Anatomical categorization of isolated non-focal dystonia: novel and existing patterns using a data-driven approach.

According to expert consensus, dystonia can be classified as focal, segmental, multifocal, and generalized, based on the affected body distribution. To provide an empirical and data-driven approach to categorizing these distributions, we used a data-driven clustering approach to compare frequency and co-occurrence rates of non-focal dystonia in pre-defined body regions using the Dystonia Coalition (DC) dataset. We analyzed 1,618 participants with isolated non-focal dystonia from the DC database. The analytic approach included construction of frequency tables, variable-wise analysis using hierarchical clustering and independent component analysis (ICA), and case-wise consensus hierarchical clustering to describe associations and clusters for dystonia affecting any combination of eighteen pre-defined body regions. Variable-wise hierarchical clustering demonstrated closest relationships between bilateral upper legs (distance = 0.40), upper and lower face (distance = 0.45), bilateral hands (distance = 0.53), and bilateral feet (distance = 0.53). ICA demonstrated clear grouping for the a) bilateral hands, b) neck, and c) upper and lower face. Case-wise consensus hierarchical clustering at k = 9 identified 3 major clusters. Major clusters consisted primarily of a) cervical dystonia with nearby regions, b) bilateral hand dystonia, and c) cranial dystonia. Our data-driven approach in a large dataset of isolated non-focal dystonia reinforces common segmental patterns in cranial and cervical regions. We observed unexpectedly strong associations between bilateral upper or lower limbs, which suggests that symmetric multifocal patterns may represent a previously underrecognized dystonia subtype.

A contrast set mining based approach for cancer subtype analysis.

The task of detecting common and unique characteristics among different cancer subtypes is an important focus of research that aims to improve personalized therapies. Unlike current approaches mainly based on predictive techniques, our study aims to improve the knowledge about the molecular mechanisms that descriptively led to cancer, thus not requiring previous knowledge to be validated. Here, we propose an approach based on contrast set mining to capture high-order relationships in cancer transcriptomic data. In this way, we were able to extract valuable insights from several cancer subtypes in the form of highly specific genetic relationships related to functional pathways affected by the disease. To this end, we have divided several cancer gene expression databases by the subtype associated with each sample to detect which gene groups are related to each cancer subtype. To demonstrate the potential and usefulness of the proposed approach we have extensively analysed RNA-Seq gene expression data from breast, kidney, and colon cancer subtypes. The possible role of the obtained genetic relationships was further evaluated through extensive literature research, while its prognosis was assessed via survival analysis, finding gene expression patterns related to survival in various cancer subtypes. Some gene associations were described in the literature as potential cancer biomarkers while other results have been not described yet and could be a starting point for future research.

Acetylene Storage and Separation Using Metal-Organic Frameworks with Open Metal Sites.

Efficient separation and storage of gas streams involving light hydrocarbons is essential for industrial applications. These hydrocarbons are widely used as energy resources and/or chemical raw materials in various chemical reactions. Here, we focus on the separation of acetylene from methane and carbon dioxide. The separation of acetylene from carbon dioxide is, in particular, challenging due to the similar kinetic diameters and boiling points of the molecules. In recent years, considerable progress has been made in adsorption-based separations using porous metal-organic frameworks (MOFs). Most reported studies are experimental. We present a computational study on these gas separations using a variety of MOFs. This allows investigation of the competitive gas adsorption, which is experimentally challenging, as well as understanding the adsorption mechanisms at the molecular level, which in turn allows further experimental MOF design for this application. MOFs with open metal sites, and particularly Fe-MOF-74, seem to be good for this separation, with a trade-off between physical adsorption capacity and selectivity. Based on experimental single-adsorption isotherms at various temperatures, we developed and validated a specific parameterization to account for the interactions of the olefin with the open metal sites. In addition to volumetric and calorimetric adsorption, we comprehensively investigate the characteristics of the interaction between the MOFs and the guest molecules in terms of binding sites and density profiles. The overall agreement of our simulated results with experimental data for pure components points to the reliability of the models and methods to successfully predict the separation of mixtures.

Evaluation of teratogenicity and genotoxicity induced by kramecyne (KACY).

