Spatial predictors of immunotherapy response in triple-negative breast cancer.

Immune checkpoint blockade (ICB) benefits some patients with triple-negative breast cancer, but what distinguishes responders from non-responders is unclear1. Because ICB targets cell-cell interactions2, we investigated the impact of multicellular spatial organization on response, and explored how ICB remodels the tumour microenvironment. We show that cell phenotype, activation state and spatial location are intimately linked, influence ICB effect and differ in sensitive versus resistant tumours early on-treatment. We used imaging mass cytometry3 to profile the in situ expression of 43 proteins in tumours from patients in a randomized trial of neoadjuvant ICB, sampled at three timepoints (baseline, n = 243; early on-treatment, n = 207; post-treatment, n = 210). Multivariate modelling showed that the fractions of proliferating CD8+TCF1+T cells and MHCII+ cancer cells were dominant predictors of response, followed by cancer-immune interactions with B cells and granzyme B+ T cells. On-treatment, responsive tumours contained abundant granzyme B+ T cells, whereas resistant tumours were characterized by CD15+ cancer cells. Response was best predicted by combining tissue features before and on-treatment, pointing to a role for early biopsies in guiding adaptive therapy. Our findings show that multicellular spatial organization is a major determinant of ICB effect and suggest that its systematic enumeration in situ could help realize precision immuno-oncology.

The Chemical Modification to Improve Solubility of Chitosan and Its Derivatives Application, Preparation Method, Toxicity as a Nanoparticles.

Chitosan is a functional polymer in the pharmaceutical field, including for nanoparticle drug delivery systems. Chitosan-based nanoparticles are a promising carrier for a wide range of therapeutic agents and can be administered in various routes. Solubility is the main problem for its production and utilization in large-scale industries. Chitosan modifications have been employed to enhance its solubility, including chemical modification. Many reviews have reported the chemical modification but have not focused on the specific characteristics obtained. This review focused on the modification to improve chitosan solubility. Additionally, this review also focused on the application of chitosan derivatives in nanoparticle drug delivery systems since very few similar reviews have been reported. The specific method for chitosan derivative-based nanoparticles was also reported and the latest report of chitosan, chitosan derivative, and chitosan toxicity were also described.

Partial hydatidiform mole and coexistent live fetus with placenta previa: a case report.

Partial molar pregnancy with a coexistent live fetus is very rare. This type of mole mostly ends in the early termination of pregnancy due to an abnormally developed fetus. Case presentation: Here, we report a case of a 24-year-old Indonesian woman with an ultrasonographic appearance of partial hydatidiform mole with initial placenta covering the internal uterine ostium in the late first trimester which then became marginal placenta previa in the third trimester. The woman decided to continue the pregnancy after considering the risks and benefits. The normal anatomy of the premature infant was vaginally delivered alive with a large and hydropic placenta. Clinical discussion: Proper diagnosis, management, and monitoring remain challenging as this case is still rarely reported. Although embryos from partial mole forms generally do not survive since the first trimester, our case reported the singleton pregnancy with the coexistent normal fetus and the partial mole characteristic of the placenta. Diploid karyotype, few and focal extent of hydatidiform tissue of placenta, low rate of molar degeneration, and the absence of fetal anemia hypothesized as the factors that influenced survival of the fetus. There were two maternal complications such as hyperthyroidism and frequent vaginal bleeding without subsequent anemia in this patient. Conclusions: A rare case of partial hydatidiform mole coexistent with a live fetus with placenta previa was reported in this study. There were also maternal complications. Thus, prompt and regular monitoring of maternal and fetal condition holds an important role.

Constraint-induced movement therapy versus bimanual intensive therapy in children with hemiplegia showing low/very low bimanual functional performance: A randomized clinical trial.

