Deep Sternal Wound Infection After Beating Heart Coronary Artery Bypass Surgery with Routine Use of Skeletonized Bilateral Internal Thoracic Artery

ABSTRACT Introduction: Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). We observed the role of routine use of BITA and off-pump coronary artery bypass grafting (OPCABG) in the incidence of DSWI and associated risk factors. Methods: Between January 2010 and December 2020, 1,207 patients were treated with isolated coronary artery bypass grafting. In all cases, OPCABG was attempted, and BITA was used whenever there was a need for a second arterial graft for the left coronary artery. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple linear regression analysis was employed to model the risk of DSWI. Results: The incidence of DSWI was 0.58%. Mortality rate was higher in DSWI group than in no-DSWI group (28.57% vs. 1.25%; P<0.001). No significant difference in DSWI incidence was observed when BITA (70.6%) or single internal thoracic artery (29.4%) were used (P=0.680). The prevalence of diabetes (100% vs. 40.7%; P=0.001), hyperlipidemia (100% vs. 85.9%; P=0.045), and obesity (71.4% vs. 26.8%; P-0.017) was significantly elevated in DSWI group, when compared with no-DSWI group. Diabetes (P=0.0001), unstable angina (P=0.0064), previous myocardial infarction > 30 days (P=0.0009), left ventricular ejection fraction < 50% (P=0.0074), and emergency surgery (P=0.0002) were independent risk factors. Conclusion: The results of routine use of skeletonized BITA after OPCABG were satisfactory regarding DSWI incidence and operative mortality in a single-center experience.

Changes in the rest-activity rhythm in migraine patients are associated with anxiety symptoms

Objective: To characterize rest-activity rhythm in chronic migraine (CM) and to investigate the relationship between this rhythm and depressive and anxiety symptoms in patients with CM. Methods: This was a study of adults aged 20 to 40 years. The rest-activity rhythm of patients with CM (n=23) and non-headache controls (NH, n=23) was assessed by actigraphy for 15 days, and they completed the following assessments: Visual Analogue Scale for pain intensity; Headache Diary; Headache Impact Test-6; Morningness-Eveningness Questionnaire; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Beck Depression Inventory; and State-Trait Anxiety Inventory. Results: Patients with CM showed less activity over 24 hours and more fragmented sleep. Reduced interdaily stability of the rest-activity rhythm was observed, with less robustness of this rhythm in the CM group. Multiple linear regressions revealed a significant association between the rest-activity rhythm and trait anxiety variables in patients with CM, specifically regarding the relative amplitude of the cycle, activity throughout 24 hours and during sleep, and robustness of the rest-activity rhythm. Conclusions: Our findings provide evidence that the robustness of the rest-activity rhythm, activity throughout 24 hours, and sleep fragmentation are associated with trait anxiety in patients with CM. Clinical trial registration: Brazilian Clinical Trials Registry (registration number: RBR-4M5J4S).

Déficits neuropsicológicos, intensidad sintomática y repercusión funcional en el trastorno por déficit de atención con hiperactividad / Neuropsychological deficits, symptom intensity and functional impairment in attention deficit hyperactivity disorder

Resumen Este estudio pretende contribuir a una mejor comprensión del trastorno por déficit de atención con hiperactividad (TDAH) examinado de manera exhaustiva la relación entre dos de los principales déficits cognitivos del trastorno (la atención y el control inhibitorio), la sintomatología (falta de atención e hipe ractividad/impulsividad) y la repercusión funcional en 85 niños/as y adolescentes con TDAH sin otros trastornos comórbidos. Encontramos, con independencia del funcionamiento intelectual general y de la edad, que i) un mayor déficit atencional e inhibitorio, predijo una mayor gravedad de los síntomas del TDAH, ii) un mayor déficit atencional e inhibitorio predijo un mayor deterioro funcional, pero no de una manera directa sino a través de los síntomas, y iii) una mayor severidad sintomática predijo una mayor repercusión funcional. Comenzar a explorar y comprender la complejidad del TDAH es clave para avanzar en nuestro conocimiento del trastorno y para la correcta toma de decisiones clínicas.

