Evaluating the effects of hypoxic storage on platelet function and health using a novel storage system.

BACKGROUND: Thousands of units of whole blood (WB) and blood components are transfused daily to treat trauma patients. Improved methods for blood storage are critical to support trauma-related care. The Hemanext ONE® system offers a unique method for hypoxic storage of WB, with successfully demonstrated storage of clinically viable RBCs. This work evaluated the system for the storage of WB, focusing on platelet health and function. STUDY DESIGN AND METHODS: WB was collected from healthy donors and processed through the Hemanext ONE® system. Hemoglobin oxygen saturation (HbSO2) levels of WB were depleted to 10%, 20%, or 30% of total HbSO2 and then stored in PVC bags sealed in oxygen-impermeable bags (except for normoxic control) with samples collected on days 1, 7, and 14 post-processing. Flow cytometry assessed the activation and apoptosis of platelets. Clot dynamics were assessed based on aggregometry and thromboelastography assays, as well as thrombin generation using a calibrated-automated thrombogram method. RESULTS: Hypoxic storage conditions were maintained throughout the storage period. Hypoxia triggered increased lactate production, but pH changes were negligible compared to normoxic control. Storage at 10% HbSO2 had a significant impact on platelet function, resulting in increased activation and reduced clot formation and aggregation. These effects were less significant at 20% and 30% HbSO2. DISCUSSION: This study indicates that platelets are sensitive to hypoxic storage and suffer significant metabolic and functional deterioration when stored at or below 10% HbSO2.

SARS-CoV-2 screening of asymptomatic women admitted for delivery must be performed with a combination of microbiological techniques: an observational study.

OBJECTIVE: The aim of this study is to assess the value of systematic screening in asymptomatic women admitted for spontaneous delivery with a combination of reverse transcription polymerase chain reaction (RT-PCR) and cycle threshold (Ct) and serum antibodies. METHODS: Since May 6 all women admitted for spontaneous delivery underwent RT-PCR in nasopharyngeal swabs and specific antibodies IgG of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in serum that were performed as part of routine clinical care in our institution. Ct of the PCR was recorded. We analyzed the first 100 women consecutively admitted for spontaneous delivery at our institution. RESULTS: Nine women were positive for SARS-CoV-2 in nasopharyngeal samples (9%) and 13 (13%) presented positive specific antibodies of the coronavirus. Overall, SARS-CoV-2 prior exposure was 15%. The Ct determination (RT-PCR test) of our 9 positive patients ranged from 36 to 41 cycles with a median of 40. Vaginal delivery occurred in 94% of the cases and only 6% underwent a cesarean section, always for obstetric reasons. No fetal transmission was observed and maternal and neonatal prognosis was excellent. CONCLUSIONS: During epidemic episodes in asymptomatic women in labor, universal testing with RT-PCR (considering Ct determination), and the detection of antibodies, permits a better interpretation of the results and avoid unnecessary isolation procedures.

Five Years of Multidisciplinary Care in Hereditary Cancer: Our Experience in a Spanish University Hospital.

OBJECTIVE: To analyse the evolution of a multidisciplinary heredofamilial cancer unit (HFCU) in a university hospital. METHODS: This was a retrospective analysis of the activity of our HFCU in its first 5 years of existence. RESULTS: Between July 2010 and July 2015, 1,518 patients from 1,318 families attended our HFCU. Genetic testing was offered to 862 patients. Of those, 833 (96.6%) accepted testing, with available results for 636 (76.4%). Pathogenic mutations in BRCA1 and BRCA2 were found in 175 patients. Lynch syndrome and adenomatous polyposis were the most frequent syndromes diagnosed (151/175, 86.3%) among 17 different syndromes studied. Of the 404 patients without a previous genetic diagnosis in the family, 62 (15.3%) were found to have mutations in disease-causing genes. Prophylactic surgery and follow-up (33.7%) or follow-up only (66.3%) was proposed for mutation carriers according to international guidelines and patients' preferences. CONCLUSION: We have a high mutation detection rate, genetic test acceptance, and compliance with risk reduction strategies. However, there is room for improvement, especially in genetic testing timing, considering that an increase in the indications for genetic testing is expected.

