Varón anciano con cáncer de mama tratado con opioides en unidad de cuidados paliativos de hospital público en El Salvador / Elderly man with breast cancer treated with opioids at the palliative care unit of a public hospital in El Salvador

El cáncer de mama en hombres es una patología poco frecuente, representa menos del 1 % de todos los cánceres masculinos y casi el 1 % de los cánceres de mama, y es responsable del 0,1 % de las muertes por cáncer en hombres. El tipo más común de cáncer de mama que se observa en los hombres es el carcinoma ductal invasivo, que constituye aproximadamente el 90 % de todos los cánceres de mama masculinos. El presente estudio reporta el caso de un hombre de 97 años al que se le diagnosticó un carcinoma ductal infiltrante invasivo que se trató con opioides en una unidad de cuidados paliativos. En este caso, que es poco frecuente en la literatura médica por el tipo de diagnóstico, sexo y edad del paciente, observamos que el buen uso de los opioides, el trabajo en equipo, el acercamiento con la familia y el seguimiento en el tiempo hace que se tomen mejores decisiones sobre el tratamiento, el bienestar, y que la calidad de vida sea mejor. (AU)

Breast cancer in men is a rare disease; it represents less than 1 % of all male cancers, and almost 1 % of breast cancers, and is responsible for 0.1 % of cancer deaths in men.The most common type of breast cancer seen in men is invasive ductal carcinoma, which accounts for approximately 90 % of all male breast cancers. The present study reports the case of a 97-year-old man who was diagnosed with invasive infiltrating ductal carcinoma, who was treated with opioids in a palliative care unit. In this case, which is rare in the medical literature due to the type of diagnosis, sex, and age of the patient, we observe that proper use of opioids, teamwork, closeness with the family, and follow-up over time result in better decisions about treatment, increased comfort, and improved quality of life. (AU)

Correction: ANKK1 is found in myogenic precursors and muscle fibers subtypes with glycolytic metabolism.

[This corrects the article DOI: 10.1371/journal.pone.0197254.].

Osteopathic Manipulative Treatment Including Specific Diaphragm Techniques Improves Pain and Disability in Chronic Nonspecific Low Back Pain: A Randomized Trial.

OBJECTIVE: To investigate the effects of an osteopathic manipulative treatment (OMT), which includes a diaphragm intervention compared to the same OMT with a sham diaphragm intervention in chronic nonspecific low back pain (NS-CLBP). DESIGN: Parallel group randomized controlled trial. SETTING: Private and institutional health centers. PARTICIPANTS: Participants (N=66) (18-60y) with a diagnosis of NS-CLBP lasting at least 3 months. INTERVENTIONS: Participants were randomized to receive either an OMT protocol including specific diaphragm techniques (n=33) or the same OMT protocol with a sham diaphragm intervention (n=33), conducted in 5 sessions provided during 4 weeks. MAIN OUTCOME MEASURES: The primary outcomes were pain (evaluated with the Short-Form McGill Pain Questionnaire [SF-MPQ] and the visual analog scale [VAS]) and disability (assessed with the Roland-Morris Questionnaire [RMQ] and the Oswestry Disability Index [ODI]). Secondary outcomes were fear-avoidance beliefs, level of anxiety and depression, and pain catastrophization. All outcome measures were evaluated at baseline, at week 4, and at week 12. RESULTS: A statistically significant reduction was observed in the experimental group compared to the sham group in all variables assessed at week 4 and at week 12 (SF-MPQ [mean difference -6.2; 95% confidence interval, -8.6 to -3.8]; VAS [mean difference -2.7; 95% confidence interval, -3.6 to -1.8]; RMQ [mean difference -3.8; 95% confidence interval, -5.4 to -2.2]; ODI [mean difference -10.6; 95% confidence interval, -14.9 to 6.3]). Moreover, improvements in pain and disability were clinically relevant. CONCLUSIONS: An OMT protocol that includes diaphragm techniques produces significant and clinically relevant improvements in pain and disability in patients with NS-CLBP compared to the same OMT protocol using sham diaphragm techniques.

ANKK1 is found in myogenic precursors and muscle fibers subtypes with glycolytic metabolism.

Ankyrin repeat and kinase domain containing 1 (ANKK1) gene has been widely related to neuropsychiatry disorders. The localization of ANKK1 in neural progenitors and its correlation with the cell cycle has suggested its participation in development. However, ANKK1 functions still need to be identified. Here, we have further characterized the ANKK1 localization in vivo and in vitro, by using immunolabeling, quantitative real-time PCR and Western blot in the myogenic lineage. Histologic investigations in mice and humans revealed that ANKK1 is expressed in precursors of embryonic and adult muscles. In mice embryos, ANKK1 was found in migrating myotubes where it shows a polarized cytoplasmic distribution, while proliferative myoblasts and satellite cells show different isoforms in their nuclei and cytoplasm. In vitro studies of ANKK1 protein isoforms along the myogenic progression showed the decline of nuclear ANKK1-kinase until its total exclusion in myotubes. In adult mice, ANKK1 was expressed exclusively in the Fast-Twitch muscles fibers subtype. The induction of glycolytic metabolism in C2C12 cells with high glucose concentration or treatment with berberine caused a significant increase in the ANKK1 mRNA. Similarly, C2C12 cells under hypoxic conditions caused the increase of nuclear ANKK1. These results altogether show a relationship between ANKK1 gene regulation and the metabolism of muscles during development and in adulthood. Finally, we found ANKK1 expression in regenerative fibers of muscles from dystrophic patients. Future studies in ANKK1 biology and the pathological response of muscles will reveal whether this protein is a novel muscle disease biomarker.

