Prevalencia de infecciones asociadas al donante en receptores de trasplante pulmonar

Resumen La complicación infecciosa es la más frecuente posterior a un trasplante. Existe una limitada descripción respecto a la prevalencia de infecciones asociadas al donante (IAD) en receptores de trasplante de pulmón (TxP). Hay reportes de dicha situación de un 7,6%, con documentación de fracaso profiláctico de 5,6%. Objetivo: estimar la frecuencia de infecciones asociadas al donante tras el TxP y su desenlace en términos de supervivencia global (SG). Materiales y métodos: estudio observacional, descriptivo, llevado a cabo en un centro trasplante de Argentina entre los meses de enero 2018 a junio 2020. Se incluyó a todos los pacientes trasplantados en dicho intervalo, y se contabilizaron a todos aquellos con IAD definida/probada. Resultados: en el periodo antedicho se realizaron 65 TxP en 64 individuos (un caso se realizó trasplante y posterior retrasplante en el mismo periodo de estudio). La mediana de edad fue de 39 (12 - 72) años. La fibrosis quística constituyó el principal motivo de TxP (26,2%). En 61/65 (94%) se aislaron gérmenes de muestras biológicas procedentes del donante: en el líquido de conservación 78,6%, secreciones del donante 73,7%, muestras quirúrgicas 21,3% y en hemocultivos 4,9%. Se identificaron IAD en 2/61 casos (prevalencia de 3,1%; IC 95% 0,4-10,7%), con una mediana de SG postrasplante de 12 meses, y una SG del 98,4% (IC 95% 91,7 - 99,9%). Conclusión: la prevalencia de IAD en receptores de TxP en la presente serie fue del 3,1%, superior a lo documentado en trasplantes de órganos sólidos en general (< 1%), aunque menor a la encontrada en los pocos reportes publicados (7,6%).

Prevalence of Donor-Associated Infections in Lung Transplant Recipients

Abstract The infectious complication is the most common condition after a transplantation. There is a limited description regarding the preva lence of donor-associated infections (DAIs) in lung transplant (LTx) recipients. There are reports of DAIs in LTx recipients of 7.6%, with documented prophylactic failure of 5.6%. Objective: to estimate the frequency of donor-associated infections after lung transplantation and their outcome in terms of overall survival (OS). Methodology: an observational, descriptive study, carried out in a transplant center in Argentina between January 2018 and June 2020. The study included all the patients who underwent a transplantation within such period and those with defined/proven DAIs. Results: during the aforementioned period, 65 LTx were performed in 64 individuals (one patient underwent transplantation and subsequent retransplantation in the same study period). The median age was 39 (12-72) years. Cystic fibrosis was the main reason for transplantation (26.2%) In 61/65 cases (94%), germs were isolated from biological samples collected from the donor: 78.6% in the preservation liquid, 73.7% in donor secretions, 21.3% surgical samples, and 4.9% blood cultures. Donor-associated infections were identified in 2/61 cases (prevalence of 3.1%; 95% CI: 0.4-10.7%), with a median posttransplant OS of 12 months, and an OS of 98.4% (95% CI: 91.7-99.9%). Conclusion: the prevalence of DAIs in LTx recipients in the present series was 3.1%: higher than the figures documented for solid organ transplants in general (< 1%), but lower than the numbers found in the few published reports (7.6%).

Caveolin-1-dependent nanoscale organization of the BCR regulates B cell tolerance.

Caveolin-1 (Cav1) regulates the nanoscale organization and compartmentalization of the plasma membrane. Here we found that Cav1 controlled the distribution of nanoclusters of isotype-specific B cell antigen receptors (BCRs) on the surface of B cells. In mature B cells stimulated with antigen, the immunoglobulin M BCR (IgM-BCR) gained access to lipid domains enriched for GM1 glycolipids, by a process that was dependent on the phosphorylation of Cav1 by the Src family of kinases. Antigen-induced reorganization of nanoclusters of IgM-BCRs and IgD-BCRs regulated BCR signaling in vivo. In immature Cav1-deficient B cells, altered nanoscale organization of IgM-BCRs resulted in a failure of receptor editing and a skewed repertoire of B cells expressing immunoglobulin-µ heavy chains with hallmarks of poly- and auto-reactivity, which ultimately led to autoimmunity in mice. Thus, Cav1 emerges as a cell-intrinsic regulator that prevents B cell-induced autoimmunity by means of its role in plasma-membrane organization.

