Retrospective analysis of the prognostic implications of tumor spread through air spaces in lung adenocarcinoma patients treated with surgery.

BACKGROUND: Tumor spread through air spaces (STAS) in lung adenocarcinoma is a novel mechanism of invasion. STAS has been proposed as an independent predictor of poor prognosis. The aim of this study was to evaluate the correlations between STAS status and other clinicopathologic variables and to assess the prognostic implications of STAS and the distance from the edge of the tumor to the farthest STAS in patients with resected lung adenocarcinoma. MATERIAL AND METHODS: This is a single-institution retrospective observational study. We included all patients with resected lung adenocarcinoma from January 2017 to December 2018 at La Paz University Hospital. The cut-off for the distance from the edge of the tumor to the farthest STAS was 1.5 mm and was assessed by the area under the receiver operating characteristic curve. RESULTS: A total of 73 patients were included. STAS was found in 52 patients (71.2%). Histological grade 3 (P = 0.035) and absence of lepidic pattern (P = 0.022) were independently associated with the presence of STAS. The median recurrence-free survival (RFS) was 48.06 months [95% confidence interval (CI) 33.58 months to not reached]. STAS-positive patients had shorter median RFS [39.23 months (95% CI 29.34-49.12 months)] than STAS-negative patients (not reached) (P = 0.04). STAS-positive patients with a distance from the edge of the tumor to the farthest STAS ≥1.5 mm had an even shorter median RFS [37.63 months (95% CI 28.14-47.11 months)]. For every 1 mm increase in distance, the risk of mortality increased by 1.26 times (P = 0.04). CONCLUSIONS: Histological grade 3 and absence of lepidic pattern were independently associated with the presence of STAS. STAS was associated with a higher risk of recurrence. The distance from the edge of the tumor to the farthest STAS also had an impact on overall survival.

Transoral laser microsurgery for polydimethylsiloxane (VOX Implant®) explantation.

INTRODUCTION: Polydimethylsiloxane (VOX Implant®) injection into the larynx is a surgical technique used to restore volume to paralysed or atrophic vocal folds. We present a case series that demonstrates the feasibility of explantation of this non-resorbable material in the event of complications secondary to this injection. DESCRIPTION: We report four cases of VOX Implant® explantation. In every case, explantation was performed following complications such as dysphonia and/or dyspnoea secondary to injection of this material. VOX Implant® explantation was performed via cordotomy using transoral lasermicrosurgical techniques. DISCUSSION: VOX Implant® explantation improved voice and breathing parameters in all patients. Explantation can be performed by transoral microsurgery in the presence of complications related to polydimethylsiloxane injection.

Suspension laryngoscopy-assisted percutaneous dilatational tracheostomy.

We describe an endoscopic-guided, suspension laryngoscopy-assisted percutaneous dilatational tracheostomy technique, which can be performed by all otolaryngologists and is suitable for any patient requiring tracheostomy. It can be performed in the context of elective surgery or as an emergency procedure. This technique was developed using suspension laryngoscopy and ENT endoscopy equipment, as well as a percutaneous dilatational tracheostomy kit. It has the advantage of ensuring optimal control of the patient's ventilation and haemostasis throughout the procedure. The good quality endoscopic vision and easy access to the airway provided by suspension laryngoscopy allow tracheostomy to be performed under optimal safety conditions.

Endoscopic lateralization of the vocal fold.

Vocal fold paralysis in adduction can result in significant breathing difficulties. Techniques such as vocal fold lateralization and/or arytenoidopexy help to improve respiratory function in this setting. These techniques require open approach or specific instruments. The authors describe an original vocal fold lateralization technique performed exclusively via an endoscopic approach. This technique helps to enlarge the glottic aperture, while preserving laryngeal architecture, and permanently improves respiratory function in patients with vocal fold paralysis in adduction.

Office-based endoscopic botulinum toxin injection in laryngeal movement disorders.

INTRODUCTION: Botulinum toxin injection is widely used for the treatment of laryngeal movement disorders. Electromyography-guided percutaneous injection is the technique most commonly used to perform intralaryngeal botulinum toxin injection. OBJECTIVE: We describe an endoscopic approach for intralaryngeal botulinum toxin injection under local anaesthesia without using electromyography. TECHNIQUE: A flexible video-endoscope with an operating channel is used. After local anaesthesia of the larynx by instillation of lidocaine, a flexible needle is inserted into the operating channel in order to inject the desired dose of botulinum toxin into the vocal and/or vestibular folds. CONCLUSION: Endoscopic botulinum toxin injection under local anaesthesia is a reliable technique for the treatment of laryngeal movement disorders. It can be performed by any laryngologist without the need for electromyography. It is easy to perform for the operator and comfortable for the patient.

