Function-guided selection of salivary antigens from Ornithodoros erraticus argasid ticks and assessment of their protective efficacy in rabbits.

The identification of new protective antigens for the development of tick vaccines may be approached by selecting antigen candidates that have key biological functions. Bioactive proteins playing key functions for tick feeding and pathogen transmission are secreted into the host via tick saliva. Adult argasid ticks must resynthesise and replace these proteins after each feeding to be able to repeat new trophogonic cycles. Therefore, these proteins are considered interesting antigen targets for tick vaccine development. In this study, the salivary gland transcriptome and saliva proteome of Ornithodoros erraticus females were inspected to select and test new vaccine candidate antigens. For this, we focused on transcripts overexpressed after feeding that encoded secretory proteins predicted to be immunogenic and annotated with functions related to blood ingestion and modulation of the host defensive response. Completeness of the transcript sequence, as well as a high expression level and a high fold-change after feeding were also scored resulting in the selection of four candidates, an acid tail salivary protein (OeATSP), a multiple coagulation factor deficiency protein 2 homolog (OeMCFD2), a Cu/Zn-superoxide dismutase (OeSOD) and a sulfotransferase (OeSULT), which were later produced as recombinant proteins. Vaccination of rabbits with each individual recombinant antigen induced strong humoral responses that reduced blood feeding and female reproduction, providing, respectively, 46.8%, 45.7%, 54.3% and 31.9% protection against O. erraticus infestations and 0.7%, 3.9%, 3.1% and 8.7% cross-protection against infestations by the African tick, Ornithodoros moubata. The joint protective efficacy of these antigens was tested in a second vaccine trial reaching 58.3% protection against O. erraticus and 18.6% cross-protection against O. moubata. These results (i) provide four new protective salivary antigens from argasid ticks that might be included in multi-antigenic vaccines designed for the control of multiple tick species; (ii) reveal four functional protein families never tested before as a source of protective antigens in ticks; and (iii) show that multi-antigenic vaccines increase vaccine efficacy compared with individual antigens. Finally, our data add value to the salivary glands as a protective antigen source in argasids for the control of tick infestations.

Four-Dimensional Computed Tomography Ventilation Image-Guided Lung Functional Avoidance Radiation Therapy: A Single-Arm Prospective Pilot Clinical Trial.

PURPOSE: The primary objective of this prospective pilot trial was to assess the safety and feasibility of lung functional avoidance radiation therapy (RT) with 4-dimensional (4D) computed tomography (CT) ventilation imaging. METHODS AND MATERIALS: Patients with primary lung cancer or metastatic disease to the lungs to receive conventionally fractionated RT (CFRT) or stereotactic body RT (SBRT) were eligible. Standard-of-care 4D-CT scans were used to generate ventilation images through image processing/analysis. Each patient required a standard intensity modulated RT plan and ventilation image guided functional avoidance plan. The primary endpoint was the safety of functional avoidance RT, defined as the rate of grade ≥3 adverse events (AEs) that occurred ≤12 months after treatment. Protocol treatment was considered safe if the rates of grade ≥3 pneumonitis and esophagitis were <13% and <21%, respectively for CFRT, and if the rate of any grade ≥3 AEs was <28% for SBRT. Feasibility of functional avoidance RT was assessed by comparison of dose metrics between the 2 plans using the Wilcoxon signed-rank test. RESULTS: Between May 2015 and November 2019, 34 patients with non-small cell lung cancer were enrolled, and 33 patients were evaluable (n = 24 for CFRT; n = 9 for SBRT). Median follow-up was 14.7 months. For CFRT, the rates of grade ≥3 pneumonitis and esophagitis were 4.2% (95% confidence interval, 0.1%-21.1%) and 12.5% (2.7%-32.4%). For SBRT, no patients developed grade ≥3 AEs. Compared with the standard plans, the functional avoidance plans significantly (P < .01) reduced the lung dose-function metrics without compromising target coverage or adherence to standard organs at risk constraints. CONCLUSIONS: This study, representing one of the first prospective investigations on lung functional avoidance RT, demonstrated that the 4D-CT ventilation image guided functional avoidance RT that significantly reduced dose to ventilated lung regions could be safely administered, adding to the growing body of evidence for its clinical utility.

Uso de la medicina natural por profesionales en el primer nivel de atención de salud / Usage of Natural Medicine by Professional at the First Level of Healthcare

Introducción: La medicina natural surge como la alternativa más eficaz y por su evidente resultado en la calidad de vida de las personas. Objetivo: Describir el nivel de utilización de la Medicina Natural por parte de los profesionales de la salud. Métodos: Se realizó un estudio observacional, descriptivo retrospectivo. El universo estuvo constituido por 44 profesionales de la salud de varias categorías, durante el período de estudio, los cuales cumplían con los criterios de inclusión. Se utilizaron variables cualitativas y cuantitativas. Resultados: El 64 por ciento de los profesionales declararon utilizar la Medicina Natural y Tradicional en todo momento del tratamiento, la modalidad más utilizada fue la fitoterapia con el 51 por ciento por parte de los estomatólogos, el 75 por ciento de los profesionales utilizaron los fitofármacos como única opción terapéutica para el tratamiento de las diferentes enfermedades; reconocieron plantas como: la caña santa, naranja agria, ajo y caléndula en enfermedades como: la hipertensión arterial, infecciones respiratorias, trastornos circulatorios y estomatitis. El 84 por ciento de los profesionales de las categorías médicos, estomatólogos, enfermeras y licenciados obtuvieron los conocimientos durante su formación profesional. Conclusiones: Existe poco aprovechamiento de las diferentes modalidades terapéuticas y sus propiedades como tratamiento médico(AU)

