Pembrolizumab in combination with gemcitabine for patients with HER2-negative advanced breast cancer: GEICAM/2015-04 (PANGEA-Breast) study.

BACKGROUND: We evaluated a new chemoimmunotherapy combination based on the anti-PD1 monoclonal antibody pembrolizumab and the pyrimidine antimetabolite gemcitabine in HER2- advanced breast cancer (ABC) patients previously treated in the advanced setting, in order to explore a potential synergism that could eventually obtain long term benefit in these patients. METHODS: HER2-negative ABC patients received 21-day cycles of pembrolizumab 200 mg (day 1) and gemcitabine (days 1 and 8). A run-in-phase (6 + 6 design) was planned with two dose levels (DL) of gemcitabine (1,250 mg/m2 [DL0]; 1,000 mg/m2 [DL1]) to determine the recommended phase II dose (RP2D). The primary objective was objective response rate (ORR). Tumor infiltrating lymphocytes (TILs) density and PD-L1 expression in tumors and myeloid-derived suppressor cells (MDSCs) levels in peripheral blood were analyzed. RESULTS: Fourteen patients were treated with DL0, resulting in RP2D. Thirty-six patients were evaluated during the first stage of Simon's design. Recruitment was stopped as statistical assumptions were not met. The median age was 52; 21 (58%) patients had triple-negative disease, 28 (78%) visceral involvement, and 27 (75%) ≥ 2 metastatic locations. Progression disease was observed in 29 patients. ORR was 15% (95% CI, 5-32). Eight patients were treated ≥ 6 months before progression. Fourteen patients reported grade ≥ 3 treatment-related adverse events. Due to the small sample size, we did not find any clear association between immune tumor biomarkers and treatment efficacy that could identify a subgroup with higher probability of response or better survival. However, patients that experienced a clinical benefit showed decreased MDSCs levels in peripheral blood along the treatment. CONCLUSION: Pembrolizumab 200 mg and gemcitabine 1,250 mg/m2 were considered as RP2D. The objective of ORR was not met; however, 22% patients were on treatment for ≥ 6 months. ABC patients that could benefit of chemoimmunotherapy strategies must be carefully selected by robust and validated biomarkers. In our heavily pretreated population, TILs, PD-L1 expression and MDSCs levels could not identify a subgroup of patients for whom the combination of gemcitabine and pembrolizumab would induce long term benefit. TRIAL REGISTRATION: ClinicalTrials.gov and EudraCT (NCT03025880 and 2016-001,779-54, respectively). Registration dates: 20/01/2017 and 18/11/2016, respectively.

Prevalence of three Mycoplasma sp. by multiplex PCR in cattle with and without respiratory disease in central Mexico.

This study aimed to identify Mycoplasma bovis, Myc. dispar, and Myc. bovirhinis, which are involved in bovine respiratory disease through a multiplex PCR as an alternative to culture's features that hamper Mycoplasma isolation. Nasal swabs were taken from 335 cattle with and without respiratory disease background (RDB) from dairy herds in the central region of Mexico. Each sample was divided in two; the first part was processed for the direct DNA extraction of the nasal swab and the second for Mycoplasma isolation, culture, and then the multiplex PCR was performed. In the nasal swabs, Myc. bovis was identified in 21.1%; Myc. dispar, in 11.8%; and Myc. bovirhinis, in 10.8% in cattle with RDB. Isolates were identified as Myc. bovis, 20.1%; Myc. dispar, 11.8%; and Myc. bovirhinis, 6.1%. There is a strong correlation between the presence of Mycoplasma identified by PCR and the clinical history of the disease (ρ < 0.0000). In animals without RDB, Myc. bovirhinis was the only species detected in 6.1% of the samples processed directly for multiplex PCR, and in 2% of the isolates. There is an excellent correlation (kappa 0.803) between the isolation and the 16S PCR and a high correlation (kappa 0.75) between the isolation and the multiplex PCR. Therefore, we conclude that the PCR multiplex test is highly sensitive and may be used for the diagnosis and surveillance of the three species in biological samples and mycoplasma isolates.

