Abemaciclib, Palbociclib, and Ribociclib in Real-World Data: A Direct Comparison of First-Line Treatment for Endocrine-Receptor-Positive Metastatic Breast Cancer.

By the end of 2020, there were more than 8 million women alive who had received a breast cancer diagnosis in the previous 5 years, making it the most prevalent neoplasia in the world. About 70% of breast-cancer cases present positivity for estrogen and/or progesterone receptors and a lack of HER-2 overexpression. Endocrine therapy has traditionally been the standard of care for ER-positive and HER-2-negative metastatic breast cancer. In the last 8 years, the advent of CDK4/6 inhibitors has shown that adding them to endocrine therapy doubles PFS. As a result, this combination has become the gold standard in this setting. Three CDK4/6 inhibitors have been approved by the EMA and the FDA: abemaciclib, palbociclib, and ribociclib. They all have the same indications, and it is at each physician's discretion to choose one or the other. The aim of our study was to perform a comparative efficacy analysis of the three CDK4/6i using real-world data. We selected patients diagnosed with endocrine-receptor-positive and HER2-negative breast cancer who were treated with all three CDK4/6i as first-line therapy at a reference center. After 42 months of retrospective follow up, abemaciclib was associated with a significant benefit in terms of progression-free survival in endocrine-resistant patients and in the population without visceral involvement. In our real-world cohort, we found no other statistically significant differences among the three CDK4/6 inhibitors.

Profilaxis farmacológica para la prevención de la enfermedad tromboembólica en paciente con enfermedad cerebrovascular / Pharmacological prophylaxis for the prevention of thromboembolic disease in patients with cerebrovascular disease

INTRODUCCIÓN: La enfermedad cerebrovascular es un conjunto de alteraciones atribuidas a lesiones agudas y focales en el sistema nervioso central, en su mayoría secundaria a aterosclerosis DESARROLLO: En la prevención de la enfermedad cerebrovascular, existen dos grandes grupos farmacológicos, los antitromboticos y los anti plaquetarios, los cuales impactan en la calidad de vida de estos pacientes mejorando el pronóstico de los mismos. CONCLUSIONES: La enfermedad cerebrovascular comparte factores de riesgo de enfermedad tromboembólica, por lo que se recomienda iniciar profilaxis.

INTRODUCTION: Cerebrovascular disease is a group of alterations attributed to acute and focal lesions in the central nervous system, mostly secondary to atherosclerosis. DEVELOPMENT: In the prevention of cerebrovascular disease, there are two major pharmacological groups, antithrombotics and antiplatelet drugs. , which impact the quality of life of these patients, improving their prognosis. CONCLUSIONS: Cerebrovascular disease shares risk factors for thromboembolic disease, so it is recommended to start prophylaxis.

[Delayed administration of thrombolytic therapy in minor stroke]. / Retraso en la administración de tratamiento trombolítico en el ictus minor.

INTRODUCTION: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. PATIENTS AND METHODS: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. RESULTS: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. CONCLUSIONS: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.

TITLE: Retraso en la administración de tratamiento trombolítico en el ictus minor.Introducción. Se considera ictus minor a aquel que se presenta con escasos síntomas; sin embargo, hasta un 40% presenta discapacidad a largo plazo. La tasa de trombólisis en estos pacientes también es inferior a la del resto de ictus. En este estudio se pretende explorar si existen diferencias en los tiempos de atención en la trombólisis intravenosa en los pacientes con ictus minor. Material y métodos. Revisión retrospectiva de los ictus tratados con trombólisis intravenosa en nuestro centro y análisis comparativo de los tiempos de asistencia entre ictus minor y el resto. Resultados. Se encontraron tiempos más alargados en los casos de ictus minor en cuanto al tiempo puerta-tomografía computarizada y puerta-aguja. No fue así, sin embargo, para el tiempo desde el inicio de los síntomas hasta la llegada al hospital. Conclusiones. La presencia de escasos síntomas en el ictus minor puede hacer difícil su reconocimiento y podría ser un motivo de retraso en el tratamiento. La formación entre el personal que atiende a estos pacientes es fundamental para mejorar este aspecto.