Diagnóstico y prevalencia de trastornos de la personalidad en atención ambulatoria. Estudio descriptive / The diagnosis and prevalence of personality disorders in outpatient services. A descriptive study

Introducción: los trastornos de personalidad (TP) son difíciles de diagnosticar. La literatura científica informa de su elevada prevalencia en muestras clínicas, pero en la práctica clínica diaria su diagnóstico es muy poco frecuente. Objetivos: Este estudio pretende estimar la prevalencia de TP en una Unidad ambulatoria de Salud Mental (USM), en situación real, para primeras citas. Método: Se aplicó el Cuestionario Salamanca (CS) como instrumento de cribado y, con los puntos de corte mínimo (2/3) y máximo (5/6), se comparó con el diagnóstico clínico realizado por un psicólogo clínico o psiquiatra, sin conocer el resultado del cribado con CS. Resultados: El diagnóstico de TP realizado por un profesional fue de un 7%, frente al 100% de positivos obtenido por el CS en el punto de corte mínimo y el 53% con el máximo: 11,8% para Cluster A, 19,8% Cluster B y 21,4% en el C. Conclusiones: La elevada prevalencia de TPs en los centros de salud mental, junto con el infradiagnóstico clínico, son otros factores que ensombrecen el pronóstico de estos pacientes (AU)

Introduction: Personality disorders (PD) are difficult to diagnose. Scientific literature shows a high prevalence in outpatient mental health services, but in daily practice the diagnosis of a PD is infrequent. Objectives: This study aims to calculate the prevalence of PD in outpatient mental health services in real clinic situation among patients who come for the first time. Method: Salamanca Questionnaire (SQ) was used as a screening method with the minimum score cut (2/3) and the maximum score cut (5/6). The results were compared with the clinical diagnose proposed by the psychiatrist or psychologyst, who did not know the result of SQ. Results: Only 7% of patients received PD diagnose although 100% of patients had pathological results with SQ using the lowest score proposed and 53% using the highest score proposed: 11,8% Clúster A, 19,8%, Clúster B and 21,4% Cluster C. Conclusions: The high prevalence of PD in outpatient mental health services and the low diagnosis rate are elements that worsen the prognosis of these patients (AU)

Copy number gain of 1q25 predicts poor progression-free survival for pediatric intracranial ependymomas and enables patient risk stratification: a prospective European clinical trial cohort analysis on behalf of the Children's Cancer Leukaemia Group (CCLG), Societe Francaise d'Oncologie Pediatrique (SFOP), and International Society for Pediatric Oncology (SIOP).

PURPOSE: The high incidence of recurrence and unpredictable clinical outcome for pediatric ependymoma reflect the imprecision of current therapeutic staging and need for novel risk stratification markers. We therefore evaluated 1q25 gain across three age- and treatment-defined European clinical trial cohorts of pediatric intracranial ependymoma. EXPERIMENTAL DESIGN: Frequency of 1q gain was assessed across 48 ependymomas (42 primary, 6 recurrent) using Affymetrix 500K single-nucleotide polymorphism arrays. Gain of 1q25 was then evaluated by interphase FISH across 189 tumors treated on the Children's Cancer Leukaemia Group/International Society for Pediatric Oncology (SIOP) CNS9204 (n = 60) and BBSFOP (n = 65) adjuvant chemotherapy trials, or with primary postoperative radiotherapy (SIOP CNS9904/RT, n = 64). Results were correlated with clinical, histologic, and survival data. RESULTS: Gain of 1q was the most frequent imbalance in primary (7/42, 17%) and recurrent ependymomas (2/6, 33%). Gain of 1q25 was an independent predictor of tumor progression across the pooled trial cohort [HR = 2.55; 95% confidence interval (CI): 1.56-4.16; P = 0.0002] and both CNS9204 (HR = 4.03; 95% CI: 1.88-8.63) and BBSFOP (HR = 3.10; 95% CI: 1.22-7.86) groups. The only clinical variable associated with adverse outcome was incomplete tumor resection. Integrating tumor resectability with 1q25 status enabled stratification of cases into disease progression risk groups for all three trial cohorts. CONCLUSIONS: This is the first study to validate a prognostic genomic marker for childhood ependymoma across independent trial groups. 1q25 gain predicts disease progression and can contribute to patient risk stratification. We advocate the prospective evaluation of 1q25 gain as an adverse marker in future international clinical trials.

