Predictors of first-year postoperative complications after fixation of low-energy ankle fractures: A single-center, retrospective cohort study of 663 consecutive fractures. / [Artículo traducido] Predictores de las complicaciones postoperatorias en el primer año tras la fijación de fracturas de tobillo de baja energía. Estudio de cohortes retrospectivo sobre 663 fracturas intervenidas consecutivamente en un único centro.

INTRODUCTION: Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation. MATERIALS AND METHODS: A retrospective single-center cohort study was completed of patients undergoing internal fixation OF low-energy ankle fractures. The primary outcome was first-year postoperative complications, classified as major (surgical) or minor (non-surgical). Data on patients, their injuries, and treatments were collected. To identify potential predictors of outcomes, logistic regression methods were used, with a backward-stepwise method used for model fitting. RESULTS: In total, 663 patients of median age 59 years were analysed. We found a high rate of complications (28.4%), with wound-healing issues and infections predominant. Overall, 14.8% had minor complications, while 13.6% required an unplanned reoperation. On multivariable analysis, the most consistent predictors of complications were older age (OR: 1.02 per year), longer operating time (3.32 per hour), and smoking (2.91). CONCLUSIONS: Older patients and smokers who sustain fractures requiring more complex surgery are at higher risk of postoperative complications.

[Translated article] Insertion of S1 iliosacral screws in the computed tomography room: An alternative to improve safety in the percutaneous management of posterior pelvic ring injuries.

INTRODUCTION: The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation. METHODOLOGY: Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results. RESULTS: Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed. CONCLUSION: We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.

Predictors of first-year postoperative complications after fixation of low-energy ankle fractures: A single-center, retrospective cohort study of 663 consecutive fractures.

INTRODUCTION: Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation. MATERIALS AND METHODS: A retrospective single-center cohort study was completed of patients undergoing internal fixation OF low-energy ankle fractures. The primary outcome was first-year postoperative complications, classified as major (surgical) or minor (non-surgical). Data on patients, their injuries, and treatments were collected. To identify potential predictors of outcomes, logistic regression methods were used, with a backward-stepwise method used for model fitting. RESULTS: In total, 663 patients of median age 59 years were analyzed. We found a high rate of complications (28.4%), with wound-healing issues and infections predominant. Overall, 14.8% had minor complications, while 13.6% required an unplanned reoperation. On multivariable analysis, the most consistent predictors of complications were older age (OR=1.02 per year), longer operating time (3.32 per hour), and smoking (2.91). CONCLUSIONS: Older patients and smokers who sustain fractures requiring more complex surgery are at higher risk of postoperative complications.

Xanthogranulomatous endometritis.

Xanthogranulomatous endometritis (XGE) is an uncommon inflammatory benign condition that can mimic endometrial cancer. The majority of the reported cases of XGE have been observed in postmenopausal women, often presenting clinically as haematometra or benign senile pyometra. We report a case of XGE in a 73-year-old woman who presented with pyometra. Diagnostic hysteroscopy is an important tool when accompanied by endometrial samples for histology in suspected cases. Knowledge of this uncommon disease is crucial for accurate diagnosis. XGE is a benign condition, however, there have been reported cases of chronic active XGE and bacterial infection in which hysterectomy was required due to complications.

Insertion of S1 iliosacral screws in the computed tomography room: An alternative to improve safety in the percutaneous management of posterior pelvic ring injuries. / Inserción de tornillos iliosacros S1 en la sala de tomografía computarizada. Una alternativa para mejorar la seguridad en el tratamiento percutáneo de las lesiones posteriores del anillo pélvico.

INTRODUCTION: The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation. METHODOLOGY: Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results. RESULTS: Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed. CONCLUSION: We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.

Effect of graphite oxide electrochemically exfoliated over a multimode interference filter.

In this work, we study multimodal interference filters with a graphite oxide coating. Use of the multimodal interference filter shows a distinctive peak in the signal spectrum, and when using the exfoliated graphite coated multimodal interference filter, the signal shows different spectral changes, such as the full width at half maximum of the curve, the maximum power, and central wavelength, which indicates that graphite oxide absorbs part of the energy. In addition, microscope observations when a He-Ne laser is passed through the filter confirm that graphite oxide is adhered to the filter.