Kramecyne (KACY), a polymer isolated from Krameria cytisoides Cav, has anti-inflammatory, anti-nociceptive, anti-arthritic and anti-ulcerogenic properties. As a part of standard preclinical safety tests, the present study sought to determine potential developmental toxicity (in female rats) and genotoxicity (in male mice) of KACY. Pregnant female rats were divided into six groups: the negative control (vehicle), the positive control (250 mg/kg of acetylsalicylic acid (ASA)), and four experimental groups (50, 250, 500 and 1000 mg/kg of KACY). To evaluate genotoxicity by in vivo micronuclei (MN) and sister chromatid exchange (SCE) tests, male mice were divided into five groups: the negative control (vehicle), the positive control (1.5 and 2.5 mg/kg of doxorubicin for MN and SCE, respectively), and three experimental groups (50, 500 and 1000 mg/kg of KACY). All treatments were administered by oral gavage. A slight maternal toxicity was evidenced by lower weight gain for rats receiving 500 and 1000 mg/kg of KACY, but no fetal malformations were found. However, there were less live fetuses/litter and greater post-implantation loss/litter at these two doses. Manifestations of developmental toxicity were limited to a higher rate of skeletal alterations. The MN tests did not evidence genotoxicity or cytotoxicity. KACY caused a slightly but significantly increased frequency of SCE. Although KACY-treated rats had skeletal alterations, these apparently were not caused by a mechanism of genotoxicity. Furthermore, the same administration in adult male mice did not produce genotoxicity. Hence, KACY herein proved to be safe for rats during the period of organogenesis.

Improving Olefin Purification Using Metal Organic Frameworks with Open Metal Sites.

The separation and purification of light hydrocarbons is challenging in the industry. Recently, a ZJNU-30 metal-organic framework (MOF) has been found to have the potential for adsorption-based separation of olefins and diolefins with four carbon atoms [H. M. Liu et al. Chem.-Eur. J. 2016, 22, 14988-14997]. Our study corroborates this finding but reveals Fe-MOF-74 as a more efficient candidate for the separation because of the open metal sites. We performed adsorption-based separation, transient breakthrough curves, and density functional theory calculations. This combination of techniques provides an extensive understanding of the studied system. Using this MOF, we propose a separation scheme to obtain a high-purity product.

Micelle Formation in Aqueous Solutions of Room Temperature Ionic Liquids: A Molecular Dynamics Study.

1-Alkyl-3-methylimidazolium cations in the presence of water are used as a test system to study by molecular dynamics the formation of micelles in aqueous mixtures of highly anisotropic room temperature ionic liquids (IL). Structural properties, i.e., radial distribution functions (RDF) and transport parameters, such as diffusion coefficients and conductivities, are computed as a function of the IL/water mole fraction. The concentration plots reveal a sharp change of the slope of both the cation self-diffusion coefficient and the first peak of the head-head RDF at approximately the same value of the concentration. This transition, considered as a measure of a critical micellar concentration, appears only for the most anisotropic systems, composed of longer alkyl chains. The formation of the micelles is confirmed from the analysis of the tail-tail and cation-water RDFs. As a general result, we found that the larger the anisotropy of the ionic liquid the lower the critical concentration and the larger the proportion of monomers forming part of the micelles. The molecular dynamics predictions are in line with the experimental evidence reported for these systems.

Liquid self-diffusion of H2O and DMF molecules in Co-MOF-74: molecular dynamics simulations and dielectric spectroscopy studies.

In this work we use molecular dynamics simulations to study the diffusion of N,N-dimethylformamide (DMF) and H2O as a function of temperature within the well-known metal-organic framework Co2(dobdc)·[G] (G = 2DMF·1H2O), also known as Co-MOF-74. The molecular dynamics simulations show that the diffusivity of guest molecules, which is almost negligible at low temperatures (T < 200 K), increases in the range of 200 < T (K) < 400 up to 3 and 4 orders of magnitude for DMF and H2O, respectively. This molecular diffusion can be easily detected by dielectric spectroscopy as it gives rise to extrinsic interfacial polarization effects that result in an apparent "colossal" dielectric constant at room temperature, εr' ∼ 42 000 (T = 300 K, ν = 10 Hz). Furthermore, the measured dielectric constant exhibits a thermal dependence similar to that of the diffusion coefficient, revealing the parallelism of the dielectric response and the molecular diffusion as a function of temperature. These results highlight: (a) the great utility of the fast and non-destructive dielectric and impedance spectroscopy techniques for the study and detection of the molecular transport of small polar molecules within porous metal-organic frameworks and related materials; (b) the peculiarity and uniqueness of MOF materials with "medium" size nanopores containing guest molecules as they are solid materials in which the guest molecules display a liquid state-like behaviour close to room temperature; and

Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology.

