Trocar shortening for pediatric vitreoretinal surgery with a 3D printed trocar spacer: Report of two cases.

PURPOSE: To show the results of a trocar spacer for pediatric vitreoretinal surgery with a 3D printed trocar spacer in 2 cases. METHODS: We used standard 27 gauge (ga) and 25 ga trocars and cannulae, and prototyped 1.5 mm × 3 mm spacers with a Prusa MK3 3D printer (0.4 mm nozzle) with Fuse deposition melting (FDM) technology. Parts were printed with a 50 µm layer height in polylactic acid or polylactide (PLA). The spacer was placed in two places: between the blade's base and the trocar, and between the trocar and the sclera depending on the desired amount of shortening. This prototype was used in 2 vitrectomy cases in pediatric patients. RESULTS: We used this trocar spacer in 2 cases with positive results. CONCLUSIONS: This 3D printed spacer has proved to effectively shorten the introduced trocar into two different small eyes. More studies are needed to validate the efficacy and safety of this spacer in clinical practice.

Prebiotics and phytogenics functional additives in low fish meal and fish oil based diets for European sea bass (Dicentrarchus labrax): Effects on stress and immune responses.

The use of terrestrial raw materials to replace fish meal (FM) and fish oil (FO) in marine fish diets may affect fish growth performance and health. In the last years functional additives have been profiled as good candidates to reduce the effects on health and disease resistance derived from this replacement, via reinforcement of the fish immune system. In the present study, three isoenergetic and isonitrogenous diets with low FM and FO (10% and 6% respectively) were tested based on supplementation either with 0.5% galactomannanoligosaccharides (GMOS diet) or 0.02% of a mixture of essential oils (PHYTO diet), a non-supplemented diet was defined as a control diet. Fish were fed the experimental diets in triplicate for 9 weeks and then they were subjected to a stress by confinement as a single challenge (C treatment) or combined with an experimental intestinal infection with Vibrio anguillarum (CI treatment). Along the challenge test, selected stress and immunological parameters were evaluated at 2, 24 and 168h after C or CI challenges. As stress indicators, circulating plasma cortisol and glucose concentrations were analyzed as well as the relative gene expression of cyp11b hydroxylase, hypoxia inducible factor, steroidogenic acute regulatory protein, heat shock protein 70 and heat shock protein 90 (cyp11b, hif-1α, StAR, hsp70 and hsp90). As immune markers, serum and skin mucus lysozyme, bactericidal and peroxidase activities were measured, as well as gene expression of Caspase-3 (casp-3) and interleukin 1ß (il-1ß). The use of functional additives induced a significant (p < 0.05) reduction of circulating plasma cortisol concentration when confinement was the unique challenge test applied. Supplementation of PHYTO induced a down-regulation of cyp11b, hif-1α, casp-3 and il-1ß gene expression 2h after stress test, whereas StAR expression was significantly (p < 0.05) up-regulated. However, when combination of confinement stress and infection was applied (CI treatment), the use of PHYTO significantly (p < 0.05) down-regulated StAR and casp-3 gene expression 2h after challenge test, denoting that PHYTO diet reinforced fish capacity of stress response via protection of head kidney leucocytes from stress-related apoptotic processes, with lower caspase-3 gene expression and a higher il-1ß gene expression when an infection occurs. Additionally, dietary supplementation with GMOS and PHYTO compounds increased fish serum lysozyme after infection. Both functional additives entailed a better capability of the animals to cope with infection in European sea bass when fed low FM and FO diets.

Fast update of undetected Mycobacterium chimaera infections to reveal unsuspected cases.

Mycobacterium chimaera is involved in a worldwide alert due to contaminated heater-cooler units. A real-time polymerase chain reaction (RT-PCR)-based procedure was implemented to survey undetected cases of M. chimaera infection. PCR was negative in the 59 prosthetic heart valves from patients with PCR-16SrRNA-negative infective endocarditis. PCR identified M. chimaera in one of 15 clinically significant retrospective Mycobacterium avium-Mycobacterium intracellulare complex isolates, which corresponded to a patient who had undergone heart valve replacement in a different institution. Whole-genome sequencing demonstrated that he was the first case in Spain with involvement of the strain responsible for the global outbreak. These results highlight the relevance of retrospective tracking for undetected M. chimaera infections.

Follicular Unit Extraction for Hair Transplantation: An Update. / Actualización del método Follicular Unit Extraction (FUE) del trasplante de pelo.

