Health Care Utilization by Patients With Chronic Pelvic Pain.

OBJECTIVE: To describe the patterns of health care utilization among patients with chronic pelvic pain. METHODS: Deidentified administrative claims data from the OptumLabs Data Warehouse were used. Adult female patients who had their first medical claim for chronic pelvic pain between January 1, 2016, and December 31, 2019, were included. Utilization was examined for 12 months after the index diagnosis. The greedy nearest neighbor matching method was used to identify a control group of individuals without chronic pelvic pain. Comparisons were made between those with and those without chronic pelvic pain using χ 2 tests for categorical data and Wilcoxon rank-sum tests for continuous data. RESULTS: In total, 18,400 patients were analyzed in the chronic pelvic pain cohort. Patients with chronic pelvic pain had a higher rate of chronic overlapping pain conditions. Patients with chronic pelvic pain had higher rates of health care utilization across all queried indices. They had more outpatient office visits; 55.5% had 10 or more office visits. Patients with chronic pelvic pain showed higher utilization of the emergency department (ED) (6.3 visits vs 1.9 visits; P <.001). Urine culture and pelvic ultrasonography were the most utilized tests. One-third of patients with chronic pelvic pain utilized physical therapy (PT), and 13% utilized psychological or behavioral therapy. Patients with chronic pelvic pain had higher rates of hysterectomy (8.9% vs 0.6%). The average total health care costs per patient with chronic pelvic pain per year was $12,254. CONCLUSION: Patients with chronic pelvic pain have higher rates of chronic overlapping pain conditions and undergo more ED visits, imaging tests, and hysterectomies than patients without chronic pelvic pain. Improving access to multidisciplinary care, increasing utilization of interventions such as PT and psychological or behavioral therapy, and reducing ED utilization may be possible targets to help reduce overall health care costs and improve patient care.

Beyond the surface: Does stage I-II endometriosis impact fertility? Exploring the challenges of mild disease.

Endometriosis is one of the most common gynecologic conditions that women face throughout their lives. Despite advances in technology, diagnosis and treatment of this relapsing and remitting condition is still challenging for many women. This review focuses on literature pertaining to minimal/mild (stage I/II) endometriosis and its impact on fertility. The effectiveness of medical interventions to improve infertility and obstetric outcomes in both natural and assisted reproductive technologies cycles remains debated. The recent ESHRE guidelines suggests that operative laparoscopy could be considered for rASRM stage I/II endometriosis as it improves ongoing pregnancy rates.

Navigating towards precision: evaluating the clinical value of non-invasive biomarkers for the diagnosis of endometriosis.

INTRODUCTION: Endometriosis is a chronic disease that affects millions of women worldwide, causing dysmenorrhea, chronic pain, and infertility, and has a significant impact on the healthcare system. Despite efforts to understand its pathogenesis, endometriosis is a disease with heterogeneous presentations and phenotypes which is manifested in part by the lack of a non-invasive biomarker available for its diagnosis. This review aims to bridge the gap between theory and practice by summarizing the most promising areas of study for developing a reliable biomarker or combination of biomarkers for the non-invasive diagnosis of endometriosis. EVIDENCE ACQUISITION: We conducted a comprehensive literature search using the electronic databases PubMed and MEDLINE. EVIDENCE SYNTHESIS: This review summarizes the potential biomarkers for endometriosis, including glycoproteins, inflammatory markers, immunologic markers, angiogenic cytokines, micro RNAs and the microbiome. Each of these biomarkers' role in the development and progression of endometriosis, and their diagnostic potential are discussed in detail. CONCLUSIONS: Endometriosis is a complex and underdiagnosed disease with significant health impact. The development of non-invasive biomarkers for its diagnosis would be immensely valuable, and promising research is being done in this area. While no single biomarker has yet emerged as a reliable diagnostic tool, this review highlights the potential of several biomarkers and the importance of continued research in this field. By improving the diagnosis of endometriosis, we can improve the lives of millions of women worldwide.

Thermal degradation of red cabbage (Brassica oleracea L. var. Capitata f. rubra) anthocyanins in a water model extract under accelerated shelf-life testing.

