Production and Characterization of Cellulosic Pulp from Mango Agro-Industrial Waste and Potential Applications.

The growing demand for cellulosic pulp presents an opportunity to explore alternatives to this material, focusing on utilizing agro-industrial residues. Mango's tegument is a rich source of cellulose, making it a valuable raw material for manufacturing single-use articles or blends with biopolymers. In this sense, employing conventional alkaline and acid chemical treatments, the mango's tegument was treated to obtain cellulosic pulp. The teguments were subjected to treatment with alkaline solutions (2% and 4% NaOH w/v) at 80 °C for 1 or 2 h or with an acetic acid solution (1:1 or 1:2 CH3COOH:H2O2) at 60-70 °C for 1 or 2 h. After treatment, an evaluation was conducted to assess the yield, color, chemical analysis, and structural, thermal, and morphological properties. The alkali treatments produced cellulosic pulps with a light color with 37-42% yield and reduced hemicellulose content. The acid treatments produced orange-brown cellulosic pulp with 47-48% yield and higher hemicellulose content. The acid pulps were thermally more stable (maximum decomposition at 348-357 °C) than the alkali pulps (maximum decomposition at 316-321 °C). The crystallinity index demonstrated that both treatments increased the crystallinity of the cellulose pulps compared with the untreated tegument. The thermal stability of cellulosic pulp at the processing temperatures of disposable tableware (50-120 °C) revealed that plates, bowls, trays, and cups could be produced. Another potential application is as a component of blends with biopolymers to make straws or rigid food packaging (trays) with reinforced structures.

Primary Spinal Cord Glioblastoma.

We present the case of a 29-year-old patient whose pain began with the interscapular region, progressing to paresthesia and loss of muscle strength in the lower extremities. MRI of the spine was done, a lesion was found in T2 to T6, ependymoma was suspected and was taken to subtotal resection with laminectomy, the histopathological report, as well as the immunohistochemistry, was compatible with glioblastoma type not otherwise specified (NOS). He received adjuvant with radiotherapy and concomitant chemotherapy, but he progressed to the cervical and lumbar spine, the patient died 16 months after diagnosis. A review of the literature is made and the clinical and radiological characteristics and treatment protocols that have been used in this entity are reported.

Development of an antioxidant biomaterial by promoting the deglycosylation of rutin to isoquercetin and quercetin.

Quercetin-3-O-rutinoside (rutin), quercetin-3-O-glucoside (isoquercetin) and quercetin have shown antioxidant, cytoprotective, vasoprotective, antiproliferative and antiinflammatory properties. The aim of this work was to determine the conversion of rutin to isoquercetin and quercetin during the production of poly(l-lactic acid) films with potential to deliver these flavonoids toward tissues, pharmaceuticals or food matrices. Three poly(l-lactic acid) formulations with 17.7, 39.6 and 39.1mg/g of rutin were prepared by the extrusion process. Processing temperatures (130-165°C) promoted the deglycosylation of rutin to produce isoquercetin and subsequently quercetin, identified by high performance liquid chromatography coupled to mass spectrometry. The effect of the process on the antioxidant activity of the films was determined by measuring the capacity to scavenge 2,2 diphenyl-1-picrylhydrazyl radicals. The material with the highest proportion of quercetin showed the highest antioxidant activity which could be used to produce delivering devices of the flavonoids to tissues, pharmaceuticals or food matrices.

Fabrication of an antimicrobial active packaging and its effect on the growth of Pseudomonas and aerobic mesophilic bacteria in chicken / Elaboración de un envase activo antimicrobiano y su efecto en el desarrollo de Pseudomonas y bacterias aerobias de pollo

