Cutaneous Metastasis Following a Six-Year History of Bladder Urothelial Carcinoma in Situ: A Case Report.

Bladder cancer with cutaneous metastasis is a rare manifestation of the advanced stage of the disease. It can result from direct invasion, lymphatic or hematogenous spread, or iatrogenic implantation. We present a case of a 67-year-old patient initially diagnosed with urothelial carcinoma (UC) in situ of the bladder, who underwent transurethral resection of bladder tumor, along with induction and maintenance Bacillus Calmette-Guerin immunotherapy. Six years post-diagnosis, the patient developed multiple ulcerating fungating lesions in the right lower extremity, confirmed as metastases from UC. The patient additionally developed right foot gangrene with subsequent infection, which progressed into sepsis and caused the patient's demise.

A three-gene expression score for predicting clinical benefit to anti-PD-1 blockade in advanced renal cell carcinoma.

In the advanced renal cell carcinoma (RCC) scenario, there are no consistent biomarkers to predict the clinical benefit patients derived from immune checkpoint blockade (ICB). Taking this into consideration, herein, we conducted a retrospective study in order to develop and validate a gene expression score for predicting clinical benefit to the anti-PD-1 antibody nivolumab in the context of patients diagnosed with advanced clear cell RCC enrolled in the CheckMate-009, CheckMate-010, and CheckMate-025 clinical trials. First, a three-gene expression score (3GES) with prognostic value for overall survival integrating HMGA1, NUP62, and ARHGAP42 transcripts was developed in a cohort of patients treated with nivolumab. Its prognostic value was then validated in the TCGA-KIRC cohort. Second, the predictive value for nivolumab was confirmed in a set of patients from the CheckMate-025 phase 3 clinical trial. Lastly, we explored the correlation of our 3GES with different clinical, molecular, and immune tumor characteristics. If the results of this study are definitively validated in other retrospective and large-scale, prospective studies, the 3GES will represent a valuable tool for guiding the design of ICB-based clinical trials in the aRCC scenario in the near future.

Multiple micronutrient deficiencies as a long-term complication of bariatric surgery.

Micronutrient deficiencies may develop as a long-term complication of bariatric surgery due to alteration of gut anatomy and disruption of normal gut absorption. Inadequate repletion of essential vitamin and mineral deficiencies can lead to multisystem dysfunction. We present a case of a woman in her 50s, with a history of Roux-en-Y gastric bypass over 10 years ago, who presented with generalised weakness and a diffuse desquamating rash. A punch biopsy performed was compatible with nutritional deficiency. Labs revealed low levels of micronutrients A, B1, B6, C, E, zinc and copper. The patient received intravenous micronutrients and an oral regimen, which improved her symptoms. Unfortunately, the patient died from cardiac arrest secondary to pulmonary oedema. This report highlights the importance of high suspicion of micronutrient deficiency in patients with a history of bariatric surgery and maintaining lifelong nutritional follow-up.

Anidación de la tortuga marina Lepidochelys olivacea (Testudinata: Cheloniidae) en Campamento Tortuguero Cedeño, Honduras (2011-2021) / Nesting of olive ridley sea turtle Lepidochelys olivacea (Testudinata: Cheloniidae) in Campamento Tortuguero Cedeño, Honduras (2011-2021)

Introducción: El Campamento Tortuguero de Cedeño ha sido el sitio menos investigado del Golfo de Fonseca, donde se protege a la tortuga golfina en Honduras desde 1975. Objetivo: Evaluar la anidación de la tortuga Golfina (Lepidochelys olivacea) durante la temporada de veda entre el 2011 y 2021 en Campamento Tortuguero Cedeño, Choluteca, Honduras. Métodos: Entre 2011 a 2021, se llevó a cabo el monitoreo diario de las actividades de anidación durante la veda del 1 al 25 de septiembre. Los patrullajes se realizaron entre las 6:00-18:00 h, y las 18:00-5:00 h. Se registró el número total de tortugas que anidaban y se recogieron sus huevos, que se transportaron al criadero, donde se tabularon los resultados de las puestas y las crías. Resultados: Se registró un total 1 065 tortugas de L. olivacea, 95 051 huevos recolectados, 1 065 nidos marcados en tres playas que fueron reubicados en viveros artificiales y una eclosión exitosa de 62 747 neonatos. La playa Las Doradas fue el sitio con el mayor número de tortugas anidadoras, seguido de Los Delgaditos y por último Cedeño. El promedio de la frecuencia de anidación fue de 96 nidos. Del 2011 al 2021 el esfuerzo de recolección de los nidos aumentó en un 91.6 %, pasando de 84 a 161 nidos. El número de personas patrullando se asoció con la cantidad de nidos detectados en las playas. Conclusión: Los esfuerzos de monitoreo y conservación para la especie han indicado que ha habido un incremento en la anidación de L. olivacea en las tres playas, con un mayor incremento en Playa Las Doradas. Este escenario comprueba la funcionalidad de la veda en esta zona.