Intraoperative electron-beam radiation therapy with or without external-beam radiotherapy in the management of paraaortic lymph-node oligometastases from gynecological malignancies

Purpose. To analyze long-term outcomes and prognostic factors in patients with paraaortic lymph-node oligometastases (LNO) from gynecological malignancies treated in a multimodal protocol. Methods. Patients with a histological diagnosis of LNO gynecological cancer [uterine cervix (n = 14, 40 %), endometrial (n = 18, 51 %), ovarian (n = 3, 9 %)] who underwent surgery with radical intent and intraoperative radiotherapy (IORT), median dose 12.5 Gy) were considered eligible for participation in this study. Additionally, 51 % received external-beam radiotherapy (EBRT). Results. From 1997 to 2012, a total of 35 patients from a single institution were analyzed. With a median follow-up time of 55 months (range 2–148), 5-year loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS) were 79, 44 and 49 %, respectively. On multivariate analysis, no EBRT treatment to the LNO (p = 0.03), and time interval from primary tumor diagnosis to LNO <24 months (p = 0.04) remained significantly associated with locoregional recurrence (LRR). We found on multivariate analysis that only R1 margin status (p = 0.01) was significantly associated with OS. Conclusion. From the current series of patients with gynecological LNO, it emerges the fact that EBRT promotes local control. Future prospective studies might be designed according to the predicted risk of LRR focusing on different subgroups (AU)

No disponible

Intraoperative electron-beam radiation therapy with or without external-beam radiotherapy in the management of paraaortic lymph-node oligometastases from gynecological malignancies.

PURPOSE: To analyze long-term outcomes and prognostic factors in patients with paraaortic lymph-node oligometastases (LNO) from gynecological malignancies treated in a multimodal protocol. METHODS: Patients with a histological diagnosis of LNO gynecological cancer [uterine cervix (n = 14, 40 %), endometrial (n = 18, 51 %), ovarian (n = 3, 9 %)] who underwent surgery with radical intent and intraoperative radiotherapy (IORT), median dose 12.5 Gy) were considered eligible for participation in this study. Additionally, 51 % received external-beam radiotherapy (EBRT). RESULTS: From 1997 to 2012, a total of 35 patients from a single institution were analyzed. With a median follow-up time of 55 months (range 2-148), 5-year loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS) were 79, 44 and 49 %, respectively. On multivariate analysis, no EBRT treatment to the LNO (p = 0.03), and time interval from primary tumor diagnosis to LNO <24 months (p = 0.04) remained significantly associated with locoregional recurrence (LRR). We found on multivariate analysis that only R1 margin status (p = 0.01) was significantly associated with OS. CONCLUSION: From the current series of patients with gynecological LNO, it emerges the fact that EBRT promotes local control. Future prospective studies might be designed according to the predicted risk of LRR focusing on different subgroups.

The use of radiotherapy for early breast cancer in woman at different ages

Age is an important feature at the time of early breast cancer diagnosis. Radiotherapy is a mandatory component of treatment for breast-conserving strategies in early disease stages. Breast radiotherapy has rapidly evolved in the last 20 years. A tendency to less treatment volume (partial-breast irradiation) and less treatment time (hypofractionation) is consolidated in modern radiation oncology practice. Age and risk for local recurrence guide the decision-making process to electro-optimal treatment. Radiotherapy technological versatility offers multiple options for individualized (risk-age adapted) recommendations (AU)

No disponible

The use of radiotherapy for early breast cancer in woman at different ages.

Age is an important feature at the time of early breast cancer diagnosis. Radiotherapy is a mandatory component of treatment for breast-conserving strategies in early disease stages. Breast radiotherapy has rapidly evolved in the last 20 years. A tendency to less treatment volume (partial-breast irradiation) and less treatment time (hypofractionation) is consolidated in modern radiation oncology practice. Age and risk for local recurrence guide the decision-making process to electro-optimal treatment. Radiotherapy technological versatility offers multiple options for individualized (risk-age adapted) recommendations.

External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer. Long-term outcome.

PURPOSE: The goal of the present study was to analyze prognostic factors in patients treated with external-beam radiation therapy (EBRT), surgical resection and intraoperative electron-beam radiotherapy (IOERT) for oligorecurrent gynecological cancer (ORGC). PATIENTS AND METHODS: From January 1995 to December 2012, 61 patients with ORGC [uterine cervix (52 %), endometrial (30 %), ovarian (15 %), vagina (3 %)] underwent IOERT (12.5 Gy, range 10-15 Gy), and surgical resection to the pelvic (57 %) and paraaortic (43 %) recurrence tumor bed. In addition, 29 patients (48 %) also received EBRT (range 30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. RESULTS: Median follow-up time for the entire cohort of patients was 42 months (range 2-169 months). The 10-year rates for overall survival (OS) and locoregional control (LRC) were 17 and 65 %, respectively. On multivariate analysis, no tumor fragmentation (HR 0.22; p = 0.03), time interval from primary tumor diagnosis to locoregional recurrence (LRR) < 24 months (HR 4.02; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.95; p = 0.02) retained significance with regard to LRR. Time interval from primary tumor to LRR < 24 months (HR 2.32; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.77; p = 0.04) showed a significant association with OS after adjustment for other covariates. CONCLUSION: External-beam radiation therapy at the time of pelvic recurrence, time interval for relapse ≥ 24 months and not multi-involved fragmented resection specimens are associated with improved LRC in patients with ORGC. As suggested from the present analysis a significant group of ORGC patients could potentially benefit from multimodality rescue treatment.

