Relating Molecular Properties to the Persistence of Marine Dissolved Organic Matter with Liquid Chromatography-Ultrahigh-Resolution Mass Spectrometry.

Marine dissolved organic matter (DOM) contains a complex mixture of small molecules that eludes rapid biological degradation. Spatial and temporal variations in the abundance of DOM reflect the existence of fractions that are removed from the ocean over different time scales, ranging from seconds to millennia. However, it remains unknown whether the intrinsic chemical properties of these organic components relate to their persistence. Here, we elucidate and compare the molecular compositions of distinct DOM fractions with different lability along a water column in the North Atlantic Gyre. Our analysis utilized ultrahigh-resolution Fourier transform ion cyclotron resonance mass spectrometry at 21 T coupled to liquid chromatography and a novel data pipeline developed in CoreMS that generates molecular formula assignments and metrics of isomeric complexity. Clustering analysis binned 14 857 distinct molecular components into groups that correspond to the depth distribution of semilabile, semirefractory, and refractory fractions of DOM. The more labile fractions were concentrated near the ocean surface and contained more aliphatic, hydrophobic, and reduced molecules than the refractory fraction, which occurred uniformly throughout the water column. These findings suggest that processes that selectively remove hydrophobic compounds, such as aggregation and particle sorption, contribute to variable removal rates of marine DOM.

Secretome analysis of the phytopathogen Macrophomina phaseolina cultivated in liquid medium supplemented with and without soybean leaf infusion.

Macrophomina phaseolina (Tassi) Goid. is a fungal pathogen that causes root and stem rot in several economically important crops. However, most of disease control strategies have shown limited effectiveness. Despite its impact on agriculture, molecular mechanisms involved in the interaction with host plant remains poorly understood. Nevertheless, it has been proven that fungal pathogens secrete a variety of proteins and metabolites to successfully infect their host plants. In this study, a proteomic analysis of proteins secreted by M. phaseolina in culture media supplemented with soybean leaf infusion was performed. A total of 250 proteins were identified with a predominance of hydrolytic enzymes. Plant cell wall degrading enzymes together peptidases were found, probably involved in the infection process. Predicted effector proteins were also found that could induce plant cell death or suppress plant immune response. Some of the putative effectors presented similarities to known fungal virulence factors. Expression analysis of ten selected protein-coding genes showed that these genes are induced during host tissue infection and suggested their participation in the infection process. The identification of secreted proteins of M. phaseolina could be used to improve the understanding of the biology and pathogenesis of this fungus. Although leaf infusion was able to induce changes at the proteome level, it is necessary to study the changes induced under conditions that mimic the natural infection process of the soil-borne pathogen M. phaseolina to identify virulence factors.

Identification of reference genes and their validation for gene expression analysis in phytopathogenic fungus Macrophomina phaseolina.

Macrophomina phaseolina is a soil-borne pathogenic fungus that infects a wide range of crop species and causes severe yield losses. Although the genome of the fungus has been sequenced, the molecular basis of its virulence has not been determined. Identification of up-regulated genes during fungal infection is important to understand the mechanism involved in its virulence. To ensure reliable quantification, expression of target genes needs to be normalized on the basis of certain reference genes. However, in the case of M. phaseolina, reference genes or their expression analysis have not been reported in the literature. Therefore, the objective of this study was to evaluate 12 candidate reference genes for the expression analysis of M. phaseolina genes by applying three different fungal growth conditions: a) during root and stem infection of soybean, b) in culture media with and without soybean leaf infusion and c) by inoculating a cut-stem. Based on BestKeeper, geNorm and NormFinder algorithms, CYP1 was identified as the best recommended reference gene followed by EF1ß for expression analysis of fungal gene during soybean root infection. Besides Mp08158, CYP1 gene was found suitable when M. phaseolina was grown in potato-dextrose broth with leaf infusion. In the case of cut-stem inoculation, Mp08158 and Mp11185 genes were found to be most stable. To validate the selected reference genes, expression analysis of two cutinase genes was performed. In general, the expression patterns were similar when the target genes were normalized against most or least stable gene. However, in some cases different expression pattern can be obtained when least stable gene is used for normalization. We believe that the reference genes identified and validated in this study will be useful for gene expression analysis during host infection with M. phaseolina.

