Trichiasis removal using dermatological punch: A case report.

Entropion, a common malposition of the eyelid, can lead to trichiasis and corneal damage. This article presents a clinical case in which, following initial surgery to correct entropion, the use of a dermatological punch was chosen to definitively eliminate persistent trichiasis. This relatively unknown yet effective approach proved to be a quick and straightforward alternative with positive outcomes, emphasizing the importance of considering innovative approaches to recurrent challenges in clinical practice.

Identification of new variants and candidate genes in women with familial premature ovarian insufficiency using whole-exome sequencing.

PURPOSE: To identify candidate variants in genes possibly associated with premature ovarian insufficiency (POI). METHODS: Fourteen women, from 7 families, affected by idiopathic POI were included. Additionally, 98 oocyte donors of the same ethnicity were enrolled as a control group. Whole-exome sequencing (WES) was performed in 14 women with POI to identify possibly pathogenic variants in genes potentially associated with the ovarian function. The candidate genes selected in POI patients were analysed within the exome results of oocyte donors. RESULTS: After the variant filtering in the WES analysis of 7 POI families, 23 possibly damaging genetic variants were identified in 22 genes related to POI or linked to ovarian physiology. All variants were heterozygous and five of the seven families carried two or more variants in different genes. We have described genes that have never been associated to POI pathology; however, they are involved in important biological processes for ovarian function. In the 98 oocyte donors of the control group, we found no potentially pathogenic variants among the 22 candidate genes. CONCLUSION: WES has previously shown as an efficient tool to identify causative genes for ovarian failure. Although some studies have focused on it, and many genes are identified, this study proposes new candidate genes and variants, having potentially moderate/strong functional effects, associated with POI, and argues for a polygenic etiology of POI in some cases.

Efectos de la inhalación de vanadio sobre las espermatogonias y calidad seminal en el modelo de ratón in vivo / Effect of vanadium inhalation on spermatogonia and seminal quality in vivo mouse model

El vanadio es un metal de transición que en las últimasdécadas se convirtió en un contaminante ambiental, producto de laquema de los combustibles fósiles. La alteración de los distintosparámetros espermáticos y daño a ADN en células gaméticas se asociacon el aumento de la contaminación ambiental, la interacción con lasespermatogonias probablemente explique estos efectos, debido a queuno de los órganos blancos del vanadio, es el testículo. El objetivo delestudio fue analizar los efectos citostático y citotóxico sobre lasespermatogonias y espermatozoides de ratones tratados de forma agudapor vía aérea con pentóxido de vanadio (V2O5), en distintasconcentraciones (0.0, 0.02, 0.04 y 0.08 M). Consistió en evaluar lasproporciones de los diferentes tipos de espermatogonias A0(Indiferenciadas), en Renovación y, diferenciadas (Tipo B) en elmodelo de ratón in vivo. Y la estimación de los valores de densidad ymorfología espermáticas, para establecer la calidad seminal. Losresultados muestran que la exposición a V2O5 aumenta la proliferaciónde las espermatogonias en Renovación, y las B disminuyen, en la dosisalta; la densidad espermática y la morfología normal disminuyeronsignificativamente (p<0.05), en todos los grupos tratados. Lasmodificaciones significativas en las proporciones de lasespermatogonias, explica el efecto del vanadio y su asociación conmala calidad seminal (efectos toxico-reproductivos). Por lo tanto, seconcluye que la exposición aguda a vanadio por vía aérea de ratones,es capaz de generar efectos citostáticos y citotóxicos sobre lasespermatogonias y los espermatozoides, respectivamente. (AU)

The Vanadium is a transition metal that in the last decades has becomean environmental pollutant, product of the burning of fossil fuels. Thealteration of the different sperm parameters and damage to DNA ingametic cells has been associated with the increase of environmentcontamination, in animals reprotoxic effects have been described, thereare some reports that describe how vanadium produces these effects,the interaction with spermatogonia could be a possibility to relate theseeffects, because one of the white organs of vanadium is the testicle. Theobjective of this study was to analyze the cytostatic and cytotoxiceffects on spermatogonias and spermatozoa of mice treated acutely byair with vanadium pentoxide (V2O5) in different concentrations (0.0,0.02, 0.04 and 0.08M). It consisted in evaluating the changes in theproportions of the different types of spermatogonia A0(Undifferentiated), Renewal and Differentiated (Type B) in a mousemodel in vivo, and in the estimation of the parameters of density andsperm morphology, to establish seminal quality. The results show thatthe exposure to vanadium 5+, increases the proliferation ofspermatogonia renewal, and type B ones decrease in the high dose;sperm density and normal morphology decreased significantly (p<0.05) in all groups treated. The change in spermatogonial proportionscould explain the effect of vanadium and its association with poorseminal quality (reprotoxic effect). Acute exposure to vanadium by airof mice is capable of generating cytostatic and cytotoxic effects onspermatogonial and spermatozoa, respectively (AU)