Introduction: Natural medicine is an effective alternative in the medical treatment of various diseases. Objective: To describe the level of use of natural medicine by health professionals. Methods: A retrospective, descriptive and observational study was carried out. The study universe consisted of 44 health professionals of various categories, who met the inclusion criteria. Qualitative and quantitative variables were used. Results: 64 percent of the professionals reported using natural medicine at all times of treatment. The most used modality was phytotherapy, accounting for 51 percent for the dental doctors. 75 percent of the professionals used phytopharmaceuticals as the only therapeutic option for treating different diseases. They recognized the use of plants such as lemon grass, bitter orange, garlic and marigold for treating arterial hypertension, respiratory infections, circulatory disorders and stomatitis. 84 percent of the professionals in the categories of physicians, dental doctors, nurses and graduates obtained the knowledge during their professional training. Conclusions: There is little use of the different therapeutic modalities and properties of natural medicine as medical treatment(AU)

Associations between parental and adolescent alcohol use: The role of gender and familism support.

INTRODUCTION: This study examined the role of gender and familism support in the associations between parental and adolescent drinking behaviors in a sample of Mexican adolescents. METHOD: Mexican adolescents (49% girls; N = 724) aged 12-19 completed measures assessing familism support, self-reported drinking behaviors, and perceptions of parental drinking behaviors. RESULTS AND CONCLUSION: Findings suggest that both gender and familism support moderate the relationship between parental drinking behaviors and adolescent drinking behaviors. For instance, the association between mothers' alcohol use frequency and adolescent binge drinking was stronger for girls. In contrast, the association between fathers' amount per drinking day and adolescent binge drinking was stronger for boys. Mother's amount per drinking day was associated with less alcohol use per drinking day among adolescents reporting high familism support. The current study expands our understanding of parental modeling on Mexican adolescent drinking behavior.

Evaluating Automatic Segmentation for Swallowing-Related Organs for Head and Neck Cancer.

Purpose: To evaluate the accuracy of deep-learning-based auto-segmentation of the superior constrictor, middle constrictor, inferior constrictor, and larynx in comparison with a traditional multi-atlas-based method. Methods and Materials: One hundred and five computed tomography image datasets from 83 head and neck cancer patients were retrospectively collected and the superior constrictor, middle constrictor, inferior constrictor, and larynx were analyzed for deep-learning versus multi-atlas-based segmentation. Eighty-three computed tomography images (40 diagnostic computed tomography and 43 planning computed tomography) were used for training the convolutional neural network, and for atlas-based model training. The remaining 22 computed tomography datasets were used for validation of the atlas-based auto-segmentation versus deep-learning-based auto-segmentation contours, both of which were compared with the corresponding manual contours. Quantitative measures included Dice similarity coefficient, recall, precision, Hausdorff distance, 95th percentile of Hausdorff distance, and mean surface distance. Dosimetric differences between the auto-generated contours and manual contours were evaluated. Subjective evaluation was obtained from 3 clinical observers to blindly score the autosegmented structures based on the percentage of slices that require manual modification. Results: The deep-learning-based auto-segmentation versus atlas-based auto-segmentation results were compared for the superior constrictor, middle constrictor, inferior constrictor, and larynx. The mean Dice similarity coefficient values for the 4 structures were 0.67, 0.60, 0.65, and 0.84 for deep-learning-based auto-segmentation, whereas atlas-based auto-segmentation has Dice similarity coefficient results at 0.45, 0.36, 0.50, and 0.70, respectively. The mean 95th percentile of Hausdorff distance (cm) for the 4 structures were 0.41, 0.57, 0.59, and 0.54 for deep-learning-based auto-segmentation, but 0.78, 0.95, 0.96, and 1.23 for atlas-based auto-segmentation results, respectively. Similar mean dose differences were obtained from the 2 sets of autosegmented contours compared to manual contours. The dose-volume discrepancies and the average modification rates were higher with the atlas-based auto-segmentation contours. Conclusion: Swallowing-related structures are more accurately generated with DL-based versus atlas-based segmentation when compared with manual contours.

Caracterización epidemiológica del cáncer de mama en el Policlínico Emilio Daudinot Bueno en el municipio de Guantánamo / Epidemiological Characterization of Breast Cancer in Emilio Daudinot Bueno Polyclinic of Guantánamo Municipality

Introducción: Cada año se producen en la región de las Américas más de 462 000 casos nuevos y casi 100 000 muertes por cáncer de mama. Objetivo: Describir los aspectos epidemiológicos del cáncer de mama en la población femenina del policlínico Emilio Daudinot Bueno. Métodos: Se realizó una investigación, descriptiva y retrospectiva en el municipio de Guantánamo en el período enero de 2014-diciembre de 2019. El universo lo constituyeron todas las mujeres del policlínico Emilio Daudinot Bueno con diagnóstico clínico y anátomopatológico de cáncer de mama (N = 83). Para la obtención de la información se aplicó un cuestionario cuyas variables recogían datos demográficos, factores de riesgo, elementos relacionados con el estado nutricional y hábitos tóxicos. Para el procesamiento de la información se hizo uso de la estadística descriptiva, utilizando medidas de resumen para variables cualitativas (frecuencias absolutas y porcentajes) y para variables cuantitativas (promedio). Resultados: Predominaron las edades comprendidas entre 50 y 60 años con edad promedio de 42,5 años, las pacientes con estado nutricional sobrepeso n = 41, seguidas de las obesas. El factor de riesgo más identificado fue no lactancia materna, y el hábito tóxico de mayor prevalencia fue el consumo de grasa animal. Conclusiones: Las mujeres con sobrepeso, el alto consumo de grasa animal y los antecedentes familiares de cáncer de mama, nuliparidad y no haber lactado, tienen una probabilidad mayor de desarrollar cáncer de mama, y más aún entre las edades comprendidas entre 50 y 60 años(AU)

