Transoral robotic surgery for squamous cell carcinoma of the oropharynx in a primarily human papillomavirus-negative patient population.

PURPOSE: Transoral robotic surgery (TORS) is one of the main treatment options for non-locally advanced primary oropharyngeal cancer in the United States. However, its use is more limited in countries with a low incidence of human papillomavirus (HPV), such as Spain, in patients with advanced disease, and as salvage surgery. To shed light on the use and potential benefit of TORS in Spanish patients, we analyzed the functional and oncologic outcomes of TORS as both primary and salvage surgery in a primarily HPV-negative population which is representative of oropharyngeal squamous cell carcinoma (OPSCC) patients in Spain. MATERIAL AND METHODS: This is a retrospective analysis of prospectively collected data on OPSCC patients treated with TORS at our center between February 2017 and February 2019. RESULTS: Fifty-four OPSCC patients were included; 79.6% were males and 80.5% were HPV negative. Median age was 62 years. Primary surgery was performed on 73.7% (48.1% stage I-II; 51.9% stage III-IV) and salvage surgery on 25.9% of patients. Positive margin rates were 4.3% for T1-2 and 25.8% for T3-4. None of the stage I-II patients and 27.7% of stage III-IV patients required adjuvant treatment. Reconstructive surgery was performed in 19.2% of all patients. Normal swallowing was achieved in 92.7% of patients at 6 months after surgery. 1- and 2-year survival rates for all patients were 94.5% and 89%, respectively. The overall complication rate was 16.1%. Bleeding occurred in 11.5% of patients. Longer hospitalization time was associated with surgical complications (P = 0.03) and reconstructive surgery (P = 0.03) but not with salvage surgery. CONCLUSION: TORS is a safe and effective treatment for HPV-negative T1-2 OPSCC patients. The positive margin rate was worse in T3-4 patients, indicating the need for careful patient selection in this subgroup.

Prevalencia de infecciones osteoarticulares por enterobacterias productoras de ß-lactamasas de espectro extendido / Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum ß-lactamases

Resumen: Introducción: Las infecciones por enterobacterias productoras de β-lactamasas de espectro extendido (BLEEs) ocasionan una gran carga a los sistemas de salud. Poco se conoce de las infecciones osteoarticulares, por lo que este trabajo estudió la prevalencia de estas infecciones en un hospital de tercer nivel. Material y métodos: Estudio de prevalencia en pacientes de un servicio de traumatología durante 2016, con criterios de infección proporcionados por el CDC de Atlanta, Georgia. Se utilizó el sistema VITEK® 2 AST-N272 (bioMérieux) para la identificación bacteriana a nivel de especie y para las pruebas de susceptibilidad antimicrobiana. Resultados: Se reportaron 7.85% (n = 86) con infecciones osteoarticulares; 22.09% (n = 19) fueron por enterobacterias BLEEs. Con un promedio de 77.1 días de hospitalización (DE 37.7) (46-200 días); el aislamiento del microorganismo se produjo 15 días posteriores al ingreso; 16 (84.2%) pacientes presentaron osteomielitis, tres (15.8%) tuvieron infección protésica de rodilla o cadera. El promedio de días de tratamiento fue de 60 días (21-129 días); 18 pacientes (94.7%) fueron dados de alta con resolución de su cuadro infeccioso; un paciente falleció con infección sobreagregada por neumonía debida a K. pneumoniae resistente a carbapenémicos. Discusión: La prevalencia de infecciones osteoarticulares por enterobacterias BLEEs no se pudo calcular con precisión, pero consideramos que se encuentra dentro de lo esperado, las medidas de control de infecciones requieren tener estándares más elevados y falta desarrollar programas de uso racional de antimicrobianos para controlar la aparición de estas patologías.

Abstract: Introduction: Infections of enterobacteria producing extended-spectrum ß-lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. Material and methods: Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. Results: 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. Discussion: The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.

[Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum -lactamases]. / Prevalencia de infecciones osteoarticulares por enterobacterias productoras de -lactamasas de espectro extendido.

INTRODUCTION: Infections of enterobacteria producing extended-spectrum -lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. MATERIAL AND METHODS: Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. RESULTS: 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. DISCUSSION: The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.

