How does a cadaver model work for testing ultrasound diagnostic capability for rheumatic-like tendon damage?

To establish whether a cadaver model can serve as an effective surrogate for the detection of tendon damage characteristic of rheumatoid arthritis (RA). In addition, we evaluated intraobserver and interobserver agreement in the grading of RA-like tendon tears shown by US, as well as the concordance between the US findings and the surgically induced lesions in the cadaver model. RA-like tendon damage was surgically induced in the tibialis anterior tendon (TAT) and tibialis posterior tendon (TPT) of ten ankle/foot fresh-frozen cadaveric specimens. Of the 20 tendons examined, six were randomly assigned a surgically induced partial tear; six a complete tear; and eight left undamaged. Three rheumatologists, experts in musculoskeletal US, assessed from 1 to 5 the quality of US imaging of the cadaveric models on a Likert scale. Tendons were then categorized as having either no damage, (0); partial tear, (1); or complete tear (2). All 20 tendons were blindly and independently evaluated twice, over two rounds, by each of the three observers. Overall, technical performance was satisfactory for all items in the two rounds (all values over 2.9 in a Likert scale 1-5). Intraobserver and interobserver agreement for US grading of tendon damage was good (mean κ values 0.62 and 0.71, respectively), with greater reliability found in the TAT than the TPT. Concordance between US findings and experimental tendon lesions was acceptable (70-100 %), again greater for the TAT than for the TPT. A cadaver model with surgically created tendon damage can be useful in evaluating US metric properties of RA tendon lesions

RAF1 kinase activity is dispensable for KRAS/p53 mutant lung tumor progression.

We thank Dr. Shiva Malek and her colleagues (Genentech Inc.) for sharing their results with us before publication. We also thank M. San Roman, R. Villar, M.C. Gonzalez, A. Lopez, N. Cabrera, P. Villanueva, J. Condo, O. Dominguez, and S. Ortega for excellent technical support. This work was supported by grants from the European Research Council (ERC-2015-AdG/695566, THERACAN); the Spanish Ministry of Science, Innovation, and Universities (RTC-2017-6576-1 and RTI2018094664-B-I00) and the Autonomous Community of Madrid (B2017/BMD-3884 iLUNG-CM) to M.B., as well as by a grant from the Spanish Ministry of Science, Innovation and Universities (RTI2018-094664-B-I00) to M.B. and M.M. M.B. is a recipient of an Endowed Chair from the AXA Research Fund. M.S., P.N., and F.F.-G. were supported by FPU fellowships from the Spanish Ministry of Education. L.E.-B. was a recipient of an FPI fellowship from the Spanish Ministry of Economy and Competitiveness. S.G.-A. is a recipient of a postdoctoral fellowship from the Asociacion Espanola Contra el Cancer (AECC).S

Competence to restart meiosis of oocytes from different follicle sizes obtained from slaughterhouse ovaries

Se evaluó la capacidad de los ovocitos de folículos según su tamaño para reiniciar la meiosis. Los folículos se midieron y clasificaron como Grupo 1 (G1 <4 mm), Grupo 2 (G2 4-8 mm) y Grupo 3 (G3 >8 mm). La aspiración se realizó por grupo con una aguja 21G conectada a una bomba de vacío, con una presión de 65 mmHg. Los complejos cúmulos de ovocitos (COC) recuperados se clasificaron como adecuados y no adecuados para la producción de embriones in vitro, de acuerdo con las características del cúmulo y del citoplasma. Los COC elegibles e inadecuados se valoraron con la prueba de azul brillante de Cresilo (BCB) y se clasificaron en BCB+ y BCB-. La maduración in vitro (IVM) se llevó a cabo en microgotas, incubadas en una cámara de CO2 al 5%, 38.5 °C y 90% de humedad durante 24 horas. La progresión meiótica se determinó por extrusión del corpúsculo polar mediante epifluorescencia bajo un microscopio invertido. La morfometría de ovocitos se estableció mediante una cámara de alta definición (Excelis AU-600-HD) y un software (AmScope v.3.7). El porcentaje de recuperación de ovocitos fue mayor de 63%. Los folículos de G2 proporcionaron un mayor porcentaje de COC elegibles (65.7%), donde el 59% de este grupo se clasificó como BCB+. Los ovocitos aptos de G1 y G2 reanudaron la meiosis en un 75%. Además, se observó que los ovocitos después de IVM redujeron su diámetro. Se concluye que los ovocitos de folículos entre 4-8 mm (G2) proporcionan un mayor porcentaje de COC maduros; sin embargo, el 50% de folículos <4 mm (G1) son una fuente prometedora de ovocitos viables, por lo que deben usarse para la producción de embriones in vitro.The competence of oocytes according to follicle size to restart meiosis was evaluated. The follicles were measured and classified as Group 1 (G1 <4 mm), Group 2 (G2 4-8 mm) and Group 3 (G3 >8 mm). The aspiration was performed by group with a 21G needle connected to a vacuum pump, with a pressure of 65 mmHg. The complex oocyte clusters (COCs) recovered were classified as suitable and unsuitable to produce embryos in vitro, according to the characteristics of the cumulus and the cytoplasm. Eligible and unsuitable COCs were assessed with the Brilliant Cresyl Blue (BCB) and were classified into BCB+ and BCB-. In vitro maturation (IVM) was carried out in microdroplets, incubated in a 5% CO2 chamber, 38.5 °C and 90% humidity for 24 hours. The meiotic progression was determined by extrusion of the polar corpuscle by epifluorescence under an inverted microscope. Oocyte morphometry was established using a high definition camera (Excelis AU-600-HD) and software (AmScope v.3.7). The recovery percentage of oocytes was greater than 63%. The G2 follicles provided a higher percentage of eligible COCs (65.7%), where 59% of this group was classified as BCB+. The fit oocytes of G1 and G2 resumed meiosis by 75%. In addition, it was observed that oocytes after IVM reduced their diameter. It is concluded that follicle oocytes between 4-8 mm (G2) provide a higher percentage of mature COCs; however, 50% of follicles <4 mm (G1) are a promising source of viable oocytes, so they should be used for in vitro embryo production