[Babel]. / Babel.

This work tries to expose the difficulties that are created from the approach of the problematic consumption of substances conceiving the same as an emergent of the society of consumption. The National Law of Mental Health 26.657, raises the interdisciplinary, intersectoral and integral attention of mental pathologies, including in its article 4 addictions. This approach gives rise to the encounter / disagreement of different theoretical frameworks with their specific implications. Implementing this law involves the intersection of speeches from different disciplines and social actors, generating obstacles on several occasions. Metaphorically an epistemic Babel, a heterogeneous set of theories that complicates its implementation. The axes to make the exposed visible will be the representations, the prejudices, the accessibility to the health and the diverse criteria between different current paradigms.

Toward characterizing germination and early growth in the non-orthodox forest tree species Quercus ilex through complementary gel and gel-free proteomic analysis of embryo and seedlings.

By using two complementary proteomics, gel-based and gel-free (shotgun) approaches, the protein profiles of the non-orthodox forest tree species Quercus ilex seeds during germination and early seedling growth have been compared. Proteins were extracted from embryo axis, radicle and shoot tissues at different developmental stages. Proteins were subjected to one- and two-dimensional gel electrophoresis. A multivariate analysis (PCA) revealed that SDS-PAGE clearly separated germination (0-24 h post-imbibition), postgermination (72-216 h post-imbibition) and early seedling growth stages (2 weeks post-imbibition). Image analysis of the two-dimensional gels revealed a total of 732 spots, 103 of which were significantly variable among developmental stages. After MALDI-TOF/TOF MS analysis, 90 spots were identified, belonging to six main functional categories: carbohydrate, amino acids, energy, and protein metabolism, biosynthesis of secondary metabolites, and redox processes. The gel-based approach disclosed important metabolic changes that occurred in the holm oak seed after the germination. However, few proteins were significantly altered during the germination period (from 0 h to 24 h post imbibition) and, because of that, a further shotgun analysis was therefore used to analyse changes in the protein profile during seed germination. Up to 1250 proteins could be confidently identified, with 153 being variable. They belonged to the main functional categories of carbohydrate, amino acids and secondary metabolism, protein degradation, and responses to abiotic stress. The accumulation of proteases and amino acids metabolism proteins in mature seeds can be reflecting the production of energy from the mobilization of storage proteins to start germination. These results, therefore, corroborate the hypothesis that the mature non-orthodox seeds of Q. ilex have all the machinery necessary for rapidly resuming metabolic activities and starting the germination process, in contrast to that occurs in orthodox seeds, which metabolic activity ceases in mature dry seeds. The use of a genus-specific database combined with the public Viridiplantae database improved the quality and quantity of protein identification in this orphan species. In addition, both proteomics approaches (gel-based and shotgun) were complementary, with shotgun increasing by over two-fold the coverage of the proteome analysed. Both approaches provided similar results and supported the same conclusions on the metabolic switch experienced by the seed upon germination. SIGNIFICANCE: The optimal seed germination is a prerequisite for successful seedling establishment and plant vigour, being of great relevance in the case of crops and commercial woody plants. By using a complementary gel-based and gel-free proteomic strategy we have study the protein profiles of the non-orthodox forest tree species Quercus ilex seeds during germination and early seedling growth. The contribution of this work is of great importance, due to the complemented proteomic approaches giving similar clues to the metabolic state of the mature Q. ilex seed before the germination starts, and the metabolic switch experienced by the imbibed acorn until the seedling is established.