Abstract This study aims to contribute to a better understanding of at tention deficit hyperactivity disorder (ADHD) by comprehensively examining the relationship between two of the main cognitive deficits of the disorder (attention and inhibitory control), symptomatology (inattention and hyperactivity/impulsivity) and functional impairment in 85 children and adolescents with ADHD without other comorbid disorders. We found, independent of general intellectual functioning and age, that i) greater atten tional and inhibitory deficits predicted greater severity of ADHD symptoms, ii) greater attentional and inhibitory deficits predicted greater functional impairment, but not in a direct way but through symptoms, and iii) greater symptomatic severity predicted greater functional impairment. Beginning to explore and understand the com plexity of ADHD is key to advance our knowledge of the disorder and for correct clinical decision making.

Craniospinal irradiation for respiratory failure secondary to central nervous system Erdheim-Chester disease

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis typically featuring lower extremity osteosclerosis (96%) from Langerin-negative histiocytes with fibrosis. Central nervous system (CNS)-only disease is extremely rare, and particularly difficult to diagnose and manage. Neurologic complaints may be refractory to systemic therapy (ST), and the role of radiation therapy (RT) is undefined. We present a patient with ECD of the medulla complicated by respiratory failure and strength deficits with disseminated leptomeningeal disease (LMD) but not systemic disease, representing the first report of CNS-limited ECD with LMD. He received upfront craniospinal irradiation (CSI), representing a rare account of CSI for ESD, with marked clinical improvement resulting in extubation and improved strength. CSI facilitated excellent preservation of quality of life, and no treatment-related toxicity was observed prior to eventual, unrelated cardiopulmonary arrest. Thus, palliative CSI may augment ST by safely offering improved local control and symptomatic relief for CNS ECD.

Comparison of transarterial n-BCA and Onyx embolization of brain arteriovenous malformations: A single-center 18-year retrospective analysis

Objective@#Brain arteriovenous malformations (AVM) are commonly treated with endovascular embolization. Due to the rapid evolution of endovascular technology and lack of consistent practice guidelines regarding AVM embolization, further study of AVM embolization outcomes is warranted. @*Methods@#We conducted a retrospective review of AVMs embolized at a single center from 2002-2019. Patient demographics, AVM characteristics, intention of embolization, and angiographic and clinical outcome after embolization were recorded. We compared the embolization results of those treated with n-butyl cyanoacrylate (n-BCA) and Onyx. @*Results@#Over an 18-year period at our institution, 30 (33%) of 92 AVMs were treated with embolization. n-BCA was used in 12 cases and Onyx in 18 cases. Eighty-seven pedicles were embolized over 47 embolization sessions. Fifty percent of AVMs treated with n-BCA underwent more than one embolization session compared to 22% when Onyx was used. The median total percent volume reduction in the n-BCA AVMs was 52% compared to 51% in Onyx AVMs. There were 2 periprocedural complications in the n-BCA cohort and none in the Onyx cohort. @*Conclusions@#In this small retrospective series, Onyx and n-BCA achieved similar occlusion results, although n-BCA required more sessions and pedicles embolized to do so.

Nuevos registros de la familia Cucumariidae (Holothuroidea: Dendrochirotida) en el Pacifico mexicano / New records of the family Cucumariidae (Holothuroidea: Dendrochirotida) for the Mexican Pacific

Introducción: Los cucumáridos son un grupo cosmopolita de pepinos de mar que habitan en sedimentos rocosos-arenosos, desde la zona intermareal hasta la zona abisal. Objetivo: Presentar nuevos registros para el Pacífico mexicano. Métodos: Se utilizó estereoscopio y microscopía electrónica de barrido para mostrar la morfología externa e interna de especímenes de la colección de la Universidad Nacional Autónoma de México. Resultados: Presentamos una sinopsis taxonómica de cucumáridos en el Pacífico mexicano y revisamos su taxonomía en las espículas. Se confirma la identidad taxonómica de Pseudocnus curatus, Pseudocnus dubiosus y Pseudocnus lubricus y se descarta la presencia de Trachythyone peruana. Conclusiones: Se presentan cuatro nuevos registros para el Pacífico mexicano: Leptopentacta nina, Pseudocnus curatus, Pseudocnus dubiosus y Pseudocnus lubricus.

Introduction: Cucumarids are a cosmopolitan group of sea cucumbers that inhabit rocky-sandy sediments, from the intertidal zone to the hadal zone. Objective: To present new records for the Mexican Pacific. Methods: We applied stereoscope and scanning electron microscopy to external and internal morphology of specimens in the collection of the National Autonomous University, Mexico. Results: We present a taxonomic synopsis of cucumarids in the Mexican Pacific and review their taxonomy on the ossicles. The taxonomic identity of Pseudocnus curatus, Pseudocnus dubiosus and Pseudocnus lubricus is confirmed, and the presence of Trachythyone peruana is ruled out. Conclusions: Four new records are presented for the Mexican Pacific: Leptopentacta nina, Pseudocnus curatus, Pseudocnus dubiosus and Pseudocnus lubricus.