PURPOSE: To evaluate the accuracy of preoperative 3T multiparametric magnetic resonance imaging (3TmMRI) for local staging of prostate cancer and its influence on the decision to change the clinical target volume (CTV), total dose and hormonal therapy when treating prostate cancer patients with radiotherapy. METHODS: From 2009 to 2013, 150 patients, who had confirmed prostate cancer and underwent a 3TmMRI before treatment with radical prostatectomy or radical radiation therapy, were included. Radiation therapy treatment (CTV, total dose and hormonal therapy) was initially determined on the basis of the clinical information, and radiation therapy plan was reevaluated after 3TmMRI review. The value of preoperative 3TmMRI in local staging and in the decision of radiotherapy treatment according to NCCN risk classification was analyzed. RESULTS: 3TmMRI performed correct, over- and under staging in 78.7 % (37/47), 6.3 % (3/47), 14.8 % patients (7/47), respectively. 3TmMRI identified 6 cT2a, 7 cT2b, 28 cT2c, 3 cT3a, 3 cT3b tumors. At final pathology, 5 tumors were classified as pT2a, 5 as pT2b, 30 as pT2c, 4 as pT3a, 3 as pT3b. After reviewing the MRI reports, the initial radiotherapy and hormonal therapy plan was changed in 33.9 % patients (35/103). CONCLUSIONS: In our group of patients, 3TmMRI has been a reliable technique providing an optimal staging for prostate cancer. Its routine use could induce important changes in radiation therapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue.

Antimicrobial and anti-adhesive potential of a biosurfactant Rufisan produced by Candida lipolytica UCP 0988.

In the last years, researches developed with biosurfactants for application in the medical area have been revealing the promising biological activities of these biomolecules. In this work the antimicrobial and anti-adhesive properties of a biosurfactant Rufisan isolated from the yeast Candida lipolytica UCP 0988, growth in a medium supplemented with ground nut refinery residue was determined against several microorganisms. The biosurfactant was able to reduce the water surface tension from 70 to 25.3 mN/m and showed a critical micelle concentration (CMC) of 0.03%. The biosurfactant was isolated after 72 h of fermentation and was tested in concentrations varying from 0.75 to 12 mg/l. The highest antimicrobial activities were observed against Streptococcus agalactiae, Streptococcus mutans, Streptococcus mutans NS, Streptococcus mutans HG, Streptococcus sanguis 12, Streptococcus oralis J22 at a concentration superior to the biosurfactant critical micelle concentration. Moreover, the biosurfactant showed anti-adhesive activity against most of the microorganisms tested. As far as we know, this is the first compilation of data on antimicrobial and anti-adhesive activities of a biosurfactant obtained from a Candida strain against such a broad group of microorganisms. The results obtained in this work showed that the biosurfactant from C. lipolytica is a potential antimicrobial and/or anti-adhesive agent for several biomedical applications.

Effects of acute ethanol administration on methionine-enkephalin expression and release in regions of the rat brain.

The dopaminergic mesolimbic system plays a key role in mediating the reinforcing properties of ethanol and other drugs of abuse. Ethanol reinforcement and high alcohol drinking behaviour have been suggested to involve the ethanol-induced activation of endogenous opioid systems. Ethanol may alter opioidergic transmission at different levels, including opioid peptide biosynthesis and release, as well as binding to opioid receptors. The aim of this work was to investigate the effects of different ethanol doses on methionine-enkephalin (Met-enk) release from the rat nucleus accumbens (NAcc). Ethanol effects were also studied on Met-enk content in the NAcc, prefrontal cortex (PFC) and caudate-putamen (CP). Met-enk release was studied by microdialysis in Wistar anesthetized rats and peptide concentrations were quantitated by radioimmunoassay. Ethanol was administered by intraperitoneal injection after a 2-h basal release period. Ethanol doses of 0.5, 1 and 2.5 g/kg induced a 2.7-, 4.9- and 3.4-fold increase in Met-enk release from the NAcc. However, ethanol responses followed different kinetics, with earliest effects observed with the highest ethanol dose. In comparison, a 2.5-fold increase in peptide release was produced by 100 mM KCl. Ethanol, at a dose of 2.5 g/kg, induced a significant 66.7% decrease in Met-enk content in the NAcc, as well as a 76.4% reduction in peptide levels in the CP. Lower ethanol doses did not alter Met-enk content in these regions. On the other hand, an ethanol dose of 0.5 g/kg produced a non-significant decrease in Met-enk levels in the PFC. Our results suggest that ethanol-induced changes in enkephalin expression and release in regions of the mesocorticolimbic and nigrostriatal pathways could be involved in ethanol central effects. Released enkephalins by ethanol may modulate the dopaminergic activity of mesolimbic neurons and play a critical role in ethanol reinforcement mechanisms.