INTRODUCTION: Children with infantile hemiplegia with low or very low bimanual functional performance have great impediments to spontaneously use their affected upper limb, which affects their performance of day-to-day activities and their quality of life. OBJECTIVE: To determine whether the order of application and the dose of modified constraint-induced movement therapy within a combined (hybrid) protocol influences the results of bimanual functional performance of the affected upper limb and the quality of life of children with congenital hemiplegia (5 to 8 years old) with low/very low bimanual functional performance. DESIGN: Single-blinded randomized controlled trial. PARTICIPANTS: Twenty-one children with congenital hemiplegia (5 to 8 years old) were recruited from two public hospitals and an infantile hemiplegia association in Spain. INTERVENTIONS: The experimental group (n = 11) received 100 hours of intensive therapies for the affected upper limb: 80 hours of modified constraint-induced movement therapy and 20 hours of bimanual intensive therapy. The control group (n = 10) received the same dose with 80 hours of bimanual intensive therapy and 20 hours of modified constraint-induced movement therapy. The protocol was provided 2 hours per day, 5 days per week, for 10 weeks. OUTCOME MEASURES: The primary outcome was bimanual functional performance, measured with the Assisting Hand Assessment, and the second outcome was quality of life, measured with the Pediatric Quality of Life Inventory Cerebral-Palsy module (PedsQL v. 3.0, CP module). Four assessments were performed: Weeks 0, 4, 8, and 10. RESULTS: The experimental group obtained an increase of 22 assisting hand assessment (AHA) units at week 8 with the application of modified constraint-induced movement, in contrast with the control group, which obtained an increase of 3.7 AHA units after bimanual intensive therapy. At week 10, the control group showed its greatest increase in bimanual functional performance, with 10.6 AHA units after modified constraint-induced movement therapy. Regarding quality of life, the greatest improvement occurred after modified constraint-induced movement, with 13.1 points in the experimental group (80 hours) and 6.3 points in the control group (20 hours). The protocol interaction was statistically significant for bimanual functional performance (p = .018) and quality of life (p = .09). CONCLUSIONS: Modified constraint-induced movement therapy is more beneficial than bimanual intensive therapy for improving upper limb functioning and quality of life in children with congenital hemiplegia showing low/very low bimanual performance. GOV IDENTIFIER: NCT03465046.

Epidemiological Pattern of Traumatic Brain Injury in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

BACKGROUND: Although the incidence of traumatic brain injury (TBI) has decreased since the beginning of the coronavirus disease 2019 (COVID-19) pandemic and severe acute respiratory syndrome coronavirus 2 is still evolving, the number of TBI cases has still greatly increased in multiple countries. In the present systematic review and meta-analysis, we evaluated the epidemiological characteristics of patients with TBI before and during the COVID-19 pandemic. METHODS: We conducted a systematic literature search of original studies, short reports, and research letters from databases on studies that contained data about the severity, mortality, presence of neurological deficits, radiological diagnosis, cause of injury, and type of management of TBI during a specified period within the pandemic compared with before the pandemic. RESULTS: A total of 18,490 subjects from 13 studies were included in the present study. The results of the meta-analysis showed a higher TBI mortality rate during the COVID-19 pandemic in the low-to-middle income countries (odds ratio, 1.65; 95% confidence interval, 1.12-2.41; P < 0.05; I2 = 40.8%; P = 0.18). The proportion of subdural hemorrhage was decreased, and the proportion of subarachnoid hemorrhage was increased in low- to middle-income and high-income countries, respectively. The proportion of assaults as the cause of TBI had increased during the pandemic (odds ratio, 1.40; 95% confidence interval, 1.06-1.86; P = 0.02; I2 = 20.8%; P = 0.28). We did not find any significant differences in the incidence of surgical intervention for TBI during the pandemic. CONCLUSIONS: Our results have indicated that during the COVID-19 pandemic, the TBI mortality rate had increased in low- to middle-income countries. The rate of assault as the cause of TBI had also increased during the pandemic.

The efficacy of virtual reality tools for total knee replacement rehabilitation: A systematic review.

Purpose. To assess the effects of training with virtual reality tools (VRT) during rehabilitation of patients after total knee replacement (TKR). Methods. Systematic review. Six databases were queried. Search criteria included studies in which participants underwent TKR, took part in a rehabilitation protocol with VRT, and clinical outcomes of rehabilitation were considered. Available demographic, interventional and outcome data, along with functional, balance, and pain outcome measures were extracted. Patient satisfaction was also summarized. Results. Six trials were included. Available information shows that multi-modal intervention with VRT is used primarily to augment conventional rehabilitation. The Wii Balance Board is the most frequently used device. Conclusions. Findings suggest that an augmented VRT physical therapy intervention that is specifically-oriented to enhance balance could be more effective for overcoming balance limitations than standard physical therapy. However, rehabilitation with VRT has no advantage over conventional training for enhancing function, resolving pain, or increasing patient satisfaction after TKR. Future studies are needed to confirm the findings, particularly regarding the feasibility of preoperative and continued in-home intervention. Registration: CRD42017057087.

