Routine pretransfusion testing before primary total hip or knee arthroplasty are an expensive and wasteful routine. Systematic review and meta-analysis.

BACKGROUND: The excessive routine ordering of pretransfusion tests (blood typing, screening, and cross-matching) for surgical cases incurs significant unnecessary costs and places an undue burden on transfusion services. This study aims to systematically review the literature regarding the necessity of routine pretransfusion tests before total hip arthroplasty (THA) or total knee arthroplasty (TKA) and summarize their outcomes. STUDY METHODS: A systematic review and meta-analysis were performed. The study's characteristics, the prevalence of over-ordering pretransfusion tests, transfusion rates, and potential cost savings to the healthcare system were analyzed. RESULTS: The study included 17,667 patients. Pooled results revealed a 96.3% over-ordering pretransfusion test rate (95% CI: 0.92-1.00; p < 0.001) among patients undergoing primary THA or TKA. The pooled prevalence of hospital transfusion rate was 3.6%. Notably, there were statistically significant differences in preoperative hemoglobin (Hb) levels between patients not requiring transfusion (Hb = 13.9 g/dl; 95% CI 12.59-15.20; p < 0.001) and those needing transfusion (Hb = 11.9 g/dl; 95% CI 10.69-13.01; p < 0.001) (p = 0.03). The per-patient total cost savings ranged from 28.63 to 191.27 dollars. DISCUSSION: Our study suggests that routine pre-transfusion testing for all patients undergoing primary THA or TKA may be unnecessary. We propose limiting pretransfusion test orders to patients with preoperative hemoglobin levels below 12 g/dl in unilateral primary TKA or THA. This targeted approach can result in significant cost savings for healthcare systems and transfusion services by reducing the over-ordering of pretransfusion tests in these surgical procedures.

Symmetrical Peripheral Gangrene: Report of Three Cases.

Symmetrical peripheral gangrene (SPG) is a rare clinical syndrome characterized by an acute onset of ischemic damage in two or more extremities without obstruction or vasculitis of supplying vessels. Body parts commonly affected include toes, hands, scrotum, and earlobes, increasing the risk of limb amputation and impairing the quality of life. The vascular injury mechanism is disseminated intravascular coagulation. SPG may manifest unpredictably in conditions associated with septic shock, low output states, vasospastic conditions, myeloproliferative disorders, or hyperviscosity syndrome. A review on the topic is presented based on a 3-case series of SPG that required amputation of fingers and toes after the administration of vasopressors in a septic shock context.

Regresión espontánea de la hernia discal lumbar de dos féminas / Spontaneous regression of the lumbar herniated disk in two women

Se describen los casos clínicos de dos féminas que habían padecido lumbociatalgias durante varios meses, por lo cual acudieron al Hospital Provincial Docente Dr. Joaquín Castillo Duany de Santiago de Cuba, donde se les diagnosticó hernia discal lumbar y recibieron seguimiento médico en la consulta de Neurocirugía por más de un año. Ante la negativa de ser intervenidas quirúrgicamente, se prescribieron esquemas terapéuticos convencionales y alternativos, así como fisioterapia. En ambas pacientes se evidenció regresión espontánea de la discopatía, lo que se confirmó mediante estudios evolutivos de resonancia magnética. Dicha correlación entre la mejoría clínica y la recuperación imagenológica del disco intervertebral no siempre sucede en la evolución de estos casos.

The case reports of two women that had suffered from lumbar sciatic pain during several months are described, reason why they went to Dr. Joaquín Castillo Duany Teaching Provincial Hospital in Santiago de Cuba, where they were diagnosed lumbar herniated disk and received medical follow up in the Neurosurgery Service for more than a year. Before the negative of being surgically intervened, conservative and alternative therapeutic outlines were prescribed, as well as physiotherapy. In both patients spontaneous regression of the lumbar herniated disk was evidenced, which was confirmed by means of evolutionary studies of magnetic resonance. This correlation between the clinical improvement and the imaging recovery of the intervertebral disk doesn't always happen in the clinical course of these cases.

In silico integrative analysis for the characterization of LYT1 a unique protein of Trypanosoma cruzi.