Role of adjuvant radiotherapy in atypical (WHO grade II) and anaplastic (WHO grade III) meningiomas: a systematic review

The systematic adoption of the histopathologic criteria provided by the 2016 update of the WHO classification of brain tumors has markedly increased the relative proportion of atypical and anaplastic meningiomas. These tumors exhibit a much greater recurrence rate compared to benign meningiomas, which negatively impacts survival. In recent years, the publication of numerous retrospective case series, yet no randomized controlled trials, on the impact of radiation therapy in non-benign meningioma, has yielded conflicting evidence. At present, maximum safe resection, including the dural attachment, is the preferred primary treatment modality for all types of meningiomas. Adjuvant radiotherapy is currently recommended for subtotally resected grade II and for all grade III meningiomas. However, in grade II meningiomas achieving complete resection, close radiologic and clinical observation is a feasible option. Despite the great amount of non-benign meningiomas available and eligible for trials, there is a striking lack of prospective studies testing adjuvant therapies against observation for this subset of patients. An updated and systematic literature review is provided on the effectiveness and indications of radiotherapy on grade II and III meningiomas (AU)

Role of adjuvant radiotherapy in atypical (WHO grade II) and anaplastic (WHO grade III) meningiomas: a systematic review.

The systematic adoption of the histopathologic criteria provided by the 2016 update of the WHO classification of brain tumors has markedly increased the relative proportion of atypical and anaplastic meningiomas. These tumors exhibit a much greater recurrence rate compared to benign meningiomas, which negatively impacts survival. In recent years, the publication of numerous retrospective case series, yet no randomized controlled trials, on the impact of radiation therapy in non-benign meningioma, has yielded conflicting evidence. At present, maximum safe resection, including the dural attachment, is the preferred primary treatment modality for all types of meningiomas. Adjuvant radiotherapy is currently recommended for subtotally resected grade II and for all grade III meningiomas. However, in grade II meningiomas achieving complete resection, close radiologic and clinical observation is a feasible option. Despite the great amount of non-benign meningiomas available and eligible for trials, there is a striking lack of prospective studies testing adjuvant therapies against observation for this subset of patients. An updated and systematic literature review is provided on the effectiveness and indications of radiotherapy on grade II and III meningiomas.

Cirugía de la patología de la arteria vertebral. Revisión / Surgery of the pathology of the vertebral artery. Revision

Se realiza una revisión sobre la patología de la arteria vertebral, valorando las repercusiones que su oclusión parcial o total desarrolla. Se analiza la clínica que ocasiona este tipo de patología a la vez que se valoran los medios diagnósticos para la detección dela lesión oclusiva. Se discuten las diferentes estrategias y procedimientos terapéuticos en los pacientes portadores de esta patología y se valoran los diferentes datos aportados en la bibliografía y que corresponden a los estudios más importantes que se han realizado. Este tipo de afección se muestra como una patología con dificultades para su detección y con unas indicaciones terapéuticas quirúrgicas muy discutibles cuando se aplican con una no muy clara evidencia científica de la pertinencia de su realización. (AU)

A review is carried out on the pathology of the vertebral artery, assessing the repercussions that its partial or total occlusion develops. The symptoms that cause this type of pathology are analyzed at the same time as the diagnostic means for detecting theocclusive lesion are evaluated. The different strategies and therapeutic procedures in patients with this pathology are discussed andthe different data provided in the bibliography and corresponding to the most important studies that have been carried out are valued. This type of condition is shown as a pathology with difficulties in its detection and with highly debatable surgical therapeuticindications when applied with not very clear scientific evidence of the relevance of its performance. (AU)

Saturn-ring proton backlighters for the National Ignition Facility.

Proton radiography is a well-established technique for measuring electromagnetic fields in high-energy-density plasmas. Fusion reactions producing monoenergetic particles, such as D3He, are commonly used as a source, produced by a capsule implosion. Using smaller capsules for radiography applications is advantageous as the source size decreases, but on the National Ignition Facility (NIF), this can introduce complications from increasing blow-by light, since the phase plate focal spot size is much larger than the capsules. We report a demonstration of backlighter targets where a "Saturn" ring is placed around the capsule to block this light. The nuclear performance of the backlighters is unperturbed by the addition of a ring. We also test a ring with an equatorial cutout, which severely affects the proton emission and is not viable for radiography applications. These results demonstrate the general viability of Saturn ring backlighter targets for use on the NIF.

