Synthesis and characterization of MoSe2 nanoscrolls via pulsed laser ablation in deep eutectic solvents.

There is ongoing interest in the rapid, reproducible production of 2-dimensional (2-D) transition metal dichalcogenides (TMD), such as molybdenum-based TMD (MoX2), where X is a chalcogen atom such as sulphur (S), selenium (Se) or tellurium (Te), driven by their unique optical and electronic properties. Once fabricated into an atomically thin layer structure, these materials have a direct-indirect bandgap transition, strong spin-orbit coupling, and favourable electronic and mechanical strain-dependent properties which are attractive for electronics. Pulsed laser ablation in liquid (PLAL) is an economic, green alternative for synthesis of TMD. It has been shown that in the case of MoX2, the chemical processes during the plasma phase of the ablation can yield the formation of multispecies, including MoOx quantum dots when oxygen-containing solvents are used. Here, we introduce the formation of MoSe2 nanoscrolls with low oxygen content synthesized via pulsed laser ablation in deep eutectic solvents (PLADES). Our results suggest that the synthesis produces a stable colloidal solution of large 2-D structures with tuneable surface charge by replacing the deep eutectic solvent (DES) with DI water. Nuclear Magnetic Resonance (NMR) results suggest that irradiating the solvent at near infrared NIR energy does not affect its chemical composition. NMR also proves that serial washing can completely remove solvent from the nanostructures. Raman shifts suggest the formation of large, thin MoSe2 nanosheets aided by the solvent confinement resulting from van der Waal forces and hydrogen bonds interactions between MoSe2 and urea. Binding energies measured by X-ray photoelectron spectroscopy (XPS) confirm MoSe2-DES preference to form 1T-MoSe2versus molybdenum oxides and 2H MoSe2 in DI-water. Raman and XPS findings were validated by transmission electron microscopy (TEM) and selected area electron diffraction (SAED). Results of this work validate the use of PLADES for the synthesis of stable, crystalline, low-surface-oxygen-content colloidal MoSe2 nanoscrolls in scalable quantities.

ZnO Decorated Graphene-Based NFC Tag for Personal NO2 Exposure Monitoring during a Workday.

This paper presents the integration of a sensing layer over interdigitated electrodes and an electronic circuit on the same flexible printed circuit board. This integration provides an effective technique to use this design as a wearable gas measuring system in a target application, exhibiting high performance, low power consumption, and being lightweight for on-site monitoring. The wearable system proves the concept of using an NFC tag combined with a chemoresistive gas sensor as a cumulative gas sensor, having the possibility of holding the data for a working day, and completely capturing the exposure of a person to NO2 concentrations. Three different types of sensors were tested, depositing the sensing layers on gold electrodes over Kapton substrate: bare graphene, graphene decorated with 5 wt.% zinc oxide nanoflowers, or nanopillars. The deposited layers were characterized using FESEM, EDX, XRD, and Raman spectroscopy to determine their crystalline structure, morphological and chemical compositions. The gas sensing performance of the sensors was analyzed against NO2 (dry and humid conditions) and other interfering species (dry conditions) to check their sensitivity and selectivity. The resultant-built wearable NFC tag system accumulates the data in a non-volatile memory every minute and has an average low power consumption of 24.9 µW in dynamic operation. Also, it can be easily attached to a work vest.

Operative Management Improves Near-term Survival of Patients With Odontoid Type II Fractures: A Propensity-matched National Registry Analysis.

