Context-dependent roles for ubiquitous mitochondrial creatine kinase CKMT1 in breast cancer progression.

Metabolic reprogramming is a hallmark of cancer, enabling cancer cells to rapidly proliferate, invade, and metastasize. We show that creatine levels in metastatic breast cancer cell lines and secondary metastatic tumors are driven by the ubiquitous mitochondrial creatine kinase (CKMT1). We discover that, while CKMT1 is highly expressed in primary tumors and promotes cell viability, it is downregulated in metastasis. We further show that CKMT1 downregulation, as seen in breast cancer metastasis, drives up mitochondrial reactive oxygen species (ROS) levels. CKMT1 downregulation contributes to the migratory and invasive potential of cells by ROS-induced upregulation of adhesion and degradative factors, which can be reversed by antioxidant treatment. Our study thus reconciles conflicting evidence about the roles of metabolites in the creatine metabolic pathway in breast cancer progression and reveals that tight, context-dependent regulation of CKMT1 expression facilitates cell viability, cell migration, and cell invasion, which are hallmarks of metastatic spread.

Central retinal vein occlusion in a patient using the antipsychotic drug olanzapine: a case report.

BACKGROUND: We report our findings in a patient who developed central retinal vein occlusion (CRVO) and was a chronic user of olanzapine, an antipsychotic medication. CASE PRESENTATION: A 50-year-old Caucasian man, non-smoker, was referred to our clinic with the chief complaint of floater appearance in his left eye for the past 3 days. His past medical history indicated that he had been taking antipsychotic drugs (olanzapine) for about 3 years, with no other systemic disease or risk factors for CRVO. In the examination, his best-corrected visual acuity (BCVA) was 0.7 in the left eye. The fundus showed signs of nonischemic CRVO with subhyaloid hemorrhage and intraretinal hemorrhage in the posterior pole and superior and inferior retina, without macular edema, confirmed by optical coherence tomography (OCT). We ruled out other probable differential diagnoses and risk factors which lead to CRVO through a complete physical exam and blood analysis (complete blood count, glucose, urea, creatinine, lipid profile, erythrocyte sedimentation rate, C-reactive protein, prothrombin time, partial thromboplastin time, Bleeding time (BT), fibrinogen level, proteins, antiphospholipid antibodies, homocysteine blood level, antithrombin III, protein C and S, factor V Leiden, prothrombin mutation, angiotensin-converting enzyme level, other autoantibodies, and human leukocyte antigen [HLA]-B51). Finally, we confirmed the probable side effect of olanzapine in CRVO, which has not been previously reported. A possible pro-thrombogenic mechanism of olanzapine at the molecular level is an affinity for 5-HT2Aserotonin receptors. Blocking these receptors results in increased platelet aggregation and increased blood coagulability. CONCLUSIONS: These results indicate that CRVO can be a complication of chronic use of antipsychotic medications such as olanzapine, as shown for the first time in our case report. Clinicians should question patients who develop a sudden CRVO whether they are using antipsychotic medications such as olanzapine.

Costo-efectividad de la reanimación cardiopulmonar con el uso del desfibrilador externo automático, comparado con reanimación cardiopulmonar básica, para personas con pérdida de conciencia en espacios de afluencia masiva de público / Cost-effectiveness of cardiopulmonary resuscitation using an automated external defibrillator compared with a basic defibrillator in unconscious patients in crowded public spaces in Colombia

Resumen Objetivo: Estimar la razón de costo-efectividad de la reanimación cardiopulmonar con el uso del desfibrilador externo automático (DEA), comparado con la reanimación cardiopulmonar básica, para la reanimación de personas con pérdida de conciencia en espacios de afluencia masiva de público en Colombia. Métodos: Para estimar los costos y desenlaces de las dos alternativas de comparación, se diseñó un árbol de decisiones en el cual se reflejan los principales desenlaces posterior a la pérdida de conciencia y la reanimación con cualquiera de las dos alternativas. Se asumió la perspectiva del sistema de salud colombiano en un horizonte temporal comprendido entre el momento de la pérdida de conciencia de la persona hasta el ingreso al hospital. Las probabilidades de los eventos se obtuvieron de un meta-análisis de ensayos clínicos y la información de costos de fuentes oficiales y consulta directa a proveedores de DEA en Colombia. Los costos fueron expresados en pesos colombianos de 2016 y la efectividad en muertes evitadas. Se realizaron análisis de sensibilidad determinísticos y probabilísticos para estimar el impacto de la incertidumbre sobre las conclusiones. Resultados: La razón de costo-efectividad de la reanimación cardiopulmonar con DEA fue de $3.267.777 por muerte evitada. La probabilidad de que esta intervención sea costo-efectiva es superior al 90% para un umbral de costo-efectividad superior a 10 millones de pesos. Conclusión: Un programa de reanimación cardiopulmonar con desfibrilación temprana mediante el uso de DEA, en espacios de afluencia masiva de público, es una alternativa costo-efectiva para el sistema de salud colombiano.