Sociodemographic factors affecting the comprehension of clinical information by inpatients undergoing trauma surgery. / Determinantes sociodemográficos de la comprensión de la información clínica en pacientes hospitalizados intervenidos de cirugía traumatológica.

INTRODUCTION: The clinical information process is the basis of the doctor-patient relationship. It starts with the information provided before signing informed consent and ends on the termination of the doctor-patient relationship. The influence of demographic variables in the information process has not been thoroughly studied for inpatients undergoing surgery. In this study we aim to answer two questions: 1) Does gender have an influence on the information process for these patients? 2) Are there other factors that affect the process? METHOD: A prospective study carried out using an 'ad hoc' designed survey on a 200-inpatient sample after undergoing surgery in the trauma and orthopaedics department of our hospital. Sampling was simple random. RESULTS: We found differences in the consistency of the answers by gender in the question regarding surgical priority, with the women having a better understanding of it (p=.04). The rest of the questions show no differences by gender. However, in the population analyzed, age and educational level are the main modifiers of understanding, and they are both related to gender (p<.0001; p=.003, respectively). CONCLUSIONS: In clinical practice, it is fundamental to keep in mind the factors that affect the information process. According to our results, the factors that define greater vulnerability in relation to the information process are age and low educational level.

Central nervous system ependymoma: clinical implications of the new molecular classification, treatment guidelines and controversial issues.

Ependymoma is an uncommon neuroepithelial tumor that may arise anywhere within the neuroaxis, both in children and in adults. It has been classically graded upon histopathological features, yet with limited clinical utility. Recently, DNA methylation profiling has provided a novel classification of ependymoma in nine molecular subgroups. This stratification method harbors prognostic value with supratentorial RELA-fusion and posterior fossa group A tumors showing a significantly shorter survival compared to the rest. Currently, the treatment of choice involves maximal safe resection and, in cases of residual disease, adjuvant conformal radiotherapy. Second-look surgery is also a feasible and recommended option for incompletely resected tumors. The role of chemotherapy is not yet established and can be considered in infants and children with relapsing disease or prior to re-intervention. Although targeted agents do not seem to play a role as adjuvant therapy, they are currently being tested for recurrent disease.

Developing a high-flux, high-energy continuum backlighter for extended x-ray absorption fine structure measurements at the National Ignition Facility.

Extended X-ray absorption fine structure (EXAFS) spectroscopy is a powerful tool for in situ characterization of matter in the high energy density regime. An EXAFS platform is currently being developed on the National Ignition Facility. Development of a suitable X-ray backlighter involves minimizing the temporal duration and source size while maximizing spectral smoothness and brightness. One approach involves imploding a spherical shell, which generates a high-flux X-ray flash at stagnation. We present results from a series of experiments comparing the X-ray source properties produced by imploded empty and Ar-filled capsules.

Genotoxicity in Brazilian coal miners and its associated factors.

The present study aims to evaluate the potential genotoxic and associated factors among coal miners, divided by degree of exposure. Blood and buccal smears were collected from 158 workers, who actively participate in different activities in coal mining, and 48 individuals living in the same city but do not have participation in coal mining activities (control group). The workers were divided into three different groups, according to the level of contact with coal extraction. A questionnaire intended to identify factors associated with DNA damage was performed in participants. The results regarding oral mucosa micronucleus test showed a significant difference ( p < 0.001) of the worker groups 1 and 2 in relation to the control group, where the group 1 has a higher degree of exposure to coal than group 2. For the lymphocyte micronucleus test and comet assay, there was no significant difference between the exposed groups and control group. There is an association between the outcome and the fact of living in the municipality of the mining company and the exposure to radiation in the last 12 months. Besides, the multivariate analysis showed an association of the tail moment with radiation exposure in the last 12 months. Thus, the findings of this study reveal genotoxicity in oral mucosa cells of workers exposed to coal and that workers with higher degree of contact with coal have a more pronounced response.

Treatment-related changes in glioblastoma: a review on the controversies in response assessment criteria and the concepts of true progression, pseudoprogression, pseudoresponse and radionecrosis.