STUDY DESIGN: National Trauma Data Bank (NTDB) review and propensity-matched analysis. OBJECTIVE: To evaluate differences in clinical outcomes by operative management. SUMMARY OF BACKGROUND DATA: Odontoid type II fractures are the most prevalent cervical fracture. Operative intervention on these fractures is frequently debated; surgical risks are compounded by clinical severity, patient age, and comorbidities. METHODS: This registry review included index admissions for odontoid type II fractures [International Classification of Diseases (ICD)-10 codes beginning with S12.11] from 1/1/2017 to 1/1/2020; patients who died in the emergency department (ED) were excluded. Propensity score techniques were used to match patients 1:1 by surgical management, using a caliper distance of 0.05, after matching on the following covariates that differed significantly between surgical and nonsurgical patients: age, sex, race, cause of injury, transfer status, injury severity score, ED Glasgow coma score, ED systolic blood pressure, presence of transverse ligamentous injury, cervical dislocation, and 8 comorbidities. The following outcomes were analyzed with McNemar tests and Wilcoxon signed-rank tests: near-term survival (discharged from the hospital to locations other than morgue or hospice), intensive care unit (ICU) admission, hospital complications, median hospital length of stay (LOS), and median ICU LOS. RESULTS: There were 16,607 patients, 2916 (17.6%) were operatively managed and 13,691 were nonoperatively managed. Before matching, survival was greater for patients managed operatively compared with nonoperatively (95.0% vs. 88.2%). The matched population consisted of 5334 patients: 2667 patients in the operative group (91.5% of this population) and 2667 well-matched patients in the nonoperative group. After matching, there was a survival benefit for patients who were operatively managed compared with nonoperative management (94.8% vs. 91.4% P <0.001). However, operative management was associated with greater development of complications, ICU admission, and longer hospital and ICU LOS. CONCLUSION: Compared with nonoperative management, operative management demonstrated a significant near-term survival benefit for patients with odontoid type II fractures in select patients. LEVEL OF EVIDENCE: III.

Análisis de la mortalidad por cáncer en México utilizando los resultados del Global Burden of Disease 2021 / Analysis of cancer mortality in Mexico using the results of the Global Burden of Disease 2021 study

Resumen Antecedentes: En México, las tasas de mortalidad por cáncer han experimentado cambios a lo largo de las últimas décadas. Objetivo: Analizar la evolución de las tasas de mortalidad por cáncer en México entre 1990 y 2021. Materiales y métodos: Del Global Burden of Disease (GBD) se obtuvieron las tasas de mortalidad de los 10 tipos de cáncer más predominantes en México, en el ámbito nacional y por estados, considerando distintos grupos etarios y el sexo. En el GBD se reasignan las causas mal clasificadas y se distribuyen entre los distintos cánceres; posteriormente se modelan y ajustan las causas al total de fallecimientos con un modelo de conjunto de causas de muerte y un corrector de causas, con lo cual se corrigen registros de mortalidad del INEGI. Resultados: La tasa de mortalidad por cáncer pasó de 117.87 en 1990 a 84.18 en 2021. En las mujeres, los cánceres de mama, cervicouterino, estómago y pulmón fueron los más frecuentes; en los hombres, de próstata, estómago, pulmón, colon y recto. Destacó la disminución de la mortalidad por cáncer en hombres y mujeres, en particular por cáncer de pulmón y cérvix uterino. Conclusiones: Los resultados ofrecen información para desarrollar políticas de salud y estrategias de prevención y control específicas para enfrentar el impacto del cáncer en México.

Abstract Background: In Mexico, cancer mortality rates have undergone changes over the past decades. Objective: To analyze the evolution of cancer mortality rates in Mexico between 1990 and 2021. Materials and methods: Based on the Global Burden of Disease study, the mortality rates for the 10 most prevalent types of cancer in Mexico were obtained, at the national and regional level and by states, considering different age groups and gender. Global Burden of Disease reassigns misclassified causes and distributes them among different types of cancer; subsequently, it models and adjusts the causes to the total number of deaths with a model of a set of causes of death and a cause corrector, which corrects INEGI’s mortality records. Results: The cancer mortality rate went from 117.87 in 1990 to 84.18 in 2021. In women, breast, cervical, stomach and lung cancers were the most frequent. In men, the most common were prostate, stomach, lung, and colon and rectum cancer. The decrease in cancer mortality for men and women stood out, particularly from lung and cervical cancer. Conclusions: The results provide information for the development of health policies and specific prevention and control strategies to address the impact of cancer in Mexico.

Epidemiology of C2 fractures and determinants of surgical management: analysis of a national registry.

