Prevalence and clinical characteristics of patients with rheumatoid arthritis with interstitial lung disease using unstructured healthcare data and machine learning

OBJECTIVES

Real-world data regarding rheumatoid arthritis (RA) and its association with interstitial lung disease (ILD) is still scarce. This study aimed to estimate the prevalence of RA and ILD in patients with RA (RAILD) in Spain, and to compare clinical characteristics of patients with RA with and without ILD using natural language processing (NLP) on electronic health records (EHR).

METHODS

Observational case-control, retrospective and multicentre study based on the secondary use of unstructured clinical data from patients with adult RA and RAILD from nine hospitals between 2014 and 2019. NLP was used to extract unstructured clinical information from EHR and standardise it into a SNOMED-CT terminology. Prevalence of RA and RAILD were calculated, and a descriptive analysis was performed. Characteristics between patients with RAILD and RA patients without ILD (RAnonILD) were compared.

RESULTS

From a source population of 3 176 165 patients and 64 241 683 EHRs, 13 958 patients with RA were identified. Of those, 5.1% patients additionally had ILD (RAILD). The overall age-adjusted prevalence of RA and RAILD were 0.53% and 0.02%, respectively. The most common ILD subtype was usual interstitial pneumonia (29.3%). When comparing RAILD versus RAnonILD patients, RAILD patients were older and had more comorbidities, notably concerning infections (33.6% vs 16.5%, p<0.001), malignancies (15.9% vs 8.5%, p<0.001) and cardiovascular disease (25.8% vs 13.9%, p<0.001) than RAnonILD. RAILD patients also had higher inflammatory burden reflected in more pharmacological prescriptions and higher inflammatory parameters and presented a higher in-hospital mortality with a higher risk of death (HR 2.32; 95% CI 1.59 to 2.81, p<0.001).

CONCLUSIONS

We found an estimated age-adjusted prevalence of RA and RAILD by analysing real-world data through NLP. RAILD patients were more vulnerable at the time of inclusion with higher comorbidity and inflammatory burden than RAnonILD, which correlated with higher mortality.

Adaptation of sea turtles to climate warming: Will phenological responses be sufficient to counteract changes in reproductive output?

Sea turtles are vulnerable to climate change since their reproductive output is influenced by incubating temperatures, with warmer temperatures causing lower hatching success and increased feminization of embryos. Their ability to cope with projected increases in ambient temperatures will depend on their capacity to adapt to shifts in climatic regimes. Here, we assessed the extent to which phenological shifts could mitigate impacts from increases in ambient temperatures (from 1.5 to 3°C in air temperatures and from 1.4 to 2.3°C in sea surface temperatures by 2100 at our sites) on four species of sea turtles, under a "middle of the road" scenario (SSP2-4.5). Sand temperatures at sea turtle nesting sites are projected to increase from 0.58 to 4.17°C by 2100 and expected shifts in nesting of 26-43 days earlier will not be sufficient to maintain current incubation temperatures at 7 (29%) of our sites, hatching success rates at 10 (42%) of our sites, with current trends in hatchling sex ratio being able to be maintained at half of the sites. We also calculated the phenological shifts that would be required (both backward for an earlier shift in nesting and forward for a later shift) to keep up with present-day incubation temperatures, hatching success rates, and sex ratios. The required shifts backward in nesting for incubation temperatures ranged from -20 to -191 days, whereas the required shifts forward ranged from +54 to +180 days. However, for half of the sites, no matter the shift the median incubation temperature will always be warmer than the 75th percentile of current ranges. Given that phenological shifts will not be able to ameliorate predicted changes in temperature, hatching success and sex ratio at most sites, turtles may need to use other adaptive responses and/or there is the need to enhance sea turtle resilience to climate warming.

