Contribution to the Screening and Early Detection in Breast Cancer

Breast cancer is a public health issue in Uruguay. The Law 16.097 declared the national interest to fight against cancer and created the Honorary Commission to Fight Against Cancer- CHLCC. One of its tasks is to coordinate and develops programs for prevention and early detection. On 1992, an education campaign about the importance of early detection in breast cancer began. Six years later a program was created for early detection, to increase life expectancy and reduce the mortality. Other actions were done, for example: support National Cancer Register; create a Training Program; collaborate with the Health Ministry in the National Program Cancer to create the National Cancer Guidelines. As a result of these actions, inequalities are drastically reduced because the early detection of the tumor between others reasons; for example universal access to mammography. Mammography equipments were purchased or obtained trough agreements with institutions, so the accessibility to the exams became easily possible. At the same time, a norm was implemented. As a result, women have one free day per year at work to do their exams. All these programs are provided by the CHLCC own fundings, coming from taxation of the state. Twenty years after the beginning of this work, the standardized mortality rate of breast cancer has dropped from 24.8 in 1997 to 19.4 cases per 100,000 inhabitants in 2014, showing a decrease of almost 22% during this period. In the present time, 66% of breast cancers are diagnosed in stages I or II and the survival rate is 86% after 5 years. Between other factors, public global action allows for early diagnosis and improvement of survival rates.

Six New Cases of a Caterpillar-Induced Bleeding Syndrome

We describe six new cases of a hemorrhagic diathesis induced by contact with Lonomia achelous caterpillars. Onset of clinical bleeding varied between a few hours and 10 days post-exposure. Laboratory coagulation tests showed prolonged PT, PTT and ThT; normal platelets and a marked decrease of fibrinogen, factor V, plasminogen and factor XIII (including its subunits A and S). Factors VII, II and alfa 2 anti-plasmin were variably affected. In addition, activation of the fibrinolytic system and the generation of a procoagulant effect could also be demonstrated. Two cases developed severe hemorrhagic diathesis and one of them died of a cerebral hemorrhage. Different aspects of this rare syndrome are discussed in relation to its complex physiopathology and the variability observed in all clinical and laboratory manifestations. Therapeutic recommendations and some possible hazards following replacement transfusions are also considered.

A New Collection of Amblyomma parvitarsum (Acari: Ixodidae) in Peru, With Description of a Gynandromorph and Report of Rickettsia Detection

Adult stages of Amblyomma parvitarsum Neumann parasitize wild and domestic camelids of the genera Lama and Vicugna in highlands of Andean Plateau and Patagonia. Within the Peruvian Andes, few reports have documented this tick-host association, and although reported in Chile and Argentina, Rickettsia-infected A. parvitarsum remains undocumented for this country. Here we report a new collection of A. parvitarsum from Peru, the finding of the first gynandromorph for the species and high prevalence of Rickettsia in adult stages.

Outcomes of Vitreoretinal Surgery for Retinal Detachment after LASIK for Myopia

PURPOSE

To report and compare outcomes of vitreoretinal surgery for repair of retinal detachment in myopic patients with and without previous laser-assisted in situ keratomileusis (LASIK).

METHODS

This is a descriptive retrospective observational study with a control group for comparison that consisted of the analysis of clinical and surgical charts of patients who underwent vitreoretinal procedures for retinal detachment at the Fundación Oftalmologica Nacional between January 1995 and December 2002. The authors identified those myopic patients who had previous history of LASIK and an age- and myopia-matched control group without refractive surgery.

RESULTS

The sample contains 24 myopic eyes of 22 patients with previous LASIK and 23 myopic eyes without previous LASIK in the control group, matched by age and myopia. Mean refractive error was -9.4 D before LASIK for the cases group and -11.2 for the control group. Poor preoperative best-corrected visual acuity was present in 71% of cases and 61% of controls (p=0.489). Macula off retinal detachment was found in 17 eyes in both groups. Five eyes required at least two procedures, achieving 91% (20 eyes) reattachments at the end of follow-up in each group. Final best-corrected visual acuity was better than 20/100 in 15 eyes (62.5%) in the LASIK group and 17 eyes (74 %) in the control group (p=0.659).