Retraso en la administración de tratamiento trombolítico en el ictus minor / Delayed administration of thrombolytic therapy in minor stroke

Introducción: Se considera ictus minor a aquel que se presenta con escasos síntomas; sin embargo, hasta un 40% presenta discapacidad a largo plazo. La tasa de trombólisis en estos pacientes también es inferior a la del resto de ictus. En este estudio se pretende explorar si existen diferencias en los tiempos de atención en la trombólisis intravenosa en los pacientes con ictus minor. Material y métodos. Revisión retrospectiva de los ictus tratados con trombólisis intravenosa en nuestro centro y análisis comparativo de los tiempos de asistencia entre ictus minor y el resto. Resultados: Se encontraron tiempos más alargados en los casos de ictus minor en cuanto al tiempo puerta-tomografía computarizada y puerta-aguja. No fue así, sin embargo, para el tiempo desde el inicio de los síntomas hasta la llegada al hospital. Conclusiones: La presencia de escasos síntomas en el ictus minor puede hacer difícil su reconocimiento y podría ser un motivo de retraso en el tratamiento. La formación entre el personal que atiende a estos pacientes es fundamental para mejorar este aspecto.(AU)

Introduction: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. Patients and methods: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. Results: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. Conclusions: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.(AU)

Multiobjective control architecture to estimate optimal set points for user comfort and energy saving in buildings.

Temperature control in buildings is usually driven by energy conservation although the occupants' comfort is also important considering its impact on productivity and health. However, energy efficiency and comfort are opposing objectives and therefore this type of problem can be resolved by means of a multiobjective optimization approach. The simulations we carried out indicate that set points optimization has the potential to reduce energy consumption in the order of 10% while also providing a comfortable work environment for the occupants.

Neurosensory issues after lateralisation of the inferior alveolar nerve and simultaneous placement of osseointegrated implants.

Our aim was to evaluate neurosensory symptoms after lateralisation of the inferior alveolar nerve (IAN). We studied a retrospective case series with one-year follow up that included 139 procedures in 123 patients. After the IAN had been located it was deflected from the mandibular body and the implant placed. Sensitivity was mapped 24hours, one month, six months, and one year after the intervention by gently pressing the skin and lips with the tip of a probe. A total of 337 implants were placed in 123 patients aged between 44 and 68 years. There were 33 men and 90 women and they all recovered. The IAN was mobilised by one of two procedures, one that involves the nerve directly (transposition) and one that does not (lateralisation). During lateralisation the nerve is deflected laterally through a mandibular osteotomy, while the mental nerve and mental foramen are not manipulated. The resulting hypoaesthetic area was drawn on a graph to assess its extension. Although different techniques are available for placing implants in atrophic jaws, mobilisation of the IAN is indicated in certain cases in which other techniques are not feasible or have a high risk of complications.

Experiencia en el manejo de terapia ECMO como factor de riesgo de mortalidad / Experience in the management of ECMO therapy as a mortality risk factor

Introducción. La membrana de oxigenación extracorpórea (ECMO) es un sistema que proporciona asistencia circulatoria y respiratoria a pacientes en fallo cardiaco o respiratorio refractarios al tratamiento convencional. Es una terapia con numerosas complicaciones asociadas y alta mortalidad. El manejo por equipos multidisciplinares y con experiencia aumenta la probabilidad de supervivencia. Objetivos. Evaluar y analizar el efecto de la curva de aprendizaje sobre la mortalidad. Métodos. Estudio retrospectivo y observacional de 31 pacientes, realizado desde enero de 2012 hasta diciembre de 2015. Los pacientes se agruparon en 2periodos que están divididos por la instauración de un protocolo ECMO. Comparamos las variables cuantitativas realizando la prueba U de Mann-Whitney; para las variables cualitativas categóricas empleamos la prueba Chi-cuadrado o el estadístico exacto de Fisher, según correspondiera. La curva de supervivencia se elaboró mediante el método de Kaplan-Meier y el análisis de la significación estadística mediante el test Log-rank. El análisis de los datos se realizó con el programa STATA 14. Resultados. En las curvas de supervivencia se muestra la tendencia a menor mortalidad en los pacientes del periodo posterior (p=0,0601). La tasa de mortalidad general en el periodo inicial fue mayor que en el periodo posterior (p=0,042). En otro análisis comparamos características de los 2grupos y concluimos que eran homogéneos. Conclusión. El grado de experiencia es un factor independiente para la mortalidad. La aplicación de un protocolo asistencial es fundamental para facilitar el manejo de la terapia ECMO (AU)