Abstract 2677: ROCK inhibitors synergize with the BCL2 inhibitor venetoclax for treatment of AML

Acute Myeloid Leukemia (AML) is a rare but catastrophic hematological cancer with a poor prognosis, high mortality, and relapse rates. Several new agents targeting specific genes or cell survival pathways have been recently approved by the FDA. AML treatment with single agents often results in resistance; therefore, combination therapies may provide more durable and effective responses. Rho kinases (ROCK1/2) are aberrantly expressed in AML patient cells, and ROCK1 has emerged lately as a potential therapeutic target for AML treatment. Previously, our group developed a new ROCK inhibitor DJ4 as an effective inducer of AML cell death. Our initial screening of DJ4 with AML standard therapy (cytarabine, daunorubicin, azacytidine, venetoclax) showed promising synergy between DJ4 and the BCL2 (B-cell lymphoma-2) inhibitor venetoclax (VEN). Enrichment of ROCK pathway in recent CRISPR drop-out screening after VEN treatment in MOLM-13 cells further validates the synergistic cooperation between ROCK and BCL2 pathways. Though VEN is widely used in hematological malignancies, its clinical efficacy is limited due to the development of resistance. Thus, we sought to investigate the novel strategy of combining VEN with ROCK inhibitors (ROCKi) for AML treatment. The combination of VEN with ROCKi (Fasudil, Y-27632, GSK269962A, DJ4) exhibited synergetic cytotoxicity in naïve (MOLM-13, MV4-11) and VEN-resistant (MV4-11/VENR, HL-60, OCI-AML3, U937) human AML cell lines. Flow cytometric analysis of Annexin V and cellular ROS levels in MV4-11 (naïve and VENR) cells upon co-treatment with sub-lethal doses of VEN and ROCKi demonstrated a significant (p&lt;0.05) increase in the apoptosis and oxidative stress compared to single agents. Treatment of MV4-11 cells with VEN+ROCKi enhanced the activity of several caspases in the MultiCaspase assay. Furthermore, the colony-forming ability of AML cell lines and primary AML patient cells was significantly reduced with the combination treatment, while single agents exhibited minimal effects. MV4-11 (naïve and VENR) cells displayed alterations in the levels of critical apoptosis regulators (Bcl2, Bax, Mcl1, cleaved caspase-3) upon co-treatment in immunoblotting analysis. Additionally, MV4-11-Luc xenograft mice exhibited a significant reduction in the average leukemic burden after combination therapy relative to single agents (p&lt;0.05). Altogether, our in vitro and in vivo findings established a synergetic interaction between VEN and ROCKi to effectively inhibit AML cell progression and overcome the VEN resistance (inherent or acquired). These results indicate that therapy co-targeting BCL2 and ROCK pathways exerted antileukemic activity by inducing apoptosis and may be particularly effective for AML treatment. Further studies are ongoing to explore the precise molecular mechanism of action of the VEN+ROCKi combination and its efficacy in pre-clinical animal models.

Citation Format: Upendarrao Golla, Satyam Patel, Diwakar B. Tukaramrao, Jeremy Hengst, Juliana Restrepo, Shantu Amin, Dhimant Desai, Sinisa Dovat, David Claxton, Arati Sharma. ROCK inhibitors synergize with the BCL2 inhibitor venetoclax for treatment of AML [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2677.

Analysis of Renal Cell Carcinoma Cell Response to the Enhancement of 5-aminolevulinic Acid-mediated Protoporphyrin IX Fluorescence by Iron Chelator Deferoxamine†

As a tumor photodiagnostic agent, 5-aminolevulinic acid (ALA) is metabolized in the heme biosynthesis pathway to produce protoporphyrin IX (PpIX) with fluorescence. ALA-PpIX fluorescence was evaluated in human renal cell carcinoma (RCC) cell lines and non-tumor HK-2 cell lines. We found that extracellular PpIX level was correlated with ABCG2 activity, illustrating its importance as a PpIX efflux transporter. Extracellular PpIX was also related to the Km of ferrochelatase (FECH) that chelates PpIX with ferrous iron to form heme. The Vmax of FECH was higher in all RCC cell lines tested than in the HK-2 cell line. TCGA dataset analysis indicates a positive correlation between FECH expression and RCC patient survival. These findings suggest FECH as an important biomarker in RCC. Effects of iron chelator deferoxamine (DFO) on the enhancement of PpIX fluorescence were assessed. DFO increased intracellular PpIX in both tumor and non-tumor cells, resulting in no gain in tumor/non-tumor fluorescence ratios. DFO appeared to increase ALA-PpIX more at 1-h than at 4-h treatment. There was an inverse correlation between ALA-PpIX fluorescence and the enhancement effect of DFO. These results suggest that enhancement of ALA-PpIX by DFO may be limited by the availability of ferrous iron in mitochondria following ALA administration.