CONCLUSIONS

Retinal detachment in patients with previous myopic LASIK has similar characteristics as in myopic patients without refractive surgery. Current vitreoretinal surgery is of good prognosis as the retina was successfully reattached in most cases in both groups.

Study of the GEM detector performance in BM@N experiment

BM@N is the fixed target experiment at the accelerator complex NICA-Nuclotron aimed to study nuclear matter in the relativistic heavy ion collisions. Triple-GEM detectors were identified as appropriate for the BM@N tracking system located inside the analyzing magnet. Seven GEM chambers are integrated into the BM@N experimental setup and data acquisition system. GEM construction, main characteristics and first obtained results of the GEM tracking system performance in the technical run with the deuteron beam are shortly reviewed.

MicroRNA-22 controls interferon alpha production and erythroid maturation in response to infectious stress in mice

MicroRNA-22 (miR-22) is a highly conserved microRNA that can regulate cell proliferation, oncogenesis, and cell maturation, especially during stress. In hematopoietic stem cells (HSCs), miR-22 has been reported to be involved in the regulation of key self-renewal factors, including Tet2. Recent work demonstrates that miR-22 also participates in regulation of the interferon (IFN) response, and expression profiling studies suggest that it is variably expressed at different stages in erythroid differentiation. We thus hypothesized that miR-22 regulates maturation of erythroid progenitors during stress hematopoiesis through its interaction with IFN. We compared the blood and bone marrow of wild-type (WT) and miR-22-deficient mice at baseline and upon infectious challenge with systemic lymphochoriomeningitis (LCMV) virus. miR-22-deficient mice maintained platelet counts better than WT mice during infection, but they showed significantly reduced red blood cells and hemoglobin. Analysis of bone marrow progenitors demonstrated better overall survival and improved HSC homeostasis in infected miR-22-null mice compared with WT, which was attributable to a blunted IFN response to LCMV challenge in the miR-22-null mice. We found that miR-22 was expressed exclusively in stage II erythroid precursors and downregulated upon infection in WT mice. Our results indicate that miR-22 promotes the IFN response to viral infection and that it functions at baseline as a brake to slow erythroid differentiation and maintain adequate erythroid potential. Impaired regulation of erythrogenesis in the absence of miR-22 can lead to anemia during infection.

Management of antiplatelet therapy in patients with coronary stents undergoing noncardiac surgery: association with adverse events

BACKGROUND

Perioperative discontinuation of antiplatelet therapy (APT) in patients with coronary stents has been associated with major adverse cardiac events. Our aim was to analyse the perioperative management of APT in such patients and its relationship to the incidence of major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events (MBE) in noncardiac surgery.

METHODS

We completed a prospective multicentre observational study of patients with coronary stents undergoing noncardiac surgery in 11 hospitals in Spain. The main objectives were to record perioperative events and prospectively analyse the management of APT, and to assess whether the different preoperative APT regimens were associated with MACCE and MBE.

RESULTS

Of 432 surgical procedures studied, 15% experienced a perioperative MACCE and 37% a MBE. Overall mortality was 3.0%. Presurgical APT was prescribed in 95% of procedures, and was preoperatively discontinued in 15%. Surgery was urgent or emergent in 22% of patients, 31% were ASA IV, and 38% had a Revised Cardiac Risk Index of IV. MACCE were related to recent myocardial infarction (P=0.038), chronic kidney disease (P<0.001), insulin-dependent diabetes (P=0.006) and no preoperative APT (P=0.018). MBE also increased MACCE risk (P<0.001). We found statin therapy (P=0.049) and obesity (P=0.016) to be protective factors for MACCE.

CONCLUSIONS

Patients with coronary stents undergoing noncardiac surgery suffer a high incidence of perioperative adverse events, even with perioperative APT. Major adverse cardiac and cerebrovascular events are mainly related to previous medical conditions and perioperative major bleeingn events. Our findings should be treated with caution when applied to an elective surgery population.