Objective: Operative management of axis fractures (C2) usually depend on the stability and location of the break and individual patient characteristics. We sought to describe the epidemiology of C2 fractures and hypothesized that determinants for surgery would differ by fracture diagnosis. Methods: Patients with C2 fractures were identified from the US National Trauma Data Bank from January 1, 2017, to January 1, 2020. Patients were classified by C2 fracture diagnosis: odontoid type II, odontoid types I and III, and non-odontoid fracture (hangman's fracture or fractures through base of the axis). The primary comparison was C2 fracture surgery versus non-operative management. Multivariate logistic regression was used to identify independent associations with surgery. Decision tree-based models were developed to identify determinants for surgery. Results: There were 38 080 patients; 42.7% had an odontoid type II fracture; 16.5% had an odontoid type I/III fracture; and 40.8% had a non-odontoid fracture. All examined patient demographics, clinical characteristics, outcomes, and interventions differed by C2 fracture diagnosis. Overall, 5292 (13.9%) were surgically managed (17.5% odontoid type II, 11.0% odontoid type I/III, and 11.2% non-odontoid; p<0.001). The following covariates increased odds of surgery for all three fracture diagnoses: younger age, treatment at a level I trauma center, fracture displacement, cervical ligament sprain, and cervical subluxation. Determinants of surgery differed by fracture diagnosis: for odontoid type II, age ≤80 years, a displaced fracture, and cervical ligament sprain were determinants; for odontoid type I/III, age ≤85 years, a displaced fracture, and cervical subluxation were determinants; for non-odontoid fractures, cervical subluxation and cervical ligament sprain were the strongest determinants for surgery, by hierarchy. Conclusions: This is the largest published study of C2 fractures and current surgical management in the USA. Odontoid fractures, regardless of type, had age and fracture displacement as the strongest determinants for surgical management, whereas associated injuries were determinants of surgery for non-odontoid fractures. Level of evidence: III.

Anti-kelchlike protein 11 antibody-associated encephalitis: Two case reports and review of the literature.

BACKGROUND AND PURPOSE: Kelchlike protein 11 antibodies (KLHL11-IgGs) were first described in 2019 as a marker of paraneoplastic neurological syndromes (PNSs). They have mostly been associated with testicular germ cell tumors (tGCTs). METHODS: Two patients with KLHL11-IgG encephalitis are reported, and the literature is comprehensively reviewed. RESULTS: Patient 1 had been in remission from a tGCT 10 years prior. He developed episodic vertigo and diplopia progressing over a few days. Treatment with corticosteroids (CSs) was started a few days after symptom onset. Patient 2 had transient diplopia, which resolved spontaneously. Visual problems persisted for 7 months, when he additionally developed a progressive cerebellar syndrome. One year after onset, CS treatment was started. Initial magnetic resonance imaging was unremarkable in both patients, but analysis of cerebrospinal fluid (CSF) revealed chronic inflammation. KLHL11-IgG was positive in both patients (Patient 1 only in CSF, Patient 2 in serum). Neoplastic screening has so far not revealed any signs of active underlying malignancy. We found 15 publications of 112 patients in total with KLHL11-IgG encephalitis. Most patients (n = 82) had a cerebellar syndrome with or without signs of rhombencephalitis. The most common symptoms were ataxia (n = 82) and vertigo (n = 47), followed by oculomotor disturbances (n = 35) and hearing disorders (n = 31). Eighty of 84 patients had a GCT as an underlying tumor. CONCLUSIONS: Our cases demonstrate classical symptoms of KLHL11-IgG encephalitis. Early diagnosis and therapy are imperative. As with other PNSs, clinical awareness is needed and further studies are required especially in regard to therapeutic management.

Anti-neurochondrin antibody as a biomarker in primary autoimmune cerebellar ataxia-a case report and review of the literature.