Introduction: Every year, there are more than 462,000 new cases and almost 100,000 deaths due to breast cancer in the region. Objective: To describe the epidemiological aspects of breast cancer in the female population of Emilio Daudinot Bueno Polyclinic. Methods: A descriptive and retrospective research was carried out in Guantánamo Municipality in the period from January 2014 to December 2019. The universe was made up of all the women belonging to Emilio Daudinot Bueno Polyclinic with a clinical and anatomopathological diagnosis of breast cancer (N=83). To obtain the information, a questionnaire was applied, whose variables included demographic data, risk factors, as well as elements related to nutritional status and toxic habits. Descriptive statistics were used to process the information, using summary measures for qualitative variables (absolute frequencies and percentages) and for quantitative variables (average). Results: The predominant age group was between 50 and 60 years, with an average age of 42.5 years. There was also a predominance of patients with overweight [n=41], followed by obese patients. The most identified risk factor was not breastfeeding, while the most prevalent toxic habit was animal fat consumption. Conclusions: Overweight women, high animal fat consumption and family history of breast cancer, together with nulliparity and not having breastfed, accounts for a higher probability of developing breast cancer, and even more so at ages between 50 and 60 years(AU)

Intervención educativa en adolescentes sospechosos por el SARS-CoV-2 en Guantánamo

RESUMEN Introducción: La COVID-19 no distingue entre edad, raza y sexo; los niños y jóvenes constituyen un sector de la población que no escapa a esta realidad. Objetivo: Diseñar una intervención educativa dirigida a elevar el conocimiento y preparación sobre COVID-19 en adolescentes de 15 a 18 años ingresados en el centro de aislamiento de la Facultad de Ciencias Médicas de Guantánamo para casos sospechosos por el SARS-CoV-2. Método: Entre enero de 2021 y marzo de 2021 se realizó un estudio experimental de tipo intervención educativa. El universo estuvo constituido por los adolescentes ingresados incluidos en el rango de edad antes señalado. Fueron incluidos en el estudio 97 adolescentes seleccionados de modo intencional. Se indagó sobre el nivel de información que poseían sobre el tema antes y después de aplicar la intervención educativa. Resultados: Antes de la implementación de la intervención educativa el 50,5 % de los adolescentes expresó tener un nivel de información insuficiente respecto a la COVID-19, y esta proporción disminuyó a un 21,6 % luego de aplicarla; lo que significó una reducción en un 57,2 % en los adolescentes con carencias teóricas respecto al tema. El porcentaje que incrementó su preparación fue de un 36,9 % (p < 0,05), lo que indicó la ventaja de implementar la intervención educativa. Conclusiones: La intervención educativa dirigida a los adolescentes ingresados con sospecha de SARS-CoV-2 posibilita mejorar los conocimientos respecto a la COVID-19.

ABSTRACT Introduction: COVID-19 does not distinguish between age, race or sex. Children and young people constitute a sector of the population that does not escape this reality. Objective: To design an educational intervention aimed at raising awareness and preparedness about COVID-19 in adolescents aged 15 to 18 years, admitted to an isolation center for suspected cases of SARS-CoV-2. Method: Between January 2021 and March 2021, a prospective, longitudinal study of an educational intervention type was carried out. The population was made up of adolescents admitted in the center, all included in the aforementioned age range. A total of 97 intentionally selected adolescents were included in the study. Inquires about the level of information they had on the subject were made, before and after applying the educational intervention. Results: Before the implementation of the educational intervention, 50.5% of the adolescents expressed having an insufficient level of information regarding COVID-19, and this proportion decreased to 21.6% after applying it; which meant a 57.2% reduction in adolescents with theoretical deficiencies regarding the subject. The percentage that increased their preparation was 36.9% (p <0.05), which indicated the advantage of implementing the educational intervention. Conclusions: The educational intervention aimed at adolescents suspected of SARS-Cov-2 infection makes it possible to improve knowledge regarding COVID-19.

RESUMO Introdução: COVID-19 não faz distinção entre idade, raça e sexo; As crianças e os jovens constituem um setor da população que não foge a esta realidade. Objetivo: Delinear uma intervenção educativa com o objetivo de aumentar a conscientização e preparação para o COVID-19 em adolescentes de 15 a 18 anos internados em um centro de isolamento por casos suspeitos de SARS-CoV-2. Método: Entre janeiro de 2021 e março de 2021, foi realizado um estudo prospectivo e longitudinal do tipo intervenção educativa. O universo foi constituído por adolescentes internados, incluídos na referida faixa etária. 97 adolescentes selecionados intencionalmente foram incluídos no estudo. Eles indagaram sobre o nível de informação que possuíam sobre o assunto antes e após a aplicação da intervenção educativa. Resultados: Antes da implementação da intervenção educativa, 50,5% dos adolescentes manifestaram nível insuficiente de informação sobre o COVID-19, e essa proporção diminuiu para 21,6% após a aplicação; o que significou uma redução de 57,2% nos adolescentes com deficiência teórica sobre o assunto. O percentual que aumentou o preparo foi de 36,9% (p<0,05), o que indicou a vantagem da implementação da intervenção educativa. Conclusões: A intervenção educativa dirigida a adolescentes internados com suspeita de SARS-CoV-2 permite aprofundar os conhecimentos sobre o COVID-19.