Introduction: The Cedeño Turtle Camp has been the least researched site in the Fonseca Gulf, where Olive Ridley Turtles in Honduras have been protected since 1975. Objective: To evaluate the nesting of Olive Ridley turtles (Lepidochelys olivacea) during the closed season from 2011 to 2021 in Campamento Tortuguero Cedeño, Choluteca, Honduras. Methods: From 2011 to 2021, daily monitoring of nesting activities was conducted during the closed season from the 1st to 25th of September. Patrols were conducted between 6:00-18:00 h, and 18:00-5:00 h. The total number of nesting turtles was recorded, and their eggs were collected and transported to the hatchery, where clutch and hatchling performance were tabulated. Results: A total of 1 065 L. olivacea turtles were recorded, 95 051 eggs collected, 1 065 nests marked on three beaches that were relocated in artificial hatcheries and a successful hatching of 62 747 hatchlings. Las Doradas beach was the site with the highest number of nesting turtles, followed by Los Delgaditos and lastly Cedeño. The average nesting frequency was 96 nests. From 2011 to 2021 the nest collection effort increased by 91.6 %, from 84 to 161 nests. The number of people patrolling was associated with the number of nests detected on the beaches. Conclusion: Monitoring and conservation efforts for L. olivacea in the Campamento Tortuguero Cedeño show a positive trend in nesting with a greater increase in Playa Las Doradas. This scenario proves the functionality of the closed season in this area.

Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study.

Background: Primary cardiac tumors are often benign and commonly present as cardiac myxomas (CMs) or papillary fibroelastomas (CPFEs). There is a paucity of prognostic indicators for tumor burden or potential for embolic cerebrovascular events (CVEs). This study was performed to address these gaps. Methods: Medical records at the University of Florida Health Shands Hospital between 1996 and 2021 were screened to identify patients with CMs or CPFEs. Clinical features, echocardiographic reports, and CVE outcomes were quantitatively assessed. Results: A total of 55 patients were included in the study: 28 CM (50.9%) and 27 CPFE (49.1%) patients. Baseline patient characteristics were similar among patients. The neutrophil-lymphocyte ratio was correlated (p < 0.005 in all cases) to three metrics of tumor size in both CM (r = 64-67%) and CPFE (r = 56-59%). CVEs were the presenting symptom in 30 (54.5%) patients. CVE recurrence was high; the 5-year CVE recurrence rate in patients with tumor resection was 24.0% compared to 60.0% without resection. No baseline patient characteristics or tumor features were associated with an initial presentation of CVEs compared to any other indication. Univariate analysis indicated that prolonged duration to surgical resection, left atrial enlargement, male sex, and a neutrophil-lymphocyte ratio >3.0 at the follow-up were significantly associated with 5-year CVE recurrence. Left atrial enlargement and a neutrophil-lymphocyte ratio >3.0 at the follow-up remained significantly associated with 5-year CVE recurrence in multivariate analysis. Conclusion: The neutrophil-lymphocyte ratio may prognosticate tumor size and recurrence of neurologic events. An increased risk of CVE within 5 years of mass resection is almost exclusive to patients initially presenting with CVEs.

Recurrent small bowel obstruction as a rare presentation of undiagnosed sarcoidosis.