Red cabbage (RC) represents a source of anthocyanins acylated with hydroxycinnamic acids (HCA) that are described to enhance their stability. Nevertheless, data about their thermal degradation are still controversial. Our aim was to comprehensively analyse the degradation kinetics of individual RC anthocyanins in a model aqueous extract treated at 40 °C × 30 days to simulate severe but realistic storage conditions. Free anthocyanins and radical-scavenging capacity showed different kinetics. The results confirm the high stability of RC anthocyanins (t1/2: 16.4-18.4 days), although HPLC analyses of each molecule displayed distinct kinetics with t1/2 from 12.6 to 35.1 days. In particular, the sinapoyl acylation negatively affected the stability of the anthocyanins, while the forms monoacylated with glycosyl p-coumaric and ferulic acids exhibited higher stability. In conclusion, our results indicate that acylation is not a prerogative of stability, as this is instead more dependent on specific acylation patterns and the glycosylation of HCA.

Physical capacity tests as a complement in the evaluation of the level of disability in women with fibromyalgia: A cross-sectional study.

INTRODUCTION: The association between motor capacity and the level of disability in patients with fibromyalgia remains underexplored. This study aims to explore the association between physical capacity tests explored in the consultation and the level of disability in women with fibromyalgia. METHODS: There were 484 women diagnosed with fibromyalgia who were evaluated with 7 physical capacity tests: 10-m walk, 2-minute walk, 5-repetition getting up from a chair and sitting (G&S), 30-second chair stand, monopodal balance (right and left), and up-and-go. Functional performance was assessed with the Revised Fibromyalgia Impact Questionnaire (FIQR). Evaluation of the association between the physical capacity tests and the FIQR was initially performed using a principal component analysis (PCA). Subsequently, agglomerative hierarchical clustering (AHC) was performed in order to characterize groups of patients. RESULTS: Results show than FIQR and the tests 10-m walk, 2-minute walk, 5-repetition G&S, 30-second chair stand, and up-and-go test were correlated. The results of the AHC determined 3 groups of patients mainly on one motor dimension with significant differences in both the FIQR and the physical capacity tests retained in the PCA (P < 0.001 for all). CONCLUSION: The application of these physical tests is simple, fast and can be a complement to the FIQR questionnaire when determining the level of disability of patients with fibromyalgia, in addition to providing information on the evolution of the patients when these tests are administered in the clinical consultation.

MiRNAs in Hematopoiesis and Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia (ALL) is the most common kind of pediatric cancer. Although the cure rates in ALL have significantly increased in developed countries, still 15-20% of patients relapse, with even higher rates in developing countries. The role of non-coding RNA genes as microRNAs (miRNAs) has gained interest from researchers in regard to improving our knowledge of the molecular mechanisms underlying ALL development, as well as identifying biomarkers with clinical relevance. Despite the wide heterogeneity reveled in miRNA studies in ALL, consistent findings give us confidence that miRNAs could be useful to discriminate between leukemia linages, immunophenotypes, molecular groups, high-risk-for-relapse groups, and poor/good responders to chemotherapy. For instance, miR-125b has been associated with prognosis and chemoresistance in ALL, miR-21 has an oncogenic role in lymphoid malignancies, and the miR-181 family can act either as a oncomiR or tumor suppressor in several hematological malignancies. However, few of these studies have explored the molecular interplay between miRNAs and their targeted genes. This review aims to state the different ways in which miRNAs could be involved in ALL and their clinical implications.

Estimations of the number people with mental diseases associated with toxoplasmosis and identification of risk factors by continent.

Strong evidence exists based on metanalysis of the relationship between toxoplasmosis and many psychiatric diseases: schizophrenia, bipolar disorder, and suicidal behavior. Herein, we estimate the number of cases based on the attributable fraction due to toxoplasmosis on these diseases. The population attributable fraction of mental disease associated with toxoplasmosis was 20,4% for schizophrenia; 27,3% for bipolar disorder; and 0,29% for suicidal behavior (self-harm). The lower and upper estimated number of people with mental disease associated with toxoplasmosis was 4'816.491 and 5'564.407 for schizophrenia; 6'348.946 and 7'510.118,82 for bipolar disorder; and 24.310 and 28.151 for self-harm; for a global total lower estimated number of 11'189.748 and global total upper estimated number of 13'102.678 people with mental disease associated with toxoplasmosis for the year 2019. According to the prediction through the Bayesian model of risk factors for toxoplasmosis associated with mental disease, these varied in importance geographically; thus, in Africa, the most important risk factor was water contamination and in the European region, the cooking conditions of meats. Toxoplasmosis and mental health should be a research priority given the enormous potential impact of reducing this parasite in the general population.

