177 research outputs found

    Moir\'e Engineering in 2D Heterostructures with Process-Induced Strain

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    We report deterministic control over moir\'e superlattice geometry in twisted bilayer graphene by implementing designable device-level heterostrain with process-induced strain engineering. We quantify strain and moir\'e interference with Raman spectroscopy through in-plane and moir\'e-activated phonon mode shifts. Results support systematic C3_{3} rotational symmetry breaking and tunable periodicity in moir\'e superlattices under the application of uniaxial or biaxial heterostrain, confirmed with density functional theory based first principles calculations. This provides a method to not only tune moir\'e interference without additional twisting, but also allows for a systematic pathway to explore new van der Waals based moir\'e superlattice symmetries by deterministic design

    NLRP3 inflammasome activation is required for fibrosis development in NAFLD

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    NLR inflammasomes, caspase 1 activation platforms critical for processing key pro-inflammatory cytokines, have been implicated in the development of nonalcoholic fatty liver disease (NAFLD). As the direct role of the NLRP3 inflammasome remains unclear, we tested effects of persistent NLRP3 activation as a contributor to NAFLD development and, in particular, as a modulator of progression from benign hepatic steatosis to steatohepatitis during diet-induced NAFLD. Gain of function tamoxifen-inducible Nlrp3 knock-in mice allowing for in vivo temporal control of NLRP3 activation and loss of function Nlrp3 knockout mice were placed on short-term choline-deficient amino acid-defined (CDAA) diet, to induce isolated hepatic steatosis or long-term CDAA exposure, to induce severe steatohepatitis and fibrosis, respectively. Expression of NLRP3 associated proteins was assessed in liver biopsies of a well-characterized group of patients with the full spectrum of NAFLD. Nlrp3−/− mice were protected from long-term feeding CDAA-induced hepatomegaly, liver injury, and infiltration of activated macrophages. More importantly, Nlrp3−/− mice showed marked protection from CDAA-induced liver fibrosis. After 4 weeks on CDAA diet, wild-type (WT) animals showed isolated hepatic steatosis while Nlrp3 knock-in mice showed severe liver inflammation, with increased infiltration of activated macrophages and early signs of liver fibrosis. In the liver samples of patients with NAFLD, inflammasome components were significantly increased in those patients with nonalcoholic steatohepatitis (NASH) when compared to those with non-NASH NAFLD with mRNA levels of pro-IL1 beta correlated to levels of COL1A1. Our study uncovers a crucial role for the NLRP3 inflammasome in the development of NAFLD. These findings may lead to novel therapeutic strategies aimed at halting the progression of hepatic steatosis to the more severe forms of this disease.Fil: Wree, Alexander. University of California at San Diego; Estados Unidos. University Hospital Essen; AlemaniaFil: McGeough, Matthew D.. University of California at San Diego; Estados UnidosFil: Peña, Carla A.. University of California at San Diego; Estados UnidosFil: Schlattjan, Martin. University Hospital Essen; AlemaniaFil: Li, Hongying. University of California at San Diego; Estados UnidosFil: Inzaugarat, Maria Eugenia. Consejo Nacional de Investigaciones CientĂ­ficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Houssay. Instituto de InmunologĂ­a, GenĂ©tica y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de InmunologĂ­a, GenĂ©tica y Metabolismo; ArgentinaFil: Messer, Karen. University of California at San Diego; Estados UnidosFil: Canbay, Ali. University Hospital Essen; AlemaniaFil: Hoffman, Hal M.. University of California at San Diego; Estados Unidos. Ludwig Institute of Cancer Research; Estados UnidosFil: Feldstein, Ariel E.. University of California at San Diego; Estados Unido

    Laparoscopic versus open colectomy for acute complicated diverticulitis: a comparative study of outcomes - a systematic review

