Multidisciplinary management of cardiovascular disease in women: Delphi consensus.

Background: Current clinical guidelines on cardiovascular disease (CVD) do not specifically address the female population. The aim of this consensus is to know the opinion of a group of experts on the management of CVD in women. Methods: Through a Delphi consensus, 31 experts in cardiology, 9 in gynecology and obstetrics, and 14 primary care physicians, showed their degree of agreement on 44 items on CVD in women divided into the following groups: (1) risk factors and prevention strategies; (2) diagnosis and clinical manifestations; and (3) treatment and follow-up. Results: After two rounds, consensus in agreement was reached on 27 items (61.4%). Most of the non-consensus items (31.8%) belonged to group 3. The lack of consensus in this group was mainly among gynecologists and primary care physicians. The panelists agreed on periodic blood pressure control during pregnancy and delivery to detect hypertensive disorders, especially in women with a history of preeclampsia and/or gestational hypertension, and diabetes mellitus control in those with gestational diabetes. Also, the panelists agreed that women receive statins at a lower intensity than men, although there was no consensus as to whether the efficacy of drug treatments differs between women and men. Conclusions: The high degree of consensus shows that the panelists are aware of the differences that exist between men and women in the management of CVD and the need to propose interventions to reduce this inequality. The low level of consensus reveals the lack of knowledge, and the need for information and training on this topic.

Exercise-based cardio-oncology rehabilitation for cardiotoxicity prevention during breast cancer chemotherapy: The ONCORE randomized controlled trial.

BACKGROUND: Breast cancer (BC) treatment with anthracyclines and/or anti-human epidermal growth factor receptor-2 (HER2) antibodies is associated with an increased risk of cardiovascular disease complications, including cancer therapy-related cardiac dysfunction (CTRCD). While Cardio-Oncology Rehabilitation (CORe) programs including exercise have emerged to minimize these risks, its role in preventing CTRCD is unclear. OBJECTIVES: We investigated the effectiveness of an exercise-based CORe program in preventing CTRCD [left ventricular ejection fraction (LVEF) drop ≥10% to a value <53% or a decrease >15% in global longitudinal strain (GLS)]. Secondary outcomes examined changes in cardiac biomarkers, physical performance including peak oxygen consumption, psychometric and lifestyle outcomes. Safety, adherence, and patient satisfaction were also assessed. METHODS: This is a randomized controlled trial including 122 early-stage BC women receiving anthracyclines and/or anti-HER2 antibodies, randomized to CORe (n = 60) or usual care with exercise recommendation (n = 62). Comprehensive assessments were performed at baseline and after cardiotoxic treatment completion. The average duration of the intervention was 5.8 months. RESULTS: No cases of CTRCD were identified during the study. LVEF decreased in both groups, but was significantly attenuated in the CORe group [-1.5% (-2.9, -0.1); p = 0.006], with no changes detected in GLS or cardiac biomarkers. The CORe intervention led to significant body mass index (BMI) reduction (p = 0.037), especially in obese patients [3.1 kg/m2 (1.3, 4.8)]. Physical performance and quality-of-life remained stable, while physical activity level increased in both groups. No adverse events were detected. CONCLUSIONS: This study suggests that CORe programs are safe and may help attenuate LVEF decline in BC women receiving cardiotoxic therapy and reduce BMI in obese patients.

Cardiovascular disease in women: Do we need new diagnostic and therapeutic strategies?

