First-Line Ipatasertib, Atezolizumab, and Taxane Triplet for Metastatic Triple-Negative Breast Cancer: Clinical and Biomarker Results.

PURPOSE: To evaluate a triplet regimen combining immune checkpoint blockade, AKT pathway inhibition, and (nab-) paclitaxel as first-line therapy for locally advanced/metastatic triple-negative breast cancer (mTNBC). PATIENTS AND METHODS: The single-arm CO40151 phase Ib study (NCT03800836), the single-arm signal-seeking cohort of IPATunity130 (NCT03337724), and the randomized phase III IPATunity170 trial (NCT04177108) enrolled patients with previously untreated mTNBC. Triplet therapy comprised intravenous atezolizumab 840 mg (days 1 and 15), oral ipatasertib 400 mg/day (days 1-21), and intravenous paclitaxel 80 mg/m2 (or nab-paclitaxel 100 mg/m2; days 1, 8, and 15) every 28 days. Exploratory translational research aimed to elucidate mechanisms and molecular markers of sensitivity and resistance. RESULTS: Among 317 patients treated with the triplet, efficacy ranged across studies as follows: median progression-free survival (PFS) 5.4 to 7.4 months, objective response rate 44% to 63%, median duration of response 5.6 to 11.1 months, and median overall survival 15.7 to 28.3 months. The safety profile was consistent with the known toxicities of each agent. Grade ≥3 adverse events were more frequent with the triplet than with doublets or single-agent paclitaxel. Patients with PFS >10 months were characterized by NF1, CCND3, and PIK3CA alterations and increased immune pathway activity. PFS <5 months was associated with CDKN2A/CDKN2B/MTAP alterations and lower predicted phosphorylated AKT-S473 levels. CONCLUSIONS: In patients with mTNBC receiving an ipatasertib/atezolizumab/taxane triplet regimen, molecular characteristics may identify those with particularly favorable or unfavorable outcomes, potentially guiding future research efforts.

Does the Prosthetic Phase of Dental Implants Justify the Prescription of Preventive Antibiotics in Healthy Patients? A Systematic Review.

Recently published surveys data show that the routine prescription of preventive antibiotics (PA) in the prosthetic phase of dental implants is more common than might be expected. The present study aimed to answer the PICO (population, intervention, comparison, and outcome) question "In healthy patients starting the implant prosthetic phase, does the prescription of PA compared with not prescribing PA decrease the incidence of infectious complications?" by a systematic literature review. A search was performed in 5 databases. The criteria employed were those described in the PRISMA Declaration. Studies included were those that provided information on the need to prescribe PA in the prosthetic phase of implants, that is, in second-stage surgeries, impression-taking, and prosthesis placement. The electronic search identified 3 studies that met the established criteria. The prescription of PA in the prosthetic phase of implants does not show a justified benefit/risk ratio. Preventive antibiotic therapy (PAT) may be indicated in the second stages or in peri-implant plastic surgery procedures lasting more than 2 hours and/or where soft tissue grafts are used extensively. In these cases, given the current lack of evidence, it is recommended to prescribe 2 g of amoxicillin 1 hour before surgery and, in allergic patients, to prescribe 500 mg of azithromycin 1 hour preoperatively.

Comparison between cultured and wild Pacific white shrimp (Penaeus vannamei) vitellogenesis: next-generation sequencing and relative expression of genes directly and indirectly related to reproduction.

Shrimp fisheries are among the most important fisheries worldwide, and shrimp culture has increased considerably in recent years. Most current studies on reproduction-related genes have been conducted on cultured shrimp. However, gene expression is intimately linked to physiological and environmental conditions, and therefore an organism's growth environment has a great influence on reproduction. Thus, gene expression profiling, should be applied in fisheries studies. Here, we identified the expression patterns of 76 reproduction-related genes in P. vannamei via the analysis of pooled transcriptomes from a time-series experiment encompassing a full circadian cycle. The expression patterns of genes associated both directly (Vtg, ODP, and ProR) and indirectly (FAMet, CruA1, and CruC1) with reproduction were evaluated, as these genes could be used as molecular markers of previtellogenic and vitellogenic maturation stages. The evaluated genes were prominently upregulated during vitellogenic stages, with specific expression patterns depending on the organism's environment, diet, and season. Vtg, ProR, ODP, and FaMet could serve as molecular markers for both wild and cultured organisms.