First-generation BNT162b2 and AZD1222 vaccines protect from COVID-19 pneumonia during the Omicron variant emergence.

OBJECTIVE: This study aimed to identify factors predicting pneumonia in adults with coronavirus disease 2019 (COVID-19) during the Omicron variant (B.1.1.529) emergence. We also evaluated, in fully vaccinated (BNT162b2 or AZD1222) individuals, if the time (<6 or ≥6 months) elapsed since the last shot was received was associated with the risk of severe illness. STUDY DESIGN: A retrospective cohort study was conducted in Mexico. METHODS: Data from 409,493 were analyzed, and risk ratios (RRs) and 95% confidence intervals (CIs) were computed through generalized linear models. RESULTS: We documented a total of 3513 COVID-19 pneumonia cases (69.5 per 100,000 person-days). In multiple analyses, a protective effect was observed in vaccinated adults (RR = 0.996, 95% CI 0.995-0.997). Male gender, increasing age, and smoking were associated with a greater risk of pneumonia. Individuals with chronic comorbidities (pulmonary obstructive disease, type 2 diabetes mellitus, arterial hypertension, kidney disease, and immunosuppression) were also at higher risk. Among fully vaccinated subjects (n = 166,869), those who had received the last shot at 6 more months were at increased risk for developing pneumonia (RR = 1.002, 95% CI 1.001-1.003). CONCLUSIONS: Our results suggest that the first-generation BNT162b2 and AZD1222 vaccines reduce the risk of COVID-19 pneumonia during the Omicron emergence. We also found that adults with longer interval from the administration of the second shot to illness onset were at increased risk of severe manifestations.

Decreased risk of COVID-19 pneumonia in children and adolescents during the Delta variant emergence.

OBJECTIVES: This study aimed to evaluate factors associated with the risk of COVID-19 pneumonia in children (aged <10 years) and adolescents (aged 10-19 years) before (March 2020-April 2021) and during (May-July 2021) the Delta (B.1.617.2) variant emergence. STUDY DESIGN: A retrospective and nationwide cohort study was conducted in Mexico. METHODS: Data from 26,961 laboratory-confirmed cases of COVID-19 were analyzed. Risk ratios (RRs) and 95% confidence intervals (CIs) were used to evaluate the association of the evaluated exposures with the risk of COVID-19 pneumonia. RESULTS: The overall incidence rate of pneumonia was 23.0 per 10,000 person-days, and it was lower during the Delta variant emergence (30.3 vs. 9.4 person-days, p < 0.001). In multiple analysis, a decreased risk of pneumonia was observed among those cases occurring in May 2021 or later (vs. March 2020-April 2021, RR = 0.98, 95% CI 0.97-0.99) and among older patients (RRper year = 0.998, 95% CI 0.996-0.998). Other comorbidities (namely, obesity, chronic kidney disease, diabetes mellitus, immunosuppression, or malignant tumors) were associated with an increased risk of severe COVID-19 manifestations. CONCLUSIONS: Our findings suggest that during the Delta variant emergence, children and adolescent patients were at reduced risk of COVID-19 pneumonia in Mexico. Further research is needed to identify factors determining the observed scenario.

Planning for the unexpected: Strategies for maintaining a robust clinical trial program.

During our entire history, Puerto Rico has suffered from being in the path of Hurricanes. The implications of these events during the conduction of clinical trials present a great challenge. On September 20, 2017 Puerto Rico suffered its most devastating hurricane in decades. We identified four main challenges faced as a result of the natural disaster: infrastructure damage, shortage of basic necessities, transportation difficulties and communication failure. By assessing the needs of each participant, we were able to aid with food, water and medicine. Protocols were resumed shortly after the disaster, participants were located and transportation to the research center was arranged for participants. Development of emergency plans within research protocols, allocation of emergency budgets, including transportation and communication costs, may overcome some of the challenges created by a natural disaster.

