SBRT-SG-01: final results of a prospective multicenter study on stereotactic body radiotherapy for liver metastases.

OBJECTIVE: This study aimed to assess the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of liver metastases. METHODS: Patients with up to 5 liver metastases were enrolled in this prospective multicenter study and underwent SBRT. Efficacy outcomes included in-field local control (LC), progression-free survival (PFS), and overall survival (OS). Acute and late toxicities were evaluated using CTCAE v.4.0. RESULTS: A total of 52 patients with 105 liver metastases were treated between 2015 and 2018. The most common primary tumor was colorectal cancer (72% of cases). Liver metastases were synchronous with the primary tumor diagnosis in 24 patients (46.2%), and 21 patients (40.4%) presented with other extrahepatic oligometastases. All patients underwent intensity-modulated radiation therapy (IMRT)/volumetric-modulated arc therapy (VMAT) with image-guided radiation therapy (IGRT) and respiratory gating, and a minimum biologically effective dose (BED10Gy) of 100 Gy was delivered to all lesions. With a median follow-up of 23.1 months (range: 13.4-30.9 months) since liver SBRT, the median actuarial local progression-free survival (local-PFS) was not reached. The actuarial in-field LC rates were 84.9% and 78.4% at 24 and 48 months, respectively. The median actuarial liver-PFS and distant-PFS were 11 and 10.8 months, respectively. The actuarial median overall survival (OS) was 27.7 months from SBRT and 52.5 months from metastases diagnosis. Patients with lesion diameter ≤ 5 cm had significantly better median liver-PFS (p = 0.006) and OS (p = 0.018). No acute or late toxicities of grade ≥ 3 were observed. CONCLUSIONS: This prospective multicenter study confirms that liver SBRT is an effective alternative for the treatment of liver metastases, demonstrating high rates of local control and survival while maintaining a low toxicity profile.

A time-efficient workflow to purify a library of alanine mutants of surface-exposed residues of the domain III of the envelope protein of dengue virus serotype 1.

Dengue complex is formed by four viral serotypes that cause the disease of the same name. Dengue is the arthropod-borne disease with the highest incidence worldwide. The envelope glycoprotein comprises three structural domains. The domain III (DIII) induces neutralizing antibodies and is involved in the interactions with soluble plasma factors from human host. Recombinant DIII proteins have been used as analytical tools for the characterization of virus-host interactions and have been evaluated as sub-unit vaccines. Here, we report a purification procedure of recombinant DIII protein and seventy-four alanine mutants refolding by size exclusion chromatography that allows obtaining highly homogeneous protein preparations and suitable for efficient purification and folding check. Four positions are identified that significantly affect either the protein expression or folding of recombinant DIIIE1, K310, G304, D330 and P332.

Fidel Pagés, el auténtico descubridor de la anestesia epidural, en el centenario de su publicación Anestesia metamérica (1921-2021) / Fidel Pagés, the true discoverer of epidural anesthesia, on the centenary of his publication Anestesia metamérica (1921-2021)

Resumen: Pocas han sido las Figuras españolas que han aportado alguna interesante novedad al mundo de la anestesia, pero ninguna tan injustamente tratada y olvidada como la de Pagés, verdadero pionero de la anestesia epidural, que él denominaría «anestesia metamérica¼ en su artículo publicado en el mes de marzo de 1921 en la Revista Española de Cirugía, fundada por él mismo. Años después, en 1931, Dogliotti, profesor de Cirugía de Módena publicó sus experiencias sobre la anestesia epidural, a la que llamó «anestesia peridural segmentaria¼, ignorando el trabajo de Pagés publicado 10 años antes. El trabajo de Dogliotti fue rápidamente reconocido, asumiendo todos los méritos de la paternidad de la técnica epidural, quedando Pagés relegado a un olvido injusto que con este trabajo tratamos de reparar. La idea central de este texto versará sobre el reconocimiento de Pagés como verdadero promotor del abordaje epidural con fines quirúrgicos. Destacar sus ideas innovadoras sobre el bienestar del paciente y la minimización de los efectos adversos de las técnicas anestésicas y quirúrgicas, así como valorar una obra que, aunque corta, bien podría incluirse entre los mejores cirujanos españoles de principio del siglo XX, un cirujano con alma de anestesiólogo.