Biomechanical remodeling of the microenvironment by stromal caveolin-1 favors tumor invasion and metastasis.

Mechanotransduction is a key determinant of tissue homeostasis and tumor progression. It is driven by intercellular adhesions, cell contractility, and forces generated within the microenvironment and is dependent on extracellular matrix composition, organization, and compliance. We show that caveolin-1 (Cav1) favors cell elongation in three-dimensional cultures and promotes Rho- and force-dependent contraction, matrix alignment, and microenvironment stiffening through regulation of p190RhoGAP. In turn, microenvironment remodeling by Cav1 fibroblasts forces cell elongation. Cav1-deficient mice have disorganized stromal tissue architecture. Stroma associated with human carcinomas and melanoma metastases is enriched in Cav1-expressing carcinoma-associated fibroblasts (CAFs). Cav1 expression in breast CAFs correlates with low survival, and Cav1 depletion in CAFs decreases CAF contractility. Consistently, fibroblast expression of Cav1, through p190RhoGAP regulation, favors directional migration and invasiveness of carcinoma cells in vitro. In vivo, stromal Cav1 remodels peri- and intratumoral microenvironments to facilitate tumor invasion, correlating with increased metastatic potency. Thus, Cav1 modulates tissue responses through force-dependent architectural regulation of the microenvironment.

Histone deacetylase inhibition attenuates cell growth with associated telomerase inhibition in high-grade childhood brain tumor cells.

Aberrant epigenetic regulation of gene expression contributes to tumor initiation and progression. Studies from a plethora of hematologic and solid tumors support the use of histone deacetylase inhibitors (HDACi) as potent anticancer agents. However, the mechanism of HDACi action with respect to the temporal order of induced cellular events is unclear. The present study investigates the anticancer effects of the HDACi trichostatin A in high-grade childhood brain tumor cells. Acute exposure to trichostatin A resulted in marked inhibition of cell proliferation, an increase in the proportion of G(2)-M cells, activation of H2A.X, and subsequent induction of apoptosis in the majority of cell lines. These phenotypic effects were associated with abrogation of telomerase activity and human telomerase reverse transcriptase downregulation in the majority of cell lines. In contrast, no cytotoxicity was observed in primary ependymal cells with respect to cilia function. Thus, inhibition of histone deacetylases leads to antiproliferative and proapoptotic effects in childhood brain tumor cells, likely to involve altered chromatin regulation at the human telomerase reverse transcriptase promoter.

Recidiva vaginal e inguinal en una paciente con adenocarcinoma de endometrio temprano tratado por vía laparoscópica / Vaginal and inguinal recurrence in a patient with early endometrial adenocarcinoma treated with laparoscopic surgery

La cirugía es el tratamiento más adecuado para el adenocarcinoma (ACA) de endometrio en estadios tempranos, con lesiones confinadas al útero (estadios I/II).Aunque la vía laparotómica se utiliza todavía con gran frecuencia, la laparoscopia está progresando en gran medida para el tratamiento de estos tumores.Los resultados obtenidos en el tratamiento del ACA de endometrio por vía laparoscópica son excelentes, similares a la laparotomía, con costes parecidos y múltiples ventajas. Por todo ello, la laparoscopia está empezando a ser la vía preferida para muchos ginecólogos oncólogos.Presentamos a continuación un caso de ACA de endometrio, pT: Ib/G1, tratado por laparoscopia: histerectomía vaginal asistida por laparoscopia (HVAL)+doble anexectomía (DA)+citología (C)+linfadenectomía pélvica (LP) en el que se presentó una metástasis en introito vaginal a los 7 meses del tratamiento y otra inguinal a los 14 meses (AU)

Surgery is the optimal treatment for early-stage endometrial adenocarcinoma, with lesions confined to the uterus (stages I/II).Although laparotomy is still frequently employed, the use of laparoscopy to treat these tumors is increasing.The results obtained by laparoscopic surgery in the treatment of endometrial adenocarcinoma are excellent, similar to those of laparotomy, with multiple benefits and similar costs. Therefore, laparoscopy is becoming the preferred option for many gynecological oncologists.We report a case of endometrial carcinoma, pT: Ib/G1 treated by laparoscopy consisting of laparoscopic assisted vaginal hysterectomy+double annexectomy+cytology+pelvic lymphadenectomy, which progressed to vaginal introitus metastasis at 7 months of treatment and inguinal metastasis at 14 months (AU)

