Harvesting visible light for enhanced catalytic degradation of wastewater using TiO2@Fe3O4 embedded on two dimensional reduced graphene oxide nanosheets.

Carbon-integrated binary metal oxide semiconductors have gained prominence in the last decade as a better material for photocatalytic wastewater treatment technology. In this regard, this research describes the investigation of the binary metal oxide TiO2@Fe3O4 embedded on reduced graphene oxide (rGO) nanosheets synthesized through a combination of sol-gel, chemical precipitation, and Hummer's processes. Besides, the catalyst is applied for the photocatalytic degradation of organic chlorophenol pollutants. The characterized diffraction results showed the peak broadening of the rGO-TiO2@Fe3O4 composite formed with tetragonal and cubic structures having small crystallite sizes. The TEM observation shows an enormous miniature of TiO2@Fe3O4 nanospheres spread on the folded 2D-rGO nanosheets with a large BET surface area. The XPS result holds the mixed phases of Fe3O4 and Fe2O3. Finally, the catalyst demonstrated a low band gap with extended light absorption towards visible light irradiation. The synergistic interactions between Fe3+ and Fe2+ improved the visible light activity due to the incorporation of rGO, and also possessed good recycling capacity. The increased mobility of electrons at the interfaces of TiO2 and Fe3O4 due to the mixing of rGO results in the separation of charge carriers by elevating the photocatalytic degradation efficiency of chlorophenol.

Erratum: Closing the gap for cervical cancer research in Vietnam: current perspectives and future opportunities: a report from the 5th Gynecologic Cancer InterGroup (GCIG) Cervical Cancer Research Network (CCRN) Education Symposium.

This corrects the article on p. e88 in vol. 34, PMID: 37668081.

Selective NO2 Detection of CaCu3Ti4O12 Ceramic Prepared by the Sol-Gel Technique and DRIFT Measurements to Elucidate the Gas Sensing Mechanism.

NO2 is one of the main greenhouse gases, which is mainly generated by the combustion of fossil fuels. In addition to its contribution to global warming, this gas is also directly dangerous to humans. The present work reports the structural and gas sensing properties of the CaCu3Ti4O12 compound prepared by the sol-gel technique. Rietveld refinement confirmed the formation of the pseudo-cubic CaCu3Ti4O12 compound, with less than 4 wt% of the secondary phases. The microstructural and elemental composition analysis were carried out using scanning electron microscopy and X-ray energy dispersive spectroscopy, respectively, while the elemental oxidation states of the samples were determined by X-ray photoelectron spectroscopy. The gas sensing response of the samples was performed for different concentrations of NO2, H2, CO, C2H2 and C2H4 at temperatures between 100 and 300 °C. The materials exhibited selectivity for NO2, showing a greater sensor signal at 250 °C, which was correlated with the highest concentration of nitrite and nitrate species on the CCTO surface using DRIFT spectroscopy.

Results of endovascular treatment of venous anastomotic stenosis in prosthetic arteriovenous for hemodialysis PTFE grafts. Comparative analysis between patent and occluded grafts.

OBJECTIVE: To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG. MATERIAL AND METHODS: A retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment <30%, and clinical success as satisfactory immediate dialysis after surgery. After ET a biannual clinical and ultrasound follow-up was performed. STATISTICAL ANALYSIS: Survival analysis was performed for time-to-event data to assess patency. RESULTS: Group A: 55 patients. Group B: 22. There were no significative differences in demographic and anatomical factors between groups. Technical and clinical success were 100% in group B and 94.5% and 91% respectively in group A. Primary patency at 1, 6 and 12 months was: Group A: 81.8%, 22.4% y 15.7% respectively. Group B: 100%, 85.9%, 76,4% (p < 0.001). Secondary patency at 1, 6 and 12 months was: Group A: 85.2%, 45.8% y 31.3% respectively. Group B 100%, 95.3%, 95.2% (p < 0.001). Use of non-covered stents was associated with an increased risk of occlusion (HR 2.669 IC 95% 1.146-6.216, p = 0.010). CONCLUSION: A higher patency of EV performed on a patent HAG is expected. It is therefore advisable to develop surveillance programs that are capable to detect VAS before its occlusion.