Sarcoidosis is an immune-mediated inflammatory disorder with unknown aetiology that is marked by non-caseating granulomas in affected organs. Pulmonary sarcoidosis is the most common manifestation, but gastrointestinal involvement, particularly in the small bowel, is exceedingly rare. While symptom-driven treatment guidelines that are steroid based are well established for pulmonary and few extrapulmonary manifestations (ie, cardiac, neurologic, renal), gastrointestinal sarcoidosis treatment is largely extrapolation with optimal management under investigation. Additionally, few works document small bowel obstruction related to small bowel sarcoidosis. We present a case of short-interval recurrent small bowel obstruction in a man in his sixties that revealed newly diagnosed sarcoidosis with suspected small bowel involvement who never underwent steroid therapy. The patient exhibited gastrointestinal symptoms, despite asymptomatic pulmonary disease and a course of prednisone may have reduced his risk of recurrence. We also review suggested gastrointestinal sarcoidosis treatment and surveillance guidelines with focus on the small bowel.

Navigating the Cancer Screening Decision for Patients with Dementia.

PURPOSE OF REVIEW: The risks of developing cancer and dementia both increase with age, giving rise to the complex question of whether continued cancer screening for older dementia patients is appropriate. This paper offers a practice-based clinical approach to determine an answer to this challenging question. RECENT FINDINGS: There is no consensus on the prevalence of cancer and dementia as co-diagnoses. Persons with dementia are screened less often compared to those without dementia. There is significant literature focusing on screening in the geriatric population, but there is little evidence to support decision-making for screening for older patients with dementia. Given this lack of evidence, individualized decisions should be made in collaboration with patients and family caregivers. Four considerations to help guide this process include prognosis, behavioral constraints, cognitive capacity, and goals for care. Future research will be challenging due to variability of factors that inform screening decisions and the vulnerable nature of this patient population.

Caracterización de Fusarium spp. asociado con la pudrición basal de la cebolla de rama / Characterization of Fusarium spp. associated with the basal rot of the green onion

RESUMEN El departamento de Nariño ocupa el cuarto lugar como productor de cebolla de rama, a nivel nacional. En los últimos años, su producción y área de cultivo se han reducido por múltiples limitantes, destacándose, como la más importante, la susceptibilidad al ataque de hongos causantes de pudriciones radicales, los cuales, perjudican el sistema productivo y la rentabilidad. El objetivo del estudio fue caracterizar morfológica y molecularmente las poblaciones de Fusarium, asociados a la enfermedad de pudrición basal de cebolla de rama. Para ello, en los municipios de Pasto, Potosi y Buesaco, se colectaron plantas con síntomas de pudrición basal, acompañada de necrosis de raíces y ablandamiento de tejido. En el laboratorio de Sanidad Vegetal de la Universidad de Nariño, se sembraron tejidos en medio PDA y, a continuación, se purificaron los aislamientos para su posterior caracterización morfológica y molecular. El estudio morfológico, se realizó usando claves taxonómicas para el género Fusarium y la caracterización molecular con cebadores específicos para el género Fusarium y mediante secuenciación. Finalmente, se realizó un análisis filogenético de la variabilidad intraespecífica. Los resultados de la caracterización morfológica y molecular corroboran la presencia de dos especies dentro del género asociadas a esta patología, F. oxysporum f sp. cepae y F. solani. Los análisis filogenéticos muestran alta variabilidad intraespecífica entre los aislamientos de F. oxysporum y F. solani, formando dos complejos Fusarium oxysporum (FOSC) y Fusarium solani (FSSC), manifestando que estas especies no parten de un ancestro común.

ABSTRACT The department of Nariño occupies the fourth place as producer of green onion nationwide. In recent years, its production and cultivation area has been reduced by multiple limitations, highlighting as the most important, the susceptibility to the attack of fungi causing radical problems, which harm the productive system and profitability. This study was carried out in order to morphologically and molecularly characterizes Fusarium populations associated with green onion basal rot disease. For this, in Pasto, Potosi and Buesaco municipalities, plants were collected with basal rot symptoms, tissue deterioration and root necrosis. In the Plant Health laboratory of the University of Nariño, tissues were planted in PDA medium and subsequently the isolates were purified for further morphological and molecular characterization. The morphological study was carried out using taxonomic keys for the genus Fusarium and molecular characterization with specific primers for the genus Fusarium, and by sequencing. Finally, a phylogenetic analysis of the intraspecific variability was carried out. Morphological and molecular characterization results corroborate the presence of two species within the genus associated with this pathology, F. oxusporum f sp. cepae and F. solani. Phylogenetic analyzes show high intraspecific variability between the isolates of F. oxysporum and F. solani, forming two Fusarium oxysporum (FOSC) complexes and Fusarium solani (FSSC), evidencing that these species do not start from a common ancestor.

