The Expression Profiles of lncRNAs Are Associated with Neoadjuvant Chemotherapy Resistance in Locally Advanced, Luminal B-Type Breast Cancer.

lncRNAs are noncoding transcripts with tissue and cancer specificity. Particularly, in breast cancer, lncRNAs exhibit subtype-specific expression; they are particularly upregulated in luminal tumors. However, no gene signature-based laboratory tests have been developed for luminal breast cancer identification or the differential diagnosis of luminal tumors, since no luminal A- or B-specific genes have been identified. Particularly, luminal B patients are of clinical interest, since they have the most variable response to neoadjuvant treatment; thus, it is necessary to develop diagnostic and predictive biomarkers for these patients to optimize treatment decision-making and improve treatment quality. In this study, we analyzed the lncRNA expression profiles of breast cancer cell lines and patient tumor samples from RNA-Seq data to identify an lncRNA signature specific for luminal phenotypes. We identified an lncRNA signature consisting of LINC01016, GATA3-AS1, MAPT-IT1, and DSCAM-AS1 that exhibits luminal subtype-specific expression; among these lncRNAs, GATA3-AS1 is associated with the presence of residual disease (Wilcoxon test, p < 0.05), which is related to neoadjuvant chemotherapy resistance in luminal B breast cancer patients. Furthermore, analysis of GATA3-AS1 expression using RNA in situ hybridization (RNA ISH) demonstrated that this lncRNA is detectable in histological slides. Similar to estrogen receptors and Ki67, both commonly detected biomarkers, GATA3-AS1 proves to be a suitable predictive biomarker for clinical application in breast cancer laboratory tests.

Modulation of Postprandial Plasma Concentrations of Digestive Hormones and Gut Microbiota by Foods Containing Oat ß-Glucans in Healthy Volunteers.

Cereal ß-glucans are beneficial health ingredients that reduce cholesterolemia and postprandial glycaemia. However, their impact on digestive hormones and gut microbiota is not yet fully established. Two randomized, double-blind, controlled studies were conducted. In the first study, 14 subjects ingested a breakfast with or without ß-glucan from oats (5.2 g). Compared to the control, ß-glucan increased orocecal transit time (p = 0.028) and decreased mean appetite score (p = 0.014) and postprandial plasma ghrelin (p = 0.030), C-peptide (p = 0.001), insulin (p = 0.06), and glucose (p = 0.0006). ß-glucan increased plasma GIP (p = 0.035) and PP (p = 0.018) without affecting leptin, GLP-1, PYY, glucagon, amylin, or 7α-hydroxy-4-cholesten-3-one, a biomarker of bile acid synthesis. In the second study, 32 subjects were distributed into 2 groups to ingest daily foods with (3 g/day) or without ß-glucan for 3 weeks; stools were collected before/after treatment. No changes in fecal microbiota composition/diversity (deep sequencing) were detected with ß-glucans. These results indicate that acute intake of 5 g ß-glucan slows transit time and decreases hunger sensation and postprandial glycaemia without affecting bile-acid synthesis, these changes being associated with decreased plasma insulin, C-peptide, and ghrelin, and increased plasma GIP and PP. However, regular daily intake of 3 g ß-glucan is not sufficient to have an effect on fecal microbiota composition.

Endogenous pannexin1 channels form functional intercellular cell-cell channels with characteristic voltage-dependent properties.

The occurrence of intercellular channels formed by pannexin1 has been challenged for more than a decade. Here, we provide an electrophysiological characterization of exogenous human pannexin1 (hPanx1) cell­cell channels expressed in HeLa cells knocked out for connexin45. The observed hPanx1 cell­cell channels show two phenotypes: O-state and S-state. The former displayed low transjunctional voltage (Vj) sensitivity and single-channel conductance of ∼175 pS, with a substate of ∼35 pS; the latter showed a peculiar dynamic asymmetry in Vj dependence and single-channel conductance identical to the substate conductance of the O-state. S-state hPanx1 cell­cell channels were also identified between TC620 cells, a human oligodendroglioma cell line that endogenously expresses hPanx1. In these cells, dye and electrical coupling increased with temperature and were strongly reduced after hPanx1 expression was knocked down by small interfering RNA or inhibited with Panx1 mimetic inhibitory peptide. Moreover, cell­cell coupling was augmented when hPanx1 levels were increased with a doxycycline-inducible expression system. Application of octanol, a connexin gap junction (GJ) channel inhibitor, was not sufficient to block electrical coupling between HeLa KO Cx45-hPanx1 or TC620 cell pairs. In silico studies suggest that several arginine residues inside the channel pore may be neutralized by hydrophobic interactions, allowing the passage of DAPI, consistent with dye coupling observed between TC620 cells. These findings demonstrate that endogenously expressed hPanx1 forms intercellular cell­cell channels and their unique properties resemble those described in innexin-based GJ channels. Since Panx1 is ubiquitously expressed, finding conditions to recognize Panx1 cell­cell channels in different cell types might require special attention.