Resultados del tratamiento endovascular de la estenosis de la anastomosis venosa en las fístulas arteriovenosas protésicas para hemodiálisis de PTFE. Análisis comparativo entre fístulas permeables y trombosadas / Results of endovascular treatment of venous anastomotic stenosis in prosthetic arteriovenous for hemodialysis PTFE grafts. Comparative analysis between patent and occluded grafts

Objetivo: Analizar los resultados del tratamiento endovascular (TEV) de las estenosis en las anastomosis venosas (EAV) de las fístulas arteriovenosas protésicas (FAVp), comparando su utilidad al realizarse sobre FAVp permeables frente a trombosadas.Material y métodosEstudio retrospectivo de pacientes intervenidos mediante TEV por EAV de fístulas humeroaxilares realizadas entre enero de 2009 y diciembre de 2019 en nuestro centro. Grupo A: FAVp trombosada secundaria a EAV; Grupo B: FAVp permeable con EAV detectada en seguimiento. Se definió éxito técnico como estenosis residual ≤ 30% y éxito clínico como diálisis efectiva inmediata. Tras el TEV se realizó un seguimiento clínico y con eco-Doppler semestral. Estudio estadístico: se realizó un análisis de supervivencia mediante el método Kaplan Meier para el estudio de permeabilidades.ResultadosGrupo A: 55 pacientes. Grupo B: 22 pacientes. No existieron diferencias significativas en las características demográficas ni anatómicas entre grupos.El éxito técnico y clínico fueron del 100% en el grupo B frente a un 94,5% y 91%, respectivamente, en el grupo A.La permeabilidad primaria a 1, 6 y 12 meses en el Grupo A fue: 81,8%, 22,4% y 15,7%, respectivamente, frente al Grupo B: 100%, 85,9%, 76,4% (p<0,001). Permeabilidad secundaria a 1, 6 y 12 meses en el Grupo A fue 85,2%, 45,8% y 31,3%, respectivamente, frente al Grupo B 100%, 95,3%, 95,2% (p<0,001). El uso de stents no cubierto se asoció a un mayor riesgo de oclusión (HR 2,669 IC 95% 1,146-6,216, p=0,010).ConclusiónEs esperable una mayor permeabilidad del TEV realizado sobre una FAVp permeable, por lo que es recomendable elaborar programas de seguimiento que sean capaces de detectar la EAV previo a su trombosis. (AU)

Objective: To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG.Material and methodsA retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment <30%, and clinical success as satisfactory immediate dialysis after surgery. After ET a biannual clinical and ultrasound follow-up was performed. Statistical analysis: Survival analysis was performed for time-to-event data to assess patency.ResultsGroup A: 55 patients. Group B: 22. There were no significative differences in demographic and anatomical factors between groups.Technical and clinical success were 100% in Group B and 94.5% and 91% respectively in Group A.Primary patency at 1, 6 and 12 months was: Group A: 81.8%, 22.4% and 15.7% respectively. Group B: 100%, 85.9%, 76.4% (p<0.001). Secondary patency at 1, 6 and 12 months was: Group A: 85.2%, 45.8% and 31.3% respectively. Group B 100%, 95.3%, 95.2% (p<0.001). Use of non-covered stents was associated with an increased risk of occlusion (HR 2.669 95% CI 1.146–6.216, p=0.010).ConclusionA higher patency of EV performed on a patent HAG is expected. It is therefore advisable to develop surveillance programs that are capable to detect VAS before its occlusion. (AU)

Results of endovascular treatment of venous anastomotic stenosis in prosthetic arteriovenous for hemodialysis PTFE grafts. Comparative analysis between patent and occluded grafts. / Resultados del tratamiento endovascular de la estenosis de la anastomosis venosa en las fístulas arteriovenosas protésicas para hemodiálisis de PTFE. Análisis comparativo entre fístulas permeables y trombosadas.

OBJECTIVE: To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG. MATERIAL AND METHODS: A retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment <30%, and clinical success as satisfactory immediate dialysis after surgery. After ET a biannual clinical and ultrasound follow-up was performed. STATISTICAL ANALYSIS: Survival analysis was performed for time-to-event data to assess patency. RESULTS: Group A: 55 patients. Group B: 22. There were no significative differences in demographic and anatomical factors between groups. Technical and clinical success were 100% in Group B and 94.5% and 91% respectively in Group A. Primary patency at 1, 6 and 12 months was: Group A: 81.8%, 22.4% and 15.7% respectively. Group B: 100%, 85.9%, 76.4% (p<0.001). Secondary patency at 1, 6 and 12 months was: Group A: 85.2%, 45.8% and 31.3% respectively. Group B 100%, 95.3%, 95.2% (p<0.001). Use of non-covered stents was associated with an increased risk of occlusion (HR 2.669 95% CI 1.146-6.216, p=0.010). CONCLUSION: A higher patency of EV performed on a patent HAG is expected. It is therefore advisable to develop surveillance programs that are capable to detect VAS before its occlusion.