The assessment of response to therapy in glioblastoma remains a challenge, because the surrogate measures of survival are subject to radiographic misinterpretation. A solid and reliable definition of progression is needed for both clinical decision-making and for evaluating response within the clinical trials. Historically, assessment criteria have used radiologic and clinical features aimed to correctly classify patients into progressive or non-progressive disease. The widely used RANO criteria are a valuable tool in disease evaluation, both in the clinical setting and in the clinical trials. However, assessment criteria have certain limitations that emerging image techniques have tried to overcome. Differentiating true progression from treatment-related changes (like pseudoprogression or pseudoresponse) is crucial in order not to prematurely discontinue adjuvant chemotherapy or redirect the patient to second-line options. This fact underscores the need for advanced radiologic techniques, like specific diffusion and perfusion MRI sequences, MR spectroscopy and PET, which seem to play a role in distinguishing these phenomena.

Capsule implosions for continuum x-ray backlighting of opacity samples at the National Ignition Facility.

Direct drive implosions of plastic capsules have been performed at the National Ignition Facility to provide a broad-spectrum (500-2000 eV) X-ray continuum source for X-ray transmission spectroscopy. The source was developed for the high-temperature plasma opacity experimental platform. Initial experiments using 2.0 mm diameter polyalpha-methyl styrene capsules with ∼20 µm thickness have been performed. X-ray yields of up to ∼1 kJ/sr have been measured using the Dante multichannel diode array. The backlighter source size was measured to be ∼100 µm FWHM, with ∼350 ps pulse duration during the peak emission stage. Results are used to simulate transmission spectra for a hypothetical iron opacity sample at 150 eV, enabling the derivation of photometrics requirements for future opacity experiments.

X-ray source development for EXAFS measurements on the National Ignition Facility.

Extended X-ray absorption Fine Structure (EXAFS) measurements require a bright, spectrally smooth, and broad-band x-ray source. In a laser facility, such an x-ray source can be generated by a laser-driven capsule implosion. In order to optimize the x-ray emission, different capsule types and laser irradiations have been tested at the National Ignition Facility (NIF). A crystal spectrometer is used to disperse the x-rays and high efficiency image plate detectors are used to measure the absorption spectra in transmission geometry. EXAFS measurements at the K-edge of iron at ambient conditions have been obtained for the first time on the NIF laser, and the requirements for optimization have been established.

Diffuse low-grade glioma: a review on the new molecular classification, natural history and current management strategies.

The management of diffuse supratentorial WHO grade II glioma remains a challenge because of the infiltrative nature of the tumor, which precludes curative therapy after total or even supratotal resection. When possible, functional-guided resection is the preferred initial treatment. Total and subtotal resections correlate with increased overall survival. High-risk patients (age >40, partial resection), especially IDH-mutated and 1p19q-codeleted oligodendroglial lesions, benefit from surgery plus adjuvant chemoradiation. Under the new 2016 WHO brain tumor classification, which now incorporates molecular parameters, all diffusely infiltrating gliomas are grouped together since they share specific genetic mutations and prognostic factors. Although low-grade gliomas cannot be regarded as benign tumors, large observational studies have shown that median survival can actually be doubled if an early, aggressive, multi-stage and personalized therapy is applied, as compared to prior wait-and-see policy series. Patients need an honest long-term therapeutic strategy that should ideally anticipate neurological, cognitive and histopathologic worsening.

Survival in glioblastoma: a review on the impact of treatment modalities.

Glioblastoma (GBM) is the most common and lethal tumor of the central nervous system. The natural history of treated GBM remains very poor with 5-year survival rates of 5 %. Survival has not significantly improved over the last decades. Currently, the best that can be offered is a modest 14-month overall median survival in patients undergoing maximum safe resection plus adjuvant chemoradiotherapy. Prognostic factors involved in survival include age, performance status, grade, specific markers (MGMT methylation, mutation of IDH1, IDH2 or TERT, 1p19q codeletion, overexpression of EGFR, etc.) and, likely, the extent of resection. Certain adjuncts to surgery, especially cortical mapping and 5-ALA fluorescence, favor higher rates of gross total resection with apparent positive impact on survival. Recurrent tumors can be offered re-intervention, participation in clinical trials, anti-angiogenic agent or local electric field therapy, without an evident impact on survival. Molecular-targeted therapies, immunotherapy and gene therapy are promising tools currently under research.

Note: A monoenergetic proton backlighter for the National Ignition Facility.