Spiral Arteries in Second Trimester of Pregnancy: When Is It Possible to Define Expected Physiological Remodeling as Abnormal?

After undergoing remodeling, uterine spiral arteries turn into wide, flexible tubes, with low resistance. If remodeling does not occur, spontaneous abortions, intrauterine growth restriction, and pregnancy-related hypertensive disorders can ensue. Arterial transformation begins at a very early gestational stage; however, second quarter pregnancy histopathological samples have yet to pinpoint the exact moment when abnormal remodeling transpires. We examined 100 samples, taken from consecutive abortions at 12-23 gestational weeks. Following Pijnenborg and Smith guidelines, blinded pathologists analyzed clinical data on remodeling stages. Lab results showed that arterial remodeling is not synchronic in all vessels; a single sample can include various remodeling stages; neither is remodeling homogenous in a single vessel: change may be occurring in one part of the vessel, but not in another. To our knowledge, no one has published this finding. In the examined age group, Smith stage IV predominates; around week 14, substantial muscle and endothelium loss takes place. After week 17, endovascular or fibrin trophoblast does not usually occur. Although scant consensus exists on what defines preeclampsia etiology, it is clear that it involves abnormal remodeling in decidua vessels. Improved understanding requires further knowledge on both the physiological and pathological aspects of the remodeling process. We observed that muscle and endothelial tissues disappear from weeks 14-17, after which time reendothelization predominates. We list the expected proportion of spiral artery changes for each gestational age which, to date, has not been available.

Compromiso pulmonar en síndrome de Sjögren / Pulmonary involvement in Sjögren's syndrome

RESUMEN El síndrome de Sjögren es una enfermedad autoinmunitaria sistémica con un alto impacto individual y social. El compromiso pulmonar presenta múltiples manifestaciones, con impacto en calidad de vida y riesgo de mortalidad. El abordaje dinámico integrado mediante un grupo de diagnóstico multidisciplinario que incluya expertos en neumología, reumatología, radiología y patología tiene el potencial de impactar en la identificación, las estrategias de manejo y los desenlaces. Aunque es necesario reconocer tempranamente a los pacientes con mayor riesgo, en la actualidad no se cuenta con biomarcadores confiables. Las estrategias de manejo farmacológico se basan en la inmunomodulación, pero la evidencia para su uso es de baja calidad. Promover el entrenamiento y la sensibilización del personal de salud podría reducir los retrasos en el acceso a una evaluación especializada.

ABSTRACT Sjögren's syndrome is a systemic autoimmune disease with a high burden for the individual, as well as society. Pulmonary compromise presents with a myriad of manifestations that influence patient quality of life and mortality risk. An integrated dynamic approach by a multidisciplinary diagnostic discussion team that includes experts in chest diseases, rheumatology, radiology, and pathology has the potential to improve the identification, management strategies, and outcomes. Although early recognition of patients at high risk is essential, there is currently a lack of reliable biomarkers. Pharmacological therapies are based on immunomodulation, although the evidence to support their use is of low quality. Increasing awareness and training among healthcare professionals may reduce a delayed access to specialized assessment.

Abemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2-, Node-Positive, High-Risk, Early Breast Cancer (monarchE).

PURPOSE: Many patients with HR+, HER2- early breast cancer (EBC) will not experience recurrence or have distant recurrence with currently available standard therapies. However, up to 30% of patients with high-risk clinical and/or pathologic features may experience distant recurrence, many in the first few years. Superior treatment options are needed to prevent early recurrence and development of metastases for this group of patients. Abemaciclib is an oral, continuously dosed, CDK4/6 inhibitor approved for HR+, HER2- advanced breast cancer (ABC). Efficacy and safety of abemaciclib in ABC supported evaluation in the adjuvant setting. METHODS: This open-label, phase III study included patients with HR+, HER2-, high-risk EBC, who had surgery and, as indicated, radiotherapy and/or adjuvant/neoadjuvant chemotherapy. Patients with four or more positive nodes, or one to three nodes and either tumor size ≥ 5 cm, histologic grade 3, or central Ki-67 ≥ 20%, were eligible and randomly assigned (1:1) to standard-of-care adjuvant endocrine therapy (ET) with or without abemaciclib (150 mg twice daily for 2 years). The primary end point was invasive disease-free survival (IDFS), and secondary end points included distant relapse-free survival, overall survival, and safety. RESULTS: At a preplanned efficacy interim analysis, among 5,637 randomly assigned patients, 323 IDFS events were observed in the intent-to-treat population. Abemaciclib plus ET demonstrated superior IDFS versus ET alone (P = .01; hazard ratio, 0.75; 95% CI, 0.60 to 0.93), with 2-year IDFS rates of 92.2% versus 88.7%, respectively. Safety data were consistent with the known safety profile of abemaciclib. CONCLUSION: Abemaciclib when combined with ET is the first CDK4/6 inhibitor to demonstrate a significant improvement in IDFS in patients with HR+, HER2- node-positive EBC at high risk of early recurrence.

