[Delayed diagnosis of osteosarcoma in adults: a prognostic factor to be considered]. / Retraso en el diagnóstico de osteosarcoma en adultos: un factor pronóstico que debemos considerar.

INTRODUCTION: different variables have been associated with a worse prognosis of patients with osteosarcoma (OS), highlighting tumor size, location in the axial skeleton and the presence of metastases. The objective of this study is to analyze the prognostic impact of diagnostic delay in osteosarcoma in adults in the Mexican population in a center specialized in sarcomas. MATERIAL AND METHODS: retrospective cohort study from January 1, 2005, to December 31, 2016, 96 patients over 21 years of age with a diagnosis of osteosarcoma were analyzed. RESULTS: the median time to diagnosis from the onset of symptoms was six months (range: 2-36). This variable was dichotomized by applying the operator-dependent curve (ROC) analysis and we determined a cut-off value greater than five months, with an area under the curve (AUC) = 0.93 [95% CI 0.86-0.97], sensitivity 93.2% and specificity 94.6%. CONCLUSION: time until diagnosis is a critical factor in the survival of adult patients with osteosarcoma, highlighting its influence on disease progression and the appearance of metastasis. The correlation between diagnostic delay and an unfavorable prognosis reinforces the need for rapid and efficient evaluation in suspected cases of osteosarcoma.

INTRODUCCIÓN: diferentes variables se han asociado con un peor pronóstico de los pacientes con osteosarcoma, destacando el tamaño tumoral, la localización en esqueleto axial y la presencia de metástasis. El objetivo de este estudio fue analizar el impacto pronóstico del retraso diagnóstico en osteosarcoma en adultos en población mexicana en un centro especializado en sarcomas. MATERIAL Y MÉTODOS: estudio de tipo cohorte retrospectiva del 1 de Enero del 2005 al 31 de Diciembre de 2016, se analizaron 96 pacientes mayores de 21 años con diagnóstico de osteosarcoma. RESULTADOS: la mediana de tiempo al diagnóstico desde el inicio de síntomas fue de seis meses (rango: 2-36). Esta variable se dicotomizó aplicando el análisis de curva dependiente de operador (ROC) y determinamos un valor de corte mayor a cinco meses con un área bajo la curva (AUC) = 0.93 [IC95% 0.86-0.97], sensibilidad 93.2% y especificidad 94.6%. CONCLUSIÓN: el tiempo hasta el diagnóstico es un factor crítico en la supervivencia de los pacientes adultos con osteosarcoma, destacando su influencia en la progresión de la enfermedad y la aparición de metástasis. La correlación entre el retraso diagnóstico y un pronóstico desfavorable refuerza la necesidad de una evaluación rápida y eficiente en casos sospechosos de osteosarcoma.

[Prognostic factors associated with failure of modular knee arthroplasty in oncologic patients]. / Factores pronósticos asociados al fracaso de la artroplastía modular de rodilla en pacientes oncológicos.

INTRODUCTION: reconstruction of large bone defects using modular knee arthroplasty (MKA) presents a significant challenge in terms of functionality. The objective of the present work was to identify the different prognostic factors associated with failure of MKA in cancer patients. MATERIAL AND METHODS: a retrospective cohort study was conducted, including patients with a diagnosis of musculoskeletal tumor in the distal femur or proximal tibia, who underwent MKA between January 1, 2010, and December 31, 2021. RESULTS: 49 patients were included, of which 25 (51.02%) were women and 24 (48.98%) men, with a mean age of 29.57 years. Of these, 14 (28.57%) patients experienced some type of MKA failure. The most frequent complication that led to failure was periprosthetic infection, observed in seven (14.29%) patients. Variables associated with MKA failure included biopsies performed outside our hospital (HR 3.2, 95% CI 1.4-6.4, p = 0.02), the length of the long axis of the tumor (HR 2.1, 95% CI 1.2-4.6, p = 0.01) and a prolonged surgical time (HR 3.37, 95% CI 1.1-8.6, p = 0.04). CONCLUSION: the most significant prognostic factors associated with MKA failure in our cohort were tumor size, prolonged surgical time, and performance of the diagnostic biopsy in a center not specialized in the management of this type of patient. These findings highlight the importance of considering these variables to improve outcomes in patients undergoing MKA.

INTRODUCCIÓN: la reconstrucción de grandes defectos óseos mediante artroplastía modular de rodilla (AMR) representa un desafío significativo en términos de funcionalidad. El objetivo del presente trabajo fue identificar los diferentes factores pronósticos asociados al fracaso de la AMR en pacientes oncológicos. MATERIAL Y MÉTODOS: se realizó un estudio de cohorte retrospectiva, incluyendo pacientes con diagnóstico de tumor musculoesquelético en el fémur distal o la tibia proximal, que fueron sometidos a AMR entre el 1 de Enero de 2010 y el 31 de Diciembre de 2021. RESULTADOS: se incluyeron 49 pacientes, de los cuales 25 (51.02%) eran mujeres y 24 (48.98%) hombres, con una edad media de 29.57 años. De éstos, 14 (28.57%) pacientes experimentaron algún tipo de fracaso de la AMR. La complicación más frecuente que condicionó el fracaso fue la infección periprotésica, observada en siete (14.29%) pacientes. Las variables asociadas con el fracaso de las AMR incluyeron biopsias realizadas fuera de nuestro hospital (HR 3.2, IC95% 1.4-6.4, p = 0.02), longitud del eje mayor del tumor (HR 2.1, IC95% 1.2-4.6, p = 0.01) y tiempo quirúrgico prolongado (HR 3.37, IC95% 1.1-8.6, p = 0.04). CONCLUSIÓN: los factores pronósticos asociados al fracaso de las AMR en nuestra cohorte fueron el tamaño del tumor, un tiempo quirúrgico prolongado y la realización de la biopsia diagnóstica en un centro no especializado en el manejo de este tipo de pacientes. Estos hallazgos resaltan la importancia de considerar estas variables en pacientes sometidos a AMR.

