Role of weight lost in breast cancer-related lymph / Importancia de la pérdida de peso en el linfedema secundario a cáncer de mama

Objective: Analysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients. Methods: Analysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits. Results: Although the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [−50 (−248 to 141) ml vs. 130 (−148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes. Conclusions: Apart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus – right from the start – on weight management or weight-loss in obese patients.(AU)

Objetivo: Analizar los datos recopilados en la práctica clínica rutinaria sobre el impacto combinado de la actividad física y la reducción del índice de masa corporal (IMC) en la reducción de la prevalencia de linfedema secundario a cáncer de mama (BCRL). Métodos: Análisis de los datos obtenidos por la unidad de rehabilitación especializada, de 99 pacientes durante 18 meses, tras prescribirse una dieta específica, un programa deportivo y una terapia descongestiva completa (TDC). En las visitas de seguimiento se recopilaron datos personales, volumen del órgano afectado, peso, nivel de actividad física y FACT-B+4 (Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer). Resultados: Aunque el índice de masa corporal medio no reflejó cambios durante el periodo de evaluación, cerca del 13% de las pacientes habían perdido peso en la segunda semana de seguimiento, incrementándose este porcentaje al 30% en la tercera semana. Las mujeres que experimentaron pérdida de peso durante la tercera visita de seguimiento presentaron una reducción del volumen del órgano afectado [-50 (-248-141)ml vs. 130 (-148-355)ml, p<0,05] en comparación con las pacientes que habían ganado peso. No se estableció relación alguna entre la actividad física y los cambios de volumen de linfedema. Conclusiones: Aparte del tratamiento convencional con ortésicos y drenaje linfático manual, la prevención y tratamiento de BCRL debe centrarse, desde el inicio, en la gestión del peso o la pérdida de peso en las pacientes obesas.(AU)

Role of weight lost in breast cancer-related lymph.

OBJECTIVE: Analysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients. METHODS: Analysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits. RESULTS: Although the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [-50 (-248 to 141) ml vs. 130 (-148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes. CONCLUSIONS: Apart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus - right from the start - on weight management or weight-loss in obese patients.

Lithium salts as a treatment for COVID-19: Pre-clinical outcomes.

INTRODUCTION: Identifying effective drugs for Coronavirus disease 2019 (COVID-19) is urgently needed. An efficient approach is to evaluate whether existing approved drugs have anti-SARS-CoV-2 effects. The antiviral properties of lithium salts have been studied for many years. Their anti-inflammatory and immune-potentiating effects result from the inhibition of glycogen synthase kinase-3. AIMS: To obtain pre-clinical evidence on the safety and therapeutic effects of lithium salts in the treatment of COVID-19. RESULTS: Six different concentrations of lithium, ranging 2-12 mmol/L, were evaluated. Lithium inhibited the replication of SARS-CoV-2 virus in a dose-dependent manner with an IC50 value of 4 mmol/L. Lithium-treated wells showed a significantly higher percentage of monolayer conservation than viral control, particularly at concentrations higher than 6 mmol/L, verified through microscopic observation, the neutral red assay, and the determination of N protein in the supernatants of treated wells. Hamsters treated with lithium showed less intense disease with fewer signs. No lithium-related mortality or overt signs of toxicity were observed during the experiment. A trend of decreasing viral load in nasopharyngeal swabs and lungs was observed in treated hamsters compared to controls. CONCLUSIONS: These results provide pre-clinical evidence of the antiviral and immunotherapeutic effects of lithium against SARS-CoV-2, which supports an advance to clinical trials on COVID-19's patients.

[Effectiveness of educational interventions on primary care physicians in the prevention of traffic accidents in the elderly]. / Eficacia de las intervenciones formativas sobre médicos de atención primaria en la prevención de accidentes de tráfico en ancianos.

The objective of this study was to assess the effect of the implementation of training programs for Primary Care Physicians for improving their clinical practice as regards the prevention of traffic accidents in the elderly. To do this, a systematic review was carried out following the PRISMA strategy. A total of 1,677 works were reviewed, of which only 5 were included because they met the inclusion criteria. Although none of the works was of an experimental type with a control group, it can be concluded that there is evidence that an adequate training in this subject by physicians improves their skills in the identification of elderly risk drivers, due to their pathologies and/or the use of drugs, as well as their level of confidence to communicate to the elderly and/or their families the need for restriction or, if necessary, the definitive cessation of driving.

