Metastasis of melanoma in non-sentinel nodes in patients with metastatic sentinel node. Can we avoid complementary lymphadenectomy?

BACKGROUND: Lymph mapping with sentinel node biopsy is the standard procedure for lymph node staging in patients with cutaneous melanoma with a tumor thickness of 1 mm or greater. Patients who have metastases in sentinel node must undergo complementary lymphadenectomy; however, it has not been shown to improve survival. OBJECTIVE: To know the prevalence in our setting of metastases in the product of complementary lymphadenectomy in patients with metastatic sentinel node. METHOD: Evaluation of a descriptive, retrospective, observational and analytical cohort of patients with metastatic sentinel node submitted to lymphadenectomy. Multivariate analysis of tumor thickness, neural invasion, location, sentinel node number, serum DHL level, lymph nodes dissected and extracapsular spread. RESULTS: 67 patients, 35 women and 32 men with a mean of 66 years, 22% had metastases in lymph nodes from complementary lymphadenectomy, 19% of them with extracapsular spread; no relationship with the Breslow level. Extracapsular spread in the sentinel node, lymphadenectomy time, and perineural invasion in the primary tumor were prognostic factors for non-sentinel node metastasis. CONCLUSIONS: In this series, 22% of the patients with a sentinel node-positive have metastases in the non-sentinel nodes, 19% of them with extracapsular spread, which justifies complementary lymphadenectomy.

ANTECEDENTES: El mapeo linfático con biopsia del ganglio centinela es el procedimiento estándar de estadificación ganglionar en pacientes con melanoma cutáneo con grosor tumoral de 1 mm o mayor. Los pacientes que tienen metástasis en él deben ser sometidos a linfadenectomía complementaria; sin embargo, esta no ha mostrado mejorar la superviviencia. OBJETIVO: Conocer la prevalencia en nuestro medio de metástasis en el producto de linfadenectomía complementaria en pacientes con ganglio centinela metastásico. MÉTODO: Evaluación de una cohorte descriptiva, retrospectiva, observacional y analítica de pacientes con ganglio centinela metastásico sometidos a linfadenectomía, con análisis multivariado de grosor tumoral, invasión neural, localización, número de ganglios centinela, concentración sérica de deshidrogenasa láctica, ganglios disecados en linfadenectomía y ruptura capsular. RESULTADOS: Hubo 67 pacientes (35 mujeres y 32 hombres), con una media de 66 años de edad, en el 22% hubo metástasis en ganglios de linfadenectomía complementaria y en el 19% ruptura capsular; sin relación con el nivel de Breslow. La ruptura capsular en el ganglio centinela, el tiempo de linfadenectomía y la invasión perineural fueron factores pronóstico de metástasis en ganglios no centinela. CONCLUSIONES: En esta serie, el 22% de los pacientes tuvieron metástasis en ganglios no centinela, el 19% de ellos con ruptura capsular, lo cual justifica la linfadenectomía complementaria.

Ganglion cell layer thinning in diabetic patients without retinopathy: related or unrelated to total macular thickness?

PURPOSE: Reduction of ganglion cell layer thickness may occur in diabetic patients without retinopathy. The relationships of this preclinical finding with retinal thickness or reduced parafoveal vessel density have not been established. This study investigated the relationships of ganglion cell layer thickness with retinal thickness and parafoveal vessel density in patients with and without diabetes. METHODS: This was an observational, cross-sectional, prospective study that used optical coherence tomography angiography to compare non-diabetic patients (group 1) with diabetic patients without retinopathy (group 2). Ganglion cell layer thickness, macular thickness, and parafoveal vessel density (central, inner, and complete) medians were compared between groups (Mann-Whitney U test), and their relationships were assessed in each group (Spearman Rho test). RESULTS: In total, 68 eyes were included in this study: 34 in group 1 and 34 in group 2. Ganglion cell layer thickness did not differ between groups in any sector. There were strong positive correlations between fields 2 (superior parafoveal), 3 (temporal parafoveal), and 4 (inferior parafoveal) of the optical coherence tomography macular thickness map and the ganglion cell layer thickness in all sectors in both groups. Central vessel density mean was lower in diabetic patients. In group 1 alone, thickness changes in the inferior and nasal inferior ganglion cell layer sectors were partially explained by inner vessel density (r2=0.32 and r2=0.27). CONCLUSIONS: Mean ganglion cell layer thickness was not lower in diabetic patients without retinopathy than in non-diabetic patients. Moreover, it exhibited a substantial correlation with total macular thickness. Parafoveal vessel density decreased before ganglion cell layer thinning was observed.

Ganglion cell layer thinning in diabetic patients without retinopathy: related or unrelated to total macular thickness? / Afinamento da camada de células ganglionares em pacientes diabéticos sem retinopatia: relacionados ou não à espessura macular total?