El adenocarcinoma de próstata en los años 1999 y 2006. Diferencias en el estudio comparativo de biopsias transrectales y de prostatectomías radicales / Prostate adenocarcinoma in 1999 and 2006. Differences in the comparative study of core biopsies and radical prostatectomies

Antecedentes: El incremento en el diagnóstico del cáncer de próstata en la última década en nuestros hospitales ha llevado consigo un aumento similar en el número de prostatectomías radicales. En este trabajo se analizan las diferencias histológicas observadas entre los pacientes tratados con cirugía radical en los años 1999 y 2006 y se evalúa la evolución habida en la indicación de cirugía radical en un lapso de 7 años. Métodos: Se analizan de forma comparativa los datos histológicos de las prostatectomías radicales, y de sus biopsias transrectales previas, diagnosticadas en 1999 y en 2006. Sólo se han incluido en el análisis los casos con la totalidad de los datos evaluables tanto en la biopsia como en la cirugía. En las biopsias transrectales se valoran la afectación uni o bilateral, el número de focos de tumor, los milímetros totales de tumor, la presencia de PIN de alto grado, el índice de Gleason, y la invasión perineural. En las prostatectomías radicales se evalúa el estadio (pT), el índice de Gleason, la presencia de PIN de alto grado, la invasión de los bordes, la afectación del ápex, la invasión perineural y vascular, la extensión extraprostática, y la invasión de las vesículas seminales. El estudio estadístico comparativo entre ambos grupos se realiza mediante pruebas de c2, t de Student, y Mann-Whitney. Resultados: El estudio incluye 24 prostatectomías radicales de 1999 y 50 de 2006. El pT es significativamente más bajo en 2006 que en 1999 (p=0,032). Asimismo, hay mayor número de carcinomas organo-confinados en 2006 (p=0,034). Además, la extensión extraprostática del cáncer y la invasión de vesículas seminales son significativamente menores en 2006 (p=0,090 y p=0,011, respectivamente). Conclusiones: En 2006, entre los pacientes que han sido tratados con cirugía radical, se observa una disminución significativa en el estadio tumoral. El número de casos con extensión extraprostática y con invasión de vesículas seminales es, asimismo, menor

Background: The increase in number of prostate cancer diagnoses in the last decade is accompanied by a similar increase in the number of radical prostatectomy specimens. We analyse the histological differences between patients treated with radical surgery in 1999 and in 2006. The evolution in the indications for surgery is also evaluated. Methods: Histological data in core biopsies and radical prostatectomies of cases diagnosed in 1999 and 2006 have been compared. Only cases with complete histological information have been included in the study. Bi/unilateral tumour invasion, number of tumour foci, total millimetres of cancer, high-grade PIN, Gleason index, and perineurial invasion have been evaluated in core biopsies. Pathological staging, Gleason index, high-grade PIN, margin status, apex invasion, perineurial and vascular permeation, extraprostatic extension and seminal vesicle invasion have been analysed in radical prostatectomies. The statistical study included c2, Student’s t, and Mann-Whitney test. Results: The study includes 24 radical prostatectomies in 1999 and 50 in 2006. The pathological staging is significantly lower in 2006 than in 1999 (p=0.032). Similarly, organ-confined disease is more frequent in 2006 (p=0.034). Extraprostatic extension and seminal vesicle invasion by prostate adenocarcinoma are significantly lower in 2006 (p=0.090 y p=0.011, respectively). Conclusions: Prostate adenocarcinoma patients treated with radical surgery in 2006 are at a lower stage compared with 1999 cases

Valoración de la invasión cervical en el carcinoma de endometrio mediante resonancia magnética / Evaluation of cervical invasion in endometrial carcinoma through magnetic resonance imaging