Prevalencia de factores de riesgo cardiovascular en pacientes hospitalizados en un hospital de Lima / Prevalence of cardiovascular risk factors in hospitalized patients in a Lima hospital

Objetivo: Determinar los factores asociados a riesgo cardiovascular en pacientes del Departamento de Medicina del Hospital Sergio E. Bernales (HSEB). Métodos: Estudio transversal, descriptivo y observacional, incluyo 83 pacientes elegidos probabilísticamente de una población de 105 hospitalizados del Departamento de Medicina del HSEB. En el análisis e interpretación de los datos se utilizaron gráficos y tablas de frecuencias relativas y absolutas. Resultados: El 53% fueron mujeres y la edad promedio fue 54,5 años. La frecuencia de factores de riesgo principales fue: El sobrepeso 30,1%, la obesidad 13,3%, el Índice Ci/Ca muy alto en mujeres 54,2%, antecedente familiar de IAM 38,5% e HTA 34,6%, DM2 65,5%, Colesterol Alto 34,4%, HTA 21.7%, según su tipo se tuvo que el 73.9% estaban controladas; y al clasificarla, fueron optimas el 21,7% y Normal-Alta 34,8, asimismo se observó también sedentarismo 50%, consumo carbohidratos 56.6%, lípidos 32.5%, comida rápida 44,6% y como grado de Ansiedad menor un 54.2% y mayor el 32,5%. Conclusión: Un mayor riesgo de evento coronario afecta más a las mujeres mayores de 50 años que en los varones, teniendo como factores de riesgo cardiovascular principales la dieta, el sedentarismo, el sobrepeso, las presiones normal- alta, la ansiedad menor, y comorbilidades asociadas como la diabetes y colesterol alto.

Objective: To determine the factors associated with cardiovascular risk in patients of the HSEB Department of Medicine. Methods: Prospective, cross-sectional, descriptive and observational study, included 83 probabilistically chosen patients from a universe of 105 hospitalized from the HSEB Department of Medicine. For the calculation, OpenEpi version 3 and Microsoft Excel 2010 were used and in the analysis and interpretation of the data, graphs and tables of relative and absolute frequencies were used. Results: 53% were women and the average age was 54.5 years. The frequency of main risk factors was: Overweight 30.1%, obesity 13.3%, the Ci / Ca index very high in women 54.2%, family history of AMI 38.5% and HTA 34.6%, DM2 65.5%, High Cholesterol 34.4% , HTA 21.7% of these 73.9% were controlled, classified and were optimal 21.7% and Normal-High 34.8, also sedentary lifestyle 50%, carbohydrate consumption 56.6%, lipids 32.5%, fast food 44.6% and as a degree of Anxiety less than 54.2% and greater than 32.5%. Conclusion:There is a higher risk of a coronary event more in women over 50 years of age than in men, having as main cardiovascular risk factors diet, sedentary lifestyle, overweight, normal-high pressures, minor anxiety, and comorbidities Associated such as diabetes and high cholesterol.