La Medicina de Desastres en el plan de estudios del médico general / The Medicine of Disasters in the study plan of general practitioners in Villa Clara

El presente trabajo describe el programa de la asignatura Medicina de Desastres que se imparte a los estudiantes de Medicina de Villa Clara, procedentes de la Escuela Latinoamericana de Medicina desde el año 2003 como experiencia única en el mundo. Consta de 120 horas lectivas distribuidas en dos estancias que se desarrollan durante el cuarto y quinto años de la carrera, con un carácter teórico-práctico. Sus contenidos están orientados a la familiarización con la temática de los factores causantes de desastres, sus efectos sobre la salud y la dinámica de la sociedad y las comunidades, así como a la incorporación de conocimientos propios acerca del riesgo y la vulnerabilidad, además de los procedimientos vinculados a su disminución; donde priman el trabajo preparatorio a la población y la interrelación de sectores para el enfrentamiento a las adversidades.

The current work describes the program of the Medicine of Disasters subject that is imparted to the future physicians of the Latin American School of Medicine in Villa Clara since 2003, as an exclusive experience in the world. It consists of 120 teaching hours distributed in two rotations that are developed during the fourth and fifth years of the career, with a theoretical-practical character. Its contents are guided to the familiarization with the topic of the disasters-causing factors, their effects upon health and the dynamics of society and the communities, as well as to the incorporation of knowledge about risks and vulnerability, besides the associated procedures to diminish them; where the preparatory work with the population and the interrelation among sectors to face adversities are predominant.

Transcriptome responses to combinations of stresses in Arabidopsis.

Biotic and abiotic stresses limit agricultural yields, and plants are often simultaneously exposed to multiple stresses. Combinations of stresses such as heat and drought or cold and high light intensity have profound effects on crop performance and yields. Thus, delineation of the regulatory networks and metabolic pathways responding to single and multiple concurrent stresses is required for breeding and engineering crop stress tolerance. Many studies have described transcriptome changes in response to single stresses. However, exposure of plants to a combination of stress factors may require agonistic or antagonistic responses or responses potentially unrelated to responses to the corresponding single stresses. To analyze such responses, we initially compared transcriptome changes in 10 Arabidopsis (Arabidopsis thaliana) ecotypes using cold, heat, high-light, salt, and flagellin treatments as single stress factors as well as their double combinations. This revealed that some 61% of the transcriptome changes in response to double stresses were not predic from the responses to single stress treatments. It also showed that plants prioritized between potentially antagonistic responses for only 5% to 10% of the responding transcripts. This indicates that plants have evolved to cope with combinations of stresses and, therefore, may be bred to endure them. In addition, using a subset of this data from the Columbia and Landsberg erecta ecotypes, we have delineated coexpression network modules responding to single and combined stresses.

Mitogen-activated protein kinase signaling in plants.

Eukaryotic mitogen-activated protein kinase (MAPK) cascades have evolved to transduce environmental and developmental signals into adaptive and programmed responses. MAPK cascades relay and amplify signals via three types of reversibly phosphorylated kinases leading to the phosphorylation of substrate proteins, whose altered activities mediate a wide array of responses, including changes in gene expression. Cascades may share kinase components, but their signaling specificity is maintained by spaciotemporal constraints and dynamic protein-protein interactions and by mechanisms that include crossinhibition, feedback control, and scaffolding. Plant MAPK cascades regulate numerous processes, including stress and hormonal responses, innate immunity, and developmental programs. Genetic analyses have uncovered several predominant MAPK components shared by several of these processes including the Arabidopsis thaliana MAPKs MPK3, 4, and 6 and MAP2Ks MKK1, 2, 4, and 5. Future work needs to focus on identifying substrates of MAPKs, and on understanding how specificity is achieved among MAPK signaling pathways.

Foreign body reactions causing spinal cord tethering: a case-based update.