Epiglottoplasty technique in endoscopic partial laryngectomy.

The main advantage of endoscopic laser surgery for laryngeal cancer is to allow tumour resection, while limiting functional sequelae, thereby improving the postoperative course. In this type of surgery, the epiglottis is often partially resected, leaving a raw zone without any reconstruction. The surgical technique described here involves endoscopic reconstruction of the epiglottis after partial resection. The sectioned edge of the epiglottis is sutured to the base of the tongue to create a neoepiglottis and to reconstruct the vallecula, thus resembling preoperative anatomy, allowing improvement of postoperative swallowing.

Pre-emptive awake airway management under dexmedetomidine sedation in a parturient with spinal muscular atrophy type-2.

Historically, pregnancy in females with spinal muscular atrophy was contraindicated due to the great risk to the parturient, but with improved management and increased survival more patients are becoming pregnant. We describe the management of a pregnant patient with spinal muscular atrophy type-2, who had severe restrictive lung disease, extensive spinal fusion that precluded neuraxial anesthesia, and chronic respiratory failure on nocturnal Bilevel Positive Airway Pressure. Airway management was further complicated by limited mouth opening and cervical spine ankylosis.

Endoscopic pharyngolaryngoplasty: A case report.

INTRODUCTION: Any technique that allows decannulation of tracheostomy-dependent patients relieves their discomfort and reduces health costs. CASE REPORT: We present the case of a 70-year-old tracheostomy-dependent patient with pharyngolaryngeal stenosis and a history of radiation therapy for laryngeal cancer in remission for 13years and multiple decannulation failures. Endoscopic pharyngolaryngoplasty was performed using reconstructive transoral laser microsurgery techniques, allowing permanent decannulation. Endoscopic sutures secured by clips were performed to remodel the pharyngolarynx and prevent recurrence of synechiae. DISCUSSION: Endoscopic surgery of the pharynx and larynx was initially developed for resection of small tumours. Reconstructive transoral laser microsurgery has been developed more recently. One of the objectives of this surgery is to reconstruct the pharyngolarynx to treat functional sequelae following surgery and/or radiation therapy for head and neck cancer. It allows reconstruction of the upper airways to restore mouth breathing in tracheostomy-dependent patients, thereby facilitating permanent decannulation.

An In Vitro Evaluation of Biochemical Processes Involved in Lead-Induced Changes on Ram Spermatozoa.

Lead (Pb(2+) ) is a toxic heavy metal which interferes with several physiological processes regulated by Ca(2+) , including those characterized by changes of the membrane stability and the motility of spermatozoa necessary for the fertilization of the oocyte. In this study, ejaculated sperm from six rams (Ovis aries) have been incubated in vitro with or without 50 ng Pb(2+) /ml during 30 min and in the presence or absence of three different potential modulators of the effects of Pb(2+) on changes in the sperm membrane before fertilization: charybdotoxin, quinacrine and staurosporine. Sperm samples incubated with Pb(2+) have shown significant reductions in acrosome integrity and sperm viability and an increase in progressive movement. None of the studied potential modulators had a protective effect against Pb(2+) action. On the contrary, Pb(2+) -incubated sperm in the presence of staurosporine had lower acrosome integrity, and lower sperm viability was observed when spermatozoa were incubated with Pb(2+) + charybdotoxin. Quinacrine was the only tested substance capable of increasing the concentration of Pb(2+) in spermatozoa; thus, the enhancement of Pb(2+) effects produced by staurosporine and charybdotoxin was not produced by an increased uptake of Pb(2+) by spermatozoa. However, the increase of intracellular Pb(2+) in those spermatozoa incubated with quinacrine did not result in an adverse effect on sperm motility or viability although the acrosome integrity was negatively affected.

A Mayan founder mutation is a common cause of deafness in Guatemala.

Over 5% of the world's population has varying degrees of hearing loss. Mutations in GJB2 are the most common cause of autosomal recessive non-syndromic hearing loss (ARNHL) in many populations. The frequency and type of mutations are influenced by ethnicity. Guatemala is a multi-ethnic country with four major populations: Maya, Ladino, Xinca, and Garifuna. To determine the mutation profile of GJB2 in a ARNHL population from Guatemala, we sequenced both exons of GJB2 in 133 unrelated families. A total of six pathogenic variants were detected. The most frequent pathogenic variant is c.131G>A (p.Trp44*) detected in 21 of 266 alleles. We show that c.131G>A is associated with a conserved haplotype in Guatemala suggesting a single founder. The majority of Mayan population lives in the west region of the country from where all c.131G>A carriers originated. Further analysis of genome-wide variation of individuals carrying the c.131G>A mutation compared with those of Native American, European, and African populations shows a close match with the Mayan population.