Abstract Objective: To estimate the cost-effectiveness of cardiopulmonary resuscitation using an automated external defibrillator (AED) compared with basic cardiopulmonary resuscitation, for the resuscitation of unconscious patients in crowded public spaces in Colombia. Methods: A decision tree was designed in order to estimate the costs and outcomes of the two alternatives. This included the main outcomes after the loss of consciousness and resuscitation by any of the two alternatives. The perspective of the Colombian Health System was adopted in a time scale consisting of the time of loss of consciousness until hospital admission. The probabilities of the events were obtained from a meta-analysis of clinical trials, and the information on costs from official sources and direct consultations with AED providers in Colombia. The costs were expressed in Colombian pesos of 2016, and the effectiveness in deaths prevented. Deterministic and probabilistic sensitivity analyses were performed to estimate the impact of uncertainty on the conclusions. Results: The cost-effectiveness of cardiopulmonary resuscitation with AED was COP $3,267,777 per death avoided. The probability that this intervention would be cost-effective is greater than 90% for cost-effectiveness threshold greater than 10 million Colombian pesos. Conclusion: A cardiopulmonary resuscitation program with early defibrillation using an AED in crowded public spaces is a cost-effective alternative for the Colombian Health System.

[Intrarectal povidone-iodine to reduce the risk of genitourinary infections after transrectal prostate biopsy]. / Iodopovidona intrarrectal y riesgo de infección genito- urinaria posterior a biopsia prostática transrectal.

BACKGROUND: The aim of this study is to compare two different preparations in patients undergoing transrectal prostate biopsies samples (TPBS) and assess the prevalence of genitourinary infections (GUI). METHODS: A historical cohort of patients undergoing TBPS for suspected prostate cancer. Two groups were compared: one with endorectal lubricant jelly and another with the addition of a povidone-iodine lubricating jelly. Complications were evaluated at three weeks. A bivariate analysis was performed by calculating the OR (95 % CI) to determine if the additional endorectal povidone-iodine pre-TBPS reduced GUI and other complications. RESULTS: 185 patients (Group I n = 86, Group II n = 96) were evaluated. 45 and 25 % had genitourinary tract infection (OR: 0.4, CI: 0.2-0.9, p = 0.004); fever was presented in 21 and 10 % respectively (OR: 0.42, CI: 0.1-0.9, p = 0.04). CONCLUSIONS: A reduction was observed in the presence of genitourinary infections in patients who had intrarectal povidone-iodine preparation applied.

Introducción: el objetivo de este estudio es comparar dos preparaciones distintas en pacientes sometidos a la toma de biopsias prostáticas transrectales (BPTR) y evaluar la prevalencia de infecciones genitourinarias (IGU). Métodos: se compararon dos grupos de pacientes con sospecha de cáncer de próstata sometidos a Biopsia Prostática Transrectal (BPTR): Con jalea lubricante endorrectal (grupo l, cohorte histórica) y con jalea lubricante más iodopovidona (grupo II, cohorte prospectiva). Se evaluaron las complicaciones a las tres semanas. Se realizó un análisis bivariado, calculando su OR (IC: 95 %) para determinar si la iodopovidona endorrectal adicional previa a la BPTR disminuye las IGU y otras complicaciones. Resultados: Se evaluaron 185 pacientes (Grupo I n = 86; grupo II n = 96). Tuvieron infección del tracto genitourinario el 45 y 25 % (OR: 0.4, IC: 0.2-0.9, p = 0.004); la fiebre se presentó en el 21 y 10 % respectivamente (OR: 0.42, IC: 0.1-0.9, p = 0.04). Conclusiones: Se observó una reducción en la presencia de infecciones genitourinarias en pacientes a quienes se aplicó en su preparación iodopovidona intrarrectal.