Follicular unit extraction (FUE) is a hair transplantation technique that uses small punches (0.8-1 mm in diameter) to extract the follicular units (FUs). Though initially the technique was not widely accepted because of the difficulty of extracting intact follicular units with such small punches, it has since gained in popularity due mainly to rising patient demand, the availability of better instrumentation and greater surgical skill acquired from experience. It is now a recognised alternative to follicular unit transplantation (FUT), a technique based on harvesting the FUs from a strip of tissue. Among the advantages of FUE are less post-procedural discomfort in the donor zone and the barely visible scarring from the punches. However, FUE is a more laborious, time-consuming procedure that involves a long learning curve for the surgeon.

Hair-follicle Transplant Into Chronic Ulcers: A New Graft Concept. / Trasplante de folículos pilosos en úlceras crónicas: un nuevo concepto de injerto.

Chronic venous leg ulcers are a major therapeutic challenge in clinical practice, and the search for new approaches to improve wound healing is essential. Many ulcers do not heal with traditional treatment using compression, debridement, and dressings. Skin-grafts variants, such as pinch grafts, punch grafts, split- or full-thickness skin grafts, and grafts derived from cells cultured in the laboratory, are among the most widely used options in ulcers that do not heal. In recent years, numerous studies have brought to our attention the important role of the hair follicle in the healing process of cutaneous wounds. Putting knowledge into practice, hair follicles from the scalp have been used in punch-type grafts transplanted to the base of chronic ulcers to stimulate healing. Results appear to be better than those with traditional hairless punch grafts, opening new lines of treatment for recalcitrant chronic venous ulcers.

Supplementation of arachidonic acid rich oil in European sea bass juveniles (Dicentrarchus labrax) diets: Effects on leucocytes and plasma fatty acid profiles, selected immune parameters and circulating prostaglandins levels.

The main objective of this study was to assess the effects of graded levels of dietary arachidonic acid (ARA), supplemented from alternative sources, on fatty acid composition of plasma and head kidney leucocytes of European sea bass (Dicentrarchus labrax). For that purpose, sea bass juveniles were fed four diets containing graded levels of ARA as follows: 0.5% (ARA0.5), 1% (ARA1), 2% (ARA2) and 4% (ARA4) during 60 days. At the end of the feeding trial fatty acid profiles of plasma and head kidney leucocytes were analyzed. Besides, plasma prostaglandins levels, head kidney leucocytes respiratory burst activity; peroxidase activity and phagocytic index were assayed. Reducing dietary ARA levels below 1% markedly reduced European sea bass growth performance. However, fish fed diet ARA0.5 tried to compensate this dietary ARA deficiency by a selective deposition of ARA on plasma and head kidney leucocytes, reaching similar levels to those fish fed diet ARA1 after 60 days of feeding. Nevertheless, head kidney phagocytic capacity was reduced as dietary ARA content in relation not only to variations on membrane composition but also to changes on fish basal prostaglandins levels. Results obtained demonstrated the importance to supply the necessary quantity n-6 LC-PUFA, and not only n-3 LC-PUFA levels, in European sea bass diets, in relation to not only growth performance but also immune system function.

Tyrosinemia type II: Mutation update, 11 novel mutations and description of 5 independent subjects with a novel founder mutation.

BACKGROUND: Tyrosinemia type II, also known as Richner-Hanhart Syndrome, is an extremely rare autosomal recessive disorder, caused by mutations in the gene encoding hepatic cytosolic tyrosine aminotransferase, leading to the accumulation of tyrosine and its metabolites which cause ocular and skin lesions, that may be accompanied by neurological manifestations, mostly intellectual disability. AIMS: To update disease-causing mutations and current clinical knowledge of the disease. MATERIALS AND METHODS: Genetic and clinical information were obtained from a collection of both unreported and previously reported cases. RESULTS: We report 106 families, represented by 143 individuals, carrying a total of 36 genetic variants, 11 of them not previously known to be associated with the disease. Variants include 3 large deletions, 21 non-synonymous and 5 nonsense amino-acid changes, 5 frameshifts and 2 splice variants. We also report 5 patients from Gran Canaria, representing the largest known group of unrelated families sharing the same P406L mutation. CONCLUSIONS: Data analysis did not reveal a genotype-phenotype correlation, but stressed the need of early diagnosis: All patients improved the oculocutaneous lesions after dietary treatment but neurological symptoms prevailed. The discovery of founder mutations in isolated populations, and the benefits of early intervention, should increase diagnostic awareness in newborns.

[Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document)]. / Documento multidisciplinar de consenso sobre elmanejo de la hemorragia masiva (document HEMOMAS)

Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).

Variances in the Use of Everolimus in Kidney Transplantation: A 2-Year Registry of Everyday Practice.

BACKGROUND: Everolimus (EVL)-based immunosuppressive strategies may permit the reduction of calcineurin inhibitors (CNI) and their side effects, while offering a safe and efficient treatment. Our aim was to describe our experience with EVL in everyday practice and provide information for its optimal utilization. METHODS: Prospective, multicenter study of 181 kidney transplant recipients treated with EVL as part of their immunosuppressive regimen, with a follow-up of 24 months. We studied demographic data, transplant characteristics, clinical information, drugs used, serum creatinine, estimated glomerular filtration rate (eGFR), rejection episodes, and adverse events. RESULTS: In total, 181 renal transplant recipients were included. Of these, 30 (16.6%) received EVL de novo and 151 (83.4%) were converted; median time from transplantation to conversion was 10 (range, 1-312) months. Main reasons for conversion were prevention of interstitial fibrosis and tubular atrophy (23.9%), intolerance to immunosuppressants (11.1%), neoplasia (13.9%), nephrotoxicity (8.9%), and cytomegalovirus infections (8.3%). The eGFR values at baseline, months 12, and 24 were 46.4 ± 27.4 mL/min, 54.8 ± 22.9 mL/min, and 55.9 ± 26.5 ml/min, respectively. Two of 181 (1.1%) patients died, 5 of 181 (2.8%) lost their grafts, 12 of 181 (6.6%) had an episode of acute rejection, 13 of 181 (7.2%) had ≥1 serious event and infection, and 85 of 181 (49.9%) had ≥1 nonserious adverse event or infection. Multivariate analysis showed that increased eGFR at month 24 was associated with lower donor age, shorter time from transplant to EVL introduction, and a baseline eGFR ≥40 mL/min. CONCLUSION: Through different strategies among centers, the inclusion of EVL improved renal function during the first 12 months.

Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document).

Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).

Immunization of sea bream (Sparus aurata) juveniles against Photobacterium damselae subsp. piscicida by short bath: Effect on some pro-inflammatory molecules and the Mx gene expression.

Cytokines are a family of proteins derived from macrophages, lymphocytes, granulocytes, mast cells and epithelial cells and can be divided into interferons (IFNs), Interleukins (ILs) and Tumor Necrosis factors (TNFs) among others. The presence of cytokines in a wide number of fish species has been proved and several molecules types have been already cloned and sequenced. In this work some proinflamatory molecules and Mx gene were detected in the liver of vaccinated sea bream juveniles with an average body weight of 5 g. The method of immunization was by short bath and three different bacterins against the marine pathogen Photobacterium damselae subsp. piscicida were designed and used to immunize fish. Five genes encoding for five different molecules were analyzed by real time PCR: IL-1ß, IL Ir-2, Cox-2, Mx and TNFα. Gene expression was quantified along four days after fish immunization and results were compared among groups. Results show that the heat-inactivated vaccine stimulates the up-regulation of IL-1ß, IL Ir-2, Cox-2 and TNFα genes whereas the UV-light inactivated vaccine was the unique vaccine which stimulates the expression of Mx gene. The present is a novel study that shows by the first time the effect of the inactivation process of vaccines on the expression levels of genes involved in the defense against Photobacterium damselae subsp piscicida.

Differential innate immune response of European seabass (Dicentrarchus labrax) against Streptococcus iniae.

Streptococcus iniae is a Gram-positive bacteria that causes invasive infections with severe septicemia and meningitis, producing high economic losses in marine and continental aquaculture. Head kidney leukocytes of European sea bass (Dicentrarchus labrax) were used to measure the differential innate immune response upon infection with S. iniae. The complete inhibition in the production of intracellular superoxide radicals and total peroxidase content was observed in infected cells. This study also elucidates changes in the relative expression of some immune-related genes. Interleukin 1ß, tumor necrosis factor-α and interleukin-6 reached a peak of expression at 4-8 h post-infection, subsequently decreasing significantly up to 48 h post-infection. However, interleukin-10 and Mx protein increased over time, reaching the pick of expression at 48 h post-infection, whereas caspase-3 showed down regulation until 48 h post-infection. The in vivo study of immune related genes show the same kinetics of mRNAs expression as in vitro experience. The proinflammatory cytokines mRNA transcription levels peaked at an earlier time in vivo than in vitro system. Our findings indicate that there is a direct relationship between the dissemination of bacteria and the resulting infection-associated inhibition of respiratory burst, apoptosis, and the pro- and anti-inflammatory gene expression profiles.