ABSTRACT Purpose: Reduction of ganglion cell layer thickness may occur in diabetic patients without retinopathy. The relationships of this preclinical finding with retinal thickness or reduced parafoveal vessel density have not been established. This study investigated the relationships of ganglion cell layer thickness with retinal thickness and parafoveal vessel density in patients with and without diabetes. Methods: This was an observational, cross-sectional, prospective study that used optical coherence tomography angiography to compare non-diabetic patients (group 1) with diabetic patients without retinopathy (group 2). Ganglion cell layer thickness, macular thickness, and parafoveal vessel density (central, inner, and complete) medians were compared between groups (Mann-Whitney U test), and their relationships were assessed in each group (Spearman Rho test). Results: In total, 68 eyes were included in this study: 34 in group 1 and 34 in group 2. Ganglion cell layer thickness did not differ between groups in any sector. There were strong positive correlations between fields 2 (superior parafoveal), 3 (temporal parafoveal), and 4 (inferior parafoveal) of the optical coherence tomography macular thickness map and the ganglion cell layer thickness in all sectors in both groups. Central vessel density mean was lower in diabetic patients. In group 1 alone, thickness changes in the inferior and nasal inferior ganglion cell layer sectors were partially explained by inner vessel density (r2=0.32 and r2=0.27). Conclusions: Mean ganglion cell layer thickness was not lower in diabetic patients without retinopathy than in non-diabetic patients. Moreover, it exhibited a substantial correlation with total macular thickness. Parafoveal vessel density decreased before ganglion cell layer thinning was observed.

RESUMO Objetivo: Pode ocorrer redução da espessura da camada de células ganglionares em pacientes diabéticos sem retinopatia. As relações desse achado pré-clínico com a espessura da retina ou a densidade reduzida de vasos parafoveais não foram estabelecidas. Este estudo investigou as relações da espessura da camada de células ganglionares com a espessura da retina e densidade dos vasos parafoveais em pacientes com e sem diabetes. Métodos: Estudo prospectivo, observacional, transversal que utilizou angiotomografia de coerência óptica para comparar pacientes não diabéticos (grupo 1) com pacientes diabéticos sem retinopatia (grupo 2). As médias da espessura da camada de células ganglionares, espessura macular e densidade dos vasos parafoveais (central, interno e completo) foram comparadas entre os grupos (teste U de Mann-Whitney) e suas relações foram avaliadas em cada grupo (Teste de Spearman Rho). Resultados: No total, 68 olhos foram incluídos neste estudo: 34 no grupo 1 e 34 no grupo 2. A espessura da camada de células ganglionares não diferiu entre os grupos em nenhum setor. Houve fortes correlações positivas entre os campos 2 (parafoveal superior), 3 (parafoveal temporal) e 4 (parafoveal inferior) do mapa da espessura macular da tomografia de coerência óptica e a espessura da camada de células ganglionares em todos os setores dos dois grupos. A média da densidade central dos vasos foi menor nos pacientes diabéticos. Somente no grupo 1, as alterações de espessura da camada de células ganglionares nos setores inferior e nasal inferior foram parcialmente explicadas pela densidade do vaso interno (r2=0,32 e r2=0,27). Conclusões: A média da espessura da camada de células ganglionares não foi menor em pacientes diabéticos sem retinopatia do que em pacientes não diabéticos. Além disso, exibiu uma correlação substancial com a espessura macular total. A densidade dos vasos parafoveais diminui antes do desbaste da camada de células ganglionares.

Circularity of the foveal avascular zone and its correlation with parafoveal vessel density, in subjects with and without diabetes.

PURPOSE: To characterize the distribution of the foveal avascular zone circularity and its correlation with parafoveal vessel density, in subjects with and without diabetes. METHODS: Observational, descriptive, cross-sectional, and prospective study; subjects without diabetes (Group 1), with diabetes without retinopathy (Group 2), or with diabetic retinopathy (Group 3) were included. Means of foveal avascular zone circularity and parafoveal vessel density were compared between groups (Kruskal-Wallis) and their correlation was calculated with Spearman's Rho test. RESULTS: Seventy-seven eyes; central vessel density mean was higher in Group 1 than in Group 2 and higher in Group 2 than in Group 3; inner and complete vessel density means were also higher in Group 2 than in Group 3. The mean of the foveal avascular zone circularity did not differ between groups, and in Group 3 it had a positive correlation with central (0.45), inner (0.56), and complete (0.53) vessel densities. CONCLUSIONS: Circularity does not differ between subjects with diabetes, with and without retinopathy, and has only a low correlation with parafoveal vessel density in people with diabetic retinopathy, which does not allow anticipating a reduction of vessel density in this disease.