BACKGROUND: Patients operated on for myelomeningocele (MMC) and lipomeningocele (LMC) can suffer from late functional worsening that, in many cases, is due to spinal cord tethering by the post-repair scarring process. ILLUSTRATIVE CASES: In this case-based update, we report two patients operated on for MMC and LMC, respectively, who presented the clinical manifestations of spinal cord tethering, which we attributed to severe foreign body reactions to the materials used at their primary back surgery. In the first case, the cause of the tethering was an intense fibrotic scar around the silk suture used at the initial MMC repair, while in the second one, it was due to a fibrotic mesh containing the lyophilized dural graft implanted for LMC surgery. After a search of the current literature, we were unable to find cases of spinal cord tethering related to excessive scarring after dural repair with foreign materials used for the surgical correction of spinal dysraphism. DISCUSSION AND CONCLUSIONS: The pathogenesis of spinal cord tethering in our instances closely relate with the histopathologically observed intense foreign body reaction around the materials used at the primary back surgery. We recommend avoiding as much as possible the use of foreign materials during the initial repair of spinal dysraphism.

Arabidopsis MAP kinase 4 regulates gene expression through transcription factor release in the nucleus.

Plant and animal perception of microbes through pathogen surveillance proteins leads to MAP kinase signalling and the expression of defence genes. However, little is known about how plant MAP kinases regulate specific gene expression. We report that, in the absence of pathogens, Arabidopsis MAP kinase 4 (MPK4) exists in nuclear complexes with the WRKY33 transcription factor. This complex depends on the MPK4 substrate MKS1. Challenge with Pseudomonas syringae or flagellin leads to the activation of MPK4 and phosphorylation of MKS1. Subsequently, complexes with MKS1 and WRKY33 are released from MPK4, and WRKY33 targets the promoter of PHYTOALEXIN DEFICIENT3 (PAD3) encoding an enzyme required for the synthesis of antimicrobial camalexin. Hence, wrky33 mutants are impaired in the accumulation of PAD3 mRNA and camalexin production upon infection. That WRKY33 is an effector of MPK4 is further supported by the suppression of PAD3 expression in mpk4-wrky33 double mutant backgrounds. Our data establish direct links between MPK4 and innate immunity and provide an example of how a plant MAP kinase can regulate gene expression by releasing transcription factors in the nucleus upon activation.

Genetic interaction and phenotypic analysis of the Arabidopsis MAP kinase pathway mutations mekk1 and mpk4 suggests signaling pathway complexity.

It has been shown that the Arabidopsis MEK kinase MEKK1 acts upstream of the MAP kinase MPK4 to negatively regulate salicylic acid-dependent defense-response pathways. Here, we report that the mekk1;mpk4 double-mutant combination causes seedling lethality. In addition, we demonstrate that mekk1 and mpk4 single-mutant plants have significantly different phenotypes. mekk1 plants are defective for lateral root formation, while mpk4 plants are not. In addition, treatment with elevated levels of sodium chloride improves the growth of mekk1 plants, while it inhibits the growth of mpk4 plants. Our results suggest that MEKK1 and MPK4 functions are not limited to a single, linear signaling pathway. Instead there appears to be more complexity to the signaling pathways in which these two proteins function.

MEKK1 is required for flg22-induced MPK4 activation in Arabidopsis plants.

The Arabidopsis (Arabidopsis thaliana) gene MEKK1 encodes a mitogen-activated protein kinase kinase kinase that has been implicated in the activation of the map kinases MPK3 and MPK6 in response to the flagellin elicitor peptide flg22. In this study, analysis of plants carrying T-DNA knockout alleles indicated that MEKK1 is required for flg22-induced activation of MPK4 but not MPK3 or MPK6. Experiments performed using a kinase-impaired version of MEKK1 (K361M) showed that the kinase activity of MEKK1 may not be required for flg22-induced MPK4 activation or for other macroscopic FLS2-mediated responses. MEKK1 may play a structural role in signaling, independent of its protein kinase activity. mekk1 knockout mutants display a severe dwarf phenotype, constitutive callose deposition, and constitutive expression of pathogen response genes. This dwarf phenotype was largely rescued by introduction into mekk1 knockout plants of either the MEKK1 (K361M) construct or a nahG transgene that degrades salicylic acid. When treated with pathogenic bacteria, the K361M plants were slightly more susceptible to an avirulent strain of Pseudomonas syringae and showed a delayed hypersensitive response, suggesting a role for MEKK1 kinase activity in this aspect of plant disease resistance. Our results indicate that MEKK1 acts upstream of MPK4 as a negative regulator of pathogen response pathways, a function that may not require MEKK1's full kinase activity.

