Brain metastases from non-small cell lung carcinoma: an overview of classical and novel treatment strategies.

Background: The development of brain metastases is a common problem in patients diagnosed with non-small cell lung carcinoma (NSCLC). Technological advances in surgery and radiotherapy have allowed greater local control. Moreover, the emergence of targeted therapies and immunotherapy with greater activity on the central nervous system than classical chemotherapy have given way to new strategies in the treatment of brain metastases. We review the current role of local treatments, surgery and radiotherapy, and the most effective combination strategies with the new systemic treatments. Relevance for patients: Brain metastases frequently occur during the course of NSCLC. In recent years, a range of treatments have appeared, such as targeted treatments or immunotherapy, with greater activity at the brain level than classical chemotherapy. Radiotherapy treatment is also now much more conformal and ablative doses can be delivered to the volume of the metastatic area, providing greater local control and less neurological toxicity. However, surgery is still required in cases where anatomopathological specimens are needed and when compressive effects appear. An important challenge is how to combine these treatments to achieve the best control and minimise patients' neurological impairments, especially because of limited experience with the new target drugs, and the unknown toxicity of the different combinations. Future research should therefore focus on these areas in order to establish the best strategies for the treatment of brain metastases from non-small cell lung cancer. Core tips: In this work, we intend to elucidate the best therapeutic options for patients diagnosed with brain metastases of NSCL, which include: surgery, WBRT, radiosurgery or systemic treatment, and the most effective combinations and timings of them, and the ones with the lowest associated toxicity.

Potential of Nanocellulose as a Dietary Fiber Isolated from Brewer's Spent Grain.

Steady growth in beer production is increasing the number of by-products named brewers' spent grain. Such by-products are a source of several components, where cellulose is usually present in high amounts. The aim of this study was to develop a protocol to obtain a mix of cellulose microfibers with an average diameter of 8-12 µm and cellulose nanoplatelets with an average thickness of 100 nm, which has several applications in the food industry. The process comprised one alkaline treatment followed by acid hydrolysis, giving a new mix of micro and nanocellulose. This mix was characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and laser scanning microscopy corroborating the presence and measurements of the cellulose nanostructure, showing an aspect ratio of up to 500. Finally, we demonstrated that the administration of this new type of nanocellulose allowed us to control the weight of mice (feed intake), showing a significant percentage of weight reduction (4.96%) after 15 days compared with their initial weight, indicating the possibility of using this material as a dietary fiber.

Methodological assessment of Mexican Clinical Practice Guidelines: GRADE framework adherence and critical appraisal.

BACKGROUND AND OBJECTIVE: Clinical Practice Guidelines (CPGs) provide evidence-based recommendations to healthcare professionals, policy makers, patients and other stakeholders. Mexico is the biggest producer of CPGs in Latin America and Caribbean countries. The National Healthcare Technology Excellence Center (acronym in Spanish: CENETEC) is responsible for the CPG development, adaptation and update. The aim of this study was to assess the adherence to the GRADE framework and to critically appraise the Mexican CPGs with the AGREE-II tool. STUDY DESIGN: We conducted a descriptive cross-sectional study with a random sample of 86 CPGs produced by CENETEC between 2015 and 2017 and published in an online database called "Catalogo Maestro". We assessed the adherence to the GRADE framework and performed a critical appraisal with the AGREE II tool. RESULTS: Of the 86 CPGs, 34 were published in 2015, 21 in 2016 and 31 in 2017. Of the 86 CPGs, 25 (29%) used the GRADE framework; adherence to GRADE standards was, however, inconsistent and generally poor. The overall methodological quality by AGREE II proved a median of 16.6% (Min 16.6%, Max 50%). CONCLUSION: CPGs produced by CENETEC during this period had a poor adherence to the GRADE framework and low score by AGREE II standards. A concerted initiative could rapidly improve CENETEC guidelines.

Removal and accumulation of cadmium and lead by Typha latifolia exposed to single and mixed metal solutions.

We investigated the effect of Cd and Pb on the growth of the aquatic macrophyte Typha latifolia; the removal from the solution and the accumulation of these elements by the plant were also studied. Thus, small plants of T. latifolia, collected from a noncontaminated site, were exposed for 10 days to Cd and Pb, in a single solution or in mixture solutions, at two concentrations of the metals (5 and 7.5 mg/L). Our results showed that T. latifolia removed effectively Cd and Pb from solutions and was able to accumulate these metals in the roots and, to a lesser extent, in the leaves. Our findings suggested a synergistic effect of Cd and Pb with respect to the toxicity to T. latifolia. Additionally, Cd diminished the Pb absorption by T. latifolia. Our results confirmed, using scanning electron microscopy, the internalization of Cd and Pb in T. latifolia.

Enzymatic hydrolysis of cellulose nanoplatelets as a source of sugars with the concomitant production of cellulose nanofibrils.