OBJETIVO: Caracterizar la distribución de la circularidad de la zona avascular foveal y su correlación con la densidad vascular perifoveal, en sujetos con y sin diabetes. MÉTODO: Estudio observacional, descriptivo, transversal y prospectivo; se incluyeron sujetos sin diabetes (Grupo 1), con diabetes sin retinopatía (Grupo 2) y con retinopatía diabética (Grupo 3). Los promedios de circularidad de la zona avascular foveal y de la densidad vascular parafoveal se compararon entre grupos (Kruskal-Wallis), y se calculó su correlación mediante la prueba Rho de Spearman. RESULTADOS: Se estudiaron 77 ojos. El promedio de la densidad vascular central fue mayor en el Grupo 1 que en el Grupo 2, y mayor en el Grupo 2 que en el Grupo 3. Los promedios de la densidad vascular interna y completa también fueron mayores en el Grupo 2 que en el Grupo 3. El promedio de la circularidad de la zona avascular foveal no difirió entre grupos, y en el Grupo 3 tuvo una correlación positiva con la densidad vascular central (0.45), interna (0.56) y completa (0.53). CONCLUSIONES: La circularidad no difiere entre sujetos con y sin diabetes, con y sin retinopatía, y solo tiene una baja correlación con la densidad vascular parafoveal en sujetos con retinopatía diabética, lo cual no permite anticipar una reducción de la densidad vascular en esta enfermedad.

Reduction of foveal sensitivity in diabetic macular edema with visual acuity 20/20.

OBJECTIVE: To compare foveal sensitivity in eyes with and without diabetic macular edema, with 20/20 visual acuity. METHODS: Non-experimental, comparative, prospective, cross sectional study in eyes with and without retinopathy and focal macular edema, with 20/20 visual acuity. The sample was divided in 3 groups: (1) non-diabetic subjects, (2) diabetics without retinopathy, and 3) diabetics with non-proliferative retinopathy and clinically significant macular edema. Median foveal sensitivity was compared between groups (Kruskal Wallis test). RESULTS: 86 eyes (28 in group 1, 26 in group 2 and 32 in group (3). Medians shown a statistical difference between groups (p = 0.001). Median foveal sensitivity was significantly lower in group 3 than in group 1 (p = 0.001) and than in group 2 (p = 0.03). Median foveal sensitivity did not differ between groups 1 and 2 (p = 0.10). CONCLUSION: Foveal sensitivity in diabetic macular edema and visual acuity 20/20 is lower in eyes with center sparing clinically significant macular edema and 20/20 visual acuity. The prognostic value of this dysfunction requires evaluation, in order to learn whether early treatment is required in these eyes.

OBJETIVO: Comparar la sensibilidad foveal en ojos con y sin edema macular diabético, con agudeza visual 20/20. MÉTODO: Estudio observacional, comparativo, transversal y prospectivo, en ojos con y sin retinopatía y edema macular focal, con agudeza visual 20/20. La muestra se dividió en tres grupos: 1) sujetos sin diabetes, 2) diabéticos sin retinopatía, y 3) diabéticos con retinopatía diabética no proliferativa y edema macular focal. Se compararon las medianas de la sensibilidad foveal entre grupos mediante la prueba de Kruskal-Wallis. RESULTADOS: Se evaluaron 86 ojos (28 del grupo 1, 26 del 2 y 32 del 3). La comparación de medianas mostró una diferencia significativa entre grupos (p = 0.001). La sensibilidad foveal fue significativamente menor en el grupo 3 que en el grupo 1 (p = 0.001) y que en el grupo 2 (p = 0.03). La mediana de la sensibilidad foveal no difirió entre los grupos 1 y 2 (p = 0.10). CONCLUSIÓN: La sensibilidad foveal en el edema macular diabético con agudeza visual 20/20 es menor en ojos con edema macular clínicamente significativo sin engrosamiento del centro de la mácula y agudeza visual 20/20. Determinar el valor pronóstico de esta disfunción requiere una evaluación adicional para identificar si se necesita tratamiento temprano en estos ojos.

Should the outcome of focal photocoagulation for center-sparing diabetic macular edema require expanding the definition of center involvement?

Photocoagulation may still be a therapeutic choice for center-sparing diabetic macular edema. We compared the visual evolution after photocoagulation, in eyes with focal diabetic macular edema, stratified per the location of thickening with optical coherence tomography. We evaluated people with type 2 diabetes and focal diabetic macular edema, before and three weeks after focal photocoagulation. We divided the sample by edema location: central (group1); paracentral (group 2) and pericentral (group 3) and compared the proportions of eyes with baseline visual impairment, visual improvement, and visual deterioration between groups; central edema was evaluated with logistic regression, as an explaining variable of baseline visual impairment and visual improvement. The study included 160 eyes: 77 in group 1, 20 in group 2, 63 in group 3; baseline visual impairment was more frequent in groups 1 and 2 (52.6%) than in group 3 (28.6%, p = 0.002, OR 2.77) and as common in groups 1 (51.9%) and 2 (55.0%, p = 0.8). The proportions of visual improvement and visual deterioration did not differ between groups (p > 0.05). The outcome after focal photocoagulation was similar in paracentral (considered center-sparing) and central macular edema; the definition of center involvement, which needs intravitreal antiangiogenics, should expand to include paracentral thickening.

