Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach.

BACKGROUND: Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. METHODS: This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. RESULTS: Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. CONCLUSIONS: The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.

Imported Hepatitis E Virus Genotype 1: A Rare Case of Acute Hepatitis Managed with Steroid Pulse Therapy.

A 26-year-old Indian man who had arrived in Japan 24 days prior presented to our hospital with abdominal pain and a fever. A blood test revealed marked hepatic dysfunction, and imaging tests confirmed a diagnosis of acute hepatitis. The patient's liver function and coagulability deteriorated, and his general condition was poor. Given the possibility of fulminant hepatic failure, we initiated steroid pulse therapy. Following the initiation of steroid therapy, the patient's liver function and subjective symptoms rapidly improved. Testing revealed positive findings for IgA-hepatitis E virus, and a genetic analysis of hepatitis E identified genotype 1, which is not endemic to Japan, leading to a definitive diagnosis of imported hepatitis E infection from India. The successful response to steroid therapy highlights the potential benefit of this approach in managing severe cases of acute hepatitis E, a rare occurrence in Japan. This case underscores the importance of considering hepatitis E infection in individuals with a recent travel history to regions with high prevalence and the potential benefits of steroid therapy in managing severe cases of acute hepatitis E.

Primary Peritonitis due to Group A Streptococcus Successfully Treated with Intraperitoneal Drainage.

A 42-year-old woman was admitted to our hospital because of lower abdominal pain and diarrhea. Although the initial symptoms and imaging findings were similar to those of acute enteritis, blood and ascites cultures led to the diagnosis of primary peritonitis caused by group A Streptococcus. In many cases, the disease rapidly deteriorates, and laparotomy is performed for the early diagnosis and to reduce the number of bacteria in the abdominal cavity. In the present case, intraperitoneal drainage was effective for avoiding surgery. We suggest that intraperitoneal drainage is effective for the treatment of this disease.

Real-world safety and effectiveness of pembrolizumab in Japanese patients with radically unresectable melanoma: An all-case postmarketing surveillance in Japan.

This all-case postmarketing surveillance (PMS) survey (101 centers; February 15, 2017, to March 3, 2020) captured factors that impact the safety and effectiveness of newly initiated pembrolizumab monotherapy for the treatment of radically unresectable melanoma in Japan. Eligible patients were enrolled both retrospectively and prospectively, and followed up at 1, 3, 6, and 12 months. Safety assessments included treatment-related adverse events (TRAEs), adverse events of special interest (AEOSIs) from the Japanese Risk Management Plan (J-AEOSIs), and J-AEOSIs related to pembrolizumab. Effectiveness assessments included objective response rate (ORR; complete response/partial response) and disease control rate (DCR) according to the RECIST criteria. Overall, 294 and 236 patients comprised the safety and effectiveness (RECIST) assessment sets, respectively. Median (range) age of the patients was 70 (22-94) years, and the majority (60.4%) received pembrolizumab as first-line therapy. The most common type of melanoma was cutaneous (41.5%), followed by mucosal (29.3%), acral (24.8%), and unknown (4.4%). Overall, 45.2% and 24.8% of patients experienced TRAEs and AEOSIs, respectively. In total, 24.8% and 9.2% of patients experienced any-grade and grade ≥3 pembrolizumab-related AEOSIs, respectively. The most common grade ≥3 pembrolizumab-related AEOSIs were endocrine disorders and liver dysfunction (2.4% each), followed by colitis/severe diarrhea (2.0%), interstitial lung disease (1%), and type 1 diabetes (0.7%). No grade 5 J-AEOSIs were observed. ORR was 16.5% at the 1-year follow-up: mucosal melanoma (20%), acral melanoma (10%), and cutaneous melanoma (17.5%). ORR was higher among patients who did not receive versus those who did receive previous systemic therapy across all three melanoma types. DCR was 52.1% at the 1-year follow-up: cutaneous melanoma (57.3%), acral melanoma (51.7%), and mucosal melanoma (43.1%). This all-case PMS survey confirmed the real-world safety and effectiveness of pembrolizumab monotherapy for the treatment of radically unresectable melanoma in Japan.