BACKGROUND AND PURPOSE: Neuronal autoantibodies can support the diagnosis of primary autoimmune cerebellar ataxia (PACA). Knowledge of PACA is still sparce. This article aims to highlight the relevance of anti-neurochondrin antibodies and possible therapeutical consequences in people with PACA. METHODS: This is a case presentation and literature review of PACA associated with anti-neurochondrin antibodies. RESULTS: A 33-year-old man noticed reduced control of the right leg in May 2020. During his first clinic appointment at our institution in September 2021, he complained about gait imbalance, fine motor disorders, tremor, intermittent diplopia and slurred speech. He presented a pancerebellar syndrome with stance, gait and limb ataxia, scanning speech and oculomotor dysfunction. Within 3 months the symptoms progressed. An initial cerebral magnetic resonance imaging, June 2020, was normal, but follow-up imaging in October 2021 and July 2022 revealed marked cerebellar atrophy (29% volume loss). Cerebrospinal fluid analysis showed lymphocytic pleocytosis of 11 x 103 /L (normal range 0-4) and oligoclonal bands type II. Anti-neurochondrin antibodies (immunoglobulin G) were detected in serum (1:10,000) and cerebrospinal fluid (1:320, by cell-based indirect immunofluorescence assay and immunoblot, analysed by the EUROIMMUN laboratory). After ruling out alternative causes and neoplasia, diagnosis of PACA was given and immunotherapy (steroids and cyclophosphamide) was started in January 2022. In March 2022 a stabilization of disease was observed. CONCLUSION: Cerebellar ataxia associated with anti-neurochondrin antibodies has only been described in 19 cases; however, the number of unrecognized PACAs may be higher. As anti-neurochondrin antibodies target an intracellular antigen and exhibit a mainly cytotoxic T-cell-mediated pathogenesis, important therapeutic implications may result. Because of the severe and rapid clinical progression, aggressive immunotherapy was warranted. This case highlights the need for rapid diagnosis and therapy in PACA, as stabilization and even improvement of symptoms are attainable.

Deep DNA sequencing of MGMT, TP53 and AGT in Mexican astrocytoma patients identifies an excess of genetic variants in women and a predictive biomarker.

PURPOSE: Astrocytomas are a type of malignant brain tumor with an unfavorable clinical course. The impact of AGT and MGMT somatic variants in the prognosis of astrocytoma is unknown, and it is controversial for TP53. Moreover, there is a lack of knowledge regarding the molecular characteristics of astrocytomas in Mexican patients. METHODS: We studied 48 Mexican patients, men and women, with astrocytoma (discovery cohort). We performed DNA deep sequencing in tumor samples, targeting AGT, MGMT and TP53, and we studied MGMT gene promoter methylation status. Then we compared our findings to a cohort which included data from patients with astrocytoma from The Cancer Genome Atlas (validation cohort). RESULTS: In the discovery cohort, we found a higher number of somatic variants in AGT and MGMT than in the validation cohort (10.4% vs < 1%, p < 0.001), and, in both cohorts, we observed only women carried variants AGT variants. We also found that the presence of either MGMT variant or promoter methylation was associated to better survival and response to chemotherapy, and, in conjunction with TP53 variants, to progression-free survival. CONCLUSIONS: The occurrence of AGT variants only in women expands our knowledge about the molecular differences in astrocytoma between men and women. The increased prevalence of AGT and MGMT variants in the discovery cohort also points towards possible distinctions in the molecular landscape of astrocytoma among populations. Our findings warrant further study.

Analysis of cancer mortality in Mexico using the results of the Global Burden of Disease 2021 study.

BACKGROUND: In Mexico, cancer mortality rates have undergone changes over the past decades. OBJECTIVE: To analyze the evolution of cancer mortality rates in Mexico between 1990 and 2021. MATERIALS AND METHODS: Based on the Global Burden of Disease study, the mortality rates for the 10 most prevalent types of cancer in Mexico were obtained, at the national and regional level and by states, considering different age groups and gender. Global Burden of Disease reassigns misclassified causes and distributes them among different types of cancer; subsequently, it models and adjusts the causes to the total number of deaths with a model of a set of causes of death and a cause corrector, which corrects INEGI's mortality records. RESULTS: The cancer mortality rate went from 117.87 in 1990 to 84.18 in 2021. In women, breast, cervical, stomach and lung cancers were the most frequent. In men, the most common were prostate, stomach, lung, and colon and rectum cancer. The decrease in cancer mortality for men and women stood out, particularly from lung and cervical cancer. CONCLUSIONS: The results provide information for the development of health policies and specific prevention and control strategies to address the impact of cancer in Mexico.