Background: One of the aims of food packaging is to protect the product from environmental factors that can cause a reduction in quality. Surface growth of microorganism is one of the leading causes of food spoilage. One option is to use antimicrobial packaging to provide an increased margin of safety and quality. Objectives: The aim of this study was evaluate the effect of active packaging with eugenol on growth of Pseudomonas and aerobic mesophilic bacteria in fresh chicken pieces. Methods: Three batches of low-density polyethylene (LDPE) film, containing 0, 9.0 and 7.7, mg g-1 eugenol (control, AAF1 and AAF2, respectively), were extruded in a pilot-plant scale blown-extrusion machine. The films with eugenol lost 42.7% and 36.8% (AAF1 and AAF2, respectively) of eugenol during processing and absorbed UV-visible light at 300-261 nm. The kinetics of eugenol release from the AAF1 into the air at 5°C and 25ºC displayed Fick's behavior, and a diffusion coefficient of 10-8 cm2 s-1 was calculated. Results: Eugenol showed antimicrobial activity on in vitro, using paper discs with 1.74, 0.87 and 0.36 mg eugenol on 108 CFU mL-1 of Pseudomonas fluorescens in Muller-Hinton agar. Chicken thighs were wrapped in the AAF2 film, and the effects on the growth of Pseudomonas and aerobic mesophilic bacteria (AMB) were evaluated after storage for 5 d at 5°C. The AAF2 showed a moderately antimicrobial effect in reducing the growth of Pseudomonas (1.1 x 106 CFU g-1) relative to growth in the control film (6.0 x 106 CFU g-1) (P < 0.05). The film with eugenol was effective in reducing the growth of AMB (9.0 x 105 CFU g-1) relative to growth in the control film (1.7 x 106 CFU g-1) (P < 0.05). Conclusions: Despite the high losses of eugenol during the extrusion of the films, they showed an antimicrobial effect during contact with fresh chicken under commercial conditions. This study shows the potential use of eugenol for application in LDPE antimicrobial packaging film.

Antecedentes: Uno de los principales objetivos del envasado de alimentos es protegerlo de factores que puedan afectar y causar una reducción en la calidad. El desarrollo de microorganismos en la superficie es uno de las causas principales del deterioro de los alimentos. Una opción es el empleo de envases con propiedades antimicrobianas. Objetivos: El objetivo del presente estudio fue evaluar el efecto de un envase antimicrobiano conteniendo eugenol en el desarrollo de Pseudomonas y bacterias mesofílicas aerobias (BMA) en piezas de pollo. Métodos: Tres lotes de película de polietileno de baja densidad (PEBD) conteniendo 0, 9.0 y 7.7 mg g-1 de eugenol (control, AAF1, AAF2, respectivamente) fueron obtenidas por extrusión-soplo utilizando un extrusor a nivel planta piloto. Se calculó la cinética de liberación del eugenol de la AAF1 hacia el aire a 5°C y 25°C. Se evaluó la capacidad antimicrobiana in vitro del eugenol sobre 108 UFC mL-1 de Pseudomona fluorescens utilizando discos de papel conteniendo 1.74, 0.87 y 0.36 mg de eugenol en agar Muller-Hinton. Las piezas de pollo fueron envueltas en la película AAF2 y almacenadas a 5°C evaluando a los 5 días el efecto de la película en el desarrollo de Pseudomonas y en BMA. Resultados: El eugenol mostró actividad antimicrobiana inhibiendo el crecimiento de P. fluorescens. Las películas conteniendo eugenol perdieron durante el proceso de extrusión 42.7% y 36.8% (AAF1 y AAF2 respectivamente) del total añadido mostrando un comportamiento fickiano con un coeficiente de difusión de 10-8 cm2 s-1. Las AAF2 mostraron un efecto moderado en la reducción del desarrollo de Pseudomonas (1.1 x 106 CFU g-1) comparadas con el control (6.0 x 106 CFU g-1) (P < 0.05). Las películas con eugenol (AAF2) fueron efectivas al reducir el desarrollo de las BMA (9.0 x 105 CFU g-1) comparadas con la película control (1.7 x 106 CFU g-1) (P < 0.05). Conclusiones: A pesar de las pérdidas del eugenol durante el proceso de extrusión para la obtención de las películas, estas mostraron un efecto antimicrobiano sobre las piezas de pollo. Por lo tanto, este estudio muestra el uso potencial del eugenol para la aplicación en envases antimicrobianos elaborados a base de PEBD.

Biology of the estrogen receptor, GPR30, in triple negative breast cancer.

BACKGROUND: Triple-negative (TN) breast cancer lacks a known signaling pathway amenable to targeted therapy. The authors hypothesized that the G protein-coupled receptor GPR30 may be present in TN breast cancer and serve a role for tumor growth. METHODS: A retrospective pathology study and chart review were conducted. All patients aged ≤49 years from 2000 to 2008 were included (n = 24). Concurrent patients aged ≥50 years were randomly selected. Paraffin sections were stained for GPR30 and reviewed by a pathologist blinded to estrogen receptor and progesterone receptor status. Disease-free survival was analyzed versus age and receptor status. Means were compared using 2-sample t tests and proportions using chi-square analysis. RESULTS: Twenty-seven patients tested GPR30 positive and 21 GPR30 negative. Seventeen of 18 TN cancers tested positive for GPR30 (P < .0001). Recurrence at a mean follow-up of 36 months was 22.2% in the GPR30-positive group and 9.5% in the GPR30-negative group. CONCLUSIONS: GPR30 is prevalent in TN breast cancer and associated with young age and possibly recurrence.