Twisted Nose: Preservation Rhinoplasty with Modified Push-Down/Let-Down Technique.

BACKGROUND: The authors present a retrospective, comparative, and analytical cohort study, that aimed to prove the utility of unilateral or asymmetrical bony wedge resection to straighten the twisted nose as applied in let-down and push-down methods. The study involved objective angle measurements preoperatively and postoperatively on frontal view photographs. METHODS: Preoperative and postoperative angle measurements were made on frontal view photographs of 78 patients with twisted noses classified as type C and type I. Angles of deviation were obtained using Scion Image software, measured in degrees. Statistical analysis was performed using Excel v15.13.3. RESULTS: Forty-two patients had twisted nose type C and 28 patients had twisted nose type I. The mean age was 19 years. There was an 81% improvement ratio for twisted nose type C and 79% for twisted nose type I, and the angle correction for each type of nasal deformity was statistically significant ( P < 0.01). The majority of postoperative results were classified as excellent to good, with the exception of four cases with bad outcomes, including two patients with type C and two with type I deviations. CONCLUSIONS: Unilateral or asymmetrical bony wedge resection is a modification of the let-down rhinoplasty technique. This study demonstrates statistically significant improvements in straightening twisted noses among patients with or without preoperative hump and preserving the nasal dorsum. The authors found this modification better suited for type C deviations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Emerging Evidence on the Use of Probiotics and Prebiotics to Improve the Gut Microbiota of Older Adults with Frailty Syndrome: A Narrative Review.

BACKGROUND: The gut microbiota can impact older adults' health, especially in patients with frailty syndrome. Understanding the association between the gut microbiota and frailty syndrome will help to explain the etiology of age-related diseases. Low-grade systemic inflammation is a factor leading to geriatric disorders, which is known as "inflammaging". Intestinal dysbiosis has a direct relationship with low-grade systemic inflammation because when the natural gut barrier is altered by age or other factors, some microorganisms or their metabolites can cross this barrier and reach the systemic circulation. OBJECTIVES: This review had two general goals: first, to describe the characteristics of the gut microbiota associated with age-related diseases, specifically frailty syndrome. The second aim was to identify potential interventions to improve the composition and function of intestinal microbiota, consequently lessening the burden of patients with frailty syndrome. METHODS: A search of scientific evidence was performed in PubMed, Science Direct, and Redalyc using keywords such as "frailty", "elderly", "nutrient interventions", "probiotics", and "prebiotics". We included studies reporting the effects of nutrient supplementation on frailty syndrome and older adults. These studies were analyzed to identify novel therapeutic alternatives to improve gut microbiota characteristics as well as subclinical signs related to this condition. RESULTS: The gut microbiota participates in many metabolic processes that have an impact on the brain, muscles, and other organs. These processes integrate feedback mechanisms, comprising their respective axis with the intestine and the gut microbiota. Alterations in these associations can lead to frailty. We report a few interventions that demonstrate that prebiotics and probiotics could modulate the gut microbiota in humans. Furthermore, other nutritional interventions could be used in patients with frailty syndrome. CONCLUSION: Probiotics and prebiotics may potentially prevent frailty syndrome or improve the quality of life of patients with this disorder. However, there is not enough information about their appropriate doses and periods of administration. Therefore, further investigations are required to determine these factors and improve their efficacy as therapeutic approaches for frailty syndrome.

Tracking moving objects through scattering media via speckle correlations.

Scattering can rapidly degrade our ability to form an optical image, to the point where only speckle-like patterns can be measured. Truly non-invasive imaging through a strongly scattering obstacle is difficult, and usually reliant on a computationally intensive numerical reconstruction. In this work we show that, by combining the cross-correlations of the measured speckle pattern at different times, it is possible to track a moving object with minimal computational effort and over a large field of view.

[Treatment protocol for COVID-19 in patients with and without an indication for hospital admission]. / Protocolo de tratamiento de la COVID-19 en pacientes con y sin indicación de ingreso hospitalario.