Asian Tiger Mosquito in Yucatan Peninsula: First Record of Aedes (Stegomyia) albopictus (Diptera: Culicidae) in Campeche, Mexico.

This report describes the presence of Aedes albopictus Skuse (Diptera: Culicidae) in Yucatan Peninsula and represents the first record of the Asian tiger invasive mosquito in Campeche State, southeastern Mexico. We collected specimens using 11,326 ovitraps put into houses of urban and rural areas, as part of the entomological surveillance by the local Ministry of Health from January 2019 to February 2020. We found Ae. albopictus in five of the 12 municipalities of Campeche (San Francisco de Campeche, Tenabo, Hecelchakán, Calkíni and Escárcega). We record 68 positive ovitraps and 226 Ae. albopictus larvae. This finding increases the number of mosquito species recorded in Campeche, Mexico, and possibly the potential for 22 arbovirus transmission.

Efficacy of direct current generated by multiple-electrode arrays on F3II mammary carcinoma: experiment and mathematical modeling.

BACKGROUND: The modified Gompertz equation has been proposed to fit experimental data for direct current treated tumors when multiple-straight needle electrodes are individually inserted into the base perpendicular to the tumor long axis. The aim of this work is to evaluate the efficacy of direct current generated by multiple-electrode arrays on F3II mammary carcinoma that grow in the male and female BALB/c/Cenp mice, when multiple-straight needle electrodes and multiple-pairs of electrodes are inserted in the tumor. METHODS: A longitudinal and retrospective preclinical study was carried out. Male and female BALB/c/Cenp mice, the modified Gompertz equation, intensities (2, 6 and 10 mA) and exposure times (10 and 20 min) of direct current, and three geometries of multiple-electrodes (one formed by collinear electrodes and two by pair-electrodes) were used. Tumor volume and mice weight were measured. In addition, the mean tumor doubling time, tumor regression percentage, tumor growth delay, direct current overall effectiveness and mice survival were calculated. RESULTS: The greatest growth retardation, mean doubling time, regression percentage and growth delay of the primary F3II mammary carcinoma in male and female mice were observed when the geometry of multiple-pairs of electrodes was arranged in the tumor at 45, 135, 225 and 325o and the longest exposure time. In addition, highest direct current overall effectiveness (above 66%) was observed for this EChT scheme. CONCLUSIONS: It is concluded that electrochemical therapy may be potentially addressed to highly aggressive and metastic primary F3II murine mammary carcinoma and the modified Gompertz equation may be used to fit data of this direct current treated carcinoma. Additionally, electrochemical therapy effectiveness depends on the exposure time, geometry of multiple-electrodes and ratio between the direct current intensity applied and the polarization current induced in the tumor.

Generation of Organotypic Multicellular Spheres by Magnetic Levitation: Model for the Study of Human Hematopoietic Stem Cells Microenvironment.

