Cáncer mucinoso de la mama

 Mujer de 49 años, acude a la Unidad de diagnóstico integral de la mama por presentar tumoración palpable, no dolorosa, en los cuadrantes superiores en la mama izquierda. Se realiza mamografía diagnóstica y estudio 3D tomo síntesis, evidenciando una tumoración de márgenes lobulados, sospechosa de malignidad, se analizó la estructura interna de la lesión reportada mediante ecografía mamaria bilateral con transductor de alta resolución y multi frecuencia, evidenciando que tenía estructura interna heterogénea, de tipo sólido-quístico, con áreas de apariencia quística periférica que por su sospechosa, se realiza biopsia, obteniendo el resultado de Cáncer mucinoso de mama de patrón micro papilar. El estudio por resonancia magnética nos permite obtener mayores características de la etiológica mencionada y sobre la verdadera extensión de la enfermedad, siendo esta negativa.A 49-year-old woman was admitted to the integral breast diagnostic Unit due to a palpable, non-painful tumor in the upper quadrants of the left breast. Diagnostic mammography and 3D tomography study were performed, showing a tumor with lobulated margins, suspicious of malignancy, the internal structure of the reported lesion was analyzed by bilateral breast ultrasound with a high-resolution and multi-frequency transducer, showing that it had a heterogeneous internal structure solid-cystic type, with areas of peripheral cystic appearance that, due to their suspicion, a biopsy is performed, obtaining the result of mucinous breast cancer with a micropapillary pattern. The magnetic resonance study allows us to obtain greater characteristics of the aforementioned etiology and the true extension of the disease, this being negative

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Correção cirúrgica da origem anômala de artéria pulmonar direita em aorta ascendente

A origem anômala da artéria pulmonar direita em aorta ascendente é uma malformação congênita rara. Descrevemos o caso de uma criança submetida à correção cirúrgica com anastomose direta entre a artéria pulmonar direita e o tronco pulmonar. Após 18 meses a paciente permanece assintomática sem apresentar estenose residual significativa na angioressonância

TAF15 amyloid filaments in frontotemporal lobar degeneration.

Acknowledgements: We thank the individuals and their families for donating brain tissue; the Queen Square Brain Bank for Neurological Disorders at University College London Queen Square Institute of Neurology, which receives support from the Reta Lila Weston Institute for Neurological Studies, for supplying tissue from individuals 2 and 3; J. Grafman for supplying tissue from individual 4; M. Jacobsen for help with neuropathological examinations; R. Richardson, K. Cox and N. Maynard for help with histology and immunohistochemistry; J. Grimmett, T. Darling and I. Clayson for help with high-performance computing; K. Yamashita and G. Murshudov for help with model refinements; and T. Behr, A. Bertolotti, R. Chen, S. Davies, M. Goedert, D. Hilvert and S. Scheres for discussions. This work was supported by the electron microscopy and scientific computing facilities at the MRC Laboratory of Molecular Biology and by the Center for Medical Genomics at the Indiana University School of Medicine. This work was supported by the Medical Research Council as part of United Kingdom Research and Innovation (also known as UK Research and Innovation) (no. MC_UP_1201/25 to B.R.-F.); the US National Institutes of Health (nos. U01-NS110437, RF1-AG071177 and R01-AG080001 to R.V. and B.G.); the Alzheimer’s Society (nos. AS-PG-18-004 and AS-PG-21-004 to T.L.); the Association for Frontotemporal Degeneration (no. 2019-0009 to Y.B. and T.L.); a Swiss National Science Foundation Postdoctoral Fellowship (no. P500PB_206890 to S.T.); and a Leverhulme Early Career Fellowship (no. ECF-2022-610 to D.A.). For the purposes of open access, the MRC Laboratory of Molecular Biology has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising.Frontotemporal lobar degeneration (FTLD) causes frontotemporal dementia (FTD), the most common form of dementia after Alzheimer's disease, and is often also associated with motor disorders1. The pathological hallmarks of FTLD are neuronal inclusions of specific, abnormally assembled proteins2. In the majority of cases the inclusions contain amyloid filament assemblies of TAR DNA-binding protein 43 (TDP-43) or tau, with distinct filament structures characterizing different FTLD subtypes3,4. The presence of amyloid filaments and their identities and structures in the remaining approximately 10% of FTLD cases are unknown but are widely believed to be composed of the protein fused in sarcoma (FUS, also known as translocated in liposarcoma). As such, these cases are commonly referred to as FTLD-FUS. Here we used cryogenic electron microscopy (cryo-EM) to determine the structures of amyloid filaments extracted from the prefrontal and temporal cortices of four individuals with FTLD-FUS. Surprisingly, we found abundant amyloid filaments of the FUS homologue TATA-binding protein-associated factor 15 (TAF15, also known as TATA-binding protein-associated factor 2N) rather than of FUS itself. The filament fold is formed from residues 7-99 in the low-complexity domain (LCD) of TAF15 and was identical between individuals. Furthermore, we found TAF15 filaments with the same fold in the motor cortex and brainstem of two of the individuals, both showing upper and lower motor neuron pathology. The formation of TAF15 amyloid filaments with a characteristic fold in FTLD establishes TAF15 proteinopathy in neurodegenerative disease. The structure of TAF15 amyloid filaments provides a basis for the development of model systems of neurodegenerative disease, as well as for the design of diagnostic and therapeutic tools targeting TAF15 proteinopathy