Vitiligo-like lesions located over In-transit metastases of malignant melanoma as a clinical marker of complete response to pembrolizumab.

Anti-programmed cell death (PD)-1 therapies in metastatic tumors have a high incidence of immune adverse events, including cutaneous manifestations such as vitiligo-like lesions. This side effect is associated with increased survival and it is a clinical marker of response to treatment. This case report is a graphic representation of the appearance of vitiligo-like lesions over in-transit metastases of malignant melanoma linked to a complete response to treatment with pembrolizumab

Concurrent plasmablastic lymphoma with malignant external otitis in the external auditory canal

Los linfomas Plasmoblásticos, constituyen un subtipo de linfomas de células B, descritos recientemente, caracterizados por su naturaleza agresiva y la diferenciación Plasmoblástica. Inicialmente fueron descritos en pacientes VIH positivos. Representan el 2,6% de todos los linfomas en pacientes con SIDA, de tal forma que un 69% se presentan en VIH positivos y el resto en inmunodeprimidos. La media de edad suele ser 39 años para los VIH positivos y 58 en los VIH negativos y son más comunes en hombres. Se localizan más frecuentemente en la cavidad oral, especialmente en los pacientes VIH positivos, aunque pueden desarrollarse en otros lugares como el tracto gastrointestinal, los ganglios linfáticos y piel. El tratamiento se basa en la quimioterapia (Ciclofosfamida, Vincristina, Doxorrubicina y prednisona).The Plasmoblásticos lymphomas are a subtype of B-cell lymphomas, recently described, characterized by its aggressive nature and Plasmoblástica differentiation. They were initially described in HIV positive patients. They represent 2.6% of all lymphomas in AIDS patients, so that 69% occur in HIV-positive and other immunosuppressed. The average age is usually 39 years for HIV-positive and 58 HIV negative and are more common in men. They are found most frequently in the oral cavity, especially in HIV-positive patients, although they may develop in other places such as the gastrointestinal tract, lymph nodes and skin. The treatment is based on chemotherapy (cyclophosphamide, vincristine, doxorubicin and prednisone)

Overeating, caloric restriction and mammographic density in Spanish women. DDM-Spain study

Objectives: Mammographic density (MD) is a strong risk factor for breast cancer. The present study evaluates the association between relative caloric intake and MD in Spanish women. Study design: We conducted a cross-sectional study in which 3517 women were recruited from seven breast cancer screening centers. MD was measured by an experienced radiologist using craniocaudal mammography and Boyd's semi-quantitative scale. Information was collected through an epidemiological survey. Predicted calories were calculated using linear regression models, including the basal metabolic rate and physical activity as explanatory variables. Overeating and caloric restriction were defined taking into account the 99% confidence interval of the predicted value. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using center-specific mixed ordinal logistic regression models, adjusted for age, menopausal status, body mass index, parity, tobacco use, family history of breast cancer, previous biopsies, age at menarche and adherence to a Western diet. Main outcome measure: Mammographic density. Results: Those women with an excessive caloric intake ( > 40% above predicted) presented higher MD (OR = 1.41, 95%CI = 0.97-2.03; p = 0.070). For every 20% increase in relative caloric consumption the probability of having higher MD increased by 5% (OR = 1.05, 95%CI = 0.98-1.14; p = 0.178), not observing differences between the categories of explanatory variables. Caloric restriction was not associated with MD in our study. Conclusions: This is the first study exploring the association between MD and the effect of caloric deficit or excessive caloric consumption according to the energy requirements of each woman. Although caloric restriction does not seem to affect breast density, a caloric intake above predicted levels seems to increase this phenotype