Clinicopathological features of PD-L1 protein expression, EBV positivity, and MSI status in patients with advanced gastric and esophagogastric junction adenocarcinoma in Japan.

This real-world study examined the prevalence of programmed death ligand-1 (PD-L1) expression and assessed the frequency of microsatellite instability-high (MSI-H) status and Epstein-Barr virus (EBV) positivity in Japanese patients with advanced gastric and gastroesophageal junction (GEJ) adenocarcinoma. This multicenter (5 sites), retrospective, observational study (November 2018-March 2019) evaluated Japanese patients with advanced gastric and GEJ adenocarcinoma after surgical resection (Stage II/III at initial diagnosis) or unresectable advanced cancer (Stage IV). The primary objectives were prevalence of PD-L1 expression (combined positive score [CPS] ≥1), MSI status, and EBV positivity. Tumor specimens of 389/391 patients were analyzed (male, 67.1%; mean age, 67.6 ± 12.2 years); 241/389 (62%) were PD-L1 positive, 24/379 (6.3%) had MSI-H tumors, and 13/389 (3.3%) were EBV positive. PD-L1 expression was higher in tumor-infiltrating immune cells than in tumor cells for lower CPS cutoffs. Among patients with MSI-H tumors and EBV-positive tumors, 19/24 (79.2%) and 9/13 (69.2%), respectively, were PD-L1 positive. A greater proportion of patients with MSI-H tumors (83.3% [20/24]) were PD-L1 positive than those with MSI-low/stable tumors (60.8% [216/355]; p = .0297); similarly, an association was observed between history of H pylori infection and PD-L1 expression. A higher proportion of patients with MSI-H tumors demonstrated PD-L1 expression with a CPS ≥10 (66.7% [16/24]) vs those with MSI-low/stable tumors (24.8% [88/355]; p < .0001). The prevalence of PD-L1 positivity among Japanese patients was comparable to that in previous pembrolizumab clinical trials and studies in gastric cancer. Particularly, higher PD-L1 expression was observed in MSI-H tumors.

The Contribution of Temporal Flat Lateral Position on the Mortality and Discharge Rates of Older Patients with Severe Dysphagia.

Severe dysphagia leads to mortality in older patients and hinders their discharge from hospitals. The temporal flat lateral position (TFLP) enables them to continuously eat, thus resolving the aforementioned issues. We aimed to explore the effect of TFLP on the mortality and discharge rates of older patients with severe dysphagia. This interventional study comprised a historical control of patients admitted to a rural community hospital from January 2019 to December 2020 and diagnosed with severe dysphagia. The primary outcomes included the mortality and the rate of discharge from the hospital. While the intervention group was treated with TFLP, the control group underwent no treatment. We selected 79 participants (intervention group = 26, control group = 53), with an average age of 87.9 years. The discharge rate was significantly higher in the intervention group than in the control group (57.7% vs. 26.4%, p = 0.012). The mortality rate was also significantly lower in the intervention group compared to the control group (34.6% vs. 71.7%, p = 0.003). TFLP can improve the discharge and mortality rates in community hospitals, thereby improving patient outcomes. Clinicians should focus on practical education and the implementation of TFLP in communities in order to promote it.

Inflammatory Pseudo-tumor of the Liver Accompanied by Eosinophilia.

A 28-year-old woman was referred to our hospital for liver dysfunction and neck pain. Blood tests revealed elevated liver enzymes and eosinophilia. Ultrasonography, computed tomography, and magnetic resonance imaging showed a mass lesion near the hepatic hilus. The tumor was considered to be an inflammatory pseudo-tumor or malignancy. A liver-mass biopsy was performed and led to a diagnosis of inflammatory pseudo-tumor. In the present case, a markedly elevated eosinophil count was a characteristic clinical feature, and the patient underwent steroid therapy. Treatment resulted in a reduced eosinophil count, improved neck symptoms, and disappearance of the inflammatory pseudo-tumor.

Late-onset type-2 autoimmune pancreatitis with two mass lesions diagnosed by endoscopic ultrasound-guided fine-needle aspiration.