A proteomics informed by transcriptomics insight into the proteome of Ornithodoros erraticus adult tick saliva.

BACKGROUND: The argasid tick Ornithodoros erraticus is the main vector of tick-borne human relapsing fever (TBRF) and African swine fever (ASF) in the Mediterranean Basin. The prevention and control of these diseases would greatly benefit from the elimination of O. erraticus populations, and anti-tick vaccines are envisaged as an effective and sustainable alternative to chemical acaricide usage for tick control. Ornithodoros erraticus saliva contains bioactive proteins that play essential functions in tick feeding and host defence modulation, which may contribute to host infection by tick-borne pathogens. Hence, these proteins could be candidate antigen targets for the development of vaccines aimed at the control and prevention of O. erraticus infestations and the diseases this tick transmits. The objective of the present work was to obtain and characterise the proteome of the saliva of O. erraticus adult ticks as a means to identify and select novel salivary antigen targets. METHODS: A proteomics informed by transcriptomics (PIT) approach was applied to analyse samples of female and male saliva separately using the previously obtained O. erraticus sialotranscriptome as a reference database and two different mass spectrometry techniques, namely liquid chromatography-tandem mass spectrometry (LC-MS/MS) in data-dependent acquisition mode and sequential window acquisition of all theoretical fragment ion spectra MS (SWATH-MS). RESULTS: Up to 264 and 263 proteins were identified by LC-MS/MS in the saliva of O. erraticus female and male ticks, respectively, totalling 387 non-redundant proteins. Of these, 224 were further quantified by SWATH-MS in the saliva of both male and female ticks. Quantified proteins were classified into 23 functional categories and their abundance compared between sexes. Heme/iron-binding proteins, protease inhibitors, proteases, lipocalins and immune-related proteins were the categories most abundantly expressed in females, while glycolytic enzymes, protease inhibitors and lipocalins were the most abundantly expressed in males. Ninety-seven proteins were differentially expressed between the sexes, of which 37 and 60 were overexpressed in females and males, respectively. CONCLUSIONS: The PIT approach demonstrated its usefulness for proteomics studies of O. erraticus, a non-model organism without genomic sequences available, allowing the publication of the first comprehensive proteome of the saliva of O. erraticus reported to date. These findings confirm important quantitative differences between sexes in the O. erraticus saliva proteome, unveil novel salivary proteins and functions at the tick-host feeding interface and improve our understanding of the physiology of feeding in O. erraticus ticks. The integration of O. erraticus sialoproteomic and sialotranscriptomic data will drive a more rational selection of salivary candidates as antigen targets for the development of vaccines aimed at the control of O. erraticus infestations and the diseases it transmits.

Proteomics informed by transcriptomics for a qualitative and quantitative analysis of the sialoproteome of adult Ornithodoros moubata ticks.

BACKGROUND: The argasid tick Ornithodoros moubata is the main vector in mainland Africa of African swine fever virus and the spirochete Borrelia duttoni, which causes human relapsing fever. The elimination of populations of O. moubata would contribute to the prevention and control of these two serious diseases. Anti-tick vaccines are an eco-friendly and sustainable means of eliminating tick populations. Tick saliva forms part of the tick-host interface, and knowledge of its composition is key to the identification and selection of vaccine candidate antigens. The aim of the present work is to increase the body of data on the composition of the saliva proteome of adult O. moubata ticks, particularly of females, since in-depth knowledge of the O. moubata sialome will allow the identification and selection of novel salivary antigens as targets for tick vaccines. METHODS: We analysed samples of female and male saliva using two different mass spectrometry (MS) approaches: data-dependent acquisition liquid chromatography-tandem MS (LC-MS/MS) and sequential window acquisition of all theoretical fragment ion spectra-MS (SWATH-MS). To maximise the number of proteins identified, a proteomics informed by transcriptomics analysis was applied using the O. moubata salivary transcriptomic dataset previously obtained by RNA-Seq. RESULTS: SWATH-MS proved to be superior to LC-MS/MS for the study of female saliva, since it identified 61.2% more proteins than the latter, the reproducibility of results was enhanced with its use, and it provided a quantitative picture of salivary components. In total, we identified 299 non-redundant proteins in the saliva of O. moubata, and quantified the expression of 165 of these in both male and female saliva, among which 13 were significantly overexpressed in females and 40 in males. These results indicate important quantitative differences in the saliva proteome between the sexes. CONCLUSIONS: This work expands our knowledge of the O. moubata sialome, particularly that of females, by increasing the number of identified novel salivary proteins, which have different functions at the tick-host feeding interface. This new knowledge taken together with information on the O. moubata sialotranscriptome will allow a more rational selection of salivary candidates as antigen targets for tick vaccine development.

Caracterización clínico-epidemiológica de la mujer infértil / Epidemiological-clinical characterization of infertile women

RESUMEN Fundamento: la infertilidad es la incapacidad para tener hijos, pero con posibilidad de embarazo que no llega a término. En el mundo existen 187 millones de parejas afectadas. Objetivo: caracterizar las mujeres atendidas en la consulta municipal de infertilidad. Métodos: se realizó un estudio descriptivo observacional y retrospectivo en Policlínico Docente Emilio Daudin Bueno, de la provincia Guantánamo, durante el periodo enero de 2017 a junio de 2020. El universo estuvo constituido por las 128 mujeres infértiles de 19-39 años atendidas en consulta. Fueron evaluadas variables cualitativas y cuantitativas. La información de cada variable estudiada se obtuvo de las historias clínicas de las pacientes atendidas en consulta. Resultados: predominaron las féminas de 25-29 años con infertilidad secundaria; las infecciones genitales como factor causal predominante, seguido de los antecedentes obstétricos desfavorables y en la mayoría de las pacientes el peso saludable como evaluación nutricional. Se pudo percibir que del total de las pacientes, en algunas existió algún grado de aumento del peso corporal. Conclusiones: la consulta de infertilidad cumple el objetivo de lograr la concepción de las féminas según las causas que impiden la misma, la actuación de cada profesional de la salud al incorporar los conocimientos necesarios a emplear en su adecuado seguimiento, permitirá concretarlo desde la Atención Primaria de Salud.