BACKGROUND AND OBJECTIVE: The characteristics of human hematopoietic stem cells are conditioned by the microenvironment of the bone marrow, where they interact with other cell populations, such as mesenchymal stem cells and endothelial cells; however, the study of this microenvironment is complex. The objective of this work was to develop a 3D culture system by magnetic levitation that imitates the microenvironment of human HSC. METHODS AND RESULTS: Human bone marrow-mesenchymal stem cells, umbilical cord blood-hematopoietic stem cells and a non-tumoral endothelial cell line (CC2811, LonzaⓇ) were used to develop organotypic multicellular spheres by the magnetic levitation method. We obtained viable structures with an average sphericity index greater than 0.6, an average volume of 0.5 mm3 and a percentage of aggregation greater than 70%. Histological studies of the organotypic multicellular spheres used hematoxylin and eosin stains, and an evaluation of vimentin expression by means of immunohistochemistry demonstrated an organized internal structure without picnotic cells and a high expression of vimentin. The functional capacity of human hematopoietic stem cells after organotypic multicellular spheres culture was evaluated by multipotency tests, and it was demonstrated that 3D structures without exogenous Flt3L are autonomous in the maintenance of multipotency of human hematopoietic stem cells. CONCLUSIONS: We developed organotypic multicellular spheres from normal human cells that mimic the microenvironment of the human hematopoietic stem cells. These structures are the prototype for the development of complex organoids that allow the further study of the biology of normal human stem cells and their potential in regenerative medicine.

Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study.

BACKGROUND: A high prevalence of periodontitis has been reported in rheumatoid arthritis (RA) patients, although the strength of this association, its temporal link and the possible relationship between the severity of periodontitis and RA disease activity remain unclear. The objective of this work was to investigate whether periodontitis is associated with RA and whether periodontitis severity is linked to RA disease activity. METHODS: This case-control study included 187 patients diagnosed with RA and 157 control patients without inflammatory joint disease. RA disease activity and severity were evaluated by the Disease Activity Score 28, the Simplified Disease Activity Index, the Clinical Disease Activity Index, rheumatoid factor, anti-citrullinated protein antibody titers, the erythrocyte sedimentation rate, C-reactive protein, presence of extra-articular manifestations and type of RA therapy. Exposure severity was assessed by the following periodontal parameters: plaque index, bleeding on probing, probing pocket depth and clinical attachment levels. Sociodemographic variables and comorbidities were evaluated as confounding variables. Outcome and exposure variables were compared by both parametric and nonparametric tests, and possible associations were assessed through regression analysis with a calculation for the adjusted odds ratio (OR). RESULTS: A significant association was demonstrated between periodontitis and RA with an adjusted OR of 20.57 (95% CI 6.02-70.27, p < 0.001). Compared with controls, all parameters related to periodontal status (plaque index, bleeding on probing, probing pocket depth and clinical attachment levels) were significantly worse in RA patients (p < 0.001). Periodontitis severity was significantly associated with RA disease activity (p < 0.001), showing in an ordinal logistic regression model an association between periodontal severity and disease activity with an adjusted OR of 2.66 (95% CI 1.24-5.74, p = 0.012). CONCLUSION: A significant association was demonstrated between periodontitis and RA, independent of other confounders. This association was more evident in patients with pronounced periodontal disease and higher RA disease activity.

A New Gene Expression Signature for Triple Negative Breast Cancer Using Frozen Fresh Tissue before Neoadjuvant Chemotherapy.

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer tumors. Comparisons between TNBC and non-triple negative breast cancer (nTNBC) may help to differentiate key components involved in TNBC neoplasms. The purpose of the study was to analyze the expression profile of TNBC versus nTNBC tumors in a homogeneous population from northeastern Mexico. A prospective study of 50 patients was conducted (25 TNBC and 25 nTNBC). Clinic parameters were equally distributed for TNBC and nTNBC: age at diagnosis (51 vs 47 years, p=0.1), glucose levels (107 mg/dl vs 104 mg/dl, p=0.64), and body mass index (28 vs 29, p=0.14), respectively. Core biopsies were collected for histopathological diagnosis and gene expression analyses. Total RNA was isolated and expression profiling was performed. 40 genes showed differential expression pattern in TNBC tumors. Among these, 9 over-expressed genes (PRKX/PRKY, UGT8, HMGA1, LPIN1, HAPLN3, and ANKRD11), and one under-expressed (ANX9) gene are involved in general metabolism. Based on this biochemical peculiarity, and the over-expression of BCL11A and FOXC1 (involved in tumor growth and metastasis, respectively) we validated by qPCR the expression profile of 7 genes out of the signature. In this report, a new gene signature for TNBC is proposed. To our knowledge, this is the first TNBC signature which describes genes involved in general metabolism. The findings may be pertinent for Mexican patients and require to be evaluated in further ethnic groups and populations.

