Transcriptomic and lipidomic analysis of the differential pathway contribution to the incorporation of erucic acid to triacylglycerol during Pennycress seed maturation.

Thlaspi arvense (Pennycress) is an emerging feedstock for biofuel production because of its high seed oil content enriched in erucic acid. A transcriptomic and a lipidomic study were performed to analyze the dynamics of gene expression, glycerolipid content and acyl-group distribution during seed maturation. Genes involved in fatty acid biosynthesis were expressed at the early stages of seed maturation. Genes encoding enzymes of the Kennedy pathway like diacylglycerol acyltransferase1 (TaDGAT1), lysophosphatidic acid acyltransferase (TaLPAT) or glycerol 3-phosphate acyltransferase (TaGPAT) increased their expression with maturation, coinciding with the increase in triacylglycerol species containing 22:1. Positional analysis showed that the most abundant triacylglycerol species contained 18:2 at sn-2 position in all maturation stages, suggesting no specificity of the lysophosphatidic acid acyltransferase for very long chain fatty acids. Diacylglycerol acyltransferase2 (TaDGAT2) mRNA was more abundant at the initial maturation stages, coincident with the rapid incorporation of 22:1 to triacylglycerol, suggesting a coordination between Diacylglycerol acyltransferase enzymes for triacylglycerol biosynthesis. Genes encoding the phospholipid-diacylglycerol acyltransferase (TaPDAT1), lysophosphatidylcholine acyltransferase (TaLPCAT) or phosphatidylcholine diacylglycerolcholine phosphotransferase (TaPDCT), involved in acyl-editing or phosphatidyl-choline (PC)-derived diacylglycerol (DAG) biosynthesis showed also higher expression at the early maturation stages, coinciding with a higher proportion of triacylglycerol containing C18 fatty acids. These results suggested a higher contribution of these two pathways at the early stages of seed maturation. Lipidomic analysis of the content and acyl-group distribution of diacylglycerol and phosphatidyl-choline pools was compatible with the acyl content in triacylglycerol at the different maturation stages. Our data point to a model in which a strong temporal coordination between pathways and isoforms in each pathway, both at the expression and acyl-group incorporation, contribute to high erucic triacylglycerol accumulation in Pennycress.

Impacto da seleção para participar de um estudo randomizado no perfil clínico/angiográfico e nos resultados: hospitalares de pacientes diabéticos submetidos à intervenção coronária percutânea / Impact of selection to participate in a randomized study on the clinical/angiographic profile and results: hospital admissions of diabetic patients undergoing percutaneous coronary intervention

INTRODUÇÃO: Em geral, pacientes (p) incluídos em estudos randomizados são selecionados e exibem perfil clínico/angiográfico de menor gravidade do que os do mundo real. Na última década, ensaios clínicos envolvendo intervenções coronárias percutâneas (ICP) com novos modelos de stents farmacológicos (SF) tem primado por estabelecer apenas critérios clínicos de avaliação dos resultados, evitando a necessidade de reestudo angiográfico compulsório na evolução, o que pode atenuar discrepâncias significativas entre casos selecionados ou não para participar dos estudos, assim como permitir a inclusão de mais p. OBJETIVO: O objetivo desta investigação foi avaliar a hipótese supracitada. MÉTODOS: Recentemente foi realizada em nosso Serviço a inclusão de p diabéticos (PD) de forma prospectiva e randomizada num estudo que avaliou um novo modelo de SF, quando comparado a outro modelo utilizado na rotina. Havia critérios de exclusão restritos. Decidimos comparar os perfis clínico e angiográfico de PD incluídos ou não no estudo, finalizando aleatoriamente a amostra quando fosse incluído o centésimo p. Desta forma, entre 10/2020 e 07/2021, foram realizadas 336 ICP em PD de forma prospectiva, subdivididos em 2 grupos: A) 100(29%) PD incluídos no estudo; B) os 236(71%) restantes. Estabeleceram-se como significativos valores de p<0.05. RESULTADOS: Sexo, idade, diabetes dependente de insulina e extensão da doença coronária não diferiram entre os grupos. Predominaram significativamente no grupo B: disfunção renal crônica(21% vs 7%; p=0.0033), idade superior a 70 anos(37% vs 23% p=0.015), antecedente de ICP(32% vs 13%; p=<0.001), ICP para pontes de veia safena(5% vs 0% p=0.03) e infarto com elevação de ST(19% vs 8%; p=0.017); antecedente de cirurgia de revascularização miocárdica previa(10% vs 4% P=0.08) e ICP uniarterial (69% vs 57% p=0.054) também foram mais observados em B, mas não de forma significante. Predominaram no grupo A: ICP de múltiplos vasos (43% vs 25%; p=0.0016), apresentação clínica de angina estável (47% vs 31%; p=0.009) e revascularização completa (62% vs 47%; p=0.0016). Embora a permanência de UTI do grupo B foi maior (1.1(±3.5) vs 0.27(±1.5) P=0.024) os resultados imediatos da fase hospitalar, em conjunto ou individualmente, não diferiram. CONCLUSÕES: 1) Cerca de um em cada três PD tratados foram incluídos no estudo; 2) mesmo com critérios de inclusão/exclusão menos rígidos, observamos perfil clínico/angiográfico de menor complexidade nos casos incluídos.