Isolation Methods of Peripheral Blood Mononuclear Cells in Spanish Biobanks: An Overview.

The Spanish Hematic Derivatives Group, consisting of 26 biobanks, was established in 2011. We describe here the viability results of our publically available standard operating procedure to freeze and thaw peripheral blood mononuclear cells (PBMCs). Our protocol maximizes PBMC viability while avoiding where possible interbiobank and intrabiobank assay variability.

Generation of a disease-specific iPS cell line derived from a patient with Charcot-Marie-Tooth type 2K lacking functional GDAP1 gene.

Human CMT2-FiPS4F1 cell line was generated from fibroblasts of a patient with Charcot-Marie-Tooth disease harbouring the following mutations in the GDAP1 gene in heterozygosis: p.Q163X/p.T288NfsX3. This patient did not present mutations in the PM22, MPZ or GJB genes. Human reprogramming factors OCT3/4, KLF4, SOX2 and C-MYC were delivered using a non-integrative methodology that involves the use of Sendai virus.

Masa endobronquial como primera manifestación de un linfoma anaplásico de células T / Endobronchial mass as the first manifestation of an anaplastic T-cell lymphoma

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Monocytes and γδ T cells control the acute-phase response to intravenous zoledronate: insights from a phase IV safety trial.

Aminobisphosphonates (NBPs) are used widely against excessive bone resorption in osteoporosis and Paget's disease as well as in metastatic bone disease and multiple myeloma. Intravenous NBP administration often causes mild to severe acute-phase responses (APRs) that may require intervention with analgesics and antipyretics and lead to treatment noncompliance and nonadherence. We here undertook a phase IV safety trial in patients with osteoporosis to investigate the APR of otherwise healthy individuals to first-time intravenous treatment with the NBP zoledronate. This study provides unique insight into sterile acute inflammatory responses in vivo, in the absence of confounding factors such as infection or cancer. Our data show that both peripheral γδ T cells and monocytes become rapidly activated after treatment with zoledronate, which ultimately determines the clinical severity of the APR. Our study highlights a key role for IFN-γ in the zoledronate-induced APR and identifies pretreatment levels of monocytes and central/memory Vγ9/Vδ2 T cells as well as their responsiveness to zoledronate in vitro as predictive risk factors for the occurrence of subclinical and clinical symptoms. These findings have diagnostic and prognostic implications for patients with and without malignancy and are relevant for Vγ9/Vδ2 T-cell-based immunotherapy approaches.

Enfermedad de Erdheim-Chester: estudio de 12 casos / Erdheim-Chester disease: study of 12 cases

Fundamento y objetivo: La enfermedad de Erdheim-Chester (EC) es una histiocitosis de células no-Langerhans que cursa con infiltración xantogranulomatosa multiorgánica por histiocitos CD68+/CD1a-. Se recogen las principales características de 12 pacientes diagnosticados de esta rara enfermedad. Pacientes y método: Se revisaron las historias clínicas y los hallazgos anatomopatológicos de 12 casos diagnosticados de enfermedad de EC en 7 hospitales terciarios de la península. Se consideró el diagnóstico de esta enfermedad ante un cuadro clínico compatible e infiltración tisular por histiocitos CD68+/CD1a-. Resultados: Se incluyó en el estudio a 12 pacientes, 7 varones, con una mediana de seguimiento de 36 meses (rango IQ: 20-84). La mediana de edad al inicio clínico de la enfermedad y en el momento del diagnóstico histológico fue de 49 (rango IQ: 28-61) y 56 años (37-62), respectivamente. En 6 casos se realizaron múltiples biopsias para poder llegar al diagnóstico, mientras que en 3 fue la revisión de las mismas piezas anatomopatológicas en un adecuado contexto de sospecha clínica lo que permitió el diagnóstico. Las manifestaciones neurológicas presentaron una asociación estadísticamente significativa con la mortalidad (p<0,05). La característica afectación ósea en forma de osteoesclerosis metadiafisaria de huesos largos se detectó en 9 casos. Conclusiones: La enfermedad de EC presenta una gran heterogeneidad en sus manifestaciones clínicas. Es preciso un alto índice de sospecha y una estrecha colaboración entre clínicos y patólogos para llegar al diagnóstico de esta enfermedad (AU)