POLYCHAETES FROM RED MANGROVE (Rhizophora mangle) AND THEIR RELATIONSHIP WITH THE WATER CONDITIONS IN THE GULF OF URABÁ, COLOMBIAN CARIBBEAN / Poliquetos de manglar rojo (Rhizophora mangle) y su relación con las condiciones acuáticas en el golfo de Urabá, Caribe Colombiano

Polychaetes play a significant role in benthic communities' ecology; they dominate the infauna, recycle nutrients from the water column and are commonly used as biological indicators. Along the Gulf of Urabá (Colombian Caribbean), particularly for the zones of the Marirrío Bay and the Rionegro Cove, there are no reports about ecological aspects of polychaete species; only a few taxonomic studies have been conducted. In this research we evaluate the relationship between polychaete species associated with red mangrove roots, Rhizophora mangle, and some physicochemical variables of the water column; also, we made some notes about the spatial distributions of polychaetes species within the two study areas. We found that the environmental variables that best explain polychaetes community segregation are the dissolved oxygen and electrical conductivity; temperature seems to have not a significant effect. In terms of spatial distribution, we found that Alitta succinea, Capitella cf. capitata and Ficopomatus miamiensis occupied the inner, middle and outer zones for both study area and seasons, while Stenoninereis sp. 1 (rainy and dry season) and the exotic polychaete Ficopomatus uschakovi (rainy season) were found just in Rionegro Cove. Finally, the species Nicolea modesta is registered by first time for the Gulf of Urabá, Colombian Caribbean.

Los poliquetos tienen un papel importante en la ecología de las comunidades bénticas, dominan la infauna, reciclan nutrientes de la columna de agua y son comúnmente usados como indicadores biológicos. En el Golfo de Urabá (Caribe Colombiano), específicamente para las zonas de Bahía Marirrío y Ensenada de Rionegro no existen estudios sobre la ecología de los poliquetos, solo se han desarrollado algunos estudos taxonómicos. En esta investigación se evaluó la relación entre algunas variables fisicoquímicas y las especies de poliquetos encontradas. Adicionalmente, se realizaron algunas observaciones sobre las distribución espacial de estas especies en las dos zonas de estudio. Se encontró que las variables que mejor explican las segregación de las especies de poliquetos fueron el oxígeno disuelto y la conductividad eléctrica; la temperatura no tuvo un efecto significativo. En términos de distribución espacial se encontró que las especies Alitta succinea, Capitella cf. capitata y Ficopomatus miamiensis ocuparon las zonas interna, media y externa de las dos áreas de estudio en las dos temporadas de muestreo; mientras que Ficopomatus uschakovi (temporada de lluvia) y Stenoninereis sp. 1 (ambas temporadas) fueron registradas solamente la Ensenada de Rionegro en diferentes temporadas. Finalmente, las especies Nicolea modesta es registrada por primera vez para el Golfo de Urabá.

Integrating Routine HIV Screening in the New York City Community Health Center Collaborative.

OBJECTIVE: One in seven of the 1.1 million people living in the United States infected with HIV are not aware of their HIV status. At the same time, many clinical settings have not adopted routine HIV screening, which promotes linkage to specialist medical care. We sought to improve HIV screening in a large community health center network by using a data-driven, collaborative learning approach and system-wide modifications, where counselor-based HIV screening and testing were replaced by health-care providers and medical assistants. METHODS: Urban Health Plan, Inc., a network of federally qualified health centers in the boroughs of the Bronx and Queens in New York City, provided HIV screening training for its health-care providers. In January 2011, it modified its electronic medical record system to incorporate HIV test offering. This study compared the 2010 baseline year with the three-year implementation follow-up period (January 2011 through December 2013) to determine the number of eligible individuals for HIV testing, HIV tests offered and performed, HIV-positive individuals, and HIV cases linked to specialty care. RESULTS: A total of 26,853 individuals at baseline and 100,369 individuals in the implementation period were eligible for HIV testing. HIV testing was performed on 2,079 (8%) of 26,853 eligible individuals in 2010 and 49,646 (50%) of 100,369 eligible individuals from 2011 through 2013. HIV-positive status was determined in 19 (0.9%) of 2,079 tested individuals in 2010 and 166 (0.3%) of 49,646 tested individuals from 2011 through 2013. Linkage to care was observed in all 19 eligible individuals and 127 (77%) of 166 eligible individuals who tested HIV positive in 2010 and 2011-2013, respectively. CONCLUSION: This study enabled routine HIV implementation testing at a community health center network, which resulted in enhanced HIV testing, an increased number of HIV-positive cases identified, and a rise in the number of patients linked to HIV specialist care.