Comparison of a known invasive physiological method used for the evaluation of ischemia and a newer noninvasive physiological method for the same propose

INTRODUCTION: FFR is the most validated method for evaluating the physiological significance of non-occlusive coronary stenosis. FFR is the ratio of distal pressure (Pd) and aortic pressure (Pa) determined during adenosine induced hyperemia. Nonhyperemic pressure ratios were later introduced and validated against FFR, being non-inferior on ischemia detection. New methods for non-invasive physiological evaluation of ischemia recently became available for our daily practice. The Murray law-based QFR (µQFR or µFR) is a novel computational software that enables accurate estimation of FFR based on the analysis of a single angiographic projection with the adequate quality adjusting both the reference vessel diameter and the outgoing flow through side branches according to fractal geometry. Objective: Both methods were compared and validated against FFR with non-inferiority, it´s to our understanding that both methods can be compared and have similar results. Our objective is to compare the invasive evaluation of coronary physiology with RFR with this novel non-invasive method µFR. METHODS: We revised data from 04/2022 to 04/2023 and found more than 100 RFR evaluations in patients that underwent coronary angiography and presented a non-occlusive coronary lesion. From those we selected 73 patients, based on RFR values of less than 0.95 and used the angiography of the procedure for the evaluation of ischemia with this new software. Once we calculated the µFR we compared the results(positive or negative) to the RFR results. We used Qui square test for the analysis. RESULT: From 73 patients, 50 RFR were positive for ischemia and 34 µFR were positive for ischemia. From those 50 RFR positives for ischemia, 36 underwent PCI or CABG for revascularization. The remaining patients had a value close to 0.89 or had a diffuse pattern without any focal lesion that would benefit from revascularization. The concordance was made with Qui Square Test that confirms the non concordance of both methods in the selected population. Qui square test was 23. On the 16 cases that werent treated or had negative µFR, most had a diffuse CAD pattern, and the method did not had an impact on the decision on treatment. CONCLUSION: In our comparison of RFR vs µFR in 73 patients in the last year we found that there is a non concordance between RFR and µFR as methods evaluating ischemia in this selected small group. The differences can be seen in 16 patients were diffuse pattern was observed.

Injury-Transplantation Interval-Dependent Amelioration of Axonal Degeneration and Motor Deficit in Rats with Penetrating Traumatic Brain Injury.

Penetrating traumatic brain injury (pTBI) is increasingly survivable, but permanently disabling as adult mammalian nervous system does not regenerate. Recently, our group demonstrated transplant location-dependent neuroprotection and safety of clinical trial-grade human neural stem cell (hNSC) transplantation in a rodent model of acute pTBI. To evaluate whether longer injury-transplantation intervals marked by chronic inflammation impede engraftment, 60 male Sprague-Dawley rats were randomized to three sets. Each set was divided equally into two groups: 1) with no injury (sham) or 2) pTBI. After either 1 week (groups 1 and 2), 2 weeks (groups 3 and 4), or 4 weeks after injury (groups 5 and 6), each animal received 0.5 million hNSCs perilesionally. A seventh group of pTBI animals treated with vehicle served as the negative control. All animals were allowed to survive 12 weeks with standard chemical immunosuppression. Motor capacity was assessed pre-transplant to establish injury-induced deficit and followed by testing at 8 and 12 weeks after transplantation. Animals were euthanized, perfused, and examined for lesion size, axonal degeneration, and engraftment. Compared to vehicle, transplanted groups showed a trend for reduced lesion size and axonal injury across intervals. Remote secondary axonal injury was significantly reduced in groups 2 and 4, but not in group 6. The majority of animals showed robust engraftment independent of the injury-transplant time interval. Modest amelioration of motor deficit paralleled the axonal injury trend. In aggregate, pTBI-induced remote secondary axonal injury was resolved by early, but not delayed, hNSC transplantation.

Percepción del enfermero peruano en el cuidado del paciente con covid-19 / Percepção da enfermeira peruana no cuidado de pacientes com covid-19 / Perception of the peruvian nurse in the care of the patient with covid-19

Objetivo: analizar la percepción del enfermero sobre la atención del paciente hospitalizado por COVID-19 en tres hospitales peruanos. Método: estudio descriptivo de análisis cualitativo con 47 enfermeras entrevistadas entre febrero a junio de 2021. Se utilizó la técnica del Análisis de Contenido Temático con uso del software Interface de R pour les Analyses multidimensionnelles de textes et de questionnaires. Resultados: fueron identificadas cinco clases temáticas: 1- Miedo de contagiar a los familiares con el virus de la COVID-19; 2- Frustración e impotencia de los profesionales de enfermería; 3- El papel de la enfermería: pasado, presente y futuro en el cuidado del paciente; 4- Capacitación para el establecimiento de nuevos protocolos y uso de Equipos de Protección Personal; 5- Doloroso proceso de adaptación para los profesionales de la salud. Consideraciones finales: el enfermero percibió que durante la pandemia su trabajo fue sufrido con carencias de recursos humanos, materiales y dilemas éticos.

