Revascularización. Reporte de un Caso Clínico.

El daño pulpar como consecuencia de traumatismos o caries en dientes inmaduros puede conducir a la pérdida de la vitalidad y a la interrupción del desarrollo radicular, dando como resultado raíces cortas con paredes delgadas con riesgo a la fractura radicular .La revascularización es un tratamiento regenerativo con un enfoque biológico para dientes inmaduros con pulpa necrótica causada por caries o traumatismos que, a diferencia de la apicoformación, permite el desarrollo radicular continuo

Prognostic significance of pathological response after neoadjuvant chemotherapy or chemoradiation for locally advanced cervical carcinoma

BACKGROUND: Cisplatin-based chemoradiation is the standard of care for locally advanced cervical cancer patients; however, neoadjuvant modalities are currently being tested. Neoadjuvant studies in several tumor types have underscored the prognostic significance of pathological response for survival; however there is a paucity of studies in cervical cancer investigating this issue. METHODS: Four cohorts of patients with locally advanced cervical carcinoma (stages IB2-IIIB); included prospectively in phase II protocols of either neoadjuvant chemotherapy with 1) cisplatin-gemcitabine, 2) oxaliplatin-gemcitabine, 3) carboplatin-paclitaxel or 4) chemoradiation with cisplatin or cisplatin-gemcitabine followed by radical hysterectomy were analyzed for pathological response and survival. RESULTS: One-hundred and fifty three (86%) of the 178 patients treated within these trials, underwent radical hysterectomy and were analyzed. Overall, the mean age was 44.7 and almost two-thirds were FIGO stage IIB. Pathological response rates were as follows: Complete (pCR) in 60 cases (39.2%), Near-complete (p-Near-CR) in 24 (15.6 %) and partial (pPR) in 69 cases (45.1%). A higher proportion rate of pCR was observed in patients treated with chemoradiotherapy (with cisplatin [19/40, 47.5%]; or with cisplatin-gemcitabine [24/41, 58.5%] compared with patients receiving only chemotherapy, 6/23 (26%), 3/8 (37.5%) and 8/41 (19.5%) for cisplatin-gemcitabine, oxaliplatin-gemcitabine and carboplatin-paclitaxel respectively [p = 0.0001]). A total of 29 relapses (18.9%) were documented. The pathological response was the only factor influencing on relapse, since only 4/60 (6.6%) patients with pCR relapsed, compared with 25/93 (26.8%) patients with viable tumor, either pNear-CR or pPR (p = 0.001). Overall survival was 98.3% in patients with pCR versus 83% for patients with either pNear-CR or pPR (p = 0.009). CONCLUSION: Complete pathological response but no Near-complete and partial responses is associated with longer survival in cervical cancer patients treated with neoadjuvant chemotherapy or chemoradiotherapy

Pathogenic variant profile in DNA damage response genes correlates with metastatic breast cancer progression-free survival in a Mexican-mestizo population

IntroductionMetastatic breast cancer causes the most breast cancer-related deaths around the world, especially in countries where breast cancer is detected late into its development. Genetic testing for cancer susceptibility started with the BRCA 1 and 2 genes. Still, recent research has shown that variations in other members of the DNA damage response (DDR) are also associated with elevated cancer risk, opening new opportunities for enhanced genetic testing strategies.MethodsWe sequenced BRCA1/2 and twelve other DDR genes from a Mexican-mestizo population of 40 metastatic breast cancer patients through semiconductor sequencing.ResultsOverall, we found 22 variants –9 of them reported for the first time– and a strikingly high proportion of variations in ARID1A. The presence of at least one variant in the ARID1A, BRCA1, BRCA2, or FANCA genes was associated with worse progression-free survival and overall survival in our patient cohort.DiscussionOur results reflected the unique characteristics of the Mexican-mestizo population as the proportion of variants we found differed from that of other global populations. Based on these findings, we suggest routine screening for variants in ARID1A along with BRCA1/2 in breast cancer patients from the Mexican-mestizo population

Routine management of locally advanced cervical cancer with concurrent radiation and cisplatin. Five-year results

BACKGROUND: Globally, cervical cancer primarily affects socially disadvantaged women. Five randomized trials were the foundation for adopting cisplatin-based chemotherapy during radiation as the standard of care for high-risk patients after primary radical hysterectomy who require adjuvant radiation and for locally advanced patients treated with definitive radiation. These results were obtained in clinical trials performed in carefully prepared academic centers; hence, we sought to determine whether these results could be reproduced when patients were treated on an out-of-protocol basis. METHODS: We reviewed the files of 294 patients with locally advanced cervical cancer who received radiation plus weekly cisplatin as routine management between 1999 to 2003, and analyzed treatment compliance, response rate, toxicity, and survival. RESULTS: A total of 294 patients who received radiation and cisplatin were analyzed. Mean age was 43.8 years (range, 26–68 years). The majority of cases were squamous cell carcinoma (87.8%), and distribution according to International Federation of Gynecology and Obstetrics (FIGO) stage was as follows: IB2-IIA, 23%; IIB, 53.3%, and IIIB, 23%; there were only two IVA cases. Overall, 96% of patients completed external beam, and intracavitary therapy. The majority of patients (67%) received the planned six courses of weekly cisplatin. Complete responses were achieved in 243 (83%) patients, whereas 51 (17%) had either persistent (32 patients, 10.8%) or progressive (19 patients, 6.4%) disease. At median follow-up (28 months; range, 2–68 months), 36 patients (12.2%) have relapsed (locally 30.5, and systemically, 69.5%). The most common toxicities were hematologic and gastrointestinal, in the majority of cases considered mild-moderate. At median follow-up (28 months; range, 2–68 months), overall and progression-free survival are 76.5 and 67%, respectively. CONCLUSION: Our results support use of chemoradiation with six weekly applications of cisplatin at 40 mg/m(2 )during external radiation for routine management of locally advanced cervical cancer

