Usefulness of last generation insertable cardiac monitors in the diagnosis of unexplained syncope.

AIMS: Guidelines recommend insertable cardiac monitor (ICM) in the early phases of the evaluation of unexplained syncope (US) syncope, when an arrhythmic etiology is suspected. We examined the diagnostic yield of the last generation ICM (LG-ICM) to establish the causes of US, by assessing in the clinical practice the incidence of: relevant arrhythmia diagnosis, syncope recurrences and CM-guided cardiac electronic device (CIED) implantation. We investigated also baseline patient characteristics associated to an increased risk of relevant arrhythmias and of syncope recurrence. METHODS: Data prospectively collected from consecutive patients receiving LG-ICM for investigation of US or presyncope in our institution between November 2020 and January 2023 were analyzed. RESULTS: A total of 109 patients (mean age 64.4 ± 16.1 years, 40.4% women) with US or pre-syncope episodes underwent implantation of the LG-ICM. During a mean follow-up of 11.7 ± 8.1 months, LG-ICM diagnostic yield was 42%. In particular, LG-ICM detected cardiac arrhythmias in 29 (27%) patients (in 6 out of them during a syncope recurrence) and to exclude the arrhythmic origin of the syncope in additional 19 (17%) patients. LG-ICM guided the implantation of a CIED in 16 (15%) US patients, due to the diagnosis of asystole or severe bradycardia. Age ≥ 65 years (p = 0.012) and atrial arrhythmia history (p = 0.004) are significant independent predictors of arrhythmic diagnoses performed by LG-ICM, while CAD is predictor of syncope recurrence (bordering on statistical significance, p = 0.056). CONCLUSIONS: The diagnostic yield of LG-ICM in US syncope is comparable to those of ILR and previous generation ICM. The advantages of LG-ICM should be sought in lower hospital workload necessary to manage ICM data. Age ≥ 65 years and atrial arrhythmia history are independent predictors of significant ICM-detected arrhythmias.

Modeling new trends in bone regeneration, using the BERTopic approach.

Aim: Bibliometric surveys are time-consuming endeavors, which cannot be scaled up to meet the challenges of ever-expanding fields, such as bone regeneration. Artificial intelligence, however, can provide smart tools to screen massive amounts of literature, and we relied on this technology to automatically identify research topics. Materials & methods: We used the BERTopic algorithm to detect the topics in a corpus of MEDLINE manuscripts, mapping their similarities and highlighting research hotspots. Results: Using BERTopic, we identified 372 topics and were able to assess the growing importance of innovative and recent fields of investigation such as 3D printing and extracellular vescicles. Conclusion: BERTopic appears as a suitable tool to set up automatic screening routines to track the progress in bone regeneration.

Genetic mutations and leukapheresis in acute myeloid leukemia: is there a link?

Acute myeloid leukemia is the most common acute leukemia in adults and up to 20% of patients present with hyperleukocytosis at the onset of the disease. The therapeutic approach involves medical support, cytoreductive treatment, and/or leukapheresis. Despite WBC count greater than 100.000/µL, not all patients develop symptoms. To clarify the role of leukapheresis in the setting of hyperleukocytotic AML, we aimed to find associations between AML morphologic subtypes and molecular alterations on presence or absence of leukostasis symptoms (and hence therapeutic vs prophylactic leukapheresis) and clinical outcomes in the cohort of 41 patients at our single center who underwent leukapheresis for hyperleukocytotic AML. There was a trend for increased WBC count, 30-day mortality, M4-M5 AML subtypes, and number of leukapheresis procedures performed in symptomatic hyperleukocytotic pts. No molecular marker was significantly associated with presence or absence of leukostasis symptoms due to small sample size, though there was a trend for increased NPM1-mutated and NPM1 + FLT3-mutated AML in asymptomatic patients and a greater proportion of symptomatic patients who were negative for all assessed molecular alterations. In conclusion, leukapheresis combined with cytoreductive treatment represents a synergic and efficient approach in the management of hyperleukocytosis especially in symptomatic patients considering the higher mortality independently from the presence of specific clonal markers whose distribution among the two groups may result more considerable with a higher number of patients.