Santiago Ramón y Cajal, neurocientífico y pintor / Santiago Ramon y Cajal, neuroscientist and painter

La vida de este extraordinario científico y pintor ha sido motivo de estudio por generaciones, pues fascinó la manera de poder unir armoniosamente sus pasiones. Santiago Felipe Ramón y Cajal, más conocido como don Santiago Ramón y Cajal (el "don" por un título de importancia de la época e "y" como una forma de darle renombre a sus apellidos), o referido por muchos simplemente como Cajal (por la sonoridad del apellido y la costumbre en España de utilizar el apellido materno). Nació en la provincia de Cataluña, primer hijo de la unión de Justo Ramón Casasús y Antonia Cajal Puentes. Su padre, médico del pueblo, vio en él un sucesor de la profesión, razón por la cual desde muy pequeño le exigió académicamente y le reprochó su fascinación por el arte. Su infancia fue marcada por múltiples sucesos que lo llevarían a tener un encanto por la naturaleza y querer plasmarla en sus dibujos. La influencia de su padre fue exitosa, ya que se convirtió en un prestigioso médico. Ansioso de conocer otros lugares y su sed de aventurero lo llevaron a viajar a Cuba para dar apoyo médico a las tropas españolas. A su regreso se encontró con múltiples oportunidades que forjaron su carrera como científico y le dieron solidez como persona. Se casó a la edad de 27 años con Silveria Fañanás, el motor de su vida y la madre de sus seis hijos. Su incansable curiosidad y su espíritu de pintor le permitieron describir y dibujar las células nerviosas de manera detallada, incluyendo su estructura magnífica y las relaciones de estas, comparándolas de manera muy acertada con la naturaleza, referidas por él mismo como "El jardín de la neurología". Siempre fue un paisajista romántico, que se intrigó tanto de lo macro (con sus dibujos sobre la naturaleza y la anatomía), como de lo micro (la histología) (Figura 1).

The life of this extraordinary scientist and painter has been studied by multiple generations, fascinated by the way he harmoniously mixes his passions. Santiago Felipe Ramón y Cajal, better known as Don Santiago Ramón y Cajal (the "Don" as a title of the importance of the age and the "Y" as a way to give renown to their surnames) or referred by many simply as "Cajal" - by the sound of the surname). He was born in the province of Catalonia, first child of the union of Justo Ramón Casasús and Antonia Cajal. His father, a physician, saw in him a successor of the profession, which is why at very young age, he demanded of him the best academic performance and reproached him for his fascination with art. His childhood was marked by many events that would lead him to be charmed with nature and want to translate this into his drawings. The influence of his father was successful because he became a physician. Eager to know other places and with the thirst of an adventurer, he travelled to Cuba, but it was not the experience he had imagined. On his return he found many opportunities that forged his career as a scientist and gave him strength as a person. He married at the age of 27 years with Silveria Fañanás, who became the mother of his six children, and was the engine of his life. With his insatiable curiosity, his painter´s spirit and with some help, he described in detail the nerve cells and portrayed in his drawings the magnificent structure and relationships thereof, successfully comparing them with nature, referring to "The Garden of Neurology". He was always a romantic landscape painter, intrigued as much by the macro (with his drawings of nature and anatomy) as the micro (histology); the latter was his greatest passion. All his work bore many fruits, which still amaze us today. Through his hard work and his refusal to placate his inner painter, he managed to mix his passions to their maximum potential, leaving behind a priceless legacy.

Análisis de costo-efectividad del uso del Desfibrilador Externo Automático (DEA) comparado con Reanimación Cardiopulmonar Básica (RCP) en Colombia / Cost-effectiveness analysis of the use of Automatic External Defibrillator (AED) compared to Basic Cardiopulmonary Resuscitation (CPR) in Colombia

Problema de investigación: Analizar los costos y la efectividad de los desfibriladores automático y semiautomático en espacios de afluencia masiva y ambulancias básicas en Colombia. Tipo de evaluación \r\neconómica: Análisis de costo-efectividad. Población objetivo: Personas que presentan pérdida de conciencia (no tose, no se mueve, no respira, no responde) en espacios de afluencia masiva de público (aeropuertos, centros comerciales, estadios, centros de convenciones, colegios, universidades, medios masivos de trasporte público, cárceles, entre otros) y en ambulancias básicas. Intervención y comparadores: I: Desfibrilador automático/semiautomático externo, C: Reanimación cardiopulmonar (RCP).Horizonte temporal: Un año. Perspectiva Sistema: General de Seguridad Social en Salud (SGSSS). Estructura del modelo: Árbol de decisión, que incluye los eventos de sobrevida y muerte. Fuentes de datos de efectividad y seguridad: Ensayos clínicos y meta-análisis. Desenlaces y valoración: Mortalidad, Años de vida ganados. Costos incluidos: Costo del dispositivo, Costo de medicamentos, Costo de procedimientos e insumos. Fuentes de datos de costos: Consulta a proveedores, SISMED, Manual tarifario ISS 2001. Resultados del caso base: En el escenario de espacios públicos, el costo de una muerte evitada es de $87.492.099. Al expresar estas cifras en costo por año de vida ganado, el DEA sería una estrategia altamente costo-efectivo. En el caso específico de ambulancias básicas, no se dispone de información suficiente que permita extraer conclusiones sólidas. Análisis de sensibilidad: Los análisis de sensibilidad y el diagrama de tornado mostraron que las \r\nvariables con mayor impacto sobre las estimaciones de costo-efectividad en espacios públicos son la probabilidad de sobrevida al alta hospitalaria y el costo del desfibrilador externo automático (DEA). Conclusión y discusión: El uso del DEA en espacios de afluencia masiva de público es una \r\nestrategia altamente costo-efectiva en Colombia. No obstante, es necesario tener en cuenta que la implementación de un programa de desfibrilación de acceso enfrenta múltiples barreras, por lo cual es \r\nfundamental fortalecer los tres primeros eslabones de la cadena de supervivencia, entre los cuales se encuentra el uso del DEA en espacio de afluencia masiva del público y la optimización de los tiempos de respuesta.(AU)