Trypanosoma rangeli is the most similar organism to Trypanosoma cruzi. They share distribution areas, hosts, and some vectors. However, there are key differences between them; the first lacks a multiplicative form in the host and does not cause disease, while the second is the etiological agent of the American tripanosomiasis, a tropical disease that still does not have an effective vaccine nor treatment. Aiming to reveal the differences in their gene expression patterns in each life cycle form, the comparison of expression profiles was made parting from the ESTs available in TriTrypDB. We verified that there are no genes unique to T. rangeli in the ESTs. Astonishingly, we determined that T. cruzi has a single copy gene called LYT1, which has no similarity to any other protein of any organism on Earth. LYT1 is involved in invasion, motility, and cell cycle, making it an attractive vaccine target. After its identification, using immunoinformatics programs, we found multiple potential B- and T-cell epitopes in this protein, which is also rich in intrinsically disordered regions. Additionally, an approximation of the 3 D structure was predicted where the B-cell epitopes were located to assess their solvent access. We propose that its particular structural conformation confers the flexibility required for the interactions with multiple proteins, which in part may be performed through N-myristoylation sites. Given its important role in the infectiveness of T. cruzi and its antigenic potential, we highlight the need for future studies focused on its molecular and immunological in vivo characterization.Communicated by Ramaswamy H. Sarma.

Síndrome de Brown-Séquard por hernia discal cervical / Brown-Séquard syndrome due to cervical disc herniation

RESUMEN Introducción: El síndrome de Brown-Séquard representa entre el 1 y el 4 % de todas las lesiones medulares espinales; es muy infrecuente. Compromete la mitad lateral de la médula espinal y se afectan unilateralmente las estructuras o funciones del segmento dorsal, el tracto corticoespinal y el tracto espinotalámico. Objetivo: Mostrar una forma de presentación atípica de la hernia discal cervical en una paciente joven sin antecedentes de traumatismo ni esfuerzo físico. Caso clínico: Paciente femenina de 24 años de edad, que presenta disminución de la fuerza muscular en los miembros del lado izquierdo, de forma progresiva, con dificultades para deambular, así como dolor cervical de intensidad moderada. Se le diagnostica una hernia discal cervical y se realiza tratamiento quirúrgico con evolución satisfactoria. Conclusiones: En el síndrome de Brown-Séquard causado por discopatía cervical, el tratamiento oportuno determina de forma esencial el mejoramiento de los síntomas de forma rápida; la fisioterapia y rehabilitación juegan un papel fundamental en la recuperación motora.

ABSTRACT Introduction: Brown-Séquard syndrome accounts for 1 to 4 % of all spinal cord injuries, very infrequent. It involves the lateral half of the spinal cord and the structures and/or functions of the dorsal segment, the corticospinal tract and the spinothalamic tract are unilaterally affected. Objective: To show an atypical presentation of cervical disc herniation in a young female patient with no history of trauma or physical exertion. Clinical case: A 24-year-old female patient presented with a progressive decrease in muscle strength on the left side of the limbs, with difficulty in walking, as well as moderate cervical pain. She was diagnosed with a cervical disc herniation and surgical treatment was performed with satisfactory evolution. Conclusions: In Brown-Séquard Syndrome caused by cervical disc disease, timely treatment is essential for rapid improvement of symptoms; physiotherapy and rehabilitation play a key role in motor recovery.

Casos clínicos sobre tratamiento conservador del hematoma subdural crónico / Clinical cases on conservative treatment of chronic subdural hematoma

Introducción: El hematoma subdural crónico es una de las entidades clínicas más comunes en la práctica neuroquirúrgica diaria, cuya incidencia y prevalencia aumentan considerablemente con la edad. El tratamiento conservador puede ser muy útil en algunos casos. Objetivo: Mostrar que el manejo farmacológico exclusivo de este padecimiento, puede ser considerado en muchos pacientes. Casos clínicos: Se presentan dos pacientes adultos mayores, atendidos en el servicio de Neurocirugía, con diagnóstico de hematoma subdural crónico, tratados solo con fármacos. Conclusiones: Como resultado final, se logró la reabsorción de las colecciones subdurales, lo cual se comprobó mediante estudios imagenológicos(AU)

