Opciones terapéuticas para una joven nulípara con mioma uterino intramural gigante / Therapeutic options for a nulliparous young woman with a giant intramural uterine myoma

RESUMEN Introducción: Los leiomiomas uterinos son los tumores ginecológicos benignos más comunes; son causa de anemia, infertilidad, alteración en la implantación embrionaria, pérdida gestacional recurrente, parto prematuro e incontinencia urinaria. Su transformación maligna es excepcional. La afectación a la fertilidad, se asocia con miomas entre el 3 % y el 31 % y depende de su ubicación y tamaño, sobre todo en los que distorsionan la cavidad uterina. Objetivo: Describir las opciones terapéuticas para una joven nulípara con un mioma uterino intramural gigante. Caso Clínico: Paciente de 30 años de edad, con antecedentes de mioma uterino intramural, de 5 años de evolución, además anemia ferripriva. Aqueja menstruaciones abundantes y dolorosas, incontinencia urinaria y constipación. El tratamiento fue escalonado, mediante el uso de acetato de goserelina, embolización selectiva de las arterias uterinas y posterior miomectomía. Conclusiones: El tratamiento del mioma uterino en la mujer joven, nulípara, depende del tamaño, localización, sintomatología asociada, edad de la paciente y deseo de engendrar descendencia.

ABSTRACT Introduction: Uterine leiomyomas are the most common benign gynecological tumors; they are a cause of anemia, infertility, altered embryo implantation, recurrent gestational loss, premature delivery and urinary incontinence. Their malignant transformation is exceptional. Fertility impairment is associated with myomas in between 3 % and 31 % and depends on their location and size, especially in those that distort the uterine cavity. Objective: To describe the therapeutic options for a nulliparous girl with a giant intramural uterine fibroid. Clinical Case: A 30-year-old patient with a 5-year history of intramural uterine fibroid, in addition to iron deficiency anemia. She complains of heavy and painful periods, urinary incontinence and constipation. Treatment was staggered, using goserelin acetate, selective embolization of the uterine arteries, and subsequent myomectomy. Conclusions: The treatment of uterine fibroid in young, nulliparous women depends on the size, location, associated symptoms, age of the patient and desire to have offspring.

Geometric Analysis of Signals for Inference of Multiple Faults in Induction Motors.

Multiple fault identification in induction motors is essential in industrial processes due to the high costs that unexpected failures can cause. In real cases, the motor could present multiple faults, influencing systems that classify isolated failures. This paper presents a novel methodology for detecting multiple motor faults based on quaternion signal analysis (QSA). This method couples the measured signals from the motor current and the triaxial accelerometer mounted on the induction motor chassis to the quaternion coefficients. The QSA calculates the quaternion rotation and applies statistics such as mean, variance, kurtosis, skewness, standard deviation, root mean square, and shape factor to obtain their features. After that, four classification algorithms are applied to predict motor states. The results of the QSA method are validated for ten classes: four single classes (healthy condition, unbalanced pulley, bearing fault, and half-broken bar) and six combined classes. The proposed method achieves high accuracy and performance compared to similar works in the state of the art.

Stokes Dynamic Polarimeter for Non-Organic and Organic Samples Characterization.

The light polarization properties provide relevant information about linear-optical media quality and condition. The Stokes-Mueller formalism is commonly used to represent the polarization properties of the incident light over sample tests. Currently, different Stokes Polarimeters are mainly defined by resolution, acquisition rate, and light to carry out accurate and fast measurements. This work presents the implementation of an automatic Stokes dynamic polarimeter to characterize non-biological and biological material samples. The proposed system is configured to work in the He-Ne laser beam's reflection or transmission mode to calculate the Mueller matrix. The instrumentation stage includes two asynchronous photoelastic modulators, two nano-stepper motors, and an acquisition data card at 2% of accuracy. The Mueller matrix is numerically calculated by software using the 36 measures method without requiring image processing. Experiments show the efficiency of the proposed optical array to calculate the Mueller matrix in reflection and transmission mode for different samples. The mean squared error is calculated for each element of the obtained matrix using referenced values of the air and a mirror. A comparison with similar works in the literature validates the proposed optical array.