Hemangiopericitoma óseo de localización humeral / Bone hemangiopericytoma located in the humerus

Planteamiento: El hemangiopericitoma es un tumor vascular maligno infrecuente de los pericitos de Zimmerman que están rodeando los espacios vasculares. Representa el 0,1 por ciento de los tumores malignos óseos y únicamente el 0,08 por ciento de los tumores primarios óseos. Material y método: Nosotros describimos un caso hemangiopericitoma óseo del húmero en una mujer de 69 años, diagnosticado con la ayuda del material citológico obtenido de la punción aspiración con aguja fina, y posteriormente de la biopsia ósea. Resultados: El material citológico el obtenido del bloque celular fue de gran utilidad, permitió descartar algunos de los procesos neoplásicos óseos primarios y metastásicos más frecuentes de origen desconocido, tal como el pulmonar y el renal. La inmunohistoquímica realizada sobre cortes histológicos nos afianzó el diagnóstico de hemangiopericitoma. Conclusiones: El diagnóstico diferencial citológico e histológico del hemangiopericitoma óseo se tiene que hacer con los tumores fusocelulares primarios óseos y metastásicos, fundamentalmente con el condrosarcoma mesenquimal, el osteosarcoma de células pequeñas, el histiocitoma fibroso maligno y el sarcoma sinovial; y con las metástasis óseas del leiomiosarcoma y el melanoma. Antes de confirmar un hemangiopericitoma óseo como primario hay que descartar un probable origen metastásico. Los hemangioperictomas primarios óseos tienen un pronóstico incierto, por lo tanto los debemos de considerar biológicamente malignos (AU)

Guía clínica de fisioterapia respiratoria para lesionados medulares espinales con ventilación mecánica invasiva hasta su decanulación / Clinical guide for respiratory physiotherapy for spinal cord injured patients with invasive mechanical ventilation until their decanulation

La insuficiencia respiratoria aguda que acontece durante la fase de schock medular hace necesario en numerosas ocasiones ventilar al paciente mecánicamente. La supervivencia del lesionado medular con disfunción respiratoria severa ha mejorado gracias al acceso invasivo de la vía aérea.La Fisioterapia respiratoria constituye un pilar imprescindible en el manejo y tratamiento de estas personas (AU)

Posturas recomendadas en el masaje / Right posture during the massage

En este artículo se exponen las posturas más indicadas a la hora de realizar un masaje, así como una serie de hábitos y ejercicios para cuidar la espalda y las articulaciones que intervienen en la ejecución del masaje. Las alternativas que aquí planteamos responden a un estudio descriptivo publicado en la revista con el título '¿Cuidas tu postura al realizar el masaje?'. En el mencionado trabajo se exponían los resultados obtenidos en forma de encuesta, con una población de 50 fisioterapeutas deportivos, a los que se les preguntó sobre sus hábitos posturales a la hora de dar el masaje, sobre las dolencias más habituales que presentaban y el carácter de las mismas (AU)

Protocolo de Fisioterapia respiratoria en el lesionado medular espinal / Protocol of respiratory Physiotherapy in the spinal cord injured subject

El daño neurológico en los lesionados medulares conlleva la afectación de su sistema respiratorio en mayor o menor medida en función de una serie de factores como pueden ser el nivel de lesión, la edad, las patologías anteriores o los traumatismos sufridos en el momento de la lesión. Es evidente, pues, que en estos pacientes la fisioterapia respiratoria será no sólo una necesidad, sino también el aprendizaje que les hará mejorar su calidad de vida. Mantener una buena higiene bronquial y mejorar la mecánica ventilatoria va a conseguir, por un lado, la prevención de complicaciones, y por otro, el bienestar del lesionado medular espinal (AU)

Programa de Prevención y Educación Postural en el Sector Textil / Prevention and Postural Education Programme in theTextile Sector

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