Tratamiento del aneurisma de aorta infrarrenal roto: cirugía abierta versus tratamiento endovascular / Treatment of ruptured abdominal aortic aneurysm: open surgical repair versus endovascular repair

Introducción: el aneurisma de aorta abdominal roto (AAAr) es una patología que asocia una elevada morbimortalidad. El objetivo es analizar los resultados del tratamiento del AAAr en nuestro centro, comparando cirugía abierta (CA) y endovascular (EVAR). Material y métodos:estudio de cohortes retrospectivo de pacientes intervenidos por AAAr con cuello infrarrenal entre enero de 2006 y diciembre de 2017, dividido en grupo CA y grupo EVAR. Análisis comparativo de comorbilidad, características anatómicas, técnica y resultados.Resultados:54 pacientes fueron incluidos, 26 (48,1 %) en el grupo CA y 28 (51,9 %) en el EVAR. Sin diferencias en cuanto a edad (70,7 ± 7,8 años vs. 72,5 ± 9,5, p = 0,45) ni comorbilidades, salvo la dislipemia (26,9 % vs. 67,9 % p = 0,003). Los aneurismas eran mayores en el grupo CA (88,1 ± 17,9 mm vs. 72,4 ± 16 mm, p = 0,02), con un mayor porcentaje de aneurisma iliaco asociado (34,6 % vs. 17,8 %, p = 0,07). Un 65,4 % del grupo CA presentó inestabilidad hemodinámica preoperatoria, frente al 60,7 % del EVAR (p = 0,72). Se empleó anestesia local en el 50 % del grupo EVAR. Las necesidades transfusionales intraoperatorias medianas para el grupo CA y EVAR fueron 11 ± 6 y 4 ± 3 concentrados de hematíes respectivamente (p = 0,001). La mortalidad hospitalaria fue mayor en el grupo CA (46,2 % vs. 28,6 %) (p = 0,18). En dicho grupo hubo 4 éxitus intraoperatorios. Un 54,5 % de pacientes del grupo CA y un 64,3 % del EVAR (p = 0,48) presentaron complicaciones mayores, siendo las más frecuentes la intubación prolongada y el fracaso renal que requirió terapia de reemplazo renal. La tasa de reintervención hospitalaria fue 18,2 % en el grupo CA y 25 % en el EVAR (p = 0,56), siendo en este grupo todas las reintervenciones en el subgrupo de endoprótesis aortouniiliaca. La supervivencia a 2 años fue del 51,7 % en el grupo CA y del 65,2 % en el EVAR (p = 0,28).(AU)

Background: the ruptured abdominal aortic aneurysm (rAAA) is associated with high morbimortality. The purpose of this study was to compare results of open surgical repair (OSR) and EVAR in our institution in the management of rAAA. Material and methods:retrospective observational cohort study was conducted on rAAA patients with infrarenal neck between January 2006 and December 2017. Sample was divided according to intervention: OSR vs. EVAR. Comorbidities, anatomical features, intervention and results were analyzed by repair method. Results:fifty-four patients were included, 26 (48,1 %) using OSR and 28 (51,9 %) using EVAR. Age (70,7 ± 7,8 years vs. 72,5 ± 9,5; p = 0,45) and comorbidities showed no statistical significance, except for dyslipidemia (26,9 % vs. 67,9 %; p = 0,003). Aneurysms were larger in OSR group (88,1 ± 17,9 mm vs. 72,4 ± 16 mm; p = 0,02), with a higher rate of associated iliac aneurysm (34,6 % vs. 17,8 %, p = 0,07). 65,4 % of patients in OSR group showed preoperative hemodynamic instability, compared to 60,7 % in EVAR group (p = 0,72). 50 % of EVAR procedures were performed under local anesthesia. Median intraoperative transfusion requirements for OSR group and EVAR group were, respectively, 11 ± 6 and 4 ± 3 red blood cell concentrates (p = 0.001). Hospital mortality was higher in OSR group (46.2 % vs. 28.6 %) (p = 0.18). There were four intraoperative deaths in this group. 54.5 % of OSR patients and 64.3 % of EVAR presented major complications. The most common ones were longtime intubation and acute renal failure requiring renal replacement therapy. Reintervention rate was 18.2 % in CA group and 25 % in EVAR group (p = 0.56), all reinterventions in EVAR group performed in rAAAs repaired by an aortouniiliac device. Two-year survival rate was 51.7 % in CA group and 65.2 % in EVAR group (p = 0.28).(AU)