Objetivo: analisar a percepção do enfermeiro sobre o atendimento do paciente hospitalizado por COVID-19 em três hospitais peruanos. Método: estudo descritivo de análise qualitativa com 47 enfermeiras entrevistadas entre fevereiro e junho de 2021. Utilizou-se a técnica da Análise de Conteúdo Temático com uso do software Interface de R pour les Analyses multidimensionnelles de textes et de questionnaires. Resultados: foram identificadas cinco classes temáticas: 1- Medo de contagiar os familiares com o vírus da COVID-19; 2- Frustração e impotência dos profissionais de enfermagem; 3- O papel da enfermagem: passado, presente e futuro no cuidado do paciente; 4- Capacitação para o estabelecimento de novos protocolos e uso de Equipamentos de Proteção Pessoal; 5- Doloroso processo de adaptação para os profissionais de saúde. Considerações finais: o enfermeiro percebeu que durante a pandemia seu trabalho foi sofrido com carências de recursos humanos, materiais e dilemas éticos.

Objective to analyze the perception of the nurse on the care of the patient hospitalized by COVID-19 in three Peruvian hospitals. Method: Descriptive qualitative analysis study with 47 nurses interviewed between February and June 2021. The Thematic Content Analysis technique was used using the R pour les Analyses multidimensionnelles de textes et de questionnaires. Results: five thematic classes were identified: 1- Fear of infecting relatives with the COVID-19 virus; 2- Frustration and impotence of nursing professionals; 3- The role of nursing: past, present and future in patient care; 4- Training for the establishment of new protocols and use of Personal Protection Equipment; 5- Painful adaptation process for health professionals. Final considerations: the nurse perceived that during the pandemic his work was suffered with shortages of human resources, materials and ethical dilemmas.

The Mental Health of the Peruvian Older Adult during the COVID-19 Pandemic.

During the pandemic, the elderly population was the most exposed to disease and changes in their daily lives. The objective was to determine the association between demographic factors, access to health services, sources of information, and physical symptoms in the mental health of the elderly during the COVID-19 pandemic-a study with 3828 older adults residing in nine cities in Peru. The data was collected using a web-based survey, and the instruments of demographic data; exposure to information (radio, television, and internet); and presence of physical symptoms, anxiety, and perceived stress were used. Descriptive and analytical analysis was performed. Female sex, those aged between 60 and 79 years old, those with secondary education, those in their own home, those residing in an urban area, and those using public services of health predominated in this study. Likewise, 62.9% presented depressive symptoms; on the stress scale, an average of 27.81 (SD = 8.71), and on the anxiety scale, an average of 27.24 (SD = 6.04). Moreover, 65.1% reported fatigue, 62.2% had a headache, and 61.2% lack of energy. There is an association between demographic variables and the physical and psychological symptoms of stress, anxiety, and depressive symptoms in the elderly during the pandemic.

Calidad de vida del estudiante universitario antes y durante la pandemia de Covid-19 / College student quality of life before and during the Covid-19 pandemic

RESUMEN Objetivo: Comparar la calidad de vida del estudiante universitario antes y durante la pandemia de Covid-19. Materiales y métodos: Descriptivo, prospectivo, comparativo. La muestra estuvo conformada por 390 estudiantes de una universidad pública peruana. Se aplicó el Índice de Calidad de Vida de Mezzich (Alfa de Cronbach= 0,870). Los datos fueron recogidos antes y durante la pandemia . Resultados: La edad promedio de los estudiantes fue de 19.3+1.6 años, 73 % de sexo femenino, 98,7 % solteros, 90,3 % convivía con la familia y 87,9 % no trabajaba. El 24,9 % estudiaba medicina humana, 16,7 % enfermería, 11,8 % trabajo social y el 46,6 % restante estudió otras carreras. Al comparar la calidad de vida general y sus dimensiones de los estudiantes, se encontró que durante la pandemia las puntuaciones promedio disminuyeron con diferencias estadísticas significativas, a excepción de Bienestar físico y Apoyo social-emocional. Así mismo, hubo disminución de la calidad de vida en las variables ocupación, forma de convivencia y carrera (p<0.05). Los varones obtuvieron mejores puntuaciones de calidad de vida, a excepción de la dimensión Funcionamiento interpersonal (p<0.05). Conclusiones: la calidad de vida de los estudiantes universitarios en la pandemia de Covid-19 se vio afectada en su vida personal y en su preparación como futuros profesionales, enfrentando grandes retos de adaptación; siendo las mujeres las más afectadas.