Cannabinoid receptor agonists reduce the short-term mitochondrial dysfunction and oxidative stress linked to excitotoxicity in the rat brain.

The endocannabinoid system (ECS) is involved in a considerable number of physiological processes in the Central Nervous System. Recently, a modulatory role of cannabinoid receptors (CBr) and CBr agonists on the reduction of the N-methyl-d-aspartate receptor (NMDAr) activation has been demonstrated. Quinolinic acid (QUIN), an endogenous analog of glutamate and excitotoxic metabolite produced in the kynurenine pathway (KP), selectively activates NMDAr and has been shown to participate in different neurodegenerative disorders. Since the early pattern of toxicity exerted by this metabolite is relevant to explain the extent of damage that it can produce in the brain, in this work we investigated the effects of the synthetic CBr agonist WIN 55,212-2 (WIN) and other agonists (anandamide or AEA, and CP 55,940 or CP) on early markers of QUIN-induced toxicity in rat striatal cultured cells and rat brain synaptosomes. WIN, AEA and CP exerted protective effects on the QUIN-induced loss of cell viability. WIN also preserved the immunofluorescent signals for neurons and CBr labeling that were decreased by QUIN. The QUIN-induced early mitochondrial dysfunction, lipid peroxidation and reactive oxygen species (ROS) formation were also partially or completely prevented by WIN pretreatment, but not when this CBr agonist was added simultaneously with QUIN to brain synaptosomes. These findings support a neuroprotective and modulatory role of cannabinoids in the early toxic events elicited by agents inducing excitotoxic processes.

Autonomic nervous system regulation of the sinoatrial cell depolarization rate: Unifying computational models.

In the last years different computational models have been proposed to simulate the sinoatrial node cell (SANC) action potential. Also, there has been a great effort to model the heart regulation mechanism by the autonomic nervous system (ANS) through the sympathetic and parasympathetic pathways. Both computational models have tried to fit the rabbit and/or the guinea-pig experimental heart rate data with an increasing success. Thus, the aim of this work was to unify the available models that have been reported to study the heart rate behavior when the SANC is stimulated by using different frequency patterns. Our results contribute to the unification of part of the Scepanovic's model [1] (involved with second messengers dynamics and its influence over specific SANC ionic channels), and the SANC ionic channels computational model proposed by Severi et al. [2] in 2012. In this model unification we did refit some parameters, particularly, those related to the Hill functions in the dynamic modeling of phosphokinase and its effect on the ionic channels currents If and ICaL, and over the Pup, parameter that is related to the Ca(++) uptake by the sarcoplasmic reticulum. Also, we eliminated the neurotransmitter effect over the ionic current IKr that is not presented in the Severi's model. These modifications were enough to successfully reproduce the heart rate experimental recordings under acetylcholine (Ach) or norepinephrine (NE) for independent stimulation: Ach 10 nM stimulation showed a 21.54% action potential shift compared with the 20% reported for experimental recordings; Isoprenaline 1 µM, also displayed a depolarization increased rate of 29.3%, compared with the experimental data of 28.2%. Furthermore, we were able to reproduce the guinea-pig experimental heart rate recordings, when the SANC model was vagal stimulated by using a 2 Hz, 10 Hz and 20 Hz frequency for 10 seconds and the experimental heart rate data for a sympathetic stimulation of 10 Hz frequency for 10 seconds.

MEG spectral analysis in subtypes of mild cognitive impairment.