SARS-CoV-2 infection causes a wide spectrum of symptoms with varying degrees of severity, from asymptomatic cases or cases in the form of self-limiting influenza-like illness to cases of rapidly progressing respiratory distress syndrome due to an anomalous immune system response in the form of a cytokine storm. Thrombotic complications are also common. Multiple antiviral treatments have been tested in COVID-19 without favorable outcomes. Only remdesivir may be useful, but not in all cases, and its use is controversial. On the contrary, immunomodulating treatments have the most solid evidence, particularly glucocorticoids. Other more specific immunosuppressors, such as interleukin-6 inhibitors, have also shown favorable results and many others are currently being studied. Thromboprophylaxis is the other pillar of COVID-19 treatment, although the anticoagulant dose to be used is still being discussed.

Seasonal trends of Cyclospora cayetanensis infections in a community of Falcon State, Northwestern Venezuela.

BACKGROUND: Cyclosporiasis has a marked seasonality. Few community-based studies have addressed this issue and there are no reports from Venezuela. A study was conducted to determine the seasonal variation of infection in a community from Falcon State, Venezuela. METHODS: A sample of 732 individuals was collected for 1 y. Stools were examined with modified Ziehl-Neelsen carbolfuchsin staining of ethyl acetate-formalin concentrates and ultraviolet epiflorescence of wet mounts. RESULTS: Cyclospora prevalence was 9.9% (73/732) with monthly variation from 0% to 35.3%. A trend of increased infections coinciding with the rainy time was observed (p<0.001). CONCLUSIONS: Cyclosporiasis is common in this area with high endemicity during the rainy periods.

A left lateral body position increases pulmonary vein stress in healthy humans.

Pulmonary vein (PV) stretch is proarrhythmic for atrial fibrillation (AF). AF patients often report that a left lateral (LL) body position can trigger arrhythmia symptoms. Because the PV myocardium is thought to trigger AF, we hypothesized that the LL compared to the supine body position increases PV wall stress. Functional cardiac magnetic resonance imaging was performed in supine and LL recumbent body position in awake condition in healthy human volunteers (n = 20). Following a change from supine to LL position, the heart moved in an anterior-LL direction in the thorax. The right superior PV diameter was increased by 19% (24.6 ± 3.1 vs. 20.7 ± 3.2 mm, p = 0.009) and left atrial (LA) volume was larger by 17% (61.7[15.4] vs. 51.0[17.8] ml, p = 0.015) in LL than supine position, respectively. The passive LA conduit fraction (normalized difference between maximum and pre-contraction LA volume) increased by 25% in LL compared to supine position (19.6 ± 9.0 vs. 15.7 ± 7.6%, respectively, p = 0.016). Local wall stress in the PV regions increased in LL compared to supine position (overall mean: 1.01 ± 0.12 vs. 1.10 ± 0.10 arb. unit, LL vs. supine, position effect p = 0.041), whereas this was not the case in the LA walls (overall mean: 1.18 ± 0.31 vs. 1.21 ± 0.21 arb. unit, LL vs. supine, position effect p = 0.381). In conclusion, a left lateral body position increases PV myocardial stress during the atrial relaxation phase of healthy volunteers. These results have implications for the mechanisms of posture-triggered AF.

Self-Reported Onset of Paroxysmal Atrial Fibrillation Is Related to Sleeping Body Position.

Background: Because stretch of the atrial myocardium is proarrhythmic for atrial fibrillation (AF) and a left lateral body position increases atrial dimensions in humans, we hypothesized that left lateral recumbence is a frequent AF-triggering body position in AF patients. Methods: We performed a questionnaire study of symptomatic paroxysmal AF (episodes of AF < 1 week) patients scheduled for a first AF ablation therapy at Catharina Hospital, Eindhoven, the Netherlands and at University Hospital, Bordeaux, France. Results: Ninety-four symptomatic paroxysmal AF patients were included [mean age 61 ± 11 years, median AF history of 29(48) months, 31% were females]. Twenty-two percent of patients reported a specific body position as a trigger of their AF symptoms. The triggering body position was left lateral position in 57% of cases, supine position in 33%, right lateral position in 10%, and prone position in 5% (p = 0.003 overall difference in prevalence). Patients with positional AF had a higher body mass index compared to patients without nocturnal/positional AF [28.7(4.2) and 25.4(5.2) kg/m2, respectively, p = 0.025], but otherwise resembled these patients. Conclusion: Body position, and the left lateral position, in particular, is a common trigger of AF in symptomatic AF patients. Moreover, positional AF is associated with overweight. Understanding of the underlying mechanisms of positional AF can contribute to AF treatment and prevention.

Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera / Impact of the COVID-19 pandemic on the mortality of the elderly patient with a hip fracture

La COVID-19 se convirtió en una amenaza para el sistema de salud público, comprometiendo la salud de la población. Los pacientes con fractura de cadera, debido a su edad y comorbilidad, fueron pacientes de alto riesgo en esta pandemia. La finalidad de este estudio fue observar cómo afectó la pandemia al manejo de las fracturas de cadera del paciente anciano. Métodos: Se trata de un estudio descriptivo, retrospectivo de todos los pacientes mayores de 65 años diagnosticados de fractura de cadera que acudieron a urgencias del Hospital Universitario Vall d’Hebron en el periodo de pandemia COVID-19 comprendido entre el 11 de marzo y el 24 de abril de 2020. Fueron seguidos durante su ingreso hospitalario y a los 30 días de la fractura. Resultados: Se incluyeron un total de 63 pacientes, 18 (28,6%) de los cuales tenían una RT-qPCR positiva para COVID-19. Cuatro no pudieron ser operados debido a la gravedad que presentaban al ingreso, falleciendo a los pocos días. Tres de estos pacientes tenían la COVID-19. El 83,3% de los pacientes con RT-qPCR positiva presentaron clínica respiratoria durante su hospitalización. La duración de la estancia hospitalaria de los pacientes con RT-qPCR positiva (18,25±8,99 días) fue mayor que los pacientes no COVID (10,9±4,52 días) (p=0,01). La mortalidad intrahospitalaria de los pacientes intervenidos fue del 20% en los pacientes con RT-qPCR positiva en comparación con el 2,3% del grupo de pacientes que testaron negativo (p=0,018). La mortalidad a los 30 días fue del 40% en el grupo con RT-qPCR positiva vs. el 6,8% de los pacientes no infectados por SARS-CoV-2 (p=0,002). Conclusión: La infección por SARS-CoV-2 en pacientes ancianos con fractura de cadera aumenta tanto el tiempo de ingreso hospitalario como la mortalidad intrahospitalaria y a los 30 días.(AU)

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. Methods: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d’Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. Results: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). Conclusion: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.(AU)

Impact of the COVID-19 pandemic on the mortality of the elderly patient with a hip fracture. / Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera.

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.

Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera / Impact of the COVID-19 pandemic on the mortality of the elderly patient with a hip fracture

La COVID-19 se convirtió en una amenaza para el sistema de salud público, comprometiendo la salud de la población. Los pacientes con fractura de cadera, debido a su edad y comorbilidad, fueron pacientes de alto riesgo en esta pandemia. La finalidad de este estudio fue observar cómo afectó la pandemia al manejo de las fracturas de cadera del paciente anciano. MÉTODOS: Se trata de un estudio descriptivo, retrospectivo de todos los pacientes mayores de 65 años diagnosticados de fractura de cadera que acudieron a urgencias del Hospital Universitario Vall d'Hebron en el periodo de pandemia COVID-19 comprendido entre el 11 de marzo y el 24 de abril de 2020. Fueron seguidos durante su ingreso hospitalario y a los 30 días de la fractura. RESULTADOS: Se incluyeron un total de 63 pacientes, 18 (28,6%) de los cuales tenían una RT-qPCR positiva para COVID-19. Cuatro no pudieron ser operados debido a la gravedad que presentaban al ingreso, falleciendo a los pocos días. Tres de estos pacientes tenían la COVID-19. El 83,3% de los pacientes con RT-qPCR positiva presentaron clínica respiratoria durante su hospitalización. La duración de la estancia hospitalaria de los pacientes con RT-qPCR positiva (18,25±8,99 días) fue mayor que los pacientes no COVID (10,9±4,52 días) (p = 0,01). La mortalidad intrahospitalaria de los pacientes intervenidos fue del 20% en los pacientes con RT-qPCR positiva en comparación con el 2,3% del grupo de pacientes que testaron negativo (p = 0,018). La mortalidad a los 30 días fue del 40% en el grupo con RT-qPCR positiva vs. el 6,8% de los pacientes no infectados por SARS-CoV-2 (p = 0,002). CONCLUSIÓN: La infección por SARS-CoV-2 en pacientes ancianos con fractura de cadera aumenta tanto el tiempo de ingreso hospitalario como la mortalidad intrahospitalaria y a los 30 días