Síndrome de Burnout en docentes universitarios / Burnout syndrome in university professors

Introducción: identificar el síndrome de Burnout o fatiga física en los trabajadores dedicados a la docencia es de suma importancia para el desarrollo de la propuesta de mejoramiento de condiciones laborales. Objetivo: determinar Burnout en los docentes de la Facultad de Enfermería de la Universidad Cooperativa de Colombia, sede Santa Marta. Métodos: estudio descriptivo correlacional con enfoque cuantitativo, con una muestra de 30 docentes, de una población de 56, selección muestral no probabilística. La información se recogió mediante el Instrumento Maslach Burnout Inventory, que mide cansancio emocional, despersonalización y desarrollo personal. Resultados: el 66,66 por ciento de las docentes presentaron cansancio emocional bajo y el 26,66 por ciento cansancio emocional medio. 96,66 por ciento nivel bajo de despersonalización y el 80 por ciento alto nivel de realización personal; se evidenció correlación positiva entre despersonalización/tiempo de servicio. Resultados que pueden indicar que la presentación de Burnout es directamente proporcional al tiempo de servicio transcurrido. Conclusiones: la actividad docente en el personal de enfermería representa una condición de riesgo para la presentación Burnout(AU)

Introduction: identify Burnout or physical fatigue in workers engaged in teaching it is of utmost importance for the development of the proposed improvement of working conditions. Objetive: to determine Burnout in teachers of the Faculty of Nursing at the Cooperative University of Colombia in Santa Marta. Methodology: descriptive correlational study with a quantitative approach, in which a sample of 30 teachers out of a total population of 56, non-probabilistic sample selection was chosen. Data collection was done through the Instrument Maslach Burnout Inventory (MBI), which measures emotional exhaustion, depersonalization and personal development. Results: the 66.6 percent had low emotional exhaustion and 26.6 percent Average emotional exhaustion. 96 percent low level of depersonalization and 80 percent higher level of personal fulfillment; positive correlation between depersonalization / length of service was evident. Results may indicate that the presentation of Burnout is directly proportional to the elapsed service. Conclusions: The teaching in the nursing staff represents a risk condition for the presentation Burnout(AU)

g-force induced giant efficiency of nanoparticles internalization into living cells.

Nanotechnology plays an increasingly important role in the biomedical arena. Iron oxide nanoparticles (IONPs)-labelled cells is one of the most promising approaches for a fast and reliable evaluation of grafted cells in both preclinical studies and clinical trials. Current procedures to label living cells with IONPs are based on direct incubation or physical approaches based on magnetic or electrical fields, which always display very low cellular uptake efficiencies. Here we show that centrifugation-mediated internalization (CMI) promotes a high uptake of IONPs in glioblastoma tumour cells, just in a few minutes, and via clathrin-independent endocytosis pathway. CMI results in controllable cellular uptake efficiencies at least three orders of magnitude larger than current procedures. Similar trends are found in human mesenchymal stem cells, thereby demonstrating the general feasibility of the methodology, which is easily transferable to any laboratory with great potential for the development of improved biomedical applications.

Redundancy and metabolic function of the glutamine synthetase gene family in poplar.

BACKGROUND: Glutamine synthetase (GS; EC: 6.3.1.2, L-glutamate: ammonia ligase ADP-forming) is a key enzyme in ammonium assimilation and metabolism in higher plants. In poplar, the GS family is organized in 4 groups of duplicated genes, 3 of which code for cytosolic GS isoforms (GS1.1, GS1.2 and GS1.3) and one group that codes for the choroplastic GS isoform (GS2). Our previous work suggested that GS duplicates may have been retained to increase the amount of enzyme in a particular cell type. RESULTS: The current study was conducted to test this hypothesis by developing a more comprehensive understanding of the molecular and biochemical characteristics of the poplar GS isoenzymes and by determinating their kinetic parameters. To obtain further insights into the function of the poplar GS genes, in situ hybridization and laser capture microdissections were conducted in different tissues, and the precise GS gene spatial expression patterns were determined in specific cell/tissue types of the leaves, stems and roots. The molecular and functional analysis of the poplar GS family and the precise localization of the corresponding mRNA in different cell types strongly suggest that the GS isoforms play non-redundant roles in poplar tree biology. Furthermore, our results support the proposal that a function of the duplicated genes in specific cell/tissue types is to increase the abundance of the enzymes. CONCLUSION: Taken together, our results reveal that there is no redundancy in the poplar GS family at the whole plant level but it exists in specific cell types where the two duplicated genes are expressed and their gene expression products have similar metabolic roles. Gene redundancy may contribute to the homeostasis of nitrogen metabolism in functions associated with changes in environmental conditions and developmental stages.