Reparación del arco aórtico mediante prótesis híbrida y su combinación con TEVAR / Aortic arch repair with elephant trunk and TEVAR combination

Introducción y objetivos: la reparación del arco y aorta torácica descendente (ATD) se asocia a una elevada morbi-mortalidad. Las prótesis híbridas del arco y las endoprótesis torácicas (TEVAR) pueden disminuir sus complicaciones.El objetivo es describir resultados a corto y medio plazo del abordaje híbrido de esta patología.Material y métodos: análisis retrospectivo de pacientes intervenidos entre agosto de 2016 y febrero de 2020 porpatología aneurismática del arco aórtico y ATD mediante una prótesis híbrida y TEVAR en dos tiempos.Resultados: trece pacientes intervenidos, todos por aneurisma sin disección. Inicialmente se empleó una prótesishíbrida con diámetro mediano de 30 mm (29-33) y una longitud de 130 mm en 12 de ellos. Se conservaron los3 TSA en todos los pacientes, con pastilla para tronco braquiocefálico y carótida izquierda y bypass a subclaviaizquierda en el 69 % de ellos.El tiempo mediano hasta el TEVAR fue de 13,5 semanas (6-20), con un éxito técnico del 100 %. Se implantó un solomódulo en 9 casos con una sobredimensión media del 10 % respecto a la trompa de elefante. No hubo ningúncaso de paraplejia, ictus o muerte perioperatoria. El tiempo mediano de ingreso hospitalario fue de 4 días (2-6) y elseguimiento mediano tras el TEVAR de 17 meses (9-25), con una supervivencia del 100 % a 24 meses. Se comprobóuna correcta exclusión del aneurisma en el angio-TC de control en todos los casos y sin objetivarse fugas de altofl ujo durante el seguimiento.Conclusiones: en nuestra experiencia, el TEVAR es una opción segura como segundo tiempo, y ofrece unos exce-lentes resultados a medio plazo en tasa de exclusión del aneurisma.(AU)

Introduction and objectives: aortic arch and descending thoracic aorta repair are associated with a high mor-bidity and mortality. The frozen elephant trunk combined with TEVAR could improve outcomes. The objective isto describe short and midterm results of the hybrid approach in this pathology.Material and methods: retrospective analysis of patients who underwent two-staged intervention with hybridprosthesis and TEVAR for aortic arch and thoracic descending aneurysm between August 2009 and February 2020.Results: thirteen patients were included, all of them secondary to non-dissecting aneurysm. First-stage interventionwith frozen elephant trunk (average prosthesis diameter: 30 mm [29-33] average length: 130 mm). Supraaorticvessel reimplantation was performed most frequently (69 %) with an island technique for innominate artery andleft common carotid artery and a left subclavian artery bypass to the aortic graft.The average time to TEVAR implantation was 13.5 weeks (6-20), with technical success of 100 %. A single devicewas implanted in 9 cases, with 10 % oversizing relative to the hybrid prosthesis. No cases of paraplegia, stroke orperioperative death were observed. The average hospital stay length was 4 days (2-6) and the average follow-upafter TEVAR was 17 months (9-25), survival at 24 months was 100 %. Correct aneurysm exclusion was documentedin all CT controls, with no high-flow endoleaks during follow-up.Conclusions: based on our experience, TEVAR is a safe option as a second-stage intervention for complex thoracicaortic aneurysm pathology, offering excellent mid-term results for aneurysm exclusion.(AU)

Aortic Rupture by an Acute Dissection of the Thoracoabdominal Aorta in a 12-Year-Old Boy.