Chikungunya Virus, Metabolism, and Circadian Rhythmicity Interplay in Phagocytic Cells.

Chikungunya virus (CHIKV) is transmitted to humans by mosquitoes of the genus Aedes, causing the chikungunya fever disease, associated with inflammation and severe articular incapacitating pain. There has been a worldwide reemergence of chikungunya and the number of cases increased to 271,006 in 2022 in the Americas alone. The replication of CHIKV takes place in several cell types, including phagocytic cells. Monocytes and macrophages are susceptible to infection by CHIKV; at the same time, they provide protection as components of the innate immune system. However, in host-pathogen interactions, CHIKV might have the ability to alter the function of immune cells, partly by rewiring the tricarboxylic acid cycle. Some viral evasion mechanisms depend on the metabolic reprogramming of immune cells, and the cell metabolism is intertwined with circadian rhythmicity; thus, a circadian immunovirometabolism axis may influence viral pathogenicity. Therefore, analyzing the interplay between viral infection, circadian rhythmicity, and cellular metabolic reprogramming in human macrophages could shed some light on the new field of immunovirometabolism and eventually contribute to the development of novel drugs and therapeutic approaches based on circadian rhythmicity and metabolic reprogramming.

Microbial indicators of efficient performance in an anaerobic/anoxic/aerobic integrated fixed-film activated sludge (A2O-IFAS) and a two-stage mesophilic anaerobic digestion process.

An analysis of the community structure, diversity and population dynamics of Bacteria and Archaea in the suspended and attached biomass fractions of a pilot-scale anaerobic/anoxic/aerobic integrated fixed-film activated sludge (A2O-IFAS) was executed. Along with this, the effluents of the acidogenic (AcD) and methanogenic (MD) digesters of a two-stage mesophilic anaerobic (MAD) system treating the primary sludge (PS) and waste activated sludge (WAS) generated by the A2O-IFAS were also analyzed. Non-metric multidimensional scaling (MDS) and Biota-environment (BIO-ENV) multivariate analyses were performed to link population dynamics of Bacteria and Archaea to operating parameters and removal efficiencies of organic matter and nutrients, in search of microbial indicators associated with optimal performance. In all samples analyzed, Proteobacteria, Bacteroidetes and Chloroflexi were the most abundant phyla, while the hydrogenotrophic methanogens Methanolinea, Methanocorpusculum and Methanobacterium were the predominant archaeal genera. BIO-ENV analysis disclosed strong correlations between the population shifts observed in the suspended and attached bacterial communities of the A2O-IFAS and the removal rates of organic matter, N and P. It is noteworthy that the incorporation of carriers combined with a short sludge retention time (SRT = 4.0 ± 1.0 days) enhanced N removal performance of the A2O by favoring the enrichment of bacterial genera able to denitrify (Bosea, Dechloromonas, Devosia, Hyphomicrobium, Rhodobacter, Rhodoplanes, Rubrivivax, and Sulfuritalea) in the attached biomass fraction. In addition, operation at short SRT enabled the generation of a highly biodegradable WAS, which enhanced the biogas and methane yields in the two-stage MAD. An increase in the relative abundance of Acetobacteroides (uncultured Blvii28 wastewater-sludge group of Rikenellaceae family) correlated positively with the volatile solids removal rate (%VSR), CH4 recovery rate and %CH4 in the biogas (r > 0.8), supporting their relevance for an efficient methanogenesis in two-stage systems.

Environmentally responsive hydrogel composites for dynamic body thermoregulation.

Hydrogel composites exhibiting dynamic thermo-hydro responsive modulation of infrared radiation (IR) in the 5-15 µm range are designed for personalized body thermoregulation. Fabrication of the proposed system relies on the periodic arrangement of submicron-sized spherical fine silica (SiO2) particles within poly(N-isopropylacrylamide) (PNIPAM)-based hydrogels. The dependence of the SiO2 particles content on the IR reflection, followed by its modulation in response to any immediate environmental changes are thereby investigated. The addition of 20 wt% of SiO2 allowed the hydrogel composites to reflect 20% of the IR emitted by the human body at constant temperature (i.e. T = 20 °C) and relative humidity (i.e. RH = 0%). According to Bragg's law, we found that the smaller the distance between the SiO2 particles, the higher the IR reflection. The IR reflection further increased to a maximum of 42% when the resulting hydrogel composites are subjected to changes in relative humidity (i.e. RH = 60%) and temperature (i.e. T = 35 °C). Thermography is used to map the IR radiation emitted from the hydrogel composites when placed on the skin of the human body, demonstrating that the composite is actually reflecting IR. The latter results are supported by theoretical models that define the IR reflection profile of the resulting hydrogel composites with respect to the silica content, relative humidity and temperature.