ANTECEDENTES: En México, las tasas de mortalidad por cáncer han experimentado cambios a lo largo de las últimas décadas. OBJETIVO: Analizar la evolución de las tasas de mortalidad por cáncer en México entre 1990 y 2021. MATERIALES Y MÉTODOS: Del Global Burden of Disease (GBD) se obtuvieron las tasas de mortalidad de los 10 tipos de cáncer más predominantes en México, en el ámbito nacional y por estados, considerando distintos grupos etarios y el sexo. En el GBD se reasignan las causas mal clasificadas y se distribuyen entre los distintos cánceres; posteriormente se modelan y ajustan las causas al total de fallecimientos con un modelo de conjunto de causas de muerte y un corrector de causas, con lo cual se corrigen registros de mortalidad del INEGI. RESULTADOS: La tasa de mortalidad por cáncer pasó de 117.87 en 1990 a 84.18 en 2021. En las mujeres, los cánceres de mama, cervicouterino, estómago y pulmón fueron los más frecuentes; en los hombres, de próstata, estómago, pulmón, colon y recto. Destacó la disminución de la mortalidad por cáncer en hombres y mujeres, en particular por cáncer de pulmón y cérvix uterino. CONCLUSIONES: Los resultados ofrecen información para desarrollar políticas de salud y estrategias de prevención y control específicas para enfrentar el impacto del cáncer en México.

COVID-19 Exposure Unmasking Systemic Amyloidosis With Hepatic Predominance.

Amyloidosis is characterized by depositing insoluble fibrillar proteins that misfold into beta-pleated sheets. This phenomenon occurs on a systemic or local level and may interfere with the function of various organs, including the heart, kidneys, and liver. Among those presenting with amyloidosis, hepatic, gastrointestinal, renal, cardiac, vitreous, and immunological involvement may occur. These manifestations are linked to several clinical presentations, varying from abdominal pain and hepatomegaly to restrictive cardiomyopathy and chronic renal failure. The two most common types of amyloid proteins are amyloid light chain (AL) and serum amyloid A (AA) proteins. AL produced by immunoglobulin light chains kappa and lambda (κ, λ) circulate systemically and accumulate in organs. At the same time, serum AA proteins are acute-phase reactants seen in infectious, chronic inflammatory states. In an immune-mediated infection such as COVID-19, serum AA levels may be a predictive factor of disease severity and a valuable biomarker to monitor the clinical course of COVID-19 patients. This report highlights a case in which infection with COVID-19 provoked an effective immune response that may have contributed to the accelerated progression of systemic amyloidosis with hepatic involvement. The study further investigates the involvement of AL and AA proteins in COVID-19 infections, including their role in synergistically exacerbating an already grueling clinical course.

Correlation between intracranial pressure monitoring for severe traumatic brain injury with hospital length of stay and discharge disposition: a retrospective observational cohort study.

OBJECTIVES: Intracranial pressure (ICP) monitoring is recommended for severe traumatic brain injuries (TBI) but some data suggests it may not improve outcomes. The objective was to investigate the effect of ICP monitoring among TBI. METHODS: This retrospective observational cohort study (1/1/2015-6/1/2020) included severe TBI patients. Outcomes [discharge destination, length of stay (LOS)] were compared by ICP monitoring and were stratified by GCS (3 vs. 4-8), α < 0.05. RESULTS: Of the123 patients who met inclusion criteria, 47% received ICP monitoring. There were baseline differences in the two groups characteristics, ICP monitored patients were younger (p = 0.02), had a subarachnoid hemorrhage less often (p = 0.04), and a subdural hematoma more often (p = 0.04) than those without ICP monitors. ICP monitored patients had a significantly longer median LOS (12 vs. 3, p < 0.01) than patients without monitoring. There was a trend towards more ICP monitored patients discharged home (40% vs. 23%, p = 0.06). Among patients with GCS = 3, ICP monitored patients had a longer LOS (p < 0.01) with no significant differences in discharge destinations. For those with a GCS of 4-8, ICP monitoring was associated with a longer LOS (p = 0.01), but fewer were discharged to a skilled nursing facility or long-term care (p = 0.01). CONCLUSIONS: For TBI patients, ICP monitoring was associated with an increased LOS, with no significant differences in discharge destinations when compared to those without ICP monitoring. However, among only those with a GCS of 4-8, ICP monitoring was associated with a decreased proportion of patients discharged to a skilled nursing facility or long-term acute care .

Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy.