Aortic dissection is exceptional in children. When they are affected, many clinical conditions as Marfan syndrome or Ehlers-Danlos syndrome are usually involved, but up to 22% have no associated background. Its high morbidity and low incidence in this age group require a high level of suspicion in children without predisposing factors when the presentation is atypical, to avoid the severe consequences of the delay of their diagnosis. In this article we describe the dissection and aortic rupture in a 12-year-old child without relevant medical history, and the open repair that was performed as treatment.

The Cervical Cancer Research Network (Gynecologic Cancer InterGroup) roadmap to expand research in low- and middle-income countries.

Cervical cancer is a global health problem which disproportionally affects women in low- and middle- income countries. The World Health Organization recently launched its global strategy to eliminate this disease in the next two decades. For those women diagnosed today with cervical cancer better strategies are needed to improve outcome and reduce treatment-related morbidity. Clinical trials are critical to shaping future treatment, and much has been achieved already. However, such opportunities are limited in low resource settings, and the Cervical Cancer Research Network is dedicated to expanding access to new technologies in surgery, radiation, and medical oncology. In this article we review the status of the trials portfolio and outline future objectives, including the launch of a number of research grants for aspiring or established researchers in low- and middle-income settings.

Prognostic Value of Initial Aneurysmal Sac Regression after EVAR.

BACKGROUND: The objective of the study was to evaluate the impact of initial aneurysmal sac reduction after endovascular aneurysm repair on the evolution of aneurysmal sac over follow-up. METHODS: A retrospective cohort study was made of patients subjected to elective treatment between January 2005 and December 2014, with a minimum follow-up of 18 months. An analysis was made of the evolution of the aneurysmal sac according to its condition one year after surgery, defining of two groups: A (sac reduction) and B (stable sac). Follow-up by computed tomography (CT) angiography was made after one month and then every 6 months or annually, depending on the presence of endoleak. RESULTS: A total of 128 patients were included. Fifty-one patients (39.8%) showed a significant decrease in diameter during the first year (group A), whereas 77 patients (60.2%) showed no initial decrease (group B). Preoperative CT angiography showed the patients in group A to have larger aneurysms (63.5 mm vs. 59.25; P = 0.048), a greater presence of posterior thrombus (68.6% vs. 30.7%; P < 0.001), and fewer patent lumbar vessels (56.9% vs. 83.1%; P = 0.001). The prevalence of endoleak at some point during follow-up was lower in group A (31.4% vs. 74% in group B; P < 0.001), and 100% of all aneurysmal growths were associated to the presence of endoleak. After 5 years, significant differences were observed in the growth-free rate (96.9% in group A vs. 85.2% in group B; hazard ratio [HR] 4.8 [1.1-21.4; P = 0.036]) and in the reintervention-free rate (95,7% vs. 84.6%; HR 6.6 [0.8-52.4; P = 0.07]). No reoperation in group A was due to type II endoleak. CONCLUSIONS: The aneurysmal sac can be expected to take a favorable course in those cases characterized by initial aneurysmal sac reduction. These findings may imply a change in the follow-up protocol, even in cases with type II endoleak.

Advancing clinical research globally: Cervical cancer research network from Mexico.

Cervical cancer is the fourth most common cancer in women with 85% of the mortality burden occurring in less-developed regions of the world. The Cervix Cancer Research Network (CCRN) was founded by the Gynecologic Cancer InterGroup (GCIG) with a mission to improve outcomes in cervix cancer by increasing access to high-quality clinical trials worldwide, with particular attention to less-developed, underrepresented sites. The CCRN held its second international educational symposium in Mexico City with ninety participants from fifteen Latin America countries in January 2017. The purpose of this symposium was to advance knowledge in cervix cancer therapy, promote recruitment to CCRN clinical trials, and to identify relevant future CCRN clinical trial concepts that could improve global care standards for women with cervical cancer.

[Ten years of the WHO Framework Convention on Tobacco Control: progress in the Americas]. / Diez años del Convenio Marco de la OMS para el Control del Tabaco: avances en las Américas.