Cardiovascular disease (CVD) is the leading cause of death worldwide affecting both sexes equally. However, in comparison to men, in women, it often is underrecognized and undertreated in both primary and secondary prevention settings. It is clear, that in the healthy population, there are profound differences both anatomically and biochemically between women and men, and this may impact how both groups present when they become ill. Moreover, some diseases affect more frequently women than men such as myocardial ischemia or infarction without obstructive coronary disease, Takotsubo syndrome, some atrial arrhythmias, or heart failure with preserved ejection fraction. Therefore, diagnostic and therapeutic strategies that have been established largely on the basis of clinical studies with a predominantly male population must be adapted before being applied to women. There is a paucity of data regarding cardiovascular disease in women. It is inadequate to only perform a subgroup analysis evaluating a specific treatment or invasive technique when women constitute fifty percent of the population. In this regard, this may affect the time of clinical diagnosis and severity assessments of some valvulopathies. In this review, we will focus on the differences in the diagnosis, management, and outcomes for women with the most frequent cardiovascular pathologies including coronary artery disease, arrhythmia, heart failure, and valvopathies. In addition, we will describe diseases that exclusively affect women that are related to pregnancy, and some of them are life-threatening. Although the lack of research on women plays a role in the poorer outcomes in women, especially in ischemic heart disease, some techniques such as transcatheter aortic valve implantation and transcatheter edge-to-edge therapy seem to have better outcomes in women.

Thirty-second sit-to-stand test as an alternative for estimating peak oxygen uptake and 6-min walking distance in women with breast cancer: a cross-sectional study.

PURPOSE: To determine whether the 30-s sit-to-stand (30STS) test can be a valid tool for estimating and stratifying peak oxygen uptake (VO2peak) and 6-min walking distance (6MWD) in women with breast cancer. METHODS: This cross-sectional study uses data from the ONCORE randomized controlled trial, including 120 women aged 18-70 years with early-stage breast cancer under treatment with anthracycline and/or anti-HER2 antibodies. Participant characteristics were collected at baseline and pooled data from functional assessment (30STS test, relative and absolute VO2peak, and 6MWD) were collected at baseline and post-intervention (comprehensive cardio-oncology rehabilitation program vs. usual care). Bivariate correlations and multivariate linear regression analyses were performed to study the relationship between functional test variables. RESULTS: The number of repetitions in the 30STS test showed (i) a moderate correlation with relative VO2peak (ml/kg/min) (r = 0.419; p < 0.001; n = 126), (ii) a weak correlation with absolute VO2peak (ml/min) (r = 0.241; p = 0.008; n = 120), and (iii) a moderate correlation with the 6MWD (r = 0.440; p < 0.001; n = 85). The ONCORE equations obtained from the multivariate regression models allowed the estimation of VO2peak and 6MWD (r2 = 0.390; r2 = 0.261, respectively) based on the 30STS test, and its stratification into tertiles (low, moderate, and high). CONCLUSION: The 30STS test was found to be a useful tool to estimate VO2peak and/or 6MWD in women with early-stage breast cancer. Its use may facilitate the assessment and stratification of functional capacity in this population for the implementation of therapeutic exercise programs if cardiopulmonary exercise testing (CPET) or 6MWT are not available. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142.

Conversaciones sobre brigadas médicas cubanas en contexto de COVID-19 desde el ambiente info-comunicativo de Twitter / Conversations on Cuban medical delegations in the context of COVID-19 from the info-communicative environment on Twitter

Introducción: La pandemia de COVID-19 modifica el ambiente info-comunicativo de los ciberusuarios. Cuba, en particular, presenta un nivel considerable de desarrollo tecnológico insertado en la plataforma social de Internet, Twitter. Este soporte desempeña un rol vertebral para el debate sobre temas relacionados a las brigadas médicas cubanas, por su enfrentamiento al virus en el ámbito internacional, que coadyuva a la conformación de una opinión global favorable. Lo planteado con anterioridad se expresa desde las conversaciones online y sus discursos en este sitio. Objetivo: Caracterizar el ambiente info-comunicativo de Twitter durante las conversaciones online sobre brigadas médicas cubanas, entre el 31 de diciembre de 2020 y el 18 de enero de 2021. Material y Métodos: Se emplea el método teórico hermenéutico, para la descripción de los resultados del procesamiento estadístico de contenido, estructura y uso en la web, correspondiente a un enfoque transdisciplinar, mediante la técnica de minería de datos y la aplicación como instrumento del algoritmo no supervisado SSA-UO para el análisis de sentimientos en Twitter. Resultados: Las características del ambiente info-comunicativo de Twitter durante las conversaciones online sobre brigadas médicas cubanas evidencian un predominio de la polaridad positiva. Conclusiones: Los retuits, las menciones y la publicación de enlaces condicionan las particularidades del debate sobre el tema en la esfera de microblogging(AU)