The role of the tumor necrosis factor (TNF)-related weak inducer of apoptosis (TWEAK) in offspring exposed to prenatal hypoxia.

Exposure to prenatal hypoxia in rats leads to intrauterine growth restriction (IUGR), decreases fetal cardiomyocyte proliferation and increases the risk to develop cardiovascular diseases (CVD) later in life. The tumor necrosis factor-related weak inducer of apoptosis (TWEAK) induces cardiomyocyte proliferation through activation of the fibroblast growth factor-inducible molecule 14 (Fn-14) receptor. The TWEAK/Fn-14 pathway becomes quiescent shortly after birth, however, it becomes upregulated with CVD; suggesting that it could be a link between the increased susceptibility to CVD in pregnancies complicated by hypoxia/IUGR. We hypothesized that offspring exposed to prenatal hypoxia will exhibit reduced cardiomyocyte proliferation due to reduced Fn-14 expression and that the TWEAK/Fn-14 pathway will be expressed in those adult offspring. We exposed pregnant Sprague Dawley rats to control (21% oxygen) or hypoxic (11% oxygen) conditions from gestational days 15 to 21. Ventricular cardiomyocytes were isolated from male and female, control and hypoxic offspring at postnatal day 1. Proliferation was assessed in the presence or absence of r-TWEAK (72 h, 100 ng/ml). Prenatal hypoxia was not associated with differences in Fn-14 protein expression in either male or female offspring. Cardiomyocytes from prenatal hypoxic male, but not female, offspring had decreased proliferation compared with controls. Addition of r-TWEAK increased cardiomyocyte proliferation in all offspring. In adult offspring of all groups, the TWEAK/Fn-14 pathway was not detectable. Cardiomyocyte proliferation was reduced in only male offspring exposed to prenatal hypoxia but this was not due to changes in the Fn-14 pathway. Studies addressing other pathways associated with CVD and prenatal hypoxia are needed.

Scheduled meal accelerates entrainment to a 6-h phase advance by shifting central and peripheral oscillations in rats.

Travelling across several time zones requires a fast adjustment of the circadian system and the differential adjustment speeds of organs and systems results in what is commonly referred as jet lag. During this transitory state of circadian disruption, individuals feel discomfort, appetite loss, fatigue, disturbed sleep and deficient performance of multiple tasks. We have demonstrated that after a 6-h phase advance of the light-dark cycle (LD) scheduled food in phase with the new night onset can speed up re-entrainment. In this study, we explored the possible mechanisms underlying the fast re-entrainment due to the feeding schedule. We focused on first- and second-order structures that provide metabolic information to the suprachiasmatic nucleus (SCN). We compared (i) control rats without change in LD cycle; (ii) rats exposed to a 6-h phase advance of the LD cycle with food ad libitum; and (iii) rats exposed to the 6-h phase advance combined with food access in phase with the new night. We found an immediate synchronizing effect of food on stomach distention and on c-Fos expression in the nucleus of the solitary tract, arcuate nucleus of the hypothalamus, dorsomedial hypothalamic nucleus and paraventricular nucleus. These observations indicate that in a model of jet lag, scheduled feeding can favour an immediate shift in first- and second-order relays to the SCN and that by keeping feeding schedules coupled to the new night, a fast re-entrainment may be achieved by shifting peripheral and extra-SCN oscillations.

Characterization of swine leucocyte antigen alleles in a crossbred pig to be used in xenotransplant studies.

We have characterized swine leucocyte antigen (SLA) classes I and II molecules of a domestic pig as a model for use in our xenotransplant program. Molecular characterization of the SLA classes I and II genes is critical to understanding the adaptive immune responses between swine and humans in the event of xenotransplantation. Seven swine leucocyte antigen genes (SLA-1, SLA-2, SLA-3, DQB1, DRB1, DQA and DRA) were analyzed and 15 alleles were identified. A novel DRA*w04re01 is reported for this limited polymorphic class II gene. The heterozygous haplotypes, Hp-32.0/35.0 and Hp-0.13/0.23 were deduced for our IU-pig model, for SLA classes I and II regions, respectively.