A 65-year-old man with ulcerative colitis presented with aggravated diabetes. Computed tomography showed two masses in the body and tail of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed, with histopathological findings suggesting autoimmune pancreatitis (AIP). Type-2 AIP was suspected, and administration of prednisolone was initiated. The pancreatic masses had disappeared after the treatment. In this case, EUS-FNA was effective for the diagnosis of type-2 AIP. The two-lesion mass formation observed here is a rare presentation of the disease. In patients with a history of ulcerative colitis, the possibility of late-onset type-2 AIP should be kept in mind.

[Laparoscopic Gastrectomy for Gastric Cancer with Adachi Type â ¥ Vascular Anomaly-A Case Report].

We report a case of laparoscopic gastrectomy for gastric cancer with an anomalous celiac trunk categorized as Type Ⅵ- Group 24 in the Adachi classification. Upper gastrointestinal endoscopy in an 81-year-old male revealed a shallow depressed lesion in the middle of the gastric body. Close examination led to diagnosis of cT1bN0M0, cStage Ⅰ gastric cancer, and laparoscopic distal gastrectomy was planned. Contrast-enhanced CT revealed no anomalous bifurcation of the hepatic artery, but the common hepatic artery ran on the dorsal side of the portal vein, branching from the superior mesenteric artery. Therefore, an Adachi Type Ⅵ-Group 24 celiac trunk anomaly was diagnosed. During surgery, the common hepatic artery could not be confirmed in guiding suprapancreatic lymph node dissection, and the portal vein was exposed. Anterior to the portal vein, nerves that are usually around the common hepatic artery continuously ran toward the hepatoduodenal ligament instead. Suprapancreatic lymph nodes were dissected, with the portal vein considered as the common hepatic artery. Adachi Type Ⅵ is a rare anomaly with an incidence of about 2%. Preoperative diagnosis enables safe and appropriate lymph node dissection.

Cholecystitis with abdominal wall biloma after percutaneous transhepatic gallbladder aspiration: A case report.

BACKGROUND: Abdominal wall biloma is an uncommon entity. We herein report an extremely rare case of cholecystitis with abdominal wall biloma after percutaneous transhepatic gallbladder aspiration (PTGBA). PRESENTATION OF CASE: A 69-year-old woman was diagnosed with acute cholecystitis, and PTGBA was performed on Day 1. PTGBA was performed a second time because of re-expansion of the gallbladder and an increased CRP level on Day 3. Computed tomography was performed on Day 9 because we suspected recurrence of cholecystitis. It revealed a well-circumscribed fluid collection between the abdominal wall or the diaphragm and the liver. Based on these intraoperative findings, we diagnosed her with cholecystitis with abdominal wall biloma. Cholecystectomy and drainage of the abdominal wall biloma were performed on Day 10. The postoperative course was uneventful, and she was discharged on Day 18. DISCUSSION: Early cholecystectomy is the gold-standard treatment for acute cholecystitis, but cholecystectomy is not performed in some cases. PTGBA is much more convenient, quicker, and less costly, but inappropriate aspiration during the second PTGBA session might have spread the infected bile to the abdominal wall through the PTGBA route. CONCLUSION: This case represents the first reported case of a biloma within the abdominal wall after PTGBA. To prevent this complication, we should aspirate gallbladder bile sufficiently during PTGBA. In addition, we should consider performing alternative therapy, such as percutaneous transhepatic gallbladder drainage or an operation, when we fail to appropriately aspirate.

Exploring roles and capacity development of village midwives in Sudanese communities.

INTRODUCTION: Home birth remains a strong preference and village midwives are the only option for maternal and neonatal care for many rural women in Sudan. This study assessed whether interventions such as strengthening linkages among health facility/staff, skilled birth attendants and village midwives (VMWs); strengthening the supervision system; and strengthening the governance capacity of local health departments improved their service delivery, and it examined factors linked with improved performance of VMWs in their communities. METHODS: This descriptive study comprised a cross-sectional baseline survey, two intervention years and an endline survey. Data collection involved in-depth, semi-structured questionnaire interviews. Fifty-seven VMWs and 151 community women were targeted for the study in Sinnar, a south-eastern state of Sudan. Participants were interviewed about demographic information, perceptions of operational barriers, training provided, function in the community, supervision and referral for emergency cases. RESULTS: Results showed the monthly average number of VMW-assisted home births increased from 1.4 at the baseline survey in October 2011 to 3.3 at the endline survey in October 2013. The annual average number of emergency cases referred by VMWs increased from 1.6 to 3.5, and the percentage of VMWs using official monthly reports increased from 33% to 80%. VMWs reported improved bonds with their supervisors and relationships in the community. CONCLUSION: Improved service provision may be associated with development of supervision systems for VMWs, active provision of community activities, strengthened linkages between health facilities and VMWs and enhanced community trust of VMWs. Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in particular settings, international communities should focus on strengthening capacity of community midwives for home births as a realistic measure.