Frecuencia de genes que codifican factores de virulencia en staphylococcus aureus aislados de niños que concurrieron al hospital general pediátrico niños de acosta ñú, durante el año 2010 / Frequency of gens that codify virulence factors in staphylococcus aureus isolated from children attending the niños de acosta ñú pediatric general hospital in 2010

Staphylococcus aureus es un microorganismo con habilidad de infectar diferentes tejidos celulares, por portar genes que le confieren resistencia a antibióticos, factores de virulencia y su plasticidad genética, que podrían contribuir a una progresión rápida y complicada de la enfermedad. El Paraguay no cuenta con datos epidemiológicos que indiquen los factores de virulencia que presentan las cepas de S. aureus, por lo que el objetivo del trabajo fue determinar un perfil de virulencia detectando los genes codificantes de: hemolisinas α y β,enterotoxinas A, B, C, D, H y toxinas exfoliativas A y B. Este estudio observacional descriptivo de corte transverso, con muestreo no probabilístico de casos consecutivos, incluyó 50 aislados de S. aureus obtenidos a partir de muestras clínicas de secreciones de piel, partes blandas o líquidos corporales de pacientes menores de 17 años que concurrieron al Hospital General Pediátrico Niños de Acosta Ñú durante el año 2.010. Las reacciones de PCR incluyeron la detección de los genes: sea+seb+sec+ADNr16S, hlA+hlB, eta+etb, sed y seh. El 82% de los aislados provenía de niños que presentaron cuadros clínicos compatibles con infecciones de piel y partes blandas y el 18% de cuadros clínicos graves como sepsis, osteomielitis y neumonías. Los aislados contaban con datos de portación de Leucocidina de Panton-Valentine, el cual fue el factor de virulencia más frecuentemente detectado (58%), seguido de las hemolisinas alfa (16%) y beta (8%). Las enterotoxinas y las toxinas exfoliativas fueron menos frecuentes (0-2%), y no se detectaron genes codificantes de las enterotoxinas C y D.

Staphylococcus aureus is a pathogen that has the ability to successfully infect differenttissues, because it carries genes that confer antibiotic resistance, virulence factors and itshigh genetic plasticity, that could contribute to a quick and complicated diseaseprogression. Paraguay does not have epidemiological data indicating the virulence factorspresented in S. aureus strains. Therefore, the aim of this study was to determine thevirulence profile by molecular methods detecting the codifying genes of: α and β hemolysin, enterotoxins A, B, C, D, H and exfoliative toxins A and B. This descriptiveobservational study with non-probability sampling of consecutives cases, included 50 S.aureus isolates obtained from clinical specimens from skin secretions, soft tissue or bodyfluids of patients younger than 17 years who attended the Niños de Acosta Ñú PediatricGeneral Hospital in 2010. The PCR reactions included the detection of the followinggenes: sea+seb+sec+ADNr16S, hlA+hlB, eta+etb, sed and seh. The 82% of the isolatescame from children skin and soft tissue infections and 18% came from invasive diseasessuch as sepsis, osteomyelitis and pneumonia. The Panton Valentine leukocidin, whichdata was previously obtained, was the most frequently virulence factor detected (58%),followed by alpha (16%) and beta (8%) hemolysins. Enterotoxins and exfoliative toxinswere less frequent (0-2%) and the enterotoxins C and D genes were not detected.

The in vitro immunomodulatory effect of extracellular products (ECPs) of Vagococcus fluvialis L21 on European sea bass (Dicentrarchus labrax) leucocytes.