Clinicopathologic spectrum of necrotizing lymphadenitis

Background: Necrotizing lymphadenitis represents a group of diseases characterized by non-granulomatous inflammation and necrosis of the lymph node, caused by a variety of infective and inflammatory diseases, most common being Kikuchi-Fujimoto disease, acute Epstein Barr viral infection and systemic lupus erythematosis (1). Objectives: To study the morphological features in lymph nodes in cases of necrotizing lymphadenitis, to correlate them with specific etiological conditions.Materials and methods-58 cases of necrotizing lymphadenitis were reviewed and categorized into different etiological sub types, i.e. acute EBV lymphadenitis, lupus lymphadenitis and the rest as Kikuchis lymphadenitis. Morphological features studied were presence of vascular proliferation, periadenitis, foamy macrophage, neutrophil and plasma cell infiltrate. Clinical follow up was done. Results: 62.2% of cases were Kikuchis lymphadenitis. Both lupus and Kikuchis had a female preponderance (78% and 62% respectively). Among the morphological parameters, plasma cell infiltration and vascular proliferation showed significant association with lupus lymphadenitis. Kikuchis and EBV lymphadenitis showed self-limiting course, with only 2 cases of Kikuchis developing recurrence .4 cases developed complications. All cases of lupus lymphadenitis needed long term therapy. Conclusion: Kikuchis lymphadenitis is the most common cause of necrotizing lymphadenitis, followed by lupus and acute EBV lyphadenitis.Young females were commonly affected in the first 2 groups. It is worthwhile to classify the cases of necrotizing lymphadenitis into etiological subgroups as the prognosis and treatment differ (2). Among the morphological features studied, plasma cell infiltrate and vascular proliferation were significantly associated with lupus lymphadenitis, hence can be used to predict etiology.

Estudios genéticos y neurodesarrollo: De la utilidad al modelo genético / Genetic studies and neurodevelopment. From effectiveness to genetic models]

Los avances en la genética han podido apoyar la sospecha que aportaba la experiencia clínica sobre el gran componente hereditario de la mayor parte de estos trastornos del neurodesarrollo (TND). Los estudios iniciales de heredabilidad, ligamiento o asociación evidenciaron desde los inicios la gran contribución de la variación genotípica a la clínica en general, y a los TND en particular. No debe obviarse la utilidad de los estudios genéticos en el ejercicio clínico, encaminados al diagnóstico etiológico. La mayor parte de los mismos están protocolizados en el estudio de trastornos como la discapacidad intelectual y el autismo; dentro de éstos, la hibridación por arrays cromosómicos ha aportado una mayor rentabilidad diagnóstica respecto a técnicas citogenéticas históricas (3 vs. 10% respectivamente). Sin embargo, la irrupción y rentabilidad de técnicas de genética molecular por secuenciación, particularmente la exómica y genómica en trío, analizando a padres, (tasas diagnósticas del 30-50%), están condicionando la modificación de los algoritmos genéticos en el diagnóstico de trastornos graves del neurodesarrollo. El mayor conocimiento de variantes causales de discapacidad intelectual y autismo está igualmente modificando los modelos teóricos poligénicos establecidos hasta la fecha.

Advances in genetics have been able to support the clinical suspicion on the large hereditary component of most of these neurodevelopmental disorders (NDD). Initial studies on heritability, linkage or association showed from the beginning the great contribution of genotypic variation to the clinic in general, and to NDD in particular. The effectiveness of genetic studies in clinical practice, targeted to aetiological diagnosis, should not be ignored. Most of these are protocolized in the study of disorders such as intellectual disability and autism; within these, the array comparative genomic hybridization have supported a greater diagnostic effectiveness with respect to historical cytogenetic techniques (3 vs. 10% respectively). However, the irruption and success of molecular genetic sequencing techniques, particularly the exome and genome in trio, analyzing the parents (diagnostic rates of 30-50%), are conditioning the modification of the genetic algorithms in the diagnosis of different NDD. The greater knowledge of causal variants in intellectual disability and autism is also modifying the polygenic theoretical models established to date.