[Sensibilidad foveal en ojos con edema macular diabético con y sin engrosamiento temporal perifoveal]. / Foveal sensitivity in eyes with diabetic macular edema with and without temporal perifoveal thickening.

BACKGROUND: Visual improvement after photocoagulation in focal diabetic macular edema is more frequent when temporal perifoveal area is not affected; functional status before treatment could be worse in eyes with perifoveal temporal thickening. The correlation between visual acuity and foveal sensitivity (usually significant), would allow to compare macular function. OBJECTIVE: To compare the correlation between retinal sensitivity and visual acuity in eyes with diabetic macular edema, with and without temporal perifoveal thickening. METHOD: Non-experimental, retrospective, comparative, cross-sectional study in type 2 diabetics with macular edema. The correlation between foveal sensitivity and visual acuity was compared in eyes without temporal perifoveal thickening (group 1) and eyes with it (group 2). Multiple regression analysis was used to identify the contribution of foveal sensitivity to the changes of visual acuity; other variables were: center point thickness, center field thickness, temporal perifoveal thickness and macular volume. RESULTS: 60 eyes in group 1, 29 eyes in group 2. Mean sensitivity did no differ between groups (30.0 ± 0.59 vs. 28.4 ± 1.05 dB; p = 0.2), but the correlation between sensitivity and visual acuity did it (group 1, rho: -0.41; group 2, rho: -0.25). In group 1, foveal sensitivity was the only explaining variable of the regression model (beta: -0.52), in group 2 no one explaining variable was included and temporal perifoveal thickness had a negative correlation with foveal sensitivity (rho: -0.60). CONCLUSIONS: Temporal perifoveal thickening reduces the correlation between foveal sensitivity and visual acuity in eyes with diabetic macular edema.

OBJETIVO: Comparar la correlación entre la sensibilidad foveal y la agudeza visual en ojos con edema macular diabético, con y sin engrosamiento temporal perifoveal, característica asociada con mala respuesta terapéutica. MÉTODO: Estudio observacional, prospectivo, comparativo, transversal, en diabéticos con edema macular. Se comparó la correlación entre la sensibilidad foveal y la agudeza visual entre ojos sin (grupo 1) y con (grupo 2) engrosamiento temporal perifoveal (Rho de Spearman). Mediante regresión múltiple se determinó la contribución de la sensibilidad a los cambios de agudeza visual. Se evaluaron también los grosores del punto central y temporal perifoveal, y el volumen macular. RESULTADOS: 60 ojos del grupo 1, 29 ojos del grupo 2. El promedio de sensibilidad no difirió entre grupos (30.0 ± 0.59 vs. 28.4 ± 1.05 dB; p = 0.2), pero la correlación entre sensibilidad y agudeza visual sí (grupo 1, rho: −0.41; grupo 2, rho: −0.25). En el grupo 1, la sensibilidad fue la variable explicativa de la agudeza visual (beta: −0.52); en el grupo 2, ninguna variable se incluyó en el modelo y el grosor temporal perifoveal correlacionó inversamente con la sensibilidad (rho: −0.60). CONCLUSIONES: el engrosamiento temporal perifoveal reduce la correlación entre la agudeza visual y la sensibilidad foveal en ojos con edema macular diabético.

HPV Could be a Potential Factor of Survival in Laryngeal Cancer: a Preliminary Study in Mexican Patients

Introduction: In Head and Neck (HN) cancer, the High-Risk Human Papillomavirus (hr HPV) infection has been associated in about 40% of these tumors. The hr HPV infection is one of the etiological factors of several epithelial tumors; however, its association with the prognosis has not yet been established for patients with Laryngeal Squamous Cell Carcinoma (LSCC). On the other hand, Epidermal Growth Factor Receptor (EGFR) is a molecular marker widely studied in cancer and its overexpression has been associated with poor prognosis in some types of cancer, including the HN cancer. In the present study, we analyzed EGFR expression and HPV detection in a cohort of Mexican patients with LSCC and define their association with clinical-pathological and survival parameters. Methods: EGFR expression analysis was performed by immunohistochemistry assay. A tissue array was constructed based on 30 paraffin-embedded tissue samples. HPV detection was performed by PCR. The results were then compared with the clinical-pathological variables and outcome measures (Kaplan Meier and Cox analysis). Results: High expression of EGFR was observed in 43% of the samples and 20% of HPV detection. The statistical analyses provided evidence of disassociation between clinical-pathological parameters and EGFR expression, but there was an association with poor prognosis. Interestingly, HPV detection is slightly associated with good prognosis. Conclusion: Both, EGFR overexpression and HPV presence could be associated with an unfavorable prognosis in patients with LSCC, independently of other clinical-pathological factors.

