Postoperative radiotherapy provides better local control and long-term outcome in selective cases of cutaneous squamous cell carcinoma with perineural invasion.

BACKGROUND: Perineural invasion (PNI) is a feature of poor prognosis in cutaneous squamous cell carcinoma (CSCC). The benefit of postoperative radiotherapy (PORT) in the management of CSCC with PNI is still not well established. OBJECTIVES: We aimed to evaluate the usefulness of PORT in the treatment of CSCC with PNI so as to determine which patients would best benefit from this type of treatment. METHODS: A retrospective multicenter cohort of 110 CSCCs with PNI was evaluated. Eighteen recurrent cases were excluded for subsequent analysis. We searched for the types of PNI associated with poor outcome and analysed the effectiveness of PORT on different groups of CSCC with PNI. We also assessed for the usefulness of PORT depending on the surgical margin status (either clear or positive). RESULTS: Postoperative radiotherapy showed clear benefit over observation in CSCC with PNI and positive margins after surgery, where the management by observation increased the risk of poor outcome events 2.43 times (P = 0.025), and especially in those with positive margins and PNI ≥0.1 mm, where the risk of poor prognosis is eight times greater following a management by observation (P = 0.0065). Multivariate competing risk analysis preserved statistical significance. CONCLUSIONS: The use of PORT on patients with CSCC with PNI and positive margins after surgery, especially in PNI ≥0.1 mm, significantly improves long-term outcome. The benefit of PORT in cases with clear margins is not as evident, especially in those with PNI of small-calibre nerves. Clinical trials are imperative.

Assessment of in vitro pharmacological effect of Neotropical Piperaceae in GABAergic bioassays in relation to plants traditionally used for folk illness by the Yanesha (Peru).

ETHNOPHARMACOLOGICAL RELEVANCE: A previous pilot ethnobotanical and ethnopharmacological study with the Q'echi׳ Maya identified the family Piperaceae, as an important taxonomic group traditionally used for the treatment of epileptic and culture-bound anxiety disorders and possessing activity in the GABA system. Following that lead, a botanical survey was conducted in Peru, where 47 species of Piperaceae were collected including 21 plants traditionally used for folk illnesses by the Yanesha of Peru, an indigenous Amazonian group. MATERIALS AND METHODS: Two high throughput bioassays were used to quantify the in vitro activity of botanical extracts on the GABA system. RESULTS: Plant extracts demonstrated moderate to high affinity to the γ-aminobutyric acid benzodiazepine (GABA-BZD) receptor. In addition, extracts demonstrated low to moderate activity in the inhibition of the GABA-transaminase, with select plants exhibiting significant activity. Plants indicated by the Yanesha showed comparable activity to the other Piperaceae plants collected. Piper cremii was the most active plant in the GABA-BZD receptor assay, and Drymaria cordata (Caryophyllaceae) in the GABA-T assay. CONCLUSION: The study provides evidence that there is a pharmacological basis behind the use of plants in the treatment of susto and mal aire in both Central and South America, and we propose that the possible mechanism of action includes an interaction with the GABA-T enzyme and/or the GABAA-BZD receptor.

Cisterna magna width at 11-13 weeks in the detection of posterior fossa anomalies.

OBJECTIVE: To construct reference ranges for cisterna magna (CM) width at 11-13 weeks' gestation in healthy fetuses and determine whether open spina bifida and posterior fossa anomalies could be diagnosed in the first trimester. METHODS: This was a retrospective study. CM width reference ranges were constructed based on the measurements obtained from 80 healthy fetuses with normal postnatal outcome undergoing routine first-trimester ultrasound at 11-13 weeks, using the Lambda-Mu-Sigma method. CM was measured in the fetal mid-sagittal view, as routinely used for nuchal translucency assessment. In addition, first-trimester ultrasound images in 11 fetuses with open spina bifida or posterior fossa anomalies, most of which were diagnosed later in pregnancy, were retrospectively reviewed, and CM measurements were compared against reference ranges. RESULTS: CM width was noted to increase with gestational age in normal fetuses. The anomalies in the 11 fetuses we reviewed were: open spina bifida (n = 5), megacisterna magna (n = 3), Blake's pouch cyst (n = 2) and posterior fossa arachnoid cyst (n = 1). All fetuses with open spina bifida had a CM width below the 5(th) percentile. In the two fetuses with Blake's pouch cyst and in two with megacisterna magna, CM width was above the 95(th) percentile. In one of the fetuses with a megacisterna magna and the one with an arachnoid cyst, CM width was within normal range. CONCLUSION: We have constructed reference ranges for CM width at 11-13 weeks using the mid-sagittal view. It appears that first-trimester CM width can be used as a marker for the early detection of open spina bifida. However, our findings need to be confirmed in prospective large series.