Transiciones, conflictos y democracia : estudios de coyuntura

México ha vivido un largo proceso de transición que ha desencadenado dinamismos económicos, culturales y políticos. En la actual coyuntura, estos dinamismos muestran toda su complejidad, su inevitable articulación y la tensión entre las fuerzas que intentan sostener un viejo modelo de gobernar y decidir el rumbo del país, y aquellas que buscan abrirse a un espectro mucho más amplio y diversificado de actores. En ellos se conjuntan las aspiraciones más legítimas de los mexicanos por avanzar en el reconocimiento y respeto de la pluralidad étnica, de género y entre generaciones, y por impulsar una dinámica en la que —en medio de los procesos de mundialización— los distintos grupos e intereses de los mexicanos puedan ser incluidos. La transición mexicana tiende a centrarse en la dimensión política. La intensidad que cobran los procesos políticos y el énfasis que importantes analistas ponen en dichos procesos, contribuyen a que esta asociación vaya cobrandoíuerza. En este sentido, es necesario advertir que en las transiciones la tendencia privatizadora, la reducción del gasto social, así como la necesidad de pactos sociales que sean respetados, la participación creciente de la sociedad civil, etc. son factores importantes que, en medio de contradicciones, van generando nuevos esquemas de relación entre gobierno y sociedad.ITESO, A.C

Telemedicine ultrasound assessment for placenta accreta spectrum: utility and interobserver reliability of asynchronous remote imaging review

Objective: Management of patients with placenta accreta spectrum (PAS) by trained multidisciplinary teams is associated with improved outcomes. Ultrasound can predict intraoperative risks, but expert ultrasound imaging of PAS is often limited. Telemedicine is used increasingly in obstetrics, permitting expert consultation when essential resources are not available locally. Our objective was to evaluate the feasibility of teleconsultation using standardized ultrasound image acquisition and reporting, and to correlate prognosis with intraoperative findings in patients at risk for PAS. Methods: A total of 12 PAS imaging experts (teleconsultants) were selected to asynchronously review deidentified standardized grayscale and color Doppler ultrasound images for five patients who had completed treatment for PAS, resulting in 60 individual teleconsultations. All patients were managed at a center using standardized imaging acquisition and intraoperative topographic classification to individualize surgical management. Teleconsultants reported the predicted topographic classification and recommended a surgical approach based on the topographic classification algorithm. Prognoses were compared with that reported by the local sonologist and with intraoperative findings. Results: In all five patients, local sonologist prognosis and antenatal topographic classification was confirmed during surgery and the final surgical approach matched that which was recommended preoperatively. Teleconsultant antenatal evaluation and management plans matched those of the local team in 71.7% of the cases. When reports differed, PAS severity was overestimated in nine reviews (16.9%) and was underestimated in six reviews (11.3%). Conclusion: Remote imaging teleconsultation provides accurate prenatal staging in most patients at risk for PAS. Teleconsultation is a feasible strategy to improve prenatal imaging, management planning, and guidance for local teams in settings with limited healthcare resources

Tumor regression and resistance mechanisms upon CDK4 and RAF1 inactivation in KRAS/P53 mutant lung adenocarcinomas.