Intraoperative electron beam radiotherapy and extended surgical resection for gynecological pelvic recurrent malignancies with and without external beam radiation therapy: long-term outcomes.

OBJECTIVE: To analyze prognostic factors in patients treated with intraoperative electrons containing resective surgical rescue of locally recurrent gynecological cancer (LRGC). METHODS: From January 1995 to December 2012, 35 patients with LRGC [uterine cervix (57%), endometrial (20%), ovarian (17%), vagina (6%)] underwent extended [multiorgan (54%), bone (9%), soft tissue (54%), vascular (14%)] surgery and intraoperative electron-beam radiation therapy [IOERT (10-15 Gy)] to the pelvic recurrence tumor bed. Sixteen (46%) patients also received external beam radiation therapy [EBRT (30.6-50.4 Gy)]. Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. RESULTS: Median follow-up time for the entire cohort of patients was 46 months (range, 3-169). Ten-year rates for locoregional control (LRC) and overall survival (OS) were 58 and 16%, respectively. On multivariate analysis non-EBRT at the time of pelvic re-recurrence [HR 4.15; p = 0.02], no tumor fragmentation [HR 0.13; p=0.05] and time interval from primary tumor to LRR < 24 months [HR 5.16; p=0.01], retained significance with regard to LRR. Non-EBRT at the time of pelvic re-recurrence [HR 4.18; p=0.02] and time interval from primary tumor to LRR < 24 months [HR 6.67; p=0.02] showed a significant association with OS after adjustment for other covariates. CONCLUSIONS: EBRT treatment integrated for rescue, time interval for relapse ≥ 24 months, and not multi-involved fragmented resection specimens are associated with improved LRC in patients with LRGC in the pelvis. Present results suggest that a significant group of patients may benefit from EBRT treatment integrated with extended surgery and IOERT.

[Breast cancer during pregnancy]. / Cáncer de mama durante el embarazo.

As women in western countries delay childbearing, it has been hypothesized that the incidence of breast cancer diagnosed during pregnancy will increase. Breast carcinoma during pregnancy(BCP) put the health of the mother in conflict with that of the fetus. The aim is to give optimal treatment to the mother to maximise the chances of survival, whilst minimising the risk of harm of the fetus. Few breast surgeons or oncologist develop expertise in this area owing the rarity of the association. We report the epidemiology, pathology, clinical picture, therapeutic management and fetal outcome of pregnant women with breast cancer treated in our institution.

Cáncer de mama durante el embarazo / No disponible

La asociación de cáncer de mama y embarazo se defi ne como la apariciónde un tumor maligno mamario en la gestación o durante el primer añoposparto. La frecuencia global oscila entre el 0.2 al 3.8% del total delos tumores malignos de la mama. El cáncer de mama se diagnostica,por término medio en 1 de cada 3000 gestaciones.Esta asociación plantea múltiples interrogantes y para su correcto tratamientoes necesario conocer una serie de aspectos generales, así comoevaluar la repercusión que tienen los distintos esquemas de tratamientooncológico sobre el embarazo y poder ofrecer secuencias terapéuticasaceptables y efi caces. A continuación se realiza una puesta al día detodos estos aspectos(AU)

As women in western countries delay childbearing, it has been hypothesizedthat the incidence of breast cancer diagnosed during pregnancywill increase. Breast carcinoma during pregnancy(BCP) put the health ofthe mother in confl ict with that of the fetus. The aim is to give optimaltreatment to the mother to maximise the chances of survival, whilstminimising the risk of harm of the fetus.Few breast surgeons or oncologist develop expertise in this area owingthe rarity of the association.We report the epidemiology, pathology, clinical picture, therapeuticmanagement and fetal outcome of pregnant women with breast cancertreated in our institution(AU)

Carcinoma neuroendocrino de cérvix uterino en estadio temprano / Early-stage neuroendocrine carcinoma of the uterine cervix