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    Acute complicated diverticulitis presents a more severe form of diverticular illness frequently needing urgent medical intervention and possibly surgical therapy. The aim of this review is to gather conclusive evidence from the literature comparing laparoscopic techniques to open and conservative ones in order to determine the most effective treatment plan for complicated diverticulitis. Online databases like PubMed, Google Scholar, Cochrane, Elsevier and many others were systematically searched according to an inclusion criterion to obtain a total of 13 studies to be included in the review. 8/13 studies presented short term outcomes while 5/13 studies concluded with long term outcomes following index surgeries. Based on the end results, it can be concluded that laparoscopic surgery, in particular laparoscopic colon resection is superior to other techniques in treating complicated diverticulitis in terms of fewer short-term complications, low mortality rate better quality of life with few recurrence rates. However, other approaches have their own advantages and can be given priority based on the unique presentation of each case. The clinicians are advised to make informed decisions keeping in view all the patient and disease associated aspects

    Mitochondrial peptide humanin facilitates chemoresistance in glioblastoma cells

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    Humanin (HN) is a mitochondrial-derived peptide with robust cytoprotective effects in many cell types. Although the administration of HN analogs has been proposed to treat degenerative diseases, its role in the pathogenesis of cancer is poorly understood. Here, we evaluated whether HN affects the chemosensitivity of glioblastoma (GBM) cells. We found that chemotherapy upregulated HN expression in GBM cell lines and primary cultures derived from GBM biopsies. An HN analog (HNGF6A) boosted chemoresistance, increased the migration of GBM cells and improved their capacity to induce endothelial cell migration and proliferation. Chemotherapy also upregulated FPR2 expression, an HN membrane-bound receptor, and the HNGF6A cytoprotective effects were inhibited by an FPR2 receptor antagonist (WRW4). These effects were observed in glioma cells with heterogeneous genetic backgrounds, i.e., glioma cells with wild-type (wtIDH) and mutated (mIDH) isocitrate dehydrogenase. HN silencing using a baculoviral vector that encodes for a specific shRNA for HN (BV.shHN) reduced chemoresistance, and impaired the migration and proangiogenic capacity of GBM cells. Taken together, our findings suggest that HN boosts the hallmark characteristics of GBM, i.e., chemoresistance, migration and endothelial cell proliferation. Thus, strategies that inhibit the HN/FPR2 pathway may improve the response of GBM to standard therapyInstituto de BiotecnologĂ­a y BiologĂ­a Molecula

    Evaluation of baculoviruses as gene therapy vectors for brain cancer

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    We aimed to assess the potential of baculoviral vectors (BV) for brain cancer gene therapy. We compared them with adenoviral vectors (AdV), which are used in neuro-oncology, but for which there is pre-existing immunity. We constructed BVs and AdVs encoding fluorescent reporter proteins and evaluated their transduction efficiency in glioma cells and astrocytes. NaĂŻve and glioma-bearing mice were intracranially injected with BVs to assess transduction and neuropathology. Transgene expression was also assessed in the brain of BV-preimmunized mice. While the expression of BVs was weaker than AdVs in murine and human glioma cell lines, BV-mediated transgene expression in patient-derived glioma cells was similar to AdV-mediated transduction and showed strong correlation with clathrin expression, a protein that interacts with the baculovirus glycoprotein GP64, mediating BV endocytosis. BVs efficiently transduced normal and neoplastic astrocytes in vivo, without apparent neurotoxicity. BV-mediated transgene expression was stable for at least 21 days in the brain of naĂŻve mice, but it was significantly reduced after 7 days in mice systemically preimmunized with BVs. Our findings indicate that BVs efficiently transduce glioma cells and astrocytes without apparent neurotoxicity. Since humans do not present pre-existing immunity against BVs, these vectors may constitute a valuable tool for the delivery of therapeutic genes into the brain.Instituto de BiotecnologĂ­a y BiologĂ­a Molecula

    First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)