KRAS mutant lung adenocarcinomas remain intractable for targeted therapies. Genetic interrogation of KRAS downstream effectors, including the MAPK pathway and the interphase CDKs, identified CDK4 and RAF1 as the only targets whose genetic inactivation induces therapeutic responses without causing unacceptable toxicities. Concomitant CDK4 inactivation and RAF1 ablation prevented tumor progression and induced complete regression in 25% of KRAS/p53-driven advanced lung tumors, yet a significant percentage of those tumors that underwent partial regression retained a population of CDK4/RAF1-resistant cells. Characterization of these cells revealed two independent resistance mechanisms implicating hypermethylation of several tumor suppressors and increased PI3K activity. Importantly, these CDK4/RAF1-resistant cells can be pharmacologically controlled. These studies open the door to new therapeutic strategies to treat KRAS mutant lung cancer, including resistant tumors.We thank S. Ortega for the generation of the Cdk4FxKD mouse model; and M. San Roman, R. Villar, M. C. Gonzalez, A. Lopez, N. Cabrera, P. Villanueva, J. Condo, J. Klett, A. Cebria, A. Otero, O. Dominguez, G. Luengo, G. Garaulet, F. Mulero, and D. Megias for excellent technical support. This work was supported by European Research Council Grant ERC-2015-AdG/695566, THERACAN, Spanish Ministry of Science, Innovation, and Universities Grant RTC-2017-6576-1, and the Autonomous Community of Madrid Grant B2017/BMD-3884 iLUNG-CM (to M.B.); Spanish Ministry of Science, Innovation, and Universities Grant RTI2018-094664B-I00 (to M.B. and M.M.); and National Natural Science Foundation of China Grant 31771469 (to H.W.). M.B. is a recipient of an Endowed Chair from the AXA Research Fund. L.E.-B. is the recipient of an FPI fellowship from the Spanish Ministry of Economy and Competitiveness. F.F.-G., M.S., and P.N. were supported by an FPU fellowships from the Spanish Ministry of Education.S

¿COVID-19 la pandemia y que sabemos de ella? Y como la afronta el Perú.

The novel coronavirus disease 2019 or COVID-19, had been reported for the first time in December 2019, in Wuhan China. To date, around 6 777 435 cases of COVID-19 were confirmed and 395 597 deaths worldwide. The COVID-19 outbreak is the largest in the past decades and is caused by a newly discovered coronavirus (SARS-CoV-2). On March 11th, 2020, the world Health Organization (WHO) has declared the COVID-19 a “Pandemic” with high rate of morbidity and mortality. This review synthesizes the scientific evidence and reports in the literature. The content of this manuscript presents the opinions of specialists and we present our interpretation and recommendations to the Peruvian government.La enfermedad del coronavirus o COVID-19, fue reportada por la primera vez en diciembre del 2019, en la ciudad de Wuhan China. A la fecha más de 6 777 435 casos de COVID-19 y 395 597muertes han sido reportadas globalmente. El brote del COVID-19 es causado por el virus SARS-CoV-2, siendo el brote más grande de las últimas décadas. Por lo cual la Organización Mundial de Salud (OMS) declaró al COVID-19 como pandemia (marzo 11, 2020), asociada con una importante morbilidad y mortalidad. Esta síntesis bibliográfica recapitula las evidencias científicas y los reportes publicados en revistas médicas. El contenido de este manuscrito recoge las opiniones y experiencias de especialistas. Y presentamos nuestra interpretación y recomendaciones a gobierno peruano

Conocimientos sobre la tuberculosis en usuarios del transporte masivo en Santiago de Cali, Colombia

Knowledge about Tuberculosis (TB) is limited among the general population of Cali, the second city in Colombia with the highest burden of TB. Here, we sought to determine the level of knowledge about TB among users of the public transportation system of the city. We conducted a cross-sectional study using a structured questionnaire to collect information in 12 main stations of the transport system. Data were collected in a working day of March 2017. Out of 193 interviewed users, 80% answered to have limited knowledge about TB. However, most of the participants identified coughing as a symptom of TB (74.6%) and recognized that TB is a contagious disease (75.1%) that could be transmitted by the air (61.7%). Seventy percent of participants knew that TB is a curable disease. On the other hand, there were misconceptions regarding TB transmission and the identification of other classical symptoms of TB was limited. Understanding the level of knowledge about TB among the general population is key to design communicative and educational strategies to control and prevent this disease.Poco se conoce sobre los conocimientos sobre tuberculosis (TB) en Cali, segunda ciudad colombiana con mayor carga de la enfermedad. Esta investigación buscó determinar el grado de conocimientos sobre TB en usuarios del transporte masivo. Se realizó un estudio descriptivo de corte transversal aplicando un cuestionario a usuarios de 12 estaciones principales del sistema de transporte público en un día laboral de marzo de 2017. De 193 encuestados, el 80% manifestó conocer poco o nada sobre TB. La mayoría identificó la tos como síntoma (74,6%) y refirió que es una enfermedad contagiosa (75,1%), transmitida por aire (61,7%) y curable (70,5%). No es tan frecuente la identificación de otros síntomas y hay concepciones erróneas sobre la transmisión. Identificar los conocimientos de la población acerca de la enfermedad permite orientar estrategias comunicativas y educativas para prevenir y controlar la TB, dirigidas al público que converge en el sistema de transporte masivo.&nbsp