Chronic Myeloid Leukemia in a Patient with Previous Idiopathic Thrombocytopenic Purpura: How to Manage Imatinib Together with Eltrombopag.

The occurrence of chronic myeloid leukemia (CML), or other myeloproliferative diseases, after the development of idiopathic thrombocytopenic purpura (ITP) is very rare in the current medical literature. Considering the advances in ITP management, and the wide use of new drugs for ITP and CML, we report an unusual case with this association. Our case report focused on a 64-year-old man with long-standing ITP treated with eltrombopag, who developed hyperleukocytosis during follow-up; after specific laboratory exams, it was diagnosed as CML and he began treatment with imatinib. The treatment with eltrombopag was balanced with imatinib to stabilize his platelet count. Data on bcr-abl and JAK2 transcripts were collected and revealed an optimal response with the achievement of negativization of both molecular signatures. We could demonstrate that treatment with imatinib and eltrombopag was well tolerated and allowed complete molecular remission of CML to be achieved, as well as of ITP.

The effects of polydeoxyribonucleotide on wound healing and tissue regeneration: a systematic review of the literature.

Aim: The present study evaluated the effects of polydeoxyribonucleotide (PDRN) on tissue regeneration, paying special attention to the molecular mechanisms that underlie its tissue remodeling actions to better identify its effective therapeutic potential in wound healing. Materials & methods: Strategic searches were conducted through MEDLINE/PubMed, Google Scholar, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials, from their earliest available dates to March 2020. The studies were included with the following eligibility criteria: studies evaluating tissue regeneration, and being an in vitro, in vivo and clinical study. Results: Out of more than 90 articles, 34 fulfilled the eligibility criteria. All data obtained proved the ability of PDRN in promoting a physiological tissue repair through salvage pathway and adenosine A2A receptor activation. Conclusion: Up to date PDRN has proved promising results in term of wound regeneration, healing time and absence of side effects.

Crianza infantil y diversidad cultural. Aportes de la antropología a la práctica pediátrica / Child rearing and cultural diversity. Contributions of anthropology to pediatric practice

En este artículo, se propone situar la crianza infantil como un proceso social y cultural que, lejos de presentar características universales e invariables, muestra una enorme diversidad, ligada, en gran medida, a particularidades culturales de las familias y comunidades que la llevan a cabo. Se considera que la perspectiva de la antropología puede contribuir a comprender esa multiplicidad de formas de criar a los niños que suele emerger en el consultorio del pediatra y que pone en juego diferentes concepciones de niñez, sujeto, cuerpo, maternidad, paternidad, entre otras. A su vez, se advierte acerca de los riesgos de limitar el abordaje de la crianza a un relativismo cultural ingenuo que esencialice el papel de la cultura, y se señala, por el contrario, la necesidad de considerar el modo en que las particularidades culturales se entrelazan con las desigualdades sociales a la hora de interpretar esa diversidad

This article proposes to define child rearing as a social and cultural process that, far from depicting universal and invariable characteristics, shows a huge diversity, mostly linked to the cultural features of families and communities in charge of such process. It has been considered that the anthropological perspective may contribute to understanding such multiple forms of bringing up children that are usually seen at the pediatrician's office and that involve different concepts in relation to childhood, individual, body, motherhood, fatherhood, among others. In turn, this article warns about the risks of restricting the approach to child rearing to a naive cultural relativism that reduces the role of culture to essentials and, on the contrary, points out the need to consider how cultural features intertwine with social inequalities when interpreting such diversity.

Child rearing and cultural diversity. Contributions of anthropology to pediatric practice. / Crianza infantil y diversidad cultural. Aportes de la antropología a la práctica pediátrica.

This article proposes to define child rearing as a social and cultural process that, far from depicting universal and invariable characteristics, shows a huge diversity, mostly linked to the cultural features of families and communities in charge of such process. It has been considered that the anthropological perspective may contribute to understanding such multiple forms of bringing up children that are usually seen at the pediatrician's office and that involve different concepts in relation to childhood, individual, body, motherhood, fatherhood, among others. In turn, this article warns about the risks of restricting the approach to child rearing to a naive cultural relativism that reduces the role of culture to essentials and, on the contrary, points out the need to consider how cultural features intertwine with social inequalities when interpreting such diversity.