The immune associated genes, interleukin-1ß (IL-1ß), interleukin-6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor-α (TNF-α), ciclo-oxigenase-2 (COX-2), and Mx gene were studied by real-time PCR in head-kidney leucocytes of sea bass after incubation with the extracellular products (ECPs) of the probiotic strain Vagococcus fluvialis L21 and polyinosinic:polycytidylic acid (POLY I:C), at different times (T1.5, T6, T12, T24, T48 and T72). In general, we can observe how pro-inflammatory cytokines IL-1ß, TNF-α, IL-6 and COX-2 studied displayed a strong peak after stimulation with 1.5 h of ECPs of V. fluvialis L21, significant differences (P < 0.05) exist with other periods and with the POLY I: C at the same time. Similarly to the case of IL-10 also produced a statistically significant (P < 0.05) peak of expression on leukocytes that were stimulated with the ECPs of V. fluvialis L21. In the case of Mx gene expression, we note that in almost all sampling times there is an up-regulation of the Mx gene in leucocytes incubated with ECPs and POLY I:C compared to the control and Mx expression was higher in leucocytes that were stimulated with the ECPs of V. fluvialis for all times, except in T24. With these results we can consider that the ECPs of V. fluvialis L21 have a great power of stimulating the in vitro expression of immune-related genes and may even be useful as adjuvants for vaccine in aquaculture.

First epidemiologic study in Argentina of the prevalence of BK viruria in kidney transplant patients.

BACKGROUND: The worldwide seroprevalence of human BK polyomavirus (BKV) in adults is 80%. About 10%-60% of renal transplant recipients experience BKV infection, nephropathy of the graft may occur in 5% of the cases, and up to 45% lose the graft. The aim of this work was to describe the prevalence of BK viruria during the 1st year after transplantation. METHODS: An epidemiologic multicenter cross-sectional study was carried out in consecutive patients at each site with kidney transplantation from August 2011 to July 2012. Clinically significant viruria was defined as >10(7) copies/mL. Viral DNA was extracted with the use of silica columns. Quantification was performed with the use of real-time polymerase chain reaction with primers that amplify a fragment of the large T-antigen gene and with a specific Taqman-MGB probe for BKV. For each assay, a standard curve with a quantified plasmid was included. RESULTS: Of 402 renal transplant recipients at 18 renal transplant sites, we analyzed 382; median age was 46.33 years, and 46.40% were female. The median of the temporal distribution for urine samples was 153 days. BK virus was detected in 50/382 samples (13%), 18 with values >10(7) copies/mL (4.7%). The median of the distribution of positive values was 123 days and the highest frequency of positive values was in months 3-7. The conditions of recipient older than 34 years and donor older than 41 years were the only ones that showed statistically significant association with BK viruria. No association with any specific immunosuppressive drug was observed. CONCLUSIONS: This is the first multicenter study conducted in Argentina to determine the prevalence of BK viruria in renal transplant recipients. Because of the growing number of the population susceptible to this infection, it is important to register and describe data about its epidemiology and associated risk factors.

CORAL SNAKE ANTIVENOM PRODUCED IN CHICKENS (Gallus domesticus) / Antiveneno de serpiente coral producido en gallinas (Gallus domesticus)

The production of anti-snake venom from large mammal's blood has been found to be low-yielding and arduous, consequently, antivenom immunoglobulins for treatment are achieved regularly as polyvalent serum. We have standardized an undemanding technique for making purified immunoglobulin IgY antivenom consisting of polyclonal antibodies against coral snake venom in the egg yolk of immunized hens. We have adapted a reported process of antibody purification from egg yolks, and achieved 90% antibody purity. The customized technique consisted of the removal of lipids from distilled water-diluted egg yolks by a freeze–thaw sequence. The specific immunoglobulins were present in the egg yolk for up to 180 days postimmunization. Therefore, by means of small venom quantities, a significant amount of immunoglobulins were found in an adequately purified state (The obtained material contained about 90% pure IgY). The antigen binding of the immunoglobulins was detected by a double immunodiffusion test. Titers of antibodies in the yolk were estimated with a serum protection assay (Median effective dose = ED50) (ED50= 477 mg/kg). Given that breeding hens is economically feasible, egg gathering is noninvasive and the purification of IgY antibodies is quick and easy, chicken immunization is an excellent alternative for the production of polyclonal antibodies. To the best of our knowledge, this is the first coral snake antivenom prepared in birds.