Background and Purpose: Clots rich in platelets and fibrin retrieved from patients with acute ischemic stroke (AIS) have been shown to be independently associated with the absence of the susceptibility vessel sign (SVS) on MRI and active malignancy. This study analyzed the association of SVS and the presence of active malignancy in patients with AIS who underwent mechanical thrombectomy (MT). Methods: This single-center, retrospective, and cross-sectional study included consecutive patients with AIS with admission MRI treated with MT between January 2010 and December 2018. SVS status was evaluated on susceptibility-weighted imaging. Adjusted odds ratios (aORs) were calculated to determine the association between absent SVS and the presence of active or occult malignancy. The performance of predictive models incorporating and excluding SVS status was compared using areas under the receiver operating characteristics curve (auROC). Results: Of 577 patients with AIS with assessable SVS status, 40 (6.9%) had a documented active malignancy and 72 (12.5%) showed no SVS. The absence of SVS was associated with active malignancy (aOR 4.85, 95% CI 1.94-12.11) or occult malignancy (aOR 11.42, 95% CI 2.36-55.20). The auROC of predictive models, including demographics and common malignancy biomarkers, was higher but not significant (0.85 vs. 0.81, p = 0.07) when SVS status was included. Conclusion: Absence of SVS on admission MRI of patients with AIS undergoing MT is associated with malignancy, regardless of whether known or occult. Therefore, the SVS might be helpful in detecting paraneoplastic coagulation disorders and occult malignancy in patients with AIS.

Lung cancer mortality trends in Mexico, 1998-2018: the impact of the General Law on Tobacco Control.

OBJECTIVE: The aim of this study was to describe trends in lung cancer (LC) mortality and trends in tobacco use. METHODS: This is an ecological time-series study to determine mortality trends due to lung cancer resulting from tobacco consumption, based on secondary open-access sources, such as the National Surveys. Smoking prevalence, tobacco use trends, mortality rates, and percentage were determined by LC. The mortality trend from LC was calculated, and a linear regression analysis was performed to evaluate the impact of the General Law for Tobacco Control. RESULTS: The prevalence of tobacco use decreased steadily between 1988 and 2015, particularly in men. Mortality rates and percentage decreased between 1998 and 2018. During this period, the mortality rate decreased from 6.3 to 5.4 per 100,000 population (-0.032/100,000 each year, p<0.001), with a net decrease of 0.9 per 100,000. We observe increases in mortality in women in the central and southeastern regions. Of 32 states, 18 showed a tendency to loss (p<0.005). The rate of change for men was -0.24, with a total reduction of 2.17 before the introduction of the laws and -0.32 after their introduction, a total reduction of 3.24 (p<0.005). Women showed no reduction. CONCLUSIONS: Mortality rates showed a limited decrease. Strategies need to be strengthened, mainly in the central and southeastern regions, and to focus on the control of tobacco use by women.

Lung cancer mortality trends in Mexico, 1998-2018: the impact of the General Law on Tobacco Control / Tendências de mortalidade por câncer de pulmão no México, 1998-2018: o impacto da Lei Geral de Controle do Tabaco

ABSTRACT: Objective: The aim of this study was to describe trends in lung cancer (LC) mortality and trends in tobacco use. Methods: This is an ecological time-series study to determine mortality trends due to lung cancer resulting from tobacco consumption, based on secondary open-access sources, such as the National Surveys. Smoking prevalence, tobacco use trends, mortality rates, and percentage were determined by LC. The mortality trend from LC was calculated, and a linear regression analysis was performed to evaluate the impact of the General Law for Tobacco Control. Results: The prevalence of tobacco use decreased steadily between 1988 and 2015, particularly in men. Mortality rates and percentage decreased between 1998 and 2018. During this period, the mortality rate decreased from 6.3 to 5.4 per 100,000 population (−0.032/100,000 each year, p<0.001), with a net decrease of 0.9 per 100,000. We observe increases in mortality in women in the central and southeastern regions. Of 32 states, 18 showed a tendency to loss (p<0.005). The rate of change for men was −0.24, with a total reduction of 2.17 before the introduction of the laws and −0.32 after their introduction, a total reduction of 3.24 (p<0.005). Women showed no reduction. Conclusions: Mortality rates showed a limited decrease. Strategies need to be strengthened, mainly in the central and southeastern regions, and to focus on the control of tobacco use by women.