Introduction: The COVID-19 pandemic modifies the info-communicative environment of cyber users. Cuba, in particular, presents a remarkable level of technological development inserted in the Internet social platform, Twitter. This support plays a key role in the debate about issues related to the Cuban medical delegations due to their confrontation with the virus at the international level, which contributes to the formation of a favorable global opinion. The aforementioned point is expressed from the online conversations and their speeches in this site. Objective: To characterize the info-communicative environment on Twitter during the online conversations about Cuban medical brigades between December 31, 2020 and January 18, 2021. Material and Methods: The hermeneutic theoretical method is used for the description of the results of the statistical processing of content, structure and use on the Web, corresponding to a transdisciplinary approach through the application of Data Mining Technique as an instrument of the unsupervised algorithm SSA-UO for sentiment analysis on Twitter. Results: The characteristics of the info-communicative environment on Twitter during the online conversations about Cuban medical delegations evidence a predominance of positive polarity. Conclusions: Retweets, mentions and the publication of links influence the particularities of the debate on the topic in the microblogging sphere(AU)

A randomized trial to evaluate the impact of exercise-based cardiac rehabilitation for the prevention of chemotherapy-induced cardiotoxicity in patients with breast cancer: ONCORE study protocol.

BACKGROUND: Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. METHODS: The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. DISCUSSION: The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142.

Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis.

INTRODUCTION: Recent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy. METHODS: We performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models. RESULTS: A total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8-201.2) in the laparoscopic group and 52.6 months (range, 0.4-166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09-2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05-4.37; P=0.03). CONCLUSION: In this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.

Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model.

BACKGROUND: In general, academic but not community endoscopists have demonstrated adequate endoscopic differentiation accuracy to make the 'resect and discard' paradigm for diminutive colorectal polyps workable. Computer analysis of video could potentially eliminate the obstacle of interobserver variability in endoscopic polyp interpretation and enable widespread acceptance of 'resect and discard'. STUDY DESIGN AND METHODS: We developed an artificial intelligence (AI) model for real-time assessment of endoscopic video images of colorectal polyps. A deep convolutional neural network model was used. Only narrow band imaging video frames were used, split equally between relevant multiclasses. Unaltered videos from routine exams not specifically designed or adapted for AI classification were used to train and validate the model. The model was tested on a separate series of 125 videos of consecutively encountered diminutive polyps that were proven to be adenomas or hyperplastic polyps. RESULTS: The AI model works with a confidence mechanism and did not generate sufficient confidence to predict the histology of 19 polyps in the test set, representing 15% of the polyps. For the remaining 106 diminutive polyps, the accuracy of the model was 94% (95% CI 86% to 97%), the sensitivity for identification of adenomas was 98% (95% CI 92% to 100%), specificity was 83% (95% CI 67% to 93%), negative predictive value 97% and positive predictive value 90%. CONCLUSIONS: An AI model trained on endoscopic video can differentiate diminutive adenomas from hyperplastic polyps with high accuracy. Additional study of this programme in a live patient clinical trial setting to address resect and discard is planned.

Descripción de la deficiencia de alfa-1-antitripsina asociada al alelo PI*Q0Ourém en una niña de 2 años de edad y su estudio familiar. Un caso infrecuente / Alpha-1 Antitrypsin Deficiency Associated with the PI*Q0ourém Allele in a 2-Year-old Girl and Family Study. An Unusual Case

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Linfangioma quístico en el reborde alveolar en recién nacido. Presentación de un caso clínico / Cystic Lymphangioma of the alveolar ridge in a neonate. A case report