Septotomía endoscópica del divertículo de Zenker / Endoscopy septotomy in zenker diverticulum

Introducción: La Diverticulotomía o Septotomía endoscópica en el divertículo de Zenker, es una alternativa a otros abordajes terapéuticos. El presente estudio muestra nuestra experiencia de esta técnica endoscópica. Pacientes y Métodos: Análisis retrospectivo, entre el 2009 y 2017 en pacientes con divertículo de Zenker. La septotomía se realizó utilizando videoendoscopio flexible, esfinterótomo aguja, electrobisturi para DSE tipo Hibridknife, mediante una técnica ya estandarizada. Resultados: Se trataron 25 pacientes con edad promedio de 71 años (rango etario de 45 a 84 años). En una paciente su mejoría fue muy poca, por lo que se sometió a intervención quirúrgica, donde tampoco hubo resultados consistentes. Veintiún pacientes mostraron un alivio completo de la disfagia. Tres pacientes que tuvieron recurrencia sintomática fueron tratados con el mismo método endoscópico entre 2 y 4 sesiones evolucionando de forma satisfactoria. Conclusiones: La septotomía endoscópica del divertículo de Zenker es un método eficaz y seguro, por lo tanto representa una alternativa real a la cirugía.

Introduction: Diverticulotomy or Endoscopic septotomy in Zenker's diverticulum is an alternative to others therapeutics approaches. The present study shows our experience of this endoscopic technique. Patients and methods: Retrospective analysis between 2009 and 2017 in patients with Zenker's diverticulum. The procedure was performed using a flexible video endoscope and a needle knife, Erbe hybrid knife probe, using an already standardized technique. Results: Twenty-five patients with an average age of 71 years (age range 45-84 years) were treated. In one patient his improvement was very little, therefore surgical procedure was performed, nevertheless this procedure had not consistent results. Twenty-one patients showed complete relief of dysphagia. Three patients who had symptomatically relapsed were retreated with the same endoscopic method between 2 and 4 sessions with good results. Conclusions: Zenker's endoscopic septotomy of the diverticulum is an effective and safe method; thereby it represents a real alternative to surgical treatment.

Pleiotropic effects of sitagliptin versus voglibose in patients with type 2 diabetes inadequately controlled via diet and/or a single oral antihyperglycemic agent: a multicenter, randomized trial.

PURPOSE: A step-up strategy for diet therapy and/or single oral antihyperglycemic agent (OHA) regimens has not yet been established. The aim of this study was to evaluate hemoglobin A1c (HbA1c) as a primary end point, and the pleiotropic effects on metabolic and cardiovascular parameters as secondary end points, of sitagliptin versus voglibose in patients with type 2 diabetes with inadequate glycemic control while on diet therapy and/or treatment with a single OHA. METHODS: In this multicenter, randomized, open-label, parallel-group trial, a total of 260 patients with inadequately controlled type 2 diabetes (HbA1c levels >6.9%) were randomly assigned to receive either sitagliptin (50 mg, once daily) or voglibose (0.6 mg, thrice daily) for 12 weeks. The primary end point was HbA1c levels. RESULTS: Patients receiving sitagliptin showed a significantly greater decrease in HbA1c levels (-0.78±0.69%) compared with those receiving voglibose (-0.30±0.78%). Sitagliptin treatment also lowered serum alkaline phosphatase levels and increased serum creatinine, uric acid, cystatin-C and homeostasis model assessment-ß values. Voglibose increased low-density lipoprotein-cholesterol levels and altered serum levels of several fatty acids, and increased Δ-5 desaturase activity. Both drugs increased serum adiponectin. The incidence of adverse events (AEs) was significantly lower in the sitagliptin group, due to the decreased incidence of gastrointestinal AEs. CONCLUSIONS: Sitagliptin shows superior antihyperglycemic effects compared with voglibose as a first-line or second-line therapy. However, both agents possess unique pleiotropic effects that lead to reduced cardiovascular risk in Japanese people with type 2 diabetes. TRIAL REGISTRATION NUMBER: UMIN 000003503.