[Guillain-Barre syndrome and thrombocytopenia after SARS-CoV-2 vaccination with Moderna. A case report]

INTRODUCTION

The massive vaccination against the SARS-CoV-2 virus has demonstrated to be one of the major measures for the reduction of the morbidity and mortality that this virus causes. However, during the last months the administration of the vaccine has been also associated with some rare, but life-threatening, adverse effects.

CASE REPORT

In this article we describe the case of a patient that developed a Guillain-Barre syndrome and an Idiopathic thrombocytopenic purpura nine days after the vaccination with the third dose for the SARS-CoV-2 virus (Moderna). He had received previously two doses of the AstraZeneca vaccine. Moreover, the patient was positive for auto-antibodies anti-SSA/Ro60 and auto-antibodies IgG anti-GM1 and IgG anti-GM3.

DISCUSSION

Even though it is not possible to stablish a clear relation of causality between the administration of the vaccine booster for SARS-CoV-2 and the diseases developed by the patient, the association of two concomitant autoimmune processes is remarkable. As well as the positivity for the auto-antibodies anti-SSA/Ro60, which have been described in the bibliography in cases of SARS-CoV-2 infection.

Pleural and pulmonary dissemination patterns from gastric adenocarcinoma among patients with treated primary disease in Latin America

Purpose

Latin America is one of the regions with the highest incidence of gastric cancer. Even though, there are not reports about the patterns of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intent and the prognosis according to each dissemination pattern.

Material and methods

We conducted a retrospective analysis of patients with gastric adenocarcinoma treated with curative intent at the National Cancer Institute (INC) between 2010 and 2017. Demographic variables, variables associated with the primary disease and variables associated with the presence of pleuro-pulmonary opacities and metastases were collected. A univariate and multivariate logistic regression analysis was performed and survival curves were presented using the Kaplan Meier method and compared using the log-rank test. A Cox regression model was performed for multivariate analysis for overall survival.

Results

The study included 450 patients, 51.3% were male and the median age was 63 years. Intestinal adenocarcinoma was the most frequent histological subtype, in 261 cases (58.0%). Gastric cancer initial pathological stage was stage I in 23.3% of the patients, stage II in 19.3% and stage III in 53.6%. During a median follow-up of 31.9 months, 37 (8.2%) patients developed pleuro-pulmonary opacities; among those, 14 (3.1%) met the criteria for pleuro-pulmonary metastases: 6 (1.3%) had lymphangitic metastasis, 4 (0.9%) had a mixed pattern of pleural and lung nodules, 3 (0.7%) had pleural metastasis, and only one (0.2%) had hematogenous metastasis. The median OS was 114.5 months for the entire cohort and 38.2 (95%CI, 19.2–57.2) months for patients with pleuro-pulmonary metastases. Patients with pleural metastasis and lymphangitic carcinomatosis had median survival of 24.3 (95%CI, 0.01–51.0) and 26.4 (95%CI, 18.2–34.7) months, respectively.

Conclusions

incidence of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intention was low. In our series, lymphangitic carcinomatosis was the main pattern of dissemination; meanwhile, hematogenous metastasis was rare and patients with pleural carcinomatosis had the lowest median survival.

Perfusión aislada de extremidad: una opción terapéutica para metástasis en tránsito de melanoma nodular y lentiginoso acral

OBJETIVO

describir la experiencia inicial en Colombia en el manejo del melanoma de extremidad con perfusión aislada y comparar la respuesta de los subtipos histológicos más frecuentes en Colombia con la literatura.

MATERIALES Y MÉTODOS

estudio descriptivo, retrospectivo de una serie de pacientes con diagnóstico de melanoma con metástasis en tránsito tratados con perfusión aislada de extremidad, seleccionados entre 2007 y 2016. Las variables cualitativas se analizaron con frecuencias absolutas y relativas. Las cuantitativas con medidas de tendencia central y dispersión.