El linfangioma es una lesión benigna que se origina del tejido linfático. Se considera también una proliferación hematomatosa de los vasos linfáticos y tejidos asociados, por lo que representa una anomalía del desarrollo o malformación congénita que aparece en niños durante los primeros años de vida. La mayoría aparece desde el nacimiento y aproximadamente en el 90% de los casos surgen hasta los 2 años de edad. Esta lesión se presentó en el reborde alveolar inferior de una niña recién nacida, con su base en la zona de los incisivos inferiores, de 3 cm de diámetro, valorada por el cirujano maxilofacial del Hospital Pediátrico Octavio de la Concepción de la Pedraja, de Holguín, en enero del 2006. Se le realizó una intervención quirúrgica a las 16 horas de nacida, pues el linfangioma impedía su alimentación. La biopsia corroboró este diagnóstico. Se evolucionó por varios años hasta la actualidad sin presentar recidivas ni secuelas. No necesitó otros tratamientos.

Lymphangioma is a benign lesion that originates from lymphatic tissue. It is also considered a hematomatous proliferation of lymphatic vessels and associated tissues, so it is a developmental anomaly or congenital malformation that appears in children during the first years of life. Most of these lesions appear from birth and approximately 90% of cases arise up to 2 years of age. This lesion was located in the lower alveolar ridge of a newborn girl, with its base in the area of ​​the lower incisors, 3 cm in diameter, assessed by the maxillofacial surgeon of the Pediatric Universitary Octavio de la Concepción de la Pedraja Hospital, on January 2006. Surgical intervention was carried out at 16 hours from birth, since the lymphangioma prevented its feeding. The biopsy corroborated this diagnosis. The patient was consulted for several years to date without recurrence or sequelae. The patient did not need other additional treatments.

Linfangioma quístico en el reborde alveolar en recién nacido. Presentación de un caso clínico / Cystic Lymphangioma of the alveolar ridge in a neonate. A case report

El linfangioma es una lesión benigna que se origina del tejido linfático. Se considera también una proliferación hematomatosa de los vasos linfáticos y tejidos asociados, por lo que representa una anomalía del desarrollo o malformación congénita que aparece en niños durante los primeros años de vida. La mayoría aparece desde el nacimiento y aproximadamente en el 90 por ciento de los casos surgen hasta los 2 años de edad. Esta lesión se presentó en el reborde alveolar inferior de una niña recién nacida, con su base en la zona de los incisivos inferiores, de 3 cm de diámetro, valorada por el cirujano maxilofacial del Hospital Pediátrico Octavio de la Concepción de la Pedraja, de Holguín, en enero del 2006. Se le realizó una intervención quirúrgica a las 16 horas de nacida, pues el linfangioma impedía su alimentación. La biopsia corroboró este diagnóstico. Se evolucionó por varios años hasta la actualidad sin presentar recidivas ni secuelas. No necesitó otros tratamientos.(AU)

Lymphangioma is a benign lesion that originates from lymphatic tissue. It is also considered a hematomatous proliferation of lymphatic vessels and associated tissues, so it is a developmental anomaly or congenital malformation that appears in children during the first years of life. Most of these lesions appear from birth and approximately 90 percent of cases arise up to 2 years of age. This lesion was located in the lower alveolar ridge of a newborn girl, with its base in the area of ​​the lower incisors, 3 cm in diameter, assessed by the maxillofacial surgeon of the Pediatric Universitary Octavio de la Concepción de la Pedraja Hospital, on January 2006. Surgical intervention was carried out at 16 hours from birth, since the lymphangioma prevented its feeding. The biopsy corroborated this diagnosis. The patient was consulted for several years to date without recurrence or sequelae. The patient did not need other additional treatments.(AU)

Embriogénesis somática en el cultivar de plátano 'FHIA - 25' (AAB) a partir de ápices meristemáticos / Somatic embryogenesis in plantain cultivar 'FHIA - 25' (AAB) from meristem tips