Reactive astrocytes promote the metastatic growth of breast cancer stem-like cells by activating Notch signalling in brain.

Brain metastasis of breast cancer profoundly affects the cognitive and sensory functions as well as morbidity of patients, and the 1 year survival rate among these patients remains less than 20%. However, the pathological mechanism of brain metastasis is as yet poorly understood. In this report, we found that metastatic breast tumour cells in the brain highly expressed IL-1ß which then 'activated' surrounding astrocytes. This activation significantly augmented the expression of JAG1 in the astrocytes, and the direct interaction of the reactivated astrocytes and cancer stem-like cells (CSCs) significantly stimulated Notch signalling in CSCs. We also found that the activated Notch signalling in CSCs up-regulated HES5 followed by promoting self-renewal of CSCs. Furthermore, we have shown that the blood-brain barrier permeable Notch inhibitor, Compound E, can significantly suppress the brain metastasis in vivo. These results represent a novel paradigm for the understanding of how metastatic breast CSCs re-establish their niche for their self-renewal in a totally different microenvironment, which opens a new avenue to identify a novel and specific target for the brain metastatic disease.

Antioxidant activity and diffusion of catechin and epicatechin from antioxidant active films made of poly(L-lactic acid).

Active membranes and food packaging containing antioxidants like catechin and epicatechin, combined with the use of materials made of biopolymers obtained from renewable sources, could create a novel alternative to reduce oxidation in food, pharmaceutical, and cosmetic products. Poly(94% L-lactic acid) films containing 1.28% catechin and 1.50% epicatechin were extruded in a pilot plant-scale extrusion machine. The diffusion kinetics of catechin and epicatechin into 95% ethanol at 20, 30, 40, and 50 °C and 50% ethanol at 40 °C displayed Fickian release behavior and diffusion coefficients between 0.5 and 50 × 10(-11) cm(2)/s. According to the Arrhenius equation, the energy of activation for the diffusion of catechin and epicatechin in the films was 110.43 and 98.92 kJ/mol, respectively. The antioxidant activity of the films was measured in methanol extracts containing 46.42 µg/mL of catechin and 57.52 µg/mL of epicatechin as 32.90 and 36.68% of scavenging the 2,2-diphenyl-1-picrylhydrazyl radical, respectively.

Ethical management of conflict of interest: proposed standards for academic surgical societies.

BACKGROUND: A significant increase in industry support of professional medical associations coupled with data suggesting that gifts from industry have significant clinical influence have prompted calls from the Institute of Medicine and physician leaders to identify and manage conflicts of interest that stem from financial support of professional medical associations by industry. STUDY DESIGN: A joint task force of members appointed by the Association for Academic Surgery and the Society of University Surgeons was convened in July 2009. Recommendations were developed regarding management of all potential conflicts of interest that can arise within the context of an academic surgical society, with specific focus on relationships with industry. Task force members reached consensus around each recommendation and the guidelines were subsequently adopted by the Executive Councils of both societies. RESULTS: The committee identified 4 primary areas of need for transparent and definitive management of conflict of interest: 1) individual society activities, including general budget support, society endorsements, and journal affiliation; 2) individual personnel conflicts such as society leadership and standards for disclosure of conflict; 3) meeting activities including budgetary support, program committee associations, and abstract review process; and 4) foundation support and research and travel awards. The resulting guidelines aim to protect the societies and their membership from undue bias that may undermine the credibility and mission of these associations. CONCLUSIONS: Policy guidelines to mitigate conflict of interest are necessary to protect the integrity of the work of academic surgical societies and their fiduciary duty to members and patients. Guidelines created and adopted by the Association for Academic Surgery and Society of University Surgeons form an effective model for academic surgical societies and their members.