ABSTRACT Objective: To compare the quality of life of the university student before and during the Covid-19 pandemic. Materials and methods: Descriptive, prospective, comparative. The sample consisted of 390 students from a Peruvian public university. The Mezzich Quality of Life Index (Cronbach's Alpha = 0.870) was applied. The data was collected before and during the Covid-19 pandemic. Results: The average age of the students was 19.3 + 1.6 years, 73 % female, 98.7 % single, 90.3 % lived with the family and 87.9% did not work. 24.9 % studied human medicine, 16.7 % nursing, 11.8 % social work and the remaining 46.6 % studied other careers. When comparing the students' general quality of life and its dimensions, it was found that during the pandemic, the average scores decreased with statistically significant differences, except for Physical well-being and Social-emotional support. Likewise, there was a decrease in the quality of life in the variable's occupation, the form of coexistence, and career (p <0.05). Men obtained better quality of life scores except for the Interpersonal Functioning dimension (p <0.05). Conclusions: the quality of life of university students in the Covid-19 pandemic was affected in their personal life and their preparation as future professionals, facing great adaptation challenges, with women being the most affected.

Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage.

We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon's failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENTWhat is already known on this subject? Postpartum haemorrhage is one of the most severe situations in the immediate postpartum period entailing a major cause of maternal morbimortality if an accurate and quick intervention is not carried out.What do the results of this study add? The use of Bakri Balloon was effective in 94.6% of patients. No statistically significant differences were found in the success rates according to obstetric or delivery characteristics. No major complications occurred due to the placement of a Bakri Balloon. In the failure group, blood loss was significantly higher and all required blood products transfusion.What are the implications of these findings for clinical practice and/or further research? Bakri Balloon is an easy-to-use device that provides an effective therapeutic alternative to more aggressive techniques in postpartum haemorrhages when medical treatment fails. Obstetrics or delivery characteristics should not entail a contraindication in its use. A continuous training system based on an agreed protocol is recommended in order to guarantee the best care possible.

Different Cis-Regulatory Elements Control the Tissue-Specific Contribution of Plastid ω-3 Desaturases to Wounding and Hormone Responses.

Trienoic fatty acids are essential constituents of biomembranes and precursors of jasmonates involved in plant defense responses. Two ω-3 desaturases, AtFAD7 and AtFAD8, synthetize trienoic fatty acids in the plastid. Promoter:GUS and mutagenesis analysis was used to identify cis-elements controlling AtFAD7 and AtFAD8 basal expression and their response to hormones or wounding. AtFAD7 promoter GUS activity was much higher than that of AtFAD8 in leaves, with specific AtFAD7 expression in the flower stamen and pistil and root meristem and vasculature. This specific tissue and organ expression of AtFAD7 was controlled by different cis-elements. Thus, promoter deletion and mutagenesis analysis indicated that WRKY proteins might be essential for basal expression of AtFAD7 in leaves. Two MYB target sequences present in the AtFAD7 promoter might be responsible for its expression in the flower stamen and stigma of the pistil and in the root meristem, and for the AtFAD7 wound-specific response. Two MYB target sequences detected in the distal region of the AtFAD8 gene promoter seemed to negatively control AtFAD8 expression, particularly in true leaves and flowers, suggesting that MYB transcription factors act as repressors of AtFAD8 gene basal expression, modulating the different relative abundance of both plastid ω-3 desaturases at the transcriptional level. Our data showed that the two ABA repression sequences detected in the AtFAD7 promoter were functional, suggesting an ABA-dependent mechanism involved in the different regulation of both ω-3 plastid desaturases. These results reveal the implication of different signaling pathways for the concerted regulation of trienoic fatty acid content in Arabidopsis.

[Clozapine in epilepsy and psychosis: effects on seizures and metabolic profile]. / Clozapina en epilepsia y psicosis: efectos en las crisis epilépticas y en el perfil metabólico.

Background: Clozapine (CZP) is an antipsychotic used in resistant psychosis, but has adverse metabolic effects and is associated with new onset or worsening of epileptic seizures (ES). There is not enough information available regarding its effect on metabolic variables and on ES in patients with epilepsy. Objective: To describe the effect of CZP on the metabolic and hematologic profiles, and on ES in patients with epilepsy and with psychosis and/or aggressive behavior. Methods: A case series of patients with epilepsy and psychosis and/or aggressive behavior that received CZP with an 18-week follow-up. Clinical records were assessed from 2008-2018. 30 patients with epilepsy that received CZP were included. A paired analysis (Student's t-test or Wilcoxon signed rank test) was performed with metabolic variables (glucose, cholesterol, and triglycerides), hematologic variables, weight, body mass index (BMI), and monthly ES before and after CZP administration. Results: The median age to CZP initiation was 31.9 ± 16.07 years. Median CZP dosage was 193 mg/day. There were changes on BMI (p = 0.001; 3.2 kg/m2 increase, median = 3.08), triglycerides (p = 0.002) and glucose (p = 0.030). Weight increase was 7 kg (p = 0.292; median = 4 kg). Monthly ES mean was decreased from 4.9 (median = 2) to 2.04 (median = 1; p = 0.001). Conclusions: This study provide information regarding the security profile of CZP in patients with epilepsy with psychosis and/or aggressive behavior. A decrease on monthly ES was observed, as well as moderate increases in triglycerides, glucose and BMI, which coincide with that described by other authors.