El cultivar de plátano 'FHIA - 25' (AAB), posee excelente rendimiento y alta resistencia a "Sigatoka negra", pero con la limitante del bajo contenido de azúcar en su fruto, lo cual hace que sea necesario disponer de un método de regeneración de plantas a nivel celular como la embriogénesis somática, que se complemente a técnicas biotecnológicas de transformación genética para mejorar la calidad del fruto. El presente trabajo se realizó con el objetivo de establecer una metodología de regeneración vía embriogénesis somática a partir del explante inicial ápices de brotes axilares establecidos directamente en medio de cultivo líquido. Se obtuvieron suspensiones celulares embriogénicas homogéneas a partir del explante antes mencionado. Se lograron las mayores tasas de multiplicación a la densidad celular de 3,0%. La incubación de los embriones somáticos durante 30 días en el medio de cultivo de maduración permitió incrementar la germinación de los mismos. Durante la fase de aclimatización las plantas provenientes de los embriones somáticos, así como las plantas regeneradas por organogénesis, mostraron un alto porcentaje de supervivencia (98 y 97 %, respectivamente), sin la presencia de variación somaclonal.

Plantain cultivar 'FHIA - 25' (AAB) shows high yielding qualities and high resistance to Black Sigatoka disease, but its sugar content in the fruit is low, so a regeneration method at cell level is necessary, such as somatic embryogenesis supported by biotechnological tools to improve fruit quality. This work was performed with the aim of establishing a plant regeneration method via somatic embryogenesis using initial explants of shoot apices from axillary buds in liquid culture medium. Homogenous embryogenic cell suspensions were obtained from mentioned explants. The highest cellular multiplication rates were achieved at 3,0% density. The incubation of somatic embryos during 30 days in the maturation culture medium permitted to increase germination. During the acclimatization stage, plants regenerated from somatic embryos, as well as plants from organogenesis, showed a high survival percentage (98 and 97 respectively), without somaclonal variation.

Protective effects of melatonin in reducing oxidative stress and in preserving the fluidity of biological membranes: a review.

Free radicals generated within subcellular compartments damage macromolecules which lead to severe structural changes and functional alterations of cellular organelles. A manifestation of free radical injury to biological membranes is the process of lipid peroxidation, an autooxidative chain reaction in which polyunsaturated fatty acids in the membrane are the substrate. There is considerable evidence that damage to polyunsaturated fatty acids tends to reduce membrane fluidity. However, adequate levels of fluidity are essential for the proper functioning of biological membranes. Thus, there is considerable interest in antioxidant molecules which are able to stabilize membranes because of their protective effects against lipid peroxidation. Melatonin is an indoleamine that modulates a wide variety of endocrine, neural and immune functions. Over the last two decades, intensive research has proven this molecule, as well as its metabolites, to possess substantial antioxidant activity. In addition to their ability to scavenge several reactive oxygen and nitrogen species, melatonin increases the activity of the glutathione redox enzymes, that is, glutathione peroxidase and reductase, as well as other antioxidant enzymes. These beneficial effects of melatonin are more significant because of its small molecular size and its amphipathic behaviour, which facilitates ease of melatonin penetration into every subcellular compartment. In the present work, we review the current information related to the beneficial effects of melatonin in maintaining the fluidity of biological membranes against free radical attack, and further, we discuss its implications for ageing and disease.

Nueva alternativa para la micropropagación en inmersión temporal del cultivar de plátano vianda INIVITPV-2011(AAB) / New alternative for micropropagation in temporary immersion system of plantain cultivar