[Frequency of cervical epithelial lesions reported in the Regional Laboratory of Exfoliative Cytology in Jalisco]. / Frecuencia de lesiones epiteliales cervicales reportadas en el Laboratorio Regional de Citología Exfoliativa de Jalisco.

BACKGROUND: The Official Mexican Norm for the prevention, treatment and control of Cervical Cancer (CC) indicates that the Papanicolau (Pap) is the procedure for the detection of this neoplasia; therefore, it is of interest to know the prevalence of suspected cases by this technique in Mexican population. In this study, we show the diagnosed cases in the State of Jalisco, México. METHODS: A retrospective study was made to the samples that arrived for their analysis to the Laboratorio Regional de Citología Exfoliativa (LARCE), of the Instituto Mexicano del Seguro Social (IMSS) in Guadalajara, Jalisco. We considered all cases from January 2010 to December 2012. RESULTS: We analyzed 188 095 cases, from which 5.3 % had a diagnosis of low dysplasia, 0.18 % of moderated dysplasia and 0.05 % of high dysplasia. Microinvasive and invasive cancer showed a low frequency (0.03 %). CONCLUSIONS: The frequency of abnormal findings identified by vaginal cervical cytology is relatively low. The number of inadequate and limited samples for cytological assessment is high; there is a high proportion of women attending for the first time in life to cytology evaluation in older age groups.

Introducción: La Norma Oficial Mexicana para la prevención, tratamiento y control del Cáncer Cérvico Uterino (CaCU) indica que el Papanicolaou (Pap) es el procedimiento de elección para la detección oportuna de esta neoplasia, por lo que es de interés conocer la prevalencia de casos tamizados mediante esta técnica en la población mexicana. En la presente investigación se muestran los casos que se identificaron como sospecha para CaCU por tamizaje en el estado de Jalisco, México. Métodos: se realizó un estudio retrospectivo de las muestras que llegaron para su análisis al Laboratorio Regional de Citología Exfoliativa (LARCE) del Instituto Mexicano del Seguro Social (IMSS) en Guadalajara, Jalisco. Se consideraron todos los casos de enero de 2010 a diciembre de 2012. Resultados: se analizaron 188 095 casos, de los cuales el 5.3 % se reportaron con sospecha de displasia leve, el 0.18 % de displasia moderada y el 0.05 % de displasia grave. En cáncer microinvasor e invasor se observó una baja frecuencia (0.03 %). Conclusiones: la frecuencia de hallazgos anormales identificados por citología cervicovaginal es relativamente baja. El número de muestras inadecuadas más limitadas para valoración citológica es alto; existe una elevada proporción de mujeres que asisten por primera vez en la vida a estudio citológico en grupos de edad avanzados.

[Epidemiological overview of uterine cervical cancer]. / Panorama epidemiológico del cáncer cervicouterino.

The World Health Organization (WHO) reported more than 6 million cases of cancer worldwide in women during 2008; 57.2 % of those cases occurred in less developed countries. Cervical cancer (CC) ranks third in the world in all cancers affecting women, with an estimated of 530 000 new cases. CC has multiple causes and it arises by the association of various risk factors. The main factor is related to the human papillomavirus infection (HPV), which acts as a necessary but not sufficient cause. Also, the interaction with other cofactors has an impact on the development and severity of this neoplasm. Survival is related to the timeliness of care and, therefore, to more access to health services. CC is a neoplasm considered a preventable cancer; thus, it is possible to save more than 150 000 lives by 2030 if control measures are applied with opportunity. The aim of this work is to review the CC in different geographical areas and to make an analysis of risk factors related to this neoplasm.

La Organización Mundial de la Salud (OMS) reportó en 2008 más de 6 millones de casos de cáncer en mujeres; el 57.2 % de esos casos ocurrió en países menos desarrollados. El cáncer cervicouterino (CaCU) ocupa el tercer lugar de las neoplasias malignas que afectan a la mujer, con un número estimado de 530 000 casos nuevos. El CaCU es multicausal y obedece a la asociación de diferentes factores de riesgo. El principal de ellos es la infección por virus de papiloma humano (VPH), que actúa como una causa necesaria pero no suficiente. Asimismo, la interacción con otros cofactores incide en el desarrollo y la severidad de esta neoplasia. La sobrevida se encuentra relacionada con la oportunidad de atención y por lo tanto con mayor accesibilidad a los servicios de salud. El CaCU es una neoplasia considerada como un cáncer prevenible, así que es factible salvar más de 150 mil vidas para 2030 si las medidas de control se aplican con oportunidad. El objetivo de este trabajo es revisar el comportamiento del CaCU en diferentes ámbitos geográficos, así como realizar un análisis de los factores de riesgo relacionados con esta neoplasia.