Introducción: La clozapina (CZP) es un antipsicótico efectivo en la psicosis que no responde a otros antipsicóticos, pero tiene efectos metabólicos adversos y se relaciona con la generación de crisis epilépticas (CE). Existe poca información sobre su efecto en variables metabólicas y sobre las CE en pacientes con epilepsia. Objetivo: Describir el efecto de la CZP en el perfil metabólico, el perfil hematológico y la frecuencia de CE en pacientes con epilepsia y con psicosis o agresividad. Método: Serie de casos de pacientes con epilepsia y psicosis o agresividad que recibieron CZP con un seguimiento de 18 semanas. Se revisaron los expedientes clínicos de 2008-2018. Se incluyeron 30 pacientes con epilepsia que recibieron CZP. Se hizo una comparación pareada (prueba t de Student o de signo y rango de Wilcoxon), antes y después del inicio de la CZP, de las variables metabólicas (glucosa, colesterol y triglicéridos) y hematológicas, el peso, el índice de masa corporal (IMC) y las CE mensuales. Resultados: La edad media al iniciar la CZP fue de 31.9 ± 16.07 años. La dosis media fue 193 mg/día. Hubo incremento en el IMC (p = 0.001; aumento de 3.2 kg/m2; mediana = 3.08), los triglicéridos (p = 0.002) y la glucosa (p = 0.030). La ganancia de peso fue de 7 ± 10.4 kg (p = 0.292; mediana = 4 kg). El promedio de CE mensuales se redujo de 4.9 (mediana = 2) a 2.04 (p = 0.001; mediana = 1). Conclusiones: Este estudio aporta información del perfil de seguridad del uso de CZP en pacientes con epilepsia y psicosis o agresividad. Se observó una disminución en la frecuencia mensual de CE, así como aumentos moderados de los triglicéridos, la glucosa y el IMC, que coinciden con lo descrito por otros autores.

Effects of Chlorophyll Triplet States on the Kinetics of Spectral Hole Growth.

Spectral hole burning has been employed for decades to study various amorphous solids and proteins. Triplet states and respective transient holes were incorporated into theoretical models and software simulating nonphotochemical spectral hole burning (NPHB) and including all relevant distributions, in particular the distribution of the angle between the electric field of light E and transient dipole moment of the chromophore µ. The presence of a chlorophyll a triplet state with a lifetime of several milliseconds explains the slowdown of NPHB (on the depth vs illumination dose scale) with the increase of the light intensity, as well as larger hole depths observed in weak probe beam experiments, compared to those deduced from the hole growth kinetics (HGK) measurements (signal collected at a fixed wavelength while a stronger burning beam is on) in cytochrome b6f and chemically modified LH2. We also considered the solvent deuteration effects on triplet lifetime and concluded that both triplet states and local heating likely play a role in slowing down the HGK with increasing burn intensity.

Impact of the Delayed Initiation of Adjuvant Chemotherapy in the Outcome of Triple Negative Breast Cancer.

BACKGROUND: Adjuvant chemotherapy decreases the recurrence risk and improves survival rates; however, it is unclear whether a delayed initiation is associated with adverse outcomes, especially in triple negative breast cancer (TNBC). In this study, we evaluated the influence of the time to start adjuvant chemotherapy (TTC) in the outcomes of TNBC. PATIENTS AND METHODS: We retrospectively analyzed 15 years of data from patients with TNBC who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). TTC was categorized into 4 groups: ≤ 30, 31 to 60, 61 to 90, and ≥ 91 days. We evaluated overall survival (OS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were used to identify prognostic factors. RESULTS: In total, 687 patients were included. The mean age at diagnosis was 49.1 years (SD, 11.8 years), and most (62.6%) patients had pathologic stage T2. The median TTC was 48.1 days (SD, 27.4 days); 189 (27.5%) received chemotherapy ≤ 30 days; 329 (47.9%), between 31 and 60 days; 115 (16.7%), between 61 and 90 days; and 54 (7.9%) in ≥ 90 days. In the multivariate analysis, a TTC between 31 and 60 days (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.17-2.72), 61 and 90 days (HR, 2.38; 95%CI, 1.43-3.97), and ≥ 91 days (HR, 2.45; 95% CI, 1.32-4.55) was associated with an increased mortality in contrast with a TTC < 30 days. Although a TTC between 31 and 60 days, 61 and 90 days, and ≥ 91 days was associated with an increased risk of DRFS (HR, 1.86; 95% CI, 1.24-2.79; HR, 2.34, 95% CI, 1.42-3.867; and HR, 3.16; 95% CI, 1.78-5.61, respectively). CONCLUSION: A delaying in TTC ≥ 30 days was associated with poorer outcomes. Our data suggest that several efforts should be conducted to avoid a delayed TTC in patients with TNBC.