Sparstolonin B inhibits pro-angiogenic functions and blocks cell cycle progression in endothelial cells.

Sparstolonin B (SsnB) is a novel bioactive compound isolated from Sparganium stoloniferum, an herb historically used in Traditional Chinese Medicine as an anti-tumor agent. Angiogenesis, the process of new capillary formation from existing blood vessels, is dysregulated in many pathological disorders, including diabetic retinopathy, tumor growth, and atherosclerosis. In functional assays, SsnB inhibited endothelial cell tube formation (Matrigel method) and cell migration (Transwell method) in a dose-dependent manner. Microarray experiments with human umbilical vein endothelial cells (HUVECs) and human coronary artery endothelial cells (HCAECs) demonstrated differential expression of several hundred genes in response to SsnB exposure (916 and 356 genes, respectively, with fold change ≥2, p<0.05, unpaired t-test). Microarray data from both cell types showed significant overlap, including genes associated with cell proliferation and cell cycle. Flow cytometric cell cycle analysis of HUVECs treated with SsnB showed an increase of cells in the G1 phase and a decrease of cells in the S phase. Cyclin E2 (CCNE2) and Cell division cycle 6 (CDC6) are regulatory proteins that control cell cycle progression through the G1/S checkpoint. Both CCNE2 and CDC6 were downregulated in the microarray data. Real Time quantitative PCR confirmed that gene expression of CCNE2 and CDC6 in HUVECs was downregulated after SsnB exposure, to 64% and 35% of controls, respectively. The data suggest that SsnB may exert its anti-angiogenic properties in part by downregulating CCNE2 and CDC6, halting progression through the G1/S checkpoint. In the chick chorioallantoic membrane (CAM) assay, SsnB caused significant reduction in capillary length and branching number relative to the vehicle control group. Overall, SsnB caused a significant reduction in angiogenesis (ANOVA, p<0.05), demonstrating its ex vivo efficacy.

Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico.

The aim of this study was to determine the clinical outcome among indigent patients with rheumatoid arthritis (RA) in Puerto Rico receiving their healthcare in a managed care system, as compared with non-indigent patients treated in fee-for-service settings. A cross-sectional study was conducted in 214 Puerto Ricans with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative clinical manifestations, disease activity (per disease activity score 28), comorbid conditions, functional status (per Health Assessment Questionnaire), and pharmacologic profile were determined. Data were examined using uni- and multivariable (logistic regression) analyses. The mean (standard deviation (SD)) age of the study population was 56.6 (13.5) years; 180 (84.1 %) were women. The mean (SD) disease duration was 10.8 (9.6) years. Sixty-seven patients were treated in the managed care setting, and 147 patients received their healthcare in fee-for-service settings. In the multivariable analyses, RA patients treated in the managed care setting had more joint deformities, extra-articular manifestations, arterial hypertension, type 2 diabetes mellitus, cardiovascular events, fibromyalgia syndrome, and poorer functional status while having a lower exposure to biological agents than those treated in fee-for-service settings. Efforts should be undertaken to curtail the gap of health disparities among these Hispanic patients in order to improve their long-term outcomes.