Variation and genetic structure in Platanus mexicana (Platanaceae) along riparian altitudinal gradient.

Platanus mexicana is a dominant arboreal species of riparian ecosystems. These ecosystems are associated with altitudinal gradients that can generate genetic differences in the species, especially in the extremes of the distribution. However, studies on the altitudinal effect on genetic variation to riparian species are scarce. In Mexico, the population of P. mexicana along the Colipa River (Veracruz State) grows below its reported minimum altitude range, possibly the lowest where this tree grows. This suggests that altitude might be an important factor in population genetics differentiation. We examined the genetic variation and population structuring at four sites with different altitudes (70, 200, 600 and 1700 m a.s.l.) using ten inter-simple sequence repeats (ISSR) markers. The highest value for Shannon index and Nei's gene diversity was obtained at 1700 m a.s.l. (He = 0.27, Ne = 1.47, I = 0.42) and polymorphism reached the top value at the middle altitude (% p = 88.57). Analysis of molecular variance (AMOVA) and STRUCTURE analysis indicated intrapopulation genetic differentiation. The arithmetic average (UPGMA) dendrogram identified 70 m a.s.l. as the most genetically distant site. The genetic structuring resulted from limited gene flow and genetic drift. This is the first report of genetic variation in populations of P. mexicana in Mexico. This research highlights its importance as a dominant species, and its ecological and evolutionary implications in altitudinal gradients of riparian ecosystems.

Human papillomavirus genotypes among females in Mexico: a study from the Mexican institute for social security.

BACKGROUND: The aetiological relationship between human papillomavirus (HPV) infection and cervical cancer (CC) is widely accepted. Our goal was to determine the prevalence of HPV types in Mexican women attending at the Mexican Institute for Social Security from different areas of Mexico. MATERIALS AND METHODS: DNAs from 2,956 cervical samples were subjected to HPV genotyping: 1,020 samples with normal cytology, 931 with low-grade squamous intraepithelial lesions (LGSIL), 481 with high grade HGSIL and 524 CC. RESULTS: Overall HPV prevalence was 67.1%. A total of 40 HPV types were found; HPV16 was detected in 39.4% of the HPV-positive samples followed by HPV18 at 7.5%, HPV31 at 7.1%, HPV59 at 4.9%, and HPV58 at 3.2%. HPV16 presented the highest prevalence both in women with altered or normal cytology and HPV 18 presented a minor prevalence as reported worldwide. The prevalence ratio (PR) was calculated for the HPV types. The analysis of PR showed that HPV16 presents the highest association with CC, HPV 31, -33, -45, -52 and -58 also demonstrating a high association. CONCLUSIONS: The most prevalent HPV types in cervical cancer samples were -16, -18, -31, but it is important to note that we obtained a minor prevalence of HPV18 as reported worldwide, and that HPV58 and -52 also were genotypes with an important prevalence in CC samples. Determination of HPV genotypes is very important in order to evaluate the impact of vaccine introduction and future cervical cancer prevention strategies.

Ent-trachyloban-19-oic acid isolated from Iostephane heterophylla as a promising antibacterial agent against Streptococcus mutans biofilms.

From the roots of Iostephane heterophylla, six known compounds, namely, ent-trachyloban-19-oic acid (1), the mixture of ent-kaur-16-en-19-oic acid (2) and ent-beyer-15-en-19-oic acid (3), xanthorrhizol (4), 16α-hydroxy-ent-kaurane (5) and 16α-hydroxy-ent-kaur-11-en-19-oic acid (6) were isolated using a bioassay-guided fractionation method. The known compounds (1-6) were identified by comparison of their spectroscopic data with reported values in the literature. In an attempt to increase the resultant antimicrobial activity of 1 and 4, a series of reactions was performed on ent-trachyloban-19-oic acid (1) and xanthorrhizol (4), to obtain derivatives 1a, 1b, and 4a-4d. All the isolated compounds (1-6) and the derivatives 1a, 1b, and 4a-4d were evaluated for their antimicrobial activity against two oral pathogens, Streptococcus mutans and Porphyromonas gingivalis associated with caries and periodontal disease, respectively. Compounds 1, 1b, 2+3, 4 and 4d inhibited the growth of S. mutans with concentrations ranging from 4.1 µg/mL to 70.5 µg/mL. No significant activity was found on P. gingivalis except for 4 with an MIC of 6.8 µg/mL. The ability of 1, 1b, 2+3, 4 and 4d to inhibit biofilm formation by S. mutans was evaluated. It was found that 1, 1b, 4 and 4d interfered with the establishment of S. mutans biofilms, inhibiting their development at 32.5, 125.0, 14.1 and 24.4 µg/mL, respectively.