Introduction: Chronic subdural hematoma is one of the most common clinical entities in everyday neurosurgical practice, which incidence and prevalence increase considerably with age. Conservative treatment can be very useful in many patients. Objective: To show that the exclusive pharmacological management of this condition can be considered in many patients. Clinical cases: Two elderly patients attended at the neurosurgery service are presented with a diagnosis of chronic subdural hematoma. They were treated only with drugs. Conclusions: The final result was the reabsorption of the subdural collections, which was proven by imaging studies(AU)

Hysteresis of pyruvate phosphate dikinase from Trypanosoma cruzi.

Trypanosoma cruzi, the causative agent of Chagas' disease, belongs to the Trypanosomatidae family. The parasite undergoes multiple morphological and metabolic changes during its life cycle, in which it can use both glucose and amino acids as carbon and energy sources. The glycolytic pathway is peculiar in that its first six or seven steps are compartmentalized in glycosomes, and has a two-branched auxiliary glycosomal system functioning beyond the intermediate phosphoenolpyruvate (PEP) that is also used in the cytosol as substrate by pyruvate kinase. The pyruvate phosphate dikinase (PPDK) is the first enzyme of one branch, converting PEP, PPi, and AMP into pyruvate, Pi, and ATP. Here we present a kinetic study of PPDK from T. cruzi that reveals its hysteretic behavior. The length of the lag phase, and therefore the time for reaching higher specific activity values is affected by the concentration of the enzyme, the presence of hydrogen ions and the concentrations of the enzyme's substrates. Additionally, the formation of a more active PPDK with more complex structure is promoted by it substrates and the cation ammonium, indicating that this enzyme equilibrates between the monomeric (less active) and a more complex (more active) form depending on the medium. These results confirm the hysteretic behavior of PPDK and are suggestive for its functioning as a regulatory mechanism of this auxiliary pathway. Such a regulation could serve to distribute the glycolytic flux over the two auxiliary branches as a response to the different environments that the parasite encounters during its life cycle.

Intervención educativa para la prevención de la conducta suicida en adolescentes y jóvenes / Educational intervention for the prevention of suicidal behavior in adolescents and young people

Introducción: La Organización Mundial de la Salud define el suicidio como "el acto deliberado de quitarse la vida". Los comportamientos suicidas abarcan un amplio espectro, desde la ideación suicida, hasta el intento y la consumación del acto. Objetivo: Determinar los efectos de una intervención educativa en el nivel de conocimientos sobre el comportamiento suicida en adolescentes y jóvenes. Métodos: Se realizó un estudio de intervención educativa encaminado a adolescentes y jóvenes, pertenecientes al área de salud del policlínico docente Bayamo Oeste, en el período comprendido entre abril del 2010 y marzo del 2011. A través de cuestionarios se identificó el riesgo suicida dentro de los participantes, así como el nivel de conocimientos sobre el tema; a partir de ello se desarrollaron actividades docentes educativas con temáticas referentes al suicidio. Los datos fueron procesados mediante el sistema SPSS y se emplearon como medidas de resumen de variables cuantitativas las frecuencias absolutas y porcentajes. Resultados: Se identificaron 11 participantes con riesgo suicida. Más del 80 por ciento del grupo de estudio muestra nuevos conocimientos luego de aplicada la intervención educativa. Conclusiones: Se diseñó y aplicó con efectividad la intervención educativa lo cual permitió elevar el nivel de conocimientos sobre el comportamiento suicida en adolescentes y jóvenes(AU)

Introduction: Suicide is defined by the World Health Organization as "the deliberate act of taking one's own life". Suicidal behavior covers a wide spectrum, from suicidal ideation to the attempt and completion of the act. Objective: To determine the effects of an educational intervention on the level of knowledge of suicidal behavior in adolescents and young people. Methods: We conducted an educational intervention study aimed at adolescents and young people, belonging to the health area of the Bayamo Oeste teaching polyclinic, in the period between April 2010 and March 2011. Through questionnaires, we identified the suicidal risk within the participants, as well as the level of knowledge about the subject; from this, educational teaching activities were developed with topics related to suicide. The data obtained were processed through the SPSS and absolute frequencies and percentages were used as summary measures of quantitative variables. Results: 11 participants with suicidal risk were identified. More than 80 percent of the study group showed new knowledge after the educational intervention was applied. Conclusions: The educational intervention was designed and effectively applied which allowed to increase the level of knowledge about suicidal behavior in adolescents and young people(AU)

Isolation of Glycosomes from Trypanosoma cruzi.