The objective of this article is to analyze the progress made in the Americas in the implementation of the World Health Organization Framework Convention on Tobacco Control (FCTC) after its tenth anniversary of entry into force. At the time of the analysis, 30 of the 35 countries of the Americas are Parties to the FCTC. While progress has been made in implementing the measures contained in the FCTC, the level of implementation has not been homogeneous either across mandates or across countries. Forty percent of Parties to the Convention in the Americas are yet to implement any of the measures at their highest level of implementation according to the WHO classification. It is crucial that the countries of the Americas continue to progress towards the full implementation of the FCTC progressively. In these efforts, it is important to take into account that FCTC measures such as those related to smoke-free environments and adoption of effective health warnings are basic public health measures, which are almost entirely within the competence of health authorities and therefore susceptible to be implemented in a prompt fashion in all countries of the region.

Diez años del Convenio Marco de la OMS para el Control del Tabaco: avances en las Américas / Ten years of the WHO Framework Convention on Tobacco Control: progress in the Americas

Resumen: El objetivo de este artículo es analizar los avances ocurridos en las Américas en la aplicación del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco (CMCT), tras cumplirse el décimo aniversario de su entrada en vigencia internacional. Al momento del análisis, 30 de los 35 países de las Américas son Parte en el CMCT, y si bien se ha avanzado en la aplicación de las medidas contenidas en el CMCT, el nivel de aplicación no ha sido homogéneo ni entre las medidas ni entre los países; a su vez, 40% de los Estados Parte no han aplicado aún ninguna de las medidas consideradas en su nivel más alto de aplicación según la clasificación de la OMS. Es importante que los países sigan avanzando hacia la aplicación integral del CMCT en forma progresiva, pero teniendo en cuenta que las medidas básicas de salud pública que están dentro de las competencias de los ministerios de salud -como los ambientes libres de humo de tabaco y las advertencias sanitarias- deberían pronto cubrir toda la región.

Abstract: The objective of this article is to analyze the progress made in the Americas in the implementation of the World Health Organization Framework Convention on Tobacco Control (FCTC) after its tenth anniversary of entry into force. At the time of the analysis, 30 of the 35 countries of the Americas are Parties to the FCTC. While progress has been made in implementing the measures contained in the FCTC, the level of implementation has not been homogeneous either across mandates or across countries. Forty percent of Parties to the Convention in the Americas are yet to implement any of the measures at their highest level of implementation according to the WHO classification. It is crucial that the countries of the Americas continue to progress towards the full implementation of the FCTC progressively. In these efforts, it is important to take into account that FCTC measures such as those related to smoke-free environments and adoption of effective health warnings are basic public health measures, which are almost entirely within the competence of health authorities and therefore susceptible to be implemented in a prompt fashion in all countries of the region.

Race and Tobacco Use: A Global Perspective.

These findings suggest that there are no "fixed" racial patterns of tobacco use around the globe. Cross-country differences in tobacco use among races could be modified by cultural influences, domestic tobacco control, or socioeconomic factors. There is need for enhanced efforts to monitor tobacco use by race/ethnicity to identify existing and emerging patterns in tobacco use by race, as well as identify opportunities for interventions. Tailored interventions to reduce tobacco use within different settings and countries may help reduce tobacco use among racial/ethnic minorities. Implementation of comprehensive tobacco control measures could be facilitated by community-based efforts, ensuring that disadvantaged populations are engaged as partners to adapt tobacco control policies and interventions to local contexts and health equity issues.

Advances and Concepts in Cervical Cancer Trials: A Road Map for the Future.

OBJECTIVE: Cervical cancer is responsible for more than a quarter of a million deaths globally each year, mostly in developing countries, making therapeutic advances in all health care settings a top priority. The Gynecologic Cancer InterGroup (GCIG) is a worldwide collaboration of leading national research groups that develops and promotes multinational trials in gynecologic cancer. In recognition of the pressing need for action, the GCIG convened an international meeting with expert representation from the GCIG groups and selected large sites in low- and middle-income countries. METHODS: The focus was to develop a consensus on several concepts for future clinical trials, which would be developed and promoted by the GCIG and launched with major international participation. The first half of the meeting was devoted to a resume of the current state of the knowledge and identifying the gaps in need of new evidence, validating control arms for present and future clinical trials and identifying national and international barriers for studies of cervix cancers. The second half of the meeting was concerned with achieving consensus on a path forward. RESULTS AND CONCLUSIONS: There were 5 principal outcomes as follows: first, a proposal to expand fertility-preserving options with neoadjuvant chemotherapy; second, validation of the assessment of sentinel lymph nodes using minimally invasive surgery with an emphasis on identification and management of low-volume metastasis, such as isolated tumor cells and micrometastasis; third, evaluation of hypofractionation for palliative and curative radiation under the umbrella of the GCIG Cervix Cancer Research Network; fourth, adding to the advances in antiangiogenesis therapy in the setting of metastatic disease; and fifth, developing a maintenance study among women at high risk of relapse. The latter 2 systemic interventions could study PI3K (phosphatidylinositol-3-kinase) inhibitors, immunotherapy, anti-human papillomavirus approaches, or novel antiangiogenic agents/combinations.