Introduction. The extracorporeal oxygenation membrane (ECMO) is a system that provides circulatory and respiratory assistance to patients in cardiac or respiratory failure refractory to conventional treatment. It is a therapy with numerous associated complications and high mortality. Multidisciplinary management and experienced teams increase survival. Objective. Our purpose is to evaluate and analyse the effect of the learning curve on mortality. Methods. Retrospective and observational study of 31 patients, from January 2012 to December 2015. Patients were separated into 2periods. These periods were divided by the establishment of an ECMO protocol. We compared the quantitative variables by performing the Mann-Whitney U test. For the categorical qualitative variables we performed the chi-square test or Fisher exact statistic as appropriate. The survival curve was computed using the Kaplan-Meier method, and the analysis of statistical significance using the Log-rank test. Data analysis was performed with the STATA programme 14. Results. Survival curves show the tendency to lower mortality in the subsequent period (P=0.0601). The overall mortality rate in the initial period was higher than in the subsequent period (P=0.042). In another analysis, we compared the characteristics of the 2groups and concluded that they were homogeneous. Conclusion. The degree of experience is an independent factor for mortality. The application of a care protocol is fundamental to facilitate the management of ECMO therapy (AU)

Experience in the management of ECMO therapy as a mortality risk factor. / Experiencia en el manejo de terapia ECMO como factor de riesgo de mortalidad.

INTRODUCTION: The extracorporeal oxygenation membrane (ECMO) is a system that provides circulatory and respiratory assistance to patients in cardiac or respiratory failure refractory to conventional treatment. It is a therapy with numerous associated complications and high mortality. Multidisciplinary management and experienced teams increase survival. OBJECTIVE: Our purpose is to evaluate and analyse the effect of the learning curve on mortality. METHODS: Retrospective and observational study of 31 patients, from January 2012 to December 2015. Patients were separated into 2periods. These periods were divided by the establishment of an ECMO protocol. We compared the quantitative variables by performing the Mann-Whitney U test. For the categorical qualitative variables we performed the chi-square test or Fisher exact statistic as appropriate. The survival curve was computed using the Kaplan-Meier method, and the analysis of statistical significance using the Log-rank test. Data analysis was performed with the STATA programme 14. RESULTS: Survival curves show the tendency to lower mortality in the subsequent period (P=0.0601). The overall mortality rate in the initial period was higher than in the subsequent period (P=0.042). In another analysis, we compared the characteristics of the 2groups and concluded that they were homogeneous. CONCLUSION: The degree of experience is an independent factor for mortality. The application of a care protocol is fundamental to facilitate the management of ECMO therapy.

Relación entre la calidad de vida y la severidad del daño funcional en pacientes con glaucoma / Quality of life in glaucoma patients and normal subjects related to the severity of damage in each eye