Asociación entre el fenotipo hipertrigliceridemia-obesidad abdominal, la resistencia a la insulina y las variables cardiometabólicas en el síndrome de ovario poliquístico / Association among the hypertriglyceridemic waist phenotype, insulin resistance and the cardiometabolic variables in the polycystic ovary syndrome

Introducción: El síndrome de ovario poliquístico se asocia con frecuencia a alteraciones cardiometabólicas; y su asociación con el fenotipo hipertrigliceridemia-obesidad abdominal ha sido poco estudiada en Cuba. Objetivo: Identificar la frecuencia del fenotipo hipertrigliceridemia-obesidad abdominal en mujeres de edad mediana con síndrome de ovario poliquístico y su asociación con la resistencia a la insulina, trastornos del metabolismo de la glucosa y ateroesclerosis subclínica. Método: Estudio descriptivo, transversal, en 30 mujeres. Se tomaron variables clínicas: edad, peso, talla, índice de masa corporal, circunferencia de cintura y cadera, índice cintura/cadera, tensión arterial, además de concentraciones de glucosa, insulina, colesterol total, triglicéridos, HDL-c y LDL-c, e índice HOMA-IR. La aterosclerosis subclínica se evaluó por doppler carotideo y ecocardiograma (hipertrofia ventricular izquierda y grasa epicárdica). El fenotipo hipertrigliceridemia-obesidad abdominal se definió como triglicéridos elevados (≥ 1,7 mmol/L) y circunferencia de la cintura ≥ 80 cm. Resultados: La frecuencia del fenotipo hipertrigliceridemia-obesidad abdominal fue 43,3 por ciento (13/30). Los valores medios de circunferencia abdominal, tensión arterial, así como de glucemia (p < 0,003), insulinemia (p = 0,028), triglicéridos (p < 0,0001), e índice HOMA-IR (p = 0,012) fueron más elevados en el grupo de mujeres con esa condición. A pesar de no haber diferencias significativas la frecuencia de mujeres con incremento del grosor íntima-media carotídeo y de grasa epicárdica fue superior en aquellas con el fenotipo. Conclusiones: La presencia del fenotipo hipertrigliceridemia-obesidad abdominal es frecuente en mujeres con síndrome de ovario poliquístico, y se asocia con alteraciones del metabolismo de la glucosa y la resistencia a la insulina. Este pudiera ser utilizado en la práctica clínica como un marcador de riesgo para alteraciones cardiometabólicas(AU)

Introduction: The polycystic ovary syndrome is frequently associated to cardiometabolic alterations; and its relation with the hypertriglyceridemic waist phenotype has been poorly studied in Cuba. Objective: Identify the frequency of the hypertriglyceridemic waist phenotype in middle age women with polycystic ovary syndrome and its association with insulin resistance, disorders in the glucose metabolism and subclinical atherosclerosis. Methods: Descriptive, cross-sectional study in 30 women. As clinical variables there were used: age, weight, size, body mass index, waist-hip circumference, waist/hip index, blood pressure; glucose, insulin, total cholesterol, triglycerides, HDL-c and LDL-c concentrations, and HOMA-IR index. Subclinical atherosclerosis was assessed by a carotid doppler and an echocardiogram (left ventricular hypertrophy and epicardial fat). The hypertriglyceridemic waist phenotype was defined as high triglycerides levels (≥ 1.7 mmol/L) and CC ≥ 80 cm. Results: The frequency of the hypertriglyceridemic waist phenotype was 43.3 percent (13/30). The mean values of abdominal circumference, blood pressure, as well as glycemia (p < 0.003), insulinaemia (p = 0.028), triglycerides (p < 0.0001), and HOMA-IR index (p = 0.012) were higher in the group of women with that condition. Although there were not significant differences, the frequency of women with increase of the carotid intima-media thickness and epicardical fat was higher in those with the phenotype. Conclusions: The presence of the hypertriglyceridemic waist phenotype is frequent in women with the polycystic ovary syndrome, and it is associated with alterations of the glucose metabolism and insulin resistance. This can be used in the clinical practice as a marker of risk for cardiometabolic alterations(AU)