KIT and Melanoma: Biological Insights and Clinical Implications

Melanoma, originating from epidermal melanocytes, is a heterogeneous disease that has the highest mortality rate among all types of skin cancers. Numerous studies have revealed the cause of this cancer as related to various somatic driver mutations, including alterations in KIT—a proto-oncogene encoding for a transmembrane receptor tyrosine kinase. Although accounting for only 3% of all melanomas, mutations in c-KIT are mostly derived from acral, mucosal, and chronically sun-damaged melanomas. As an important factor for cell differentiation, proliferation, and survival, inhibition of c-KIT has been exploited for clinical trials in advanced melanoma. Here, apart from the molecular background of c-KIT and its cellular functions, we will review the wide distribution of alterations in KIT with a catalogue of more than 40 mutations reported in various articles and case studies. Additionally, we will summarize the association of KIT mutations with clinicopathologic features (age, sex, melanoma subtypes, anatomic location, etc.), and the differences of mutation rate among subgroups. Finally, several therapeutic trials of c-KIT inhibitors, including imatinib, dasatinib, nilotinib, and sunitinib, will be analyzed for their success rates and limitations in advanced melanoma treatment. These not only emphasize c-KIT as an attractive target for personalized melanoma therapy but also propose the requirement for additional investigational studies to develop novel therapeutic trials co-targeting c-KIT and other cytokines such as members of signaling pathways and immune systems.

Enfermedad de mano-pie-boca atípica causada por virus Coxsackie A6 en Argentina, 2015 / Atypical hand, foot, and mouth disease caused by Coxsackievirus A6 in Argentina in 2015

We present two groups of cases of atypical hand, foot, and mouth disease (HFMD) caused by Coxsackievirus A6 (CV-A6) detected in Argentina in 2015. The first group involved 14 patients from Chubut province and the second group affected 12 patients from San Luis province. Molecular analysis of the complete VP1 protein gene revealed the circulation of E2 sublineage, the most predominant worldwide. To our knowledge, this is the first report of CV-A6 infections associated with atypical HFMD in Argentina and South America.

Se describen dos grupos de casos de enfermedad de mano-pie-boca (HFMD) atípica causada por el virus Coxsackie A6 (Coxsackievirus A6, CV-A6) detectados en Argentina en el año 2015. El primero de los grupos involucró a 14 pacientes de Chubut y el segundo a 12 pacientes de San Luis. El análisis molecular del gen de la proteína VP1 completa reveló la circulación del sublinaje E2, el predominante a nivel global. Hasta donde sabemos, este es el primer reporte de infecciones CV-A6 asociadas con HFMD atípica en Argentina y Sudamérica.

Trastorno por déficit de atención/hiperactividad: Hábitos de estudio / Attention deficit/hyperactivity disorder. Study habits

El trastorno por déficit de atención/hiperactividad (TDAH) es uno de los trastornos más prevalentes en la población infanto-juvenil, con un impacto ya conocido sobre el aprendizaje y rendimiento escolar. La falta de atención, la disfunción ejecutiva asociada y los problemas comórbidos -particularmente los relacionados con el aprendizaje y la ansiedad-, condicionan marcadamente este dominio conceptual. Los jóvenes afectos, tienen más problemas para la toma de apuntes, finalización de trabajos, programación escolar y menor motivación al estudio. A pesar de una mayor dedicación al estudio y mayor uso de recursos de apoyo, el fracaso escolar y la no consecución de objetivos curriculares son más frecuentes en estos pacientes. El diagnóstico temprano del TDAH y sus comorbilidades, la intervención psicoeducativa y farmacológica adecuada e individualizada, han demostrado mejorar el pronóstico académico a corto y largo plazo. Para este propósito, es imprescindible la participación activa de profesionales de la salud y la educación.

Attention deficit / hyperactivity disorder (ADHD) is one of the most prevalent disorders in the child-youth population, with a known impact on learning and school performance. Lack of attention, associated executive dysfunction and comorbid problems -particularly those related to learning and anxiety-, strongly determine this conceptual domain. Affected youths have more problems for taking notes, completion of homework, school programming and less motivation to study. Despite greater dedication to homework and greater use of support resources, school failure and non-achievement of curricular objectives are more frequent in these patients. The early diagnosis of ADHD and its comorbidities, the adequate and individualized psychoeducational and pharmacological intervention, have been shown to improve academic prognosis in the short and long term. For this purpose, the active participation of health and education professionals is essential.