Propósito: Evaluar la calidad de vida en pacientes con glaucoma y sujetos normales, y su relación con la gravedad del daño en cada ojo. Método: Estudio transversal con selección prospectiva de los casos. Se incluyó a un total de 664sujetos en el estudio. Se clasificaron en 4 categorías. En el grupo 1 los sujetos presentaban los 2 ojos normales: presión intraocular (PIO), disco óptico y campos visuales (CV) normales o los 2 ojos con glaucoma leve definido como PIO sin tratamiento > 21mmHg y CV anormal con defecto medio (DM) menor a -6 dB. En el grupo 2 se incluyó a pacientes con los 2ojos con glaucoma leve o moderado, esto es, PIO sin tratamiento > 21mmHg y CV anormal con DM entre -6 y -12dB. El grupo 3 lo formaron pacientes con glaucoma moderado o grave, esto es, PIO sin tratamiento >21 mmHg y CV anormal con DM menos de -12dB en ambos ojos. El grupo 4 estaba compuesto por pacientes con daño glaucomatoso asimétrico, eso es, un ojo con glaucoma severo y el otro ojo normal o con glaucoma leve. Todos los sujetos completaron 3 cuestionarios de calidad de vida diferentes. La calidad de vida global se evaluó con EuroQol (EQ-5D). La calidad de vida relacionada con la visión se evaluó con el Visual Functional Questionnaire (VFQ-25) y la relacionada con la superficie ocular se evaluó con el Ocular Surface Disease Index (OSDI). Resultados: En cuanto a la calidad de vida relacionada con la visión, el VFQ-25 mostró que el grupo 3 tiene puntuaciones significativamente inferiores al grupo 1 en salud mental (p = 0,006), dependencia (p = 0,006), visión de colores (p = 0,002) y visión periférica (p = 0,002). El EQ-5D no mostró diferencias significativas entre ningún grupo, pero sí se halló una tendencia a una mayor dificultad en el grupo 3 que en los grupos 1 y 2 en todas las dimensiones. El OSDI mostró una mayor puntuación, o lo que es lo mismo una mayor discapacidad, en los grupos 2 y 3 que en el grupo 1 (p = 0,021 y p = 0,014, respectivamente). Analizando los resultados en cada dimensión del VFQ-25, en los distintos grupos, solo se han encontrado diferencias significativas entre el grupo 1 y el grupo 4 en la visión general. En las dimensiones de la visión donde sí se han encontrado diferencias significativas entre los grupos 1 y 3 (los 2 ojos con grado moderado o avanzado), estas no existen en los grupos 1 y 4 (grupo en el que un ojo tiene solo daño de grado leve o sano). Este hallazgo confirma que el ojo con menor daño glaucomatoso es el que determina la calidad de vida del paciente. Conclusiones: Nuestros resultados demuestran que la calidad de vida está alterada en pacientes con glaucoma, y esta alteración es mayor cuanto más avanzado es el daño por glaucoma en el mejor o en ambos ojos (AU)

Objective: To assess the quality of life in glaucoma patients and normal subjects, and to assess its relationship with the severity of damage in each eye. Methods: A cross-sectional study was conducted with prospective selection of cases. The study included 464 subjects and were distributed into 4 categories. Subjects included in group 1 had both eyes normal, that is with a normal intraocular pressure (IOP), optic disk and visual fields (VF), or mild glaucoma, defined as untreated IOP > 21mmHg and abnormal VF with mean defect (MD) over -6 dB. Group 2 consisted of patients with both eyes with mild or moderate glaucoma, defined as untreated IO P> 21mmHg and abnormal VF with MD between -6 and-12 dB. Group 3 included patients with moderate to severe glaucoma, that is, untreated IOP > 21mmHg and abnormal VF with MD of less than -12dB in both eyes. Group 4 consisted of patients with asymmetric glaucoma damage, that is, they had one eye with severe glaucoma and the other eye normal or with mild glaucoma. All subjects completed 3 different questionnaires. Global quality of life was evaluated with EuroQol-5D (EQ-5D). Vision related quality of life was assessed with Visual Function Questionnaire (VFQ-25). Quality of life related to ocular surface disease was measured with Ocular Surface Disease Index (OSDI). Results: VFQ-25 showed that group 3 had significantly lower scores than group 1 in mental health (P=.006), dependence (P=.006), colour vision (P=.002), and peripheral vision (P=.002). EQ-5D showed no significant differences between any group, but a trend was found to greater difficulty in group 3 than in groups 1 and 2, and in all dimensions. OSDI showed a higher score, or which was the same as a major disability, in groups 2 and 3 than group 1 (P=.021 and P=.014, respectively). VFQ-25 only found significant differences between group 1 and group 4. Dimensions with significant differences were found between group 1 and 3 (both eyes with advanced or moderate glaucoma). These were not found between group 1 and group 4 (the group in which one eye has only mild glaucoma or no glaucoma). This finding confirms that the eye with less glaucoma damage determines the quality of life. Conclusions: Our results demonstrate that quality of life is impaired in patients with glaucoma, and this alteration is greater the more advanced is glaucoma damage in the best or both eyes (AU)

Quality of life in glaucoma patients and normal subjects related to the severity of damage in each eye. / Relación entre la calidad de vida y la severidad del daño funcional en pacientes con glaucoma.