Barreras y facilitadores de la implementación del programa provincial de prevención y detección temprana del cáncer colorrectal / Barriers and facilitators of the implementation of the provincial program for the prevention and early detection of colorectal cancer

El cáncer colorrectal constituye un problema sanitario por su elevada incidencia y mortalidad, y por la complejidad de su abordaje por los sistemas de salud. Los programas de detección oportuna son difíciles de implementar debido a la presencia de numerosas barreras. El objetivo general del trabajo fue evaluar barreras y facilitadores en la implementación del Programa Provincial de Prevención y control del Cáncer Colorrectal en Florencio Varela desde la perspectiva de los equipos de salud, a través de un estudio prospectivo, exploratorio, con metodología cuali-cuantitativa. Se relevaron fuentes de información secundaria y se analizaron las barreras y facilitadores para la implementación utilizando el marco conceptual consolidado para la investigación en implementación. El componente cuantitativo del estudio utilizó fuentes secundarias, se analizaron datos de 9 centros de salud. Se identificó una baja adherencia al Programa por parte de los equipos de salud y una baja tasa de cobertura global alcanzada en la población usuaria del primer nivel de atención. Para el componente cualitativo se realizaron entrevistas a actores claves del sistema de salud. Las principales barreras identificadas por las personas entrevistadas fueron la vulnerabilidad y la falta de concientización de la población objetivo del programa sobre el cáncer colorrectal, las demoras en el acceso a la videocolonoscopía y las fallas de los mecanismos formales de derivación al centro de mayor complejidad . La presencia y articulación de políticas y programas, el liderazgo de las autoridades, así como la receptividad de los CAPS involucrados y su compromiso con la iniciativa y la comunidad de referencia, constituyeron elementos que facilitaron la implementación del programa.

Neutrophil-to-lymphocyte ratio predicts early mortality in females with metastatic triple-negative breast cancer.

BACKGROUND: The aim of this study was to determine the utility of the neutrophil-to-lymphocyte ratio (NLR) as a biomarker for predicting early-mortality (<2 years) among females with metastatic triple-negative breast cancer (mTNBC). METHODS: We reviewed 118 medical records of females with mTNBC. The cut-off value for the NLR (<2.5 and ≥2.5) was determined with receiver operating characteristic curves (area under the curve: 0.73; 95% CI: 0.62-0.85). Survival curves were estimated using the Kaplan-Meier method and compared with the Log-rank test. Multivariate Cox regression was used to identify the risk of mortality at two years. Moreover, we performed sensitivity analyses with different cut-off values and a subgroup analysis in females that only received chemotherapy. RESULTS: The median follow-up was 24 months. Females with NLR ≥2.5 had a poor overall survival compared to females with NLR <2.5 (6% vs. 28%, p<0.001) at two years. This outcome remained when we stratified for females that only received chemotherapy (8% vs. 36%, p = 0.001). Multivariate analyses identified NLR ≥2.5 as a poor prognostic risk factor for mortality in the entire population (HR: 2.12, 95% CI: 1.32-3.39) and among females that received chemotherapy (HR: 2.68, 95% CI: 1.46-4.92). CONCLUSION: The NLR is an accessible and reliable biomarker that predicts early mortality among females with mTNBC. Our results suggest that females with high NLR values have poor prognosis despite receiving standard chemotherapy. Health providers should evaluate the possibility to enroll these patients in novel immunotherapy trials.

Functional analysis of ß-ketoacyl-CoA synthase from biofuel feedstock Thlaspi arvense reveals differences in the triacylglycerol biosynthetic pathway among Brassicaceae.

KEY MESSAGE: Differences in FAE1 enzyme affinity for the acyl-CoA substrates, as well as the balance between the different pathways involved in their incorporation to triacylglycerol might be determinant of the different composition of the seed oil in Brassicaceae. Brassicaceae present a great heterogeneity of seed oil and fatty acid composition, accumulating Very Long Chain Fatty Acids with industrial applications. However, the molecular determinants of these differences remain elusive. We have studied the ß-ketoacyl-CoA synthase from the high erucic feedstock Thlaspi arvense (Pennycress). Functional characterization of the Pennycress FAE1 enzyme was performed in two Arabidopsis backgrounds; Col-0, with less than 2.5% of erucic acid in its seed oil and the fae1-1 mutant, deficient in FAE1 activity, that did not accumulate erucic acid. Seed-specific expression of the Pennycress FAE1 gene in Col-0 resulted in a 3 to fourfold increase of erucic acid content in the seed oil. This increase was concomitant with a decrease of eicosenoic acid levels without changes in oleic ones. Interestingly, only small changes in eicosenoic and erucic acid levels occurred when the Pennycress FAE1 gene was expressed in the fae1-1 mutant, with high levels of oleic acid available for elongation, suggesting that the Pennycress FAE1 enzyme showed higher affinity for eicosenoic acid substrates, than for oleic ones in Arabidopsis. Erucic acid was incorporated to triacylglycerol in the transgenic lines without significant changes in their levels in the diacylglycerol fraction, suggesting that erucic acid was preferentially incorporated to triacylglycerol via DGAT1. Expression analysis of FAE1, AtDGAT1, AtLPCAT1 and AtPDAT1 genes in the transgenic lines further supported this conclusion. Differences in FAE1 affinity for the oleic and eicosenoic substrates among Brassicaceae, as well as their incorporation to triacylglycerol might explain the differences in composition of their seed oil.

Lymph node ratio as best prognostic factor in triple-negative breast cancer patients with residual disease after neoadjuvant chemotherapy.