A physiologic rise in cytoplasmic calcium ion signal increases pannexin1 channel activity via a C-terminus phosphorylation by CaMKII.

Pannexin1 (Panx1) channels are ubiquitously expressed in vertebrate cells and are widely accepted as adenosine triphosphate (ATP)-releasing membrane channels. Activation of Panx1 has been associated with phosphorylation in a specific tyrosine residue or cleavage of its C-terminal domains. In the present work, we identified a residue (S394) as a putative phosphorylation site by Ca2+/calmodulin-dependent kinase II (CaMKII). In HeLa cells transfected with rat Panx1 (rPanx1), membrane stretch (MS)-induced activation-measured by changes in DAPI uptake rate-was drastically reduced by either knockdown of Piezo1 or pharmacological inhibition of calmodulin or CaMKII. By site-directed mutagenesis we generated rPanx1S394A-EGFP (enhanced green fluorescent protein), which lost its sensitivity to MS, and rPanx1S394D-EGFP, mimicking phosphorylation, which shows high DAPI uptake rate without MS stimulation or cleavage of the C terminus. Using whole-cell patch-clamp and outside-out excised patch configurations, we found that rPanx1-EGFP and rPanx1S394D-EGFP channels showed current at all voltages between ±100 mV, similar single channel currents with outward rectification, and unitary conductance (∼30 to 70 pS). However, using cell-attached configuration we found that rPanx1S394D-EGFP channels show increased spontaneous unitary events independent of MS stimulation. In silico studies revealed that phosphorylation of S394 caused conformational changes in the selectivity filter and increased the average volume of lateral tunnels, allowing ATP to be released via these conduits and DAPI uptake directly from the channel mouth to the cytoplasmic space. These results could explain one possible mechanism for activation of rPanx1 upon increase in cytoplasmic Ca2+ signal elicited by diverse physiological conditions in which the C-terminal domain is not cleaved.

Adenosine triphosphate, polymyxin B and B16 cell-derived immunization induce anticancer response.

Aim: Whole dead tumor cells can be used as antigen source and the induction of protective immune response could be enhanced by damage-associated molecular patterns. Materials & methods: We generated whole dead tumor cells called B16-immunogenic cell bodies (ICBs) from B16 melanoma cells by nutrient starvation and evaluated the in vivo antitumor effect of B16-ICBs plus ATP and polymyxin B (PMB). Results: The subcutaneous immunization with B16-ICBs + PMB + ATP a 50% of tumor-free animals and induced a significant delay in tumor growth in a prophylactic approach. These results correlated with maturation of bone marrow-derived dendritic cells and activation of T CD8+ lymphocytes in vitro. Conclusion: Altogether, ICB + ATP + PMB is efficient in inducing the antitumor efficacy of the whole dead tumor cells vaccine.

Stretch-Induced Activation of Pannexin 1 Channels Can Be Prevented by PKA-Dependent Phosphorylation.

Pannexin 1 channels located in the cell membrane are permeable to ions, metabolites, and signaling molecules. While the activity of these channels is known to be modulated by phosphorylation on T198, T308, and S206, the possible involvement of other putative phosphorylation sites remains unknown. Here, we describe that the activity of Panx1 channels induced by mechanical stretch is reduced by adenosine via a PKA-dependent pathway. The mechanical stretch-induced activity-measured by changes in DAPI uptake-of Panx1 channels expressed in HeLa cell transfectants was inhibited by adenosine or cAMP analogs that permeate the cell membrane. Moreover, inhibition of PKA but not PKC, p38 MAPK, Akt, or PKG prevented the effects of cAMP analogs, suggesting the involvement of Panx1 phosphorylation by PKA. Accordingly, alanine substitution of T302 or S328, two putative PKA phosphorylation sites, prevented the inhibitory effect of cAMP analogs. Moreover, phosphomimetic mutation of either T302 or S328 to aspartate prevented the mechanical stretch-induced activation of Panx1 channels. A molecular dynamics simulation revealed that T302 and S328 are located in the water-lipid interphase near the lateral tunnel of the intracellular region, suggesting that their phosphorylation could promote conformational changes in lateral tunnels. Thus, Panx1 phosphorylation via PKA could be modulated by G protein-coupled receptors associated with the Gs subunit.