Mild cognitive impairment (MCI) has been described as an intermediate stage between normal aging and dementia. Previous studies characterized the alterations of brain oscillatory activity at this stage, but little is known about the differences between single and multidomain amnestic MCI patients. In order to study the patterns of oscillatory magnetic activity in amnestic MCI subtypes, a total of 105 subjects underwent an eyes-closed resting-state magnetoencephalographic recording: 36 healthy controls, 33 amnestic single domain MCIs (a-sd-MCI), and 36 amnestic multidomain MCIs (a-md-MCI). Relative power values were calculated and compared among groups. Subsequently, relative power values were correlated with neuropsychological tests scores and hippocampal volumes. Both MCI groups showed an increase in relative power in lower frequency bands (delta and theta frequency ranges) and a decrease in power values in higher frequency bands (alpha and beta frequency ranges), as compared with the control group. More importantly, clear differences emerged from the comparison between the two amnestic MCI subtypes. The a-md-MCI group showed a significant power increase within delta and theta ranges and reduced relative power within alpha and beta ranges. Such pattern correlated with the neuropsychological performance, indicating that the a-md-MCI subtype is associated not only with a "slowing" of the spectrum but also with a poorer cognitive status. These results suggest that a-md-MCI patients are characterized by a brain activity profile that is closer to that observed in Alzheimer disease. Therefore, it might be hypothesized that the likelihood of conversion to dementia would be higher within this subtype.

[Cranberry juice and its role in urinary infections]. / El jugo de arándano y su papel en las infecciones de las vías urinarias.

The urinary tract infection is a worldwide health problem, with a ratio of 9 to 1 in women compared with men. In 80% of the cases, the causing bacteria is Escherichia coli. During reproductive life this infection represents a great amount of work disabilities, hence the need to insist on its prophylaxis. The red cranberry juice is an option to prevent urinary tract infection, a quality demonstrated in several recent publications which emphasize that its mechanism of action lies in the effect exerted by proantocyanidines, especially those of type A, in the urothelium that prevent Escherichia coli from adhering to this and exerts its antibacterial action, which is achieved with the ingestion of at least 300 mL of juice every day.

Fertiloscopia: una nueva técnica en el estudio de la esterilidad de origen desconocido / Fertiloscopy: a new technique in the study of infertility of unknown etiology

Objetivo: Comprobar la efectividad y la seguridad de la fertiloscopia como técnica alternativa a la laparoscopia diagnóstica en el estudio de la esterilidad de origen no filiado.Material y Métodos: Un total de 17 pacientes con diagnóstico de esterilidad de origen no filiado y candidatas a laparoscopia diagnóstica se reclutaron para el estudio. Se les realizó fertiloscopia (hidrolaparoscopia transvaginal, cromopertubación, salpingoscopia e histeroscopia en un tiempo) con anestesia general o regional.Resultados: La hidrolaparoscopia transvaginal, cromopertubación e histeroscopia se completó en 16 pacientes. En una paciente no se consiguió acceder al fondo de saco de Douglas. La salpingoscopia se realizó uni o bilateralmente en 14 pacientes (82,3 por ciento). No tuvimos ninguna complicación.Conclusiones: La fertiloscopia es un método fácil de realizar y seguro, como alternativa a la laparoscopia diagnóstica en pacientes con esterilidad de origen no filiado. (AU)

Antifungal activity of the essential oil of flowerheads of garland chrysanthemum (Chrysanthemum coronarium) against agricultural pathogens.

The antifungal activity of Chrysamthemum coronarium was evaluated against 12 agricultural pathogens. Flowerhead oil was active both in contact and headspace in vitro assays producing hyphal growth inhibition, although there was less activity on faster growing fungi. The main compounds identified in the oil were camphor (29.2%), alpha-pinene (14.8%), beta-pinene (9.5%) and lyratyl acetate (9.8%). The blue color of the oil was due to the presence of chamazulene (0.5%).

Diagnóstico prenatal del corazón univentricular / Prenatal diagnosis of univentricular heart

No disponible

Six thousand office diagnostic-operative hysteroscopies.

OBJECTIVE: To compare CO(2) and normal saline as distention media in office diagnostic hysteroscopy. METHODS: The outcome of more than 6000 office hysteroscopies was analyzed. We used carbon dioxide or saline as distension medium. Minor hysteroscopic techniques were performed when indicated. RESULTS: The major indication was abnormal uterine bleeding (45%). Satisfactory hysteroscopy was achieved in 92. 4% with CO(2) and in 98.3% with saline (P<0.05). Local anesthesia was used in 54 patients (1.5%) with CO(2) and in three patients (0. 1%) with saline (P<0.001). Four hundred and two women (16.3%) underwent hysteroscopic procedures under saline hysteroscopy. Endometrial polyps were removed in 281 patients, 75 IUDs were removed, 14 fibroids were extracted, uterine septa were excised in 11 cases and mild and moderate adhesions were transected in 21 patients. CONCLUSION: Saline office diagnostic hysteroscopy offers at least all the advantages of the CO(2) hysteroscopy, and gives the possibility to easily 'find and treat in situ' many of the lesions observed.