Medicinal properties of Angelica archangelica root extract: Cytotoxicity in breast cancer cells and its protective effects against in vivo tumor development / 中西医结合学报

OBJECTIVE@#Although Angelica archangelica is a medicinal and aromatic plant with a long history of use for both medicinal and food purposes, there are no studies regarding the antineoplastic activity of its root. This study aimed to evaluate the cytotoxicity and antitumor effects of the crude extract of A. archangelica root (CEAA) on breast cancer.@*METHODS@#The cytotoxicity of CEAA against breast adenocarcinoma cells (4T1 and MCF-7) was evaluated by a 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. Morphological and biochemical changes were detected by Hoechst 33342/propidium iodide (PI) and annexin V/PI staining. Cytosolic calcium mobilization was evaluated in cells staining with FURA-4NW. Immunoblotting was used to determine the effect of CEAA on anti- and pro-apoptotic proteins (Bcl-2 and Bax, respectively). The 4T1 cell-challenged mice were used for in vivo assay.@*RESULTS@#Using ultra-high-performance liquid chromatography-mass spectrometry analysis, angelicin, a constituent of the roots and leaves of A. archangelica, was found to be the major constituent of the CEAA evaluated in this study (73 µg/mL). The CEAA was cytotoxic for both breast cancer cell lines studied but not for human fibroblasts. Treatment of 4T1 cells with the CEAA increased Bax protein levels accompanied by decreased Bcl-2 expression, in the presence of cleaved caspase-3 and cytosolic calcium mobilization, suggesting mitochondrial involvement in breast cancer cell death induced by the CEAA in this cell line. No changes on the Bcl-2/Bax ratio were observed in CEAA-treated MCF7 cells. Gavage administration of the CEAA (500 mg/kg) to 4T1 cell-challenged mice significantly decreased tumor growth when compared with untreated animals.@*CONCLUSION@#Altogether, our data show the antitumor potential of the CEAA against breast cancer cells in vitro and in vivo. Further research is necessary to better elucidate the pharmacological application of the CEAA in breast cancer therapy.

Antibodies against canine distemper virus, parvovirus and Ehrlichia spp. in wild captive carnivores in midwestern Brazil / Anticorpos contra o vírus da cinomose canina, parvovírus e Ehrlichia spp. em carnívoros selvagens cativos no centro-oeste do Brasil

The occurrence of antibodies against canine distemper virus (CDV), parvovirus and Ehrlichia spp. in wild captive carnivores was evaluated in a zoological park in midwestern Brazil. Serum samples were collected between 2007 and 2014 from 45 carnivores. Antibodies were evaluated by virus neutralization assay for CDV, hemagglutination inhibition test for parvovirus, indirect immunofluorescent and Enzyme-linked immunosorbent assay for Ehrlichia spp. Antibodies against CDV and parvovirus were detected in 75% of Canidae and Felidae. Procyonidae were negative for CDV, although one Mustelidae was positive. TwoCanidae presented antibodies reactive to E. canis antigens. The high antibodies rates to CDV and parvovirus suggest the contact with both pathogens, however since no clinical history of disease are registered in the Zoo-UFMT, we can presume that carnivores have responded satisfactorily against the antigens. The low serological rates observed against Ehrlichia spp. may be resulted to the low occurrence of ticks among carnivores.(AU)

A ocorrência de anticorpos contra o vírus da cinomose canina (CDV), parvovírus e Ehrlichia spp. em carnívoros selvagens em cativeiro foi avaliada em um parque zoológico do centro oeste do Brasil. As amostras de soro foram coletadas entre 2007 e 2014 de 45 carnívoros. Os anticorpos foram avaliados por ensaio de neutralização de vírus para CDV, teste de inibição de hemaglutinação para parvovírus, imunofluorescência indireta e ensaio imunoenzimático ligado à enzima para Ehrlichia spp. Anticorpos contra CDV e parvovírus foram detectados em 75% de canídeos e felídeos. Procionídeos foram negativos para CDV, embora um mustelídeo fora positivo. Dois canídeos apresentaram anticorpos reativos aos antígenos de E. canis. As altas taxas de anticorpos para CDV e parvovírus sugerem o contato com ambos os patógenos, entretanto desde que nenhuma história clínica de doença está registrada no Zoo-UFMT, podemos presumir que os carnívoros têm respondido satisfatoriamente contra os antígenos. As baixas taxas serológicas observadas contra Ehrlichia spp. pode ser resultado da baixa ocorrência de carrapatos entre os carnívoros.(AU)