Bibliometric analysis of main diseases due to exposure to altitude in the world / Análise bibliométrica das principais doenças decorrentes da exposição à altitude no mundo

Introduction: Around 140 million people in the world live-in high-altitude regions; however, there are few bibliometric studies. Objective: Describe the scientific production of the main diseases due to exposure to altitude in the world. Methods: Observational study, bibliometric type. After a systematic search in Scopus, original articles were included, whose main variable was mountain sickness, high-altitude cerebral edema and high-altitude pulmonary edema. Characteristics of each study were manually extracted and analyzed using descriptive statistics. Results: 2305 articles were found on mountain sickness (n=1531), high-altitude pulmonary edema (n=549) and high-altitude cerebral edema (n=225), respectively, in Scopus. Regarding the most influential journal was High Altitude Medicine and Biology in all three diseases, the country with the highest number of articles was the United States (458, 168 and 75), the most used language was English (91.31%, 85.33% and 84.19%), the author with the highest number of publications was Bartsh P. (2.94%, 18.60% and 3.42%) and most of the articles were open access (41.08%, 42.06% and 76.53%), respectively. Conclusion: The scientific production of original articles on mountain sickness, high-altitude pulmonary edema and high-altitude cerebral edema in Scopus has increased in recent years; however, it is still scarce compared to other diseases.

Introdução: Cerca de 140 milhões de pessoas no mundo vivem em regiões de grande altitude, porém, existem poucos estudos bibliométricos. Objetivo: Descrever a produção científica sobre as principais doenças decorrentes da exposição à altitude no mundo. Métodos: Estudo observacional, do tipo bibliométrico. Após busca sistemática no Scopus, foram incluídos artigos originais, cuja variável principal foi mal da montanha, edema cerebral de altitude e edema pulmonar de altitude. As características de cada estudo foram extraídas manualmente e analisadas por meio de estatística descritiva. Resultados: Foram encontrados 2.305 artigos sobre mal da montanha (n=1.531), edema pulmonar de altitude (n=549) e edema cerebral de altitude (n=225), respectivamente no Scopus. Em relação ao periódico mais influente foi High Altitude Medicine and Biology nas três doenças, o país com maior número de artigos foi os Estados Unidos (458, 168 e 75), o idioma mais utilizado foi o inglês (91,31%, 85,33% e 84,19%), o autor com maior número de publicações foi Bartsh P. (2,94%, 18,60% e 3,42%) e a maioria dos artigos foi de acesso aberto (41,08%, 42,06% e 76,53%), respectivamente. Conclusão: A produção científica de artigos originais sobre mal da montanha, edema pulmonar de altitude e edema cerebral de altitude em Scopus tem aumentado nos últimos anos, porém ainda é escassa em comparação com outras doenças

Endometriosis biomarkers of the disease: an update.

PURPOSE OF REVIEW: Endometriosis is a complex benign gynaecologic condition with heterogenous presentations and a large impact on the global healthcare system and on the quality of life for millions of women. Currently, the gold standard for diagnosis involves direct visualization of lesions during surgery confirmed by histopathological diagnosis, resulting in an average delay in its initial diagnosis of 8-10 years. Therefore, the search for noninvasive diagnostic testing options has been subject to a large body of research. RECENT FINDINGS: Multiple potential biomarkers have been explored for noninvasive testing for endometriosis, including glycoproteins, inflammatory cytokines, immunological molecules, angiogenesis markers, hormones, micro RNAs (miRNAs), proteomics, metabolomics, genomics and the microbiome. SUMMARY: Although there are challenges to consider, areas for real promise and advancement in the noninvasive diagnosis of endometriosis are currently being explored with real promise in the area of miRNAs, proteomics, metabolomics, genomics and the microbiome.

Historical Overview of the Only Neuro-Psycho-Pathology Center in the Democratic Republic of Congo.

