Scleromyxedema is a rare chronic cutaneous mucinosis of unknown etiology. It is characterized by papular eruption and scleroderma with microscopic evidence of mucin deposition, fibroblast proliferation, and fibrosis. Most patients with scleromyxedema have monoclonal gammopathy and systemic manifestations resulting in significant morbidity and mortality. Several types of treatment have been reported with partial or inconsistent responses. Despite showing unpredictable evolution, systemic consequences of scleromyxedema and treatment side effects may result in death. We describe a rare case of a patient with scleromyxedema without paraproteinemia with systemic involvement that evolved to death despite treatment with cyclophosphamide.

Red nacional para la atención de niños/as con fisuras orales: organización, funcionamiento y primeros resultados / National Health Care Network for children with oral clefts: organization, functioning, and preliminary outcomes

Introducción. Las fisuras orales son anomalías congénitas mayores que comprometen la integridad del labio y/o paladar, y pueden también afectar la nariz y las fosas nasales. La prevalencia enArgentina esde, aproximadamente, 15 afectados cada 10 000 nacimientos. El Ministerio de Salud de la Nación implemento, a partir del año 2015, una red nacional para la atención de niños/as con fisuras orales en Argentina a través de un trabajo conjunto entre la Red Nacional de Anomalías Congénitas (RENAC) (centro coordinador de la red nacional) y el Programa SUMAR. El objetivo de este trabajo es describir la red de atención y sus primeros resultados. Población y métodos. Se identificaron y acreditaron 61 instituciones que realizaban el tratamiento de fisuras orales de manera integral o articuladamente con otras instituciones. Se conectaron las maternidades con las instituciones tratantes, que se agruparon en nodos de la red de atención. Resultados. En el período entre marzo de 2015 y febrero de 2016, se identificaron 550 recién nacidos con cobertura exclusiva del sector público de salud. De ellos, un 18% presentó fisura de labio; 62%, fisura de labio y paladar; y 20%, fisura de paladar únicamente; en un 75% se presentaron de forma aislada y, en un 25%, asociadas a otras anomalías congénitas. Conclusión. Un 70% de los niños fue evaluado por una institución tratante acreditada y se encuentran en tratamiento. Se busca mejorar la sistematización de los datos, incorporar mayor cantidad de instituciones, fortalecer el trabajo interdisciplinario de los equipos y promover estándares de calidad para los tratamientos.

Introduction. Oral clefts are major congenital anomalies that may affect the lip and/or palate, and that may also involve the nose and nostrils. In Argentina, their prevalence is approximately 15 per 10 000 births. In 2015, the Ministry of Health of Argentina created a national health care network for children with oral clefts in Argentina through the joint work with the National Registry of Congenital Anomalies (Red Nacional de Anomalías Congénitas, RENAC) (coordinating center for the national network) and the SUMAR Program. The objective of this study was to describe the health care network and its preliminary outcomes. Population and methods. A total of 61 centers that provided a comprehensive treatment for oral clefts or in collaboration with other centers were identified and accredited. Maternity centers were connected with treating centers grouped in health care network nodes. Results. In the period between March 2015 and February 2016, 550 newborn infants who were exclusively covered by the public health care system were identified. Among these, 18% had a cleft lip; 62%, cleft lip and palate; and 20%, cleft palate only; 75% were isolated cases and 25%, in association with other congenital anomalies. Conclusion. Approximately 70% of children were assessed by a certified treating institution and are receiving treatment. The network seeks to improve data systematization, include the largest number of centers possible, strengthen interdisciplinary team work, and promote high-quality standards for treatments.

Engineering 3D cell instructive microenvironments by rational assembly of artificial extracellular matrices and cell patterning.

Engineered artificial microenvironments hold enormous potential as models to study developmental, physiological, pathological, and regenerative processes under highly defined conditions. Such platforms aim at bridging the gap between traditional in vitro 2D culture systems and animal models. By dissecting the biological complexity into an amenable number of parameters, systemic manipulation and study in controllable environments closely resembling the in vivo situation is possible. Novel strategies that address the evaluation of either ECM components, growth factors or cell-cell interactions on cellular behaviour are being developed. However, reliable methods that simultaneously recapitulate the natural instructive microenvironments in terms of cell and matrix composition, biological cues, heterogeneity and geometry are not yet available. Such spatially-defined microenvironments may be necessary to initiate and guide the formation of artificial tissues by morphogenetic processes. In this work, we introduce a flexible strategy that relies on the combination of artificial extracellular matrices with patterning techniques as well as a layer-by-layer approach to mimic rationally-designed instructive milieus. By a rational arrangement of cells and defined biochemical and biophysical extracellular cues, we report control of cell migration and generation of an artificial vascularized bone tissue-like construct.

Felt Stigma in Injection Drug Users and Sex Workers: Focus Group Research with HIV-Risk Populations in Puerto Rico.

Though many studies have conclusively linked felt stigma and HIV, few have focused on the experiences of rejection felt by members of such socially marginalized groups as intravenous drug users (IDU) and sex workers (SW). Using focus groups, our study explored these experiences in 34 individuals (17 male UDUs and 17 female SWs) at risk of becoming infected with HIV, the objective being to discover why they engaged in maladaptive behaviors as a way of coping with felt stigma. We used deductive and inductive analysis to codify the resulting data. Concepts associated with the word stigma, emotional reactions to felt stigma, and the impact of felt stigma on self-schema helped elucidate how the internalization of felt stigma can lead to negative affective states and self-destructive behaviors (e.g., drug use and syringe exchange). Results underline the importance of developing intervention models that reduce stigma as a means of HIV prevention in vulnerable populations.