Fatores de risco associados à prevalência de anticorpos anti-Sarcocystis neurona, Neospora spp. e Toxoplasma gondii em equinos de Roraima, Amazônia / Risk factors associated to the prevalence of anti-Sarcocystis neurona, Neospora spp. and Toxoplasma gondii antibodies in horses from Roraima, Brazilian Amazon

Amostras de sangue de 303 equinos provenientes de 56 propriedades do município de Rorainópolis, Roraima, foram avaliadas por Reação de Imunofluorescência Indireta (RIF) para pesquisa de anticorpos contra Sarcocystis neurona, Toxoplasma gondii e Neospora spp. Algumas amostras de soros positivos para Sarcocystis spp. foram avaliadas pelo Western Blotting (WB) utilizando antígenos crus de S. neurona. A partir dos resultados sorológicos, possíveis fatores de risco foram avaliados frente a variáveis individuais e de propriedade. A prevalência de anticorpos anti-Sarcocystis spp. foi estimada em 43,2% (37,6-49,0%), anti-Neospora sp. em 26,7% (21,9-32,2%) e anti-T. gondii de 18,5% (14,3-23,4%). Quatorze amostras (14/15) testadas por WB resultaram positivas para antígenos de S. neurona. Das propriedades, 76,8% (43/56) apresentaram pelo menos um equino positivo para Sarcocystis spp.; 69,6% (39/56) para Neospora spp. e 55,4% (31/56) para T. gondii. Dos equinos, 13 (4,3%) apresentarem anticorpos para os três agentes, 50 (16,5%) para Sarcocystis spp. e Neospora spp., 10 (3,3%) para Neospora spp. e T. gondii, e oito (2,6%) para Sarcocystis spp. e T. gondii. As variáveis associadas (P≤0,05) à presença de anticorpos foram: para Neospora spp. não pastejar em áreas alugadas, ausência de assistência veterinária na propriedade, sexo masculino, não estabular animais e plantel equino acima de 5 animais; enquanto para T. gondii foram o contato com felinos, animais da raça lavradeiro, animal estabulado, criação de bovinos na propriedade e plantel equino acima de 5 animais. Não houveram variáveis associadas a presença de anticorpos contra S. neurona. Relata-se no presente estudo a primeira detecção de anticorpos anti-S. neurona, Neospora spp. e T. gondii em equinos do estado de Roraima, localizado na Amazônia Setentrional Brasileira, ressaltando para a elevada frequência de fazendas com equinos soropositivos.

Samples of 303 horses from 56 ranches of Rorainópolis municipality, state of Roraima, were evaluated by means of the Indirect Immunofluorescence Test (IFAT) to detect antibodies against Sarcocystis spp., Toxoplasma gondii and Neospora spp. A subset of positive sample (n=15) against Sarcocystis spp. was evaluated by Western Blotting (WB) with crude antigen of S. neurona. From the serological result, possible risk factors were evaluated against individual or farming variables. The prevalence of anti-Sarcocystis spp. antibodies was estimated to be 43.2% (37.6-49.0%), anti-Neospora sp. was 26.7% (21.9-32.2%), and anti-T. gondii was 18.5% (14.3-23.4%). Fourteen samples (14/15) evaluated by WB were positive for S. neurona antigens. From the ranches, 76.8% (43/56) presented at least one positive horse for Sarcocystis spp., 69.6% (39/56) for Neospora spp., and 55.4% (31/56) for T. gondii. Thirteen (14.3%) horses had antibodies against all agents, 50 (16.5%) had antibodies against Sarcocystis spp. and Neospora spp., 10 (3.3%) for Neospora spp. and T. gondii, and eight (2.6%) for Sarcocystis spp. and T. gondii. Associated variables (P≤0.05) for antibodies against Neospora spp. were not found in horses fed on rented pastures, not in horses without veterinary assistance and stables, and not in herds up to 5 horses; while they were associated for T. gondii by contact with cats, in the Lavradeiro breed with use of stables, in horses raise with cattle, and in herds up to 5 horses. There were no variables associated with the presence of antibodies against S. neurona. Antibodies against S. neurona, Neospora spp. and T. gondii were reported in horses from the state of Roraima, Northern Brazilian Amazon, highlighting to the elevate prevalence on ranches.(AU)