Myeloid Sarcomas Causing Unilateral Cranial Nerve Palsies in a Patient with Relapsed Acute Myeloblastic Leukemia.

Myeloid sarcomas (MS) are a rare manifestation of myeloid malignancies and can often be misdiagnosed, leading to a delay in treatment. The objective of this clinical case is to highlight the challenges of the clinical presentation and to emphasize the importance of this manifestation ensuring timely diagnosis and therapy. Here, we present a 43-year-old man who was diagnosed with acute myeloblastic leukemia (AML) after being evaluated for unintentional weight loss, subcutaneous nodules, thrombocytopenia, and anemia. The patient underwent chemotherapy with complete remission and presented 4 months later with dysphagia and cranial nerve palsies. Appropriate imaging and biopsy led to a diagnosis of myeloid sarcoma, and a decision was made to begin reinduction chemotherapy for AML achieving a second complete remission although his neurological deficits did not improve. Our case illustrates the protean presentation of myeloid sarcomas; clinicians should have a high suspicion for MS and remain vigilant when unexplained signs and symptoms arise in the background of a myeloid malignancy although challenges still remain when presentation is de novo. Advancements in understanding the pathophysiology of MS have been performed but remain not completely understood. High clinical suspicion, appropriate imaging, biopsy techniques, and expertise are paramount for timely diagnosis and treatment.

A Phase IIa Trial of Metformin for Colorectal Cancer Risk Reduction among Individuals with History of Colorectal Adenomas and Elevated Body Mass Index.

Obesity is associated with risk of colorectal adenoma (CRA) and colorectal cancer. The signaling pathway activated by metformin (LKB1/AMPK/mTOR) is implicated in tumor suppression in ApcMin/+ mice via metformin-induced reduction in polyp burden, increased ratio of pAMPK/AMPK, decreased pmTOR/mTOR ratio, and decreased pS6Ser235/S6Ser235 ratio in polyps. We hypothesized that metformin would affect colorectal tissue S6Ser235 among obese patients with recent history of CRA. A phase IIa clinical biomarker trial was conducted via the U.S. National Cancer Institute-Chemoprevention Consortium. Nondiabetic, obese subjects (BMI ≥30) ages 35 to 80 with recent history of CRA were included. Subjects received 12 weeks of oral metformin 1,000 mg twice every day. Rectal mucosa biopsies were obtained at baseline and end-of-treatment (EOT) endoscopy. Tissue S6Ser235 and Ki-67 immunostaining were analyzed in a blinded fashion using Histo score (Hscore) analysis. Among 32 eligible subjects, the mean baseline BMI was 34.9. Comparing EOT to baseline tissue S6Ser235 by IHC, no significant differences were observed. Mean (SD) Hscore at baseline was 1.1 (0.57) and 1.1 (0.51) at EOT; median Hscore change was 0.034 (P = 0.77). Similarly, Ki-67 levels were unaffected by the intervention. The adverse events were consistent with metformin's known side-effect profile. Among obese patients with CRA, 12 weeks of oral metformin does not reduce rectal mucosa pS6 or Ki-67 levels. Further research is needed to determine what effects metformin has on the target tissue of origin as metformin continues to be pursued as a colorectal cancer chemopreventive agent.

Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis. / Enucleación bilateral por panoftalmitis endógena polimicrobiana fulminante.

The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.