The Neuro-Psycho-Pathology Center (NPPC) in the Democratic Republic of Congo is a 450-bed neuropsychiatric clinic that pioneered efforts to synergize various disciplines: neurology, neurosurgery, neuropsychiatry, and psychiatry. It serves the brain and behavioral health needs of Congolese patients, and at its peak, the NPPC was a major domestic neuropsychiatry center that averaged 320 admissions annually. Financial and resources shortages have curtailed its functions at 10% of its real capacity. Our report accounts the NPPC's early vision, and we also highlight the ongoing challenges faced by this institution.

Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis.

BACKGROUND: Neonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community. METHODS: We used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana. RESULTS: Compared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT). CONCLUSIONS: Using systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don't forgo prenatal care for fear of punitive consequences.

Hallazgos moleculares y citogenéticos en pacientes pediátricos, diagnosticados de leucemia linfoide aguda: Un estudio de centro único / Molecular and cytogenetic findings in pediatric patients diagnosed with acute lymphoid leukemia: A single center study / Achados moleculares e citogenéticos em pacientes pediátricos com diagnóstico de leucemia linfóide aguda: um estudo de centro único

Introducción: La leucemia linfoblástica aguda (LLA) es la neoplasia maligna de mayor frecuencia en la infancia; advertir sus alteraciones moleculares y citogenéticas permite establecer el riesgo, el pronóstico asociado y además plantear esquemas terapéuticos apropiados; el objetivo de este estudio es conocer la prevalencia de estas alteraciones en nuestra población. Metodología: Estudio de tipo retrospectivo y transversal, basado en los registros de las alteraciones moleculares y citogenéticas de los pacientes pediátricos diagnosticados con leucemia linfoblástica aguda durante el periodo comprendido entre enero 2014 a diciembre de 2018, en el Hospital del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo". Resultados: Se incluyeron 338 pacientes, de los cuales el principal grupo etario lo constituyo el de 0 a 4 años; el inmunofenotipo más observado fue el B-común. En el 24.56% de los casos se detectó altercaciones estructurales, principalmente por estudios de biología molecular; siendo la más común la translocación t(12;21). Se obtuvieron resultados por citogenética en 167 pacientes, en cuales la principal alteración numérica correspondió a la hiperdiploidía de entre 47 a 51 cromosomas. Conclusión: Los avances en la caracterización molecular y citogenética de la LLA, permiten mejorar la estratificación de su riesgo; y establecer estrategias terapéuticas que permitan una mejoría en la sobrevida.

Introduction: Acute lymphoblastic leukemia (ALL) is the most frequent malignant neoplasm in childhood; Noting its molecular and cytogenetic alterations allows to establish the risk, the associat-ed prognosis and also to propose appropriate therapeutic schemes; The objective of this study is to know the prevalence of these alterations in our population. Methods: Retrospective and cross-sectional study, based on the records of molecular and cytogenetic alterations of pediatric patients diagnosed with acute lymphoblastic leukemia during the period from January 2014 to December 2018, at the National Oncological Institute Hospital "Dr. Juan Tanca Marengo". Results: 338 patients were included, of which the main age group was made up of 0 to 4 years; the most observed immunophenotype was B-common. In 24.56% of the cases, structural alterations were detected, mainly by molecular biology studies; the most common being the t (12; 21) translocation. Cytogenetics results were obtained in 167 patients, in which the main numerical alteration corresponded to hyperdiploidy of between 47 and 51 chromosomes. Conclusions: Advances in the molecular and cytogenetic characterization of ALL make it possible to improve the stratification of its risk; and establish therapeutic strategies that achieve an improvement in survival.

Introdução: A leucemia linfoblástica aguda (LLA) é a neoplasia maligna mais comum na infância; Observar suas alterações moleculares e citogenéticas permite estabelecer o risco, o prognóstico associado e também propor esquemas terapêuticos adequados; O objetivo deste estudo é conhecer a prevalência dessas alterações em nossa população. Metodologia: Estudo retrospectivo e transversal, baseado nos registros de alterações moleculares e citogenéticas de pacientes pediátricos com diagnóstico de leucemia linfoblástica aguda no período de janeiro de 2014 a dezembro de 2018, no Hospital del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo ". Resultados: Foram incluídos 338 pacientes, cuja faixa etária principal era de 0 a 4 anos; o imunofenótipo mais observado foi B-comum. Em 24,56% dos casos, foram detectadas alterações estruturais, principalmente por estudos de biologia molecular; o mais comum é a translocação t (12; 21). Os resultados citogenéticos foram obtidos em 167 pacientes, nos quais a principal alteração numérica correspondeu à hiperdiploidia entre 47 e 51 cromossomos. Conclusão: Os avanços na caracterização molecular e citogenética da LLA permitiram melhorar a estratificação de risco; e estabelecer estratégias terapêuticas que permitam uma melhora na sobrevida.