Depresión y ansiedad y su relación con el perfil antropométrico de los pacientes en rehabilitación cardíaca fases I y II / Depression and anxiety and their relationship with the anthropometric profile of patients in Cardiac Rehabilitation Phases I and II

RESUMEN Introducción: La depresión es una alteración del estado mental que afecta a muchas personas alrededor del mundo y que, junto con la ansiedad, constituye un problema a nivel mundial que puede afectar a los pacientes en el período posquirúrgico cardiovascular. Objetivo: Determinar los niveles de depresión y ansiedad, y su relación con el sobrepeso y la obesidad, en pacientes que asisten a rehabilitación cardíaca fases I y II. Método: Se hizo la selección de 50 participantes de rehabilitación cardíaca (25 de fase I y 25 en fase II). Se utilizó la Hospital Anxiety and Depression Scale (HADS) para la detección de trastornos de ansiedad y depresión. Además, se valoró la antropometría de los participantes y se realizaron pruebas de normalidad de Kolmogorov-Smirnov y Shapiro-Wilk; como también, la media, desviación estándar y el coeficiente de correlación de Pearson con un grado significativo de p<0,05. Resultados: Los 50 participantes (66% hombres) tenían una edad promedio de 63,86±10,99, con diagnósticos posoperatorios de revascularización miocárdica (44%), angioplastia coronaria (40%), enfermedad aterosclerótica (4%), reemplazo de válvula aórtica (4%), cierre de comunicación interauricular (4%), marcapasos implantado (2%) y desacondicionamiento físico (2%). Se encontró una depresión de 36% y ansiedad de 30%. Conclusiones: Existe una alta prevalencia de depresión y ansiedad en los programas de rehabilitación cardíaca, su frecuencia es mayor en la fase I en comparación con la II. Además, se encontró que existe una correlación moderada leve entre la ansiedad y el normopeso y la obesidad, al igual que entre la depresión frente al sobrepeso.

ABSTRACT Introduction: Depression is a mental state disorder that affects a good number of people around the world and that, along with anxiety, is a wide-reaching problem that can strike patients after undergoing heart surgery. Objective: To determine the levels of depression and anxiety, and their relationship with overweight and obesity, in patients attending cardiac rehabilitation phases I and II. Method: Fifty patients receiving cardiac rehabilitation (25 in phase I and 25 in phase II) were selected. The Hospital Anxiety and Depression Scale (HADS) was used to screen anxiety and depression disorders. In addition, the anthropometry of the participants was examined and Kolmogorov-Smirnov and Shapiro-Wilk normality tests were performed. Mean, standard deviation and Pearson correlation coefficient with a significant degree of p<0.050 were also applied. Results: The 50 participants (66% men) had an average age of 63.86±10.99, with postoperative diagnosis of coronary-artery bypass grafting (44%), coronary angioplasty (40%), atherosclerotic disease (4%), aortic valve replacement (4%), atrial septal defect closure (4%), implanted pacemaker (2%) and physical deconditioning (2%). Depression was found at 36% and anxiety at 30%. Conclusions: There is a high prevalence of depression and anxiety in cardiac rehabilitation programs; its frequency is higher in phase I compared to phase II. Moreover, we found that there is a slight-mild correlation between anxiety versus normal weight and obesity, as well as depression versus overweight.