ABSTRACT Background: infertility is the inability to have children, but with the possibility of pregnancy, which does not reach term. There are one hundred and eighty-seven million affected couples in the world. Objective: to characterize women treated in the municipal consultation of infertility. Methods: an observational and retrospective descriptive study was carried out in Emilio Daudinot Bueno Docent Polyclinic, Guantánamo, during the period January 2017 to June 2020. The universe was made up of 128 infertile women who met the inclusion criteria: 19-39 years old, seen in infertility consultation and fulfill the concept of infertility. Qualitative and quantitative variables were evaluated. The primary data was obtained from the medical records of the patients seen. Results: females aged 25-29 years with secondary infertility predominated; genital infections as the predominant cause factor, followed by unfavorable obstetric history and, in most patients, healthy weight as a nutritional assessment. It was possible to perceive that of the total number of patients, in some there was some degree of increase in body weight. Conclusions: the infertility consultation fulfills the objective of achieving the conception of women by attenuating the causes that prevent it, the performance of each health professional by incorporating the necessary knowledge to be used in its adequate follow-up, will allow specifying it from Primary Care of health.

Prognostic Value of Computed Tomography and/or 18F-Fluorodeoxyglucose Positron Emission Tomography Radiomics Features in Locally Advanced Non-small Cell Lung Cancer.

INTRODUCTION: We investigated whether adding computed tomography (CT) and/or 18F-fluorodeoxyglucose (18F-FDG) PET radiomics features to conventional prognostic factors (CPFs) improves prognostic value in locally advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: We retrospectively identified 39 cases with stage III NSCLC who received chemoradiotherapy and underwent planning CT and staging 18F-FDG PET scans. Seven CPFs were recorded. Feature selection was performed on 48 CT and 49 PET extracted radiomics features. A penalized multivariate Cox proportional hazards model was used to generate models for overall survival based on CPFs alone, CPFs with CT features, CPFs with PET features, and CPFs with CT and PET features. Linear predictors generated and categorized into 2 risk groups for which Kaplan-Meier survival curves were calculated. A log-rank test was performed to quantify the discrimination between the groups and calculated the Harrell's C-index to quantify the discriminatory power. A likelihood ratio test was performed to determine whether adding CT and/or PET features to CPFs improved model performance. RESULTS: All 4 models significantly discriminated between the 2 risk groups. The discriminatory power was significantly increased when CPFs were combined with PET features (C-index 0.82; likelihood ratio test P < .01) or with both CT and PET features (0.83; P < .01) compared with CPFs alone (0.68). There was no significant improvement when CPFs were combined with CT features (0.68). CONCLUSION: Adding PET radiomics features to CPFs yielded a significant improvement in the prognostic value in locally advanced NSCLC; adding CT features did not.

RNA-seq analysis and gene expression dynamics in the salivary glands of the argasid tick Ornithodoros erraticus along the trophogonic cycle.

BACKGROUND: The argasid tick Ornithodoros erraticus is the main vector of tick-borne human relapsing fever (TBRF) and African swine fever (ASF) in the Mediterranean Basin. Tick salivary proteins secreted to the host at the feeding interface play critical roles for tick feeding and may contribute to host infection by tick-borne pathogens; accordingly, these proteins represent interesting antigen targets for the development of vaccines aimed at the control and prevention of tick infestations and tick-borne diseases. METHODS: To identify these proteins, the transcriptome of the salivary glands of O. erraticus was de novo assembled and the salivary gene expression dynamics assessed throughout the trophogonic cycle using Illumina sequencing. The genes differentially upregulated after feeding were selected and discussed as potential antigen candidates for tick vaccines. RESULTS: Transcriptome assembly resulted in 22,007 transcripts and 18,961 annotated transcripts, which represent 86.15% of annotation success. Most salivary gene expression took place during the first 7 days after feeding (2088 upregulated transcripts), while only a few genes (122 upregulated transcripts) were differentially expressed from day 7 post-feeding onwards. The protein families more abundantly overrepresented after feeding were lipocalins, acid and basic tail proteins, proteases (particularly metalloproteases), protease inhibitors, secreted phospholipases A2, 5'-nucleotidases/apyrases and heme-binding vitellogenin-like proteins. All of them are functionally related to blood ingestion and regulation of host defensive responses, so they can be interesting candidate protective antigens for vaccines. CONCLUSIONS: The O. erraticus sialotranscriptome contains thousands of protein coding sequences-many of them belonging to large conserved multigene protein families-and shows a complexity and functional redundancy similar to those observed in the sialomes of other argasid and ixodid tick species. This high functional redundancy emphasises the need for developing multiantigenic tick vaccines to reach full protection. This research provides a set of promising candidate antigens for the development of vaccines for the control of O. erraticus infestations and prevention of tick-borne diseases of public and veterinary health relevance, such as TBRF and ASF. Additionally, this transcriptome constitutes a valuable reference database for proteomics studies of the saliva and salivary glands of O. erraticus.