Glycosomes are peroxisome-related organelles of trypanosomatids in which the glycolytic and some other metabolic pathways are compartmentalized. We describe here two methods for the purification of glycosomes from Trypanosoma cruzi for preparative purposes, differential and isopycnic centrifugation. These are two techniques that allow the separation of different cellular compartments based on their different physicochemical characteristics. The first type of centrifugation is a rapid method that does not require large inputs and allows for fractions enriched in specific cell compartments to be obtained. The second type of centrifugation is a more elaborate method, but enables highly purified cellular compartments to be isolated. The success in obtaining these purified, intact organelles critically depends on using an appropriate method for controlled rupture of the cells.

Structure, Properties, and Function of Glycosomes in Trypanosoma cruzi.

Glycosomes are peroxisome-related organelles that have been identified in kinetoplastids and diplonemids. The hallmark of glycosomes is their harboring of the majority of the glycolytic enzymes. Our biochemical studies and proteome analysis of Trypanosoma cruzi glycosomes have located, in addition to enzymes of the glycolytic pathway, enzymes of several other metabolic processes in the organelles. These analyses revealed many aspects in common with glycosomes from other trypanosomatids as well as features that seem specific for T. cruzi. Their enzyme content indicates that T. cruzi glycosomes are multifunctional organelles, involved in both several catabolic processes such as glycolysis and anabolic ones. Specifically discussed in this minireview are the cross-talk between glycosomal metabolism and metabolic processes occurring in other cell compartments, and the importance of metabolite translocation systems in the glycosomal membrane to enable the coordination between the spatially separated processes. Possible mechanisms for metabolite translocation across the membrane are suggested by proteins identified in the organelle's membrane-homologs of the ABC and MCF transporter families-and the presence of channels as inferred previously from the detection of channel-forming proteins in glycosomal membrane preparations from the related parasite T. brucei. Together, these data provide insight in the way in which different parts of T. cruzi metabolism, although uniquely distributed over different compartments, are integrated and regulated. Moreover, this information reveals opportunities for the development of drugs against Chagas disease caused by these parasites and for which currently no adequate treatment is available.

Proteomic analysis of glycosomes from Trypanosoma cruzi epimastigotes.

In Trypanosoma cruzi, the causal agent of Chagas disease, the first seven steps of glycolysis are compartmentalized in glycosomes, which are authentic but specialized peroxisomes. Besides glycolysis, activity of enzymes of other metabolic processes have been reported to be present in glycosomes, such as ß-oxidation of fatty acids, purine salvage, pentose-phosphate pathway, gluconeogenesis and biosynthesis of ether-lipids, isoprenoids, sterols and pyrimidines. In this study, we have purified glycosomes from T. cruzi epimastigotes, collected the soluble and membrane fractions of these organelles, and separated peripheral and integral membrane proteins by Na2CO3 treatment and osmotic shock. Proteomic analysis was performed on each of these fractions, allowing us to confirm the presence of enzymes involved in various metabolic pathways as well as identify new components of this parasite's glycosomes.

Caracterización clínica epidemiológica de pacientes operados de tumores raquimedulares / Clinical epidemiological characterization of patients operated on spinal cord tumors