Programa de intervención cognoscitivo conductual en la calidad de sueño de cuidadores familiares / Cognitive-behavioral intervention program concerning the sleep quality of family caregivers

El objetivo principal del presente estudio fue diseñar un programa de intervención cognoscitivo conductual para mejorar la calidad del sueño de cuidadores familiares de personas con enfermedades crónicas. El programa y un manual de aplicación fue el resultado final del desarrollo tecnológico en este primer estudio. Los psicólogos profesionales, los practicantes del área de la Psicología de la Salud y los profesionales de la salud que trabajen en equipos interdisciplinarios y que estén interesados en velar por la calidad de vida de los cuidadores, podrán hacer uso de estos productos. Está conformado por ocho sesiones, formatos de registro y de tareas para la casa. En la primera y la última sesión se sugiere la aplicación de algunas pruebas (pre y postest); en ellas, se emplean: un formato de entrevista estructurada, el Índice de Calidad de Sueño de Pittsburgh, validado en Colombia por Escobar-Córdoba y Eslava-Schmalbach en el 2005, y la Escala Atenas de Insomnio, versión en español validada en México por Nenclares y Jiménez en el 2005, con el fin de realizar una comparación y contemplar las diferencias existentes entre las condiciones de entrada de los pacientes en los diferentes aspectos evaluados y lo que se observa después de aplicado el programa. A partir de la segunda sesión, se plantea el manejo de información sobre el papel del cuidador; el sueño y el compromiso que debe adquirirse para mejorar la calidad del sueño; el entrenamiento en higiene del sueño en técnicas de relajación; la realización de un plan estratégico del descanso y la utilización de reestructuración cognoscitiva. Finalmente el programa propone una etapa de seguimiento, que se plantea en tres momentos, el primero al mes de manera presencial, el segundo a los seis meses y, el tercero al año, por medio de una llamada telefónica. El seguimiento permitirá conocer el mantenimiento de los resultados después de concluido el programa. En el texto del estudio realizado por Orozco, Eustache y Grosso en el 2011, se presenta el programa y Manual completos.

The purpose of this study was to design a cognitivebehavioral\r\nintervention program addressed to improve\r\nthe sleep quality of chronic diseases patient's family\r\ncaregivers. The program represents the final proposal\r\nof technological development, with the intervention\r\napplication manual designed for professional psychologists\r\nand practitioners in the area of Health Psychology.\r\nThe program comprises eight sessions, registration\r\nforms and homework; in the first and last session the\r\napplication of a pre-test and post-test is suggested and\r\nconducted using: a structured interview format, the\r\nPittsburgh Sleep Quality Index, Colombian Version -\r\nvalidated by Escobar-Córdoba and Eslava-Schmalbach,\r\n2005 and Athens Insomnia Scale, Spanish Version -\r\nvalidated in Mexico by Nenclares and Jimenez, 2005,\r\nto make comparisons and appreciate the differences\r\nbetween the conditions of entry of patients evaluated\r\nin the different aspects and what is observed after\r\napplication of the program. Commencing with the\r\nsecond session the information processed is about the\r\nrole of the caregiver, the sleep and commitment of\r\nthe caregiver with the need to improve their quality\r\nof sleep; a training is implemented in terms of sleep\r\nhygiene, relaxation techniques, a strategic plan in the\r\nbenefit of rest and cognitive restructuring. At the end\r\na three time follow-up phase at one month (in person),\r\nsix and twelve months by a telephone call. In the\r\noriginal study by Orozco, Esutache y Grosso (2011)\r\nthe complete program and Manualsare available.

Renal biopsies in Puerto Rico patients with lupus nephritis.

The purpose of was to evaluate the renal pathology findings as described by the World Health Organization classification for systemic lupus erythematosus (SLE) in a group of Puerto Rico patients with lupus nephritis and determine the association with clinical and laboratory findings. The medical records from patients seen at the Lu pus Clinic from 1985 to 2005 were reviewed and patients with a performed renal biopsy included. All patients fulfilled the American ColIege of Rheumatology criteria for SLE. Data gathered from the medical records included demographics, cumulative clinical manifestations and serologic tests at the time of the renal biopsy. There were 139 patients with lupus nephntis (LN) and 71 patients (51%) had a renal biopsy done. From these 86% were females and their mean age at LN diagnosis was 25 years. The mean time between diagnosis of LN and renal biopsy was 1.5 years. The most frequent renal pathology was membranous glomewlonephritis (GN) class V (37%) followed by mesangial GN class II (23%). All groups were similar in clinical manifestations and laboratory parameters. The majority of Puerto Rico patients with LN had membranous GN class V. This data is different from other ethnic groups were diffuse GN type IV has been described as most prevalent.