La producción de antiveneno de serpiente usando sangre de grandes mamíferos se ha encontrado que es de bajo rendimiento y de trabajo arduo, en consecuencia, las inmunoglobulinas antiveneno para el tratamiento se obtienen generalmente, como suero polivalente. Hemos estandarizado una técnica poco exigente para la fabricación de inmunoglobulina purificada IgY, que consistió en generar anticuerpos policlonales contra el veneno de la serpiente coral en huevos de gallinas inmunizadas. La técnica consistió en la eliminación de lípidos de las yemas del huevo, diluidas en agua y en una secuencia de congelación-descongelación. Las inmunoglobulinas específicas estuvieron presentes en la yema de huevo hasta 180 días después de la inmunización. La unión del antígeno a las inmunoglobulinas se detectó mediante un ensayo de inmunodifusión doble. Los títulos de anticuerpos en la yema fueron estimados con un ensayo de protección (dosis efectiva media = ED50). Dado que las gallinas reproductoras son económicamente viables, la recolección de huevos es no invasiva y la purificación de anticuerpos IgY es rápida y fácil, la inmunización de la gallina es una excelente alternativa para la producción de anticuerpos policlonales. A nuestro entender, esta es el primer anti-veneno contra serpiente de coral preparado en aves.

Carcinoma oculto de la mama. Experiencia en el Centro Clínico de Estereotaxia ­ CECLINES / Occult breast cancer. Experience in Centro Clinico de Estereotaxia ­ CECLINES

A pesar de los avances científicos y las numerosas reuniones de expertos en todo el mundo y quizás por su presentación poco frecuente, aún existen dudas en el manejo de los pacientes con carcinoma oculto de la mama (COM). Algunos autores señalan que su comportamiento es similar a los carcinomas estadio II/III. Métodos: Retrospectivamente estudiamos en la base de datos del Centro Clínico de Estereotaxia CECLINES en Caracas, 841 pacientes, de las cuales el grupo de COM representa el 0.71% (6/841) y pacientes con St II el 16.52% (139/841). Resultados: Para COM el seguimiento promedio fue de 4.33 años (0.08 a 10.25, DS 4.04). En el estudio definitivo de la disección axilar las pacientes COM presentaron promedio de 2.17 ganglios (1-6 + 0.83) positivos y el grupo ST II un promedio de 2.72 ganglios (0-9 + 0.26) (p>0.05). La tasa de recaída para COM fue de 16.7% (1/6) y para ST II fue 15.1% (21/139)(p=0.089). La sobrevida a los 5 años, para COM fue 83.2% y para ST II 80.4% (p=0.630). Conclusión: La sobrevida de pacientes con COM es discretamente mejor que la de STII. El esquema propuesto parece ser factible en el manejo de pacientes con COM, ya que ha arrojado cifras de recaídas y sobrevida similar a lo reportado a nivel internacional(AU)

Despite scientific advances and the numerous meetings of experts around the world and perhaps it´s rare presentation, there are still doubts in the management of patients with occult breast carcinoma (OBC). Some authors suggest that it´s behavior is similar to those breast cancer stage (ST) II/III. Methods: Retrospectively we studied in the database of Centro Clínico de Estereotaxia CECLINES at Caracas, 841 patients, in which OBC represents 0.71% (6/841) and ST II breast cancer 16.52% (139/841). Results: For OBC the median follow up was 4.33 years (0.08-10.25, SD 4.04). In the definitive study of the axillary disecction of OBC there was a median of 2.17 (1-6 + 0.83) positie nodes and for the grup ST II a median of 2.72 (0-9 + 0.26) positive nodes (p>0.05). The recurrence rate for OBC was 16.7% (1/6) and for St II 15.1% (21/139)(p=0.089). The 5y survival for OBC was 83.2% y and for ST II 80.4% (p=0.630). Conclusion: The 5y survival for OBC patients was quietly better than that of ST II. The algorithm proposed seems to be feasible for the management of patients with OBC because it has produce results such as recurrence and survival similar as those reported internationaly(AU)

Seguro Popular, condiciones psicosociales de trabajo y violencia en empleados de una institución de salud en méxico: un análisis desde el modelo de los determinantes sociales de la salud / Popular Health Insurance, psychosocial factors at workplace, and violence in employees from a health institution in Mexico: an analysis from the model of the social determinants of health