Pannexin-1 Channels Are Essential for Mast Cell Degranulation Triggered During Type I Hypersensitivity Reactions.

Mast cells (MCs) release pro-inflammatory mediators through a process called degranulation response. The latter may be induced by several conditions, including antigen recognition through immunoglobulin E (IgE) or "cross-linking," classically associated with Type I hypersensitivity reactions. Early in this reaction, Ca2+ influx and subsequent increase of intracellular free Ca2+ concentration are essential for MC degranulation. Several membrane channels that mediate Ca2+ influx have been proposed, but their role remains elusive. Here, we evaluated the possible contribution of pannexin-1 channels (Panx1 Chs), well-known as ATP-releasing channels, in the increase of intracellular Ca2+ triggered during cross-linking reaction of MCs. The contribution of Panx1 Chs in the degranulation response was evaluated in MCs from wild type (WT) and Panx1 knock out (Panx1-/-) mice after anti-ovalbumin (OVA) IgE sensitization. Notably, the degranulation response (toluidine blue and histamine release) was absent in Panx1-/- MCs. Moreover, WT MCs showed a rapid and transient increase in Ca2+ signal followed by a sustained increase after antigen stimulation. However, the sustained increase in Ca2+ signal triggered by OVA was absent in Panx1-/- MCs. Furthermore, OVA stimulation increased the membrane permeability assessed by dye uptake, a prevented response by Panx1 Ch but not by connexin hemichannel blockers and without effect on Panx1-/- MCs. Interestingly, the increase in membrane permeability of WT MCs was also prevented by suramin, a P2 purinergic inhibitor, suggesting that Panx1 Chs act as ATP-releasing channels impermeable to Ca2+. Accordingly, stimulation with exogenous ATP restored the degranulation response and sustained increase in Ca2+ signal of OVA stimulated Panx1-/- MCs. Moreover, opening of Panx1 Chs in Panx1 transfected HeLa cells increased dye uptake and ATP release but did not promote Ca2+ influx, confirming that Panx1 Chs permeable to ATP are not permeable to Ca2+. These data strongly suggest that during antigen recognition, Panx1 Chs contribute to the sustained Ca2+ signal increase via release of ATP that activates P2 receptors, playing a critical role in the sequential events that leads to degranulation response during Type I hypersensitivity reactions.

Dead Tumor Cells Expressing Infectious Salmon Anemia Virus Fusogenic Protein Favor Antigen Cross-Priming In Vitro.

Antigen cross-presentation is a crucial step in the assembly of an antitumor immune response leading to activation of naïve CD8 T cells. This process has been extensively used in clinical trials, in which dendritic cells generated in vitro are loaded with tumor antigens and then autotransplanted to the patients. Recently, the use of autologous transplant of dendritic cells fused with dying tumor cells has demonstrated good results in clinical studies. In this work, we generated a similar process in vivo by treating mice with dead tumor cells [cell bodies (CBs)] expressing the fusogenic protein of the infectious salmon anemia virus (ISAV). ISAV fusion protein retains its fusogenic capability when is expressed on mammalian cells in vitro and the CBs expressing it facilitates DCs maturation, antigen transfer by antigen-presenting cells, and increase cross-presentation by DCs in vitro. Additionally, we observed in the melanoma model that CBs with or without ISAV fusion protein reduce tumor growth in prophylactic treatment; however, only ISAV expressing CBs showed an increase CD4 and CD8 cells in spleen. Overall, our results suggest that CBs could be used as a complement with other type of strategies to amplify antitumor immune response.

Anti-aggressive effect elicited by coca-paste in isolation-induced aggression of male rats: influence of accumbal dopamine and cortical serotonin.