Epidemiologia del dengue en la edad pediátrica en Guantánamo / Epidemiology of pediatric dengue in Guantánamo

RESUMEN Introducción: El dengue en la edad pediátrica continúa siendo una de las causas frecuentes de morbilidad y mortalidad. Objetivo: Caracterizar la epidemia de dengue en la edad pediátrica en Guantánamo. Métodos: Estudio observacional descriptivo retrospectivo de corte transversal en un universo de 150 casos confirmados atendidos en el Policlínico Docente Emilio Daudinot Bueno durante el periodo entre enero de 2018-diciembre de 2019 y se contrastaron los resultados de estos años. Se evaluaron las variables: grupo de edad, sexo, tiempo de ingreso en horas, manifestaciones clínicas, signos y síntomas de alarma y meses del año. Los datos se obtuvieron de las historias clínicas epidemiológicas de cada uno de los casos. Resultados: El año 2019 tuvo el mayor número de casos confirmados (72,6 %), donde el sexo masculino (50,4 %) y el grupo de edad de 15 a 18 años (30,2 %) prevalecieron. En ambos años (2018 y 2019) el mayor porcentaje de los pacientes que ingresaron, lo hicieron durante las primeras 24 horas del inicio de los síntomas (73,1 y 47,7 % respectivamente). El síntoma predominante fue la fiebre (97,5 % y 92,0 %) durante los años señalados. La aparición de signos de alarma en pacientes al momento de su ingreso tuvo mayor frecuencia durante 2019 (81,5 %). Los meses de mayor número de casos confirmados durante el 2018 fueron los de septiembre, julio y octubre, que agrupó 69 %; en 2019 fueron los de diciembre, septiembre y octubre con el 60 %. Conclusiones: Los resultados obtenidos avalan la necesidad de continuar la vigilancia del dengue en la edad pediátrica y aportan conocimientos necesarios para su prevención.

ABSTRACT Introduction: Pediatric dengue continues to be a frequent cause of morbidity and mortality. Objective: Characterize the pediatric dengue epidemic in Guantánamo. Methods: An observational cross-sectional retrospective descriptive study was conducted of a universe of 150 confirmed cases attending Emilio Daudinot Bueno polyclinic from January 2018 to December 2019, contrasting the results obtained for those years. The variables considered were age group, sex, hospital stay in hours, clinical manifestations, warning signs and symptoms, and month of the year. Data were obtained from the epidemiological medical records of all the cases. Results: There was an increase in the number of confirmed cases in 2019 with respect to 2018. The most affected age groups were 5-9 years in 2018 (36.5 %) and 15-18 years in 2019 (30.2 %) in the male sex. Admission within 24 hours prevailed in both periods, with 73.1 % in 2018 and 47.7 % in 2019. Fever was the main clinical manifestation in both years, with 97.5 % and 92.0 %, respectively. The appearance of alarm signs in patients at the time of admission was more frequent during 2019 (81.5 %). The months with the highest number of confirmed cases during 2018 were September, July and October, which accounted for 69 %; in 2019 they were those of December, September and October with 60 %. Conclusions: The results obtained support the need to continue surveillance of dengue in children and provide the necessary knowledge for its prevention.

Heberprot-P® en úlcera del pie diabético. Policlínico Universitario "Emilio Daudinot Bueno" / Heberprot-P® in diabetic foot ulcer. "Emilio Daudinot Bueno" University Polyclinic

RESUMEN Fundamento: El Heberprot-P® es un producto de cicatrización para la úlcera del pie diabético; este medicamento se utiliza en el Policlínico Universitario Emilio Daudinot Bueno de Guantánamo; por ello es necesario un mayor conocimiento acerca de los elementos científicos para su aplicación práctica con una perspectiva integral. Objetivo: Describir el comportamiento del uso del Heberprot-P® en pacientes con úlcera del pie diabético en el Policlínico Universitario Emilio Daudinot Bueno del municipio Guantánamo, durante el periodo enero 2017 a diciembre 2018. Metodología: Se realizó un estudio de observación descriptivo, el universo fueron los 140 pacientes que cumplieron los criterios de inclusión: pertenecer al área de salud y atenderse en la consulta de úlcera del pie diabético del policlínico. La información se obtuvo de las historias clínicas de los pacientes atendidos. Resultados: Predominó el grupo etario 65-74 años, el sexo femenino, la diabetes mellitus tipo 2, el hábito de fumar como factor de riesgo fundamental y con diagnóstico etiológico de la úlcera del pie diabético neuroinfeccioso y Wagner tipo 2. No se detectó en la mayoría de los pacientes alguna reacción adversa al aplicar el medicamento. Conclusiones: La mayoría de los pacientes atendidos evolucionaron satisfactoriamente, lo que constata la efectividad del Heberprot-P®.

ABSTRACT Background: Heberprot-P® is a healing product for diabetic foot ulcer; this medication is used at Emilio Daudinot Bueno University Polyclinic in Guantánamo; so, a greater knowledge about scientific elements is necessary for its practical application with a comprehensive perspective. Objective: To describe the behavior of the use of Heberprot-P® in patients with diabetic foot ulcer at Emilio Daudinot Bueno University Polyclinic in Guantánamo municipality, from January 2017 to December 2018. Methodology: A descriptive observational study was carried out; the universe consisted of 140 patients who had the inclusion criteria: belonging to the health area and attending the diabetic foot ulcer clinic at the polyclinic. The information was obtained from the medical records of the assisted patients. Results: The age group 65-74 years, female sex, type 2 diabetes mellitus, smoking as a fundamental risk factor and with an etiological diagnosis of neuroinfectious diabetic foot ulcer and Wagner type 2 prevailed. It was not detected in most of the patients some adverse reaction when applying the medication. Conclusions: Most of the assisted patients evolved satisfactorily, this assures the effectiveness of Heberprot-P®.