[Effectiveness of a brief educational intervention relating to the correct use of inhalers on the prevention of exacerbation in patients suffering from chronic obstructive pulmonary disease]. / Eficacia de una intervención educativa breve sobre el correcto uso de los inhaladores en la prevención de agudizaciones en pacientes con enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To predict the effect of a brief educational intervention aimed at improving the inhaler technique on the reduction of exacerbations in patients with COPD over a year. MATHERIAL AND METHODS: A triple blind, randomised controlled clinical trial with parallel design. INCLUSION CRITERIA: to be between 40-75 years, having been diagnosed with COPD, and being on treatment with inhalers. A total of 97 patients were randomly selected. They were randomly assigned into 2groups according to their functional severity measured with spirometry. Intervention group: evaluation of the inhalation technique. Their mistakes were corrected using a brief educational intervention. Reinforcement visits were made in the second and seventh month. CONTROL GROUP: evaluation of the inhalation technique. No educational intervention was made. After 1 year of follow-up, the number of exacerbations in each group was checked. VARIABLES MEASURED: social and demographic, study, dyspnoea level, body-mass index, tobacco use, FEV1, FEV1/FVC, COPD stage, BODEX index, number, type, and inhaler technique, number of previous exacerbations. Bayesian inference analysis was performed using logistic regression models. RESULTS: A total of 56 patients were assigned to de intervention group and 41 to the control one. There were 16 and 14 lost to follow-up, respectively. In the intervention group, 44.6% of the patients had an exacerbation, compared to the control group, with 56.1%. OR adjusted = 0.57 (95% CI: 0.22-1.22). Posterior probability OR < 1 = 93%. Exacerbations which required hospital admission had an OR = 0.21 (95% CI: 0.02-0.75) with posterior probability OR < 1= 99%. CONCLUSIONS: A brief educational technique is an effective method for reducing the number of exacerbations in patients with COPD.

Building two-dimensional metal-organic networks with tin.

We show that Sn atoms combined with organic ligands can be used to build 2D coordination networks on Au(111) surfaces.

Prevention of colonic neoplasia with polyethylene glycol: A short term randomized placebo-controlled double-blinded trial.

Chemoprevention represents an attractive modality against colorectal cancer (CRC) although widespread clinical implementation of promising agents (e.g. aspirin/NSAIDS) have been stymied by both suboptimal efficacy and concerns over toxicity. This highlights the need for better agents. Several groups, including our own, have reported that the over-the-counter laxative polyethylene glycol (PEG) has remarkable efficacy in rodent models of colon carcinogenesis. In this study, we undertook the first randomized human trial to address the role of PEG in prevention of human colonic neoplasia. This was a double-blind, placebo-controlled, three-arm trial where eligible subjects were randomized to 8g PEG-3350 (n = 27) or 17g PEG-3350 (n = 24), or placebo (n = 24; maltodextrin) orally for a duration of six months. Our initial primary endpoint was rectal aberrant crypt foci (ACF) but this was changed during protocol period to rectal mucosal epidermal growth factor receptor (EGFR). Of the 87 patients randomized, 48 completed study primary endpoints and rectal EGFR unchanged PEG treatment. Rectal ACF had a trend suggesting potentially reduction with PEG treatment (pre-post change 1.7 in placebo versus -0.3 in PEG 8+ 17g doses, p = 0.108). Other endpoints (proliferation, apoptosis, expression of SNAIL and E-cadherin), previously noted to be modulated in rodent models, appeared unchanged with PEG treatment in this clinical trial. We conclude that PEG was generally well tolerated with the trial failing to meet primary efficacy endpoints. However, rectal ACFs demonstrated a trend (albeit statistically insignificant) for suppression with PEG. Moreover, all molecular assays including EGFR were unaltered with PEG underscoring issues with lack of translatability of biomarkers from preclinical to clinical trials. This data may provide the impetus for future clinical trials on PEG using more robust biomarkers of chemoprevention. TRIAL REGISTRATION: ClinicalTrials.gov NCT00828984.

Ubiquitous deprotonation of terephthalic acid in the self-assembled phases on Cu(100).