Psychological Effects of Group Hypnotherapy on Breast Cancer Patients During Chemotherapy.

The purpose of this study was to evaluate the effect of group hypnotherapy on anxiety, depression, stress, self-esteem, optimism, and social support during chemotherapy, in patients with breast cancer, compared with a control group with standard medical care. Hypnotherapy consisted of 24 sessions that included suggestions to encourage relaxation, self-esteem, the resolution of past traumatic events, physical healing, and optimism. Results show that the hypnotherapy group significantly decreased anxiety, distress, increased self-esteem, and optimism in the first 12 sessions. However, at the end of the 24 sessions, only self-esteem and optimism remained significant compared with the control group. The convenience of using hypnotherapy to encourage optimism and self-esteem in patients with breast cancer during chemotherapy treatment is discussed given its protective effect on health.

A new species of Torrestrongylus (Trichostrongylidae, Anoplostrongylinae) from Macrotus waterhousii (Chiroptera: Phyllostomidae) in Central Mexico.

A new species of nematode, Torrestrongylus tetradorsalis n. sp., is described herein, based on specimens recovered from the small intestine of the leaf-nosed bat, Macrotus waterhousii, from the Biosphere Reserve "Sierra de Huautla" in the state of Morelos, Mexico. The new species is included in Torrestrongylus because it features a bursa of the type 3 - 2, a divided cephalic vesicle with an anterior half in the shape of an umbrella, and a posterior widened half. The new species can be distinguished from the only other congener T. torrei Pérez-Vigueras, 1935 by four key features: first, by the absence of cervical alae in both males and females; second, by the relatively longer second half of the cephalic cap; third, by the configuration of the dorsal ray, that does not have a medial terminal ray, and finally, by the structure of the spicules. This is the second species in the genus, previously known from bats of the families Phyllostomidae and Molossidae in Cuba, and now in Mexico.

Macuahuitloides inexpectans n. gen., n. sp. (Molineidae: Anoplostrongylinae) from Mormoops megalophylla (Chiroptera: Mormoopidae).

Macuahuitloides inexpectans n. gen., n. sp. (Molineidae: Anoplostrongylinae) is herein described. The description is based on specimens removed from the small intestine of ghost-faced bats, Mormoops megalophylla, from central Mexico. The monotypic genus is unique in featuring sexual dimorphism on the cuticular ornamentation, which consists of the presence of spines on the anterior quarter of females, and of the presence of rugosities on the surface of the cephalic vesicle of males. The cuticular spines are arranged in spiral rings on the anterior quarter of the body, and there is no trace of said structures on the cuticle of males. The synlophe of the males possess 12 ridges, whereas there is no synlophe in females. Finally, females show a prominent caudal terminus (spine) and 3 subterminal tubercles, whereas males show bursal rays in a 3-2 arrangement, with a relatively prominent dorsal ray.

Valoración por estudiantes de Estomatología sobre su aprendizaje y la dirección del proceso docente educativo / Assessment by Dentistry students of their learning and the management of the teaching-learning process

Fundamento: el perfeccionamiento de la labor docente del profesor desde la óptica de sus alumnos contribuye a la autocrítica profesional y a su paulatina transformación en su desempeño como docente. Métodos: se realiza un estudio de casos con alumnos de tercer año de la carrera de Estomatología, del curso 2010-2011. De un universo de 112 estudiantes, se selecciona una muestra intencional de 18, al tener en cuenta que recibieron toda su formación en la educación en el trabajo con el mismo docente. A ellos se les aplicó una encuesta inicial, para una autovaloración de los conocimientos y habilidades adquiridos en el tema mencionado, y además responder positiva o negativamente respecto a la influencia ejercida por el docente. Se realiza un análisis documental del registro de asistencia y evaluación, para constatar las evaluaciones alcanzadas en el seminario, educación en el trabajo, examen práctico del tema, y en la pregunta del examen final correspondiente a la estancia. Resultados: los alumnos expresan criterios favorables sobre el desarrollo del proceso docente educativo y el tratamiento de los diferentes componentes procesales, también se constatan resultados satisfactorios en las evaluaciones realizadas. Conclusiones: los resultados alcanzados apuntan hacia una correcta dirección del proceso docente educativo a partir de la preparación del docente en el campo pedagógico.