RESULTADOS

11 pacientes fueron tratados con perfusión aislada de extremidad. Hubo respuesta parcial en siete pacientes (63,6%), enfermedad estable en dos pacientes (18,2%) y progresión en dos pacientes (18,2%). Después del tratamiento, cinco pacientes (45,5%) presentaron complicaciones menores.

CONCLUSIONES

la perfusión aislada sigue siendo importante para el tratamiento del melanoma localmente avanzado con el fin de mejorar la calidad de vida de los pacientes. La respuesta puede cambiar según el tipo clínico de melanoma, siendo menor, según este estudio, en pacientes con melanoma lentiginoso acral y nodular, aunque por el bajo poder, esto no se puede concluir.

OBJECTIVE

to describe the initial experience in Colombia of locally advanced melanoma treated by isolated limb perfusion and compare the response rate of our melanoma subtypes with the literature.

METHODS

descriptive, retrospective study of a series of patients selected between 2007 and 2016. Qualitative variables were analyzed with proportions and frequencies, and quantitative variable with central tendency measures and measures of dispersion.

RESULTS

11 patients were treated by isolated limb perfusion. After the treatment, seven patients (63.6%) had partial response, two patients (18.2%) had stable disease and two patients (18.2%) had disease progression. Five patients (45.5%) had mild complications.

CONCLUSIONS

Isolated limb perfusion is still an important treatment strategy for locally advanced melanoma, with the goal of improving the patient quality of life. The response can change according to the type of melanoma, and could be smaller in patients with acral lentiginous and nodular melanoma, although we cannot make this conclusion with this type of study because it has low power and lack of a comparison group.

Primary BRAF Mutant Melanoma of the Lung Treated with Immunotherapy and Pulmonary Bilobectomy: A Case Report

BACKGROUND Primary melanoma of the lung is a rare tumor that represents 0.01% of primary lung tumors, with only 40 cases reported in the literature. Mucosal melanomas are tumors with a biological and clinical presentation that differs from that of cutaneous melanomas; therefore, the therapeutic approach differs as well. Survival rates of patients with primary melanoma of the lung are much lower than those of patients with cutaneous melanoma, and there are no diagnostic or treatment guidelines for this entity. Radical surgery is the treatment of choice when disease is resectable. The effectiveness of current established treatments for cutaneous melanoma (eg, immunotherapy and targeted therapy) is unknown in this particular subgroup. CASE REPORT We present the case of a patient who presented with cough and hemoptysis. The fiberoptic bronchoscopy revealed an endobronchial mass and the computed tomography images suggested an unresectable mass. The patient was initially diagnosed with an unresectable primary lung melanoma with a clinical stage IIIB (T4N2M0). This lesion achieved partial response after treatment with Pembrolizumab, which allowed radical surgery to be performed, achieving complete resection with negative margins and adequate postoperative evolution. Despite the delays in our health care system, she is currently alive and disease-free more than 24 months after diagnosis. CONCLUSIONS Immunotherapy can reduce the size of mucosal melanoma to the point that it can be resectable and this therapeutic approach increases the survival opportunities of these patients.

[Colorectal anastomotic leak treated with E-VAC with polyvinyl sponge could reduce treatment time]

Colorectal anastomosis leaks have an incidence of 5 to 15% and their management depends on the clinical manifestations, the distance to the anal verge and the intra or extra peritoneal location. In some selected cases, endoscopic management has proven to be an effective treatment. In this case report, the vacuum-assisted transanal rectal drainage system described by Weidenhagen et al. was used for the treatment of an anastomotic leak. We used a polyvinyl sponge instead of the polyurethane sponge traditionally used with the intention to reduce sponge changes and treatment time.