Promising genes and variants to reduce chemotherapy adverse effects in acute lymphoblastic leukemia.

Almost two decades ago, the sequencing of the human genome and high throughput technologies came to revolutionize the clinical and therapeutic approaches of patients with complex human diseases. In acute lymphoblastic leukemia (ALL), the most frequent childhood malignancy, these technologies have enabled to characterize the genomic landscape of the disease and have significantly improved the survival rates of ALL patients. Despite this, adverse reactions from treatment such as toxicity, drug resistance and secondary tumors formation are still serious consequences of chemotherapy, and the main obstacles to reduce ALL-related mortality. It is well known that germline variants and somatic mutations in genes involved in drug metabolism impact the efficacy of drugs used in oncohematological diseases therapy. So far, a broader spectrum of clinically actionable alterations that seems to be crucial for the progression and treatment response have been identified. Although these results are promising, it is necessary to put this knowledge into the clinics to help physician make medical decisions and generate an impact in patients' health. This review summarizes the gene variants and clinically actionable mutations that modify the efficacy of antileukemic drugs. Therefore, knowing their genetic status before treatment is critical to reduce severe adverse effects, toxicities and life-threatening consequences in ALL patients.

Modified Starch as a Filter Controller in Water-Based Drilling Fluids.

Herein, the effectiveness of an itaconic acid (IA) graft copolymer on native corn starch (NCS) as a filter control agent in fresh water-based drilling fluids (WBDFs) was evaluated. The copolymer (S-g-IA_APS) was synthesized by conventional radical dispersion polymerization using the redox initiation system (NH4)2S2O8/NaHSO3. The modification of the starches was verified by volumetry, Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). Then, three WBDFs were formulated in which only the added polymer (NCS, S-g-IA_APS, and a commercial starch (CPS)) was varied to control the fluid losses. The physico-chemical, rheological, and filtering properties of the formulated systems were evaluated in terms of density (ρ), pH, plastic viscosity (µp), apparent viscosity (µa), yield point (Yp), gel strength (Rg), and filtrated volume (VAPI). In order to evaluate the resistance to temperature and contaminants of the WBDFs, they were subjected to high pressure and high temperature filtering (VHPHT). The filter control agents were also subjected to aging and contamination with cement and salt. The S-g-IA_APS addition improved the filtering behavior at a high pressure and temperature by 38%.

Caso Clínico: Lipoblastoma en un Lactante / Clinical Case: Lipoblastoma in an Infant

Introducción: El lipoblastoma es una neoplasia benigna de presentación infrecuente originada en el tejido adiposo, de presentación casi exclusiva en pacientes pediátricos antes de los tres años de edad, con predominio en el sexo masculino. Se localiza principalmente en las extremidades y tronco, como una tumoración indolora de crecimiento progresivo. El tratamiento de elección es quirúrgico y tiene pronóstico favorable. Las recidivas se presentan en los casos en los que la resección no pudo ser completa. Caso clínico: Lactante mujer de 7 meses de edad. Desde los tres meses de edadpresentó aumento progresivo del volumen de la extremidad inferior izquierda.Al examen físico se evidenciógran tumoraciónde 12 x 7 centímetrosque compromete la cara posterior del muslo izquierdo: Masa indolora y bien delimitada. Sin compromiso de la movilidad, sin edema de miembro. Taller diagnóstico: La Resonancia Magnética reportó unatumoración sólida de muslo izquierdo hiper-intensa en T1 y T2, hipo-intensa en STIR con septos finos en su interior, se extiende desde el musculo abductor magno del bíceps femoral y mide 11.2 x 7.9 x 8.4 cm en sus ejes longitudinal, anteroposterior y transversal respectivamente, desplazando y comprimiendo a los músculos semitendinoso, semimembranoso y gracilis. La paciente fue sometida a escisión completa y amplia de la masa, mediante abordaje posterolateral. Desenlace:Patología reportóun tumor constituido por tejido adiposo con tejido mixoide,sin atipia nuclear; se evidencia infiltración parcial del musculo esquelético adyacente, sin afectación de piel, sin necrosisy bordes quirúrgicos negativos para neoplasia. Inmunohistoquímica con marcador de proliferación celular KI-67 resultado positivo de 1%, y estudio de MDM2 (inhibidor de la activación transcripcional de p53) negativo; hallazgos compatibles con lipoblastoma. El estudio citogenético no fue realizado. Evolución: La paciente fue dada de alta al cuarto día post-operatorio sin complicaciones. Con una recuperación completa, en el quinto mes de seguimiento se realizónuevo estudio de resonancia magnética en la cual no se visualizan imágenes que sugieran tumor residual ni recidiva tumoral. Conclusión: El lipoblastoma debe ser tomada en cuenta como diagnóstico diferencial en niños con tumores de partes blandas, su tratamiento es eminentemente quirúrgico con un buen pronóstico si la extirpación es completa