Laparoscopic Management of a Complex Adrenal Cyst.

Adrenal cysts are rare, and their clinical management remains controversial. We report a case involving an adrenal cyst with a complicated appearance on radiological studies. Unenhanced computed tomography revealed a unilocular, noncalcified, hypoattenuating mass with a thin wall in the left adrenal gland. The lesion gradually increased in size from 10 to 50 mm at two-year follow-up. On contrast-enhanced magnetic resonance imaging, a mural nodule with contrast enhancement was observed. The entire adrenal gland was excised en bloc via a lateral transperitoneal laparoscopic approach without violating the principles of surgical oncology. The pathological diagnosis was an adrenal pseudocyst. Laparoscopic adrenalectomy is a safe option for the treatment of complex adrenal cysts, while maintaining the benefits of minimal invasiveness.

Poliposis linfomatosa intestinal secundaria a: 1.1 linfoma no hodgkin inmunofenotipo celulas b:linfoma folicular primario. A propósito de un caso / SECONDARY INTESTINAL LYMPHOMATOUS PO- LYPOSIS IMMUNE CELLS B: PRIMARY FOLLICULAR LYMPHOMA NON-HODGKIN LYMPHOMA. A CASE PRESENTATION

Paciente femenino de 30 años de edad, con enfermedad actual de 7 meses de evolución, caracterizado por Astenia, adi- namia, palidez cutáneo mucosa, pérdida de peso 12 kg en el último mes y episodios de evacuaciones liquidas de 10 días de evolución en #15 veces al día en abundante cantidad, sin moco, ni sangre; también refería vómito #01 vez al día de contenido alimentario. Antecedentes personales, familiares y hábitos psicobiológicos: no contributorios. Exploración funcional: niega síntomas B. Examen físico positivo: Signos Vitales: normales, IMC: 17.2 kg/m2 leve palidez cutáneo-mucosa e hipotrofia muscular. Paraclínicos positivo: Anemia macrocítica e hipercrómica severa, sin alteración del recuento leucocitario, LDH: 1578 U/L y el resto de la química básica normal. Ultrasonido abdominal: normal. TAC de abdomen con doble contraste: esplenomegalia leve adenopatías retroperitoneales y mesentéricas de aspecto inespecífico, Endoscopia Digestiva Superior: poliposis duodenal. Enteroscopia: Poliposis Intestinal. Colonoscopia: normal. Biopsia e inmunohistoquimico: poliposis linfomatosa intestinal: linfoma no hodgking inmunofenotipo celulas B: linfoma folicular. Un tipo infrecuente de linfoma extranodal del estirpe celular B, infrecuente como forma de presentación de poliposis linfomatosa, con el que debemos que hacer diagnóstico diferencial con: 1.Linfoma del Manto 2. Hiperplasia Linfoide Folicular Reactiva 3. Pólipos Epiteliales 4. Compromiso secundario de linfoma folicular ganglionar.

Patient women 30 years of age, with 7 months of current disease, characterized by asthenia, adinamia, mucous skin pallor, loss of weight 12 kg in the last month, and episodes of evacuations liquid 10 days of evolution in #15 times a day in copious amounts, without mucus, or blood; also meant vomiting #01 time per day of food content. Personal history, family, and psychobiological habits: not contributorios. Functional exploration: denies symptoms B. positive physical examination: vital signs: normal BMI: 17.2 kg/m2 light pale mucosa and muscular hypotrophy. Positive paraclinical: anemia macrocytic e hyperchromic severe, without alteration of the Leukocyte count, LDH: 1578 u / and the rest of basic chemistry was normal. Abdominal ultrasound: normal. CT of abdomen with doublecontrast: splenomegaly mild retroperitoneal adenopathies and mesenteric nonspecific aspect, upper digestive endoscopy: duodenal polyposis. Enteroscopy: Intestinal polyposis. Colo- noscopy: normal. Biopsy and immunohistochemical: intestinal lymphomatous polyposis: Lymphoma non-Hodgkins immune b cells follicular lymphoma. An uncommon type of extranodal lymphoma cell line B, uncommon as a form of presentation of lymphomatous polyposis, that we have to make differential diagnosis with: 1. Mantle cell Lymphoma. 2. Reactive follicular Lymphoid Hyperplasia. 3. Epithelial polyp. 4. Nodal follicular Lymphoma secondary commitment.