Soporte nutricional en lesión renal aguda / Nutritional support in acute kidney injury

El desgaste proteico energético (DPE) es altamente prevalente en pacientes con lesión renal aguda (LRA), lo que incrementa la mortalidad, complicaciones y el uso de recursos sanitarios. Los objetivos del soporte nutricional (SN) incluyen: adecuar el aporte de nutrientes, prevenir el DPE, preservar la masa corporal magra, mantener el estado nutricional, evitar otros trastornos metabólicos, mejorar la cicatrización de heridas, apoyar la función inmune y reducir la mortalidad. Los pacientes con LRA en terapia de reemplazo renal (TRR) deben recibir al menos 1.5 g/kg/d de proteína y no más de 30 kcal no proteicas/kg/d. Se deben tomar en cuenta las pérdidas de macronutrientes y micronutrientes especialmente en los diferentes tipos de TRR, así como las alteraciones metabólicas, subalimentación o sobrealimentación. La nutrición enteral debe ser la primera elección de alimentación, sin embargo, la nutrición parenteral sola o combinada debe ser utilizada para alcanzar los objetivos nutricionales. El SN debe ser temprano durante las primeras 24-48 hrs. Los requerimientos nutricionales y el tipo de SN deben ser individualizados y reevaluados con frecuencia en pacientes con LRA (AU)

Protein-energy wasting (PEW) is highly prevalent in patients with acute kidney injury (AKI), increasing mortality, complications and use of health resources. The goals of nutritional support (NS) include: adequate intake of nutrients, prevent PEW, preservation of lean body mass, maintenance of nutritional status, avoidance of further metabolic derangements, enhancement of wound healing, support of immune function and reduction in mortality. Patients with AKI on renal replacement therapy (RRT) should receive at least 1.5 g/kg/d of protein and not more than 30 nonprotein kcal/kg/d. It should be taken into account losses macronutrients and micronutrients specially in the different types of RRT, metabolic alterations and underfeeding or overfeeding. Enteral nutrition should be the first choice of feeding, however, alone or complementary parenteral nutrition should be used to achieve nutritional goals. NS should be early in the first 24-48 hrs. The nutritional requirements and type of NS should be frequently reassessed and individualized in patients with AKI (AU)

[ASSOCIATION OF SERUM ALBUMIN AND SUBJECTIVE GLOBAL ASSESSMENT ON INCIDENT PERITONEAL DIALYSIS PATIENTS]. / ASOCIACIÓN DE ALBÚMINA SÉRICA Y VALORACIÓN GLOBAL SUBJETIVA EN PACIENTES INCIDENTES EN DIÁLISIS PERITONEAL.

INTRODUCTION: serum albumin the biomarker most frequently used as one of three biochemical criteria for diagnosis of protein energy wasting (PEW). However, as a nutritional parameter it's unreliable in chronic kidney disease (CKD). The subjective global assessment (SGA) has been recommended for nutritional evaluation and the PEW in CKD. OBJECTIVE: determine association between the levels of serum albumin and SGA in patients with end stage renal disease (ESRD) who started peritoneal dialysis (PD). METHODS: a cross-sectional study in patients with ESRD were evaluated prior to starting PD. Levels of serum albumin were determined and nutritional assessment was performed by SGA. RESULTS: 69 patients, 46 (67%) men and 23 (33%) women, average age 39.97 ± 18.30 years old, serum albumin 2.75 ± 0.65 g/dl, creatinine 18.91 ± 10.98 mg/dl, urea 314.80 ± 152.74 mg/dl and BMI 23.37 ± 3.79 kg/m2, median of GFR 3 (1-12) mL/min/1.73m2. The SGA showed that 34.8% was well nourished, 40.6% had risk of moderate PEW and the 24.6% had severe PEW. There was no association (p = ns) between the levels of serum albumin and SGA. CONCLUSION: the present study shows hypoalbuminemia and PEW are very frequent. The identification of levels of serum albumin and SGA at the beginning of PD in our population could be predictors of mortality. Serum albumin is not a useful tool for nutritional assessment in patients with ERSD who initiate PD.