Cellulose, the most abundant biopolymer on earth, is produced at different ratios by all land plants. Since the morphology and crystallinity of cellulose are key factors involved in its enzymatic hydrolysis, in the present work, we tackled the study of the effects of such variables on the nanocellulose conversion into glucose. Cellulase from Trichoderma sp at 37 °C was used to produce glucose, the best results were found for the cellulose nanoplatelets (S-CNP) after 60 h of hydrolysis, which afforded a conversion of 47% to glucose, in contrast to 15% for the non-purified sample (W-CP) and 22% for microcrystalline cellulose (MCC20) used as control. The X-ray diffractogram recorded on the samples showed an initial crystallinity index of 45%, 54% and 72% for W-CNP, S-CNP and MCC20, respectively. Also, we showed that after 24 h of hydrolysis, long cellulose nanofibrils (∅ ≈ 30 nm) were found as a residue.

Production and detailed characterization of bean husk-based carbon: efficient cadmium (II) removal from aqueous solutions.

We report the production of a modified carbon by heat treating bean husk (Phaseolus vulgaris) at 270 degrees C in Ar, followed by chemical activation using HNO(3). The material was studied using thermogravimetric analysis (TGA), infrared spectroscopy (IRS), high-resolution transmission electron microscopy (HRTEM), elemental mapping, energy dispersive X-ray spectroscopy (EDX), X-ray powder diffraction and scanning electron microscopy (SEM). Cd(2+) sorption studies with this material were carried out at different concentrations. It was found that cadmium (II) is effectively removed by the modified material obtained from bean husk (180 mg/g). The sorption mechanism is discussed in terms of the activated surface properties. A relationship between the oxygen content and sorption was found in this novel material. Commercial activated carbon (AC) (F400) was used for comparison.

Avances y logros de la gerencia sectorial de diagnóstico y vigilancia epidemiológica del Instituto Nacional de Higiene Rafael Rangel / Progress and achievements of the diagnosis and management sector epidemiological surveillance of the Intituto Nacional de Higiene Rafael Rangel

Las actividades de diagnóstico se inician desde el Decreto de creación del Instituto Nacional de Higiene en 1938, donde en el Artículo Nº 2 se establecen las funciones del Instituto, siendo una de ellas la “Investigación sistemática de enfermedades endemoepidémicas y de epizootias nacionales y de todas aquellas enfermedades que puedan existir en el país, y el estudio de los métodos más apropiados para combatirlas”. Es así, como en sus inicios se habla de Laboratorios de Bacteriología, Parasitología, Micología, Epidemiología, cuyas actividades funcionaban independientemente bajo la dirección general del Instituto, que actúa como asesor y proveedor de los mismos, perfilándose como un centro de investigación, de consulta y de enseñanza del futuro personal de laboratorio del país, destacándose en estas labores el Dr. Félix Pifano, Dr. Allan Scott, Dr. Martín Mayer, entre otros. La Gerencia Sectorial de Diagnóstico y Vigilancia Epidemiológica ha tenido varias reestructuraciones; actualmente está conformada por la División de Enfermedades Transmisibles, de la cual dependen los Departamentos de Virología, Bacteriología y Micología; y la División de Vigilancia Epidemiológica, a la cual está adscrita la Unidad de Atención al Paciente. La Gerencia ha tenido notable desarrollo, lo cual le ha permitido ser Centro de Referencia Nacional de enfermedades infecciosas en las áreas de Bacteriología, Virología y Micología. Es además un centro de investigación aplicada de enfermedades infectocontagiosas, tales como: Fiebres Hemorrágicas, Encefalitis, Brucelosis, Resistencia Bacteriana, Micosis Superficiales y Profundas y Enfermedades Respiratorias. Contribuye con la Vigilancia Epidemiológica, en apoyo a los programas del Ministerio del Poder Popular para la Salud (MPPS). Se realiza el Diagnóstico y seguimiento de pacientes VIH positivos como parte del Programa Nacional de Control de Infecciones de Transmisión Sexual y SIDA del MPPS. La Gerencia participa activamente en docencia...

The diagnostic activities, started with the creation of the National Institute of Hygiene in 1938. due to the fact that N° 2 Article established the Institute functions, being one of them “the systematic investigation of endemoepidemic diseases, and natural epizooties, and all of those illness that might exist all over the country and their appropriate methods to combat them”. That’s why, from the beginning, the bacteriology, parasitological, mycology, epidemiology laboratories were contemplated, everyonewith different activities, under the Institute General Control, which work as their counselor and supplier coming up as an investigation center, consulting and teaching for the future laboratories workers of the country, being distinguished the doctors Felix Pifano, Scott, Martín Mayer, among others. The Diagnosis Division and Epidemiologic Control Management have got several restructurations. It is currently conformed by the Transmissible Disease Division, from which depend the Virology, Bacteriology and Mycology departments, and the Epidemic Survei llance Division where the Patient Unity Attention is attached. The Diagnostic Management has had a great development, which allowed it to be a National Reference Center of Infectious Diseases, in the bacteriology, virology and mycology fields. It is also a center for applied investigations to infectiouscontagious diseases such, as Bleeding Fever, Brain fever, Brucellosis, Bacterial Resistance, Superficial and Profound Mycosis, and Respiratory diseases. It contributes to the support of epidemiologic alertness, with the Ministerio del Poder Popular para la Salud programs. Diagnosis and follow up of positive VIH patients are carry out, as part of the National Control of Infectious and Sexual Transmission and Aid Programs from the Ministerio del Poder Popular para la Salud. It also participates actively in teaching, with a Medical Mycology spe cialization course, and pre and post academic courses in themi crobiology...