Envases activos antioxidantes y su efecto sobrela calidad sensorial y los compuestos volátiles en leche entera deshidratada / Antioxidant active packaging effect whole milk powder sensorial quality and production of volatile compounds

El sabor de la leche está estrechamente relacionado con su composición, especialmente con su contenido graso. Factores como la luz, los materiales de envase y las condiciones de almacenamiento pueden favorecer la oxidación de la grasa y alterar las características sensoriales del producto. El presente estudio buscó evaluar el efecto de los envases activos multicapa con diferentes antioxidantes en su capa más interna: butilhidroxitolueno, butil hidroxianisol, alfa-tocoferol y una mezcla de butil hidroxianisol-alfa-tocoferol, sobrela calidad sensorial de la leche entera deshidratada. El entrenamiento de un panel sensorial permitió la evaluación del atributo de sabor oxidado en la leche y la correlación de estos resultados con la producción de pentanal, hexanal y heptanal, cuantificados mediante cromatografía gaseosa usando microextracción enfase sólida. Los análisis sensoriales revelaron cambios en las características de sabor oxidado en las muestras de leche. La correlación general de estos datos y las concentraciones de volátiles cuantificadas permitieron encontrar una correlación moderada pero significativa entre el sabor oxidado y los volátiles pentanal, hexanal y heptanal. En general, los envases activos con butil hidroxianisol-alfa-tocoferol y alfa-tocoferol obtuvieron una menor calificación en cuanto a su sabor oxidado y, en consecuencia, representan una alternativa viable para la conservación de las propiedades sensoriales de la leche.

Milk flavor is highly related with ITS components, especially with fat content. Factors such as light, packaging material and storage conditions can produce lipid oxidation and favor changes in the sensorial characteristics of product. The aim of this study was to evaluate the effect of active packaging with different antioxidants: butylated hydroxyanisole, butylated hydroxytoluene and alfa-tocopherol, on sensorial quality of whole milk powder. The panel members were trained to recognize the taste and smell of oxidized fat in milk and these results to be correlated with volatile compounds pentanal, heptanal and hexane quantified in milk samples using gas chromatography with solid phase microextraction. Sensorial tests showed changes in oxidized fat flavor in milk. The general correlation of these data and volatiles concentration allowed finding a moderate but significant correlation between oxidized fat flavor and thepentanal, hexanal and heptanal volatiles. In general, the active packaging with alfa-tocopherol-butylatedhidroxyanisole and alfa-tocopherol presented low score in oxidized fat flavor, representing a viable alternativefor the conservation of sensorial properties in milk during storage time.

American Ginseng inhibits induced COX-2 and NFKB activation in breast cancer cells.

BACKGROUND: Epidemiologic evidence suggests reduced breast cancer mortality in users of American Ginseng (AG) (Panax quinquefolium). We hypothesized that AG extract decreases proliferation of human breast cancer cells via an anti-inflammatory effect applicable to the prevention of breast and other cancers. MATERIAL AND METHODS: A defined lyophilized aqueous extract of AG (LEAG) was dissolved in DMSO 1mg/mL, and serially diluted in saline. The cell lines MDA MB 231 and MCF7 were stimulated with the phorbol ester PDBu and treated with 100-500 mcg/mL LEAG. Proliferation was measured by MDA assay. Induced COX-2 expression was assayed by ELISA. Activation of NFkappaB by phosphorylation of the p65 subunit was quantified by CASE (cellular activation of signaling ELISA). RESULTS: Both cell lines had reduced proliferation when treated with LEAG. PDBu stimulation of MDA MB 231 increased expression of the COX-2 protein 20-fold at 48 hours (P<0.005). COX-2 protein expression remained at baseline concentrations in PDBu- treated MDA MB 231 cells exposed to 100 mcg/mL LEAG. The CASE assay showed a 4-fold increase in p65 activation 24 hours after PDBu treatment in normal medium, while phosphorylated p65 dropped below baseline in the cells treated with PDBu plus LEAG. CONCLUSION: In MDA MB 231, COX-2 was inducible with PDBu. This induced COX-2 expression was blocked by 100 microgram/mL LEAG in a time course consistent with the decline in the activated p65 subunit of NFkappaB. These results provide an anti-inflammatory mechanism for a possible anti-cancer effect of American Ginseng.

Vitamin E increases biomarkers of estrogen stimulation when taken with tamoxifen.