Evaluation of aminolevulinic acid-mediated protoporphyrin IX fluorescence and enhancement by ABCG2 inhibitors in renal cell carcinoma cells

Aminolevulinic acid (ALA) has been approved as an intraoperative molecular imaging probe for protoporphyrin IX (PpIX) fluorescence-guided resection of glioma. Here we explored its potential application for renal cell carcinoma (RCC) that is showing increased incidence in recent years. ALA-mediated PpIX in cell lysates (intracellular) and culture medium was measured in five human RCC cell lines (786-O, 769-P, A-704, Caki-1, Caki-2) and a non-tumor human kidney epithelial cell line HK-2 by spectrofluorometry and flow cytometry. The activity of PpIX bioconversion enzyme ferrochelatase (FECH) and PpIX efflux transporter ABCG2 was determined to correlate with the PpIX level. We found that ALA-PpIX fluorescence was highly variable among RCC cell lines and A-704 was the only RCC cell line exhibiting significantly higher intracellular PpIX than HK-2 cells. Neither the intracellular PpIX level nor the total amount of PpIX (including PpIX in cell lysates and the medium) had significant correlation with the activity of FECH or ABCG2. To enhance the intracellular PpIX, cells were treated with Ko143, a pharmacological inhibitor of ABCG2. Ko143 significantly increased the intracellular PpIX in cell lines with ABCG2 activity, but not in cell lines with little ABCG2 activity. In fact, there was a positive correlation between the ABCG2 activity and Ko143-induced PpIX enhancement across kidney cell lines. To identify clinically relevant ABCG2 inhibitors, small molecule inhibitors targeting various cell signaling pathways, some of which are known to inhibit ABCG2, were evaluated for the enhancement of ALA-PpIX in Caki-2 cells that had the highest ABCG2 activity in the RCC cell panel. Our screening led to the identification of several clinically available inhibitors that significantly increased the intracellular PpIX. Particularly, kinase inhibitor lapatinib exhibited the strongest enhancement effect. These clinical inhibitors can be used for the enhancement of ALA-PpIX fluorescence in tumors with elevated ABCG2 activity.

Treatment Alternatives for Recurrent Esophagogastric Junction Adenocarcinoma: Case Report of an Ileocolonic Reconstruction and Literature Review

Esophagogastric junction tumors are a challenging pathology for surgeons and the best treatment depends on an adequate initial localization and stadification. Approximately half of patients relapse after curative surgery during the first two years. Surgical resection could increase the survival of these patients, but the esophageal reconstruction is a surgical challenge for which there are multiple reconstruction techniques described with different organs. In this report, we present the case of a patient with an esophagogastric junction tumor treated initially with total gastrectomy and esophageal margin. The patient presented an anastomotic recurrence that was taken to surgical resection, but a second recurrence required a residual esophagectomy with ileocolonic reconstruction, to achieve adequate oncologic treatment.

Peritoneal Metastasis of Cholangiocarcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy at the Instituto Nacional de Cancerología, Colombia

Cholangiocarcinoma is a low-frequency neoplasm of onset with a poor prognosis. Peritoneal carcinomatosis is the most frequent site of metastasis with a standard palliative chemotherapy treatment.

In the present article, we describe the case of a 35-year-old woman with peritoneal carcinomatosis secondary to an intrahepatic cholangiocarcinoma who was treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as a non-standard therapeutic method. The patient has disease-free survival of 12 months with very good quality of life.

The treatment of peritoneal metastasis from cholangiocarcinoma by CRS and HIPEC is feasible and could proportion better survival to these patients compared to systemic palliative chemotherapy. These therapeutic modalities can complement each other.

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience

Background

Robotic assisted videothoracoscopic surgery (RVATS) adoption has increased worldwide from 3.4% in 2010 to 17.5% in 2015. However, in Latin America, the literature is limited to a report of a series of 10 patients who underwent RVATS lobectomy and one case report of an RVATS thymectomy from Brazil.

Methods

This is a retrospective review of all RVATS performed in Bogotá Colombia since 2012. A single thoracic surgeon (RB) performed all the operations at three institutions: Clínica de Marly, Fundación Clínica Shaio and Instituto Nacional de Cancerología. Preoperative, intraoperative, postoperative and pathology report variables were included. Patients were analyzed in three groups: robotic RVATS pulmonary resections, RVATS mediastinal surgeries and other RVATS procedures. Descriptive statistics were used to report the median and interquartile range (IQR) of the continuous variables, and number and percentage were used to describe categorical variables. The association between total operative time and the year the surgery was analyzed using a linear regression model.