Expresión de mucinas: MUC1, MUC2, MUC5AC, MUC6, HGM y CD10 en carcinomas gástricos y lesiones pre-neoplasicas adyacentes / MUCIN EXPRESSION: MUC1, MUC2, MUC5AC, MUC6, HGM AND CD10 IN GASTRIC CARCINOMAS AND ADJACENT PRE-NEOPLASTIC LESIONS

Introducción: Las mucinas son glicoproteínas y desempeñan funciones biológicas. Diversas anormalidades genéticas y epgenéticas han sido descritas en el cáncer gástrico. El objetivo de la investigación fue observar la inmuno-expresión de mucinas en cánceres difusos e intestinales y las lesiones pre-neoplásicas limítrofes. Métodos: Se evaluaron 18 cánceres difusos (56.3%) y 14 intestinales (43.7%) y las lesiones precursoras adyacentes al cáncer gástrico. Se realizó inmunohistoquímica para los siguientes marcadores: MUC-1, MUC-2, MUC5-AC, MUC-6, HGM y CD10. Resultados: La inmune-expresiones fue: MUC-1 (54.5%), de los cánceres intestinales y (45.5%) de los cánceres difusos. MUC-2 (50%) de los cánceres difusos y (50%) de los cánceres del tipo intestinal. MUC-5AC (39.3%) del tipo difuso (60.7%) del tipo intestinal. HGM (37.5%) del tipo intestinal y (62.5%) del tipo difuso. MUC-6 (57.9%) del tipo difuso (42.1%) los del tipo intestinal. CD10 (55.6%) del tipo intestinal, y (44.4%) en los difusos.En las lesiones pre- cursoras adyacentes al cáncer gástrico la MUC-1 se inmunoexpresa en metaplasia intestinal (9.7%). MUC-2 (83.9%) en metaplasia intestinal. MUC5-AC (90,6%) en foveolas MUC-6 (100%) positiva en glándulas. CD10 (54.8%) positiva en metaplasia intestinal.HGM (75%) en foveolas y el (64.5%) en metaplasia intestinal. MUC-6 (100%) en glándulas profundas y (64,5%) en metaplasia intestinal. Las dis- plasias expresaron MUC-2 y MUC-5AC, en el 80% y 100% respectivamente. Conclusiones: La inmunotipificación del cáncer gástrico permitirá una clasificación más exacta de los tumores asi como la identificación de posibles dianas terapéuticas y su relación con factores genético y epigeneticos.

Introduction: Mucins are glycoproteins and has diverse biological roles. Epi-genetic abnormalities have been described in gastric cancer. The aim of the research was evaluate immunoexpression of mucins in diffuse and intestinal cancers and pre-neoplastic lesions. Methods: We evaluated 18 diffuse cancers (56.3%) and 14 intestinal (43.7%) and adjacent precursor lesions to gastric cancer immunohistochemical markers used was MUC-1, MUC-2-AC MUC5, MUC-6, and CD10 HGM. Results: The immuno-expression was: MUC-1 (54.5%), and intestinal cancers (45.5%) diffuse cancers. MUC-2 (50%) and diffuse cancers (50%) of cancers of the intestinal type. MUC-5AC (39.3%) diffuse type (60.7%) of intestinal type.HGM (37.5%) intestinal type (62.5%) in diffuse type. MUC-6 (57.9%) diffuse type (42.1%) in the intestinal type. CD10 (55.6%) in intestinal type, and (44.4%) in the diffuse type In adjacent precursor lesions to gastric cancer we observed MUC-1 in intestinal metaplasia (9.7%). MUC-2 (83.9%) in intestinal metaplasia. MUC5-AC (90.6%) in foveolasMUC-6 (100%) positive glands. CD10 (54.8%) positive in intestinal.HGM metaplasia(75%) and in foveolae (64.5%) in metaplasia intestinal. MUC-6 (100%) deep glands (64.5%) in metaplasia.intestinal. Dys- plasias expressed MUC-2 and MUC-5AC, 80% and 100% respectively. Conclusions: The gastric cancer immunotyping allow more accurate classification of tumors and the identification of potential therapeutic targets and its relationship with genetic and epigenetic factors.