El trabajo fue desarrollado en el Laboratorio de Biotecnología Vegetal del Instituto de Investigaciones en Viandas Tropicales (INIVIT) con el objetivo de incrementar el coeficiente de multiplicación en el cultivar de plátano vianda "INIVITPV-2011" (AAB) en el Sistema de Inmersión Temporal (SIT). Se estudiaron diferentes tiempos de inmersión (10, 20 (control) y 30 minutos) y frecuencias de inmersión (3, 6 (control) y 8 horas) en frascos Nalgene de 10 L de capacidad, se estudió además el volumen de medio de cultivo por explante (20, 40 (control) y 60 ml de medio de cultivo/explante), así como el tiempo de subcultivo (15, 18, 21 (control) y 25 días) y la densidad de explantes por frasco (20, 40 (control), 60 y 80 explantes/frasco de cultivo). Se utilizó el medio de cultivo de multiplicación MS suplementado 2,0 mg.L-1 de 6-BAP; 3,5 mg.L-1de AIA; 30,0 g.L-1 de sacarosa; 10,0 mg.L-1 de ácido ascórbico. Los resultados obtenidos permitieron establecer una metodología para la micropropagación en el Sistema de Inmersión Temporal del cultivar de plátano vianda "INIVITPV-2011" (AAB) la cual consistió en utilizar un tiempo de inmersión de 10 minutos con una frecuencia cada 3 horas, es decir, 8 inmersiones al día, además para cada frasco de 10 L se inocularon 60 explantes y la renovación con 3600 ml de medio de cultivo y un tiempo de cultivo de 18 días permitió alcanzar la mayor productividad del material en fase de multiplicación. Estos resultados, utilizando el Sistema de Inmersión Temporal permitieron establecer una metodología eficiente para la micropropagación del cultivar de plátano vianda INIVITPV-2011.

This work was developed at the Plant Biotechnology Laboratory from the Research Institute of Tropical Root and Tuber Crops (INIVIT) in order to increase the multiplication coefficient in plantain cultivar "INIVITPV-2011" (AAB) in Temporary Immersion Systems (TIS). Different immersion times (10, 20 (control) and 30 minutes) and immersion frequencies (3, 6 (control) and 8 hours) in 10 L Nalgene flasks, and culture medium volume per explants (20, 40 (control) and 60 ml culture medium / explants) were studied, as well as, subculture time (15, 18, 21(control) and 25 days) and explants density per flask (20, 40 (control), 60 and 80 explants / culture flask). The multiplication culture medium MS supplemented with 2.0 mg.L-1 6-BAP, 3.5 mg.L-1 IAA, 30.0 gL-1 sucrose, 10.0 mg.L-1 ascorbic acid was used. Results obtained allowed to establish a methodology for micro-propagation of plantain cultivar "INIVITPV-2011" (AAB) in temporary immersion system, which consisted of using a 10 minute immersion time with 3 hour frequency (8 immersions per day). Besides, 60 explants were inoculated in each 10 L flask, and the renewal with 3600 ml culture medium and 18 day culture time allowed to obtain the highest productivity in the multiplication stage. These results, using the temporary immersion system allowed to establish a method for micro-propagation of plantain cultivar INIVITPV-2011.

Postprandial glucose, insulin and gastrointestinal hormones in healthy and diabetic subjects fed a fructose-free and resistant starch type IV-enriched enteral formula.

BACKGROUND: Reducing the dietary glycaemic response has been proposed as a means of reducing the risk of diabetes. AIM: To evaluate the effects of a new diabetes-specific formula (DSF) enriched with resistant starch type IV and fructose-free on postprandial glycaemia, insulinaemia and gastrointestinal hormones in healthy volunteers and in outpatient type 2 diabetics. METHODS: (1) Twenty-four healthy volunteers were divided into two groups: Group 1 ( n = 10) was provided 50 g of the carbohydrate (CHO) constituent of the new product and 50 g of glucose separated by 1 week; Group 2 ( n = 14) was provided 400 ml of the new DSF (T-Diet Plus(®) Diabet NP) and 400 ml of a control product separated by 1 week. (2) Ten type 2 diabetic patients received 400 ml of the new DSF and two other commercially available DSF (Glucerna(®) SR and Novasource(®) Diabet) on three occasions separated by 1 week. Venous blood samples were drawn at time 0 and at different times until 120 min. Glucose, insulin and gastrointestinal hormones were determined. Glycaemic and insulinaemic indices and glycaemic load were calculated. RESULTS: The CHO constituent and the new DSF showed low glycaemic index and glycaemic load. In healthy subjects, insulin and C-peptide release were lower after administration of the CHO constituent as well as after the new DSF (P < 0.001). Ghrelin, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) production were lower after intake of the CHO constituent (P ranging from <0.001 to 0.019) compared with glucose, and GIP was lower after ingestion of the new DSF (P = 0.002) than after the control product. In type 2 diabetic patients, glucose AUC was lower after the administration of the new DSF (P = 0.037) compared with the others. CONCLUSIONS: Our results indicate that this new product could be beneficial for diabetic patients.