Results

Forty-seven patients underwent RVATS pulmonary resections; 72.3% (n=34) of these patients underwent a RVATS lobectomy. The median total operative time was 220 (IQR: 200 to 250) minutes, 6.4% (n=3) had intraoperative complications, and the most frequent histologic diagnosis was adenocarcinoma (n=24, 51.1%). Of 18 patients who underwent RVATS mediastinal surgeries, 50.0% (n=9) had RVATS thymectomy, the median total operative time was 195.5 (IQR: 131 to 221) minutes and two patients (11.1%) had intraoperative complications. The linear regression model of the association between total operative time and the year the surgery showed a 10.3 minute reduction per year (P=0.006).

Conclusions

This is the second series of RVATS published in Latin America and the first published in Colombia, with comparable perioperative results to other reports.

Change in the magnetic configurations of tubular nanostructures by tuning dipolar interactions

We have investigated the equilibrium states of ferromagnetic single wall nanotubes by means of atomistic Monte Carlo simulations of a zig-zag lattice of Heisenberg spins on the surface of a cylinder. The main focus of our study is to determine how the competition between short-range exchange (J) and long-range dipolar (D) interactions influences the low temperature magnetic order of the nanotubes as well as the thermal-driven transitions involved. Apart from the uniform and vortex states occurring for dominant J or D, we find that helical states become stable for a range of intermediate values of γ = D/J that depends on the radius and length of the nanotube. Introducing a vorticity order parameter to better characterize helical and vortex states, we find the pseudo-critical temperatures for the transitions between these states and we establish the magnetic phase diagrams of their stability regions as a function of the nanotube aspect ratio. Comparison of the energy of the states obtained by simulation with those of simpler theoretical structures that interpolate continuously between them, reveals a high degree of metastability of the helical structures that might be relevant for their reversal modes.

Safety profile of the 9-valent human papillomavirus vaccine: assessment in prior quadrivalent HPV vaccine recipients and in men 16 to 26 years of age

A 9-valent HPV (9vHPV) vaccine has been developed to protect against HPV type 6/11/16/18/31/33/45/52/58-related infection and disease. Previous safety analyses from 7 clinical trials conducted in 9vHPV vaccine recipients 9–26 years of age, including comparisons of 9vHPV and quadrivalent HPV (qHPV) vaccines in girls and women 16–26 years of age, showed that the 9vHPV vaccine was generally well tolerated. Additional safety analyses were conducted to include the results of new clinical studies. The safety profile of the 9vHPV vaccine in prior qHPV vaccine recipients (n = 3756 from 1 randomized controlled trial and 2 open-label extension studies) and young men (n = 248 9vHPV and n = 248 qHPV vaccine recipients from 1 randomized controlled trial) was evaluated. Vaccine was administered as a 3-dose regimen (at Day 1 and Months 2 and 6), and adverse events (AEs) were monitored. The most common AEs were injection-site events (91.1% and 79.0% in prior qHPV vaccine recipients and young men, respectively), the majority of which were mild. Discontinuations due to an AE were rare (0.2% and 0.0% among prior qHPV vaccine recipients and young men, respectively). In young men, the AE profile of the 9vHPV vaccine was generally similar to that of the qHPV vaccine. Overall, the 9vHPV vaccine was generally well tolerated in prior qHPV vaccine recipients and in young men, with an AE profile generally consistent with that previously reported with the broader clinical program.

Ex vivo trypanocidal activity of 1-(2-hydroxybenzylidene)thiosemicarbazide against Trypanosoma equiperdum

Trypanosoma equiperdum is the causative agent of dourine, a venereal disease in horses and donkeys. This parasite has a widely distribution, is found in Africa, Asia, Southern and Eastern Europe, Russia, Mexico and Venezuela. The T. equiperdum is morphologically indistinguishable to other Trypanozoon species, however differs from other mammalian trypanosomes due to the fact that it is primarily a tissue parasite, generating cutaneous plaques, swelling of genitalia and neurological signs. The aim of this study was to evaluate the trypanocidal effectiveness of a set of derivatives of thiosemicarbazones on a T. equiperdum ex vivo culture. All compounds appeared to have trypanocidal activity, however one of them shown better solubility and a dose-dependent effect. The median inhibitory concentration (IC₅₀) was 1.2μM. The selected compound exhibits a greater inhibitory activity than diminazene aceturate, a common drug for animal trypanosomosis treatment.