Transición de adolescentes con infección HIV / Transition of adolescents with HIV infection

El desarrollo de nuevas opciones terapéuticas para el manejo de la infección HIV mejoró la sobrevida de los niños con infección perinatal. Estos avances llevaron a la necesidad de preparar a los adolescentes para la transición. Frente a los obstáculos planteados por el cambio se ha observado que la planificación de la transición facilita el proceso de transferencia de la atención de jóvenes que alcanzan la madurez. El presente estudio piloto se planificó con el objetivo de analizar el funcionamiento de un programa de transición de adolescentes con infección HIV/SIDA desde un hospital pediátrico a centros de atención de adultos de la Ciudad Autónoma de Buenos Aires (CABA). Se diseñó un estudio prospectivo en el que se incluyeron pacientes adolescentes ≥16 años con diagnóstico de infección HIV seguidos en el Hospital Garrahan. En el período comprendido entre agosto de 2007 y diciembre de 2010, fueron incluidos 90 pacientes, 66 fueron transferidos a hospitales generales, 46 de ellos cumplen con criterios de transición exitosa, en 10 pacientes aún no se puede evaluar el éxito de la transición y 10 pacientes no pudieron ser transferidos. El 63.6% de los pacientes se encontraba en estadío C de enfermedad con una duración de tratamiento (mediana) de 13 años. Sesenta y cinco pacientes (73%) concurrían actualmente a la escuela. Se realizaron un total de 25 talleres y 52% de los adolescentes asistió al menos una vez, 66% concurrieron solos a la consulta al menos una vez y 54% utilizó opciones de comunicación ofrecidas (mensajes de texto y mail)...

Información escrita entregada por los equipos de soporte de Cuidados Paliativos a pacientes, familia y personal de atención primaria de salud en las visitas en domicilio / No disponible

Objetivo: conocer y comparar los distintos documentos que entregan los Equipos de Soporte de Cuidados Paliativos (ESCP) a los pacientes, familia y profesionales de Atención Primaria de Salud responsables del seguimiento de los pacientes incluidos en el Programa Regional de Cuidados Paliativos de Extremadura, en las visitas domiciliarias. Pretendemos averiguar si existen diferencias en las distintas áreas de salud y, de existir, si tienen relación con las características de dichas áreas y de sus ESCP. Material y método: el material de estudio son los documentos entregados por los ESCP y los datos demográficos y de recursos sanitarios de las áreas de salud de Extremadura, sin olvidar el personal de los ESCP. En cuanto a la metodología se realiza estudio estadístico descriptivo e inferencial. Resultados: cinco son los documentos entregados en domicilio: informe médico y de enfermería (lo entrega el 50% de los ESCP), hoja de tratamiento (100%), documento de presentación (75%), consejos impresos (75%) y hoja de registro de medicación subcutánea continua (12,5%). En cuanto al análisis comparativo solo encontramos diferencias estadísticamente significativas en el empleo de informe médico y de enfermería por los ESCP con menor presión asistencial (p = 0,0135). Conclusiones: existen pequeñas diferencias en el número, contenido y formato de los documentos que entregan los ESCP en domicilio. Cada ESCP ha encontrando lo que facilita la atención a los pacientes, familias y personal de Atención Primaria. Las diferencias son enriquecedoras, deben de verse como algo que respetar y de donde aprender

Objective: to know the different documents given by Palliative Care Support Teams in Extremadura’s Regional Palliative Care Program to patients, family members, and primary care professionals during home visits. We attempt to know any differences between health areas, and their relation to demographic characteristics and Palliative Care Support Teams. Material and method: the study material includes all documents given by Palliative Care Support Teams, and the demography and resources of health areas in Extremadura, including Palliative Care Support Team staff. A descriptive and comparative statistical study is made. Results: five documents are given during home visits: medical and nursing report (50%), treatment (100%), presentation document (75%), advice (75%), and registry for continuous subcutaneous medication (12.5%). Differences are statistically significant in the use of medical and nursing reports by Palliative Care Support Teams (p = 0.0135). Conclusions: differences in number, content, and format between the written documents given by Palliative Care Support Teams at home are small. The different Palliative Care Support Teams use the most appropriate written documents in their health areas. Differences are good, we must respect and learn from differences

Effect of physical, chemical and environmental characteristics on arbuscular mycorrhizal fungi in Brachiaria decumbens (Stapf) pastures.