We performed an exhaustive study of terephthalic acid (TPA) self-assembly on a Cu(100) surface, where first-layer molecules display two sequential phase transitions in the 200-400 K temperature range, corresponding to different stages of molecular deprotonation. We followed the chemical and structural changes by means of high-resolution X-ray photoelectron spectroscopy (XPS) and variable-temperature scanning tunneling microscopy (STM), which were interpreted on the basis of density functional theory (DFT) calculations and photoemission simulations. In order to reveal the spectroscopic contributions of the molecules in different states of deprotonation, we modified the substrate reactivity by deposition of a small amount of Sn, which hampers the deprotonation reaction. We found that the characteristic molecular ribbons of the TPA/Cu(100) α-phase at a low temperature contain a significant fraction of partially deprotonated molecules, in contrast to the expectation of a fully protonated phase, where the self-assembly was claimed to be simply driven by the intermolecular double hydrogen bonds [OHO]. On the basis of our simulations, we propose a model where the carboxylate groups of the partially deprotonated molecules form single hydrogen bonds with the carboxylic groups of the fully protonated molecules. Using real time XPS, we also monitored the kinetics of the deprotonation reaction. We show that the network of mixed single and double hydrogen bonds inhibits further deprotonation up to ∼270 K, whereas the isolated molecules display a much lower deprotonation barrier.

Differential humoral and cellular immunity induced by vaccination using plasmid DNA and protein recombinant expressing the NS3 protein of dengue virus type 3.

BACKGROUND: The dengue non-structural 3 (NS3) is a multifunctional protein, containing a serine-protease domain, located at the N-terminal portion, and helicase, NTPase and RTPase domains present in the C-terminal region. This protein is considered the main target for CD4+ and CD8+ T cell responses during dengue infection, which may be involved in protection. However, few studies have been undertaken evaluating the use of this protein as a protective antigen against dengue, as well as other flavivirus. In the present work we evaluated the potential of the NS3 (protease domain) as a protective antigen by comparing the administration of a recombinant protein versus a DNA vaccine in the mouse model. RESULTS: BALB/c mice were immunized with the recombinant protein NS3-DEN3 via intraperitoneal and with plasmid pcDNA3/NS3-DEN3 intramuscularly and the immune response was evaluated. The activity of T lymphocytes was analyzed by the MTT assay, and cells of mice immunized with the recombinant protein showed no activity when stimulated with the homologous protein. However, cells from mice immunized with DNA, responded to stimulation with the recombinant protein. When the expression (RT-PCR) and cytokine production (ELISA) was evaluated in the splenocytes, different behavior depending on the type of immunization was observed, splenocytes of mice immunized with the recombinant protein expressed cytokines such as IL-4, IL-10 and produced high concentrations of IL-1, IL-6 and TNFα. Splenocytes from mice immunized with DNA expressed IL-2 and IFNγ and did not produce IL-6. In addition, immunization with the recombinant protein induced the production of antibodies that are detected up to a dilution 1:3200 by ELISA and Western blot assays, however, the serum of mice immunized with DNA presented no detectable antibody titers. CONCLUSION: The results obtained in this study show that administration of pcDNA3/NS3-DEN3 induces a favorable response in the activation of T lymphocytes with low production of specific antibodies against NS3-DEN3.

[Diabetic retinopathy screening programme in primary health care. Diagnostic concordance between family and eye care practitioners]. / Cribado de retinopatía diabética en atención primaria. Concordancia diagnóstica entre médicos de familia y oftalmólogos.

AIM: To evaluate the diagnostic concordance in retinography interpretation between primary care and eye care practitioners and assess the soundness index of a diabetic retinography screening programme during its implementation stage. MATERIAL AND METHODS: Descriptive, observational study was conducted on a sample of 243 patients with diabetes mellitus (type 1 and 2) over age 14, in 2 urban health care centers, gathered in an opportunistic manner between the dates of 21/07/2011 and 26/01/2012. A 45° digital bilateral retinography, intraocular pressure and visual acuity were obtained from each patient. The primary care practitioners prepared a report for each patient, which was telematically sent to the eye care doctor within the corresponding retinographies. A new diagnostic report was prepared then by the eye care doctor after revising the images. The lack of retinographies and/or reports were considered both as losses. The diagnostic concordance between the observers and the validity and reliability from the screening programme were estimated. RESULTS: The kappa value obtained was 0.62 (95% CI 0.42-0.82) and 0.89 PABAK. The following validity indexes were obtained: Sensitivity 68.8%, specificity 96.5%, positive and negative predictive values: 61.1 and 97.5%, respectively. A percentage of 57.2 of the patients were not observed any pathology requiring referral to a eye care doctor. CONCLUSIONS: The concordance value obtained varied between considerable and almost perfect, depending on the index used for the analysis (kappa/PABAK, respectively). It's worth highlighting that carrying out retinographies in the primary care centers enhances patient-treatment capacity of the primary care doctors and the patients accessibility to screening.