En este artículo, se propone situar la crianza infantil como un proceso social y cultural que, lejos de presentar características universales e invariables, muestra una enorme diversidad, ligada, en gran medida, a particularidades culturales de las familias y comunidades que la llevan a cabo. Se considera que la perspectiva de la antropología puede contribuir a comprender esa multiplicidad de formas de criar a los niños que suele emerger en el consultorio del pediatra y que pone en juego diferentes concepciones de niñez, sujeto, cuerpo, maternidad, paternidad, entre otras. A su vez, se advierte acerca de los riesgos de limitar el abordaje de la crianza a un relativismo cultural ingenuo que esencialice el papel de la cultura, y se señala, por el contrario, la necesidad de considerar el modo en que las particularidades culturales se entrelazan con las desigualdades sociales a la hora de interpretar esa diversidad.

3D-printed chitosan scaffolds modified with D-(+) raffinose and enriched with type IV collagen to improve epithelial cell colonization.

Tissue regeneration often requires the use of biocompatible resorbable scaffolds to support the ingrowth of cells from neighboring tissues into a localized tissue defect. Such scaffolds must possess surface molecular cues that stimulate cells to populate the device, the first necessary condition for the formation of a healthy tissue. Chitosan is a natural polymer that has long been tested in biomedical applications because of its high biocompatibility, which can be further increased by modifying its formulation, e.g. adding D-(+) raffinose. We used this formulation in an ad hoc designed 3D printer to create regularly ordered scaffolds, which we then enriched with type IV collagen, an isoform of collagen that is exclusively found in basement membranes. Human epithelial A549 cells were then seeded on control scaffolds or on scaffolds coated with collagen, which was precipitated, or on scaffolds first collagenized and then exposed to either UVB or UVC radiation. Observations by the transmission light microscope, confocal microscope after staining with calcein-AM/propidium iodide, and by environmental scanning electron microscope revealed that collagen-enriched UV-treated scaffolds promoted the attachment of a higher number of cells, which covered a more extensive area of the scaffold, as also confirmed by alamar blue viability assay. Together these data confirm that coating 3D-printed scaffolds made of D-(+) raffinose-modified chitosan with type IV collagen and exposing them to UV light sensibly increases the cell compatibility of scaffolds, making them a better candidate to serve as a tool for the regeneration of epithelia.

Construcción de la infancia y de un saber médico especializado: los comienzos de la pediatría en Buenos Aires, 1890-1920 / The construction of childhood and its specialized medical care: the beginnings of pediatrics in Buenos Aires, 1890-1920

Resumen Se analiza la constitución de la pediatría como un saber médico especializado en Buenos Aires, entre 1890 y 1920. Se busca mostrar que este proceso resulta de un doble movimiento: la delimitación y caracterización del niño como un particular objeto de conocimiento e intervención y la institucionalización de ciertos médicos como un grupo profesional que procura legitimar su especificidad tanto hacia el interior de la medicina como en el campo social más amplio. Luego de contextualizar socio históricamente las preocupaciones del saber médico acerca de la infancia, se profundiza en el modo en que ésta es construida, así como en el movimiento asociativo y académico que permite a los pediatras constituirse como un grupo de especialistas portadores de un saber experto.

Abstract It analyzes the set-up of pediatrics as a specialized medical field in Buenos Aires, between 1890-1920. The article seeks to demonstrate this process as a result of two movements: the delimitation and characterization of children as a particular object of knowledge and intervention, and the institutionalization of some physicians as a professional group that sought to legitimate their specificity within the medicine field and beyond. After contextualizing socially and historically the concerns of medical knowledge on childhood, it explores with detail how the field was constructed, and the associative and academic movement that allowed pediatricians to constitute themselves as a group of specialists that bear a specific expertise.