Coca-paste (CP), an illicit drug of abuse, has been frequently associated with aggressive and impulsive behaviors in humans. However, preclinical studies have not been carried out in order to characterize CP effects on aggression. The acute effect of CP, cocaine and caffeine (the main adulterant present in seized samples) on aggression was assessed using the isolation-induced aggression paradigm in male rats. The dopaminergic (DA) neurotransmission in the nucleus accumbens (NAcc) and serotonergic (5-HT) activity in the frontal cortex were explored. CP and cocaine induced a similar anti-aggressive effect on isolated rats although CP-treated animals showed a shorter latency to the first attack. Aggressive behavior was not increased per se by caffeine. Social investigation time was slightly reduced only by cocaine while exploratory activity and time spent walking were increased by the three drugs. Accumbal DA levels were significantly augmented by CP, cocaine and caffeine, although differences in DOPAC and HVA levels were evidenced. A decrease in DA turnover was only observed after CP and cocaine administration. Increased cortical 5-HT levels with a concomitant decrease in 5-HT turnover were observed after CP and cocaine whereas caffeine did not alter it. As cocaine but not caffeine reduced aggression, it seems like cocaine content was mainly responsible for CP anti-aggressive action; however, the presence of caffeine in CP may have a role in the shorter latency to attack compared to cocaine. Despite the increase in NAcc DA, the enhancement of cortical 5-HT levels can likely underlie the anti-aggression observed in CP-treated animals.

Polymyxin B increases the depletion of T regulatory cell induced by purinergic agonist.

Regulatory T cells (Treg) are important in the development of immune tolerance under normal physiological conditions. However, in pathological situations such as cancer, Treg increases have been correlated with bad prognoses. Treg depletion can be achieved in vitro under several stimuli, including the activation of the purinergic P2X7 receptor. Our aim was to determine whether polymyxin B (PMB), which is a positive modulator of this receptor, could affect mice Treg depletion by ATP and related compounds. For that purpose, we evaluated by flow cytometry changes in Treg populations under several treatments with PMB and/or purinergic agonists and antagonists. We found that both ATP and NAD induce a dose-dependent decrease on the Treg CD4+ CD25+ population. PMB not only potentiated the effect of exogenous ATP and NAD, but also decreased the CD4+ CD25+ population when it was applied alone. While ATP mediated effects are related to the P2X7 receptor, PMB effects appear to be related to another mechanism. We conclude that PMB positively modulates the depletion of the CD4+ CD25+ population of Treg. Therefore PMB could constitute a non-canonical drug with potential use on Treg depletion and cancer treatment.

Visión intercultural de conocimientos, actitudes y prácticas sobre alimentación ancestral mapuche en una escuela con programa oficial / Intercultural vision of knowledge, attitudes and practices concerning ancestral mapuche food in a school with an official program

Al decir interculturalidad se hace referencia a la interacción comunicativa que se produce entre dos o más grupos humanos de diferentes culturas. En el presente trabajo se ahonda sobre la interacción entre cultura occidental y cultura mapuche, a la articulación entre modernidad y tradiciones ancestrales. El propósito fue describir desde una perspectiva intercultural los conocimientos, actitudes y prácticas actuales sobre alimentación tradicional mapuche, en la Comunidad educativa de la Escuela Provincial Nº 89 de Epuyén, Provincia de Chubut, Argentina. Se realizó un estudio cualitativo, descriptivo, transversal. Participaron 67 niños/as mapuche y no mapuche de cuarto, quinto y sexto grado, 12 madres, 2 directivos, 3 docentes y 3 no docentes, seleccionados todos de manera intencional. Los datos sobre conocimientos, actitudes, prácticas y modos de transmisión respecto a la alimentación tradicional mapuche se obtuvieron mediante la combinación de técnicas: observación participante, grupos focales, entrevistas semiestructuradas y actividades didácticas. El análisis y tratamiento de datos se determinó por el método de comparación constante, hasta obtener saturación teórica. La heterogeneidad cultural, mapuche y no mapuche en un mismo espacio, y un sistema educativo no intercultural son las principales características de la escuela. En la comunidad educativa se evidencia el sentimiento deno pertenencia a la etnia; abandono del modelo de crianza, educativo y organizacional; diferencias de conocimientos, prácticas y transmisión del saber-hacer alimentario tradicional. A pesar de esto, la identidad perdura yse apoya en su último bastión para reelaborarse: los apellidos. Esta realidad heterogénea se homogeniza en las actitudes de reactivación, recuperación, revalorización y protección de la alimentación ancestral mapuche, como reafirmación de una identidad que por tantos años fue acallada.(AU)