Introducción: la albúmina sérica es el biomarcador más frecuentemente utilizado como uno de los tres criterios bioquímicos para el diagnóstico del desgaste proteico energético (DPE). Sin embargo, como parámetro nutricional es poco fiable en la enfermedad renal crónica (ERC). La valoración global subjetiva (VGS) ha sido recomendada para la evaluación nutricional y del DPE en ERC. Objetivo: determinar la asociación de los niveles de albúmina sérica y la VGS en pacientes con insuficiencia renal crónica terminal (IRCT) que iniciaron diálisis peritoneal (DP). Métodos: estudio transversal analítico en pacientes con IRCT que fueron evaluados previo a iniciar DP. Se determinaron niveles de albúmina sérica y se realizó una evaluación nutricional mediante la VGS. Resultados: 69 pacientes, 46 (67%) hombres y 23 (33%) mujeres, con una media de edad de 39,97 ± 18,30 años, albúmina sérica 2,75 ± 0,65 g/dl, creatinina 18,91 ± 10,98 mg/dl, urea 314,80 ± 152,74 mg/dl e IMC 23,37 ± 3,79 kg/m2, la mediana de TFG 3 (1-12) mL/min/1,73m2. La VGS mostró que el 34,8% estaba bien nutrido, el 40,6% tenía riesgo de DPE o moderado y el 24,6% presentaba un DPE severo. No existió asociación (p = ns) entre los niveles de albúmina sérica y la VGS. Conclusión: el presente estudio muestra que la hipoalbuminemia y el DPE son muy frecuentes. La identificación de los niveles de albúmina sérica y la VGS al iniciar DP en nuestra población pudieran ser predictores de mortalidad. La albúmina sérica no es una herramienta útil para la evaluación nutricional en pacientes con IRCT que iniciarán DP.

Newcastle Disease Virus: Potential Therapeutic Application for Human and Canine Lymphoma.

Research on oncolytic viruses has mostly been directed towards the treatment of solid tumors, which has yielded limited information regarding their activity in hematological cancer. It has also been directed towards the treatment of humans, yet veterinary medicine may also benefit. Several strains of the Newcastle disease virus (NDV) have been used as oncolytics in vitro and in a number of in vivo experiments. We studied the cytolytic effect of NDV-MLS, a low virulence attenuated lentogenic strain, on a human large B-cell lymphoma cell line (SU-DHL-4), as well as on primary canine-derived B-cell lymphoma cells, and compared them to healthy peripheral blood mononuclear cells (PBMC) from both humans and dogs. NDV-MLS reduced cell survival in both human (42% ± 5%) and dog (34% ± 12%) lymphoma cells as compared to untreated controls. No significant effect on PBMC was seen. Cell death involved apoptosis as documented by flow-cytometry. NDV-MLS infections of malignant lymphoma tumors in vivo in dogs were confirmed by electron microscopy. Early (24 h) biodistribution of intravenous injection of 1 × 10(12) TCID50 (tissue culture infective dose) in a dog with T-cell lymphoma showed viral localization only in the kidney, the salivary gland, the lung and the stomach by immunohistochemistry and/or endpoint PCR. We conclude that NDV-MLS may be a promising agent for the treatment of lymphomas. Future research is needed to elucidate the optimal therapeutic regimen and establish appropriate biosafety measures.