Prevalencia comparativa entre cáncer gástrico y colorrectal avanzado en una zona geográfica de alto riesgo / COMPARATIVE PREVALENCE BETWEEN ADVANCED GASTRIC CANCER AND COLORECTAL CANCER IN HIGH RISK POPULATION FOR GASTRIC CANCER

Introducción: Partiendo de las diferencias en las tasas de incidencia y mortalidad en cáncer gástrico (CG) y cáncer colorrectal (CCR) en el mundo, incluso en un mismo país, se comparó la prevalencia entre estos tumores, en una zona geográfica de alto riesgo. Materiales y métodos: Se realizó un estudio de prevalencia analítica incluyendo pacientes mayores de 18 años a quienes se les realizó endoscopia digestiva alta y colonoscopia, entre enero de 1996 y abril de 2015, que tuvieran diagnóstico endoscópico de cáncer, confirmación histológica de adenocarcinomas gástricos o colorrectales y que fueran tumores esporádicos. Resultados: De un total de 131.490 procedimientos endoscópicos (109.034 endos- copia digestiva superior y 22.456 colonoscopias). Se encontraron un total de 1982 cánceres, de los cuales 1562 eran CG (78.8%) y 420 eran CCR (21.2%). El CG fue más frecuente en hombres (68.75%) y el CCR en mujeres (51.43%), con edades promedio similar en ambos. Conclusión: En el presente trabajo se encontró que la relación de cáncer gástrico avanzado con respecto a cáncer colorrectal avanzado es de 4:1 respectivamente.

Introduction: Based on differences in the rates of incidence and mortality in gastric cancer (GC) and cancer colorrectal (CCR) in the world, even in the same country, compared the prevalence among these tumors, a geographical area of high risk. Materials and methods: an analytical prevalence study was conducted including patients over 18 years old who underwent upper endoscopy and colonoscopy, between January 1996 and April 2015, which had cancer, histological confirmation of adenocarcinomas of gastric or colorectal endoscopic diagnosis and which were sporadic tumors. Results: A total of 131.490 (109.034 upper digestive endoscopy and 22,456 colonoscopies) endoscopy procedures were performed. We met a total of 1982 cancers, of whom 1562 were CG (78.8 percent) and 420 were CCR (21.2%). The CG was more frequent in men (68.75%) and CRC in women (51.43%), with similar average ages in both. Conclusion: This study found that the advanced with respect to advanced colorectal cancer, gastric cancer ratio is 4:1 respectively.

Adenocarcinoma gástrico primario concomitante con tumor del estromal gastrointestinal (gist): reporte de dos casos / PRIMARY GASTRIC ADENOCARCINOMA CONCOMITANT WITH GASTROINTESTINAL STROMAL TUMOR (GIST):: EPORT OF TWO CASES

A nivel mundial, el cáncer gástrico (CG) es la segunda causa más frecuente de muerte por cáncer. Otros tipos histológicos como linfomas y sarcomas son menos frecuentes, resultando aún más infrecuente, el desarrollo sincrónico de un adenocarcinoma con un tumor del estromal gastrointestinal (GIST). En este trabajo se documentan dos casos de pacientes con Adenocarcinoma Gástrico concomitante con Tumor del Estroma Gastrointestinal, con diferente presentación clínica. El primero de ellos se trata de paciente femenino de 76 años de edad quien acude por síntomas dispépticos con Ca gástrico precoz IIc + III, la paciente se somete a gastrectomía subtotal radical y en la pieza quirúrgica adicionalmente se observa lesión elevada subepitelial en cuerpo con curva menor que mide 0,6 cm, al corte la lesión compromete la capa submucosa, tratándose de tumores sincrónicos con histogénesis diferente. Y el otro caso se trata de paciente femenino de 66 años de edad acude por pesquisa, con un tumor de colisión.