Combined Immune Checkpoint Blockade and Stereotactic Ablative Radiotherapy Can Stimulate Response to Immunotherapy in Metastatic Melanoma: A Case Report.

Skin cancer is the most commonly diagnosed malignancy in the United States, and invasive cutaneous melanoma is responsible for the vast majority of skin cancer-related deaths. Treatment options for patients with regional nodal disease, in-transit metastases, or locally advanced or distant metastatic disease are challenging. Historically survival rates in this patient population are dismal. Improved systemic control is possible using targeted agents and checkpoint inhibitors have redefined treatment outcomes. Furthermore, multi-modal therapy incorporating radiation may improve survival outcomes by priming the immune system for antigen release and help in reversing T-cell exhaustion. Herein, we describe a patient with widespread metastatic melanoma with progressive systemic disease while receiving checkpoint inhibition therapy that was reversed after combined immunoradiotherapy. The patient is now more than 41 months from diagnosis with durable, stable systemic disease.

Intervención educativa sobre cáncer de mama en mujeres, Policlínico Universitario Emilio Daudinot Bueno, Guantánamo 2017-2018 / Intervenção educacional sobre câncer de mama em mulheres, Universidade Policlínica Emilio Daudinot Bueno, Guantánamo 2017-2018 / Educational intervention on breast cancer in women, University Polyclinic Emilio Daudinot Bueno, Guantanamo 2017-2018

Introducción: El cáncer de mama es un problema de salud lo que hace necesario la educación de las mujeres encaminada a su diagnóstico precoz. Objetivo: Diseñar una intervención educativa dirigida a elevar la preparación respecto al tema en mujeres de 18 a 60 años del Consultorio No. 12 del Policlínico Universitario Emilio Daudinot Bueno. Método: Entre noviembre de 2017 y octubre de 2018 se realizó un estudio prospectivo, de tipo intervención educativa. El universo fue el total de mujeres incluidas en el rango de edad que se señaló y se incluyeron en el estudio 97 seleccionadas de modo intencional. Se indagó su nivel de información sobre el tema antes y después de aplicar la intervención educativa. Resultados: Antes de la implementación de la intervención educativa diseñada, el 50,5 por ciento de las mujeres expresó un nivel de información insuficiente respecto al cáncer de mama y ésta proporción disminuyó a un 21,6 por ciento luego de aplicarla, lo que significó una reducción en un 57,2 por ciento de las mujeres con carencias teóricas respecto al tema. El porcentaje que incrementó su preparación fue de un 36,9 por ciento (p < 0,05), lo que indicó la ventaja de implementar la intervención educativa diseñada. Conclusiones: La intervención educativa dirigida a la preparación de las mujeres respecto al cáncer de mama en el Policlínico Universitario Emilio Daudinot Bueno posibilitó enriquecer su cultura respecto al tema(AU)

Introdução: O câncer de mama é um problema de saúde que torna necessária a educação das mulheres para o diagnóstico precoce. Objetivo: Projetar uma intervenção educacional destinada a elevar a preparação sobre o assunto em mulheres dos 18 aos 60 anos do escritório 12 da Clinicva Universitária Emilio Daudinot Bueno. Método: Entre novembro de 2017 e outubro de 2018, foi realizado um estudo prospectivo, do tipo intervenção educacional. O universo foi o número total de mulheres incluídas na faixa etária indicada e 97 intencionalmente selecionadas foram incluídas no estudo. O nível de informação sobre o assunto foi investigado antes e após a aplicação da intervenção educativa. Resultados: Antes da implementação da intervenção educacional planejada, 50,5por cento das mulheres expressavam um nível insuficiente de informações sobre os Escritorio médico 12, e essa proporção diminuiu para 21,6por cento após a aplicação, o que significou uma redução no 57,2por cento das mulheres com déficits teóricos em relação ao tema. O percentual que aumentou a sua preparação foi de 36,9por cento (p<0,05), o que indicou a vantagem de implementar a intervenção educacional que foi planejada. Conclusões: A intervenção educativa voltada para a preparação de mulheres para o câncer de mama na Clínica Universitária Emilio Daudinot Bueno possibilitou enriquecer sua cultura sobre o assunto(AU)

Introduction: Breast cancer is a health problem which makes the education of women necessary for early diagnosis. Objective: To design an educational intervention aimed at raising the preparation on the subject in women from 18 to 60 years of the Family office 12 of the University Polyclinic Emilio Daudinot Bueno. Method: Between November 2017 and October 2018 a prospective study was carried out, of the educational intervention type. The universe was the total number of women included in the age range indicated, and 97 intentionally selected were included in the study. Their level of information on the subject was investigated before and after applying the educational intervention. Results: Before the implementation of the designed educational intervention, 50.5per cent of the women expressed an insufficient level of information regarding the Family office, and this proportion decreased to 21.6por cento after applying it, which meant a reduction in 57.2per cent of women with theoretical deficits regarding the issue. The percentage that increased their preparation was 36.9per cent (p <0.05), which indicated the advantage of implementing the educational intervention that was designed. Conclusions: The educational intervention aimed at the preparation of women regarding breast cancer in the University Polyclinic Emilio Daudinot Bueno made it possible to enrich their culture regarding the subject(AU)

Factores causales de infertilidad / Fatores causadores de infertilidade / Causative factors of infertility