A monoenergetic, isotropic proton source suitable for proton radiography applications has been demonstrated at the National Ignition Facility (NIF). A deuterium and helium-3 gas-filled glass capsule was imploded with 39 kJ of laser energy from 24 of NIF's 192 beams. Spectral, spatial, and temporal measurements of the 15-MeV proton product of the (3)He(d,p)(4)He nuclear reaction reveal a bright (10(10) protons/sphere), monoenergetic (ΔE/E = 4%) spectrum with a compact size (80 µm) and isotropic emission (∼13% proton fluence variation and <0.4% mean energy variation). Simultaneous measurements of products produced by the D(d,p)T and D(d,n)(3)He reactions also show 2 × 10(10) isotropically distributed 3-MeV protons.

Immunotherapy in prostate cancer: review of the current evidence.

Prostate cancer is the most common male malignancy in the Western world. Once it metastasizes, it is incurable. The current gold standard for metastatic disease is the combined docetaxel/prednisone regimen. Prostate cancer shows several characteristics that make it a suitable candidate for immunotherapy, as recently exemplified by the approval of sipuleucel-T, the first vaccine to treat any malignancy. Here, we review different tumor-associated antigen immunotherapy strategies currently being investigated, from a humanized radiolabeled monoclonal antibody (J-591) that targets radiation into tumor cells, moving on to vaccines and through to immunomodulator agents such as anti-CPLA-4 and anti-PD-1 monoclonal antibodies that activate T-cell responses via immune checkpoint inhibition. We explore different opinions on the best approach to integrate immunotherapy into existing standard therapies, such as androgen-deprivation therapy, radiotherapy or chemotherapy, and review different combination sequences, patient types and time points during the course of the disease to achieve a lasting immune response. We present data from recent phase III clinical trials that call for a change in trial endpoint design with immunotherapy agents, from the traditional tumor progression to overall survival and how such trials should include immune response measurements as secondary or intermediate endpoints to help identify patient clinical benefit in the earlier phases of treatment. Finally, we join in the recent questioning on the validity of RECIST criteria to measure response to immunotherapeutic agents, as initial increases in the size of tumors/lymph nodes, which are part of a normal immune response, could be categorized as disease progression under RECIST.

Baseline micronuclei and nuclear abnormalities frequencies in native fishes from the Paraná River (Argentina).

This work aims to establish baseline frequencies of micronuclei (MN) and nuclear abnormalities (NA) in native fish species collected in situ from the Paraná River. For this purpose, the micronucleus test was applied in peripheral blood erythrocytes from specimens obtained from samplings collected at two localities (Posadas and Candelaria, Misiones, Argentina) during the period 2007-2010. The results were statistically analyzed using the Kruskal Wallis test. Data from nine fish species were obtained, among which Steindachnerina brevipinna (Characiformes) revealed the highest baseline frequency of MN and NA, showing statistically significant differences with regard to the other analyzed species. These results are the first report of baseline MN and NA frequencies for native fish species studied and could be useful for future comparisons with data of fishes belonging to other environments.

Toxicity and adherence to treatment for latent tuberculosis infection in patients with hematologic malignancies.

PURPOSE: Oncohematological patients undergoing chemotherapy who have latent tuberculosis infection (LTBI) are at a high risk of developing active tuberculosis (TB). The identification and treatment of these patients can prevent LTBI progressing to active TB. This study analyzed the degree of adherence with and safety of the treatment of latent tuberculosis infection (TLTBI) in oncohematological patients undergoing antineoplastic chemotherapy. METHODS: This is a retrospective study of a cohort of oncohematological patients receiving TLTBI and antineoplastic chemotherapy simultaneously, between January 2007 and June 2010. The proportions of toxicity and adherence to TLTBI in these patients were compared with a non-oncohematological control group, matched for age, sex, and year in which the TLTBI was started. In addition, a minimum 2-year follow-up was carried out for all patients. RESULTS: A total of 105 patients who received TLTBI were included, 21 of whom had received antineoplastic chemotherapy simultaneously. The mean age of the patients was 63 years. There were no significant baseline differences in transaminase values. The percentages of patients completing treatment were 76.2% in the control group and 71.4% in the oncohematological group [risk ratio (RR): 1.07, 95% confidence interval (CI): 0.79-1.43]. The voluntary dropout proportion was similar in both groups (12.3 vs. 11.8%, RR: 1.05, 95% CI: 0.25-4.42). Treatment was discontinued because of toxicity in three oncohematological patients and in 11 patients from the control group (RR: 1.14; 95% CI: 035-3.66). No patient developed TB during the follow-up period. CONCLUSION: The safety of TLTBI is not influenced by simultaneous antineoplastic chemotherapy in oncohematological patients.