Babesiose cerebral em bezerros / Cerebral babesiosis in calves

Babesiose cerebral é uma enfermidade causada pelo protozoário Babesia bovis. O agente faz parte do complexo Tristeza Parasitária Bovina, uma das mais importantes doenças parasitárias em bovinos. O presente estudo relata um surto causado por B. bovis em vinte bezerros de aproximadamente 7 a 25 dias de idade. O surto ocorreu entre março e junho de 2015, na região sul do Brasil, área de instabilidade enzoótica para a Tristeza Parasitária Bovina. O diagnóstico foi realizado pela epidemiologia, lesões macroscópicas e pela presença de numerosas formas parasitárias de Babesia bovis em capilares encefálicos, observados em imprints corados por Giemsa. Surtos de babesiose por B. bovis cerebral nos primeiros dias de vida de bezerros é incomum, porém não pode ser desconsiderada em surtos com alta letalidade em áreas de instabilidade enzoótica.(AU)

Cerebral babesiosis is a protozoan disease caused by Babesia bovis. This parasite belongs to the bovine parasitic complex of tick-borne diseases that affect livestock worldwide. The present study reports an outbreak caused by B. bovis affected twenty 7-25 day-old calves. Outbreak occurred from May to July 2015 in the south of Brazil, where there is an area of enzootic instability for cattle tick fever. The macroscopic lesions were anemia, hemoglobinuria, splenomegaly, hepatomegaly, yellow liver and cherry-pink discoloration of cerebral and cerebellar cortex. The diagnosis was based on epidemiology, necropsy and microscopic findings in the brain that showed B. bovis in the capillary vessels of the brain in imprints stained by Giemsa. Cases of cerebral babesiosis by Babesia bovis in such young calves are uncommon but should be considered as a diagnosis possibility when there is high mortality rate in areas ofen zootic instability.(AU)

Randomized controlled trials - mechanistic studies of testosterone and the cardiovascular system / 亚洲男科学杂志(英文版)

Testosterone deficiency is common in men with cardiovascular disease (CVD), and randomized placebo-controlled trials (RCTs) have reported beneficial effects of testosterone therapy on exercise-induced cardiac ischemia in chronic stable angina, functional exercise capacity, maximum oxygen consumption during exercise (VO2max) and muscle strength in chronic heart failure (CHF), shortening of the Q-T interval, and improvement of some cardiovascular risk factors. Testosterone deficiency is associated with an adverse CV risk profile and mortality. Clinical and scientific studies have provided mechanistic evidence to support and explain the findings of the RCTs. Testosterone is a rapid-onset arterial vasodilator within the coronary circulation and other vascular beds including the pulmonary vasculature and can reduce the overall peripheral systemic vascular resistance. Evidence has demonstrated that testosterone mediates this effect on vascular reactivity through calcium channel blockade (L-calcium channel) and stimulates potassium channel opening by direct nongenomic mechanisms. Testosterone also stimulates repolarization of cardiac myocytes by stimulating the ultra-rapid potassium channel-operated current. Testosterone improves cardiac output, functional exercise capacity, VO2maxand vagally mediated arterial baroreceptor cardiac reflex sensitivity in CHF, and other mechanisms. Independent of the benefit of testosterone on cardiac function, testosterone substitution may also increase skeletal muscle glucose metabolism and enhance muscular strength, both factors that could contribute to the improvement in functional exercise capacity may include improved glucose metabolism and muscle strength. Testosterone improves metabolic CV risk factors including body composition, insulin resistance, and hypercholesterolemia by improving both glucose utilization and lipid metabolism by a combination of genomic and nongenomic actions of glucose uptake and utilization expression of the insulin receptor, glucose transporters, and expression on regulatory enzymes of key metabolic pathways. The effect on high-density lipoprotein-cholesterol (HDL-C) differs between studies in that it has been found to fall, rise, or have no change in levels. Testosterone replacement can suppress the levels of circulating pro-inflammatory cytokines and stimulate the production of interleukin-10 (IL-10) which has anti-inflammatory and anti-atherogenic actions in men with CVD. No effect on C-reactive protein has been detected. No adverse effects on clotting factors have been detected. RCTs have not clearly demonstrated any significant evidence that testosterone improves or adversely affects the surrogate markers of atherosclerosis such as reduction in carotid intima thickness or coronary calcium deposition. Any effect of testosterone on prevention or amelioration of atherosclerosis is likely to occur over years as shown in statin therapy trials and not months as used in testosterone RCTs. The weight of evidence from long-term epidemiological studies supports a protective effect as evidenced by a reduction in major adverse CV events (MACEs) and mortality in studies which have treated men with testosterone deficiency. No RCT where testosterone has been replaced to the normal healthy range has reported a significant benefit or adverse effect on MACE nor has any recent meta-analysis.