Asociación de albúmina sérica y valoración global subjetiva en pacientes incidentes en diálisis peritoneal / Association of serum albumin and subjective global assessment on incident peritoneal dialysis patients

Introducción: la albúmina sérica es el biomarcador más frecuentemente utilizado como uno de los tres criterios bioquímicos para el diagnóstico del desgaste proteico energético (DPE). Sin embargo, como parámetro nutricional es poco fiable en la enfermedad renal crónica (ERC). La valoración global subjetiva (VGS) ha sido recomendada para la evaluación nutricional y del DPE en ERC. Objetivo: determinar la asociación de los niveles de albúmina sérica y la VGS en pacientes con insuficiencia renal crónica terminal (IRCT) que iniciaron diálisis peritoneal (DP). Métodos: estudio transversal analítico en pacientes con IRCT que fueron evaluados previo a iniciar DP. Se determinaron niveles de albúmina sérica y se realizó una evaluación nutricional mediante la VGS. Resultados: 69 pacientes, 46 (67%) hombres y 23 (33%) mujeres, con una media de edad de 39,97±18,30 años, albúmina sérica 2,75±0,65 g/dl, creatinina 18,91±10,98 mg/dl, urea 314,80±152,74 mg/dl e IMC 23,37±3,79 kg/m2, la mediana de TFG 3 (1-12) mL/min/1,73m2. La VGS mostró que el 34,8% estaba bien nutrido, el 40,6% tenía riesgo de DPE o moderado y el 24,6% presentaba un DPE severo. No existió asociación (p=ns) entre los niveles de albúmina sérica y la VGS. Conclusión: el presente estudio muestra que la hipoalbuminemia y el DPE son muy frecuentes. La identificación de los niveles de albúmina sérica y la VGS al iniciar DP en nuestra población pudieran ser predictores de mortalidad. La albúmina sérica no es una herramienta útil para la evaluación nutricional en pacientes con IRCT que iniciarán DP (AU)

Introduction: serum albumin the biomarker most frequently used as one of three biochemical criteria for diagnosis of protein energy wasting (PEW). However, as a nutritional parameter it’s unreliable in chronic kidney disease (CKD). The subjective global assessment (SGA) has been recommended for nutritional evaluation and the PEW in CKD. Objective: determine association between the levels of serum albumin and SGA in patients with end stage renal disease (ESRD) who started peritoneal dialysis (PD). Methods: a cross-sectional study in patients with ESRD were evaluated prior to starting PD. Levels of serum albumin were determined and nutritional assessment was performed by SGA. Results: 69 patients, 46 (67%) men and 23 (33%) women, average age 39.97±18.30 years old, serum albumin 2.75±0.65 g/dl, creatinine 18.91±10.98 mg/dl, urea 314.80±152.74 mg/dl and BMI 23.37±3.79 kg/m2 , median of GFR 3 (1-12) mL/min/1.73m2 . The SGA showed that 34.8% was well nourished, 40.6% had risk of moderate PEW and the 24.6% had severe PEW. There was no association (p=ns) between the levels of serum albumin and SGA. Conclusion: the present study shows hypoalbuminemia and PEW are very frequent. The identification of levels of serum albumin and SGA at the beginning of PD in our population could be predictors of mortality. Serum albumin is not a useful tool for nutritional assessment in patients with ERSD who initiate PD (AU)

Fibrolipomas de cavidad oral: tumores comunes en sitios poco frecuentes: reporte de dos casos y revisión de la literatura / Oral fibrolipoma: unusual presentation of common tumors: report of two cases and review

Los lipomas son tumores mesenquimales benignos compuestos por adipocitos maduros. Corresponden a casi el 50% de los tumores de tejidos blandos, presentes entre el 1 y 5% en cavidad oral, especialmente en mucosa yugal, piso de la boca y márgenes laterales de la lengua. Suelen ser asintomáticos y su color depende del espesor de la mucosa que lo cubre. Histológicamente están conformados por lóbulos de adipocitos maduros rodeados por una cápsula fibrosa. Las variedades histológicas están determinadas por el tejido adicional que contienen; los más frecuentes son el lipoma simple y el fibrolipoma. Su curso es benigno y el tratamiento consiste en la escisión quirúrgica. En el presente artículo se reportan dos casos de fibrolipoma, un tumor común en una localización poco frecuente.