Introduction: Lipoblastoma is an infrequent benign neoplasm originating in adipose tissue, presenting almost exclusively in pediatric patients before the age of three years, predominantly in males. It is located mainly on the limbs and trunk, as a painless, progressively growing tumor. The treatment of choice is surgical and has a favorable prognosis. Recurrences occur in cases in which the resection could not be complete. Clinical case: 7-month-old female infant. From the age of three months, he presented a progressive increase in the volume of the left lower limb. Physical examination revealed a large mass measuring 12 x 7 centimeters that involves the posterior aspect of the left thigh: a painless and well-defined mass. No compromise of mobility, no limb edema. Diagnostic workshop: Magnetic resonance imaging reported a hyper-intense solid tumor of the left thigh in T1 and T2, hypo-intense in STIR with fine septa inside it, extending from the abductor magnus muscle of the biceps femoris and measuring 11.2 x 7.9 x 8.4 cm in its longitudinal, anteroposterior and transverse axes respectively, displacing and compressing the semitendinosus, semimembranosus and gracilis muscles. The patient underwent a complete and wide excision of the mass using a posterolateral approach. Outcome: Pathology reported a tumor made up of adipose tissue with myxoid tissue, without nuclear atypia; partial infiltration of the adjacent skeletal muscle is evidenced, without skin involvement, without necrosis and negative surgical margins for neoplasia. Immunohistochemistry with a cell proliferation marker KI-67, a positive result of 1%, and a negative MDM2 study (inhibitor of transcriptional activation of p53); findings consistent with lipoblastoma. The cytogenetic study was not performed. Evolution:The patient was discharged on the fourth postoperative day without complications. With a complete recovery, in the fifth month of follow-up a new magnetic resonance study was performed in which no images that suggest residual tumor or tumor recurrence are visualized Conclusion: Lipoblastoma should be taken into account as a differential diagnosis in children with soft tissue tumors, its treatment is eminently surgicalwith a good prognosis if the removal is complete

Cdk5 phosphorylates CaV1.3 channels and regulates GABAA-mediated miniature inhibitory post-synaptic currents in striato-nigral terminals.

Neurotransmission is one of the most important processes in neuronal communication and depends largely on Ca2+ entering synaptic terminals through voltage-gated Ca2+ (CaV) channels. Although the contribution of L-type CaV channels in neurotransmission has not been unambiguously established, increasing evidence suggests a role for these proteins in noradrenaline, dopamine, and GABA release. Here we report the regulation of L-type channels by Cdk5, and its possible effect on GABA release in the substantia nigra pars reticulata (SNpr). Using patch-clamp electrophysiology, we show that Cdk5 inhibition by Olomoucine significantly increases current density through CaV1.3 (L-type) channels heterologously expressed in HEK293 cells. Likewise, in vitro phosphorylation showed that Cdk5 phosphorylates residue S1947 in the C-terminal region of the pore-forming subunit of CaV1.3 channels. Consistent with this, the mutation of serine into alanine (S1947A) prevented the regulation of Cdk5 on CaV1.3 channel activity. Our data also revealed that the inhibition of Cdk5 increased the frequency of high K+-evoked miniature inhibitory postsynaptic currents in rat SNpr neurons, acting on L-type channels. These results unveil a novel regulatory mechanism of GABA release in the SNpr that involves a direct action of Cdk5 on L-type channels.