[Surgical margins as prognostic factor in pelvis chondrosarcoma. Cohort study in a sarcoma unit]. / Márgenes quirúrgicos como factor pronóstico del condrosarcoma de pelvis. Estudio de cohorte en una unidad de sarcomas.

INTRODUCTION: chondrosarcoma is the second most common primary malignant tumor, constitutes approximately one quarter of all primary bone sarcomas. Surgical margins in pelvic chondrosarcoma have a direct impact as a prognostic factor, both on overall survival and on recurrence-free survival of this disease. OBJECTIVES: to analyze the impact of surgical margins as a prognostic factor in pelvic chondrosarcoma. MATERIAL AND METHODS: a retrospective database cohort with prospective follow-up of sarcomas in patients diagnosed with primary pelvic chondrosarcoma who underwent surgical treatment. Clinical-demographic variables were obtained, a descriptive analysis of each variable was performed, and these were contrasted with the outcome variables. RESULTS: seventeen patients were included, of which nine were female. The median age was 41 years, ranging from 23 to 65 years. The average tumor size was 20.9 cm (range 5 to 46 cm). The average surgical margin was 5.3 mm, ranging from 1 to 30 mm, with 58% positive margins. The average overall survival was 64 months (range 7 to 108 months). The distribution of pelvic involvement was as follows: zone I in nine patients (52.9%), zone II in two (11.8%), a combination of zones I-III in two (11.8%), I+II in one (5.9%), II+III in one (5.9%), I-III plus sacrum in one (5.9%) and I plus sacrum in one (5.9%). Tumor grades were classified as low in seven patients (41.2%), intermediate in sven (41.2%), high in two (11.8%), and dedifferentiated in one (5.9%). Regarding the type of resection, 12 patients (70.6%) underwent internal hemipelvectomy and five (29.4%) external hemipelvectomy. Recurrence was recorded in five cases (29.4%), metastasis in three (17.6%), and mortality in four (23.5%). CONCLUSIONS: this series represents the largest cohort reported in Latin America of primary pelvic chondrosarcomas. A more favorable prognosis was observed in patients with surgical margins greater than 1 mm. The presence of chondrosarcoma in multiple pelvic zones was associated with a worse oncological prognosis. Additionally, a higher incidence of positive surgical margins and local recurrence rates were identified in pelvic chondrosarcomas compared to those located in the extremities.

INTRODUCCIÓN: el condrosarcoma (CS), el segundo tumor maligno óseo primario más común, constituye aproximadamente una cuarta parte de todos los sarcomas óseos primarios. Los márgenes quirúrgicos en el condrosarcoma pélvico tienen un impacto directo como factor pronóstico, tanto en la supervivencia global como en la supervivencia libre de recurrencia de esta enfermedad. OBJETIVOS: analizar el impacto de los márgenes quirúrgicos como factor pronóstico en el condrosarcoma de la pelvis. MATERIAL Y MÉTODOS: cohorte de base de datos retrospectiva con seguimiento prospectivo de sarcomas de pacientes con diagnóstico de condrosarcoma primario de la pelvis que fueron sometidos a tratamiento quirúrgico. Se obtuvieron variables clínico-demográficas, se realizó un análisis descriptivo de cada variable y se contrastaron con las variables desenlace. RESULTADOS: se incluyeron 17 pacientes, de los cuales nueve eran mujeres. La mediana de edad fue de 41 años (rango de 23 a 65 años). El tamaño promedio del tumor fue de 20.9 cm (rango de 5 a 46 cm). El margen quirúrgico promedio fue de 5.3 mm, variando entre 1 y 30 mm, con 58% de márgenes positivos. La supervivencia global promedio fue de 64 meses (rango de 7 a 108 meses). La distribución de la afectación pélvica fue: zona I en nueve pacientes (52.9%), zona II en dos (11.8%), combinación de zonas I-III en dos (11.8%), I+II en uno (5.9%), II+III en uno (5.9%), I-III más sacro en uno (5.9%) y I más sacro en uno (5.9%). Los grados tumorales se clasificaron en bajo en siete pacientes (41.2%), intermedio en siete (41.2%), alto en dos (11.8%) y desdiferenciado en uno (5.9%). Respecto al tipo de resección, 12 pacientes (70.6%) se sometieron a hemipelvectomía interna y cinco (29.4%) a hemipelvectomía externa. Se registró recurrencia en cinco casos (29.4%), metástasis en tres (17.6%) y mortalidad en cuatro (23.5%). CONCLUSIONES: esta serie representa la cohorte más extensa reportada en Latinoamérica de condrosarcomas primarios de la pelvis. Se observó un pronóstico más favorable en pacientes con márgenes quirúrgicos superiores a 1 mm. La presencia de condrosarcoma en múltiples zonas pélvicas se asoció con un peor pronóstico oncológico. Además, se identificó una mayor incidencia de márgenes quirúrgicos positivos y tasas de recurrencia local en condrosarcomas de la pelvis en comparación con aquellos ubicados en las extremidades.

Mitochondrial Ultrastructure and Activity Are Differentially Regulated by Glycolysis-, Krebs Cycle-, and Microbiota-Derived Metabolites in Monocytes.