Lipomas are benign mesenchymal tumors of mature adipocytes. They correspond to almost 50% of soft tissue tumors, 1 to 5% of them localized in the oral cavity, especially in the oral mucosa, floor of mouth and lateral edges of the tongue. Oral lipomas are usually asymptomatic and the color depends of the thickness of the overlying mucosa. Histologically there are lobules of mature adipocytes surrounded by a fibrous capsule, and there are several types according to the additional tissue, being the most frequent the single lipomas and fibrolipomas. The course is benign and the definitive treatment is surgical excision. This article reports two cases of fibrolipoma, a common tumor in an unusual presentation.

[The 2010 curriculum of the faculty of medicine at the National University of Mexico]. / Plan de Estudios 2010 de la facultad de medicina de la Universidad Nacional Autónoma de México.

The 2010 undergraduate medical degree curriculum at the faculty of medicine of the Universidad Nacional Autonoma de Mexico (UNAM) constitutes an important curricular reform of medical education in our country. It is the result of an institutional reflective process and academic dialog, which culminated in its approval by UNAM's Academic Council for the Biology, Chemistry, and Health Sciences areas on February 2nd, 2010. Some distinguishing characteristics of the new academic curriculum are: organization by courses with a focus on outcome competencies; three curricular axes that link three knowledge areas; four educational phases with achievement profiles; new courses (biomedical informatics, basic-clinical and clinical-basic integration, among others); and core curriculum. The aforementioned curriculum was decided within a framework of effective teaching strategies, competency oriented learning assessment methods, restructuring of the training of teaching staff, and establishment of a curriculum committee follow-up and evaluation of the program. Curricular change in medical education is a complex process through which the institution can achieve its mission and vision. This change process faces challenges and opportunities, and requires strategic planning with long-term foresight to guarantee a successful dynamic transition for students, teachers, and for the institution itself.

The effects of ultra low fluence rate single and repetitive photodynamic therapy on glioma spheroids.

BACKGROUND AND OBJECTIVE: Achieving local control of gliomas with photodynamic therapy (PDT) requires the delivery of adequate light fluences to depths of 1-2 cm in the resection margin where the majority of local recurrences originate. This is clinically impractical with current single-shot, intraoperative PDT treatments due to the length of time required to deliver adequate fluences. Multiple or extended treatment protocols would therefore seem to be required. The response of human glioma spheroids to 5-aminolevulinic acid (ALA)-mediated PDT using single or, repetitive light delivery protocols was investigated at both low and ultra low fluence rates. STUDY DESIGN/MATERIALS AND METHODS: Human glioma spheroids (400 microm diameter) were subjected to sub-threshold light fluence (1.5, 3, or 6 J cm(-2)) ALA-PDT consisting of four light delivery schemes: single treatment given over either 1 or 24 hours, repetitive treatment given either as four 1 hour light treatments separated by a 4 day interval, or 24 hours light delivery, consisting of four 24 hours treatments separated by a 3 day interval. Treatment efficacy was evaluated using a growth assay. In some cases, confocal microscopy was used to image cell viability. RESULTS: The repetitive and single light treatment protocols were most effective when delivered at ultra low (microW cm(-2)) fluence rates. In all cases, growth inhibition was light dose-dependent. The repetitive ultra low fluence rate treatment (1.5 J cm(-2); irradiance = 17 microW cm(-2)) light delivery protocol was the most effective resulting in total growth inhibition during the 2-week observation period. CONCLUSION: Ultra low light fluence rate ALA-PDT results in significant spheroid growth inhibition. Repeated administration of ALA was required during repetitive and/or protracted single PDT treatment protocols. The existence of a lower fluence rate limit, below which the efficacy of threshold light fluences diminish was not found in these studies. Lasers Surg. Med. 41:578-584, 2009. (c) 2009 Wiley-Liss, Inc.

Motexafin gadolinium enhances the efficacy of aminolevulinic acid mediated-photodynamic therapy in human glioma spheroids.