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    Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.Fil: Pons Estel, Bernardo A.. Centro Regional de Enfermedades Autoinmunes y ReumĂĄticas; ArgentinaFil: Bonfa, Eloisa. Universidade de Sao Paulo; BrasilFil: Soriano, Enrique R.. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cardiel, Mario H.. Centro de InvestigaciĂłn ClĂ­nica de Morelia; MĂ©xicoFil: Izcovich, Ariel. Hospital AlemĂĄn; ArgentinaFil: Popoff, Federico. Hospital Aleman; ArgentinaFil: Criniti, Juan M.. Hospital AlemĂĄn; ArgentinaFil: VĂĄsquez, Gloria. Universidad de Antioquia; ColombiaFil: Massardo, Loreto. Universidad San SebastiĂĄn; ChileFil: Duarte, Margarita. Hospital de ClĂ­nicas; ParaguayFil: Barile Fabris, Leonor A.. Hospital Angeles del Pedregal; MĂ©xicoFil: GarcĂ­a, Mercedes A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de ClĂ­nicas General San MartĂ­n; ArgentinaFil: Amigo, Mary Carmen. Centro MĂ©dico Abc; MĂ©xicoFil: Espada, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo GutiĂ©rrez"; ArgentinaFil: Catoggio, Luis J.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Sato, Emilia Inoue. Universidade Federal de Sao Paulo; BrasilFil: Levy, Roger A.. Universidade do Estado de Rio do Janeiro; BrasilFil: Acevedo VĂĄsquez, Eduardo M.. Universidad Nacional Mayor de San Marcos; PerĂșFil: ChacĂłn DĂ­az, Rosa. PoliclĂ­nica MĂ©ndez GimĂłn; VenezuelaFil: Galarza Maldonado, Claudio M.. CorporaciĂłn MĂ©dica Monte SinaĂ­; EcuadorFil: Iglesias Gamarra, Antonio J.. Universidad Nacional de Colombia; ColombiaFil: Molina, JosĂ© Fernando. Centro Integral de ReumatologĂ­a; ColombiaFil: Neira, Oscar. Universidad de Chile; ChileFil: Silva, ClĂłvis A.. Universidade de Sao Paulo; BrasilFil: Vargas Peña, Andrea. Hospital Pasteur Montevideo; UruguayFil: GĂłmez Puerta, JosĂ© A.. Hospital Clinic Barcelona; EspañaFil: Scolnik, Marina. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Pons Estel, Guillermo J.. Centro Regional de Enfermedades Autoinmunes y ReumĂĄticas; Argentina. Hospital Provincial de Rosario; ArgentinaFil: Ugolini Lopes, Michelle R.. Universidade de Sao Paulo; BrasilFil: Savio, VerĂłnica. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Drenkard, Cristina. University of Emory; Estados UnidosFil: Alvarellos, Alejandro J.. Hospital Privado Universitario de CĂłrdoba; ArgentinaFil: Ugarte Gil, Manuel F.. Universidad Cientifica del Sur; PerĂș. Hospital Nacional Guillermo Almenara Irigoyen; PerĂșFil: Babini, Alejandra. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cavalcanti, AndrĂ©. Universidade Federal de Pernambuco; BrasilFil: Cardoso Linhares, Fernanda Athayde. Hospital Pasteur Montevideo; UruguayFil: Haye Salinas, Maria Jezabel. Hospital Privado Universitario de CĂłrdoba; ArgentinaFil: Fuentes Silva, Yurilis J.. Universidad de Oriente - NĂșcleo BolĂ­var; VenezuelaFil: Montandon De Oliveira E Silva, Ana Carolina. Universidade Federal de GoiĂĄs; BrasilFil: Eraso Garnica, Ruth M.. Universidad de Antioquia; ColombiaFil: Herrera Uribe, SebastiĂĄn. Hospital General de Medellin Luz Castro de GutiĂ©rrez; ColombiaFil: GĂłmez MartĂ­n, DIana. Instituto Nacional de la NutriciĂłn Salvador Zubiran; MĂ©xicoFil: Robaina Sevrini, Ricardo. Universidad de la RepĂșblica; UruguayFil: Quintana, Rosana M.. Hospital Provincial de Rosario; Argentina. Centro Regional de Enfermedades Autoinmunes y ReumĂĄticas; ArgentinaFil: Gordon, Sergio. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de ReumatologĂ­a y Enfermedades Autoinmunes SistĂ©micas; ArgentinaFil: Fragoso Loyo, Hilda. Instituto Nacional de la NutriciĂłn Salvador Zubiran; MĂ©xicoFil: Rosario, Violeta. Hospital Docente Padre Billini; RepĂșblica DominicanaFil: Saurit, VerĂłnica. Hospital Privado Universitario de CĂłrdoba; ArgentinaFil: Appenzeller, Simone. Universidade Estadual de Campinas; BrasilFil: Dos Reis Neto, Edgard Torres. Universidade Federal de Sao Paulo; BrasilFil: Cieza, Jorge. Hospital Nacional Edgardo Rebagliati Martins; PerĂșFil: GonzĂĄlez Naranjo, Luis A.. Universidad de Antioquia; ColombiaFil: GonzĂĄlez Bello, Yelitza C.. Ceibac; MĂ©xicoFil: Collado, MarĂ­a Victoria. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones MĂ©dicas; ArgentinaFil: Sarano, Judith. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones MĂ©dicas; ArgentinaFil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones CientĂ­ficas y TĂ©cnicas. Centro CientĂ­fico TecnolĂłgico Conicet - CĂłrdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de CĂłrdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Sattler, MarĂ­a E.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva PerĂłn"; ArgentinaFil: Gamboa CĂĄrdenas, Rocio V.. Hospital Nacional Guillermo Almenara Irigoyen; PerĂșFil: Cairoli, Ernesto. Universidad de la RepĂșblica; UruguayFil: Conti, Silvana M.. Hospital Provincial de Rosario; ArgentinaFil: Amezcua Guerra, Luis M.. Instituto Nacional de Cardiologia Ignacio Chavez; MĂ©xicoFil: Silveira, Luis H.. Instituto Nacional de Cardiologia Ignacio Chavez; MĂ©xicoFil: Borba, Eduardo F.. Universidade de Sao Paulo; BrasilFil: Pera, Mariana A.. Hospital Interzonal General de Agudos General San MartĂ­n; ArgentinaFil: Alba Moreyra, Paula B.. Universidad Nacional de CĂłrdoba. Facultad de Medicina; ArgentinaFil: Arturi, Valeria. Hospital Interzonal General de Agudos General San MartĂ­n; ArgentinaFil: Berbotto, Guillermo A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva PerĂłn"; ArgentinaFil: Gerling, Cristian. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de ReumatologĂ­a y Enfermedades Autoinmunes SistĂ©micas; ArgentinaFil: Gobbi, Carla Andrea. Universidad Nacional de CĂłrdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones CientĂ­ficas y TĂ©cnicas; ArgentinaFil: Gervasoni, Viviana L.. Hospital Provincial de Rosario; ArgentinaFil: Scherbarth, Hugo R.. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de ReumatologĂ­a y Enfermedades Autoinmunes SistĂ©micas; ArgentinaFil: Brenol, JoĂŁo C. Tavares. Hospital de Clinicas de Porto Alegre; BrasilFil: Cavalcanti, Fernando. Universidade Federal de Pernambuco; BrasilFil: Costallat, Lilian T. Lavras. Universidade Estadual de Campinas; BrasilFil: Da Silva, Nilzio A.. Universidade Federal de GoiĂĄs; BrasilFil: Monticielo, Odirlei A.. Hospital de Clinicas de Porto Alegre; BrasilFil: Seguro, Luciana Parente Costa. Universidade de Sao Paulo; BrasilFil: Xavier, Ricardo M.. Hospital de Clinicas de Porto Alegre; BrasilFil: Llanos, Carolina. Universidad CatĂłlica de Chile; ChileFil: MontĂșfar Guardado, RubĂ©n A.. Instituto Salvadoreño de la Seguridad Social; El SalvadorFil: Garcia De La Torre, Ignacio. Hospital General de Occidente; MĂ©xicoFil: Pineda, Carlos. Instituto Nacional de RehabilitaciĂłn; MĂ©xicoFil: Portela HernĂĄndez, Margarita. Umae Hospital de Especialidades Centro Medico Nacional Siglo Xxi; MĂ©xicoFil: Danza, Alvaro. Hospital Pasteur Montevideo; UruguayFil: Guibert Toledano, Marlene. Medical-surgical Research Center; CubaFil: Reyes, Gil Llerena. Medical-surgical Research Center; CubaFil: Acosta Colman, Maria Isabel. Hospital de ClĂ­nicas; ParaguayFil: Aquino, Alicia M.. Hospital de ClĂ­nicas; ParaguayFil: Mora Trujillo, Claudia S.. Hospital Nacional Edgardo Rebagliati Martins; PerĂșFil: Muñoz Louis, Roberto. Hospital Docente Padre Billini; RepĂșblica DominicanaFil: GarcĂ­a Valladares, Ignacio. Centro de Estudios de InvestigaciĂłn BĂĄsica y ClĂ­nica; MĂ©xicoFil: Orozco, MarĂ­a Celeste. Instituto de RehabilitaciĂłn PsicofĂ­sica; ArgentinaFil: Burgos, Paula I.. Pontificia Universidad CatĂłlica de Chile; ChileFil: Betancur, Graciela V.. Instituto de RehabilitaciĂłn PsicofĂ­sica; ArgentinaFil: AlarcĂłn, Graciela S.. Universidad Peruana Cayetano Heredia; PerĂș. University of Alabama at Birmingahm; Estados Unido