[The construction of childhood and its specialized medical care: the beginnings of pediatrics in Buenos Aires, 1890-1920]. / Construcción de la infancia y de un saber médico especializado: los comienzos de la pediatría en Buenos Aires, 1890-1920.

It analyzes the set-up of pediatrics as a specialized medical field in Buenos Aires, between 1890-1920. The article seeks to demonstrate this process as a result of two movements: the delimitation and characterization of children as a particular object of knowledge and intervention, and the institutionalization of some physicians as a professional group that sought to legitimate their specificity within the medicine field and beyond. After contextualizing socially and historically the concerns of medical knowledge on childhood, it explores with detail how the field was constructed, and the associative and academic movement that allowed pediatricians to constitute themselves as a group of specialists that bear a specific expertise.

Se analiza la constitución de la pediatría como un saber médico especializado en Buenos Aires, entre 1890 y 1920. Se busca mostrar que este proceso resulta de un doble movimiento: la delimitación y caracterización del niño como un particular objeto de conocimiento e intervención y la institucionalización de ciertos médicos como un grupo profesional que procura legitimar su especificidad tanto hacia el interior de la medicina como en el campo social más amplio. Luego de contextualizar socio históricamente las preocupaciones del saber médico acerca de la infancia, se profundiza en el modo en que ésta es construida, así como en el movimiento asociativo y académico que permite a los pediatras constituirse como un grupo de especialistas portadores de un saber experto.

Construcción de la infancia y de un saber médico especializado: los comienzos de la pediatría en Buenos Aires, 1890-1920 / The construction of childhood and its specialized medical care: the beginnings of pediatrics in Buenos Aires, 1890-1920

Se analiza la constitución de la pediatría como un saber médico especializado en Buenos Aires, entre 1890 y 1920. Se busca mostrar que este proceso resulta de un doble movimiento: la delimitación y caracterización del niño como un particular objeto de conocimiento e intervención y la institucionalización de ciertos médicos como un grupo profesional que procura legitimar su especificidad tanto hacia el interior de la medicina como en el campo social más amplio. Luego de contextualizar socio históricamente las preocupaciones del saber médico acerca de la infancia, se profundiza en el modo en que ésta es construida, así como en el movimiento asociativo y académico que permite a los pediatras constituirse como un grupo de especialistas portadores de un saber experto.(AU)

Down-regulation of miR-23b induces phenotypic switching of vascular smooth muscle cells in vitro and in vivo.

AIMS: Phenotypic switch of vascular smooth muscle cells (VSMCs) plays a key role in the pathogenesis of different vascular diseases, such as atherosclerosis and restenosis after coronary intervention. MicroRNAs have been identified as key regulators of VSMC biology. The miR-23b is highly expressed in VSMCs and it is involved in differentiation, proliferation, and migration of several non-vascular cell types. However, the role of miR-23b in vascular disease is currently unknown. Thus, the aim of the present study was to evaluate the role of miR-23b on VSMC phenotypic switch in vitro and after vascular injury in vivo. METHODS AND RESULTS: To determine the changes of miR-23b expression in the injured arterial wall, we used the standard rat carotid artery balloon injury model. In vivo studies demonstrated that miR-23b is down-regulated after vascular injury. Gain-of-function studies showed that overexpression of miR-23b inhibited VSMC proliferation and migration, whereas the opposite effect was obtained with the in vitro inhibition of miR-23b. We further demonstrated that miR-23b can significantly promote the expression of VSMC marker genes such as smooth muscle α-actin (ACTA2) and smooth muscle myosin heavy chain (MYH11). Overexpression of miR-23b in balloon-injured arteries by Ad-miR-23b markedly decreased neointimal hyperplasia. Finally, miR-23b specifically suppresses urokinase-type plasminogen activator, SMAD family member 3, and transcription factor forkhead box O4 (FoxO4) expression in phenotypically modulated VSMCs. By luciferase reporter assay, we validated the transcription factor FoxO4 as a direct target of miR-23b in VSMCs. CONCLUSIONS: We identify miR-23b as a novel regulator of VSMC phenotypic switch in vitro and following vascular injury in vivo.