OBJECTIVE: To assess the quality of life in glaucoma patients and normal subjects, and to assess its relationship with the severity of damage in each eye. METHODS: A cross-sectional study was conducted with prospective selection of cases. The study included 464 subjects and were distributed into 4categories. Subjects included in group 1 had both eyes normal, that is with a normal intraocular pressure (IOP), optic disk and visual fields (VF), or mild glaucoma, defined as untreated IOP>21mmHg and abnormal VF with mean defect (MD) over -6dB. Group 2 consisted of patients with both eyes with mild or moderate glaucoma, defined as untreated IOP>21mmHg and abnormal VF with MD between -6 and -12dB. Group 3 included patients with moderate to severe glaucoma, that is, untreated IOP>21mmHg and abnormal VF with MD of less than -12dB in both eyes. Group 4 consisted of patients with asymmetric glaucoma damage, that is, they had one eye with severe glaucoma and the other eye normal or with mild glaucoma. All subjects completed 3 different questionnaires. Global quality of life was evaluated with EuroQol-5D (EQ-5D). Vision related quality of life was assessed with Visual Function Questionnaire (VFQ-25). Quality of life related to ocular surface disease was measured with Ocular Surface Disease Index (OSDI). RESULTS: VFQ-25 showed that group 3 had significantly lower scores than group 1 in mental health (P=.006), dependence (P=.006), colour vision (P=.002), and peripheral vision (P=.002). EQ-5D showed no significant differences between any group, but a trend was found to greater difficulty in group 3 than in groups 1 and 2, and in all dimensions. OSDI showed a higher score, or which was the same as a major disability, in groups 2 and 3 than group 1 (P=.021 and P=.014, respectively). VFQ-25 only found significant differences between group 1 and group 4. Dimensions with significant differences were found between group 1 and 3 (both eyes with advanced or moderate glaucoma). These were not found between group 1 and group 4 (the group in which one eye has only mild glaucoma or no glaucoma). This finding confirms that the eye with less glaucoma damage determines the quality of life. CONCLUSIONS: Our results demonstrate that quality of life is impaired in patients with glaucoma, and this alteration is greater the more advanced is glaucoma damage in the best or both eyes.

Eficacia de la educación sanitaria a pacientes y familiares en la Unidad de Monitorización de Epilepsia / Efficacy of healthcare education for patients and relatives in the Epilepsy Monitoring Unit

Objetivo: evaluar la efectividad, en el conocimiento y manejo de la epilepsia, de una intervención educativa personalizada sistematizada (IEPS) versus atención convencional, en pacientes ingresados con epilepsia fármaco resistente y sus familiares, durante su estancia en la Unidad de Monitorización de Epilepsia del Hospital Universitario Germans Trias i Pujol (Barcelona). Método: ensayo controlado y aleatorizado. Muestra de 20 pacientes y 20 familiares. Se realiza una IEPS al grupo experimental por enfermeras especializadas dirigida a pacientes epilépticos ingresados en la unidad acompañados de un familiar (el grupo control recibió atención habitual). Variable dependiente: conocimientos y manejo de la epilepsia tras la intervención educativa, a los seis meses y al año, con instrumentos ad hoc (puntuación 0 a 36). Se utilizaron las pruebas de contraste de hipótesis t de Student, U de Mann-Whitney, prueba de Wilcoxon, y test de Friedman. Resultados: muestra final de 42 participantes (21 pacientes y 21 familiares). En el caso de los pacientes, el impacto de la intervención educativa fue estadísticamente significativo a favor del grupo experimental frente al grupo experimental frente al grupo control al alta (p= <0,001) y a los seis meses (p= 0,003), pero no a los 12 meses (p= 0,111). En el grupo de familiares solo se encuentran diferencias estadísticamente significativas al alta (p=0,016), no a los seis meses (p= 0,593), ni a los 12 meses (p= 0,104). Conclusiones: la intervención educativa incide en el grado de conocimientos frente al manejo de la epilepsia del paciente y familiar. Los resultados obtenidos alientan a seguir con la implantación del programa educativo y realizar la educación para la salud en la unidad de monitorización de epilepsia (AU)