Trauma and burn education: a global survey.

BACKGROUND: The World Health Assembly recently adopted a resolution to urge improved competency in the provision of injury care through medical education. This survey sought to investigate trauma education experience and competency among final year medical students worldwide. METHODS: An Internet survey was distributed to medical students and conducted from March 2008 to January 2009. Demographic data and questions pertaining to both instruction and attainment of specific skills in burn and trauma care were assessed. RESULTS: There were 776 responses from final year medical students in 77 countries, with at least 10 countries from each economic stratum. Over 93% of final year students reported receiving some form of trauma or burn training, with 79% reporting a minimum compulsory requirement. Students received theoretical instruction without practical exposure. Few felt prepared to undertake basic procedures, such as laceration repair (19%), vascular access (8%), or endotracheal intubation (21%). Over 99% agreed that trauma education should be mandatory, but only half felt prepared to provide basic care. Those from low income and low middle income countries felt better prepared to provide trauma care than students from high middle and high income countries. CONCLUSIONS: Trauma education and experience varies among medical students in different countries. Many critical concepts are not formally taught and practical experience with many basic procedures is often lacking. The present study confirms that the trauma care training received by medical students needs to be strengthened in countries at all economic levels.

[A case of the calcifying epithelial odontogenic tumor (Pindborg's tumor). Reported and literature review]. / Tumor odontogénico epitelial calcificante (tumor de Pindborg). Informe de un caso y revisión de la literatura.

The calcifying epithelial odontogenic tumor known as Pindborg's tumor, is a rare odontogenic neoplasm of the jaws. One of their characteristics is the cortical expansion and the relationship with a non erupted tooth. Since the original description in 1955, only 200 cases approximately have been described in the world literature. This article reviews the literature and describes a case of patient who presented calcifying epithelial odontogenic tumor in the jaw undergoing surgical excision treatment with an evolution without complications.

Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit.

BACKGROUND: Central line-associated bloodstream infections occur commonly and are a potentially preventable source of morbidity in the critical care setting. The purpose of this study was to find a way to decrease central line-associated bloodstream infections. METHODS: Data were collected from February 1, 2005, to April 31, 2007, on all patients in the critical care unit who had a central venous catheter placed at New York Methodist Hospital in Brooklyn, which is a community teaching hospital with 628 beds. After 5 months of baseline data collection, a multidisciplinary team created a central line bundle to be used when placing central venous catheters. A bundle is a protocol put in place to ensure that a procedure is performed using the latest evidence-based techniques. In this case, it included maximal barrier precautions, hand washing, skin preparation with ChloraPrep (Enturia, Leawood, Kan), use of a central line cart, and avoidance of femoral lines. All central lines placed from the time of intervention were placed using the bundle provided. The variables included the number of central lines, number of central line days, and development of a line infection. RESULTS: The study period was 24 months, which included 9,938 central line days from a total of 1,395 central venous catheters. The average number of central line-associated bloodstream infections per 1000 catheter days decreased from 5.0 to 0.90 (P < .001) after the bundle intervention was initiated. CONCLUSION: The implementation of a central line bundle campaign resulted in a significant decrease in line-associated bloodstream infections. Based on our study, we recommend that this protocol be adopted nationwide.

Tablas de vida para la población derechohabiente del Instituto Mexicano del Seguro Social, delegación estatal en Jalisco: 1983 / Life tables for the protected population of the Instituto Mexicano del Seguro Social, State of Jalisco: 1983

Con base a los certificados de defunción de los derecho habientes del Instituto Mexicano del Seguro Social en Jalisco, se elaboraron tablas abreviadas de vida para ambos sexos, para mujeres y para hombres; encontrando una esperanza de vida de 74,97; 76,40 y 73,38 años. Se establecen algunas comparaciones con los datos obtenidos, que señalan la importancia del desarrollo histórico social para el proceso salud-enfermedad