Introducción: Los tumores raquimedulares son la mayor causa de morbilidad y mortalidad entre pacientes con afecciones oncológicas y representan aproximadamente del 10 al 15 por ciento de todos los tumores del sistema nervioso central. Objetivo: Identificar aspectos clínicos y epidemiológicos en pacientes operados de tumores raquimedulares. Métodos: Se realizó un estudio observacional descriptivo, de serie de casos, en 31 pacientes de más de 19 años, operados/as de tumores intrarraquídeos, en el servicio de Neurocirugía del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, durante el período comprendido desde enero del 2008 a diciembre del 2013. Resultados: En los casos estudiados (n= 31) la edad tuvo un recorrido entre 19 y 76 años, predominó el sexo femenino (54,8 por ciento), las lesiones benignas (64,5 por ciento), así como mayor localización dorsal y extradural en el eje espinal. Conclusiones: Las principales características clínicas y epidemiológicas fueron: edad de presentación más frecuente en la sexta década de la vida, sintomatología con compromiso neurológico variable, dolor del raquis en todos los casos y predominio de lesiones benignas(AU)

Introduction: Spinal cord tumors are the leading cause of morbidity and mortality among patients with oncological conditions and it represents approximately 10 percent to 15 percent of all tumors of the central nervous system. Objective: To identify clinical and epidemiological aspects of patients operated on spinal cord tumors, from 2008 to 2013. Methods: We conducted an observational, descriptive study of a series of cases in 31 patients older than 19 years at the Neurosurgery Service of Saturnino Lora Provincial Teaching Hospital in Santiago de Cuba from January 2008 to December 2013. The subjects had diagnosis of intratracheal tumors. Results: In the cases studied (n = 31) age ranged 19 to 76 years. Female patients (54.8percent) and benign lesions (64.5 percent) were the majority. The most frequent localization was dorsal and extradural in the spinal axis. Conclusions: The main clinical and epidemiological characteristics were age of more frequent presentation of tumor lesions, that is 60 years of age; symptomatology with variable neurological involvement, spinal pain in all cases, and predominance of benign lesions(AU)

Reto neuroquirúrgico actual del cordoma cervical / Current neurosurgical challenge of the cervical chordoma

El cordoma es un tumor osteocartilaginoso raro, de lento crecimiento, con una tasa de incidencia global de 8,4 casos por cada 10 millones de habitantes. Comúnmente aparece en la quinta y sexta década de la vida, predomina en el sexo masculino. Se presenta un paciente masculino de 47 años de edad, con cervicobraquialgia, cuadriparesia y masa tumoral palpable en región anterolateral del cuello. El estudio de resonancia magnética demostró la presencia de una lesión retrofraríngea con destrucción vertebral y compresión extradural. Se decidió resección quirúrgica de la lesión. El diagnóstico histopatológico por inmunohistoquímica arrojó como resultado, un cordoma(AU)

Chordoma is a rare, slow-growing osteocartilaginous tumor with an overall incidence rate of 8.4 cases per 10 million inhabitants. Commonly appears in the fifth and sixth decade of life, predominates in the male sex. We present a 47-year-old male patient with cervicobrachialgia, quadriparesis and palpable tumor mass in the anterolateral region of the neck. The magnetic resonance study showed the presence of a retropharyngeal lesion with vertebral destruction and extradural compression. Surgical resection of the lesion was decided. The histopathological diagnosis by immunohistochemistry resulted in a chordoma(AU)

Supervivencia libre de progresión en pacientes portadores de meningiomas vacunados con nimotuzumab / Progression free survival in patients with meningioma which got Nimotuzumab vaccine

Introducción: en los últimos años la biología de los meningiomas cerebrales ha comenzado a entenderse mejor. La inmunoterapia activa contra el factor de crecimiento epidérmico es un concepto emergente, en el que se propone manipular la respuesta inmune del individuo, para generar anticuerpos específicos contra el factor de crecimiento epidérmico, capaces de bloquear la unión ligando-receptor y por consiguiente la señalización a través de este último. El receptor del factor de crecimiento epidérmico está sobrexpresado en este tipo de tumor. Objetivo: estimar la sobrevida libre de progresión de la entidad clínica y su relación con algunas variables socio-demográficas y terapéuticas seleccionadas. Métodos: se realizó un estudio descriptivo, transversal, en 25 pacientes portadores de meningiomas, tratados con un anticuerpo monoclonal humanizado (AcM h-R3) (nimotuzumab), en el Hospital Provincial Docente Clínico Quirúrgico Saturnino Lora de Santiago de Cuba, en el período comprendido entre el 1 de diciembre del 2013 y el 30 de noviembre del 2015. Resultados: el conjunto de pacientes incluidos en el estudio (n= 25) se caracterizó por el predominio del sexo femenino (60 por ciento), edad de 50 y más años (68 por ciento), piel blanca (48 por ciento) y escala de Karnofsky de 100 puntos (84 por ciento). El tiempo medio libre de progresión fue de 17 ± 8,6 meses. Conclusiones: fueron identificadas las principales características de la supervivencia libre de progresión del meningiomas en pacientes vacunados con AcM h-R3 y el tiempo fue como promedio de alrededor de año y medio(AU)