Several intermediate metabolites harbour cell-signalling properties, thus, it is likely that specific metabolites enable the communication between neighbouring cells, as well as between host cells with the microbiota, pathogens, and tumour cells. Mitochondria, a source of intermediate metabolites, participate in a wide array of biological processes beyond that of ATP production, such as intracellular calcium homeostasis, cell signalling, apoptosis, regulation of immune responses, and host cell-microbiota crosstalk. In this regard, mitochondria's plasticity allows them to adapt their bioenergetics status to intra- and extra-cellular cues, and the mechanisms driving such plasticity are currently a matter of intensive research. Here, we addressed whether mitochondrial ultrastructure and activity are differentially shaped when human monocytes are exposed to an exogenous source of lactate (derived from glycolysis), succinate, and fumarate (Krebs cycle metabolic intermediates), or butyrate and acetate (short-chain fatty acids produced by intestinal microbiota). It has previously been shown that fumarate induces mitochondrial fusion, increases the mitochondrial membrane potential (Δψm), and reshapes the mitochondrial cristae ultrastructure. Here, we provide evidence that, in contrast to fumarate, lactate, succinate, and butyrate induce mitochondrial fission, while acetate induces mitochondrial swelling. These traits, along with mitochondrial calcium influx kinetics and glycolytic vs. mitochondrial ATP-production rates, suggest that these metabolites differentially shape mitochondrial function, paving the way for the understanding of metabolite-induced metabolic reprogramming of monocytes and its possible use for immune-response intervention.

SELNET clinical practice guidelines for bone sarcoma.

Bone sarcoma are infrequent diseases, representing < 0.2% of all adult neoplasms. A multidisciplinary management within reference centers for sarcoma, with discussion of the diagnostic and therapeutic strategies within an expert multidisciplinary tumour board, is essential for these patients, given its heterogeneity and low frequency. This approach leads to an improvement in patient's outcome, as demonstrated in several studies. The Sarcoma European Latin-American Network (SELNET), aims to improve clinical outcome in sarcoma care, with a special focus in Latin-American countries. These Clinical Practice Guidelines (CPG) have been developed and agreed by a multidisciplinary expert group (including medical and radiation oncologist, surgical oncologist, orthopaedic surgeons, radiologist, pathologist, molecular biologist and representatives of patients advocacy groups) of the SELNET consortium, and are conceived to provide the standard approach to diagnosis, treatment and follow-up of bone sarcoma patients in the Latin-American context.

Insights into the removal of pharmaceutically active compounds from sewage sludge by two-stage mesophilic anaerobic digestion.

The removal efficiencies (REs) of twenty-seven pharmaceutically active compounds (PhACs) (eight analgesic/anti-inflammatories, six antibiotics, four ß-blockers, two antihypertensives/diuretics, three lipid regulators and four psychiatric drugs) were evaluated in a pilot-scale two-stage mesophilic anaerobic digestion (MAD) system treating thickened sewage sludge from a pilot-scale A2O™ wastewater treatment plant (WWTP) which was fed with wastewater from the pre-treatment of the full-scale WWTP Murcia Este (Murcia, Spain). The MAD system was long-term operated using two different sets of sludge retention times (SRTs) for the acidogenic (AcD) and methanogenic (MD) digesters (phase I, 2 and 12 days; and phase II, 5 and 24 days, in AcD and MD, respectively). Quantitative PCR (qPCR) and Illumina MiSeq sequencing were used to estimate the absolute abundance of Bacteria, Archaea, and Fungi and investigate the structure, diversity and population dynamics of their communities in the AcD and MD effluents. The extension of the SRT from 12 (phase I) to 24 days (phase II) in the MD was significantly linked with an improved removal of carbamazepine, clarithromycin, codeine, gemfibrozil, ibuprofen, lorazepam, and propranolol. The absolute abundances of total Bacteria and Archaea were higher in the MD regardless of the phase, while the diversity of bacterial and archaeal communities was lower in phase II, in both digesters. Non-metric multidimensional scaling (MDS) plots showed strong negative correlations among phyla Proteobacteria and Firmicutes and between genera Methanosaeta and Methanosarcina throughout the full experimental period. Strong positive correlations were revealed between the relative abundances of Methanospirillum and Methanoculleus and the methanogenesis performance parameters (volatile solids removal, CH4 recovery rate and %CH4 in the biogas), which were also related to longer SRT. The REs of several PhACs (naproxen, ketoprofen, ofloxacin, fenofibrate, trimethoprim, and atenolol) correlated positively (r > 0.75) with the relative abundances of specific bacterial and archaeal groups, suggesting their participation in biodegradation/biotransformation pathways.

[Functional evaluation of the management of massive rotator cuff ruptures with the use of the subacromial balloo]. / Evaluación funcional del manejo de rupturas masivas del manguito de los rotadores con el uso del balón subacromial.

INTRODUCTION: Rotator cuff (MR) ruptures occur in more than 50% of patients over the age of 60, and can cause changes in normal shoulder biomechanics that can trigger rotator cuff tear arthropathy. There is currently no consensus on treatment for massive rotator cuff tears. OBJECTIVE: To evaluate the clinical and radiographic outcomes of subacromial balloon placement in these lesions. MATERIAL AND METHODS: Analytical, longitudinal and retrospective study of 10 consecutive patients treated with the use of the subacromial balloon. Constant (CS) and ASES scales were used preoperatively and at 6, 12 months of post-surgical follow-up. Radiographic results were assessed using the Acromio-humeral Interval (AHI) on a true AP shoulder X-ray. RESULTS: The average improvement in CS was 41.7 ± 8.93 at 12 months of follow-up, the ASES scale showed an average improvement of 64.6 ± 4.9 at 12 months of follow-up. The presurgical AHI was 6.1 ± 1.10 and the mean at 12 months of follow-up was 7.1 ± 0.9. Clinical and radiographic improvement was observed at all scales, however no statistically significant results were found. CONCLUSION: The subacromial balloon prevents the ascent of the humeral head in the first 12 months of placement; we assume that it could restore normal glenohumeral kinematics by improving mobility and decreasing pain.