BACKGROUND: Vitamin E (alpha-tocopherol acetate, AT) diminishes the antiproliferative effect of tamoxifen on breast cancer cells in vitro. METHODS: A prospective study of seven women taking tamoxifen for adjuvant therapy of breast cancer. Four who were already taking AT supplements had random core biopsies of the normal breast and again 30 days after discontinuing AT. Three who were not on AT had biopsies before and after adding AT 400 mg for 30 days. Biopsies were stained for estrogen receptor (ER) and the mitogen-activated protein kinase p-ERK. Tissue extracts were assayed for p-ERK by enzyme-linked immunosorbent assay. Serum levels of alpha-tocopherol and tamoxifen were measured. RESULTS: Five out of seven patients had lower tamoxifen levels while taking AT, four of these went to subtherapeutic levels. Biopsies showed 23% of ductal cells were ER positive when patients were off AT and 70% on AT (P = 0.02). P-ERK staining was 21% off AT and 82% on AT. Five of seven patients had significantly higher tissue p-ERK when on AT. CONCLUSIONS: Biomarkers of estrogen-stimulation (ER, progesterone receptor, and p-ERK) were higher in breast biopsies of women taking vitamin E supplements while taking tamoxifen. Findings suggest that vitamin E supplements may interfere with the therapeutic effects of tamoxifen.

Rare anorectal neoplasms: gastrointestinal stromal tumor, carcinoid, and lymphoma.

Several uncommon tumors occur in the anal canal such as gastrointestinal stromal tumors, carcinoids, and lymphoma. Increased clinical experience and advancements in molecular biology have improved the accuracy of pathologic diagnosis and guided treatment recommendations, which the author addresses in this article.

Effect of a low-density polyethylene film containing butylated hydroxytoluene on lipid oxidation and protein quality of Sierra fish (Scomberomorus sierra) muscle during frozen storage.

Fresh sierra fish (Scomberomorus sierra) fillets were packed in low-density polyethylene films with butylated hydroxytoluene (BHT-LDPE) added. Fillets packed in LDPE with no BHT were used as controls (LDPE). The packed fillets were stored at -25 degrees C for 120 days in which the film released 66.5% of the antioxidant. The influence of the antioxidant on lipid and protein quality, lipid oxidation, muscle structure changes, and shear-force resistance was recorded. As compared to LDPE films, fillets packed in BHT-LDPE films showed lower lipid oxidation, thiobarbituric acid values (4.20 +/- 0.52 vs 11.95 +/- 1.06 mg malonaldehyde/kg), peroxide values (7.20 +/- 1.38 vs 15.15 +/- 1.48 meq/kg), and free fatty acids (7.98 +/- 0.43 vs 11.83 +/- 1.26% of oleic acid). Fillets packed in BHT-LDPE films showed less tissue damage and lost less firmness than fillets packed in LDPE. A significant relationship between lipid oxidation and texture was detected (R2 adjusted, 0.70-0.73). BHT-LDPE films may be used not only to prevent lipid oxidation but also to minimize protein damage to prolong the shelf life of sierra fish.

Effect of vitamin E on tamoxifen-treated breast cancer cells.

BACKGROUND: Induction of apoptosis by tamoxifen has been postulated to involve oxidative stress. Tamoxifen (TAM) may act on estrogen receptors (ER) located in the plasma membrane. Our hypothesis that supplemental antioxidant vitamin E (alpha-tocopherol) acts at the plasma membrane to alter the effectiveness of tamoxifen was tested in ER-positive breast cancer cell lines, MCF-7 and T47D. METHODS: Cells were treated in vitro with 20-muM TAM alone and in combination with 10-muM alpha-tocopherol (AT). Estrogen growth signals were quantified by immunohistochemical staining for the mitogen-activated protein kinase p-ERK. Rapid changes in intracellular calcium were detected in TAM-treated MCF-7 and T-47D cells by fluorescence microscopy of cells loaded with the calcium-sensitive dye Fluo 4AM. Apoptosis was assayed by flow cytometry. RESULTS: Proliferating cells in normal medium exhibited strong p-ERK staining. Addition of TAM abolished p-ERK staining and caused cell rounding and death. The addition of AT led to the restoration of cell proliferation and p-ERK expression even in the presence of high-dose TAM. Intracellular calcium rapidly increased in MCF-7 and T47D cells upon exposure to TAM, followed by an increase in caspase activation and eventual apoptosis. The increase in intracellular calcium was abolished by the addition of 10muM AT to TAM, and pan-caspase staining decreased at 5 hours from 72% to 41%. CONCLUSIONS: These studies suggest that supplemental vitamin E decreases the inhibitory effect of TAM on the proliferation of ER+ breast cancer cells and eliminates the rapid rise in intracellular calcium that leads to apoptosis stimulated by TAM. The use of vitamin E acetate supplements may be inadvisable for women taking tamoxifen.

Vitamin E succinate decreases lung cancer tumor growth in mice.