HPV 16 and 18 viral loads are greater in patients with high-grade cervical epithelial lesions.

BACKGROUND: Cervical cancer is the second most common cancer in women worldwide. High-risk infection with HPV type 16 or type 18 is the most important risk factor associated with the development of cervical cancer. AIMS: To determine the viral load of HPV-16 and HPV-1 8 in samples from women with cervical epithelial lesion in the State of Colima, Mexico. MATERIALS AND METHODS: A cross-sectional analytic study was conducted that included 45 samples positive for HPV- 16 and 45 samples positive for HPV-1 8 from patients with cervical cancer or precursor lesion. Real time PCR was employed to determine the number of copies /101 cells. Viral load was determined in the two groups of patients and correlated with tumor grade. RESULTS: THe authors found that the HPV-1 6 viral load was greater than that of HPV-18 through a Mann-Whitney U analysis, resulting in ap = 0.000; as the malignancy of the cervical lesion progressed, the viral load increased, and HPV-16 showed a moderate positive association with an r = 0.509 and a p = 0.000, whereas HPV-18 showed a weak positive correlation with an r = 0.372 and a p = 0.0 12. CONCLUSIONS: The viral load of HPV-16 was greater than that of HPV-18. The HPV-16 viral load had a moderate positive association in relation to cervical lesion severity, whereas the viral load of HPV- 18 had a weak positive correlation with respect to the cervical lesion grade.

Loss of lipid material during the dehulling of oilseeds with different structural characteristics.

The loss of lipid material by migration to the hull during the dehulling of oilseeds with different structural characteristics was evaluated. The samples selected -three sunflower hybrids and a safflower cultivar- were processed under optimal dehulling operating conditions and with two passes through a dehuller. From the SEM micrographs of the samples it was possible to observe structural differences which affect the mechanical properties of the pericarps and, consequently, the dehulling process. The black-hull sunflower hybrid exhibited residual hull percentages lightly above those recommended by the industry after one pass through the dehuller, therefore, this hybrid should not be further processed to avoid oil losses due to migration to the hull. On the other hand, the safflower cultivar and the high stearic high oleic sunflower hybrid and the traditional striped-hull sunflower require two passes through the dehuller, but this resulted in an oil loss due to migration to the hull of over 0.9 % per gram of grains processed. These results suggest the need to reach 'compromise' decisions based on economic impact studies in the face of the variables that originate simultaneously both positive and negative effects.

Serum adiposity-induced biomarkers in obese and lean children with recently diagnosed autoimmune type 1 diabetes.

BACKGROUND/OBJECTIVE: Obesity increases the risk of cardiovascular disease and diabetic complications in type 1 diabetes. Adipokines, which regulate obesity-induced inflammation, may contribute to this association. We compared serum adipokines and inflammatory cytokines in obese and lean children with new-onset autoimmune type 1 diabetes. SUBJECTS AND METHODS: We prospectively studied 32 lean and 18 obese children (age range: 2-18 yr) with new-onset autoimmune type 1 diabetes and followed them for up to 2 yr. Serum adipokines [leptin, total and high molecular weight (HMW) adiponectin, omentin, resistin, chemerin, visfatin], cytokines [interferon (IFN)-gamma, interleukin (IL)-10, IL-12, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha] and C-reactive protein (CRP) were measured at a median of 7 wk after diagnosis (range: 3-16 wk). RESULTS: Lean children were 71.9% non-Hispanic White, 21.9% Hispanic, and 6.3% African-American, compared with 27.8, 55.6, and 16.7%, respectively, for obese children (p = 0.01). Compared with lean children, obese children had significantly higher serum leptin, visfatin, chemerin, TNF-alpha and CRP, and lower total adiponectin and omentin after adjustment for race/ethnicity and Tanner stage. African-American race was independently associated with higher leptin among youth ≥10 yr (p = 0.007). Leptin levels at onset positively correlated with hemoglobin A1c after 1-2 yr (p = 0.0001) independently of body mass index, race/ethnicity, and diabetes duration. Higher TNF-alpha was associated with obesity and female gender, after adjustment for race/ethnicity (p = 0.0003). CONCLUSION: Obese children with new-onset autoimmune type 1 diabetes have a proinflammatory profile of circulating adipokines and cytokines that may contribute to the development of cardiovascular disease and diabetic complications.