Although lymph node status (ypN) is one of the most important prognostic factors of survival, the lymph node ratio (LNR) has emerged as an equitable factor. We aimed to compare the prognostic value of both ypN and LNR in patients with residual triple-negative breast cancer (TNBC) after neo-adjuvant chemotherapy (NAC). This was a retrospective cohort study of patients treated in a tertiary care center during the period 2000-2014. We stratified the population based on LNR (≤0.20, 0.20-0.65, and >0.65) and ypN (N1, N2, and N3) status. The overall survival (OS) and progression-free survival (PFS) were estimated with Kaplan-Meier curves and the log-rank + test. We further compared patient mortality and disease recurrence using multivariate Cox regression analysis. We evaluated 169 patients with a median follow-up of 87 months. At 2 years of follow-up, patients with low-risk LNR compared to those with moderate and high risk had a higher PFS (54% vs 31% vs 18%, respectively; P < .001) and OS (74% vs 64% vs 45%, respectively; P < .001). Moreover, ypN1 patients compared to ypN2 and ypN3 showed similar results in PFS (53% vs 35% vs 19%, respectively; P = .001) and OS (73% vs 69% vs 43%, respectively; P < .001). Compared to the low-risk population, patients with moderate (hazard ratio [HR]: 3.50; 95% confidence interval [CI]: 1.41-8.71) and high risk (HR: 6.90; 95% CI: 2.29-20.77) had a worse PFS. Regarding OS, moderate-risk (HR: 2.85; 95% CI: 1.10-7.38) and high-risk patients (HR: 6.48; 95% CI: 2.13-19.76) showed considerably worse outcomes. On the other hand, ypN staging was not associated with PFS or OS in the multivariate analysis. The LNR is a better prognostic factor of survival than ypN. The LNR should be considered in the stratification of risk after NAC in patients with TNBC.

Tratamiento con drenaje percutáneo ecoguiado de hematomas vesicouterinos postcesárea complicados. Experiencia en 4 casos / Treatment with ultrasound-guided percutaneous drainage of complicated post-cesarean vesicouterine hematomas. Experience in 4 cases

Resumen ANTECEDENTES: Los hematomas vesicouterinos sobreinfectados son una rara complicación de la histerotomía segmentaria transversa. La acumulación de sangre entre la pared posterior de la vejiga y el segmento uterino facilita la proliferación de microorganismos patógenos. Cuando el tratamiento antibiótico falla deben plantearse técnicas invasivas para su resolución, entre las que destaca el drenaje percutáneo ecoguiado. CASOS CLÍNICOS: Se exponen 4 casos de mujeres que, después de la cesárea, iniciaron con descenso del hematocrito, fiebre (3 casos) y cuadro pseudooclusivo (1 caso). Con base en la ecografía se estableció el diagnóstico de hematoma vesicouterino sobreinfectado. Después de la falla del tratamiento con antibióticos se propuso el drenaje percutáneo ecoguiado. Se observó mejoría clínica en todos los casos de forma significativa. El cultivo del material drenado orientó al tratamiento antibiótico específico. La evolución de las pacientes fue satisfactoria. CONCLUSIONES: El drenaje percutáneo ecoguiado permite evacuar el contenido hemático, obtener suficiente muestra para el cultivo y aportar información del microorganismo patógeno concreto. Además, es una técnica efectiva, menos invasiva que la cirugía y se asocia con escasas complicaciones.

Abstract BACKGROUND: Infected bladder-flap hematomas are a rare complication after a lower uterine segment caesarean section. This blood collection located in the space between the posterior bladder wall and the lower uterine segment allows microorganism proliferation. When the treatment with antibiotics fails, invasive techniques are considered, such as ultrasound percutaneous drainage. CLINICAL CASE: We present 4 cases of women whom, after the performance of a cesarean section, began with a decrease in hemoglobin levels, spiking fevers in 3 cases and pseudo-occlusive symptoms in the other one. With an ultrasound examination, the diagnosis of infected bladder-flap hematomas were achieved. After the failure of the antibiotics treatment, an ultrasound percutaneous drainage was performed. As a result of the evacuation of the collection, the clinical situation improved significantly. Culture of the sample obtained permitted to establish a more effective antibiotic treatment. CONCLUSIONS: Ultrasound percutaneous drainage allows not only the evacuation of the blood collection to obtain a sample for culture, but also provides information about the presence of a specific microorganism. Moreover, it is a highly efficient technique, less invasive than surgery which presents few complications.

Evidence of Simultaneous Spectral Hole Burning Involving Two Tiers of the Protein Energy Landscape in Cytochrome b6f.