Human leukocyte antigens I and II haplotypes associated with human papillomavirus 16-positive invasive cervical cancer in Mexican women.

Infection with human papillomavirus (HPV), mainly HPV type 16, is the major etiologic factor associated with cervical cancer (CC), but HPV infection alone is not sufficient for progression of precursor lesions. Host genetic susceptibility may lead to abnormal immune response resulting from virus persistence. Several studies have suggested a possible association with specific human leukocyte antigen (HLA) class I and II alleles and CC, but results are not consistent. The association of genetic HLA class I (A and B) and HLA class II (DR*B1 and DQ*B1) haplotypes with HPV16-positive CC (n = 104) and base population controls (n = 104) was evaluated in this Mexican population study. Sequence-specific primer HLA genes were determined by polymerase chain reaction (PCR)-based methods in peripheral blood cell counts (PCR sequence-specific oligonucleotides). The cervical swabs of 208 women were tested for HPV16 by Hybrid Capture II. Allele and haplotype HLA frequencies, Hardy-Weinberg tests, and a haplotype homogeneity test were estimated using the Arlequin software v. 3.01. Odds ratio (OR) was calculated to compare cases and control women. Consistent associations across other studies in women with CC and infected by HPV16 were observed for HLA-DRB1*15 (OR, 3.9; 95% CI, 1.6-10.2) and the haplotype DRB1*15 DQB1*0602 (OR, 4.1; 95% CI, 1.4-12.7) compared with control women. The HLA-A2-B44-DR4-DQ*0302, HLA-A24-B35-DR16-DQ*0301, and HLA-A2-B40-DR4-DQ*0302 haplotypes showed a positive association with CC (OR, >1), whereas HLA-A2-B39-DR4-DQ*0302, HLA-A24-B35-DR4-DQ*0302, and HLA-A68-B40-DR4-DQ*0302 showed a negative association (OR, <1). These results support the hypothesis that some HLA class I and II haplotypes could be involved with susceptibility for developing CC.

[Global expression analysis in uterine cervical cancer: metabolic pathways and altered genes]. / Análisis de expresión global del cáncer cérvico uterino: rutas metabólicas y genes alterados.

High risk human papillomavirus (HPV) infection is considered to be the most important etiological factor of Cervical Uterine Cancer. In order to determine the global expression pattern and to identify possible molecular markers of cervical cancer, cDNA arrays with probe sets complementary to 8,000 human genes were used to examine the expression profiles among 5 cell lines derived from human cervical cancer, three HPV16(+) tumor samples and three normal cervical tissues HPV(-). The levels of expression of different cellular processes were identified. Hierarchical clustering was performed and the gene expression using RT-PCR was confirmed. Two genes were found to be consistently overexpressed in invasive cervical cancer biopsies; one of them, IL-6 was previously reported to be overexpressed in cervical cancer and one novel gene, MMP10, previously not known to be related to cervical cancer. Hierarchical clustering of the expression data revealed that samples with common HPV type infection grouped together, maybe this could mean that differences between HPV types could be indirectly determined by expression profiles.

Análisis de expresión global del cáncer cérvico uterino: rutas metabólicas y genes alterados / Global expression analysis in uterine cervical cancer: Metabolic pathways and altered genes

High risk human papillomavirus (HPV) infection is considered to be the most important etiological factor of Cervical Uterine Cancer. In order to determine the global expression pattern and to identify possible molecular markers of cervical cancer, cDNA arrays with probe sets complementary to 8,000 human genes were used to examine the expression profiles among 5 cell lines derived from human cervical cancer, three HPV16(+) tumor samples and three normal cervical tissues HPV(-). The levels of expression of different cellular processes were identified. Hierarchical clustering was performed and the gene expression using RT-PCR was confirmed. Two genes were found to be consistently overexpressed in invasive cervical cancer biopsies; one of them, IL-6 was previously reported to be overexpressed in cervical cancer and one novel gene, MMP10, previously not known to be related to cervical cancer. Hierarchical clustering of the expression data revealed that samples with common HPV type infection grouped together, maybe this could mean that differences between HPV types could be indirectly determined by expression profiles.