[Distal radius fracture: clinico-radiographic correlation after fixation with volar plate]. / Fractura de radio distal, correlación clínica-radiográfica posterior a fijación con placa volar.

UNLABELLED: The purpose of the study was to assess and correlate the clinical and radiographic results of patients with distal radius fracture treated with a volar approach and plate osteosynthesis thus identifying the factors that determine or contribute to functional results in these patients. METHODS: All patients who underwent surgical treatment for distal radius fracture with a volar approach and plate osteosynthesis from May 2010 to May 2011 were identified. They were radiographically assessed with measurements of the volar and radial angle and clinically with the Mayo Wrist Score; the correlation coefficient was used to obtain the results. RESULTS: A total of 35 patients met the selection criteria; 23 females and 12 males; mean age was 40 years (18-62); the right extremity was predominant (25:10) and was the dominant limb in 57% of cases. The assessment using the MWS was done at postoperative year one; mean score was 81 (50-100): 37% were excellent, 31% good, 26% satisfactory, and 6% poor. The correlation showed that the MWS-radial angle and the MWS-volar angle had statistically significant values with p values of 0.0001 and 0.0008 respectively, both with a 95% confidence interval. CONCLUSION: The clinical and radiographic correlation showed that the radial and volar angles are determining factors for a satisfactory course. Age, sex, the dominant limb, the number of days elapsed and the AO classification did not show statistically significant values for patient course.

Pathologic fracture of the distal tibia secondary to melanoma: A case report of a very rare entity.

Malignant melanoma is not a common cause of cancer metastasis to the skeleton, however, when melanoma does metastasize, one of the most common sites is the skeleton. In the literature, there are very few reports of bone metastasis and bone fracture from malignant melanoma, but they do clearly occur. When skeletal metastasis from malignant melanoma occurs, it is a sign of a very serious stage of the disease. We here present a case of a 39-year-old man with a history of ankle pain since an ankle sprain two months before, who was remitted to our unit with the diagnosis of pathological fracture of the distal tibia secondary to disseminated melanoma.

Cervical human papillomavirus infection in Mexican women with systemic lupus erythematosus or rheumatoid arthritis.

Cervical human papillomavirus (HPV+) infection is associated with an increased risk of cervical dysplasia. Although the frequency of HPV+ in systemic lupus erythematosus (SLE) has been investigated in some races its prevalence in Hispanic women is still unknown. This cross-sectional study evaluated the prevalence of cervical HPV+ in Mexican women with SLE (n = 34) or rheumatoid arthritis (RA) (n = 43) and in healthy controls (n = 146). These women were interviewed about risk factors for sexually transmitted infections and cervical cytology analysis was performed. HPV+ viral types were identified using PCR: HPV+ was observed in 14.7% of SLE, 27.9% of RA and 30.8% of controls. High-risk HPV types were observed in 11.7% of women with SLE, 27.9% of women with RA, and in 26% of the controls. High-risk viral types 58, 35 and 18 were the most frequently identified in SLE. Two women with SLE had a high-grade squamous intraepithelial lesion and one had cervical cancer. An association was observed between methotrexate utilization, longer duration of therapy with prednisone, and HPV+ in RA or SLE. Thus, there is a high prevalence of cervical HPV infection in Mexican women with SLE or RA, and physicians must be vigilant in preventing the development of cervical dysplasia.