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality

Effect of low dose metronomic therapy on MCF-7 tumor cells growth and angiogenesis. Role of muscarinic acetylcholine receptors.

The non-neuronal cholinergic system refers to the presence of acetylcholine, choline acetyltransferase, acetylcholinesterase and cholinergic receptors, nicotinic and muscarinic (mAChRs) expressed in non-neuronal cells. The presence of mAChRs has been detected in different type of tumor cells and they are linked with tumorigenesis. We had previously documented the expression of mAChRs in murine and human mammary adenocarcinomas and the absence of these receptors in normal mammary cells of the same origins. We also demonstrated that mAChRs are involved in breast cancer progression, pointing to a main role for mAChRs as oncogenic proteins. Since the long term treatment of breast cancer cells with the muscarinic agonist carbachol promoted cell death, here we investigated the ability of low doses of this agonist combined with paclitaxel (PX), a taxane usually administered to treat breast cancer, to inhibit the progression of human MCF-7 tumor cells. We demonstrated that PX plus carbachol reduced cell viability and tumor growth in vitro probably due to a down-regulation in cancer stem cells population and in the expression of ATP "binding cassette" G2 drug extrusion pump; also a reduction in malignant-induced angiogenesis was produced by the in vivo administration of the mentioned combination in a metronomic schedule to MCF-7 tumor-bearing NUDE mice. Our results confirm that mAChRs could be considered as therapeutic targets for metronomic therapy in breast cancer as well as the usefulness of a muscarinic agonist as repositioning drug in the treatment of this type of tumors.

Síndrome de WEBINO (wall-eyed bilateral internuclear ophthalmoplegia) secundario a ictus isquémico, a propósito de un caso / WEBINO syndrome (wall-eyed bilateral internuclear ophthalmoplegia) secondary to ischemic stroke, about a case

El síndrome de WEBINO (wall-eyed bilateral internuclear ophthalmoplegia) se caracteriza por un déficit bilateral en la aducción ocular, nistagmo horizontal bilateral a la abducción, así como la presencia de exotropía en la mirada primaria. Presentamos el caso de un paciente varón de 68 años que se presentó en el servicio de urgencias con diplopía de inicio súbito. La exploración fue compatible con síndrome de WEBINO, y también presentaba ataxia de la marcha. Entre los antecedentes relevantes, constaba que era trasplantado hepático en tratamiento con tacrolimus. Las exploraciones complementarias pusieron de manifiesto la existencia de una lesión isquémica en tegmento mesencefálico, involucrando el fascículo longitudinal medial de forma bilateral, así como el área pretectal. El síndrome de WEBINO es un síndrome poco frecuente. Entre las etiologías destacan la isquémica y la desmielinizante como las más frecuentes. En nuestro caso también se consideró la iatrogenia. La lesión asienta en un área anatómica específica, siendo clave su conocimiento para la realización de exploraciones complementarias que lleven al diagnóstico etiológico específico

WEBINO (wall-eyed bilateral internuclear ophthalmoplegia) syndrome is characterized by bilateral adduction impairment, nystagmus of the abducting eye, and primary gaze exotropia. We present the case of a 68 year-old man who was initially attended in emergency department with sudden onset diplopia. Neurological exploration revealed WEBINO and gait ataxia. Relevant medical history included liver transplantation and subsequent tacrolimus prescription. Complementary exams revealed ischemic lesion in mesencephalic tegmentum, involving medial longitudinal fasciculus and pretectal area. WEBINO syndrome is unfrequent. Among its etiologies, ischemic and demyelinating are the most frequent. In our case, iatrogenic etiology was also considered. Clinical recognition of this syndrome is required to perform adequate exams in order to reach diagnosis