Abstract: Few Spanish Figures have contributed any interesting novelty to the world of anesthesia. But none so unjustly treated and forgotten such as Pagés, a true pioneer of epidural anesthesia, which he would call «metameric anesthesia¼ in his article published in March 1921 in the Spanish Journal of Surgery, founded by himself. Later, in 1931, Dogliotti, Modena Professor of Surgery published his experiences on epidural anesthesia, which he called «segmental peridural anesthesia¼, ignoring Pagés work published 10 years earlier. Dogliotti's work was quickly recognized, assuming all the merits of the paternity of the epidural technique, leaving Pagés relegated to an unjust oblivion that with this work we try to repair. The central idea of this text will focus on the recognition of Pagés as a true promoter of the epidural approach for surgical purposes. Highlight his innovative ideas about patient well-being and minimizing the adverse effects of anesthetic and surgical techniques. As well as assessing a work that, although short, could well be included among the best Spanish surgeons of the early twentieth century, a surgeon with the soul of an anesthesiologist.

Multiple Skeletal Deformities in a Middle-Aged Man.

A 54-year-old man was seen in our endocrinology clinic with evidence of a limited range of motion in his left foot. He had a history of diabetes mellitus type 2 and atrial fibrillation. His family history included evidence of skeletal deformities in some of his relatives. This could imply the potential existence of a hereditary condition. It is worth noting that spontaneous mutations have been reported in some cases. A pertinent physical examination revealed a surgical scar on the patient's left knee, a hallux valgus deformity on his left foot with compromised joint function, and painless bony prominences on that same foot. The skeletal survey findings were consistent with multiple hereditary exostoses. Multiple osteochondromatosis (MO) is a rare genetic disorder associated with serious complications that may significantly affect the health related quality of life of anyone having the disorder. To prevent further complications, these patients require long-term follow-up with regular clinical and radiological examinations.

Generalized eruptive histiocytoma: a rare disease in an elderly patient.

Generalized eruptive histiocytoma is considered an extremely rare subtype of non-Langerhans cells histiocytosis. In the literature, there are few reports of this disease that mainly affects adults. In this report, we present a case of generalized eruptive histiocytoma in an elderly patient who had presented symptoms for over two months. Multiple erythematous papules, asymptomatic and symmetrically distributed were observed on the trunk and limbs. Histological examination showed a dense mononuclear cell dermal infiltrate. In the immunohistochemical analysis, the cells were CD68 positive, but CD1a, S100 and CD34 negative. A diagnosis of generalized eruptive histiocytoma was established. The aim of our paper is to report a case of a very rare disease, whose subtype and affected age group are even more unusual.

Diferente adaptación sensorio-motora a nuevas dentaduras, entre no portadores y portadores de dentaduras completas / Varied sensory-motor adaptation to new dentures among full denture wearers and non wearers

La pérdida de las piezas dentarias provoca cambios importantes en la actividad sensorio-motora de los pacientes que la sufren, cambios que a su vez pueden afectarse al colocar una dentadura completa (DC) y todos en conjunto pueden alterar el proceso de la masticación a tal grado que se afecten condiciones generales de salud como, por ejemplo, una adecuada alimentación, por lo que ha sido importante estudiar la respuesta de los músculos masticatorios ante la colocación de una DC y además comparar entre aquellos pacientes que previamente han usado DC y aquellos que la utilizan por vez primera, considerando que pudiera existir un estado funcional diferente. Para ello se hicieron registros electromiográficos (EMG) en los músculos maseteros de 29 pacientes, antes (1ª sesión), a los 8 y 30 días (2ª y 3ª sesión respectivamente) de la colocación de la DC. Formando dos grupos: el grupo 1 (G1) (n = 15; 12 ♀ , 5 ♂ , edad promedio 67.2 años) aquellos que previamente estaban usando ya una DC y el grupo 2 (G2) (n = 12; 8 ♀ , 4 ♂ , edad promedio 66.5 años) los que nunca antes la habían usado. Los resultados indican que existe una diferencia funcional entre los músculos de aquellos pacientes que previamente han usado una DC con respecto a la de los músculos de los pacientes que no han usado antes DC. Se registró menor amplitud EMG en la 1ª sesión en el G1 con respecto al G2 y una menor capacidad de generar los ciclos masticatorios, ello podría influir, también a largo plazo, en una disminución de la capacidad masticatoria y en la calidad de vida de los pacientes. Es necesario continuar este tipo de estudios tanto para corroborar los resultados reportados en el presente trabajo como para que, en su caso, se implementen medidas que coadyuven a una mejor adaptación a la DC.