Cytochrome b6f, with one chlorophyll molecule per protein monomer, is a simple model system whose studies can help achieve a better understanding of nonphotochemical spectral hole burning (NPHB) and single-complex spectroscopy results obtained in more complicated photosynthetic chlorophyll-protein complexes. We are reporting new data and proposing an alternative explanation for spectral dynamics that was recently observed in cytochrome b6f using NPHB. The relevant distribution of the tunneling parameter λ is a superposition of two components that are nearly degenerate in terms of the resultant NPHB yield and represent two tiers of the energy landscape responsible for NPHB. These two components likely burn competitively; we present the first demonstration of modeling a competitive NPHB process. Similar values of the NPHB yield result from distinctly different combinations of barrier heights, shifts along the generalized coordinate d, and/or masses of the entities involved in conformational changes m, with md2 parameter different by a factor of 2.7. Consequently, in cytochrome b6f, the first (at least) 10 h of fixed-temperature recovery preferentially probe different components of the barrier- and λ-distributions encoded into the spectral holes than thermocycling experiments. Both components most likely represent dynamics of the protein and not of the surrounding buffer/glycerol glass.

El amor, resonancia esencial del cuidado para la vida, desde la experiencia del familiar donante renal vivo. Lima (Perú) / Love, the essential resonance of care for life, from the experience of the familiar living kidney donor. Lima (Peru)

Resumen Objetivos: El proceso de donación de órganos es el punto de partida de este estudio, cuyo objetivo fue describir y analizar las resonancias de cuidado que el familiar donante renal vivo establece con el familiar receptor en el proceso de donación. Material y métodos: Se desarrolló como una investigación cualitativa descriptiva exploratoria. La muestra estuvo conformada por seis familiares donantes renales vivos residentes en Lima (Perú), determinada por criterio de saturación teórica. La recolección de datos se hizo mediante la entrevista a profundidad realizada en los hogares de los participantes en 2017. Los datos fueron organizados, clasificados, categorizados según criterio de Minayo y las bases teóricas de Boff. Se utilizó el análisis de discurso oral de Orlandi para la construcción de las categorías empíricas que emergieron de los textos. Resultados: Del análisis de discurso emerge el constructo Cuidado-Vida y la resonancia del amor en complementariedad y simultaneidad de las resonancias de Compasión, Ternura, Caricia, Esperanza, categorías que tienen como respaldo teórico, epistémico y filosófico las resonancias del cuidado humano. Conclusiones: Entre las conclusiones del estudio destaca que la resonancia del amor es la categoría principal que emerge desde el familiar donante renal vivo en el constructo Cuidado; vida, se concretiza en el cuidado para la supervivencia, conservación y bien-vivir del familiar receptor de órganos, en el que la resonancia del amor se revela como la gran fuerza que transforma la vida, une y solidariza en conjunción con la compasión, caricia, ternura, esperanza, resonancias que humanizan el cuidado de la familia, sensibilizan el acto de donación de órganos.

Abstract Objectives: The process of organ donation is the starting point of this study, whose objective was to describe and analyze the resonances of care that the living renal donor family establishes with the recipient family member in the donation process. Material and methods: It was developed as an exploratory descriptive qualitative research; the sample consisted of six living renal donor relatives residing in Lima-Peru, determined by criterion of theoretical saturation. The data collection was done through in-depth interviews conducted in the homes of the participants in 2017. The data was organized, classified, categorized according to Minayo criteria and the theoretical basis of Boff. Orlandi's oral discourse analysis was used to construct the empirical categories that emerged from the texts. Results: From the analysis of discourse, the Care-Life construct emerges and the resonance of love simultaneously complements the resonances of Compassion, Tenderness, Caress, Hope, categories that have as theoretical, epistemic and philosophical support the resonances of care human. Conclusions: Among the conclusions of the study, the resonance of love is the main category that emerges from the kidney donor relative in the Care-life construct, it is cemented in the care for the survival, conservation and well-being of the recipient family of organs, where the resonance of love is revealed as the great force that transforms life, unites and solidifies in conjunction with compassion, caress, tenderness, hope, resonances that humanize the care of the family, sensitize the act of organ donation.

Uso exitoso del balón de Bakri en un caso de hemorragia postaborto de segundo trimestre y cesárea anterior / Successful use of Bakri balloon in a case of second trimester postabortion hemorrhage and prior caesarean section

Presentamos el caso de una secundigesta de 24 años (19+1 semanas de gestación) con cesárea anterior que presenta un aborto espontáneo y posterior hemorragia tras la evacuación uterina. Durante la exploración se constata una dehiscencia uterina. Ante el fracaso del tratamiento médico se coloca un balón de Bakri, consiguiendo detener el sangrado. Este caso pone de manifiesto la eficacia del taponamiento uterino en otras indicaciones diferentes a la hemorragia postparto. El manejo conservador con el balón de Bakri evitó una histerectomía, con la consiguiente preservación de la fertilidad y reducción de la morbi-mortalidad asociada

This article introduces the case of a 24-year-old gravida 2 (19+1 weeks of gestation) having had performed a previous cesarean, who presents a spontaneous abortion and a hemorrhage after uterine evacuation. Throughout the examination, it is remarkable a cesarean scar dehiscence and placenta accreta is suspected to be present. Having the starting therapies failed to work, a Bakri balloon is set managing to stop the bleeding. This case highlights the efficacy of uterine tamponade in situations different from postpartum hemorrhage. A hysterectomy was avoided with the Bakri balloon, resulting in the subsequent preservation of fertility and associated morbi-mortality reduction