AIM: To evaluate the effects of soil physical and chemical factors (pH, conductivity, humidity, available phosphorus and organic matter) and environmental factors (temperature, relative air humidity, altitude and atmospheric pressure) on arbuscular mycorrhizal fungi (AMF)-Brachiaria decumbens grass relationship. Furthermore to establish patterns of microbiological responses that allow to differentiate the study sites in two relief types. METHODS AND RESULTS: Mycorrhizal characteristics (spore density, external hyphae and root colonizations by hyphae, vesicles and arbuscules), physical and chemical factors in soil and environmental factors were measured. CONCLUSIONS: The effect of physical, chemical and environmental factors on microbiological variables was related to the type of relief 'valley and hilly terrain'; the AMF behaviour was affected only over narrower ranges of evaluated variables. Similarly, the colonization of B. decumbens roots by AMF hyphae, vesicles and the mycorrhizal spore density follow different patterns according to the relief type. SIGNIFICANCE AND IMPACT OF THE STUDY: The type of relief is one of the factors to be taken into consideration to evaluate the AMF inoculum and root colonization of these pastures, because of the influence of slope - as physical property of soil - on AMF.

Towards a noninvasive intracranial tumor irradiation using 3d optical imaging and multimodal data registration.

Conformal radiotherapy (CRT) results in high-precision tumor volume irradiation. In fractioned radiotherapy (FRT), lesions are irradiated in several sessions so that healthy neighbouring tissues are better preserved than when treatment is carried out in one fraction. In the case of intracranial tumors, classical methods of patient positioning in the irradiation machine coordinate system are invasive and only allow for CRT in one irradiation session. This contribution presents a noninvasive positioning method representing a first step towards the combination of CRT and FRT. The 3D data used for the positioning is point clouds spread over the patient's head (CT-data usually acquired during treatment) and points distributed over the patient's face which are acquired with a structured light sensor fixed in the therapy room. The geometrical transformation linking the coordinate systems of the diagnosis device (CT-modality) and the 3D sensor of the therapy room (visible light modality) is obtained by registering the surfaces represented by the two 3D point sets. The geometrical relationship between the coordinate systems of the 3D sensor and the irradiation machine is given by a calibration of the sensor position in the therapy room. The global transformation, computed with the two previous transformations, is sufficient to predict the tumor position in the irradiation machine coordinate system with only the corresponding position in the CT-coordinate system. Results obtained for a phantom show that the mean positioning error of tumors on the treatment machine isocentre is 0.4 mm. Tests performed with human data proved that the registration algorithm is accurate (0.1 mm mean distance between homologous points) and robust even for facial expression changes.

Lactancia en niños asturianos menores de un año de edad / Lactation in children under one year of age in Asturias