INTRODUCCIÓN: Las rupturas del manguito de los rotadores (MR) se presentan en más de 50% de los pacientes mayores de 60 años y pueden causar cambios en la biomecánica normal del hombro que pueden desencadenar una artropatía por desgarro del MR. Actualmente, no existe un consenso sobre el tratamiento para el desgarro masivo del MR. OBJETIVO: Evaluar los resultados clínicos y radiográficos de la colocación del balón subacromial en estas lesiones. MATERIAL Y MÉTODOS: Estudio analítico, longitudinal y retrospectivo de 10 pacientes consecutivos tratados con el uso del balón subacromial. Se utilizaron escalas de Constant (CS) y ASES prequirúrgicas, a los seis y 12 meses de seguimiento postquirúrgico. Los resultados radiográficos fueron valorados por medio del intervalo acromio-humeral (IAH) en una radiografía anteroposterior (AP) verdadera de hombro. RESULTADOS: La mejoría promedio en la CS fue de 41.7 ± 8.93 a los 12 meses de seguimiento, la escala de ASES mostró una mejoría promedio de 64.6 ± 4.9 a los 12 meses de seguimiento. El IAH prequirúrgico fue de 6.1 ± 1.10 y la media a los 12 meses de seguimiento fue de 7.1 ± 0.9. Se observó una mejoría clínica y radiográfica en todas las escalas; sin embargo, no se encontraron resultados estadísticamente significativos. CONCLUSIÓN: El balón subacromial previene el ascenso de la cabeza humeral en los primeros 12 meses de colocado; suponemos que podría restaurar la cinemática glenohumeral normal mejorando movilidad y disminuyendo dolor.

Effect of perfluorohexane sulfonate on pig oocyte maturation, gap-junctional intercellular communication, mitochondrial membrane potential and DNA damage in cumulus cells in vitro.

Perfluorohexane sulfonate (PFHxS) is one of the most abundant perfluorinated compounds in the environment. Exposure to this compound has been correlated to a decrease in human fertility, although the molecular and cellular mechanisms underlying this correlation have not been described. The adverse reproductive effects of PFHxS could be based on alterations in oocyte maturation, the process rendering oocytes competent for fertilization. The aim of this study was to evaluate the effect of PFHxS on porcine oocyte viability and maturation in vitro, as well as on gap-junctional intercellular communication (GJIC) in cumulus-oocyte complexes (COCs), oocyte mitochondrial membrane potential (mΔΨ) and DNA damage in cumulus cells, as possible mechanisms of action. PFHxS caused cytotoxicity (medium lethal concentration, LC50 = 329.1 µM) and inhibition of oocyte maturation (medium inhibitory concentration, MIC50 = 91.68 µM). GJIC was not affected in exposed COCs. However, the mitochondrial membrane potential was significantly decreased in PFHxS-exposed oocytes at the germinal vesicle breakdown (GVBD) stage. In addition, exposure to PFHxS induced DNA damage in cumulus cells. Thus, inhibition of oocyte maturation by PFHxS could be attributed to a decreased oocyte mΔΨ at the GVBD and to DNA damage of the cumulus cells that support the oocyte.

[Current status of chondrosarcoma in a reference center]. / Estado actual del condrosarcoma en un centro de referencia.

INTRODUCTION: Chondrosarcoma is the second most frequent primary malignant bone tumor, is characterized by the formation of a chondroid matrix, is more frequent in advanced ages and its prognosis is directly related to the histological subtype and tumor grade. The objective of this article is to present the demographic and treatment profile in a reference center. MATERIAL AND METHODS: A retrospective, descriptive, observational, analytical cohort-type study was conducted in a reference center between January 1, 2005 and December 31, 2019, the demographic variables were analyzed and contrasted with the outcome variables that were overall survival and disease-free period. RESULTS: 85 patients were included, the mean age of presentation was 43.3 years, the clinical stage at the time of presentation was mostly IIa and IIb covering 54.1%. 35 patients had metastases with clinical stage IV. The main site of metastasis was the lung in 32 patients (37.6%). Thirty-six patients (42.3%) had specific mortality. 35 patients (41.2%) died as a result of metastatic disease to lung or other organs, one patient died from direct extension of the tumor in the cervical spine. CONCLUSION: The important prognostic factors found in our series that influence global survival are: the presence of metastases and axial localization.