Manejo conservador de los esguinces del tobillo. Movilidad temprana / Conservative treatment for ankle sprains. Early mobility

Objetivo. La intención de este trabajo es el pronto regreso a las actividades deportivas de jugadores de fútbol soccer, con la ventaja de evitar largos periodos de inmovilización. Material y métodos. De un total de 571 lesiones registradas en los integrantes de los equipos de nuestra Universidad, tanto del profesional de la Primera División como de las fuerzas básicas, durante las temporadas de 1993, 1994 y 1995, 113 casos fueron esguinces del tobillo (28.7 por ciento). La edad de los jugadores fue de 13 a 30 años. Se les aplicó un programa de rehabilitación progresiva consistente en: 1) hielo y vendaje adhesivo durante 72 horas, 2) movimientos activos y estimulación eléctrica a partir de las 24 horas, 3) ejercicios de propiocepción, así como de estiramiento y fortalecimiento sural a las 48 horas, 4) saltos y carrera en una pista de 50 metros con 10 por ciento de inclinación, y 5) los movimientos de rapidez necesarios para el fútbol. Resultados. La recuperación total en 78 casos de esguince grado I se obtuvo en 2 a 65 días, promedio 10.7 (ñ 8.71 DE) y en 34 casos de grado II se obtuvo en 3 a 52 días, promedio 16.2 (ñ 10.73 DE). Únicamente hubo un caso grado III, que requirió cirugía por inestabilidad del tobillo, después de 251 días. Conclusión. El tratamiento dirigido, temprano y dinámico reduce el periodo de incapacidad en deportistas con esguince del tobillo grados I y II.

Educación basada en competencias ¿Necesario el conocimiento en el personal de salud? / Education based on skills. Is knowledge neccesary to health personnel?

Introducción: el impacto de la globalización económica se refleja en el cambio educativo con el reto de transformar la manera de formar individuos con los elementos necesarios para vivir en una sociedad competitiva. Objetivo: es identificar el conocimiento del personal de salud sobre la Educación Basada en Competencias (E.B.C). Material y métodos: estudio descriptivo transversal y prospectivo, en el periodo comprendido del 22 a 25 de agosto del 2000. Se recolectaron datos a través de un instrumento estructurado especialmente para el estudio, se aplicó en los diferentes turnos. Resultados: de un total de 446 encuestas el 64% corresponde al personal de enfermería y el 36% al personal médico, de estos solamente el 7.4%, tiene conocimiento del modelo educativo basado en competencias, el 44% de los médicos no familiares tiene conocimiento parcial del modelo y el personal de enfermería en un 29.1%. Discusión y conclusiones: se encontró que existe desconocimiento del modelo, y que el personal se inclina más por el saber, que por el hacer, el ser o el convivir, siendo estos los pilares de la E.B.C.

Introduction: the impact of the economic globalization is reflected in the educational change with the challenge of transforming the way to form individuals with the necessary elements to live in a competitive society. The objective of this study is to identify the personnel's of health knowledge on the Based Education in Competitions (E.B.C.). Material and methods: it was a descriptive traverse and prospective study, in the period of the 22 at August 25 the 2000. Data were gathered through an instrument structured especially for the study, it was applied in the different shifts. Results: of a total of 446 surveys 64% corresponds to the infirmary personnel and 36% to the medical personnel, of these solely 7.4%, he/she has knowledge of the educational pattern based on competitions, 44% of the doctors non relatives has partial knowledge of the pattern and the infirmary personnel in 29.1 %. Discussion and conclusions: it was found that ignorance of the pattern exists, and that the personnel leans more for the knowledge that for making, the being or cohabiting, being these the pillars of the E.B.C.