Surgical site infection after spinal surgery. Analysis of risk factors

Objetivo: Determinar la incidencia de infección del sitio quirúrgico (ISQ) en los pacientes intervenidos de cirugía raquimedular y analizar los factores de riesgo intrínsecos y extrínsecos. Material y métodos: Se realizó un estudio observacional retrospectivo en el Servicio de Neurocirugía del Hospital Universitario de La Ribera (Valencia, España) que abarcó el periodo 2005-2015, donde se incluyeron los enfermos que habían sido intervenidos de cirugía de columna y que desarrollaron ISQ hasta un año después de la intervención. Resultados: De un total de 2301 cirugías vertebromedulares realizadas en 2090 pacientes, 20 presentaron ISQ en un tiempo medio de 37,7 días, lo que supone una incidencia acumulada de infección del 0,87%. Destacan factores como el tiempo quirúrgico mayor de 3 horas (65%), la cirugía invasiva vía posterior con material de osteosíntesis por lesión traumática (55%) y la fístula de líquido cefalorraquídeo (5%). En relación a la evolución del paciente, fueron variables estadísticamente significativas la obesidad y las infecciones coexistentes (p=0,043; OR=2,00). Conclusión: La obesidad o la presencia de infecciones coexistentes en el paciente sometido a cirugía raquimedular causa el doble de probabilidad de exitus por ISQ.Objective: To determine the incidence of surgical site infection (SSI) in patients undergoing spinal surgery and to analyze the intrinsic and extrinsic risk factors. Material and methods: A retrospective observational study was conducted in the Neurosurgery Service of the University Hospital of La Ribera (Valencia, Spain), which covered the period 2005-2015, where all the patients who had undergone surgery for spinal surgery and who developed SSI until one year after the intervention. Results: Of a total of 2301 spinal surgeries performed in 2090 patients, 20 had SSI in a mean time of 37.7 days, which implies an accumulated infection incidence of 0.87%. Highlights factors such as surgical time over 3 hours (65%), posterior approach invasive surgery with osteosynthesis material for traumatic injury (55%) and cerebrospinal fluid fistula (5%). In relation to the evolution of the patient, obesity and coexisting infections was statistically significant (p=0.043, OR=2.00). Conclusion: Obesity or the presence of coexisting infections in the patient undergoing spinal surgery causes double the probability of exitus due to SSI

Prevalence of healthy lifestyles against cancer in Spanish women

Modifying behavior towards healthier lifestyles could prevent a significant number of malignant tumors. We evaluated the prevalence of healthy habits against cancer in Spanish women free of this disease, taking as a reference the recommendations for cancer prevention included in the European Code Against Cancer (ECAC), and we explored the characteristics associated with it. Our population comprised 3,584 women recruited in a population-based cross-sectional study carried out in 7 breast cancer screening programs. Information was directly surveyed and used to calculate a score based on ECAC recommendations referred to bodyweight, physical activity, diet, breastfeeding, tobacco, alcohol and hormone replacement therapy use. The degree of adherence was estimated with a score that evaluated null (0 points), partial (0.5 points) and full adherence (1 point) of each specific recommendation. Associations were explored using binary and ordinal logistic regression models. The median score was 5.7 out of 9 points. Recommendations with lower adherence were those related to intake of red/processed meat and foods high in salt (23% of total adherence), physical activity (24%) and body weight (29%), and recommendations with greater adherence where those related to hormone replacement therapy use (91%), vegetable intake (84%), alcohol (83%) and tobacco (61%). Overall adherence was better among older women, parous women, and in those living in rural areas, and worse among women with higher caloric intake. These recommendations should be evaluated periodically. Screening programs can be an appropriate place to disseminate this information.This study was supported by the Spanish Public Health Research Fund (FIS PI060386 & PS09/0790); by the Spanish Ministry of Health, Social Policy and Equality (EC11-273), by the Carlos III Institute of Health (ISCIII) (AESI PI15CIII/00013); by the Spanish Ministry of Economy and Competitiveness, Juan de la Cierva de Incorporación grant (IJCI-2014-20900); by the EPY 1306/06 Collaboration Agreement between Astra-Zeneca and the Carlos III Institute of Health; and a grant from the Spanish Federation of Breast Cancer patients (FECMA EPY 1169/10). The authors wish to thank the participants in the DDM-Spain study for their contribution to breast cancer research.S

Prevalence and molecular epidemiology of bovine leukemia virus in Colombian cattle