Objective: to evaluate the efficacy in terms of knowledge and management of epilepsy of a systematic personalized educational intervention (SPEI) vs. conventional care, in patients hospitalized with drug-resistant epilepsy and their relatives, during their stay at the Epilepsy Monitoring Unit in the Hospital Universitario Germans Trias i Pujol (Barcelona). Method: a controlled and randomised clinical trial, with a sample of 20 patients and 20 relatives. A SPEI was conducted on the experimental group by specialized nurses, targeted to epileptic patients hospitalized in the unit and accompanied by a relative (the control arm received the usual care). Dependent variable: knowledge and management of epilepsy after the educational intervention, at six months and at one year, with ad hoc tools (score 0 to 36). The hypothesis contrast tests used were: Student’s t, Mann-Whitney’s, Wilcoxon test, and Friedman test. Results: a final sample of 42 participants (21 patients and 21 relatives). In the case of patients, the impact of educational intervention was statiscally significant in favour of the experimental arm vs. the control arm at discharge (p= <0.001) and at six months (p= 0.003), but not at 12 months (p= 0.111). In the relatives arm, statistically significant differences were only found at discharge (p= 0.016), but not at six months (p= 0.593), or at 12 months (p= 0.104). Conclusions: the educational intervention has an impact on the level of knowledge regarding epilepsy management by patients and relatives. The outcomes obtained are encouraging to continue the implementation of the educational program, and to conduct health education in the Epilepsy Monitoring Unit (AU)

Electrical burns in times of economic crisis: A new epidemiologic profile.

Electrical injuries and especially those of high voltage still remain a source of high morbidity. Over the past few years, a change in the epidemiologic profile of these lesions was noticed at the Vall d'Hebron University Hospital Burn Unit, corresponding to an increase in cases out of the legal framework. It is our aim to describe this particular subset, to determine the extent of their injuries and to understand the reason for their increased incidence. We think this was favoured by the rise in the unemployment rate, along with higher copper prices.

Description of high rates of unapparent and simultaneous multiple dengue virus infection in a Colombian jungle settlement.

Dengue disease statistics is mainly based on consulting patients with febrile illness, but misdiagnosed and asymptomatic cases are important to measure dengue epidemiology in endemic areas. The main objective of this work was to determine the prevalence of IgM and IgG antibodies or NS1 antigen and viral RNA in a group of healthy volunteers from an isolated village in Colombian Chocó rain forest. It found 51.7% of virologically PCR confirmed asymptomatic cases, despite low IgM seroprevalence. It was confirmed that all four serotypes are in the circulation and in 17.2% of individuals it detected natural coinfections of two or three different serotypes simultaneously. This is the first report in Colombia evaluating viremia in asymptomatic volunteers. These findings pose a big concern about the transmission of dengue virus by asymptomatic individuals because they can spread the virus without take appropriate control measures.

Loss of the tumor suppressor spinophilin (PPP1R9B) increases the cancer stem cell population in breast tumors.

The spinophilin (Spn, PPP1R9B) gene is located at 17q21.33, a region frequently associated with microsatellite instability and loss of heterozygosity, especially in breast tumors. Spn is a regulatory subunit of phosphatase1a (PP1), which targets the catalytic subunit to distinct subcellular locations. Spn downregulation reduces PPP1CA activity against the retinoblastoma protein, pRb, thereby maintaining higher levels of phosphorylated pRb. This effect contributes to an increase in the tumorigenic properties of cells in certain contexts. Here, we explored the mechanism of how Spn downregulation contributes to the malignant phenotype and poor prognosis in breast tumors and found an increase in the stemness phenotype. Analysis of human breast tumors showed that Spn mRNA and protein are reduced or lost in 15% of carcinomas, correlating with a worse prognosis, a more aggressive tumor phenotype and triple-negative tumors, whereas luminal tumors showed high Spn levels. Downregulation of Spn by shRNA increased the stemness properties along with the expression of stem-related genes (Sox2, KLF4, Nanog and OCT4), whereas ectopic overexpression of Spn cDNA reduced these properties. Breast tumor stem cells appeared to have low levels of Spn mRNA, and Spn loss correlated with increased stem-like cell appearance in breast tumors as indicated by an increase in CD44+/CD24- cells. A reduction of the levels of PPP1CA mimicked the cancer stem-like cell phenotype of Spn downregulation, suggesting that the mechanism of Spn involves PP1a. These increased cancer stem cell-like properties with reduced Spn might account for the malignant phenotype observed in Spn-loss tumors and may contribute to a worse patient prognosis.