    Sloan Digital Sky Survey IV: Mapping the Milky Way, Nearby Galaxies, and the Distant Universe

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    We describe the Sloan Digital Sky Survey IV (SDSS-IV), a project encompassing three major spectroscopic programs. The Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2) is observing hundreds of thousands of Milky Way stars at high resolution and high signal-to-noise ratios in the near-infrared. The Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey is obtaining spatially resolved spectroscopy for thousands of nearby galaxies (median z∌0.03z\sim 0.03). The extended Baryon Oscillation Spectroscopic Survey (eBOSS) is mapping the galaxy, quasar, and neutral gas distributions between z∌0.6z\sim 0.6 and 3.5 to constrain cosmology using baryon acoustic oscillations, redshift space distortions, and the shape of the power spectrum. Within eBOSS, we are conducting two major subprograms: the SPectroscopic IDentification of eROSITA Sources (SPIDERS), investigating X-ray AGNs and galaxies in X-ray clusters, and the Time Domain Spectroscopic Survey (TDSS), obtaining spectra of variable sources. All programs use the 2.5 m Sloan Foundation Telescope at the Apache Point Observatory; observations there began in Summer 2014. APOGEE-2 also operates a second near-infrared spectrograph at the 2.5 m du Pont Telescope at Las Campanas Observatory, with observations beginning in early 2017. Observations at both facilities are scheduled to continue through 2020. In keeping with previous SDSS policy, SDSS-IV provides regularly scheduled public data releases; the first one, Data Release 13, was made available in 2016 July

    Sloan Digital Sky Survey IV: mapping the Milky Way, nearby galaxies, and the distant universe

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    We describe the Sloan Digital Sky Survey IV (SDSS-IV), a project encompassing three major spectroscopic programs. The Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2) is observing hundreds of thousands of Milky Way stars at high resolution and high signal-to-noise ratios in the near-infrared. The Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey is obtaining spatially resolved spectroscopy for thousands of nearby galaxies (median ). The extended Baryon Oscillation Spectroscopic Survey (eBOSS) is mapping the galaxy, quasar, and neutral gas distributions between and 3.5 to constrain cosmology using baryon acoustic oscillations, redshift space distortions, and the shape of the power spectrum. Within eBOSS, we are conducting two major subprograms: the SPectroscopic IDentification of eROSITA Sources (SPIDERS), investigating X-ray AGNs and galaxies in X-ray clusters, and the Time Domain Spectroscopic Survey (TDSS), obtaining spectra of variable sources. All programs use the 2.5 m Sloan Foundation Telescope at the Apache Point Observatory; observations there began in Summer 2014. APOGEE-2 also operates a second near-infrared spectrograph at the 2.5 m du Pont Telescope at Las Campanas Observatory, with observations beginning in early 2017. Observations at both facilities are scheduled to continue through 2020. In keeping with previous SDSS policy, SDSS-IV provides regularly scheduled public data releases; the first one, Data Release 13, was made available in 2016 July

    Global Retinoblastoma Presentation and Analysis by National Income Level.

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    Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs
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