INTRODUCCIÓN: El condrosarcoma es el segundo tumor óseo maligno primario más frecuente, se caracteriza por la formación de matriz condroide, es más común en edades avanzadas y su pronóstico guarda relación directa con el subtipo histológico y el grado tumoral. El objetivo de este artículo es presentar el perfil demográfico y de tratamiento en un centro de referencia. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, descriptivo, observacional, analítico de tipo cohorte en un centro de referencia entre el 01 de Enero de 2005 y el 31 de Diciembre de 2019, se analizaron las variables demográficas y se contrastaron con las variables de desenlace que fueron supervivencia global y período libre de enfermedad. RESULTADOS: Se incluyeron 85 pacientes, la media edad de presentación fue 43.3 años, la etapa clínica al momento de la presentación fue mayormente IIa y IIb abarcando 54.1%, 35 pacientes tuvieron metástasis con etapa clínica IV. El principal sitio de metástasis fue el pulmón en 32 pacientes (37.6%). De los pacientes, 36 (42.3%) presentaron mortalidad cáncer específica, 35 (41.2%) fallecieron como consecuencia de la enfermedad metastásica a pulmón u otros órganos y un paciente falleció por extensión directa del tumor en columna cervical. CONCLUSIÓN: Los factores pronósticos importantes hallados en nuestra serie que influyen en la supervivencia global son: la presencia de metástasis y la localización axial.

Linking microbial diversity and population dynamics to the removal efficiency of pharmaceutically active compounds (PhACs) in an anaerobic/anoxic/aerobic (A2O) system.

The removal efficiencies (REs) of nineteen pharmaceutically active compounds (PhACs) (six antibiotics-clarithromycin, ofloxacin, sulfadiazine, sulfamethazine, sulfamethoxazole and trimethoprim -, four ß-blockers -atenolol, metoprolol, propranolol and sotalol-, two antihypertensives/diuretics -furosemide and hydrochlorothiazide-, three lipid regulators -bezafibrate, fenofibrate and gemfibrozil-, and four psychiatric medications -carbamazepine, diazepam, lorazepam and paroxetine) were ascertained in a pilot-scale anaerobic/anoxic/aerobic (A2O) system treating urban wastewater, long term operated during two experimental phases using different sets of environmental conditions and operating parameters. Illumina MiSeq sequencing was used to investigate the structure, diversity and population dynamics of bacteria, archaea and fungi communities in the activated sludge. The results showed that mixed liquor suspended solids (MLSS) and food-to-microorganisms ratio (F/M) were operational parameters significantly influencing the REs of five of the analyzed PhACs in the A2O system. Biota-environment (BIO-ENV) analysis revealed strong correlations between population shifts of the activated sludge community and the REs of PhACs of the different pharmaceutical families. Increased REs of clarithromycin, furosemide, bezafibrate and gemfibrozil were concomitant to higher relative abundances of bacterial phylotypes classified within the Rhodobacteraceae and Sphingomonadaceae (Alphaproteobacteria), while those of Betaproteobacteria, Chloroflexi and Methanomethylovorans (Euryarchaea) correlated positively with the REs of up to seven PhACs belonging to different therapeutic groups.

[Synchronous primary double: condrosarcoma and sarcoma high grade fusocelular associated with Maffucci syndrome]. / Doble primario sincrónico: condrosarcoma y sarcoma fusocelular de alto grado asociado a síndrome de Maffucci.

Maffucci syndrome is characterized by the presence of multiple enchondromes and hemangiomas that can affect soft tissues and other organs. The risk of malignant transformation of lesions is 100% during the life of the individual, with chondrosarcoma being the most frequently associated malignant tumor. We present the case of a 44-year-old man diagnosed with Maffucci syndrome who developed a synchronous double primary: chondrosarcoma and high-grade multicenter fusocellular sarcoma of scapular and tricipital region, was treated with disarticulation interscapule-thoracic, presented accelerated progression and lung disease. There are other neoplasms associated with Maffucci syndrome, such as pancreatic adenocarcinoma, mesenchymal ovarian tumors, gliomas, astrocytomas and pituitary tumors. It is therefore very interesting to report the uncommon association between fusocellular sarcoma and secondary chondrosarcoma in patients with Maffucci syndrome. Follow-up in this group of patients is complex and is based on the intentional search for accelerated growing lesions, paying attention to progressive growth injuries, clinical symptoms or radiological malignancy data.

El síndrome de Maffucci se caracteriza por la presencia de múltiples encondromas y hemangiomas que pueden afectar tejidos blandos y otros órganos. El riesgo de transformación maligna de las lesiones es de 100% durante la vida del individuo, siendo el condrosarcoma el tumor maligno más frecuentemente asociado. Se presenta el caso de un hombre de 44 años de edad con diagnóstico de síndrome de Maffucci, el cual desarrolló un doble primario sincrónico: condrosarcoma y sarcoma fusocelular de alto grado multicéntrico de región escapular y tricipital, fue tratado con desarticulación interescapulotorácica, mostró progresión acelerada y enfermedad pulmonar. Existen otras neoplasias asociadas al síndrome de Maffucci tales como adenocarcinoma de páncreas, tumores mesenquimales de ovario, gliomas, astrocitomas y tumores de la pituitaria. Por lo que resulta muy interesante reportar la asociación infrecuente entre un sarcoma fusocelular y un condrosarcoma secundario en pacientes con síndrome de Maffucci. El seguimiento en este grupo de pacientes es complejo y se basa en la búsqueda intencionada de lesiones con crecimiento acelerado, prestando atención en lesiones de crecimiento progresivo, síntomas clínicos o datos radiológicos de malignidad.

[Dedifferentiated diaphyseal juxtacortical osteosarcoma of ulna with metastasis to the lung]. / Osteosarcoma parostal desdiferenciado en diáfisis de cúbito metastásico a pulmón.