Background and objective: Erdheim-Chester disease (EC) is a rare form of non-Langerhans’ cell histiocytosis. It is characterized by the xanthomatous infiltration of tissues with foamy CD68+/CD1a- histiocytes. We report a series of 12 patients diagnosed with EC.Patients and methods: We reviewed the clinical, pathological and therapeutic aspects of 12 cases diagnosed with EC at 7 tertiary teaching hospitals in Spain. Patients were included if tissue infiltration by histiocytes CD68+/CD1a- could be demonstrated in an appropriate clinical setting. Results: Twelve patients (7 male) were included. Median follow-up was 36 months (IQR: 20-84). The median age at the time of clinical onset and pathological diagnosis was 49 (IQR: 28-61) and 56 years (IQR: 37-62), respectively. In 6 cases multiples biopsies were performed (skin, muscle, testicular) previous to diagnosis, which was confirmed in 3 cases after a carefully review of pathological tissues. Neurological involvement was independently associated with mortality (P<.05). Characteristic long bone osteosclerosis was detected in 9 patients. Conclusion: EC is a multisystemic and heterogeneous clinicopathological condition. A high index of suspicion and fluent communication between clinicians and pathologists is necessary to achieve a correct diagnosis (AU)

[Erdheim-Chester disease: study of 12 cases]. / Enfermedad de Erdheim-Chester: estudio de 12 casos.

BACKGROUND AND OBJECTIVE: Erdheim-Chester disease (EC) is a rare form of non-Langerhans' cell histiocytosis. It is characterized by the xanthomatous infiltration of tissues with foamy CD68+/CD1a- histiocytes. We report a series of 12 patients diagnosed with EC. PATIENTS AND METHODS: We reviewed the clinical, pathological and therapeutic aspects of 12 cases diagnosed with EC at 7 tertiary teaching hospitals in Spain. Patients were included if tissue infiltration by histiocytes CD68+/CD1a- could be demonstrated in an appropriate clinical setting. RESULTS: Twelve patients (7 male) were included. Median follow-up was 36 months (IQR: 20-84). The median age at the time of clinical onset and pathological diagnosis was 49 (IQR: 28-61) and 56 years (IQR: 37-62), respectively. In 6 cases multiples biopsies were performed (skin, muscle, testicular) previous to diagnosis, which was confirmed in 3 cases after a carefully review of pathological tissues. Neurological involvement was independently associated with mortality (P<.05). Characteristic long bone osteosclerosis was detected in 9 patients. CONCLUSION: EC is a multisystemic and heterogeneous clinicopathological condition. A high index of suspicion and fluent communication between clinicians and pathologists is necessary to achieve a correct diagnosis.

Enfermedad por crioaglutininas y neumonía neumocócica / Cold agglutin in disease and pneumococal pneumonia

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Characterization of trisomic natural killer cell abnormalities in a patient with constitutional trisomy 8 mosaicism.

Malignancies found in children and adults with constitutional trisomy 8 mosaicism (CT8M) could be in part the consequence of dysfunction of trisomic immune cells. An adult patient exhibiting trisomy in the entire natural killer (NK) cell population has made possible the characterization of trisomy 8-positive NK cells. The study showed normal cytotoxic activity but predominance of an immunosenescent phenotype (CD56(dim)CD94/NKG2(bright)) characterized by a weak response to IL-2, increased upregulation of CD95/Fas, and impaired TNF-alpha production. As these defects may contribute to the escape and expansion of neoplastic cells, the authors hypothesize that cancer predisposition in CT8M may be partly a result of altered immunosurveillance.

Trombosis portal como primera manifestación de un síndrome mieloproliferativo crónico oculto / Recurrent meningoencephalitis caused by Eubacterium lentum

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Cross-linking of MHC class I molecules on human NK cells inhibits NK cell function, segregates MHC I from the NK cell synapse, and induces intracellular phosphotyrosines.

Engagement of major histocompatibility complex (MHC) class I molecules on immune cells, where they are usually highly expressed, induces signal transduction events of unclear significance. We show here that antibody-mediated cross-linking of MHC-I molecules on human natural killer (NK) cells inhibits their cytotoxic activity against tumor target cells. Inhibition by anti-MHC class I monoclonal antibody exhibits molecular specificity and is an isotype and Fc-independent process. Physical hindrance of specific molecular recognition, induction of apoptosis, or reciprocal NK cell killing, which could be induced by cross-linking of MHC I molecules, has also been ruled out as putative mechanisms of inhibition. Confocal microscopy analysis revealed that MHC class I molecules on the surface of NK cells colocalize constitutively with GM1, a marker of lipid rafts. Cross-linking of MHC class I resulted in the asymmetric redistribution of GM1-enriched raft domains, which are concentrated to the immunological synapse, and MHC I molecules, which segregate to the opposite pole. Also, the cross-linking of MHC I on NK cells induced intracellular tyrosine phosphorylations. These results suggest that MHC I molecules on NK cells could transmit inhibitory signals upon engagement with putative ligands expressed on the surface of those cells that need to be protected from natural cytotoxicity.