NCD Prevention and Control in Latin America and the Caribbean: A Regional Approach to Policy and Program Development.

This article describes efforts from the Pan American Health Organization (PAHO) that have supported progress in country-driven planning and implementing of actions to address noncommunicable diseases (NCD), as well as mechanisms that PAHO has supported for countries in the Americas to share and build on each other's experiences. The Regional Strategy and Plan of Action for NCD, approved by all member states in 2006, is the major frame for this work. The strategy has 4 lines of action: policy and advocacy; surveillance; health promotion and disease prevention; and integrated management of NCD and risk factors. Cross-cutting strategies include resource mobilization, communication, training, and networks and partnerships. The strategy is operationalized through biannual work plans for which countries link and commit to achieving specific objectives. PAHO then provides technical support toward achieving these plans, and countries report progress annually. The CARMEN (Collaborative Action for Risk Factor Prevention and Effective Management of NCD [Conjunto de Acciones para la Reducción y el Manejo de las Enfermedades No transmisibles]) Network provides a major platform for sharing, and the multisector Pan American Forum for Action on NCD has been launched to extend the network to include business and civil society. PAHO also supported civil society capacity building. Almost all member states have made substantial progress in implementing their national chronic disease programs, in most instances reporting exceeding the indicators of the strategic plan related to chronic diseases. From the Caribbean countries, leadership has been provided to achieve the historic UN High-Level Meeting on NCD in September 2011. The region is on track to meet the mortality reduction target set for 2013, though much remains to be done to further increase awareness of and resources for scaling up NCD prevention and control programs, given the huge health and economic burden, increasing costs, and worrying increases of some conditions such as obesity. Major challenges include getting NCD into social protection packages, building the human resource capacity, strengthening surveillance, achieving true intersectoral and multipartner action, given that most determinants of the epidemic lie outside the health sector, and increasing investment in prevention.

Cigarette labeling policies in Latin America and the Caribbean: progress and obstacles.

OBJECTIVE: To describe cigarette labeling policies in Latin America and the Caribbean as of August 2010. MATERIAL AND METHODS: Review of tobacco control legislation of all 33 countries of the region; analysis of British American Tobacco (BAT)'s corporate social reports; analysis of information from cigarette packages collected in 27 countries. RESULTS: In 2002, Brazil became the first country in the region to implement pictorial health warning labels on cigarette packages. Since then, six more countries adopted pictorial labels. The message content and the picture style vary across countries. Thirteen countries have banned brand descriptors and nine require a qualitative label with information on constituents and emissions. Tobacco companies are using strategies commonly used around the world to block the effective implementation of WHO Framework Convention on Tobacco Control (FCTC)'s Article 11. CONCLUSIONS: Since 2002, important progress has been achieved in the region. However, countries that have ratified the FCTC have not yet implemented all the recommendations of Article 11 Guidelines.

[Status of the implementation of the Framework Convention on Tobacco Control in the region of the Americas]. / Estado de la implementación del Convenio Marco para el Control del Tabaco en la región de las Américas.

OBJECTIVE: To assess the status of implementing the following Framework Convention on Tobacco Control (FTCT) mandates in the Americas: (1) Price and tax measures, (2) Protection from exposure to tobacco smoke, (3) Packaging and labeling, (4) Advertising, promotion and sponsorship, (5) Cessation, (6) Surveillance. MATERIAL AND METHODS: Progress is assessed based on the data published in the WHO Reports on the Global Tobacco Epidemic. The WHO Reports are based on national legislation collected at country level, analyzed by WHO and validated by corresponding national authorities. RESULTS: The essay concludes that FCTC implementation has been uneven throughout the Americas. CONCLUSION: A very small group of countries have been able to implement effective policies for at least two out of the six measures assessed, but the vast majority of countries, while having some existing legislation, have yet to meet the requirements laid out in the FCTC or be consistent with international best practices.