Background: the improvement of the teachers' teaching, from the perspective of the students, contributes to professional self-criticism and a gradual transformation in their performance as teachers. Methods: a case study was conducted with 3rd year Dentistry students in the academic year 2010-2011. From a universe of 112 students, a purposive sample of 18 students was selected, taking into account that they received all their training in education at work with the same teacher. They were given an initial survey, for a self-assessment of the knowledge and skills acquired in the above mentioned subject; and they were also asked to respond positively or negatively on the influence exerted by the teacher. A documentary analysis of the attendance and assessment records was conducted to verify the marks achieved at the seminar, education at work, practical examination of the subject, and the final exam question related to the rotation stay. Results: students express favorable criteria on the development of the teaching-learning process and the treatment of different procedural components. There were also satisfactory results in the examinations performed. Conclusions: the obtained results point to the correct management of the teaching-learning process based on the preparation of teachers in the pedagogical field.

Pterygodermatites (Pterygodermatites) mexicana n. sp. (Nematoda: Rictulariidae), a parasite of Balantiopteryx plicata (Chiroptera) in Mexico.

A new species of nematode, Pterygodermatites (Pterygodermatites) mexicana n. sp., is described based on specimens recovered from the intestine of the gray sac-winged bat, Balantiopteryx plicata (Chiroptera, Emballonuridae), from the Biosphere Reserve "Sierra de Huautla" in the state of Morelos, Mexico. This is the second species in the genus described from bats in the New World, since most of the rictaluriids reported in these hosts belong to the closely related genus Rictularia Froelich, 1802. However, members of Rictularia possess only a single oesophageal tooth at the base of the buccal capsule, whereas in the current nematodes three conspicuous oesophageal teeth are present. They are therefore included in Pterygodermatites Wedl, 1861. The new species is characterized by the presence of 23 small denticles on the periphery of the buccal capsule and by the presence of 40 and 66 pairs of cuticular processes in males and females, respectively. Additionally, males possess 3-4 ventral precloacal fan-like processes, and the cuticular processes of females are divided into 40 pairs of comb-like and 26 pairs of spine-like processes; the vulva opens on the level of approximately pair 40. The dorsally directed stoma and the 40 prevulvar cuticular processes makes it difficult to place the species in any of the subgenera present in the New World, yet characters correspond with the diagnosis of Pterygodermatites (Pterygodermatites) in the Mediterranean region and North Africa.

La neurorrehabilitación como alternativa esencial en el abordaje terapéutico de las ataxias cerebelosas / Neurorehabilitation as an essential alternative in the therapeutic approach to cerebellar ataxias

Introducción: la ataxia cerebelosa constituye uno de los trastornos motores más complejos asociada a enfermedades neurológicas. Objetivo: destacar la efectividad de la neurorrehabilitación en la reducción del deterioro de las funciones motoras en pacientes atáxicos. Fuente de datos: revisión de la literatura publicada sin límite de fecha y hasta septiembre del 2012, en las bases de datos MedLine, Embase, Hinari, Lilacs y SciELO; estrategia de búsqueda con vocabulario controlado y la inclusión de las siguientes palabras clave: ataxia, neurorrehabilitación, recuperación motora. Se tomaron los criterios de especialistas en neurorrehabilitación del Centro internacional de Restauración Neurológica. Resultados: la terapia física es el factor esencial del proceso de rehabilitación en los pacientes con ataxia, incluye adiestramiento, ejercicios y manipulación física del cuerpo del paciente con la intención de restaurar el movimiento, el equilibrio y la coordinación. Las estrategias terapéuticas en los pacientes con ataxia cerebelosa requieren un enfoque intensivo e interdisciplinario. La recuperación motora en ellos está muy relacionada con el incremento de la capacidad de fuerza después de la aplicación de programas de rehabilitación. En la medida en que aumentan los niveles de fuerza, comienzan a aparecer signos de recuperación en el comportamiento motor, desde actividades tan simples como realizar transferencias de una posición a otra, hasta las más complejas, como es caminar. Conclusiones: el comportamiento motor de los pacientes con ataxia cerebelosa se modifica significativamente con el empleo de la neurorrehabilitación, con registro de mejorías notables en los trastornos de la postura y la marcha, el movimiento y la fuerza(AU)