Introducción: la infertilidad adquiere cada día mayor auge en las sociedades. Objetivo: facilitar la labor del médico de la familia en la captación y seguimiento de los casos de infertilidad. Método: se realizó una revisión bibliográfica, mediante consulta digital de las revistas especializadas, actualizadas y de libre acceso disponibles en el sitio web de la Biblioteca Virtual de Salud. Para la localización de las publicaciones fueron empleadas varias palabras clave, que contuvieron fundamentalmente el término infertilidad. Las citas digitales más recientes y que mostraban el trabajo de manera íntegra, fueron sometidas a un análisis que permitió obtener la información. Desarrollo: dentro de las causas de infertilidad identificadas con mayor frecuencia se encuentran en el caso de las femeninas, las infecciones genitales y como exponente de la masculina con el varicocele. Conclusiones: fomentar la incorporación del conocimiento permitirá el diseño de acciones preventivas sobre los principales factores causales de la infertilidad desde la Atención Primaria de Salud(AU)

Introduction: infertility is becoming increasingly popular in societies. Objective: to facilitate the work of the family doctor in the collection and follow-up of cases of infertility. Method: a bibliographic review was carried out, through digital consultation of specialized journals, updated and freely available on the website of the Virtual Health Library. Several keywords were used to locate the publications, which mainly contained the term infertility. The most recent digital citations, which showed the work in their entirety, were subjected to an analysis that allowed obtaining the information. Development: Among the causes of infertility identified most frequently are in the case of females, genital infections and as an exponent of the male with the varicocele. Conclusions: promoting the incorporation of knowledge will allow the design of preventive actions on the main causal factors of infertility from the Primary Health Care(AU)

Introdução: a infertilidade está se tornando cada vez mais popular nas sociedades. Objetivo: facilitar o trabalho do médico de família na coleta e acompanhamento de casos de infertilidade. Método: foi realizada uma revisão bibliográfica, por meio de consulta digital de periódicos especializados, atualizado e disponível gratuitamente no site da Biblioteca Virtual em Saúde. Diversas palavras-chave foram utilizadas para localizar as publicações, que continham, principalmente, o termo infertilidade, sendo que as citações digitais mais recentes, que apresentaram o trabalho na íntegra, foram submetidas a uma análise que permitiu a obtenção das informações. Desenvolvimento: Dentro das causas da infertilidade identificaram mais freqüentemente encontrada no caso das mulheres, infecções genitais e como um expoente do sexo masculino com os varicocele. Consideraciones finais: promover a incorporação do conhecimento permitem o desenho de ações preventivas em principais fatores causais da infertilidade da Atenção Primária à Saúde(AU)

Radiomics-based Assessment of Radiation-induced Lung Injury After Stereotactic Body Radiotherapy.

BACKGROUND: Over 50% of patients who receive stereotactic body radiotherapy (SBRT) develop radiographic evidence of radiation-induced lung injury. Radiomics is an emerging approach that extracts quantitative features from image data, which may provide greater value and a better understanding of pulmonary toxicity than conventional approaches. We aimed to investigate the potential of computed tomography-based radiomics in characterizing post-SBRT lung injury. METHODS: A total of 48 diagnostic thoracic computed tomography scans (acquired prior to SBRT and at 3, 6, and 9 months post-SBRT) from 14 patients were analyzed. Nine radiomic features (ie, 7 gray level co-occurrence matrix [GLCM] texture features and 2 first-order features) were investigated. The ability of radiomic features to distinguish radiation oncologist-defined moderate/severe lung injury from none/mild lung injury was assessed using logistic regression and area under the receiver operating characteristic curve (AUC). Moreover, dose-response curves (DRCs) for radiomic feature changes were determined as a function of time to investigate whether there was a significant dose-response relationship. RESULTS: The GLCM features (logistic regression P-value range, 0.012-0.262; AUC range, 0.643-0.750) outperformed the first-order features (P-value range, 0.100-0.990; AUC range, 0.543-0.661) in distinguishing lung injury severity levels. Eight of 9 radiomic features demonstrated a significant dose-response relationship at 3, 6, and 9 months post-SBRT. Although not statistically significant, the GLCM features showed clear separations between the 3- or 6-month DRC and the 9-month DRC. CONCLUSION: Radiomic features significantly correlated with radiation oncologist-scored post-SBRT lung injury and showed a significant dose-response relationship, suggesting the potential for radiomics to provide a quantitative, objective measurement of post-SBRT lung injury.

Loss of miR-203 regulates cell shape and matrix adhesion through ROBO1/Rac/FAK in response to stiffness.

Breast tumor progression is accompanied by changes in the surrounding extracellular matrix (ECM) that increase stiffness of the microenvironment. Mammary epithelial cells engage regulatory pathways that permit dynamic responses to mechanical cues from the ECM. Here, we identify a SLIT2/ROBO1 signaling circuit as a key regulatory mechanism by which cells sense and respond to ECM stiffness to preserve tensional homeostasis. We observed that Robo1 ablation in the developing mammary gland compromised actin stress fiber assembly and inhibited cell contractility to perturb tissue morphogenesis, whereas SLIT2 treatment stimulated Rac and increased focal adhesion kinase activity to enhance cell tension by maintaining cell shape and matrix adhesion. Further investigation revealed that a stiff ECM increased Robo1 levels by down-regulating miR-203. Consistently, patients whose tumor expressed a low miR-203/high Robo1 expression pattern exhibited a better overall survival prognosis. These studies show that cells subjected to stiffened environments up-regulate Robo1 as a protective mechanism that maintains cell shape and facilitates ECM adherence.