The Levels of Inflammatory Markers in the Treatment of Stroke study (LIMITS): inflammatory biomarkers as risk predictors after lacunar stroke.

BACKGROUND: Inflammation is increasingly recognised as playing a central role in atherosclerosis, and peripheral blood markers of inflammation have been associated with incident and recurrent cardiac events. The relationship of these potentially modifiable risk markers to prognosis after ischaemic stroke is less clear. The Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) study will address hypotheses related to the role of inflammatory markers in secondary stroke prevention in an efficient manner using the well-established framework of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (NCT00059306). METHODS: SPS3 is an ongoing Phase III multicentre secondary prevention trial focused on preventing recurrent stroke in patients with small vessel ischaemic stroke, or lacunes. In SPS3, patients are assigned in a factorial design to aspirin vs. aspirin plus clopidogrel, and to usual vs. aggressive blood pressure targets. The purpose of LIMITS is to determine whether serum levels of inflammatory markers - including high-sensitivity C-reactive protein, serum amyloid A, CD40 ligand, and monocyte chemoattractant protein-1 - predict recurrent stroke and other vascular events among lacunar stroke patients. The project will also determine whether these markers predict which people will respond best to dual antiplatelet therapy with clopidogrel and aspirin, as well the relationship to cognitive function. ANALYSIS: plan Multivariable Cox proportional hazard regression modeling will be used to estimate hazard ratios for the effect of marker levels on risk of recurrent stroke and other outcomes after adjusting for additional potential risk factors, including age, gender, ethnicity, treatment arm, and traditional stroke risk factors. Interactions between marker levels and treatment assignment for both arms of the SPS3 study will be assessed. Observations will be censored at the time of last follow-up visit. CONCLUSIONS: LIMITS represents an efficient approach to the identification of novel inflammatory biomarkers for use in risk prediction and treatment selection in patients with small vessel disease.

Glycerol as substrate for the production of biosurfactant by Pseudomonas aeruginosa UCP0992.

In this work the influence of the carbon source concentration, of the type and concentration of the nitrogen source and of the cultivation conditions (temperature, aeration and agitation speed) in mineral medium formulated with glycerol was studied for biosurfactant production by Pseudomonas aeruginosa UCP0992. The kinetics of microorganism growth and biosurfactant production have been described for the medium supplemented with 3% glycerol and 0.6% NaNO(3), at 28 degrees C during 120 h under 200 rpm, showing a growth-associated production. The isolated biosurfactant corresponded to a concentration of 8.0 g/l after 96 h. The medium surface tension was reduced to 27.4 mN/m and the emulsification index of hexadecane reached 75-80% after 72 h. A CMC of 700 mg/l and an interfacial tension against hexadecane of 2 mN/m were obtained. The biosurfactant showed stability when submitted at 90 degrees C during 2 h, and thermal (4-120 degrees C) and pH (4-12) stability regarding the surface tension reduction and the emulsification capacity of vegetable oils and hydrocarbons, and tolerance under high salt concentrations (2-10%). The biosurfactant was characterized as a group of rhamnolipids with anionic nature. The crude biosurfactant did not show toxicity against the microcrustacean Artemia salina and the cabbage (Brassica oleracea), while the isolated biosurfactant showed toxicity against the microcrustacean at the CMC. The application of the biosurfactant in diesel recovery from sand was demonstrated by removal percentiles above 85%. The results obtained in this work are noteworthy for possible biosurfactant production from glycerol with potential of application in the environment.