RESUMO: Objetivos: Descrever tendências na mortalidade por câncer de pulmão e no uso do tabaco. Métodos: Realizamos um estudo ecológico de séries temporais para determinar a tendência de mortalidade por câncer de pulmão de acordo com o consumo de tabaco, com base em fontes secundárias de acesso aberto, como as Pesquisas Nacionais. Prevalência de tabagismo, tendências de uso de tabaco, porcentagem e taxas de mortalidade foram determinadas pelo câncer de pulmão. A tendência de mortalidade por câncer de pulmão foi calculada e uma análise de regressão linear foi realizada para avaliar o impacto da lei geral para o controle do tabagismo. Resultados: A prevalência do uso de tabaco diminuiu continuamente entre 1988 e 2015, principalmente em homens. As taxas e percentuais de mortalidade diminuíram entre 1998 e 2018. Durante esse período, a taxa de mortalidade diminuiu de 6,3 para 5,4 por 100 mil habitantes (-0,032 por 100 mil a cada ano, p<0,001), com redução líquida de 0,9 por 100 mil. Observamos aumentos na mortalidade de mulheres nas regiões Centro e Sudeste. Dos 32 estados, 18 apresentaram tendência à perda (p<0,005). A taxa de mudança para os homens foi de -0,24, com redução total de 2,17 antes da introdução das leis e -0,32 após a sua introdução — redução total de 3,24 (p<0,005). As mulheres não apresentaram redução. Conclusões: As taxas de mortalidade mostraram redução limitada. Estratégias precisam ser fortalecidas, principalmente nas regiões Centro e Sudeste, e deve-se enfocar o controle do uso do tabaco pelas mulheres.

Hemi-central retinal vein occlusion as a rare manifestation of the hypercoagulable state in COVID-19.

To date, COVID-19 has no definite effective targeted therapy, and management is primarily supportive. Central retinal vein occlusion (CRVO) is frequently caused by systemic risk factors posing hypercoagulable states. In April 2020, a female patient with a history of hypertension, diabetes mellitus and chronic kidney disease presented with 2 days of loose, watery stools, nasal congestion and severe lethargy. The patient denied dyspnoea or fever. A week after the initial symptoms, the patient reported decreased vision from the left eye. Dilated funduscopy and fluorescein angiography suggested hemi-CRVO. The patient refused intravitreal antivascular endothelial growth factor agents because of non-severe visual loss. Testing was positive for COVID-19 IgG antibodies; reverse transcription PCR was not available. Vision improved within 3 weeks of presentation. We recommend that clinicians keep a high suspicion for acute onset of thrombotic events in patients with COVID-19 and thrombotic predisposing risk factors.

Fulminant Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis After 10 Years of Hydralazine Use.

Vasculitis, by definition, causes changes in the walls of blood vessels, including thickening, weakening, narrowing, and scarring, leading to inflammation and necrosis of the blood vessel walls. Small-vessel vasculitis is commonly associated with anti-neutrophil cytoplasmic antibodies (ANCA), which activate cytokine-primed neutrophils and monocytes that express ANCA antigens proteinase 3 (PR3) and myeloperoxidase (MPO) on their surface. The continuous injury and inflammation of these small vessels characterized by circulating immune complexes and antinuclear antibodies result in clinical features standard in all types of vasculitis. When a 59-year-old male with a history of heart failure, hypertension (on hydralazine 100 mg every eight hours for more than ten years), diabetes mellitus, and dyslipidemia presented to the hospital, he was complaining of hematuria, intermittent periumbilical abdominal pain, and 40-lb weight loss over four months. Initial evaluation showed symptomatic anemia and large blood cells with proteinuria on urine analysis. During his clinical course, the patient developed a new diffuse purpuric rash. Imaging showed systemic involvement with ground-glass opacities, diffuse alveolar hemorrhage, and peripancreatic inflammatory changes, consistent with small-vessel vasculitis. Immunological tests confirmed ANCA-associated vasculitis, and kidney biopsy showed ANCA-mediated pauci-immune glomerulonephritis supported by the salvage technique used by pronase immunofluorescence, which provides evidence against the glomerular disease of the complex immune type in the setting of MPO-ANCA seropositivity. Despite the withdrawal of hydralazine and prompt initiation of immunosuppressive therapy and alternating sessions of plasmapheresis, the patient succumbed to acute massive pulmonary hemorrhage and subsequent demise. We recommend that patients on the common antihypertensive, hydralazine, should be monitored with non-specific inflammatory markers and, if warranted, with qualitative and quantitative assessment tools to measure inflammatory disease activity for possible complications of hydralazine drug-induced vasculitis or hydralazine ANCA-associated vasculitis (HAAV). Furthermore, cumulative dosages may be a predisposing factor for HAAV to present as a pulmonary-renal syndrome, which can be fulminant and fatal, despite aggressive efforts. Therefore, screening, revisiting therapy, early diagnosis, and prompt discontinuation of the drug are imperative.