Objetivo: Analizar el valor de la resonancia magnética (RM) en el estudio de la invasión cervical del carcinoma de endometrio en nuestro medio. Material y métodos: Estudio retrospectivo realizado sobre las RM pélvicas (dinámico, con contraste intravenoso con gadolinio) realizadas de manera sistemática en el estudio preoperatorio de los carcinomas endometriales en nuestro servicio. Se realizaron 124 RM pélvicas de las pacientes diagnosticadas de carcinoma de endometrio entre los años 2000 y 2004. Después se contrastaron los resultados con el estudio anatomopatológico de la pieza quirúrgica. Resultados: De las 124 neoplasias analizadas, en 14 había invasión cervical en el estudio histológico, 7 de las cuales eran superficiales (invasión glandular) y otras 7 invadían el estroma. La RM presentó concordancia con la histología en 120 casos. La sensibilidad de este método fue del 71,42%, la especificidad del 97,34%, el valor predictivo positivo (VPP) del 76,92%, el valor predictivo negativo (VPN) del 96,49% y el VPN corregido (VPNc) del 99,09%. Conclusiones: La RM pélvica con contraste intravenoso (gadolinio) es una buena técnica para descartar la invasión cervical (VPNc: 99,09%) en el carcinoma de endometrio y también para confirmar la invasión, aunque en menor medida (VPP: 76,92%)

Objective: To assess the value of magnetic resonance (MRI) in the evaluation of cervical invasion in endometrial carcinoma in our service. Material and methods: We performed a retrospective study of pelvic MRI scans (dynamic, intravenous contrast media with gadolinium) systematically performed in the presurgical study of endometrial carcinoma in our service. A total of 124 pelvic MRI scans were performed in women diagnosed with endometrial carcinoma between 2000 and 2004. The results were compared with those of histological analysis of the surgical specimen. Results: Of the 124 neoplasms studied, 14 were found to have cervical invasion on histological analysis, seven were superficial (glandular invasion) and a further seven invaded the stroma. The results of MRI were concordant with those of histology in 120 patients. The sensitivity of MRI was 71.42%, specificity was 97.34%, the positive predictive value (PPV) was 76.92%, the negative predictive value (NPV) was 96.49% and the corrected negative predictive value (cNPV) was 99.09%. Conclusions: Pelvic MRI with endovenous contrast media (gadolinium) is a good technique to rule out cervical invasion (cNPV: 99.09%) in endometrial carcinoma and, to a lesser extent, to confirm invasion (PPV: 76.92%)

Radial scars diagnosed at stereotactic core-needle biopsy: surgical biopsy findings.

We retrospectively reviewed surgical biopsy findings of lesions diagnosed as radial scars (RS) at stereotactic core-needle biopsy (SCNB). RS was diagnosed in 52 of 1415 (3.7%) consecutive mammographically detected lesions that underwent 14-gauge automated SCNB. Subsequent surgical biopsy findings were available for 43 lesions in 41 women constituting the study group. Of these 43 lesions, histopathological analysis of the surgical specimen yielded RS in 27 (63%), RS plus atypical ductal hyperplasia (ADH) in 8 (18%), RS plus carcinoma in five (12%), and only carcinoma in three (7%). Carcinomas underestimated at SCNB (n=8) were two in situ carcinomas, two invasive ductal carcinomas not otherwise specified, and four tubular carcinomas. A statistically significant difference (P=0.02) was found between the mean pathologic size of RS without carcinoma and of RS containing carcinoma. Mammographic features could not be used reliably to predict the presence of carcinoma at excision of lesions diagnosed as RS at SCNB. The results suggest that the diagnosis of RS at 14-gauge SCNB of mammographically detected lesions is an indication for surgical biopsy because of the high prevalence of carcinoma in these lesions.

Correlación radio-patológica en dos casos de lesión esclerosante radial con y sin carcinoma tubular asociado / Radiopathological correlation in two cases of radial sclerosing lesion with and without associated tubular carcinoma

La lesión esclerosante radial (LER), es una lesión mamaria benigna cuya importancia reside en la dificultad para distinguirlo del carcinoma tanto en la mamografía como en el estudio histológico de las muestras obtenidas mediante biopsia con aguja gruesa (BAG). En muchas ocasiones es un hallazgo accidental al analizar histológicamente un material de biopsia.Actualmente la amplia difusión de la mamografía, fundamentalmente debido a la puesta en marcha de programas de detección precoz de cáncer de mama, conlleva un aumento en la detección de este tipo de lesiones.Su histogénesis, diagnóstico diferencial y potencial precanceroso, continúan en debate (AU)

Localized scleroderma of the breast.

We report a 44-year-old patient with right-breast morphea. Mammography, MRI and needle biopsy were used for assessment of the case. Mammography demonstrated thickening of the skin and the subcutaneous tissue. The MRI showed replacement of the subcutaneous and breast fat by a low signal intensity, non-enhancing tissue. Skin biopsy confirmed the histological features of scleroderma.