Objetivo: Estudiar las características clinicopatológicas que han tenido lugar en 6 casos de carcinoma neuroendocrino de cérvix uterino en estadio temprano, diagnosticados en el Hospital General Universitario Gregorio Marañón, entre 1992-2001.Material y métodos: Del total de 6 pacientes, se encontraron 4 casos en estadio Ib y dos en estadio IIa. Se analizan las siguientes variables: edad, antecedentes personales, paridad, presentación clínica, pruebas diagnósticas, estadio clínico, estudio histológico, tratamiento primario, tratamiento adyuvante, recurrencia temprana (1-3 meses) y tardía de la enfermedad, y por último la supervivencia. Resultados: La edad media de las pacientes fue de 44 años, y la metrorragia irregular fue la presentación clínica habitual. La variante histológica de células pequeñas fue la más frecuente. A pesar del tratamiento, la enfermedad recurrió de forma temprana en el 33,33 por ciento y de forma tardía en el 50 por ciento. La supervivencia media fue de 22 meses. Conclusiones: El carcinoma neuroendocrino de cuello uterino (CNC) es una entidad rara. La afección ganglionar es la norma y suele hacerlo de forma temprana. A pesar de los múltiples tratamientos agresivos, esta enfermedad presenta una elevada tasa de recurrencia temprana y tardía, así como de fracasos terapéuticos. Su mal pronóstico describe una de las tumoraciones más agresivas del tracto genital femenino (AU)

Malas noticias y apoyo emocional / Bad news and emotional support

Con bastante frecuencia los profesionales sanitarios nos vemos en la situación de tener que dar malas noticias. La falta de formación en áreas de comunicación, en general, hace que dar malas noticias nos genere ansiedad e inseguridad, pudiendo incluso provocar más dolor del necesario al informar. A través de esta revisión deseamos, inicialmente, crear un espacio de reflexión sobre qué son malas noticias y si debemos de informar o no en situaciones de mal pronóstico vital. Creemos que desde una práctica centrada en el paciente la categoría de mala noticia la debe otorgar quien la sufre y quien la sufre tiene derecho a ser informado si así lo desea. Una vez hecha esta reflexión pasamos a describir algunas habilidades necesarias en la comunicación de malas noticias y una estrategia de información progresiva por etapas (Estrategia de Buckman) que creemos es adecuada a nuestro medio cultural y laboral. Finalmente resaltamos la necesidad del seguimiento posterior a la información desde territorios educativos y de promoción de salud en lo que concierne a la información y manejo de enfermedades crónicas y desde el acompañamiento emocional cuando se trata de enfermedades con mal pronóstico vital; enfatizamos la necesidad de permitir y facilitar la expresión de miedos en situaciones de incertidumbre terapéutica para realizar un acompañamiento real y aliviar, en lo que podamos, el acercamiento a la muerte, en caso de que finalmente se llegue a ella (AU)

Entrevista motivacional / The motivational interview

La entrevista motivacional es un tipo de entrevista, centrada en el paciente, que busca ayudar a explorar y resolver contradicciones sobre conductas o hábitos insanos. Intenta aumentar la conciencia de los pacientes sobre sus riesgos de salud y su capacidad para hacer algo al respecto. Además, cuida la salud mental de los sanitarios porque incrementa la satisfacción como profesionales y previene la sensación de impotencia. La fuerza de voluntad para cambiar un hábito o conducta insanos es la motivación que se tiene para desear ese cambio, y su mayor motor está en la incomodidad de la persona entre lo que hace y lo que desearía hacer. Si ayudamos a que el paciente sea más consciente de su situación y sus deseos le facilitamos el cambio y le resultará menos duro pagar su precio que es el sufrimiento que tendrá al dejar su conducta habitual. El paciente es el protagonista y nosotros podemos ser facilitadores de su proceso de cambio. A veces, es difícil olvidarnos de nuestra tendencia habitual a conseguir rendimientos rápidamente y nos adelantamos al ritmo del paciente. Según el tipo de relación que le ofrezcamos facilitaremos el cambio o lo entorpeceremos. Una actitud empática, en la que el paciente se siente apoyado y no juzgado, favorece el cambio y, por el contrario, una insistencia en el cese del hábito puede generar resistencia al mismo. Hay una serie de técnicas que podemos aprender y que nos ayudarán a mejorar la entrevista clínica motivacional. Existen, también, unas características del profesional sanitario que proporcionan el ambiente de seguridad y apoyo ideal para el cambio: empatía, calidez emocional y autenticidad (AU)

Ran stimulates spindle assembly by altering microtubule dynamics and the balance of motor activities.