Robotic simultaneous resection of rectal cancer and liver metastases

Surgical resection is the only potential cure for colorectal cancer with synchronous liver metastases (SLM). Simultaneous resection of colorectal cancer and SLM using robotic‐assistance has been rarely reported. We demonstrate that robotic‐assisted simultaneous resection of colorectal cancer and SLMs is feasible, safe, and has potential to demonstrate good oncologic outcomes.

Composition and Nutritive Value of Amazonian Palm Fruits

This paper is a contribution to the study of the use of natural resources from tropical moist forests with a view to avoiding deforestation for farming purposes. This study analysed the moisture, fat, protein, ash, total dietary fibre, nitrogen-free extract, and gross energy content of various parts of the fruits of several Amazonian palms belonging to the Aracaceae (Palmae) family—Attalea racemosa, Euterpe precatoria, Mauritia flexuosa, Oenocarpus bataua, and Oenocarpus bacaba— and also the fatty acid content of the oils extracted from the fractions of the fruit with the highest fat content. the high fat content of the mesocarp makes these foods an excellent source of energy, particularly those from A. racemosa, M. flexuosa, and O. bacaba, with fat contents of 58.1, 49.1, and 30.2 g/100 g of sample, respectively. the kernels have a high level of nitrogen-free extract, consisting basically of carbohydrates, particularly those of O. bataua and M. flexuosa, which have 83.9 and 72.5 g/100 g of sample, respectively. Apart from A. racemosa mesocarp oil, the fatty acid content of these oils, particularly oleic acid, is quite similar to that of oils with a high market value, such as olive, sunflower, corn, and soya oil. the cultivation of these species in the forest, just as the natives have always done, should be encouraged, since in addition to being potential sources of high-quality vegetable oils, they are alternative foods for the population in that region because of their nutritive value. the sale of these oils could increase the resources of tropical moist forests, which would in turn contribute considerably to the conservation of the forests.

Neoatherosclerosis causing edge in-stent restenosis: optical coherence tomography findings

A patient presenting with ‘edge’ in-stent restenosis 12 years after the implantation of a bare-metal stent in the mid-left anterior descending coronary artery is described. Optical coherence tomography disclosed the presence of ruptured neoatherosclerosis at the stent edge. The value of this imaging technique to unravel this unique underlying anatomic substrate is discussed. The therapy of choice for patients presenting with edge in-stent restenosis (ISR) is reviewed.

Monte Carlo simulation of the hysteresis phenomena on ferromagnetic nanotubes

In this work the hysteretic properties of single wall ferromagnetic nanotubes were studied. Hysteresis loops were computed on the basis of a classical Heisenberg model involving nearest neighbor interactions and using a Monte Carlo method implemented with a single spin movement Metropolis dynamics. Nanotubes with square and hexagonal unit cells were studied varying their diameter, temperature and magneto-crystalline anisotropy. Effects of the diameter were found stronger in the square unit cell magnetic nanotubes (SMNTs) than in the hexagonal unit cell magnetic nanotubes (HMNTs). The ferromagnetic behavior was observed in SMNTs at higher temperature than in HMNTs. Moreover in both cases, SMNTs and HMNTs, the magneto-crystalline anisotropy in the longitudinal direction showed a linear correspondence with the coercive field.

Potencial del Chontaduro como Fuente Alimenticia de Alto Valor Nutricional en Países Tropicales

Potencial del Chontaduro como Fuente Alimenticia de Alto Valor Nutricional en Países Tropicales

[Factors associated to the visiting time in patients with ischaemic cerebrovascular disease]

INTRODUCTION

The high prevalence of cerebrovascular disease in underdeveloped countries has made it a public health issue. Establishing therapy within the first three hours in the case of patients with cerebrovascular disease has proved to have beneficial effects on the patient.

AIM

To identify the factors associated with the time taken to visit the hospital emergency department by patients with ischaemic cerebrovascular disease in the population of Colombia.