Kinetics of HE4 and CA125 as prognosis biomarkers during neoadjuvant chemotherapy in advanced epithelial ovarian cancer.

BACKGROUND: Ovarian cancer (OC) is considered the most lethal gynecological cancer, of which more than 65% cases are diagnosed in advanced stages, requiring platinum-based neoadjuvant chemotherapy (NACT). METHODS: A prospective-longitudinal study was conducted among women with advanced epithelial ovarian cancer (AEOC), III and IV stages, and treated with NACT, at the National Cancer Institute - Mexico, from July 2017 to July 2018. Serum samples were obtained for quantification of CA125 and HE4 using ELISA at the first and in each of the three NACT cycles. The therapeutic response was evaluated through standard tomography. We determined whether CA125 and HE4, alone or in combination, were associated with TR to NACT during follow up. RESULTS: 53 patients aged 38 to 79 years were included, 92.4% presented papillary serous subtype OC. Higher serum HE4 levels were observed in patients with non-tomographic response (6.89 vs 5.19 pmol/mL; p = 0.031), specially during the second (p = 0.039) and third cycle of NACT (p = 0.031). Multivariate-adjusted models showed an association between HE4 levels and TR, from the second treatment cycle (p = 0.042) to the third cycle (p = 0.033). Changes from baseline HE4 levels during the first cycle was negative associated with TR. No associations were found between CA125 and TR. CONCLUSIONS: Serum HE4 levels were independently associated with TR among patients with AOEC treated with NACT, also a reduction between baseline HE4 and first chemotherapy levels was also independently associated with the TR. These findings might be relevant for predicting a lack of response to treatment.

"Two for One", Novel Dual Left Anterior Descending Artery (LAD) Variant: Type XIII.

Dual left anterior descending artery (LAD) is a rare phenomenon that occurs in less than one percent of the population. To date, 12 variants have been identified. Proper identification of coronary vessels is crucial in emergent situations that require prompt action, such as percutaneous coronary intervention (PCI). We propose that our case highlights a novel 13th (type XIII) variant. We present the case of a 57-year-old African American woman with a past medical history of hypertension, glaucoma, cerebral vascular accident, dyslipidemia who presented to the ED complaining of atypical chest pain for one day duration. Electrocardiography showed normal sinus rhythm at 60 beats per minute (bpm), normal axis, normal intervals, no acute ischemic changes, and an isolated T wave inversion in DIII. Cardiac markers were within normal limits. The patient was started on aspirin 81mg, atorvastatin 40mg, and restarted on amlodipine 5mg. Echocardiography showed a left ventricular ejection fraction (LVEF): 65%, normal right ventricular size and systolic function, mild mitral valve regurgitation, and mild aortic regurgitation. Computed tomographic (CT) angiography showed a novel subtype of dual LAD, the left circumflex and right coronary arteries were patent. The patient was discharged once stabilized and advised to follow up with cardiology. Dual LAD describes a rare anatomic variant in which two coronary branches, known as short and long LAD arteries, supply the territory normally supplied by the solitary LAD artery. To date, 12 variants of dual LAD, classified by origin and course of the short and long LAD arteries, have been described in the literature. To the best of our knowledge, the current case describes a novel subtype of dual LAD, variant XIII. The LAD originates as usual from the left main coronary artery (LMCA) and initially runs in the anterior interventricular groove for a short course before bifurcating into two long LADs which both leave the interventricular groove and course out to the apex. One of the vessels courses laterally and the other courses medially of the interventricular groove. It is pertinent to identify the coronary vessels accurately before certain interventions are taken. Acknowledgement of this phenomenon can help guide accurate management in the future for patients with this condition.