Introduction: cerebellar ataxia is one of the most complex motor impairments derived from neurological diseases. Objective: to highlight the effectiveness of neurorehabilitation of the motor functions in patients with cerebellar ataxia. Data source: systematic literature review of documents published up to September 2012 in MEDLINE, EMBASE, HINARI LILACS and SciELO, search strategy using controlled vocabulary and the keywords ataxia, neurorehabilitation and motor recovery. Several criteria from specialists in neurorehabilitation in the International Center of Neurological Restoration were consulted in and taken into consideration. Results: the physical therapy is the essential factor of the rehabilitation process for ataxic patients and includes training, exercising and physical handling of the patient's body aimed at recovering movement, balance and coordination. The therapeutic strategies for patients with cerebellar ataxia require an intensive and interdisciplinary approach. Motor function recovery was very much related to significant strength increase after implementation of the rehab program. As the strength levels rise, there begins to appear signs of recovery in the patient's motor behavior that covers moving from one position to another including turning up to the most complex ones like walking. Conclusions: the motor behavior of patients suffering cerebellar ataxia can be significantly modified with neurorehabilitation, leading to significant reduction on posture, gait, movement and strength impairments(AU)

La neurorrehabilitación como alternativa esencial en el abordaje terapéutico de las ataxias cerebelosas / Neurorehabilitation as an essential alternative in the therapeutic approach to cerebellar ataxias

Introducción: la ataxia cerebelosa constituye uno de los trastornos motores más complejos asociada a enfermedades neurológicas. Objetivo: destacar la efectividad de la neurorrehabilitación en la reducción del deterioro de las funciones motoras en pacientes atáxicos. Fuente de datos: revisión de la literatura publicada sin límite de fecha y hasta septiembre del 2012, en las bases de datos MedLine, Embase, Hinari, Lilacs y SciELO; estrategia de búsqueda con vocabulario controlado y la inclusión de las siguientes palabras clave: ataxia, neurorrehabilitación, recuperación motora. Se tomaron los criterios de especialistas en neurorrehabilitación del Centro internacional de Restauración Neurológica. Resultados: la terapia física es el factor esencial del proceso de rehabilitación en los pacientes con ataxia, incluye adiestramiento, ejercicios y manipulación física del cuerpo del paciente con la intención de restaurar el movimiento, el equilibrio y la coordinación. Las estrategias terapéuticas en los pacientes con ataxia cerebelosa requieren un enfoque intensivo e interdisciplinario. La recuperación motora en ellos está muy relacionada con el incremento de la capacidad de fuerza después de la aplicación de programas de rehabilitación. En la medida en que aumentan los niveles de fuerza, comienzan a aparecer signos de recuperación en el comportamiento motor, desde actividades tan simples como realizar transferencias de una posición a otra, hasta las más complejas, como es caminar. Conclusiones: el comportamiento motor de los pacientes con ataxia cerebelosa se modifica significativamente con el empleo de la neurorrehabilitación, con registro de mejorías notables en los trastornos de la postura y la marcha, el movimiento y la fuerza

Introduction: cerebellar ataxia is one of the most complex motor impairments derived from neurological diseases. Objective: to highlight the effectiveness of neurorehabilitation of the motor functions in patients with cerebellar ataxia. Data source: systematic literature review of documents published up to September 2012 in MEDLINE, EMBASE, HINARI LILACS and SciELO, search strategy using controlled vocabulary and the keywords ataxia, neurorehabilitation and motor recovery. Several criteria from specialists in neurorehabilitation in the International Center of Neurological Restoration were consulted in and taken into consideration. Results: the physical therapy is the essential factor of the rehabilitation process for ataxic patients and includes training, exercising and physical handling of the patient's body aimed at recovering movement, balance and coordination. The therapeutic strategies for patients with cerebellar ataxia require an intensive and interdisciplinary approach. Motor function recovery was very much related to significant strength increase after implementation of the rehab program. As the strength levels rise, there begins to appear signs of recovery in the patient's motor behavior that covers moving from one position to another including turning up to the most complex ones like walking. Conclusions: the motor behavior of patients suffering cerebellar ataxia can be significantly modified with neurorehabilitation, leading to significant reduction on posture, gait, movement and strength impairments

[Reduction of omalgia in laparoscopic cholecystectomy: clinical randomized trial ketorolac vs ketorolac and acetazolamide]. / Reducción de omalgia en colecistectomía laparoscópica: ensayo clínico aleatorizado con ketorolaco vs ketorolaco y acetazolamida.