Visión intercultural de conocimientos, actitudes y prácticas sobre alimentación ancestral mapuche en una escuela con programa oficial / Intercultural vision of knowledge, attitudes and practices concerning ancestral mapuche food in a school with an official program

Al decir interculturalidad se hace referencia a la interacción comunicativa que se produce entre dos o más grupos humanos de diferentes culturas. En el presente trabajo se ahonda sobre la interacción entre cultura occidental y cultura mapuche, a la articulación entre modernidad y tradiciones ancestrales. El propósito fue describir desde una perspectiva intercultural los conocimientos, actitudes y prácticas actuales sobre alimentación tradicional mapuche, en la Comunidad educativa de la Escuela Provincial Nº 89 de Epuyén, Provincia de Chubut, Argentina. Se realizó un estudio cualitativo, descriptivo, transversal. Participaron 67 niños/as mapuche y no mapuche de cuarto, quinto y sexto grado, 12 madres, 2 directivos, 3 docentes y 3 no docentes, seleccionados todos de manera intencional. Los datos sobre conocimientos, actitudes, prácticas y modos de transmisión respecto a la alimentación tradicional mapuche se obtuvieron mediante la combinación de técnicas: observación participante, grupos focales, entrevistas semiestructuradas y actividades didácticas. El análisis y tratamiento de datos se determinó por el método de comparación constante, hasta obtener saturación teórica. La heterogeneidad cultural, mapuche y no mapuche en un mismo espacio, y un sistema educativo no intercultural son las principales características de la escuela. En la comunidad educativa se evidencia el sentimiento deno pertenencia a la etnia; abandono del modelo de crianza, educativo y organizacional; diferencias de conocimientos, prácticas y transmisión del saber-hacer alimentario tradicional. A pesar de esto, la identidad perdura yse apoya en su último bastión para reelaborarse: los apellidos. Esta realidad heterogénea se homogeniza en las actitudes de reactivación, recuperación, revalorización y protección de la alimentación ancestral mapuche, como reafirmación de una identidad que por tantos años fue acallada.

Visión intercultural de conocimientos, actitudes y prácticas sobre alimentación ancestral mapuche en una escuela con programa oficial / Intercultural vision of knowledge, attitudes and practices concerning ancestral mapuche food in a school with an official program

Al decir interculturalidad se hace referencia a la interacción comunicativa que se produce entre dos o más grupos humanos de diferentes culturas. En el presente trabajo se ahonda sobre la interacción entre cultura occidental y cultura mapuche, a la articulación entre modernidad y tradiciones ancestrales. El propósito fue describir desde una perspectiva intercultural los conocimientos, actitudes y prácticas actuales sobre alimentación tradicional mapuche, en la Comunidad educativa de la Escuela Provincial Nº 89 de Epuyén, Provincia de Chubut, Argentina. Se realizó un estudio cualitativo, descriptivo, transversal. Participaron 67 niños/as mapuche y no mapuche de cuarto, quinto y sexto grado, 12 madres, 2 directivos, 3 docentes y 3 no docentes, seleccionados todos de manera intencional. Los datos sobre conocimientos, actitudes, prácticas y modos de transmisión respecto a la alimentación tradicional mapuche se obtuvieron mediante la combinación de técnicas: observación participante, grupos focales, entrevistas semiestructuradas y actividades didácticas. El análisis y tratamiento de datos se determinó por el método de comparación constante, hasta obtener saturación teórica. La heterogeneidad cultural, mapuche y no mapuche en un mismo espacio, y un sistema educativo no intercultural son las principales características de la escuela. En la comunidad educativa se evidencia el sentimiento deno pertenencia a la etnia; abandono del modelo de crianza, educativo y organizacional; diferencias de conocimientos, prácticas y transmisión del saber-hacer alimentario tradicional. A pesar de esto, la identidad perdura yse apoya en su último bastión para reelaborarse: los apellidos. Esta realidad heterogénea se homogeniza en las actitudes de reactivación, recuperación, revalorización y protección de la alimentación ancestral mapuche, como reafirmación de una identidad que por tantos años fue acallada.(AU)