Investigación y conceptualización del diseño

Departamento de Procesos y Técnicas de Realización, Área de investigación Nuevas Tecnologías.El propósito de este libro es despertar y transmitir el interés, por la investigación y conceptualización del diseño. Los artículos que se presentan en este libro, muestran la intención de los editores de abrir la publicación a la discusión académica novedosa, e inteligente, en una experiencia interdisciplinaria. Así, el tema principal del primer capítulo es el diseño incluyente donde la responsabilidad del diseñador radica en comprender las necesidades y experiencias de los usuarios y asegurarse que sus diseños sean inclusivos desde el principio. El siguiente capítulo ahonda sobre la transformación de la pedagogía del diseño; El tercer artículo nos presenta una serie de formatos muy útiles para reflexionar ante las carencias o excesos de cada una de las partes que conforman un proyecto de investigación; en el cuarto capítulo se presenta al diseño como instrumento de influencia en la mejora de la calidad de vida de las y los ciudadanos; la publicación continúa con el trabajo donde se ubica la metodología de la investigación participativa como una metodología de investigación aplicada principalmente en los ámbitos de las ciencias sociales; el libro continúa con La metodología en el campo de la representación en el proceso de enseñanza aprendizaje del diseño. Caso de estudio taller de proyectos arquitectónicos, el cual se enfoca a la arquitectura pero éste en el ámbito de la enseñanza; la siguiente lectura aborda el tema del uso del diseño centrado en el usuario el cual parte de comprender y responder a las necesidades de los usuarios a través de la investigación, diseño orientado a objetivos, pruebas y enfoque en la accesibilidad; para continuar, en el penúltimo artículo se hace un análisis detallado sobre el desarrollo del conocimiento y el método científico y cómo impulsó la necesidad de llevar a cabo investigación formal dentro del diseño y su desarrollo; para cerrar Carlos Córdoba Cely y Yadira Alatriste Martínez nos presentan El taller y el laboratorio como estrategia de autonomía creativa. Nos hablan de la larga tradición en la academia que se remonta a la primera escuela de diseño.Directoras de la publicación: Adriana Acero Gutiérrez; Beatriz Irene Mejía Modesto; coordinadores: Lorenzo Miguel Ángel Herrera Batista; Marco Antonio Marín Álvarez; Yadira Alatriste Martínez; Adriana Acero Gutiérrez; Beatriz Irene Mejía Modest

Full-Exon Pyrosequencing Screening of BRCA Germline Mutations in Mexican Women with Inherited Breast and Ovarian Cancer

Hereditary breast cancer comprises 10% of all breast cancers. The most prevalent genes causing this pathology are BRCA1 and BRCA2 (breast cancer early onset 1 and 2), which also predispose to other cancers. Despite the outstanding relevance of genetic screening of BRCA deleterious variants in patients with a history of familial cancer, this practice is not common in Latin American public institutions. In this work we assessed mutations in the entire exonic and splice-site regions of BRCA in 39 patients with breast and ovarian cancer and with familial history of breast cancer or with clinical features suggestive for BRCA mutations by massive parallel pyrosequencing. First we evaluated the method with controls and found 41–485 reads per sequence in BRCA pathogenic mutations. Negative controls did not show deleterious variants, confirming the suitability of the approach. In patients diagnosed with cancer we found 4 novel deleterious mutations (c.2805_2808delAGAT and c.3124_3133delAGCAATATTA in BRCA1; c.2639_2640delTG and c.5114_5117delTAAA in BRCA2). The prevalence of BRCA mutations in these patients was 10.2%. Moreover, we discovered 16 variants with unknown clinical significance (11 in exons and 5 in introns); 4 were predicted as possibly pathogenic by in silico analyses, and 3 have not been described previously. This study illustrates how massive pyrosequencing technology can be applied to screen for BRCA mutations in the whole exonic and splice regions in patients with suspected BRCA-related cancers. This is the first effort to analyse the mutational status of BRCA genes on a Mexican-mestizo population by means of pyrosequencing

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Near Optimal Solution for Continuous Move Transportation with Time Windows and Dock Service Constraints

Abstract. We consider a pickup and delivery vehicle routing problem (PDP) commonly found in the real-world logistics operations. The problem includes a set of practical complications that have received little attention in the vehicle routing literature. There are multiple vehicle types available to cover a set of transportation orders with different pickup and delivery time windows. Transportation orders and vehicle types must satisfy a set of compatibility constraints. In addition, we include some dock service capacity constraints as required in real-world operations when there are a large number of vehicles to schedule. This problem requires to be attended on large scale instances: transportation orders ≥ 500, single-haul vehicles ≥ 100. Exact algorithms are not suitable for large scale instances. We propose a model to solve the problem in three stages. The first stage constructs initial solutions at the aggregated level relaxing time windows and dock service constraints of the original problem. The other two stages impose time windows and dock service constraints within a cut generation scheme. Our results are favorable in finding good quality solutions in relatively short computational time