Espasticidad postictus con patrón distónico en paciente con tumor glómico carotídeo: aplicación de toxina botulínica tipo A / Post-stroke spasticity with dystonic pattern in patient with carotid glomus tumor: application of botulin toxin type A

Los tumores del glomus carotídeo son lesiones de crecimiento lento e infrecuentes. Por la localización anatómica se recomienda su extirpación. Se presenta un paciente de 35 años con tumor del glomus carotídeo derecho agresivo. Se realizó embolización prequirúrgica; 24 horas después presentó ictus en territorio de la arteria cerebral media derecha, objetivándose en resonancia magnética nuclear material de embolización, apareciendo paresia facial izquierda leve. Se interviene tras 5 meses, presenta postcirugía: parálisis facial izquierda central, voz bitonal, disfagia leve, hemiparesia izquierda espástica de predominio braquial. Recibió tratamiento con toxina botulínica tipo A (TboA) en miembros izquierdos, seguido de estiramientos de la musculatura afectada. Objetivando en revisiones seriadas: mejoría en el dolor, patrón de marcha, posición del miembro superior y mejoría funcional. El tratamiento con TboA producirá mejoría global en patrones distónicos si se selecciona la musculatura y la dosis de forma correcta, obteniendo mejoras en funcionalidad y calidad de vida (AU)

Carotid glomus tumor are uncommon and slow growing lesions. Removal is recommended due to their anatomical localization. The case of a 35-year old patient with aggressive right carotid glomus tumor is presented. Presurgery embolization was performed. At 24 hour, the patient suffered stroke in the right middle cerebral artery territory, observing embolization material with the MRI, mild left facial paresis appearing. Surgery was performed 5 months later. Post-surgery, the patient has left central facial paralysis, bitonal voice, mild dysphagia, left spastic hemiparesis with brachial predominance. The patient was treated with botulinum toxin type A (TboA) in left limbs, followed by stretchings of the affected muscles. The seriated check-up studies showed improvement in pain, gait pattern, position of the upper limb as well as functional improvement. Treatment with TboA would produce an overall improvement in dystonic patterns, if the muscles and the dose are correctly selected, obtaining improvements in functionality and quality of life (AU)

Angiogenic imbalance and plasma lipid alterations in women with preeclampsia from a developing country.

BACKGROUND: An imbalance between anti-angiogenic factors (e.g. soluble vascular endothelial growth factor receptor-1 (s-FLT1) and soluble endoglin (s-Eng)) and pro-angiogenic factors (e.g. placental growth factor (PlGF)) as well as increased oxidized low-density lipoprotein (ox-LDL) concentrations have been associated with preeclampsia (PE). Risk factors associated with the development of PE, however, are known to be different between developed and developing countries. The aim of the study was to determine the levels of s-FLT1, s-Eng, PIGF, and ox-LDL in women with PE from a developing country. METHODS: A multi-center case-control study was conducted. One hundred and forty three women with PE were matched by age and parity with 143 healthy pregnant women without cardiovascular or endocrine diseases. Before delivery, blood samples were taken and serum was stored until analysis. RESULTS: Women with PE had lower concentrations of PIGF (p<0.0001) and higher concentrations of s-Eng (p=0.001) than healthy pregnant women. There were no differences between the groups regarding ox-LDL or s-FLT1. Women with early onset PE had higher s-FLT1 concentrations (p=0.0004) and lower PIGF concentrations (p<0.0001) than their healthy pregnant controls. Women with late onset PE had higher concentrations of s-Eng (p=0.005). Women with severe PE had higher concentrations of s-Eng (p=0.0008) and ox-LDL (p=0.01), and lower concentrations of PIGF (p<0.0001). CONCLUSIONS: Women with PE from a developing country demonstrated an angiogenic imbalance and an increased rate of LDL oxidation. Findings from this study support the theory that PE is a multifactorial disease, and understanding differences in these subpopulations may provide a better target to approach future therapies.

Gaslike model of social motility.

We propose a model to represent the motility of social elements. The model is completely deterministic, possesses a small number of parameters, and exhibits a series of properties that are reminiscent of the behavior of communities in social-ecological competition; these are (i) similar individuals attract each other; (ii) individuals can form stable groups; (iii) a group of similar individuals breaks into subgroups if it reaches a critical size; (iv) interaction between groups can modify the distribution of the elements as a result of fusion, fission, or pursuit; (v) individuals can change their internal state by interaction with their neighbors. The simplicity of the model and its richness of emergent behaviors, such as, for example, pursuit between groups, make it a useful toy model to explore a diversity of situations by changing the rule by which the internal state of individuals is modified by the interactions with the environment.

Breast cancer incidence in Metro Manila and Rizal province: 1980-1992.