Worldwide, gastric cancer (GC) is the second most frequent cause of death by cancer. Other histological types as lympho- mas and sarcomas are less frequent, resulting even rarer, the synchronous development of adenocarcinoma with a tumor of the gastrointestinal stromal (GIST). In this work are documented two cases of patients with gastric Adenocarcinoma concomitant with Gastrointestinal stromal Tumor, with different clinical presentation. The first of these is 76-year-old female patient who goes by dyspeptic symptoms with early gastric Ca IIc + III, the patient undergoes radical subtotal gastrectomy and the surgical specimen additionally shows subepithelial elevated lesion on gastric body with lesser curvature measuring 0.6 cm, histopathological evaluation showed that the gastric cáncerinvasión was confined to thethe submucosal layer, case of synchronous tumours with different histogenesis. The other case is 66-year-old female patient who came to our gastric cáncer screening and we found a colission tumor in the stomach.

Renoprotective effects of atorvastatin compared with pravastatin on progression of early diabetic nephropathy.

INTRODUCTION: Several studies have shown that statins suppress the progression of diabetic nephropathy. However, few reports have directly compared the renoprotective effects between potent and conventional statins. MATERIALS AND METHODS: Patients with diabetic nephropathy, selected as those with a serum creatinine level of 0.9-1.5 mg/dL and simultaneously having either microalbuminuria or positive proteinuria, were randomly assigned to one of three groups: a conventional diet therapy group, a group given 10 mg of pravastatin and a group given 10 mg of atorvastatin. Renal function was evaluated before and after a 12-month period of therapy. RESULTS: The atorvastatin group had a significant decrease in low-density lipoprotein cholesterol at 3 months and thereafter compared with the other groups. The urinary albumin-to-creatinine ratio significantly decreased in the atorvastatin group; the degree of this decrease was significantly greater than that in the diet therapy group. The kidney function estimated with cystatin C (CysC) and the estimated glomerular filtration rate calculated from CysC were significantly preserved in the atorvastatin group compared with the pravastatin group. In a multivariate regression analysis, the use of atorvastatin was the only explanatory variable for the changes in CysC; this was independent of changes in low-density lipoprotein cholesterol. CONCLUSIONS: Atorvastatin is more effective than pravastatin for the prevention of increase in CysC, and this renoprotective effect was considered to a result of the pleiotropic effect of atorvastatin independent of its lipid-lowering effect. This study was registered with UMIN (no. UMIN 000001774).

Who possesses drug resistance genes in the aquatic environment?: sulfamethoxazole (SMX) resistance genes among the bacterial community in water environment of Metro-Manila, Philippines.

Recent evidence has shown that antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are ubiquitous in natural environments, including sites considered pristine. To understand the origin of ARGs and their dynamics, we must first define their actual presence in the natural bacterial assemblage. Here we found varying distribution profiles of sul genes in "colony forming bacterial assemblages" and "natural bacterial assemblages." Our monitoring for antibiotic contamination revealed that sulfamethoxazole (SMX) is a major contaminant in aquatic environments of Metro-Manila, which would have been derived from human and animal use, and subsequently decreased through the process of outflow from source to the sea. The SMX-resistant bacterial rate evaluated by the colony forming unit showed 10 to 86% of the total colony numbers showed higher rates from freshwater sites compared to marine sites. When sul genes were quantified by qPCR, colony-forming bacteria conveyed sul1 and sul2 genes in freshwater and seawater (10(-5)-10(-2) copy/16S) but not sul3. Among the natural bacterial assemblage, all sul1, sul2, and sul3 were detected (10(-5)-10(-3) copy/16S), whereas all sul genes were at an almost non-detectable level in the freshwater assemblage. This study suggests that sul1 and sul2 are main sul genes in culturable bacteria, whereas sul3 is conveyed by non-culturable bacteria in the sea. As a result marine bacteria possess sul1, sul2 and sul3 genes in the marine environment.