Percepciones de un grupo de epidemiólogos en formación acerca de su propia vejez / Perceptions about their own old age from the perspective of a group of epidemiologists in training

RESUMEN Objetivo Explorar desde la mirada de un grupo de epidemiólogos en formación, las percepciones sobre su propia vejez. Material y Métodos Estudio exploratorio, cualitativo - descriptivo, en el cual se hizo aplicación de herramientas etnográficas: observación, diario de campo y entrevista grupal (GF). Resultados El grupo consensuo que programarse para llegar a una vejez funcional y digna es importante, a pesar de las desfavorables y adversas condiciones actuales, reconociendo que no todos lograrán llegar a ella, y que es menos común en los jóvenes pensar y planear su propia vejez, y menos trabajar con y para los viejos. Los significados sobre vejez más frecuentemente referidos por el grupo contienen la palabra "etapa", en cuyo concepto y cuidados se reflejan los altos estándares deseados a nivel individual. Se puso de manifiesto que los hogares para ancianos son necesarios, pero que los servicios prestados son diferenciados pues "la economía determina la atención para el anciano". Conclusión La reflexión acerca de la percepción de la propia vejez, para el grupo de epidemiólogos en formación, ayudó a visualizar sus inquietudes, miedos, expectativas y a reflexionar acerca de su responsabilidad y posibilidades en el aporte de evidencia científica que permita planear y tomar decisiones acertadas para un envejecimiento y vejez dignas de la población nariñense.(AU)

ABSTRACT Objective Exploring, from the perspective of a group of epidemiologists in training, the perceptions about their own old age. Material and Methods Exploratory, qualitative-descriptive study, in which ethnographic tools were applied: observation, field diary and group interview (GF). Resultados Explored from the perspective of a group of epidemiologists in training. The group agreed that to plan to reach a functional and decent old is important, despite the current unfavorable and adverse conditions, recognizing that not all will reach there, and it is less common for young people to think and plan their own old age, and even less work with and for the elderly. The meaning of aging most often mentioned by the group contain the word "phase", in which concept and care reflect the high standards desired individually. It became clear, that nursing homes for old age people are necessary, but the services provided are differentiated since "the economy determines the care for the elderly". Conclusion Reflecting on the perception of old age itself, for the group of epidemiologists in training, helped visualize their concerns, fears, expectations, and to reflect on their responsibilities and possibilities in providing scientific evidence to plan and make sound decisions for a dignified old age and aging of the population from Nariño.(AU)

Next-generation Sequencing-based genomic profiling: Fostering innovation in cancer care?

OBJECTIVES: With the development of next-generation sequencing (NGS) technologies, DNA sequencing has been increasingly utilized in clinical practice. Our goal was to investigate the impact of genomic evaluation on treatment decisions for heavily pretreated patients with metastatic cancer. METHODS: We analyzed metastatic cancer patients from a single institution whose cancers had progressed after all available standard-of-care therapies and whose tumors underwent next-generation sequencing analysis. We determined the percentage of patients who received any therapy directed by the test, and its efficacy. RESULTS: From July 2013 to December 2015, 185 consecutive patients were tested using a commercially available next-generation sequencing-based test, and 157 patients were eligible. Sixty-six patients (42.0%) were female, and 91 (58.0%) were male. The mean age at diagnosis was 52.2 years, and the mean number of pre-test lines of systemic treatment was 2.7. One hundred and seventy-seven patients (95.6%) had at least one identified gene alteration. Twenty-four patients (15.2%) underwent systemic treatment directed by the test result. Of these, one patient had a complete response, four (16.7%) had partial responses, two (8.3%) had stable disease, and 17 (70.8%) had disease progression as the best result. The median progression-free survival time with matched therapy was 1.6 months, and the median overall survival was 10 months. CONCLUSION: We identified a high prevalence of gene alterations using an next-generation sequencing test. Although some benefit was associated with the matched therapy, most of the patients had disease progression as the best response, indicating the limited biological potential and unclear clinical relevance of this practice.