Description of high rates of unapparent and simultaneous multiple dengue virus infection in a Colombian jungle settlement

Dengue disease statistics is mainly based on consulting patients with febrile illness, but misdiagnosed and asymptomatic cases are important to measure dengue epidemiology in endemic areas. The main objective of this work was to determine the prevalence of IgM and IgG antibodies or NS1 antigen and viral RNA in a group of healthy volunteers from an isolated village in Colombian Chocó rain forest. It found 51.7% of virologically PCR confirmed asymptomatic cases, despite low IgM seroprevalence. It was confirmed that all four serotypes are in the circulation and in 17.2% of individuals it detected natural coinfections of two or three different serotypes simultaneously. This is the first report in Colombia evaluating viremia in asymptomatic volunteers. These findings pose a big concern about the transmission of dengue virus by asymptomatic individuals because they can spread the virus without take appropriate control measures.

A role for the transducer of the Hippo pathway, TAZ, in the development of aggressive types of endometrial cancer.

Although TAZ, the final effector of the Hippo pathway that modulates epithelial to mesenchymal transition and stemness, has been implicated in the development of different types of cancer, its role in endometrial cancer has not yet been studied. Thus, we evaluated the expression of TAZ in different types of endometrial cancer by immunohistochemistry. TAZ expression was detected in 76% of undifferentiated endometrial carcinomas, 54% of endometrial carcinosarcomas, 46% of endometrial serous carcinomas, 36% of grade 3 endometrioid carcinomas, and 18% of grade 1-2 endometrioid carcinomas, with statistically significant differences. We analyzed the WWTR1 gene that encodes TAZ by FISH and MassARRAY spectrometry, ruling out gene amplification and differential promoter methylation as the main mechanisms that modulate TAZ expression in endometrial tumors. However, we did detect a significant association between Scribble hypoexpression and delocalization with TAZ expression. Moreover, we demonstrated that TAZ promoted invasiveness, and it favored cell motility and tumor growth, in endometrial cancer cell lines. In addition, TAZ expression was associated with the transition from an epithelial to mesenchymal phenotype, both in vitro and in human tumors. Together, these data reveal a previously unknown role for TAZ and the Hippo pathway in the progression of aggressive subtypes of endometrial cancer.

Actinomicosis apendicular como causa de masa ileocecal en la edad pediátrica: Caso clínico / Appendicular actinomycosis as a cause of ileocecal mass in children: Case report

Introducción. La actinomicosis apendicular es una patología rara producida por la invasión del apéndice cecal por bacterias del género Actinomyces al alterarse la barrera mucosa después de una causa predisponente, como podría ser una apendicitis aguda. Se presenta con mayor frecuencia en adultos, aunque en la literatura se han descrito algunos casos en edad pediátrica. En este artículo se presenta un nuevo caso pediátrico de actinomicosis apendicular de presentación atípica y se revisa la literatura al respecto. Caso clínico. Paciente varón de 10 años de edad derivado a nuestro hospital por el hallazgo intraoperatorio en otro centro de una tumoración en flanco derecho, sin identificación del apéndice cecal. Tras completar el estudio con pruebas de imagen, el paciente fue reintervenido bajo la orientación diagnóstica de apendicitis aguda complicada. Intraoperatoriamente, se identifica un plastrón organizado y con escasos signos inflamatorios agudos. La evolución postquirúrgica fue favorable con tratamiento antibiótico convencional. El estudio anatomopatológico de la pieza reveló una actinomicosis apendicular, por lo que se amplió el tratamiento antibiótico de forma ambulatoria y se descartó patología predisponente. Comentarios. La actinomicosis apendicular es una causa infrecuente de apendicitis que puede simular una tumoración intraabdominal en niños y adultos. Es necesario descartar patología predisponente y realizar un tratamiento antibiótico adecuado