CLINICAL TRIAL REGISTRATION

NCT01171612.

[Massive pulmonary embolism. When medical treatment is not enough]

Emergency bedside veno-arterious ECMO implantation can be the only saving gesture in the suspicion of acute massive pulmonary embolism leading to haemodynamic failure, even before CT-scan imaging. Once the massive pulmonary embolism is confirmed it is possible to undergo surgical or percutaneous pulmonary thrombectomy, when thrombolytic therapy is contraindicated.

Inhibitors of PEX14 disrupt protein import into glycosomes and kill Trypanosoma parasites

The parasitic protists of the Trypanosoma genus infect humans and domestic mammals, causing severe mortality and huge economic losses. The most threatening trypanosomiasis is Chagas disease, affecting up to 12 million people in the Americas. We report a way to selectively kill Trypanosoma by blocking glycosomal/peroxisomal import that depends on the PEX14-PEX5 protein-protein interaction. We developed small molecules that efficiently disrupt the PEX14-PEX5 interaction. This results in mislocalization of glycosomal enzymes, causing metabolic catastrophe, and it kills the parasite. High-resolution x-ray structures and nuclear magnetic resonance data enabled the efficient design of inhibitors with trypanocidal activities comparable to approved medications. These results identify PEX14 as an "Achilles' heel" of the Trypanosoma suitable for the development of new therapies against trypanosomiases and provide the structural basis for their development.

Plasmodium DNA-mediated TLR9 activation of T-bet+ B cells contributes to autoimmune anaemia during malaria

Infectious pathogens contribute to the development of autoimmune disorders, but the mechanisms connecting these processes are incompletely understood. Here we show that Plasmodium DNA induces autoreactive responses against erythrocytes by activating a population of B cells expressing CD11c and the transcription factor T-bet, which become major producers of autoantibodies that promote malarial anaemia. Additionally, we identify parasite DNA-sensing through Toll-like receptor 9 (TLR9) along with inflammatory cytokine receptor IFN-γ receptor (IFN-γR) as essential signals that synergize to promote the development and appearance of these autoreactive T-bet+ B cells. The lack of any of these signals ameliorates malarial anaemia during infection in a mouse model. We also identify both expansion of T-bet+ B cells and production of anti-erythrocyte antibodies in ex vivo cultures of naive human peripheral blood mononuclear cells (PBMC) exposed to P. falciprum infected erythrocyte lysates. We propose that synergistic TLR9/IFN-γR activation of T-bet+ B cells is a mechanism underlying infection-induced autoimmune-like responses.

Effect of Light-Curing Exposure Time, Shade, and Thickness on the Depth of Cure of Bulk Fill Composites

Purpose:

To investigate the effect of different light exposure times, shades, and thicknesses on the depth of cure (DOC) of bulk fill composites.

Methods and Materials:

Two bulk fill composites, Tetric EvoCeram Bulk Fill (TBF) and Sonic Fill (SF), and a conventional composite, Filtek Supreme Ultra (FSU), were evaluated. Samples (n=10) were made using two different shades (light and dark), thicknesses (2 and 4 mm) and exposure times (20 and 40 seconds). A Tukon 2100B-testing machine was used to obtain three Knoop hardness numbers (KHNs) measured at the top and bottom of each sample, and DOC was calculated as the bottom/top ratio. Statistical analysis was done using a Student t-test for comparisons between groups with a Bonferroni correction of p &lt; 0.004.

Results:

Top hardness values ranged from 79.79 to 85.07 for FSU, 69.49 to 91.65 for SF, and 51.01 to 57.82 for TBF. Bottom KHNs ranged from 23.54 to 73.25 for FSU, 45.74 to 77.12 for SF, and 36.95 to 52.51 for TBF. TBF had the lowest overall KHNs. Light-curing exposure time, shade, and material thickness influenced the DOC in most groups, especially at 4-mm depths. A higher bottom/top ratio was achieved when a 40-second cure was compared to a 20-second cure, when light shades were compared to dark shades, and when 2-mm increments were compared to 4-mm increments.