Teeth loss elicits significant changes in the sensory-motor activity of patients thus afflicted. These changes can in turn be affected upon placement of a full denture (FD). Overall changes can alter mastication processes, to the point of affecting the patient's general state of health, as would be the case when impinging on proper feeding. This shows the importance of studying masticatory muscles response to the placement of a full denture. It is as well opportune to compare patients who have previously worn dentures with new denture wearers, since it must be borne in mind they could present different functional states. To this end, electromyographic records (EMR) were conducted in masseter muscles of 29 patients before (1st session) at 8 and 30 days (2nd and 3rd session) of FD placement. Two groups were tailored: Group 1 (G1) (n = 15, 12 ♀, 5 ♂, average age 67.2 years) those who had previously worn a full denture, and group 2 (G2), (n =12, 8 ♀, 4 ♂, average age 66.5 years) comprising individuals who had never before worn a full denture. Results indicated there was functional difference among muscles of patients having previously worn FD when compared to muscles of patients who had never worn a FD. Lesser EMG amplitude was found in G1 when compared to G2 in the first session as well as lesser ability to generate masticatory cycles. In the long run, this could also bear upon masticatory ability decrease and patients quality of life. It is necessary to continue this type of studies to substantiate recorded results of the present study, as well as to implement measures geared at contributing to improved FD adaptation.

Síndrome metabólico en mujeres obesas: evaluación de biomarcadores de resistencia insulínica y lipoproteicos / Metabolic syndrome in obese women: evaluation of insulin resistance and lipoprotein biomarkers

El síndrome metabólico (SM) es un importante factor de riesgo aterogénico. Las mujeres, antes de la menopausia, presentan menor riesgo de padecer enfermedad cardiovascular que los hombres. Sin embargo, la presencia de obesidad se correlaciona con un aumento de dicho riesgo. Los objetivos del presente trabajo fueron determinar la frecuencia del SM en un grupo de mujeres obesas y evaluar la sensibilidad diagnóstica de distintas variables asociadas al SM. Se estudiaron 123 mujeres obesas (índice de masa corporal 30 Kg/m²). Se evaluaron índices antropométricos, presión arterial, indicadores del metabolismo de hidratos de carbono, niveles de fibrinógeno, ácido úrico, lípidos y lipoproteínas. En esta población, la frecuencia relativa del SM fue 40,7 por ciento, considerablemente superior a lo informado para la población femenina general. La presencia del SM se asoció con resistencia insulínica, hipertensión arterial, hiperuricemia, modificaciones del metabolismo de los hidratos de carbono y un perfil lipoproteico aterogénico que consistía en alteraciones de las lipoproteínas ricas en triglicéridos y las lipoproteínas de alta densidad (HDL). El valor de corte hallado para el modelo del registro homeostático (HOMA) fue 3,1. Este índice, junto con la presión arterial sistólica, los niveles plasmáticos de triglicéridos y el índice triglicéridos/colesterol-HDL resultaron ser los predictores más sensibles de la presencia del SM (AU)

Síndrome metabólico en mujeres obesas: evaluación de biomarcadores de resistencia insulínica y lipoproteicos / Metabolic syndrome in obese women: evaluation of insulin resistance and lipoprotein biomarkers

El síndrome metabólico (SM) es un importante factor de riesgo aterogénico. Las mujeres, antes de la menopausia, presentan menor riesgo de padecer enfermedad cardiovascular que los hombres. Sin embargo, la presencia de obesidad se correlaciona con un aumento de dicho riesgo. Los objetivos del presente trabajo fueron determinar la frecuencia del SM en un grupo de mujeres obesas y evaluar la sensibilidad diagnóstica de distintas variables asociadas al SM. Se estudiaron 123 mujeres obesas (índice de masa corporal 30 Kg/m²). Se evaluaron índices antropométricos, presión arterial, indicadores del metabolismo de hidratos de carbono, niveles de fibrinógeno, ácido úrico, lípidos y lipoproteínas. En esta población, la frecuencia relativa del SM fue 40,7 por ciento, considerablemente superior a lo informado para la población femenina general. La presencia del SM se asoció con resistencia insulínica, hipertensión arterial, hiperuricemia, modificaciones del metabolismo de los hidratos de carbono y un perfil lipoproteico aterogénico que consistía en alteraciones de las lipoproteínas ricas en triglicéridos y las lipoproteínas de alta densidad (HDL). El valor de corte hallado para el modelo del registro homeostático (HOMA) fue 3,1. Este índice, junto con la presión arterial sistólica, los niveles plasmáticos de triglicéridos y el índice triglicéridos/colesterol-HDL resultaron ser los predictores más sensibles de la presencia del SM

Differential susceptibility of poplar hybrids to the aphid Chaitophorus leucomelas (Homoptera: Aphididae).