Bovine leukemia virus (BLV) is one of the five agents considered most significant for cattle. It is important to determine the prevalence and molecular epidemiology of BLV throughout the country in order to gain a more thorough understanding of the current situation of BLV and to reveal the possibility of masked genotypes that the primers used by OIE are unable to identify. Blood samples were collected at random from 289 cows distributed in 75 farms across the country. PCR amplification of env, gag and tax gene segments was performed. The obtained amplicons were sequenced and then subjected to phylogenetic analyses. A total of 62% of the cows present at 92% of the farms were BLV-positive for gag fragment. Genotype 1 was exclusively detected by env gene segment when analyzed using previously reported primers. However, tax gene analysis revealed circulation of genotype 6 variants, which were also detected based on env gene analysis with newly designed primers. These results indicate that current genotyping approaches based on partial env sequencing may bias BLV genetic variability approaches and underestimate the diversity of the detected BLV genotypes. This report is one of the first molecular and epidemiological studies of BLV conducted in Colombia, which contributes to the global epidemiology of the virus; it also highlights the substantial impact of BLV on the country's livestock and thus is a useful resource for farmers and government entities

A pediatric regimen for adolescents and young adults with Philadelphia chromosome-negative acute lymphoblastic leukemia : Results of the ALLRE08 PETHEMA trial

Altres ajuts: Supported in part by grants from Fundació La Caixa and CIBERONC (JMHR and AO).Pediatric-based or -inspired trials have improved the prognosis of adolescents and young adults (AYA) with Philadelphia chromosome-negative (Ph-neg) acute lymphoblastic leukemia (ALL). This study reports the results of treatment of the ALLRE08 trial, a full pediatric trial for AYA aged 15-30 years with standard-risk (SR) ALL. From 2008 to 2018, 89 patients (38 adolescents [15-18 years] and 51 young adults [YA, 19-30 years], median age: 20 [15-29] years) were enrolled in the ALLRE08 trial. The complete response (CR) was 95%. Twenty-two patients were transferred to a high-risk (HR) protocol because of poor marrow response on day 14 (n = 20) or high-level of end-induction minimal residual response (MRD ≥ 0.25%, n = 2). Cumulative incidence of relapse (CIR) at 5 years was 35% (95%CI: 23%-47%), with significant differences between adolescents and YA: 13% (4%-28%) vs 52% (34%-67%), P = .012. No treatment-related mortality was observed in 66/66 patients following the ALLRE08 trial vs 3/23 patients moved to a HR trial. The estimated 5-year overall survival (OS) was 74% (95%CI: 63%-85%), with significantly higher rates for adolescents vs YA: 87% (95%CI: 74%-100%) vs 63% (46%-80%), P = .021. Although CIR or OS were lower in patients who were transferred to a HR trial, the differences were not statistically significant (CIR: 34% [21%-47%] vs 37% [14%-61%]; OS: 78% [66%-90%] vs 61% [31%;91%]). A full pediatric trial is feasible and effective for AYA with Ph-neg, SR-ALL, with better results for adolescents than for YA. Outcome of patients with poor early response rescued with a HR trial was not significantly inferior. A full pediatric trial is feasible and effective for adolescent and young adults with acute lymphoblastic leukemia, with better results for adolescents than for young adults. The outcome of patients showing poor early response was not significantly inferior than that observed for good responders after being transferred to a high-risk trial

Sleep patterns, sleep disorders and mammographic density in spanish women: The DDM-Spain/Var-DDM study

[EN] We explored the relationship between sleep patterns and sleep disorders and mammographic density (MD), a marker of breast cancer risk. Participants in the DDM-Spain/var-DDM study, which included 2878 middle-aged Spanish women, were interviewed via telephone and asked questions on sleep characteristics. Two radiologists assessed MD in their left craneo-caudal mammogram, assisted by a validated semiautomatic-computer tool (DM-scan). We used log-transformed percentage MD as the dependent variable and fitted mixed linear regression models, including known confounding variables. Our results showed that neither sleeping patterns nor sleep disorders were associated with MD. However, women with frequent changes in their bedtime due to anxiety or depression had higher MD (e¿:1.53;95%CI:1.04¿2.26).This work was supported by grants from the Spanish Ministry of Economy and Competitiveness - Carlos III Institute of Health (ISCIII) (FI14CIII/00013, FIS PI060386 & PS09/0790), from the Spanish Federation of Breast Cancer Patients (FECMA 485 EPY 1170-10), Gent per Gent Fund (EDEMAC Project), the EPY1306/06 collaboration agreement between Astra-Zeneca and the ISCIII and partially funded by the European Regional Development Fund (FEDER)Pedraza-Flechas, AM.; Lope, V.; Moreo, P.; Ascunce, N.; Miranda-García, J.; Vidal, C.; Sánchez-Contador, C.... (2017). Sleep patterns, sleep disorders and mammographic density in spanish women: The DDM-Spain/Var-DDM study. Maturitas. 99:105-108. https://doi.org/10.1016/j.maturitas.2017.02.015S1051089