Photodynamic therapy (PDT) has been investigated as a postoperative treatment in patients with high grade gliomas. The purpose of this in vitro investigation was to determine whether motexafin gadolinium (MGd), a known radiation sensitizer, could potentiate the effects of 5-aminolevulinic acid (ALA)-PDT. Human glioma (ACBT) spheroids (250 microm diameter) were incubated in 5-aminolevulinic acid (ALA) with and without MGd and irradiated with 635 nm light for a total light fluence of 6, 12, or 18 J cm(-2) delivered at a fluence rate of 5 mW cm(-2). Spheroid growth was monitored for a period of 4 weeks following each treatment. In another set of experiments, 400-500 microm diameter ACBT spheroids were implanted into a gel collagen matrix and subjected to ALA-PDT (fluence: 3 or 6 J cm(-2)), MGd, or a combination of ALA-PDT and MGd. The migration distance of surviving glioma cells in each treatment group was recorded over a 5-day period. The results showed that MGd interacted with PDT in a synergistic manner resulting in greater cytotoxicity than that achievable with either treatment modality alone. The degree of synergism was shown to increase with increasing light fluence. At the highest light fluence investigated (18 J cm(-2)), the percentage of spheroids demonstrating growth 4 weeks following exposure to MGd, ALA-PDT, or MGd + ALA-PDT was 100%, 75%, and 15%, respectively. The results of cell migration studies revealed that the combination of PDT and MGd produced a significant inhibitory effect on glioma cell migration: the addition of MGd resulted in an approximately three times reduction in migration distance compared with PDT alone. Overall, the results suggest that MGd can potentiate both the cytotoxic and migration inhibitory effects of ALA-PDT and hence, this combined therapeutic approach has the potential to extend treatment volumes in patients with malignant gliomas.

Effects of combined photodynamic therapy and ionizing radiation on human glioma spheroids.

The effects of combined photodynamic therapy (PDT) and ionizing radiation are studied in a human glioma spheroid model. The degree of interaction between the two modalities depends in a complex manner on factors such as PDT irradiation fluence, fluence rate and dose of ionizing radiation. It is shown that gamma radiation and PDT interact in a synergistic manner only if both light fluence and gamma radiation dose exceed approximately 25 J cm(-2) and 8 Gy, respectively. Synergistic interactions are observed only for the lower fluence rate (25 mW cm(-2)) investigated. The degree of interaction appears to be independent of both sequence and the PDT or ionizing radiation time intervals investigated (1 and 24 h). Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling assays show that low-fluence rate PDT is very efficient at inducing apoptotic cell death, whereas neither high-fluence rate PDT nor ionizing radiation produces significant apoptosis. Although the mechanisms remain to be elucidated, the data imply that the observed synergism is likely not due to gamma-induced cell cycle arrest or to PDT-induced inhibition of DNA repair.

Lesion cerebral en recien nacidos asficticos. Un enfoque obstetrico / Brain lesion in the asphyxiated newborn. An obstetric approach

Se estudiaron 102 ninos atendidos en la consulta de neurodesarrollo del Hospital Ginecobstetrico "Ramon Gonzalez Coro" de Ciudad de La Habana, que habian sufrido al nacer una asfixia severa y/o una encefalopatia hipoxico isquemica. La muestra se clasifica en 2 grupos; con (66) y sin (36) trastornos del neurodesarrollo en los 2 primeros anos de vida. Al analizar los factoresobstetricos presentes en ambos grupos se encuentran diferencias significativas (p < 0,05) en el precedente de sufrir una EIII y grados de la misma, en enfermedades maternas que cursan con daficit en la circulacion utero placentaria, cardiotocografia fetal anteparto e intraparto patologicas, motivo de la interrupcion de la gestacion, tiempo de trabajo de parto en pacientes nuliparas, presencia de meconio y diagnostico de sufrimiento fetal