Patrón y calidad subjetiva de sueño en médicos residentes y su relación con ansiedad y depresión / Sleep pattern and perception of sleep quality among medical residents and the relation to anxiety and depression

Objetivos: Determinar el patrón y la calidad de sueño predominante en médicos residentes de diferentes especialidades de un hospital regional, así como su relación con distintas variables especialmente con ansiedad, depresión y el consumo de sustancias. Métodos: Estudio observacional del tipo transversal en el que se aplicaron a médicos residentes los siguientes instrumentos: “Índice de calidad del sueño de Pittsburgh”, “Cuestionario para evaluar el consumo de sustancias” y “Escala de ansiedad y depresión de Goldberg”. También se recogió la edad, sexo, grado académico, especialidad, patrón de sueño, guardias realizadas, y trabajos y actividades familiares o sociales ajenas a la residencia. Se estudió si alguna variable se asociaba con un patrón corto de sueño o con una calidad mala-muy mala del mismo. Resultados: Participaron el 91,8% de los residentes de las especialidades de urgencias, anestesiología, cirugía, pediatría y medicina interna. La edad fue de 25,6 ± 2,6 años y el 53,6% eran varones. Tanto el patrón como la calidad del sueño se deterioraron significativamente tras iniciar la residencia (p < 0,001), donde el patrón fue corto en el 75,0% de los casos y la calidad mala-muy mala en el 32,2%. El 87,5% consumían café, el 51,8% bebidas alcohólicas, el 37,5% cigarrillos, el 46,4% mostraron rasgos de ansiedad y el 37,5% de depresión. Se encontró asociación significativa de los patrones de sueño corto y especialidad de urgencias (..) (AU)

Objectives: To determine the prevailing sleep pattern and perception of sleep quality among medical residents indifferent specialties at a regional hospital and to explore their relation with several variables, especially with anxiety, depression, and psychoactive substance use on the other. Methods: Cross-sectional observational survey of medical residents in Regional Hospital 25. The subjects gave their informed consent to participation. The instruments used were the Pittsburgh sleep quality index, a questionnaire on use of psychoactive substances, and the Goldberg anxiety and depression scale. Other variables explored were age, gender, year of residency training, specialty, sleep pattern, number of on-call days, outside work, and family or social obligations, and their relationship with the sleep pattern and quality. Results: In the specialties of emergency medicine, anesthesiology, surgery, pediatrics and internal medicine, a total of 91.80% of the residents participated. The mean (SD) age was 25.6 (2.6) years; 53.6% of the respondents were men. Sleep pattern and quality significantly worsened after residence sterting (p < 0.001), when short sleep pattern was present in 75.0% of residents and poor or very poor quality in 32,2%. Routine coffee drinking was reported by 87.5%,and 51.8% drank alcoholic beverages regularly; 37.5% were smokers. Signs of anxiety were detected in 46.4% and depression in 37.5%. A significant (AU)

High-sensitivity C-reactive protein predicts mortality but not stroke: the Northern Manhattan Study.

OBJECTIVE: To determine whether high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) predict stroke, vascular events, and mortality in a prospective cohort study. BACKGROUND: Markers of inflammation have been associated with risk of myocardial infarction (MI). Their association with stroke is controversial. METHODS: The Northern Manhattan Study includes a stroke-free community-based cohort study in participants aged > or =40 years (median follow-up 7.9 years). hsCRP and SAA were measured using nephelometry. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of markers with risk of ischemic stroke and other outcomes after adjusting for demographics and risk factors. RESULTS: hsCRP measurements were available in 2,240 participants (mean age 68.9 +/- 10.1 years; 64.2% women; 18.8% white, 23.5% black, and 55.1% Hispanic). The median hsCRP was 2.5 mg/L. Compared with those with hsCRP <1 mg/L, those with hsCRP >3 mg/L were at increased risk of ischemic stroke in a model adjusted for demographics (HR = 1.60, 95% CI 1.06-2.41), but the effect was attenuated after adjusting for other risk factors (adjusted HR = 1.20, 95% CI 0.78-1.86). hsCRP >3 mg/L was associated with risk of MI (adjusted HR = 1.70, 95% CI 1.04-2.77) and death (adjusted HR = 1.55, 95% CI 1.23-1.96). SAA was not associated with stroke risk. CONCLUSION: In this multiethnic cohort, high-sensitivity C-reactive protein (hsCRP) was not associated with ischemic stroke, but was modestly associated with myocardial infarction and mortality. The value of hsCRP and serum amyloid A may depend on population characteristics such as age and other risk factors.

