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The Wnt/ß-catenin pathway plays an important role in tumor progression and chemotherapy resistance and seems to be essential for the maintenance of cancer stem cells (CSC) in several tumor types. However, the interplay of these factors has not been fully addressed in bladder cancer. Here, our goal was to analyze the role of the Wnt/ß-catenin pathway in paclitaxel resistance and to study the therapeutic efficacy of its inhibition in bladder cancer cells, as well as to determine its influence in the maintenance of the CSC-like phenotype in bladder cancer. Our results show that paclitaxel-resistant HT1197 cells have hyperactivation of the Wnt/ß-catenin pathway and increased CSC-like properties compared with paclitaxel-sensitive 5637 cells. Paclitaxel sensitivity diminishes in 5637 cells after ß-catenin overexpression or when they are grown as tumorspheres, enriched for the CSC-like phenotype. Additionally, downregulation of ß-catenin or inhibition with XAV939 sensitizes HT1197 cells to paclitaxel. Moreover, a subset of muscle-invasive bladder carcinomas shows aberrant expression of ß-catenin that associates with positive expression of the CSC marker ALDH1A1. In conclusion, we demonstrate that Wnt/ß-catenin signaling contributes to paclitaxel resistance in bladder cancer cells with CSC-like properties.

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Paclitaxel is a treatment option for advanced or metastatic bladder cancer after the failure of first-line cisplatin and gemcitabine, although resistance limits its clinical benefits. Mcl-1 is an anti-apoptotic protein that promotes resistance to paclitaxel in different tumors. Obatoclax, a BH3 mimetic of the Bcl-2 family of proteins, antagonizes Mcl-1 and hence may reverse paclitaxel resistance in Mcl-1-overexpressing tumors. In this study, paclitaxel-sensitive 5637 and -resistant HT1197 bladder cancer cells were treated with paclitaxel, obatoclax, or combinations of both. Apoptosis, cell cycle, and autophagy were measured by Western blot, flow cytometry, and fluorescence microscopy. Moreover, Mcl-1 expression was analyzed by immunohistochemistry in bladder carcinoma tissues. Our results confirmed that paclitaxel alone induced Mcl-1 downregulation and apoptosis in 5637, but not in HT1197 cells; however, combinations of obatoclax and paclitaxel sensitized HT1197 cells to the treatment. In obatoclax-treated 5637 and obatoclax + paclitaxel-treated HT1197 cells, the blockade of the autophagic flux correlated with apoptosis and was associated with caspase-dependent cleavage of beclin-1. Obatoclax alone delayed the cell cycle in 5637, but not in HT1197 cells, whereas combinations of both retarded the cell cycle and reduced mitotic slippage. In conclusion, obatoclax sensitizes HT1197 cells to paclitaxel-induced apoptosis through the blockade of the autophagic flux and effects on the cell cycle. Furthermore, Mcl-1 is overexpressed in many invasive bladder carcinomas, and it is related to tumor progression, so Mcl-1 expression may be of predictive value in bladder cancer.

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INTRODUCCIÓN: Los objetivos de este estudio fueron el análisis de los factores asociados a la incidencia de dehiscencia postoperatoria de la laparotomía y el impacto de esta última en la mortalidad, las estancias y los costes hospitalarios. MÉTODOS: Estudio observacional retrospectivo de una muestra de pacientes intervenidos mediante laparotomía recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. RESULTADOS: Se estudiaron 323.894 ingresos por cirugía abdominal, entre los cuales hubo 2.294 pacientes con DPL. Los pacientes de mayor edad, varones, con ingreso urgente, con trastornos por alcohol, tabaco y drogas, y con más comorbilidades presentaron mayor incidencia. Además, aquellos con DPL presentaron un incremento de mortalidad (107,5%), una estancia mas prolongada (15,6 días) y un exceso de costes (14.327 euros). CONCLUSIONES: Hay una asociación entre ciertas variables demográficas, conductuales y comorbilidades, y la incidencia de DPL, y esta complicación aumenta la mortalidad, la duración de la estancia y su coste. Medidas preventivas podrían disminuir su incidencia y su impacto sanitario y económico