La infección por virus de papiloma de alto riesgo (VPH) es considerada como el factor etiológico más importante del cáncer cérvico uterino (CaCU). Con el fin de determinar el patrón de expresión global e identificar algunos posibles genes marcadores del CaCU, se utilizaron microhileras de DNA que contenían 8,000 secuencias que codificaban para transcritos diferentes, para estudiar los perfiles de expresión de cinco líneas celulares derivadas de CaCU, tres muestras tumorales conteniendo VPH 16 y tres muestras normales negativas para la presencia de VPH. Se identificaron los niveles de expresión de genes relacionados con diferentes rutas metabólicas. Se llevó a cabo el análisis de agrupamiento jerárquico y posteriormente se confirmó la sobrexpresión de dos genes mediante RT-PCR. Estos dos genes se encontraron sobrexpresados en biopsias tumorales cervicales. Uno de ellos, el gen de IL6, que ha sido previamente reportado en relación con CaCU, así como el gen de la matriz-metaloproteasa 10 (MMP10) por primera vez relacionado con esta neoplasia. El análisis de agrupamiento jerárquico, además, reveló que las muestras que contienen el mismo tipo viral están asociadas, sugiriendo posibles diferencias en expresión entre tipos virales.

Association between high-risk human papillomavirus DNA load and precursor lesions of cervical cancer in Mexican women.

OBJECTIVE: Our objective was to determine the association between viral load of high risk human papilloma virus (HPV) using the Hybrid Capture II (HC II) system and cervical intraepithelial neoplasia (CIN) lesion stage. METHODS: A total of 182 consecutive women with confirmed diagnoses of CIN 1-3 and 182 healthy women with negative Pap were included. All subjects underwent structured interviews focused on socioeconomic and reproductive factors. HC II testing was used to detect human papilloma virus (HPV) DNA. Viral load was measured by light measurements expressed as relative lights unit (RLU) ratio (specimens/control). Log(10)RLU ratios were categorized for analysis into four groups: negative (

Determinación de plastificantes en alimentos / Determination of plasticizers in foods

Se estudió la migración del dioctiladipato en quesos y embutidos envueltos en películas de PVC flexible y del dioctilftalato en refrescos y cervezas envasados en botellas de cristal con retapas de plastisol. Los valores de migración del dioctilftalato estuvieron entre 0,09 y 0,40 mg/L, lo cual no constituye un riesgo para la salud por estar muy por debajo del límite máximo permisible para este plastificantre. Los valores de la migración del dioctiladipato estuvieron entre 341,5 y 677,7 mg/kg en los embutidos y entre 822,9 y 1 450,2 mg/kg en los quesos, en relación directa con el contenido de grasa. No se detectaron cambios organolépticos significativos en estos alimentos atribuibles al dioctiladi. A pesar de que la migración resulta elevada, no se puede asegurar que esto pueda constituir un riesgo para la salud, ya que no existen datos suficientes sobre la toxicidad de este compuesto. Se recomienda continuar el uso de estos materiales de envase manteniendo un control sanitario sobre los mismos

Determinación de plastificantes en alimentos / Determination of plasticizers in foods

Se estudió la migración del dioctiladipato en quesos y embutidos envueltos en películas de PVC flexible y del dioctilftalato en refrescos y cervezas envasados en botellas de cristal con retapas de plastisol. Los valores de migración del dioctilftalato estuvieron entre 0,09 y 0,40 mg/L, lo cual no constituye un riesgo para la salud por estar muy por debajo del límite máximo permisible para este plastificantre. Los valores de la migración del dioctiladipato estuvieron entre 341,5 y 677,7 mg/kg en los embutidos y entre 822,9 y 1 450,2 mg/kg en los quesos, en relación directa con el contenido de grasa. No se detectaron cambios organolépticos significativos en estos alimentos atribuibles al dioctiladi. A pesar de que la migración resulta elevada, no se puede asegurar que esto pueda constituir un riesgo para la salud, ya que no existen datos suficientes sobre la toxicidad de este compuesto. Se recomienda continuar el uso de estos materiales de envase manteniendo un control sanitario sobre los mismos

Meniscectomía en niños: nuestra experiencia / Meniscectomy in children: our experience

Generalmente las lesiones de los meniscos no son frecuentes en el niño, y raramente son traumáticas. Se ha comprobado que los resultados del tratamiento quirúrgico están influídos por el sexo, lesión del menisco interno y la duración de ésta. Sin embargo, nuestra casuística durante cuatro años fue de 12 pacientes que necesitaron el tratamiento quirúrgico, y alos cuales se les realizó la meniscectomía total y su estudio anatomopatológico. Se puede señalar que las lesiones del menisco se presentan de 12 a 14 años fundamentalmente, y en el sexo femenino (83,33%); que el menisco interno fue el más lesionado (66,67%), al igual que predominó la causa traumática. Los resultados obtenidos se catalogan de satisfactorios