Genetic variability of five ADRB2 polymorphisms among Mexican Amerindian ethnicities and the Mestizo population.

The Mexican population is characterized by high and particular admixture, and the picture of variants associated with disease remains unclear. Here we investigated the distribution of single nucleotide polymorphisms (SNPs) in the Mexican population. We focused on two non-synonymous and three synonymous SNPs in the beta-2 adrenergic receptor gene (ADRB2), which plays key roles in energy balance regulation. These SNPs were genotyped in 2,011 Mexican Amerindians (MAs) belonging to 62 ethnic groups and in 1,980 geographically matched Mexican Mestizos (MEZs). The frequency distribution of all five ADRB2 variants significantly differed between MAs, MEZs, and other continental populations (CPs) from the 1000 Genomes database. Allele frequencies of the three synonymous SNPs rs1042717A, rs1042718A, and rs1042719C were significantly higher in Mexican individuals, particularly among MAs, compared to in the other analyzed populations (P<0.05). The non-synonymous ADRB2 Glu27 allele (rs1042714G), which is associated with several common conditions, showed the lowest frequency in MAs (0.03) compared to other populations worldwide. Among MEZs, this allele showed a frequency of 0.15, intermediate between that in MAs and in Iberians (0.43). Moreover, Glu27 was the only SNP exhibiting a geographic gradient within the MEZ population (from 0.22 to 0.11), reflecting admixed mestizo ancestry across the country. Population differentiation analysis demonstrated that Glu27 had the highest FST value in MAs compared with Europeans (CEU) (0.71), and the lowest between MAs and Japanese (JPT) (0.01), even lower than that observed between MAs and MEZs (0.08). This analysis demonstrated the genetic diversity among Amerindian ethnicities, with the most extreme FST value (0.34) found between the Nahuatls from Morelos and the Seris. This is the first study of ADRB2 genetic variants among MA ethnicities. Our findings add to our understanding of the genetic contribution to variability in disease susceptibility in admixed populations.

Environmentally Friendly Fertilizers Based on Starch Superabsorbents.

Superabsorbents starches (SASs) were synthesized and characterized starting from native corn starch, bitter cassava and sweet cassava by graft copolymerization with itaconic acid. Additionally, their swelling behavior was studied both in water and in buffer solutions with different pHs and saline solutions. Their applicability was tested as environmentally friendly fertilizers in the absorption and release of urea, potassium nitrate and ammonium nitrate at different concentrations of fertilizers. The values of swelling at the equilibrium (H∞) in water and different media of the graft copolymers demonstrated their superabsorbent capacity, polyelectrolyte behavior, and smart response to environmental stimuli. The percentage of fertilizer absorbed and released from the SASs was a function of the initial concentration of the fertilizer in the medium. The loading and release of SASs were depended on the initial concentration of the fertilizer in the medium as well as the nature, structure, and morphology of the starch used.

Assessing the state of lean and six sigma practices in healthcare in Mexico.

PURPOSE: The purpose of this study is to assess the state at which lean and six sigma (LSS) are used as a management system to improve the national health system national health system of Mexico. DESIGN/METHODOLOGY/APPROACH: Cross-sectional survey-research. The survey was administered at 30 different hospitals across six states in Mexico. These were selected using convenience sampling and participants (N = 258) were selected through random/snowball sampling procedures, including from top managers down to front-line staff. FINDINGS: Only 16 per cent of respondents reported participation in LSS projects. Still, these implementations are limited to using isolated tools, mainly 5s, failure mode and effects analysis (FMEA) and Fishbone diagram, with the lack of training/knowledge and financial resources as the top disabling factors. Overall, LSS has not become systematic in daily management and operations. RESEARCH LIMITATIONS/IMPLICATIONS: The sampling procedure was by convenience; however, every attempt was made to ensure a lack of bias in the individual responses. If still there was a bias, it is conjectured that this would likely be in overestimating the penetration of LSS. PRACTICAL IMPLICATIONS: The penetration of LSS management practices into the Mexican health system is in its infancy, and the sustainability of current projects is jeopardized given the lack of systematic integration. Hence, LSS should be better spread and communicated across healthcare organizations in Mexico. ORIGINALITY/VALUE: This is the first research work that evaluates the use of LSS management practices in a Latin American country, and the first journal paper that focuses on LSS in healthcare in Mexico.