Evolución del cáncer de mama en Aragón (España). Proyecciones a 15 años / Breast cancer in Aragon (Spain). Projections to 15 years

Objetivo. Conocer la evolución del cáncer de mama en Aragón, mediante las proyecciones de las tasas de incidencia, prevalencia y mortalidad, durante el periodo de 15 años desde 2008 hasta 2022. Material y métodos. Los datos se han obtenido del Instituto Nacional de Estadística y el programa utilizado ha sido el MIAMOD. Resultados Se estima que entre los años 2008 y el 2022, la tasa de incidencia del cáncer de mama en Aragón disminuirá desde 53,06 hasta 45,56 (ajustada desde 31,66 a 25,22). La mortalidad disminuirá gradualmente de 15,6 en 2008 a 12,93 (8,13 y 6,37, respectivamente) y la prevalencia disminuirá de 568,33 a 522,17 (ajustadas 322,15 a 271,32). Conclusiones. Estas proyecciones indican que la incidencia, la mortalidad y la prevalencia del cáncer de mama en Aragón disminuirán, aunque solo la reducción de la tasa de incidencia lo hará de una forma estadísticamente significativa (AU)

Objective. The aim of this study was to determine the trend in breast cancer in Aragon by projecting the incidence rates, prevalence and mortality over a 15-year period from 2008 to 2022. Material and methods. Data were obtained from the National Institute of Statistics and the program used was the MIAMOD. Results. We estimated that from 2008 to 2022, the incidence rate of breast cancer in Aragon will decrease from 53.06 to 45.56 (adjusted from 31.66 to 25.22). Mortality will decline gradually from 15.6 in 2008 to 12.9 (adjusted from 8.13 to 6.37) and the prevalence will decrease from 568.33 to 522.17 (adjusted from 322.15 to 271.32). Conclusions. These projections indicate that the incidence, mortality and prevalence of breast cancer in Aragon will decrease, although only the reduction in the incidence rate will be statistically significant (AU)

Multiplicación del clon de banano ‘FHIA-18’ (AAAB) en Sistema de Inmersión Temporal / Multiplication of banana clone 'FHIA-18' (AAAB) in Temporary Immersion System

Con el propósito de desarrollar un protocolo para la multiplicación del clon de banano ´FHIA-18´ (AAAB) en sistema de inmersión temporal, se definieron como objetivos del trabajo determinar el efecto del tiempo (5, 10 y 15 minutos) y la frecuencia de inmersión (3, 6 y 8 horas por día), así como la influencia de diferentes combinaciones de reguladores del crecimiento (2,0; 3,0 y 4,0 mg.L-1 de 6-BAP y 2,0; 2,5; 3,0; 3,5 y 4,0 mg.L-1 de 6 AIA), el efecto del volumen de medio de cultivo por planta (20, 30, 40 y 50 ml/explante) y la densidad de explantes por frasco de cultivo (30, 50, 70 y 90 explantes/frasco) para incrementar el coeficiente de multiplicación. Con el empleo de un tiempo de 10 minutos y una frecuencia de inmersión cada tres horas, se alcanzaron los mejores resultados en cuanto al número de explantes obtenidos. Con este tiempo y frecuencia de inmersión los explantes presentaron el mayor diámetro del pseudotallo. Para cada frasco de 10,0 L se inocularon 70 explantes y la renovación con 2800 ml de medio de cultivo (40 ml/explante) con un tiempo de cultivo de 21 días permitió alcanzar la mayor productividad del material en fase de multiplicación. Además al utilizar las sales MS suplementadas con 3,0 mg.L-1 de 6-BAP; 2,0 mg.L-1 de AIA; 10,0 mg.L-1 de ácido ascórbico, se logró disminuir el crecimiento innecesario de los tallos y hojas de los brotes en la fase de multiplicación y por lo tanto un mayor número de explantes.