Dedifferentiated parosteal osteosarcoma is a variant in which a high grade osteosarcoma coexists with a parosteal osteosarcoma. We report the case of a 20-year-old female patient who presented with six months of evolution of pain and functional limitation of the right forearm, with no apparent cause; radiographs were performed, observing a tumoral lesion in the diaphysis of the right ulna. Physical examination showed pain upon palpation in the diaphysis of the ulna and limitation of prone-supination. Axial computed tomography of the thorax revealed metastatic disease in the upper lobe of the left lung. An incisional biopsy was performed on the right ulna, with a report of dedifferentiated parosteal osteosarcoma. Therefore, the patient was managed with neoadjuvant chemotherapy with cisplatin and doxorubicin until completing three cycles. Surgical treatment consisted of intercalary resection of the diaphysis of the right ulna, plus reconstruction of the microvascularized autologous graft of the right fibular diaphysis and graft stabilization with 3.5 mm dynamic compression plate (DCP) and one-third tubular plate. In the same procedure, pulmonary metastasectomy was performed by thoracoscopy. Post-surgical histopathological report with 100% necrosis. Currently, the patient is asymptomatic, with no evidence of tumor activity. Dedifferentiated parosteal osteosarcoma is a rare pathology, but should be suspected as a differential diagnosis in the presence of a parosteal osteosarcoma; it should be taken into account that this disease can metastasize due to its dedifferentiated pattern. It is important to plan a surgical treatment that allows an adequate functional reconstruction, always taking into account the oncological principle.

El osteosarcoma parostal desdiferenciado es una variante en la cual un osteosarcoma de alto grado coexiste con un osteosarcoma parostal. Se presenta el caso de un paciente femenino de 20 años; acudió con seis meses de evolución de dolor y limitación funcional en el antebrazo derecho sin causa aparente; se le realizaron radiografías, donde se observó una lesión tumoral en la diáfisis del cúbito derecho. A la exploración física, presentó dolor a la palpación en la diáfisis del cúbito y limitación a la pronosupinación. La tomografía axial computada de tórax reveló enfermedad metastásica en el lóbulo superior del pulmón izquierdo. Se le efectuó una biopsia incisional de la tumoración en el cúbito derecho, con reporte de osteosarcoma parostal desdiferenciado. Por ello, inició manejo con quimioterapia neoadyuvante con cisplatino y doxorrubicina hasta completar tres ciclos. El tratamiento quirúrgico consistió en resección intercalar de la diáfisis del cúbito derecho más reconstrucción de injerto autólogo microvascularizado de la diáfisis del peroné derecho y estabilización del injerto con placa de compresión dinámica (DCP) 3.5 mm y placa tercio de caña. En el mismo procedimiento se le efectuó metastasectomía pulmonar por toracoscopía. El reporte histopatológico postquirúrgico, con necrosis de 100%. Actualmente, la paciente se encuentra asintomática, sin datos de actividad tumoral. El osteosarcoma parostal desdiferenciado es una patología rara, pero que se debe sospechar como diagnóstico diferencial ante un osteosarcoma parostal; se debe tener en cuenta que esta enfermedad puede generar metástasis por su patrón desdiferenciado. Es importante planificar un tratamiento quirúrgico que permita una adecuada reconstrucción funcional, siempre teniendo en cuenta el principio oncológico.

Removal of anti-inflammatory/analgesic pharmaceuticals from urban wastewater in a pilot-scale A2O system: Linking performance and microbial population dynamics to operating variables.

In this study, the removal rates of eight anti-inflammatory and/or analgesic pharmaceuticals, AIAPs (acetaminophen, ibuprofen, naproxen, ketoprofen, diclofenac, codeine, indomethacin and propyphenazone) were assessed in a pilot-scale A2O system (including anaerobic/anoxic/aerobic zones), long term operated during two experimental phases using different sets of environmental conditions and operating parameters. qPCR was used to quantify the absolute abundances of total Bacteria, total Archaea, mycolic-acid containing filamentous Actinobacteria (Mycolata) and Fungi within the activated sludge microbial community developed in the system. Multivariate analyses and Spearman correlation coefficients were used in search of significant links among the removal rates of the AIAPs, the abundances of the targeted microbial groups in the activated sludge, and the changes of environmental/operating variables in the A2O system. Improved removal efficiencies of several of the AIAPs analyzed (acetaminophen, ibuprofen, naproxen, ketoprofen) were correlated to higher organic load in the influent water, higher concentration of mixed liquor suspended solids (MLSS), lower temperature and lower food-to-microorganisms ratio (F/M). Removal efficiencies of several pharmaceuticals correlated with increased abundances of Mycolata in the A2O system, pointing at this group of bacteria as candidate key players for AIAPs removal in activated sludge.

Surgical treatment in bone metastases in the appendicular skeleton. / Tratamiento quirúrgico de las metástasis óseas en el esqueleto apendicular.

INTRODUCTION: Metastatic bone disease is the most common neoplastic process that affects the skeletal system. Eighty percent of bone metastases come from carcinomas of the breast, lung, kidney, thyroid and prostate. The Katagiri scale enables an estimation of the survival of patients based on the presence or absence of visceral metastases, multiple bone metastases and functional status according to the ECOG scale. MATERIAL AND METHODS: A retrospective, descriptive and observational study conducted between March 1, 2013 and June 30, 2015. Thirty-two patients were studied with a diagnosis of metastatic bone disease and who had undergone some type of orthopaedic surgical treatment for pathological fracture or impending fracture. RESULTS: 28 cases (87.5%) presented pathological fracture and 4 cases (12.5%) impending fracture according to the Mirels score. Fifteen cases (46.875%) were treated by placing a central medullary nail + spacer in the long bone diaphysis, 15 cases (46.875%) with modular arthroplasties and 2 patients (6.25%) with forequarter amputation. Eleven patients (34.375%) died during the course of this study, all with a Katagiri greater than or equal to 4. DISCUSSION: The presence of a fracture in previously damaged territory is a catastrophic complication for most cancer patients. A clear understanding of the life expectancy of patients with bone metastases is of great help to prevent errors and failures in treatment.