Introduction: in recent years the biology of brain meningiomas has begun to be better understood. Active immunotherapy against epidermal growth factor is an emerging concept, in which it is proposed to manipulate the immune response of the individual, to generate specific antibodies against epidermal growth factor, capable of blocking the ligand / receptor binding and therefore signaling through the latter. The epidermal growth factor receptor is overexpressed in this type of tumor. Objective: to estimate the progression free survival and its relation with some selected socio-demographic and therapeutic variables. Methods: a descriptive, cross-sectional study was conducted in 25 patients with meningiomas, treated with a humanized monoclonal antibody (mAb h-R3) (Nimotuzumab), in the Provincial Clinical-Surgical Teaching Hospital Saturnino Lora of Santiago de Cuba, from December 1, 2013 to November 30, 2015. Results: the group of patients included in the study (n= 25), was characterized by the predominance of females (60 percent), age 50 and over (68 percent), white skin (48 percent) and Karnofsky scale of 100 points (84 percent). The mean progression-free time was 17 ± 8.6 months. Conclusions: the main characteristics of progression-free survival of meningiomas were identified in patients vaccinated with mAb h-R3 and the progression-free time reached almost of a year and a half(AU)

Reto neuroquirúrgico actual del cordoma cervical / Current neurosurgical challenge of the cervical chordoma

El cordoma es un tumor osteocartilaginoso raro, de lento crecimiento, con una tasa de incidencia global de 8,4 casos por cada 10 millones de habitantes. Comúnmente aparece en la quinta y sexta década de la vida, predomina en el sexo masculino. Se presenta un paciente masculino de 47 años de edad, con cervicobraquialgia, cuadriparesia y masa tumoral palpable en región anterolateral del cuello. El estudio de resonancia magnética demostró la presencia de una lesión retrofraríngea con destrucción vertebral y compresión extradural. Se decidió resección quirúrgica de la lesión. El diagnóstico histopatológico por inmunohistoquímica arrojó como resultado, un cordoma(AU)

Chordoma is a rare, slow-growing osteocartilaginous tumor with an overall incidence rate of 8.4 cases per 10 million inhabitants. Commonly appears in the fifth and sixth decade of life, predominates in the male sex. We present a 47-year-old male patient with cervicobrachialgia, quadriparesis and palpable tumor mass in the anterolateral region of the neck. The magnetic resonance study showed the presence of a retropharyngeal lesion with vertebral destruction and extradural compression. Surgical resection of the lesion was decided. The histopathological diagnosis by immunohistochemistry resulted in a chordoma(AU)

Supervivencia libre de progresión en pacientes portadores de meningiomas vacunados con nimotuzumab / Progression free survival in patients with meningioma which got Nimotuzumab vaccine

Introducción: en los últimos años la biología de los meningiomas cerebrales ha comenzado a entenderse mejor. La inmunoterapia activa contra el factor de crecimiento epidérmico es un concepto emergente, en el que se propone manipular la respuesta inmune del individuo, para generar anticuerpos específicos contra el factor de crecimiento epidérmico, capaces de bloquear la unión ligando-receptor y por consiguiente la señalización a través de este último. El receptor del factor de crecimiento epidérmico está sobrexpresado en este tipo de tumor. Objetivo: estimar la sobrevida libre de progresión de la entidad clínica y su relación con algunas variables socio-demográficas y terapéuticas seleccionadas. Métodos: se realizó un estudio descriptivo, transversal, en 25 pacientes portadores de meningiomas, tratados con un anticuerpo monoclonal humanizado (AcM h-R3) (nimotuzumab), en el Hospital Provincial Docente Clínico Quirúrgico Saturnino Lora de Santiago de Cuba, en el período comprendido entre el 1 de diciembre del 2013 y el 30 de noviembre del 2015. Resultados: el conjunto de pacientes incluidos en el estudio (n= 25) se caracterizó por el predominio del sexo femenino (60 por ciento), edad de 50 y más años (68 por ciento), piel blanca (48 por ciento) y escala de Karnofsky de 100 puntos (84 por ciento). El tiempo medio libre de progresión fue de 17 ± 8,6 meses. Conclusiones: fueron identificadas las principales características de la supervivencia libre de progresión del meningiomas en pacientes vacunados con AcM h-R3 y el tiempo fue como promedio de alrededor de año y medio(AU)