After its recent introduction to Chile, the aphid Chaitophorus leucomelas Koch is becoming a serious pest affecting commercial poplar, Populus spp., plantations. The pattern of natural infestation of C. leucomelas among poplar hybrids with different pedigrees and the aphid intrinsic rate of increase (r(m)), of C. leucomelas were assessed in the field. In most of the hybrids, aphid abundance peaked in March (late summer). Among 12 types of poplar crosses, [(P. trichocarpa Torr. & Gray x P. deltoides Bartram ex Marshall) x (P. trichocarpa x P. deltoides)] and [(P. trichocarpa x P. maximowiczii Henry) x P. maximowiczii] showed the highest and lowest aphid densities, respectively. A trend to find more aphids in branch bases was apparent. The intrinsic rate of C. leucomelas increase was higher in [(P. trichocarpa x P. deltoides) x P. deltoides] hybrids, and lower in [(P. trichocarpa x P. maximowiczii) x P. trichocarpa] hybrids. Aphid density and performance were higher in hybrids with P. deltoides parentage, whereas hybrids with P. maximowiczii parentage showed lower aphid densities and performance. Hybrids with P. nigra L. parentage, namely, [P. trichocarpa x P. nigra], also had high aphid density, but aphid performance was lower compared with hybrids with P. deltoides parentage. These results suggest that among poplar hybrids studied, susceptibility to C. leucomelas is inherited through P. deltoides, whereas resistance seems to be inherited through P. maximowiczii. Thus, P. maximowiczii hybrids are recommended for commercial or ornamental planting programs in zones where there is a high risk of aphid infestation.

Aptitud clínica en estudiantes de enfermería ante situaciones clínicas complejas / Clinical aptitude in nursing students in the presence of complex clinical situations

Introducción: Dentro del proceso educativo, la investigación ha estado permanentemente interesada en la búsqueda de respuestas a las interrogantes que plantea el conocimiento para satisfacer las necesidades y exigencias de la sociedad actual, para lo cual se requiere de personal altamente preparado, con una educación reflexiva en la construcción del conocimiento, para lograr un mayor nivel de aptitud clínica y como estrategia de cambio en la educación y atención del paciente. Objetivo: Evaluar la aptitud clínica en estudiantes de licenciatura en enfermería y obstetricia, antes y después de iniciar la etapa práctica en el área de pediatría. Metodología: Se realizó un estudio con estudiantes de licenciatura en enfermería del cuarto semestre, en el que se evaluó la aptitud clínica antes de iniciar la etapa práctica y después de ésta. Se construyó y validó un instrumento para medir la aptitud clínica basándose en casos clínicos reales. Resultados: El instrumento obtuvo un coeficiente de confiabilidad de 0.99, al aplicar la fórmula 20 de Kuder Richardson. La mediana de las calificaciones globales fue de 42 con un rango de 17 a 60, al proceder matemáticamente para las 96 preguntas. No se encontró significancia estadística en ninguno de los grupos, ni en indicadores de acuerdo a la prueba de Kruskall-Wallis y la prueba de pares pareados de Wilcoxon. Conclusiones: Los resultados obtenidos reflejan que la aptitud clínica no depende sólo de los conocimientos adquiridos en aula, sino de la estimulación de la reflexión hacia situaciones reales. Lo cual orienta hacia la implementación de técnicas educativas que vinculen los conocimientos adquiridos en aula con actitud reflexiva ante situaciones clínicas reales.

Introduction: Within the educative process, research has been permanently interested in the search looking time more complete answers which knowledge presents to explain all the needs and demands of the current society, for which highly prepared personnel is needed, i.e. oriented to wards reflexive education and not to the recall of knowledge, achieving in this way a higher level in clinical aptitude and thus make a change to education and patient care. Objective: To explore the degree of clinical aptitude development in bacalaureate nursing and obstetrics students, before initiating and after initiating clinical practice in the pediatric area. Methodology: A longitudinal, prospective, and analytical study was performed among fourth semester baccalaureate nursing students whose clinical aptitude was measured before initiating practical phase and after its conclusion. An instrument to explore clinical aptitude based on real clinical cases, was construted and validated. Results: The instrument had a confiability coefficient of 0.9966 when the formula 20 of Kuder Richardson was applied. The global scores median was 42 with a range of (17 to 60 when proceeding mathematically for the questions' total. No statistical significance was found in either group nor in the indicators according to the Kruskall-Wallis test ant the Wilcoxon test of paired pairs. Conclusions: The obtained results reflect that clinical aptitude does not only depend on the knowledge obtained in the classroom but on the stimulation of the reflection of real situations. This leads us to the implementation of new educational techniques based on the linkage of knowledge and the real cases away from the traditional education.