In order to develop a protocol for multiplication of Banana clone 'FHIA-18' (AAAB) in temporary immersion systems, the following working objectives were defined: to determine the effect of immersion time (5, 10 and 15 minutes) and frequency (3, 6 and 8 hours per day), as well as, the influence of different combinations of growth regulators (2,0; 3,0 and 4,0 mg.L-1 de 6-BAP and 2,0; 2,5; 3,0; 3,5 and 4,0 mg.L-1 de 6 AIA), the volume effect of culture medium plants (20, 30, 40 and 50 ml/explant) and explants density per culture flask (30, 50, 70 y 90 explants/flask) to increase the multiplication coefficient. With 10 minutes immersion time and an immersion frequency every three hours, the best results were achieved in relation to the number of explants obtained. With this immersion time and frequency, explants showed the highest pseudostem diameter. Seventy explants were inoculated in each 10,0 L culture flask. The highest productivity at the multiplication phase was achieved with a culture medium renewal of 2800 ml (40 ml/explants), and a 21 day culture time. In addition to using MS salts supplemented with 3.5 mg.L-1 of 6-BAP, 1.30 mg.L-1 of IAA, 10.0 mg.L-1 ascorbic acid, the unnecessary growth of stems and leaves of shoots in the multiplication phase was reduced and; therefore, a greater number per explant.

Multiplicación en sistema de inmersión temporal del clon de Malanga Viequera -Xanthosoma spp / Multiplication in temporary immersion system cocoyam clone Viequera - Xanthosoma spp

El Sistema de inmersión temporal (SIT) constituye una alternativa en la micropropagación de plantas. El presente trabajo se realizó con el objetivo de establecer un protocolo para la multiplicación en SIT del clon de malanga “Viequera”. Se evaluó el efecto de tres tiempos de inmersión (7, 14 y 21 minutos), tres frecuencias de inmersión (2, 4 y 6 horas por día), cuatro volúmenes de medio de cultivo (5, 10, 15 y 20 ml por brote inicial) y cuatro tiempos de cultivo (15, 18, 21 y 25 días) en la multiplicación de los brotes de yemas axilares. Con tiempo de inmersión de 14 minutos cada 4 horas, un volumen de 15 ml de medio de cultivo por brote inicial y 18 días de cultivo, se logró el mejor comportamiento en la multiplicación de los brotes de yemas axilares, con un coeficiente de multiplicación de 10,50. El protocolo propuesto aumenta la productividad del material propagado en comparación con los desarrollados en medios de cultivo semisólidos, lo que representa una reducción en los costos de producción al introducir la multiplicación del cultivo en laboratorios comerciales de propagación.

Temporary Immersion System (TIS) is a alternative in the micropropagation of plants. This work was carried out to establish a protocol for the multiplication of clone TIS cocoyam “Viequera”. The effect of three immersion times (7, 14 and 21 minutes), three immersion frequencies (2, 4 and 6 hours per day), four volumes of culture medium (5, 10, 15 and 20 mL per shoot initial) and four times of cultivation (15, 18, 21 and 25 days) in the multiplication of shoots from axillary buds. With immersion time of 14 minutes every 4 hours, a volume of 15 ml of culture medium for initial outbreak and 18 days of culture, achieved the best performance in the multiplication of shoots from axillary buds, with a coefficient of multiplication 10.50. The proposed protocol increases the productivity of propagated material compared to those developed in semisolid culture media, representing a reduction in production costs by introducing the increase in cultivation in commercial laboratories.

Cardiopatía isquémica en la mujer: ¿cada vez más diferencias? / Ischemic heart disease in women: Increasing differences?

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