BACKGROUND: In vitro studies have shown that Vitamin E succinate (VES) arrests lung cancer proliferation; however, in vivo studies have not been performed. This study examined in vivo effects of VES on lung cancer. METHODS: An in vitro dose-response curve of human A549 lung cancer tumors to VES was established. A549 tumors were established in the right submammary fat pads of athymic nude mice (C57/BL/6J-Hfh11nu). Seven days after injection, mice were separated into VES and control groups. VES mice (n = 12) underwent daily intraperitoneal (IP) injection of VES (150 mg/kg in 7% dimethyl sulfoxide, 93% polyethylene glycol); control mice (n = 11) were injected with vehicle only. At 27 days, harvested tumors were measured and weighed. Lungs were stained for metastases using hematoxylin-eosin. Tumor volume and weights were compared using a two-sample t test. Tumor growth curves were compared using a mixed model analysis of variance. RESULTS: In vitro studies demonstrated dose-dependent manner inhibition of A549 cell proliferation by VES (IC(50) 18 mug/mL). Tumor volumes and weights differed significantly between VES and control mice with volumes of 192.6 +/- 20.4 mm(3)versus 292.9 +/- 31.4 mm(3) (P = 0.01) and weights of 168.6 +/- 20.0 mg versus 255.7 +/- 37.0 mg, respectively (P = 0.05). Tumor growth differed significantly (P < 0.001). Both groups of mice showed pulmonary metastases. CONCLUSIONS: Lung cancer cells appear to respond to VES, albeit incompletely. Because tumor cell response is seen, lung cancer patients may derive some benefit from VES and should be considered in eventual clinical studies using this vitamin E derivative.

Migration of bisphenol A (BPA) from epoxy can coatings to jalapeño peppers and an acid food simulant.

Effects of heat processing, storage time, and temperature on migration of bisphenol A (BPA) from an epoxy type can coating to an acid food simulant and jalapeño peppers were determined. Commercial jalapeño pepper cans (8 oz, dimensions 211 x 300) were stored at 25 degrees C for 40, 70, and 160 days. A solution of 3% acetic acid was canned in 211 x 300 cans from the same batch used for jalapeño peppers. Heat processing was applied to two-thirds of the cans, and the remaining cans were not heat processed. Cans were stored at 25 and 35 degrees C for 0, 40, 70, and 160 days. Results showed that there is a minimal effect of heat treatment. An effect of storage time on migration of BPA during the first 40 days at 25 degrees C was observed. An increase on migration of BPA was observed with storage time at 35 degrees C. The highest level of migration was 15.33 microg/kg of BPA at 160 days at 35 degrees C. A correction factor of approximately 0.4 was calculated for migration under simulating conditions of storage compared to the real ones. The highest level of BPA found in jalapeño peppers cans, surveyed from three supermarkets, was 5.59 +/- 2.43 microg/kg. Migration of BPA, performed according to the European and Mercosur conditions, was 65.45 +/- 5.29 microg/kg. All the migration values found in this study were below those legislation limits (3 mg/kg).

Long-term survival after radical operations for cancer treatment-induced sarcomas: how two survivors invite reflection on oncologic treatment concepts.

Extent and radicality of surgical oncologic treatment has changed in the past 30 years. Two patients with node-positive breast cancer are presented, who underwent (total or radical) mastectomy with lymphadenectomy and postoperative radiation 24 and 40 years ago. A radiation-associated sarcoma of the parascapular soft tissue developed in one patient 9 years after treatment; the other one sought treatment for a lymphedema-associated Stewart-Treves lymphangiosarcoma 16 years after initial therapy. Both patients underwent a forequarter amputation for their treatment-associated high-grade sarcoma. Both are currently alive and cancer-free 15 and 24 years after amputation. These reports remind us that radical locoregional treatment can cure some solid cancers in the absence of systemic therapy; that such extensive treatment may induce significant disability or secondary malignancies long-term; that even advanced treatment-associated sarcomas can be cured with aggressive resection; that today's multimodality therapy approaches and appropriate patient selection have rendered such extensive locoregional treatment for many tumors obsolete or unnecessary; and that if no effective alternative treatment exists and organ or limb preservation is not feasible, an aggressive resection approach for high-grade cancer should not be discounted unless systemic failure is certain or imminent.

Cardiomiopatia diabetica. Primer caso reportado en la República Dominicana: revisión de la literatura / Diabetic cardiomyopathy : first case reported in the Dominican Republic; review of the literature

Se reporta un caso de cardiomiopatía diabética por primera vez en la República Dominicana y se hace una revisión de la literatura sobre esta patología