PATIENTS AND METHODS

We conducted a cross-sectional analytical study that included patients over 18 years old who had been clinically diagnosed as having an acute ischaemic cerebrovascular disease. The time between onset of symptoms and admission to the emergency department was estimated and then related to sociodemographic and cultural factors and the severity of the clinical features.

RESULTS

The mean time taken to visit hospital was 17 hours and 48 minutes (standard deviation: 24 hours and 12 minutes). In 22.8% of cases the patient was admitted within the first three hours. Patients who were covered by the subsidised health care system and came from low socioeconomic classes, together with those from rural areas took longer to visit (p < 0.005). The values on the United States Institute of Health scale did not have any relation to visiting times.

CONCLUSIONS

The time that elapses between the presentation of the cerebrovascular disease and visiting the emergency department in the Colombian population is high, especially among the population with lower levels of income and schooling. There is a need to implement models of education targeted towards the community and focused on the early identification of signs, symptoms and impact of cerebrovascular disease, as well as to set up a system of health care that prevents delays by coordinating resources both inside and outside hospitals.

Liver transplantation in Medellin, Colombia: Initial experience

OBJECTIVE

The goal of this article is to present the experience of a new liver transplant team.

MATERIALS AND METHODS

This review includes all patients who received a liver transplant between March 15, 2000 and March 15, 2003.

RESULTS

We performed 87 transplantations on 84 patients; 39 were females and 45 were males of average age 43.6 years, including 6 children. The majority of the patients were from Colombia with time on the waiting list of less than 1 month. The average donor age was 26.7 years. The preservation solutions included Wisconsin, HTK-Brettschneider (Custodiol), and Corpaúl (similar to Henn-Ross). In this study, 95.4% were whole livers, with 97.7% using the piggyback method. We placed 23 arterial grafts and 2 venous grafts for vascular reconstructions; 95.4% were duct-to-duct anastomosis (95.4%). Among the cohort, 8.3% experienced acute rejection and 1.2% experienced chronic rejection. Two patients required retransplantation due to hepatic artery thrombosis with biliary tree necrosis.

CONCLUSIONS

We consider that we have passed the crisis of beginning a new program with a reduction in postoperative complications and improving patient and graft survival. At present, we are a center that performs liver transplantations in adults and children, with a good organ donation culture in our city that allows us to offer a waiting time on the list less than one month. Neither a veno-venous bypass nor a T-tube were necessary for our cases. We also have developed a new, less expensive form of perfusing the liver in the donor.

Poststreptococcal reactive arthritis in adults: long-term follow-up

BACKGROUND

Poststreptococcal reactive arthritis (PSReA) is a recognized inflammatory articular syndrome that follows group A streptococcal infection in persons not fulfilling the Jones criteria for the diagnosis of acute rheumatic fever. Characteristic features include nonmigratory arthritis, lack of response to aspirin or nonsteroidal anti-inflammatory agents, and the presence of extra-articular manifestations, including vasculitis and glomerulonephritis. Whether or not patients with PSReA develop carditis is a point of contention.

METHODS

We analyzed the clinical features, laboratory findings, response to therapy, and outcome in patients diagnosed with PSReA between 1983 and 1998 and observed through April 2000. All patients were contacted, reexamined, and repeat antistreptolysin, rheumatoid factor, C3 and C4 complement components, and echocardiograms were performed.

RESULTS

Seventeen patients (4 men and 13 women) were included. All were of low socioeconomic status. All patients had acute severe arthritis that began shortly after a sore throat episode. Extra-articular involvement including tenosynovitis, vasculitis, and glomerulonephritis was relatively common. More importantly, none exhibited clinical and/or echocardiographic evidence of cardiac involvement. Longterm antibiotic therapy was not given.

CONCLUSION

Cardiac involvement did not occur in this group of patients with PSReA. Prolonged prophylactic antibiotic therapy may not be required for adult patients presenting with PSReA.

[The plantar flap in reconstructive surgery of the foot]

The plantar flap is a sensory skin flap fed by the lateral plantar artery. It is taken from the instep of the plantar vault and therefore has no functional consequences. It is particularly useful to resurface heel defects.