OBJETIVO : analizar el impacto de la implementación y operación del Seguro Popular en las condiciones psicosociales de trabajo y la exposición a situaciones y comportamientos de violencia de un grupo de trabajadores que laboran en una institución de salud. METODOLOGIA: se realizó un estudio cualitativo bajo el marco de la sociología fenomenológica. Se aplicó una encuesta a 206 trabajadores para valorar las condiciones psicosociales negativas en el entorno laboral. Posteriormente, se identificaron 18 sujetos caso por haber obtenido puntajes negativos altos en la encuesta y haber estado expuestos o haber participado en situaciones y comportamientos de violencia en el trabajo. RESULTADOS Y DISCUSIÓN :la implementación y operación del Seguro Popular provocó un deterioro y precarización de las condiciones psicosociales y del proceso de trabajo. La exposición a situaciones y comportamientos de violencia se manifestó como estrés , desgaste emocional, pérdida de la motivación, minusvalía y depresión. CONCLUSIONES : las reformas laborales y de la administración pública, expresadas en un nuevo modelo de gestión organizacional orientado a la eficiencia y reducción de costos prioriza los criterios administrativos y desestima la satisfacción y bienestar de los trabajadores.

OBJECTIVE: to analyze the impact of the implementation and operation of the Popular Health Insurance underwork psychosocial conditions and violence of a group of workers from a health institution. METHODOLOGY a qualitative study was realized under the framework of the phenomenological sociology. A survey was applied to two hundred six workers for the evaluation of the negative psychosocial conditions in the work environment. Later, it was identified to eighteen individual «cases¼for having obtained high negatives scores in the survey and having been exposed or for having taken part in situations and behaviors of violence at workplace. RESULTS AND DISCUSSION:the implementation and operation of the Popular Health Insurance provoked deterioration and precarious psychosocial conditions and work process alterations. Violence at workplace expressed like distress, emotional exhaustion, loss of motivation, disability and depression. CONCLUSIONS : labor and public administration, reforms in a new model of organizational management oriented to efficiency and cost reductions, prioritizes the administrative criteria and rejects the satisfaction and subjective well-being of workers.

Cytokine expression in head-kidney leucocytes of European sea bass (Dicentrarchus labrax L.) after incubation with the probiotic Vagococcus fluvialis L-21.

The European sea bass (Dicentrarchus labrax L.) is one of the most extensively farmed marine fish in the Mediterranean sea. Under the high-density condition, common in aquaculture, the infectious diseases can cause significant economic losses. Probiotics are presented as an alternative to antibiotics for the control of aquaculture diseases. This study used real-time PCR to investigate in vitro the dynamic of expression of immune-related genes in sea bass after incubation with live and inactivated (heat and Uv-light) probiotic Vagoccus fluvialis L-21 at different times (T1, T12, T24, T48). The immune associated genes, interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin 10 (IL-10), TumourTumour necrosis factor- (TNF-), ciclo-oxigenase-2 (COX-2), caspase-3 (Casp-3) and Mx were studied in head-kidney (HK) leucocytes of sea bass after incubation with the probiotic strain. Transcript of proinflammatory cytokines (IL-1, TNF-, COX-2) was highly up-regulated after 1 h of incubation with the probiotic strain V. fluvialis L-21. We found statistically significant difference in pick of expression of TNF-, after 1 h of incubation with Uv-light inactivated probiotic strain. The COX-2 expression was highly up-regulated at all times studied, with the exception of 12 and 24 h post incubation for the Uv-light inactivated bacteria. Transcript of IL-10 and Casp-3 showed the higher statistically significant differences of expression after 48 h post incubation with live bacteria. In the contrast, sea bass HK leucocytes expressed Mx at 12 and 48 h without statistically differences among treatments. Our results suggest that V. fluvialis L-21 is able to stimulate in vitro some immune-related genes associated with the early inflammatory response. Future studies in vivo are necessary to clarify this process in sea bass.

Linfoma folicular primario duodenal: informe de un caso y revisión de la literatura / Primary follicular lymphoma of the duodenum: case report and literature review

Mujer de 80 años con síntomas dispépticos a quien se le realizó endoscopia de vías digestivas altas que mostró lesiones polipoides confluentes en la segunda porción del duodeno, cuyo estudio histológico indicó un linfoma no Hodgkin B folicular primario, neoplasia duodenal infrecuente de bajo grado, la cual debe diferenciarse de hiperplasia linfoide folicular reactiva y de otros linfomas

Patient was an 80 year old woman with dyspepsia. An upper endoscopy showed confluent polypoid lesions in the second portion of the duodenum. A histological study showed a follicular B-cell lymphoma. This is a rare low grade neoplasm of duodenum which must be differentiated from follicular reactive hyperplasia and other lymphomas