Mucosectomía rectal con engrapadora sola y combinada con otros procedimientos quirúrgicos anorrectales: análisis multivariado de los factores que afectan el resultado clínico / Stapled rectal mucosectomy alone and in combination with other surgical anorectal procedures: multivariate analysis of factors affecting clinical outcome

Objetivo: Comparar el resultado clínico de la mucosectomía rectal con engrapadora (MRE) sola y de la MRE combinada con esfinterotomía y con plastia anal de colgajos cutáneos, y examinar qué factores influyen sobre las complicaciones y la satisfacción del paciente. Material y métodos: Se incluyeron pacientes con enfermedad hemorroidal grados II a IV sometidos a MRE sola o en combinación con otros procedimientos. Se analizaron las complicaciones posoperatorias, resolución de síntomas y grado de satisfacción. Resultados: 241 pacientes consecutivos con seguimiento mínimo de un año se dividieron en tres grupos: MRE sola (n = 187), MRE combinada con esfinterotomía (n = 31) y MRE combinada con plastia de colgajos (n = 23). Los pacientes con MRE con esfinterotomía presentaron un porcentaje de complicaciones mayor que el resto (32 versus 12.8 % y 13 %, respectivamente, p = 0.02). La MRE con esfinterotomía se asoció con mayor riesgo de complicaciones que la MRE sola (RM = 3.5, IC 95 % = 1.4-8.7); la inclusión exclusiva de epitelio columnar en la zona resecada se asoció con menor riesgo de complicaciones que cuando se incluyó además epitelio transicional (RM = 0.4, IC 95 % = 0.2-0.8). La resolución de síntomas preoperatorios en la mayor parte de los pacientes fue > 80 % en los tres grupos. No hubo asociación de complicaciones o del tipo de procedimiento con el grado de satisfacción. Cuando el porcentaje de síntomas resueltos fue < 80 % se asoció con grado bajo o intermedio de satisfacción (p < 0.001). Conclusiones: La resolución de los síntomas preoperatorios con los tres procedimientos es similar. La MRE con esfinterotomía tiene mayor riesgo de complicaciones. El grado de satisfacción se asocia con la resolución de los síntomas preoperatorios.

BACKGROUND: We undertook this study to compare the clinical outcome of stapled rectal mucosectomy (SRM) alone and in combination with sphincterotomy and cutaneous flap anoplasty and to determine the influence of factors related to complications and patient satisfaction. METHODS: Patients with second- to fourth-degree hemorrhoids who underwent SRM alone or in combination with other anorectal procedures were included. Postoperative complications, symptom resolution and patient satisfaction were analyzed. RESULTS: Two hundred forty one patients with a minimum follow-up of 1 year were divided into three groups: SRM alone (n = 187), SRM combined with sphincterotomy (n = 31) and SRM combined with cutaneous flap anoplasty (n = 23). Patients with SRM with sphincterotomy showed a higher complication rate than the other groups (32 vs. 12.8% and 13%, respectively, p = 0.02). SRM combined with sphincterotomy was associated with a higher rate of complications (OR = 3.5; 95% CI = 1.4-8.7). SRM alone with low mucosal resection was associated with a lower complications rate (OR = 0.4, 95% CI = 0.2-0.8). Resolution of preoperative symptoms was >80% among the three groups. There was no association between complications and type of procedure with satisfaction level. Resolution of symptoms <80% was associated with low/intermediate level of satisfaction (p <0.001). CONCLUSIONS: Resolution of preoperative symptoms is similar among the three groups. SRM combined with sphincterotomy has a higher risk of complications. The satisfaction level is associated with resolution of preoperative symptoms.

Stapled rectal mucosectomy alone and in combination with other surgical anorectal procedures: multivariate analysis of factors affecting clinical outcome.