INTRODUCCIÓN: Las infecciones por enterobacterias productoras de -lactamasas de espectro extendido (BLEEs) ocasionan una gran carga a los sistemas de salud. Poco se conoce de las infecciones osteoarticulares, por lo que este trabajo estudió la prevalencia de estas infecciones en un hospital de tercer nivel. MATERIAL Y MÉTODOS: Estudio de prevalencia en pacientes de un servicio de traumatología durante 2016, con criterios de infección proporcionados por el CDC de Atlanta, Georgia. Se utilizó el sistema VITEK® 2 AST-N272 (bioMérieux) para la identificación bacteriana a nivel de especie y para las pruebas de susceptibilidad antimicrobiana. RESULTADOS: Se reportaron 7.85% (n = 86) con infecciones osteoarticulares; 22.09% (n = 19) fueron por enterobacterias BLEEs. Con un promedio de 77.1 días de hospitalización (DE 37.7) (46-200 días); el aislamiento del microorganismo se produjo 15 días posteriores al ingreso; 16 (84.2%) pacientes presentaron osteomielitis, tres (15.8%) tuvieron infección protésica de rodilla o cadera. El promedio de días de tratamiento fue de 60 días (21-129 días); 18 pacientes (94.7%) fueron dados de alta con resolución de su cuadro infeccioso; un paciente falleció con infección sobreagregada por neumonía debida a K. pneumoniae resistente a carbapenémicos. DISCUSIÓN: La prevalencia de infecciones osteoarticulares por enterobacterias BLEEs no se pudo calcular con precisión, pero consideramos que se encuentra dentro de lo esperado, las medidas de control de infecciones requieren tener estándares más elevados y falta desarrollar programas de uso racional de antimicrobianos para controlar la aparición de estas patologías.

Paternal line multigenerational passage of altered risk assessment behavior in female but not male rat offspring of mothers fed a low protein diet.

Maternal low protein (MLP) diets in pregnancy and lactation impair offspring brain development and modify offspring behavior. We hypothesized multigenerational passage of altered behavioral outcomes as has been demonstrated following other developmental programming challenges. We investigated potential multigenerational effects of MLP in rat pregnancy and/or lactation on offspring risk assessment behavior. Founder generation mothers (F0) ate 20% casein (C) or restricted (R) 10% casein diet, providing four groups: CC, RR, CR, and RC (first letter pregnancy, second letter lactation diet) to evaluate offspring (F1) effects influenced by MLP in F0. On postnatal day (PND 250), F1 males were mated to non-colony siblings producing F2. On PND 90, F2 females (in diestrous) and F2 males were tested in the elevated plus maze (EPM) and open field. Corticosterone was measured at PND 110. Female but not male CR and RC F2 made more entries and spent more time in EPM open arms than CC females. Overall activity was unchanged as observed in male F1 fathers. There were no open field differences in F2 of either sex, indicating that multigenerational MLP effects are due to altered risk assessment, not locomotion. MLP in pregnancy reduced F1 male and F2 female corticosterone. We conclude that MLP in pregnancy and/or lactation increases the innate tendency to explore novel environments in F2 females via the paternal linage, suggesting lower levels of caution and/or higher impulsiveness to explore unknown spaces. Further studies will be necessary to identify the epigenetic modifications in the germ line through the paternal linage.

Thrombotic dysfibrinogenemia. Fibrinogen "Caracas V" relation between very tight fibrin network and defective clot degradability.

Fibrinogen Caracas V is a thrombotic dysfibrinogenemia with an Aalpha 532 Ser-->Cys mutation characterized by a tight fibrin network formed of thin fibers responsible for a less porous clot than a normal one. In the present work, fibrinogen Caracas V is further characterized in order to understand the relationship between the structural defect and thrombophilia. This thrombotic disorder has been attributed to a tight fibrin network responsible for a decreased permeation of flow through the clot, leading to defective thrombus lysis due to a diminished availability of fibrinolytic enzymes to the inner fibrin surface. Correction of clot structure anomaly, by addition of dextran 40 to fibrinogen before clotting, induces an improvement in fibrin degradation that was attributed to an increase in porosity. The pulmonary embolism observed in this family has been related to an hyper rigidity of the clot, an anomaly that is also corrected by dextran. Furthermore, this abnormal fibrinogen binds more albumin than does normal fibrinogen, a phenomenon attributed to the mutation of serine in Aalpha-532 by cysteine. Therefore, this fibrinogen shows a striking similarity to the fibrinogen Dusart, allowing us to confirm that the alphaC-terminal part of fibrinogen plays an important role in fibrin structure, and to conclude that the anomaly of fibrin network observed in fibrinogen Caracas V is responsible for a deficient thrombus lysis.