Objetivo: Conocer los hábitos de lactancia de los niños menores de 12 meses de edad de nuestro Área Sanitaria. Comparar los datos obtenidos en dos estudios realizados en 1996 y 2000. Material y métodos: Estudio observacional descriptivo y transversal a través de dos encuestas telefónicas idénticas realizadas a madres de niños menores de 12 meses de edad nacidos en nuestro Hospital. Fecha de realización: primera encuesta en abril 1996 y segunda encuesta en abril de 2000. Población diana: niños de nuestro Área Sanitaria menores de un año. Población a estudio: niños menores de un año nacidos en nuestro Hospital entre marzo 1995 y marzo 1996 en primera encuesta, y marzo 1999 y marzo 2000 en segunda encuesta. Muestreo aleatorio estratificado por trimestres. Tamaño muestral deseable: 310 niños por encuesta. Tamaño muestra inicial: 400 niños por encuesta. Resultados: Respuestas válidas: 77,7 por ciento. El 20,2 por ciento de todos los niños encuestados tomaron lactancia materna el día de la entrevista. Lactancia al salir del hospital: 58,7 por ciento lactancia materna, 26,7 por ciento lactancia artificial y 14,6 por ciento lactancia mixta. Supervivencia media de lactancia materna: 2,1 meses (1,2 meses para lactancia materna exclusiva). Diferencias estadísticamente significativas entre ambas encuestas en lactancia exclusiva. Lactancia artificial: 83,8 por ciento tomaba leche adaptada el día de la encuesta. El 42,1 por ciento de los niños había tomado más de una marca de leche adaptada desde su nacimiento. El 17,5 por ciento había tomado en su casa, en algún momento, una leche especial desde su nacimiento (46,8 por ciento leche antirreflujo, 20,2 por ciento leche sin lactosa, 14,7 por ciento hidrolizado, 9,2 por ciento leche hipoalergénica y 3,7 por ciento leche de soja). Leche entera de vaca: 4,8 por ciento de los niños el día de la encuesta. Conclusiones: La prevalencia de la lactancia materna es baja en nuestro Área Sanitaria, con una supervivencia media de 2,1 meses. Existe un consumo importante de leches medicamento. Sólo un 4,8 por ciento de los niños consume leche entera de vaca en el primer año de vida. Existen algunas variaciones entre los datos obtenidos en 1996 y 2000, aunque su importancia clínica parece muy discreta (AU)

Suppression of HIV type 1 replication by a dominant-negative Ets-1 mutant.

Activity of the distal region of the human immunodeficiency virus (HIV-1) long terminal repeat (LTR), which contains binding sites for the Ets-1 and USF-1 proteins, is integral for HIV-1 replication. The Ets-1 and USF-1 proteins play a critical role in the activity of the HIV-1 LTR distal enhancer region, as indicated by the potent dominant negative effect of a mutant Ets-1 lacking trans-activation domains on the transcriptional activity of the LTR. To determine the biological relevance of the Ets-1 and USF-1 proteins in HIV-1 replication, we examined the effect of expression of the dominant-negative mutant of Ets-1 (dnEts-1) on HIV-1 infection of T cells. We demonstrated that expression of dnEts markedly suppressed HIV-1 infection of a T cell line. This finding indicates that formation of a transcriptionaly active USF-1/Ets-1 complex is important in the productive infection of cells by HIV-1, and suggests that inhibition of the interaction between USF-1 and Ets-1 with the HIV-1 LTR may provide a new target for anti-HIV-1 gene therapy.

[The utility of gammagraphy with Tc 99-labelled dimercaptosuccinic acid (DMSA) in the protocol for studying urinary infection in a 2nd-level hospital]. / Utilidad de la gammagrafía con ácido dimercaptosuccínico (DMSA) marcado con Tc99 en el protocolo de estudio de la infección urinaria en un hospital de segundo nivel.

OBJECTIVE: Not all hospitals in our country have their own nuclear medicine laboratory. Most small and medium size hospitals must arrange their radioisotope studies with private clinics. The objective of this study was to assess if a single DMSA scan performed after an acute infection in a group of patients chosen according to certain risk criteria would allow the selection of those who run the risk of progressive renal damage. PATIENTS AND METHODS: A descriptive and retrospective study of the clinical records of 65 patients under 14 years of age with urinary tract infection (UTI) seen at our institution between 1994 and 1995 and on whom a DMSA scan had been performed was carried out. The study groups was formed by the fifteen children with scintigraphic findings compatible with renal scarring. The fifty children with normal DMSA scans were used as controls. RESULTS: Renal scarring was found more often in patients over one year of age (p < 0.05), in those with reinfections (p < 0.001) and in those kidneys with grade III vesicoureteral reflux (VUR, p < 0.05). The most severe lesions, with reduction of renal size, shape abnormalities and diminished uptake of the tracer were found together with VUR. The renal sonogram performed during the acute stage of the UTI was able to detect only four of the six children most severely affected. CONCLUSIONS: Delaying the practice of the DMSA scan until 6 months after the last episode of bacteriuria would allow selection of those patients at the highest risk of progressive renal damage. This guideline would reduce scintigraphic studies 30 to 90%, since it would avoid repeated studies in those children with abnormal findings in the acute stage. The practice of the radioisotope study only in a reduced subset of patients selected on the basis of risk criteria such as recurrent UTI, VUR or suspected pyelonephritis does not allow detection of all scars.