Lycopene induces cell growth inhibition by altering mevalonate pathway and Ras signaling in cancer cell lines.

Several evidences suggest that cancer cells have abnormal cholesterol biosynthetic pathways and prenylation of small guanosine triphosphatase proteins. Tomato lycopene has been suggested to have beneficial effects against certain types of cancer, including that of prostate, although the exact molecular mechanism(s) is unknown. We tested the hypothesis that lycopene may exert its antitumor effects through changes in mevalonate pathway and in Ras activation. Incubation of the Ras-activated prostatic carcinoma LNCaP cells with a 24 h lycopene treatment (2.5-10 µM) dose dependently reduced intracellular total cholesterol by decreasing 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase expression and by inactivating Ras, as evidenced by its translocation from cell membranes to cytosol. Concomitantly, lycopene reduced the Ras-dependent activation of nuclear factor-kappaB (NF-κB). Such a reduction was parallel to an inhibition of reactive oxygen species production and to a decrease in the phosphorylation ofc-jun N-terminal kinase, extracellular signal-regulated kinase 1/2 and p38. These effects were also accompanied by an arrest of cell cycle progression and by apoptosis induction, as evidenced by a decrease in cyclin D1 and phospho-AKT levels and by an increase in p21, p27 and p53 levels and in Bax:Bcl-2 ratio. The addition of mevalonate prevented the growth-inhibitory effects of lycopene as well as its increase in Ras cytoplasmatic accumulation and the subsequent changes in NF-κB. The ability of lycopene in inhibiting HMG-CoA reductase expression and cell growth and in inactivating Ras was also found in prostate PC-3, colon HCT-116 and HT-29 and lung BEN cancer cells. These findings provide a novel mechanistic insight into the growth-inhibitory effects of lycopene in cancer.

[Television as agent of socialization. Influence of television on the construction of subjectivity in children and adolescents]. / La televisión como agente de socialización. Influencia de la televisión en la construcción de la subjetividad en niños y adolescentes.

UNLABELLED: In the human process of socialization the family (main agent in the first years) takes part together with friends, school and mass media, specially T.V, among others. The aim of our research is to analize television's influence upon the construction of subjectivity in the child and adolescent. We intend avoid the sterilizing antinomy: TV is either good or bad. SAMPLE: 587 children and adolescents from 5th to 9th grade (EGB). Parents and teachers were included to compare answers. MATERIAL AND METHOD: Semi-structured questionnaires. Years 2004-2005.

Atención de la salud infantil en una comunidad toba de un medio urbano / The care of child health in a toba indian community of an urban envioronment

El presente artículo se centra en las representaciones y prácticas a través de las cuales las mujeres de un grupo indígena toba,establecido en la ciudad de La Plata,dan cuenta de la salud-enfermedad de sus hijos.Tres sistemas de atención del proceso salud-enfermedad coexisten en el grupo estudiado:el de la "medicina oficial",el de la"medicina tradicional-popular" y el de la "medicina religiosa".Estos sistemas son articulados,de forma compleja y diversa en las distinatas estrategias de atención que se ponen en juego ante la enfermedad de un niño.En la configuración de dichas estrategias intervienen tanto las creencias y valores propios de la cultura toba como las limitaciones económicas que resultan de su posición social

Atención de la salud infantil en una comunidad toba de un medio urbano / The care of child health in a toba indian community of an urban envioronment

El presente artículo se centra en las representaciones y prácticas a través de las cuales las mujeres de un grupo indígena toba,establecido en la ciudad de La Plata,dan cuenta de la salud-enfermedad de sus hijos.Tres sistemas de atención del proceso salud-enfermedad coexisten en el grupo estudiado:el de la "medicina oficial",el de la"medicina tradicional-popular" y el de la "medicina religiosa".Estos sistemas son articulados,de forma compleja y diversa en las distinatas estrategias de atención que se ponen en juego ante la enfermedad de un niño.En la configuración de dichas estrategias intervienen tanto las creencias y valores propios de la cultura toba como las limitaciones económicas que resultan de su posición social