The guanosine tri-phosphatase Ran stimulates assembly of microtubule spindles. However, it is not known what aspects of the microtubule cytoskeleton are subject to regulation by Ran in mitosis. Here we show that Ran-GTP stimulates microtubule assembly by increasing the rescue frequency of microtubules three- to eightfold. In addition to changing microtubule dynamics, Ran-GTP also alters the balance of motor activities, partly as a result of an increase in the amount of motile Eg5, a plus-end-directed microtubule motor that is essential for spindle formation. Thus, Ran regulates multiple processes that are involved in spindle assembly.

Análisis univariante y multivariante de factores pronósticos en cáncer epitelial de ovario / Univariate and multivalent analysis of prognostic factors for epithelial ovarian cancer

Objetivo: Determinar qué variables predicen de modo independiente el pronóstico de las pacientes con cáncer epitelial de ovario en nuestro medio. Material y métodos: Tras seleccionar 217 pacientes con diagnóstico histológico de cáncer epitelial de ovario tratadas entre 1985 y 1995 se revisaron sus preparaciones y se confirmó el diagnóstico por un mismo patólogo. Se revisó la clasificación del tipo histológico, grado arquitectural y nuclear. Finalmente se ha realizado un análisis de las variables que modificaron la supervivencia de modo univariante y multivariante aplicando un modelo de regresión múltiple para conocer las variables independientes. Resultados: La supervivencia actuarial global a los 5 años de nuestras pacientes fue del 54 por ciento y la supervivencia actuarial a los 10 años del 36 por ciento. La supervivencia actuarial libre de enfermedad fue del 48 por ciento y a los 10 años ha sido del 26 por ciento. El análisis multivariante demostró que las variables independientes que modificaron la supervivencia en el estadio I fueron: grado nuclear del tumor, ascitis (×6) y tamaño del tumor (×4). En los estadios avanzados (II-IV) fueron: enfermedad clínica tras quimioterapia (×7) y grado nuclear (×6).Conclusiones: El grado nuclear del tumor valorado por un mismo patólogo y la existencia de enfermedad clínica tras quimioterapia fueron las variables independientes que modificaron la supervivencia de las pacientes con cáncer de ovario tras la aplicación de un análisis multivariante (AU)

Valor de la sobreexpresión de la proteína nuclear p53 en la supervivencia de pacientes con cáncer epitelial de ovario / Value of nuclear protein p53 overexpression in survival of patients with epithelial ovarian cancer

Objetivos: Evaluar si la sobreexpresión de la proteína nuclear p53 tiene algún impacto en la supervivencia en las pacientes con cáncer de ovario y si se asocia con otros factores pronósticos. Material y métodos: Se evalúan mediante técnicas de inmunohistoquímica la sobreexpresión de p53 en 78 pacientes con cáncer epitelial de ovario diagnosticadas en nuestro centro entre 1985 y 1993. Resultados: La sobreexpresión de la proteína p53 mutada empeora la supervivencia de estas pacientes al considerar todos los estadios. (Supervivencia a cinco años del 84 por 100 en el grupo de tinción negativa frente al 46 por 100 en el grupo de tinción positiva. p < 0,05). La sobreexpresión de dicha proteína se correlaciona de modo estadísticamente significativo con estadios avanzados (83 por 100 de tinción positiva frente a un 62 por 100 en estadios precoces), tumores con grado nuclear agresivo (90 por 100 de positividad en pacientes con grado nuclear G3, frente al 55 por 100 en pacientes G1-G2) y pacientes que fueron sometidas a citorreducción subóptima (85 por 100 de positividad frente al 65 por 100 en pacientes con citorreducción óptima). Conclusión: La acumulación de p53 en el núcleo de las células de cáncer epitelial de ovario se asocia a un peor pronóstico y se correlaciona con estadios más avanzados, grados nucleares más agresivos y cirugía subóptima (AU)

Dependencia química en mujeres / Chemical dependence in women

El presente trabajo es un intento de analizar la fármaco dependencia en mujeres, diferenciándola de la adicción en varones. Se evalúan diversas variables características en relación a los aspectos sicológicos y sociales. Se analiza la situación mundial de la fármaco dependencia y el SIDA. Se discute sobre los tratamienos convencinales y el por qué resulta más difícil la rehabilitación ded la fármaco dependencia. Se plantean alternativas en el tratamiento. Se predsentan dos edstudios nacionales. El p;rimero de ello realizado en el Servicio de Gineco-Obstetricia del Hospital Guillermo Almenara en 100 gestantes para determinar la existencia de adicción a drogas. El segundo, es una encuesta realizada en alumnos de un colegio particular de Lima. con la finalidad de elaborar un Plan de Prevención de Drogas. Dicha encuesta, es en base al cuestionario de CONADIC de la Ciudad de México. Se hace un análisis de los resultados y se elaboran las conclusines