BACKGROUND: Laparoscopy cholecystectomy for the surgical treatment of cholelithiasis has been considered the gold standard. The referred pain to the shoulder (omalgia) may be present to 63% of the patients and limits outpatient management. OBJECTIVE: The study was to evaluate the usefulness of acetazolamide associated with ketorolac for reduction of the omalgia to minimally invasive treatment. METHODS: We performed a clinical trial, randomized, double blind in patients undergoing laparoscopic cholecystectomy to assess the reduction of post-operative omalgia comparing ketorolac and ketorolaco+acetazolamida. 31 patients in each group were studied. The study group: 250 mg of acetazolamide before anesthetic induction and 30 mg of ketorolac in the immediate postoperative period. CONTROL GROUP: one tablet of placebo prior to the anesthetic induction and 30 mg of ketorolac in the immediate postoperative. The presence of omalgia was assessed using the analog visual scale. The variables recorded included: age, sex, flow of carbon dioxide intra-abdominal pressure, surgical time, urgent or elective surgery, omalgia, severity of pain evaluated by analog visual scale, addition analgesia. RESULTS: Both groups were homogeneous and statistical analysis showed no differences in the variables studied. The omalgia in the study group was presented at 9.67% and in the group control was the 58.06% (p < 0.001). CONCLUSION: 250 mg oral acetazolamide associated 30 mg of ketorolac reduces significantly the development of omalgia in patients undergoing laparoscopic cholecystectomy.

Antecedentes: la colecistectomía laparoscópica es el patrón de referencia del tratamiento de la colelitiasis sintomática. El 63% de los pacientes operados sufre dolor postquirúrgico referido al hombro (omalgia), circunstancia que limita el tratamiento ambulatorio. Objetivo: evaluar la utilidad de la acetazolamida asociada con ketorolaco para disminuir la omalgia consecutiva al tratamiento de mínima invasión. Material y métodos: ensayo clínico, aleatorizado, doble ciego realizado en pacientes a quienes se efectuó colecistectomía laparoscópica para evaluar la reducción de la omalgia postoperatoria y comparar el efecto de ketorolaco y ketorolaco más acetazolamida. En cada grupo se estudiaron 31 pacientes. El grupo de estudio recibió 250 mg de acetazolamida antes de la inducción anestésica, y 30 mg de ketorolaco en el postoperatorio inmediato. El grupo control recibió una tableta de placebo antes de la inducción anestésica, y 30 mg de ketorolaco en el postoperatorio inmediato. La omalgia se evaluó con la escala visual análoga. Las variables estudiadas incluyeron: edad, sexo, flujo de dióxido de carbono, presión intrabdominal, tiempo quirúrgico, cirugía electiva o urgente, omalgia, intensidad del dolor evaluada con la escala visual análoga y analgesia de rescate. Resultados: los grupos estudiados fueron homogéneos, el análisis estadístico no mostró diferencias en las variables estudiadas. En el grupo de estudio la omalgia coexistió en 9.67% de los pacientes y en el grupo control en 58.06% (p < 0.001). Conclusión: la administración por vía oral de 250 mg de acetazolamida y 30 mg de ketorolaco redujo significativamente la omalgia en los pacientes a quienes se realizó colecistectomía laparoscópica.

A new spirurid (Nematoda) parasite from mormoopid bats in Mexico.

A new nematode species, Spirura mexicana n. sp., is described from specimens recovered from the esophageal mucosa of the Parnell's mustached bat Pteronotus parnellii , Davy's naked-backed bat Pteronotus davyi, Wagner's mustached bat Pteronotus personatus, and the ghost-faced bat Mormoops megalophylla in the State of Morelos, Mexico. This nematode is characterized by having a relatively short prostoma, 5-6 pairs of caudal papillae, and a smooth distal end of the tail in females. This is the first species of Spirura described from bats in the New World.