Fracturas por avulsión de la pelvis en un equipo de fúltbol mexicano. Reporte de casos de fracturas por avulsión de la espina iliaca anterior superior o inferior / Avulsion fractures of the pelvis in a Mexican soccer team. A report of fractures of anterior iliac spines, superior or inferior

Las fracturas por avulsión de las espinas ilíacas anterior e inferior son lesiones poco frecuentes. Se presenta en adolescentes entre 13 y 15 años, que realizan deporte en forma organizada. Se reportan los cinco casos que se presentaron en el Club Universidad Nacional de 1993 a 1998, de fractura por avulsión de la espina ilíaca anterior superior o inferior. Fueron del sexo masculino con un promedio de 14.6 años de edad, presentando el mismo patrón en cuanto al mecanismo, edad, síntomas, hallazgos clínicos y radiográficos. La mayoría se fracturó al estar pateando con el lado dominante. Se trataron con reposo del deporte, fisioterapia, fortalecimiento y ejercicios de flexibilidad. El tiempo de recuperación en promedio fue de 54.6 días. Es importante realizar un diagnóstico oportuno, considerar reposo del deporte, fisioterapia y rehabilitación para el regreso al deporte.

Validación diagnóstica de la aspiración manual endouterina para la detección de hiperplasia y cáncer de endometrio en pacientes con sangrado uterino anormal / Diagnostic validity of endouterine manual aspiration for detection of hiperplasia and cancer of endometrium in patients with abnormal uterine bleeding

Determinar el valor diagnóstico de la aspiración manual endouterina con cánula de Karman (AMEU) para la detección de hiperplasia/cáncer de endometrio en pacientes con sangrado uterino anormal. Se incluyeron 50 pacientes con sangrado uterino anormal a las que se realizó biopsia endometrial por AMEU e inmediatamente después legrado uterino instrumental (LUI. Se registró la necesidad de dilatación cervical para la toma de los especímenes. Se llevó a cabo un análisis pareado de los reportes histológicos por medio de la prueba de contraste de Wilcoxon. Para la validación diagnóstica de la biopsia endometrial por AMEU se consideró como el estándar de referencia a la histología del espécimen obtenido por LUI. Se calculó sensibilidad, especificidad, probabilidad pre prueba (prevalencia), probabilidades post-prueba (valores predictivos) y razones de verosimilitud. No se encontró diferencia estadísticamente significativa en el análisis pareado de los reportes histológicos. Fue significativamente más frecuente la necesidad de dilatación cervical para la toma del espécimen endometrial por LUI (p = 0.0002) sin encontrar diferencia en la proporción de muestras insuficientes entre ambas técnicas. La prevalencia (probabilidad pre prueba) de hiperplasia/cáncer fue de 20 por ciento Hubo dos casos de hiperplasia no detectados por AMEU (falsos negativos 20 por ciento) La AMEU mostró una sensibilidad de 71 por ciento y especificidad de 93 por ciento. La probabilidad post prueba para una biopsia endometrial anormal y normal (valor predictivo positivo y negativo) fueron 62 5 y 95 2 por ciento, respectivamente, con una razón de verosimilitud positiva de 10 23 y negativa de 0 3. La biopsia endometrial por AMEU tiene un valor diagnóstico elevado. similar al LUI en la detección de hiperplasia/cáncer de endometrio en pacientes con sangrado uterino anormal, con la ventaja de ser un procedimiento de consultorio sin los riesgos y costos del LUI.

Recolección y registro de lesiones en el fútbol soccer / Registration of soccer football injuries

Muchos estudios epidemiológicos de las lesiones en el fútbol, se han realizado de manera retrospectiva, sin embargo de esta manera se pierden datos pues en ocasiones los registros no fueron adecuados al momento de la lesión. En la actualidad los estudios deben realizarse de manera prospectiva para tratar de detectar los factores de riesgo y poder en un futuro modificarlos para disminuir el riesgo de presentar lesión. Estos factores de riesgo se pueden registrar si se utiliza un instrumento de recolección adecuado para el fútbol. Se muestra el instrumento de recolección que se ha utilizado en el Club Universidad Nacional AC, para el registro de las lesiones en el fútbol, en profesionales y fuerzas básicas desde 1992 con buenos resultados. Se propone como instrumento de recolección para estudios epidemiológicos prospectivos de lesiones en el fútbol