Ensayo terapéutico con un preparado a base de propoleo propolisina en la giardiasis del humano

Se presentaron los resultados de un ensayo clínico con un preparado a base de propóleo (sustancia elaborada por las abejas) o "Propolisina", con el objeto de demostrar su efectividad como antigiardiásico. Se estudiaron 138 pacientes (48 niños y 90 adultos, en dos grupos) seleccionados aleatoriamente para ser tratados con "Propolisina" o un derivado imidazóilico (tinidazol). El método para el diagnóstico de certeza usado en los niños fue el aspirado duodenal, y en los adultos el frotis de mucosa duodenal, mediante la duodenoscopía. Se utilizaron estudios similares como critério de curación, realizados en un término menor de cinco días después de finalizado el tratamiento. La Propilisina se utilizó con diferentes concentraciones: en los niños -concentración al 10% -los resultados mostraron una curación de un 52%. En 40 adultos, con una concentración del 20%, se obtuvo una eficacia similar a la del Timidazol; al elevar la concentración de la Propolisina al 30% en los restantes 50 pacientes, hubo una mayor efectividad -60% de curación vs. 40% con el tinidazol-. Este trabajo demuestra la utilidad de este producto natural, de fácil obtención en Cuba y sin reacciones secundarias, en el tratamiento de este parasitismo intestinal, lo que resulta de gran trascendencia económica para nuestros pueblos

Ensayo terapéutico con un preparado a base de propoleo propolisina en la giardiasis del humano

Se presentaron los resultados de un ensayo clínico con un preparado a base de propóleo (sustancia elaborada por las abejas) o "Propolisina", con el objeto de demostrar su efectividad como antigiardiásico. Se estudiaron 138 pacientes (48 niños y 90 adultos, en dos grupos) seleccionados aleatoriamente para ser tratados con "Propolisina" o un derivado imidazóilico (tinidazol). El método para el diagnóstico de certeza usado en los niños fue el aspirado duodenal, y en los adultos el frotis de mucosa duodenal, mediante la duodenoscopía. Se utilizaron estudios similares como critério de curación, realizados en un término menor de cinco días después de finalizado el tratamiento. La Propilisina se utilizó con diferentes concentraciones: en los niños -concentración al 10% -los resultados mostraron una curación de un 52%. En 40 adultos, con una concentración del 20%, se obtuvo una eficacia similar a la del Timidazol; al elevar la concentración de la Propolisina al 30% en los restantes 50 pacientes, hubo una mayor efectividad -60% de curación vs. 40% con el tinidazol-. Este trabajo demuestra la utilidad de este producto natural, de fácil obtención en Cuba y sin reacciones secundarias, en el tratamiento de este parasitismo intestinal, lo que resulta de gran trascendencia económica para nuestros pueblos (AU)

[Clinical trial with a preparation based on propolis "propolisina" in human giardiasis]. / Ensayo terapéutico con un preparado a base de propóleo "propolisina" en la giardiasis del humano.

The results of a clinic assay with an extract made out of propolis (bee glue) or "Propolisina" were showed with the aim of showing its effectivity against giardiasis. One hundred and thirty eight patients were studied 48 children and 90 adults, in 2 groups and they selected aleatorily to be treated with "Propolosina" or an imidazole derivate (tinidazole). The method for an exact diagnosis in children was duodenal aspiration and in adults duodenal mucosa frotis by means of duodenoscopy. Similar studies were carried out as a cure criterium in a 5-day term after being through with the treatment. Propolisina was used with different concentrations: in children (concentration at 10%) results showed a 52% cure. In 40 adults (concentration at 20%) it was obtained a similar result to that of tinidazole; and when propolisina concentration was elevated at 30% in the remaining 50 patients there was a higher effectivity (60 of cure Vs 40% with tinidazole). This work shows the success of this natural product, which is very easy to obtain in Cuba and with no side effects in the treatment of this intestinal parasitism, what is of great economical importance for our countries.

Ensayo terapéutico con un preparado a base de propóleo [quot ]propolisina[quot ] en la giardiasis del humano. / [Clinical trial with a preparation based on propolis [quot ]propolisina[quot ] in human giardiasis]

The results of a clinic assay with an extract made out of propolis (bee glue) or [quot ]Propolisina[quot ] were showed with the aim of showing its effectivity against giardiasis. One hundred and thirty eight patients were studied 48 children and 90 adults, in 2 groups and they selected aleatorily to be treated with [quot ]Propolosina[quot ] or an imidazole derivate (tinidazole). The method for an exact diagnosis in children was duodenal aspiration and in adults duodenal mucosa frotis by means of duodenoscopy. Similar studies were carried out as a cure criterium in a 5-day term after being through with the treatment. Propolisina was used with different concentrations: in children (concentration at 10

) results showed a 52

cure. In 40 adults (concentration at 20

) it was obtained a similar result to that of tinidazole; and when propolisina concentration was elevated at 30

in the remaining 50 patients there was a higher effectivity (60 of cure Vs 40

with tinidazole). This work shows the success of this natural product, which is very easy to obtain in Cuba and with no side effects in the treatment of this intestinal parasitism, what is of great economical importance for our countries.