BACKGROUND: We undertook this study to compare the clinical outcome of stapled rectal mucosectomy (SRM) alone and in combination with sphincterotomy and cutaneous flap anoplasty and to determine the influence of factors related to complications and patient satisfaction. METHODS: Patients with second- to fourth-degree hemorrhoids who underwent SRM alone or in combination with other anorectal procedures were included. Postoperative complications, symptom resolution and patient satisfaction were analyzed. RESULTS: Two hundred forty one patients with a minimum follow-up of 1 year were divided into three groups: SRM alone (n = 187), SRM combined with sphincterotomy (n = 31) and SRM combined with cutaneous flap anoplasty (n = 23). Patients with SRM with sphincterotomy showed a higher complication rate than the other groups (32 vs. 12.8% and 13%, respectively, p = 0.02). SRM combined with sphincterotomy was associated with a higher rate of complications (OR = 3.5; 95% CI = 1.4-8.7). SRM alone with low mucosal resection was associated with a lower complications rate (OR = 0.4, 95% CI = 0.2-0.8). Resolution of preoperative symptoms was >80% among the three groups. There was no association between complications and type of procedure with satisfaction level. Resolution of symptoms <80% was associated with low/intermediate level of satisfaction (p <0.001). CONCLUSIONS: Resolution of preoperative symptoms is similar among the three groups. SRM combined with sphincterotomy has a higher risk of complications. The satisfaction level is associated with resolution of preoperative symptoms.

The social construction of anemia in school shelters for indigenous children in Mexico.

Indigenous children in school shelters in Mexico suffer from anemia in spite of food that is subsidized, prepared, and served to them. Economically and biomedically centered strategies to reduce anemia have achieved only partial and short-term success. An interdisciplinary team investigated the food security system of the school shelters and collected data through interviews and participant observation. The analysis revealed that the children's nutrition depends on a frail chain of events in which a single link's failure can lead to nutritional insecurity. The authors conclude that the social actors involved in the process are mainly considering the economic aspects of nutrition, but anemia persists as a social construction of the faulty relationship between the institution that runs the shelters and the indigenous culture. The authors make suggestions for an intervention that empowers the community by involving it actively in solving the problem.

Prospective study of factors affecting postoperative pain and symptom persistence after stapled rectal mucosectomy for hemorrhoids: a need for preservation of squamous epithelium.

PURPOSE The purpose of the study was to determine the variables associated with postoperative pain and the clinical response of patients with uncomplicated hemorrhoidal disease treated with stapled rectal mucosectomy in the medium term. METHODS Patients with Grade II to IV, uncomplicated hemorrhoidal disease who underwent stapled rectal mucosectomy were prospectively included. The basal characteristics of the population were evaluated and level of stapling and placement of hemostatic suture determined. Histologically, the type of resected epithelium and presence of muscle fibers was evaluated. Postoperative pain was evaluated by means of a visual analog scale. Complications and clinical response were evaluated. RESULTS One hundred patients with a mean age of 43.9 years were included. Only columnar epithelium was resected in 48, transitional epithelium in 47, and squamous epithelium in 5 patients. Smooth muscle fragments were found in 55 patients, and, in 12 of these, fibers from the external muscular layer of rectum were also seen. Follow-up was 12.6 +/- 3.4 (range, 7-24) months. A total of 79 patients were completely asymptomatic at the end of follow-up. Resected squamous epithelium was associated with a higher postoperative pain level in the multivariate analysis (coefficient beta = 1.16 (95 percent confidence interval, 0.08-2.24); P = 0.035). CONCLUSIONS Rectal mucosectomy with stapler is an effective method for the treatment of uncomplicated prolapsing hemorrhoidal disease. Intensity of postoperative pain was associated with the type of resected epithelium. This suggests that low transection of hemorrhoids must be avoided.

Anorexia nerviosa: estudio clínico-fenomenológico de siete casos / Anorexia nervosa: clinical and phenomenological study of 7 cases

La anorexia nerviosa es un importante problema de salud. Estimaciones de la tasa de morbilidad y mortalidad fluctúan entre el 4 por ciento y el 18 por ciento. Esta enfermedad es más frecuente en mujeres y la edad de comienzo es la adolescencia. Se estudiaron 7 pacientes que cumplían los criterios diagnósticos del ICD-9 utilizando el método clínico fenomenológico. Se describen los fenómenos y las características psicopatológicas comunes a todas estas pacientes y su actitud frente a la enfermedad son reportados en este estudio. Los hallazgos sugieren que la anorexia nerviosa es una entidad clínica psiquiátrica con sus propios hechos psicopatológicos, las que claramente difieren de otros desórdenes psiquiátricos que presentan perturbación del apetito y disminución del peso corporal. Finalmente, nuestra impresión clínica es que las pacientes con anorexia nerviosa desarrollan inicialmente su hábito alimenticio por una necesidad de obtener una imagen corporal ideal la que posteriormente daría paso a una búsqueda permanente de la sensación de bienestar, la que alcanzan pero es inestable y frágil