[Primary sacral tumors: analysis of results and complications]. / Tumores primarios de sacro: análisis de resultados y complicaciones.

INTRODUCTION: Primary sacral tumors are rare, treatment in most cases is surgical with or without adjuvant radiotherapy; oncology and functional results are usually adverse with a high rate of complications. MATERIAL AND METHODS: We conducted a retrospective, analytical and observational studies that includes 22 cases treated between 2000 and 2017, analyzed their characteristics demographic, the type of treatment received, and the oncological, functional results and the rate of complications were analized. RESULTS: 22 patients were subjected to sacrectomy with posterior approah because of cordoma (13 patients), giant cell tumour (three patients) and other (six patients). Three total sacrectomies, 13 partial sacrectomies, two hemisacrectomies and four sacrectomies enlarged were performed. The mean surgical time was 229 minutes, with an average bleeding of 2,100 cm3, the average tumour size was 13.8 cm (6-30cm); 10 patients were presented with complications, eight by surgical site infection, one sacral hernia and one osteomyelitis. Overall survival was 44.4 months. CONCLUSIONS: Treatment of sacral tumors is complex, requires a multidisciplinary team; the oncological result is adequate when you get free margins of neoplasia, the functional results will be determined by the type of resection, and the rate of complications is high however is the best alternative healing in our hospital.

INTRODUCCIÓN: Los tumores primarios de sacro son poco frecuentes, el tratamiento en la mayoría de los casos es quirúrgico con o sin radioterapia adyuvante; los resultados oncológicos y funcionales suelen ser adversos con una tasa alta de complicaciones. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, analítico y observacional que incluye 22 casos tratados entre el 2000 y 2017, se analizaron sus características demográficas, el tipo de tratamiento en la recidiva y el resultado oncológico y funcional; asimismo, se analizó la tasa de complicaciones. RESULTADOS: 22 pacientes fueron sometidos a sacrectomía, con abordaje posterior por cordoma (13 pacientes), tumor de células gigantes (tres pacientes) y otros (seis pacientes). Se realizaron tres sacrectomías totales, 13 sacrectomías parciales, dos hemisacrectomías y cuatro sacrectomías ampliadas. La media de duración quirúrgica fue de 229 minutos, con un sangrado promedio de 2,100 cm3, el tamaño tumoral promedio fue de 13.8 cm (6-30 cm); presentaron complicaciones 10 pacientes, ocho por infección de sitio quirúrgico, uno por hernia sacra y uno por osteomielitis. La supervivencia global fue de 44.4 meses. DISCUSIÓN: El tratamiento de los tumores sacros es complejo y requiere un equipo multidisciplinario; el resultado oncológico es adecuado cuando se consiguen márgenes libres de neoplasia, los resultados funcionales estarán determinados por el tipo de resección y la tasa de complicaciones es alta; sin embargo, es la mejor alternativa de curación.

[Unusual presentation of pigmented villonodular synovitis of the hip joint: case report and review of the literature]. / Presentación atípica de sinovitis villonodular pigmentada de la articulación coxofemoral. Reporte de un caso y revisión de la literatura.

INTRODUCTION: Pigmented villonodular synovitis (PVNS) is a rare clinical entity with higher incidence in women (3:1) and an age of presentation between 20 and 40 years. The hip is a rare site of appearance, being involved in only 15% of all cases. CASE REPORT: 47-year-old male with 10 years of evolution characterized by a limited range of motion, pain associated with an increase in volume and shortening of the pelvic limb. Imaging studies showed destruction of the hip joint and extension to the pelvis. The histopathology report described pigmented villonodular synovitis. His final treatment was left hemipelvectomy. DISCUSSION: The presentation of the diffuse pigmented villonodular synovitis of the hip has a lower incidence and a locally aggressive behavior. It is necessary to consider differential diagnoses that include malignant neoplasms. The standard treatment is surgical.

INTRODUCCIÓN: La sinovitis villonodular pigmentada (SNVP) es una entidad clínica poco frecuente, con un incidencia mayor en las mujeres (3:1) y una edad de presentación entre los 20 y 40 años. La cadera es un sitio poco común de ocurrencia, estando involucrada en tan solo 15% de todos los casos. REPORTE DE CASO: Masculino de 47 años con cuadro de 10 años de evolución caracterizado por limitación de los arcos de movilidad, dolor asociado a aumento de volumen y acortamiento del miembro pélvico; los estudios de imagen mostraron destrucción de la articulación coxofemoral y extensión a la pelvis; el reporte histopatológico describió sinovitis villonodular pigmentada. Fue manejado con hemipelvectomía externa izquierda. DISCUSIÓN: La presentación de la sinovitis villonodular pigmentada difusa en la cadera tiene una incidencia baja y comportamiento localmente agresivo. Es necesario tener en cuenta diagnósticos diferenciales que incluyan neoplasias malignas. El estándar de tratamiento es quirúrgico.