Introduction: in recent years the biology of brain meningiomas has begun to be better understood. Active immunotherapy against epidermal growth factor is an emerging concept, in which it is proposed to manipulate the immune response of the individual, to generate specific antibodies against epidermal growth factor, capable of blocking the ligand / receptor binding and therefore signaling through the latter. The epidermal growth factor receptor is overexpressed in this type of tumor. Objective: to estimate the progression free survival and its relation with some selected socio-demographic and therapeutic variables. Methods: a descriptive, cross-sectional study was conducted in 25 patients with meningiomas, treated with a humanized monoclonal antibody (mAb h-R3) (Nimotuzumab), in the Provincial Clinical-Surgical Teaching Hospital Saturnino Lora of Santiago de Cuba, from December 1, 2013 to November 30, 2015. Results: the group of patients included in the study (n= 25), was characterized by the predominance of females (60 percent), age 50 and over (68 percent), white skin (48 percent) and Karnofsky scale of 100 points (84 percent). The mean progression-free time was 17 ± 8.6 months. Conclusions: the main characteristics of progression-free survival of meningiomas were identified in patients vaccinated with mAb h-R3 and the progression-free time reached almost of a year and a half(AU)

Subcellular localization of glycolytic enzymes and characterization of intermediary metabolism of Trypanosoma rangeli.

Trypanosoma rangeli is a hemoflagellate protist that infects wild and domestic mammals as well as humans in Central and South America. Although this parasite is not pathogenic for human, it is being studied because it shares with Trypanosoma cruzi, the etiological agent of Chagas' disease, biological characteristics, geographic distribution, vectors and vertebrate hosts. Several metabolic studies have been performed with T. cruzi epimastigotes, however little is known about the metabolism of T. rangeli. In this work we present the subcellular distribution of the T. rangeli enzymes responsible for the conversion of glucose to pyruvate, as determined by epifluorescense immunomicroscopy and subcellular fractionation involving either selective membrane permeabilization with digitonin or differential and isopycnic centrifugation. We found that in T. rangeli epimastigotes the first six enzymes of the glycolytic pathway, involved in the conversion of glucose to 1,3-bisphosphoglycerate are located within glycosomes, while the last four steps occur in the cytosol. In contrast with T. cruzi, where three isoenzymes (one cytosolic and two glycosomal) of phosphoglycerate kinase are expressed simultaneously, only one enzyme with this activity is detected in T. rangeli epimastigotes, in the cytosol. Consistent with this latter result, we found enzymes involved in auxiliary pathways to glycolysis needed to maintain adenine nucleotide and redox balances within glycosomes such as phosphoenolpyruvate carboxykinase, malate dehydrogenase, fumarate reductase, pyruvate phosphate dikinase and glycerol-3-phosphate dehydrogenase. Glucokinase, galactokinase and the first enzyme of the pentose-phosphate pathway, glucose-6-phosphate dehydrogenase, were also located inside glycosomes. Furthermore, we demonstrate that T. rangeli epimastigotes growing in LIT medium only consume glucose and do not excrete ammonium; moreover, they are unable to survive in partially-depleted glucose medium. The velocity of glucose consumption is about 40% higher than that of procyclic Trypanosoma brucei, and four times faster than by T. cruzi epimastigotes under the same culture conditions.

Interaction of Trypanosoma evansi with the plasminogen-plasmin system.