Aggregation behavior of western spotted cucumber beetle (Coleoptera: Chrysomelidae) in vegetable cropping systems.

Aggregation behavior of adult western spotted cucumber beetles (Diabrotica undecimpunctata undecimpunctata Mannerheim) (Coleoptera: Chrysomelidae) was examined in six snap bean (Phaseolus vulgaris) fields adjacent to corn fields in western Oregon in 2004-2006. In the 2004 and 2005 studies, sweep net sampling was used to estimate beetle numbers along transect lines running perpendicular to the edges of the bean fields next to sweet corn fields. Beetles were collected from the fields and dissected to determine sex and egg development. Beetles were highly aggregated along the edge of the snap bean field next to the sweet corn, with the highest number of beetles occurring within the first meter next to the edge. Beetles in the aggregation areas were mostly females (average female to male ratio of 8.4 to 1), whereas beetles in the field section away from the edges were mostly male (female to male ratio of 0.6 to 1). Of the females collected in the aggregation areas, an average of 53% contained developing or fully developed eggs. In the 2006 study, beetle densities in the field edges were compared with densities within the fields in 40 bean fields with adjacent corn fields. Linear regression analysis showed that, across fields, nearly two times as many beetles were found in the field borders as in the rest of the field. These data suggest modifying traditional field scouting protocol to include field margins when a bean field is adjacent to or near a sweet corn field. A pest management strategy of only spraying the edges of bean fields containing beetle aggregations shows potential for significant pesticide reduction, as well as reducing risk of economic loss from crops harvested from the highly aggregated areas.

First report of chikungunya from the Maldives.

An outbreak, characterised by fever, arthralgia and myalgia, in Malé and other islands of the Maldives began in December 2006. The illness was suspected as being due to chikungunya virus based on clinical symptoms and the prevailing chikungunya epidemic in the Indian Ocean region. The Department of Public Health initiated an investigation and collected blood samples from 67 patients; 21% were IgM-positive for chikungunya and 96% were PCR-positive. Six percent were positive for dengue by enzyme immunosorbent assay and 4% had evidence of dual infection. This is the first time that chikungunya fever has been confirmed in the Maldives. A total of 11,879 suspected and confirmed cases affecting 61% of inhabited islands (attack rate ranging from 0% to 72% on individual islands) were reported by the end of the epidemic in April 2007.

[Primary testicular lymphoma. Report of a new case and review of the literature]. / Linfoma testicular primario. Aportación de un nuevo caso y revisión de la literatura.

Primary testicular lymphoma is an uncommon testicular tumour that accounts for no more than 9% of all testicular tumours in those series with higher incidence; testicular lymphoma as haematopoietic tumours are also rare accounting for just 1% of all lymphomas; but due to their highly malignant histopathology they may become highly aggressive tumours. Patient age at presentation is over 60 years old which makes it the most frequent tumour for this age group. There is no standard protocol to treat this malignancy due to lack of extensive series. We contribute one case and make a literature review discussing the current therapeutic trends for this disease.

Linfoma testicular primario. Aportación de un nuevo caso y revisión de la literatura / Primary testicular lymphoma. Contribution of one case and literature review

El linfoma testicular primario es un tumor testicular infrecuente, suponiendo no más del 9 por ciento de los tumores testiculares en las series con mayor incidencia; a su vez el linfoma testicular como tumor hematopoyético es infrecuente, con una incidencia del 1 por ciento de los linfomas, pero debido a su histopatología en la mayoría de los casos de alta malignidad, les hace ser de los tumores testiculares más agresivos. La edad de aparición es por encima de los 60 años, convirtiéndose en el tumor más frecuente para este grupo de edad. La falta de series amplias, hace que no exista un protocolo establecido para el tratamiento de esta patología. Presentamos un nuevo caso, realizando revisión de la bibliografía presentando las tendencias terapéuticas actuales para este tipo de patología (AU)

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