Introduction. Appendicular actinomycosis is a rare disease produced by cecal appendix invasion by Actinomyces gender bacteria after a predisposing cause that disrupts mucosal barrier, such as acute appendicitis. The highest frequency appears in adults; however, there are cases in paediatric age described in literature. The aim of this article is to introduce a case of appendicular actinomycosis in a child with atypical presentation and to review the literature. Clinical case. 10-year-old boy transferred to our hospital due to intraoperative finding at a different centre of a right flank tumor, without identification of cecal appendix. After completing the study with image tests, the patient was re-intervened with the diagnosis of complicated acute appendicitis. Intraoperatively, an organized plastron lacking of acute inflammatory signs was found. Post-surgical evolution was positive with conventional antibiotic treatment. Histological study of the specimen revealed an appendicular actinomycosis, so antibiotic treatment was widened in an outpatient basis and predisposing diseases were ruled out. Comments. Appendicular actinomycosis is an infrequent cause of appendicitis that can simulate an intra-abdominal tumor in children and adults. It is necessary to rule out predisposing diseases and to administer an adequate antibiotic treatment

Cuidados integrales de los últimos días y horas de vida / Comprehensive care in the last days and hours of life

Este artículo identifica los elementos más significativos del proceso de atención enfermera a los últimos días y horas de vida en el contexto de una enfermedad en situación terminal previamente diagnosticada. Para ello se revisan las principales guías clínica de cuidados integrales y, en especial, la diseñada por el Hospital San Juan de Dios de Sevilla. Se concluye que es necesario saber identificar la fase de agonía para aplicar, en consecuencia, un plan asistencial predeterminado capaz de responder de forma personalizada a las necesidades específicas que se presentan en las últimas horas de la vida de un paciente en situación terminal. La actuación interprofesional continuada y coordinada sobre el paciente y la familia siguiendo estándares normalizados permite el logro de una muerte en paz y libre de un sufrimiento evitable (AU)

This article identifies the most significant elements of the process of nurse attention to the last days and hours of life in the context of a disease previously diagnosed like a terminal situation. For this object, we have reviewed the main clinical guidelines on comprehensive care and, especially, the guideline that was designed by the Saint John of God Hospital in Seville. We conclude that it is necessary to know how to identify the phase of agony to apply, therefore a default care plan that allows to respond customized to the specific needs that occur in the last hours of the life of a terminal patient. A continued and coordinated interprofessional assistance to patient and family following standardized standards allows achieving a peaceful death and free from avoidable suffering (AU)

Comparison of the hemodynamic response to induction and intubation during a target-controlled infusion of propofol with 2 different pharmacokinetic models. A prospective ramdomized trial.

OBJECTIVE: Determine the best propofol pharmacokinetic model that meets patient requirements and is devoid of major haemodynamic side effects. MATERIAL AND METHODS: Prospective, randomised, open-label, clinical trial was performed on an intention to treat basis. It included 280 patients with ASA physical status i-iii, aged 18 to 80 years and weight range between 45 to 100kg, scheduled for surgery under general anaesthesia. They were randomized into 2 groups according to the pharmacokinetic model: Modified Marsh group and Schnider group. The haemodynamic changes that occurred during the induction and intubation were analysed. A propofol target controlled infusion was started to achieve and maintain a bispectral index value between 35 and 55. At minute 6, orotracheal intubation was performed and the study finished at minute 11. Heart rate, mean arterial pressure and their product (HR×MAP) were measured and recorded every minute throughout the study. Every HR×MAP value was compared to its baseline value to determine the minimum value before intubation, the maximum value after intubation, the maximum variation after intubation, and its final value. The GRADIENTE (MIN, MAX) variable (primary endpoint of this study) analyses the difference between maximal and minimal values related to intubation. Propofol doses and calculated concentrations and any hypotensive events were also recorded. RESULTS: No differences were found between groups regarding haemodynamic performance. GRADIENTE (MIN, MAX) values and the percentage of hypotensive events were: Modified Marsh group median 77.41% vs. Schnider group 84.86% (p= 0.821) and 17.3% vs. 12.8% (p = 0.292), respectively. CONCLUSION: The study failed to demonstrate any haemodynamic difference between the 2 groups, even though the Modified Marsh group received a larger dose of propofol.