Frecuencia de lesiones en jugadores de fútbol soccer del Club Universidad Nacional. Lesiones en los niveles: profesional y fuerzas básicas / Injury frequency in soccer players of the University of Mexic. comparative trial between categories: professional and basic forces

Se observó la incidencia y frecuencia de lesiones de 190 jugadores de fútbol soccer pertenecientes a los equipos profesionales y fuerzas básicas, durante dos temporadas 1991-1992 y 1992-1993. Se registraron un total de 402 lesiones. El 53.2 por ciento fueron leves, 29.9 por ciento moderadas y 16.9 por ciento severas. Las lesiones más frecuentes fueron: musculares 27.5 por ciento, los esguinces de tobillo 21.1 por ciento, las contusiones 19.7 por ciento y por sobreuso 19.7 por ciento. La única diferencia entre profesionales y fuerzas básicas fue que son más frecuentes las fracturas en los profesionales y el Osgood-Schlatter sólo se presentó en las fuerzas básicas, el resto de las lesiones se comportaron igual en ambos grupos. Tomando en cuenta la exposición no hubo diferencia significativa en los dos grupos. Los resultados en los estudios epidemiológicos han variado por la diferencia en la metodología de recolección, este estudio se realiza en equipos de fuerzas básicas como profesionales y el criterio médico de diagnóstico, tratamiento y criterio para regresar al deporte fue el mismo. Sabemos que falta todavía mucho para explicarnos las causas y mecanismos en las lesiones en el fútbol soccer

Radioquimioterapia concurrente en pacientes con tumores digestivos localmente avanzados y diseminados / Radiochemotherapy in patients with locally advanced digestive tumors

Objetivos: Evaluamos en forma retrospectiva: factibilidad, toxicidad, respuesta, paliación de síntomas (Pal S) y sobrevida en 41 pacientes (PTS) con tumores digestivos (TD) localmente avanzados (LA) y avanzados (AV) tratados con radioquimioterapia. Pacientes y Métodos: Entre 7/94 y 4/96, y basados en un esquema de la Mayo Clinic (J Clin Oncol 12, 1994), losPTS recibieron: radioterapia (1,8 Gy/d, 5d x semana) + quimioterapia concurrente (5FU 400 mg/m al cuadrado/d + leucovorina-LV-20 mg/m al cuadrado/d, ambos en bolo i.v. por 4 d en la primera semana y por 3 ó 4 d en la última semana de radioterapia) y 2 cursos posteriores de quimioterapia con 5FU + LV. Veintiocho PTS tenían TD altos: 22 LA y 6 AV, 13 PTS tenían TD bajos: 9 LA y 4 AV. Resultados: La Pal S para PTS LA-AV fue del 68 por ciento-33 por ciento en TD altos y 44 por ciento-75 por ciento en TD bajos. Las respuestas completas y parciales en PTS LA con TD altos fueron 18 por ciento-41 por ciento y en TD bajos 22 por ciento-44 por ciento. Con una mediana de seguimiento para PTS LA-AV de 6 - 4 m en TD altos y de 11 - 11 m en TD bajos están vivos: 68 por ciento - 33 por ciento y 66 por ciento - 75 por ciento de los PTS. TOXICIDAD MAS FRECUENTE: RADIOQUIMIOTERAPIA: G1-2: anemia 54 por ciento, fatiga 49 por ciento, diarrea 34 por ciento, náuseas 29 por ciento, leucopenia 20 por ciento, eritema 12 por ciento; G3: diarrea 10 por ciento. QUIMIOTERAPIA: G1-2: anemia 27 por ciento, náuseas 27 por ciento, diarrea 27 por ciento, mucositis 23 por ciento. Conclusiones: en nuestro medio, este plan ambulatorio fue sencillo, factible y de toxicidad aceptable. Es un esquema recomendable para el manejo paliativo de PTS con TD y para el tratamiento neoadyuvante de PTS con tumores rectales (favoreciendo la resecabilidad)