Trypanosoma evansi is a widely-distributed haemoflagellated parasite of veterinary importance that infects a variety of mammals including horses, mules, camels, buffalos, cattle and deer. It is the causal agent of a trypanosomiasis known as Surra which produces epidemics of great economic importance in Africa, Asia and South America. The main pathology includes an enlarged spleen with hypertrophy of lymphoid follicles, congested lungs, neuronal degeneration and meningoencephalitis, where migration of the parasites from the blood to the tissues is essential. Most cells, including pathogenic cells, use diverse strategies for tissue invasion, such as the expression of surface receptors to bind plasminogen or plasmin. In this work, we show that T. evansi is able to bind plasminogen and plasmin on its surface. The analysis of this binding revealed a high affinity dissociation constant (Kd of 0.080±0.009µM) and 1×10(5) plasminogen binding sites per cell. Also a second population of receptors with a Kd of 0.255±0.070µM and 3.2×10(4) plasminogen binding sites per cell was determined. Several proteins with molecular masses between ∼18 and ∼70kDa are responsible for this binding. This parasite-plasminogen interaction may be important in the establishment of the infection in the vertebrate host, where the physiological concentration of available plasminogen is around 2µM.

Trypanosoma cruzi contains two galactokinases; molecular and biochemical characterization.

Two different putative galactokinase genes, found in the genome database of Trypanosoma cruzi were cloned and sequenced. Expression of the genes in Escherichia coli resulted for TcGALK-1 in the synthesis of a soluble and active enzyme, and in the case of TcGALK-2 gene a less soluble protein, with predicted molecular masses of 51.9kDa and 51.3kDa, respectively. The Km values determined for the recombinant proteins were for galactose 0.108mM (TcGALK-1) and 0.091mM (TcGALK-2) and for ATP 0.36mM (TcGALK-1) and 0.1mM (TcGALK-2). Substrate inhibition by ATP (Ki 0.414mM) was only observed for TcGALK-2. Gel-filtration chromatography showed that natural TcGALKs and recombinant TcGALK-1 are monomeric. In agreement with the possession of a type-1 peroxisome-targeting signal by both TcGALKs, they were found to be present inside glycosomes using two different methods of subcellular fractionation in conjunction with mass spectrometry. Both genes are expressed in epimastigote and trypomastigote stages since the respective proteins were immunodetected by western blotting. The T. cruzi galactokinases present their highest (52-47%) sequence identity with their counterpart from Leishmania spp., followed by prokaryotic galactokinases such as those from E. coli and Lactococcus lactis (26-23%). In a phylogenetic analysis, the trypanosomatid galactokinases form a separate cluster, showing an affiliation with bacteria. Epimastigotes of T. cruzi can grow in glucose-depleted LIT-medium supplemented with 20mM of galactose, suggesting that this hexose, upon phosphorylation by a TcGALK, could be used in the synthesis of UDP-galactose and also as a possible carbon and energy source.

Trypanosoma evansi contains two auxiliary enzymes of glycolytic metabolism: Phosphoenolpyruvate carboxykinase and pyruvate phosphate dikinase.

Trypanosoma evansi is a monomorphic protist that can infect horses and other animal species of economic importance for man. Like the bloodstream form of the closely related species Trypanosoma brucei, T. evansi depends exclusively on glycolysis for its free-energy generation. In T. evansi as in other kinetoplastid organisms, the enzymes of the major part of the glycolytic pathway are present within organelles called glycosomes, which are authentic but specialized peroxisomes. Since T. evansi does not undergo stage-dependent differentiations, it occurs only as bloodstream forms, it has been assumed that the metabolic pattern of this parasite is identical to that of the bloodstream form of T. brucei. However, we report here the presence of two additional enzymes, phosphoenolpyruvate carboxykinase and PPi-dependent pyruvate phosphate dikinase in T. evansi glycosomes. Their colocalization with glycolytic enzymes within the glycosomes of this parasite has not been reported before. Both enzymes can make use of PEP for contributing to the production of ATP within the organelles. The activity of these enzymes in T. evansi glycosomes drastically changes the model assumed for the oxidation of glucose by this parasite.