Incidence was derived from published data from two population-based registries--the Philippine Cancer Society-Manila Cancer Registry, and the Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1674 sq. km area that comprises Metro Manila and Rizal province. 13 registry clerks actively sought new cancer cases in 96 hospitals and 30 Civil Registry offices. Both registries are members of the International Association of Cancer Registries and receive continuing professional assistance from the International Agency for Research on Cancer. For the period 1988-92, the combined age-standardized incidence rate (ASR) was 43.4 per 100,000 females, making breast cancer the second most common following lung cancer, and the highest among women. Breast cancer ASR in the Manila Registry was the highest in Asia with the exception of the Jews in Israel. Age-specific rates began to rise steeply starting at age-group 30-34 years and peaked at 196.6 for age-group 70-74 years. There were significant differences between cities and municipalities. The rates in the oldest and most urbanized cities were similar to some populations in Europe, South America, and Oceania, and were almost 3 times those of residents in rural municipalities whose new rates were similar to some Asian and African populations. The ASR has doubled in the 13-year period between 1980 and 1992. While the combined rates were still lower than those of Filipino migrants to Hawaii, San Francisco and Los Angeles, rates in some cities had approximated those observed in the migrant populations.

Efficacy of fine-needle capillary biopsy in the assessment of patients with superficial lymphadenopathy.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) is an important tool for the cytologic assessment of patients with lymphadenopathy. The nonaspiration method (without the use of a syringe or a handle), or fine-needle capillary biopsy (FNCB), is becoming popular for its ease of learning and use. The authors compared the two techniques of fine-needle biopsy (with and without aspiration) for identifying the cause of superficial lymphadenopathy. METHODS: Over a 2-year period 50 cytologic examinations were conducted in patients with superficial lymphadenopathy. Both procedures were performed at the same site; the order in which they were performed was determined randomly. Slides were fixed in a similar manner and examined by a cytotechnologist and pathologists blind to the procedure. Scores were tabulated and compared and diagnosis was confirmed by histologic examination. RESULTS: The best and the average score for the yield of cellular material was higher with FNCB (P < 0.004). Cell preservation also was superior with FNCB (P = 0.00066). However, the failure rate was lower with FNAB (P = 0.7662). CONCLUSIONS: FNCB of superficial lymph nodes yields adequate cellular material of superior quality, which may be advantageous in certain situations. However, the diagnostic yield does not appear to be significantly increased using this technique.

Cancer in Al-Qassim, Saudi Arabia: A retrospective study (1987-1995).

Regional differences in the pattern of cancer are obvious in Saudi Arabia. From January 1987 to December 1995, 1106 new cases of cancer (642 males, 464 females) were seen at the King Fahd Specialist Hospital in Buraidah, Al-Qassim. Overall, lymphomas, non-Hodgkin's and Hodgkin's disease combined were the most common malignancy seen (15.10%), followed by esophageal carcinoma (7.77%). Thyroid cancer was the most common malignancy among females (12.50%), followed by breast cancer (9.48%). The majority of the patients were in the younger age group (77% were <50 years of age). Among the hematological malignancies, acute lymphoblastic leukemia was the most frequent type (36.23%). Lymphomas were the most common malignancy (66.12%) seen in the pediatric age group (0-14 years), followed by leukemias and brain tumors. The pattern of cancer in Al-Qassim is generally similar to other regions of Saudi Arabia, with few regional variations. prominent among such variations is the high frequency of non-Hodgkin's lymphomas (NHL), esophageal and thyroid carcinomas.

[Transrectal ultrasound of the prostate]. / Ultrasonido transrectal de próstata.

We studied 100 cases of prostatic disease with transrectal ultrasound; all were confirmed by histopathology. 83 cases were diagnosed as benign hyperplasia, 76 were confirmed 7 were cancer. Sensitivity 89.4%. 17 cases were diagnosed as cancer, biopsy confirmed 8, the other 9 were hyperplasia (sensitivity 53.3%). The more reliable ultrasonographic signs of cancer are the interruption on the continuity of the prostatic capsule, the extrinsic compression of the bladder and/or the seminal glands. The echogenicity of the prostatic tissue can have variations, it can be iso-, hypo- or hyperechoic in cancer and also in benign hyperplasia. We conclude, as in other reports, that transrectal ultrasound can demonstrate abnormal prostatic tissue, yet there is not enough sensitivity. Therefore biopsy is necessary and it can be performed by means of this procedure.