Evaluation of mammographic density patterns: reproducibility and concordance among scales

<p>Abstract</p> <p>Background</p> <p>Increased mammographic breast density is a moderate risk factor for breast cancer. Different scales have been proposed for classifying mammographic density. This study sought to assess intra-rater agreement for the most widely used scales (Wolfe, Tabár, BI-RADS and Boyd) and compare them in terms of classifying mammograms as high- or low-density.</p> <p>Methods</p> <p>The study covered 3572 mammograms drawn from women included in the DDM-Spain study, carried-out in seven Spanish Autonomous Regions. Each mammogram was read by an expert radiologist and classified using the Wolfe, Tabár, BI-RADS and Boyd scales. In addition, 375 mammograms randomly selected were read a second time to estimate intra-rater agreement for each scale using the kappa statistic. Owing to the ordinal nature of the scales, weighted kappa was computed. The entire set of mammograms (3572) was used to calculate agreement among the different scales in classifying high/low-density patterns, with the kappa statistic being computed on a pair-wise basis. High density was defined as follows: percentage of dense tissue greater than 50% for the Boyd, "heterogeneously dense and extremely dense" categories for the BI-RADS, categories P2 and DY for the Wolfe, and categories IV and V for the Tabár scales.</p> <p>Results</p> <p>There was good agreement between the first and second reading, with weighted kappa values of 0.84 for Wolfe, 0.71 for Tabár, 0.90 for BI-RADS, and 0.92 for Boyd scale. Furthermore, there was substantial agreement among the different scales in classifying high- versus low-density patterns. Agreement was almost perfect between the quantitative scales, Boyd and BI-RADS, and good for those based on the observed pattern, i.e., Tabár and Wolfe (kappa 0.81). Agreement was lower when comparing a pattern-based (Wolfe or Tabár) versus a quantitative-based (BI-RADS or Boyd) scale. Moreover, the Wolfe and Tabár scales classified more mammograms in the high-risk group, 46.61 and 37.32% respectively, while this percentage was lower for the quantitative scales (21.89% for BI-RADS and 21.86% for Boyd).</p> <p>Conclusions</p> <p>Visual scales of mammographic density show a high reproducibility when appropriate training is provided. Their ability to distinguish between high and low risk render them useful for routine use by breast cancer screening programs. Quantitative-based scales are more specific than pattern-based scales in classifying populations in the high-risk group.</p

Self-assembly of iron oxide precursor micelles driven by magnetic stirring time in sol-gel coatings

The purpose of this work is to fabricate self-assembled microstructures by the sol-gel method and study the morphological, structural and compositional dependence of epsilon-Fe_2O_3 nanoparticles embedded in silica when glycerol (GLY) and cetyl-trimethylammonium bromide (CTAB) are added as steric agents simultaneously. The combined action of a polyalcohol and a surfactant significantly modifies the morphology of the sample giving rise to a different microstructure in each of the studied cases (1, 3 and 7 days of magnetic stirring time). This is due to the fact that the addition of these two compounds leads to a considerable increase in gelation time as GLY can interact with the alkoxide group on the surface of the iron oxide precursor micelle and/or be incorporated into the hydrophilic chains of CTAB. This last effect causes the iron oxide precursor micelles to be interconnected forming aggregates whose size and structure depend on the magnetic stirring time of the sol-gel synthetic route. In this paper, crystalline structure, composition, purity and morphology of the sol-gel coatings densified at 960 degrees C are examined. Emphasis is placed on the nominal percentage of the different iron oxides found in the samples and on the morphological and structural differences. This work implies the possibility of patterning epsilon-Fe_2O_3 nanoparticles in coatings and controlling their purity by an easy one-pot sol-gel method