INTRODUCTION: The Charcot foot (CF) consists of a progressive deterioration of the bones and joints, most common in diabetic patients with advanced neuropathy. The great problem is that can be confused with other processes, delaying the diagnosis and specific treatment. The aim is to analyze the cases of CF diagnosed in our hospital and especially to highlight the role of the general surgeon. MATERIAL AND METHODS: Retrospective study of all registered cases diagnosed of CF between the diabetic population of our Department of Health. A review of the literature was performed. RESULTS: From 2008 to 2012, there 7 cases of CF were diagnosed (prevalence 1:710). Two of the patients were diagnosed erroneously of cellulitis. The average time of delay in the diagnosis was 10 weeks (minimum 1, maximum 24). The initial treatment was immobilization of the extremity. Once the edema was eliminated, an offload orthesis was placed according to Sanders's anatomical classification. Evolution was favorable in 5 patients, 1 patient needed amputation, and other one died of acute cardiac pathology. CONCLUSIONS: The CF is a more frequent pathology than we believe. The general surgeon is the fundamental prop in the diagnosis and initial treatment. Before the presence of inflammation and edema of the foot in a patient with diabetes and severe neuropathy, once cellulitis, osteomyelitis, and TVP are ruled out, Charcot neuroarthropathy should be considered

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INTRODUCTION: The objectives of this study were to investigate the relationship between several factors and the incidence of postoperative abdominal wall dehiscence (POAD), and to estimate the influence of POAD on in-hospital mortality, excess length of stay and costs. METHODS: Retrospective observational study of a sample of abdominal surgery patients from a minimal basic data set of 87 Spanish hospitals during 2008-2010. RESULTS: Among 323,894 admissions for abdominal surgery reviewed there were 2,294 patients with POAD. Elderly patients, male, with non-elective admission, with alcohol, tobacco or drugs abuse, and with more comorbidities had higher incidence. POAD patients had an increase in in-hospital death (mortality excess of 107.5%), excess length of stay (15.6 days) and higher cost (14,327 euros). CONCLUSIONS: Certain demographic and behavioral variables, and several comorbidities are associated with the incidence of POAD, and this complication shows an increase in in-hospital mortality, the length of hospital stay and costs. Preventive measures might decrease the incidence of POAD and its impact on health and extra-costs.

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Acacia glomerosa, Anterolobium cyclocarpum e Hymenaea courbaril, especies arbóreas ampliamente disemindas en Venezuela producen gomas con buen rendimiento. La mezcla de estas gomas se ensayó, como estabilizante en la preparación de helados de bajo contenido calórico. La viscosidad, el porcentaje de derretido y las propiedades sensoriales fueron determinados. Estas características físico-químicas se compararon con las exhibidas por los productos obtenidos con base en mezcla de gomas comerciales. La mezcla de gomas de las especies estudiadas incrementó la viscocidad del sistema, por lo tanto, favoreció una excelente incorporación y una distribución uniforme del aire; aportó textura y estabilidad durante el almacenamiento; mejoró la capacidad de expansión de la espuma y las propiedades de derretido. Por otra parte, aportó buenas características sensoriales, como la indica el alto puntaje alcanzado; apariencia (7.78), cremosidad (7.62), sabor (8.01) y bajo puntaje en presencia de cristales de hielo (3.06). Este trabajo evidenció la funcionalidad como estabilizante de la mezcla de gomas investigadas en la preparación de helados bajo en calorías.

Acacia glomerosa, Enterolobium cyclocarpum and Hymenaea courbaril, species widely disseminated in Venezuela, South America, produce gum with good yield. The mixture of these gums was tested as stabilizer in the low fat ice cream preparation. Viscosity, overrun, foam expansion, meltdown, shape factor and sensory properties were determined. These quality characteristics were compared with those exhibited by the product obtained with a mixture of commercial gums. The mixture tested provided the suitable viscosity for the ice cream mix with the corresponding overrun and texture. It gave better foaming properties and air incorporation. On the other hand, it was demonstrated the good sensory attributes by the highest score i.e. appearance (7.78), creaminess (7.62), flavor (8.01) and lowest score of iciness (3.06). This work showed good functionality as stabilizer of the mixture of gums investigated in the low fat ice cream preparation.

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