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Introduction: Breast cancer (BC) is the leading cause of death among women, primarily due to its potential for metastasis. As BC progresses, the extracellular matrix (ECM) produces more type-I collagen, resulting in increased stiffness. This alteration influences cellular behaviors such as migration, invasion, and metastasis. Specifically, cancer cells undergo changes in gene expression that initially promote an epithelial-to-mesenchymal transition (EMT) and subsequently, a transition from a mesenchymal to an amoeboid (MAT) migration mode. In this way, cancer cells can migrate more easily through the stiffer microenvironment. Despite their importance, understanding MATs remains challenging due to the difficulty of replicating in vitro the conditions for cell migration that are observed in vivo. Methods: To address this challenge, we developed a three-dimensional (3D) growth system that replicates the different matrix properties observed during the progression of a breast tumor. We used this model to study the migration and invasion of the Triple-Negative BC (TNBC) cell line MDA-MB-231, which is particularly subject to metastasis. Results: Our results indicate that denser collagen matrices present a reduction in porosity, collagen fiber size, and collagen fiber orientation, which are associated with the transition of cells to a rounder morphology with bleb-like protrusions. We quantified how this transition is associated with a more persistent migration, an enhanced invasion capacity, and a reduced secretion of matrix metalloproteinases. Discussion: Our findings suggest that the proposed 3D growth conditions (especially those with high collagen concentrations) mimic key features of MATs, providing a new platform to study the physiology of migratory transitions and their role in BC progression.
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Neutrófilos , Prolactina , Biomarcadores , Humanos , Inflamación , Recuento de Leucocitos , Linfocitos , Estudios RetrospectivosRESUMEN
OBJECTIVE: Multiple factors are involved in the physiology and variability of postsurgical pain, a great part of which can be explained by genetic and environmental factors and their interaction. Epigenetics refers to the mechanism by which the environment alters the stability and expression of genes. We conducted a scoping review to examine the available evidence in both animal models and clinical studies on epigenetic mechanisms involved in the regulation of postsurgical and chronic postsurgical pain. METHODS: The Arksey and O'Malley framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analysis, scoping reviews extension) guidelines were used. The PubMed, Web of Science, and Google Scholar databases were searched, and the original articles cited in reviews located through the search were also reviewed. English-language articles without time limits were retrieved. Articles were selected if the abstract addressed information on the epigenetic or epigenomic mechanisms, histone, or DNA methylation and microribonucleic acids involved in postsurgical and chronic postsurgical pain in animal models and clinical studies. RESULTS: The initial search provided 174 articles, and 95 were used. The available studies to date, mostly in animal models, have shown that epigenetics contributes to the regulation of gene expression in the pathways involved in postsurgical pain and in maintaining long-term pain. CONCLUSION: Research on possible epigenetic mechanisms involved in postsurgical pain and chronic postsurgical pain in humans is scarce. In view of the evidence available in animal models, there is a need to evaluate epigenetic pain mechanisms in the context of human and clinical studies.
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Epigenómica , Dolor Postoperatorio , Epigénesis Genética/genética , Humanos , Dolor Postoperatorio/genéticaRESUMEN
During coronavirus disease 2019 (COVID-19) pandemic, efforts have been made to rethink the health system and provide various recommendations to the best care of patients and for the protection of health personnel. In patients with suspicion or confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who require surgical intervention and anesthetic management, strategies must be established to minimize aerosol-generating procedures. Regional anesthesia (RA) is not considered an aerosol-generating procedure per se and is currently proposed such as a safe strategy and part of comprehensive perioperative care. However, the preoperative evaluation has undergone changes in the context of the COVID-19 pandemic, so in addition to routine preoperative evaluation, a patient-oriented history, clinical, laboratory, and radiologic evaluation should be performed, and a series of general recommendations should be taken into account before, during, and after the performance of RA procedure. A search of PubMed/MEDLINE, Web of Science, and Google Scholar databases was performed until August 22, 2020, using the words: ãregional anesthesia or nerve block or peripheral nerve block or spinal anesthesia or epidural anesthesia and SARS-CoV-2 or COVID-19 or MERS or SARS-CoV-1 or influenza.ã We included in this review all articles, regardless of design, published in the English language. Given the benefits reported with the use of RA techniques, both for the patient and for healthcare personnel, it has recently been suggested that RA should be considered as the first choice. However, it is important to generate more precise and homogeneous management guidelines based on the evidence obtained every day during the care of patients with COVID-19.
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Anestesia de Conducción , COVID-19 , Anestesia Local , Humanos , Pandemias , SARS-CoV-2RESUMEN
Microcephaly is defined by an occipital-frontal head circumference (OFD) 2 standard deviations (SD) smaller than the average expected for age, gender and population. Its incidence has been reported between 1.3 and 150 cases per 100,000 births. Currently, new clinical characteristics, causes and pathophysiological mechanisms related to microcephaly continue to be identified. Its etiology is varied and heterogeneous, with genetic and non-genetic factors that produce alterations in differentiation, proliferation, migration, repair of damage to deoxyribonucleic acid and neuronal apoptosis. It requires a multidisciplinary diagnostic approach that includes a medical history, detailed prenatal and postnatal clinical evaluation, cerebral magnetic resonance imaging, neuropsychological evaluation, and in some cases complementary tests such as metabolic screening, tests to rule out infectious processes and genetic testing. There is no specific treatment or intervention to increase cerebral growth; however, timely intervention strategies and programs can be established to improve motor and neurocognitive development, as well as to provide genetic counseling. The objective of this work is to review the available information and reinforce the proposal to carry out an etiopathogenic approach for microcephaly diagnosis and management.
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Microcefalia , Cefalometría , Femenino , Pruebas Genéticas , Humanos , Imagen por Resonancia Magnética , Microcefalia/etiología , Microcefalia/genética , EmbarazoAsunto(s)
Anestesia de Conducción , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Betacoronavirus , COVID-19 , Humanos , Oxígeno , SARS-CoV-2RESUMEN
The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.
El objetivo de este artículo es revisar las características del SARS-CoV-2, los aspectos clínico-epidemiológicos de COVID-19 y las implicaciones que tienen para los anestesiólogos al realizar procedimientos generadores de aerosoles. Se realizó una búsqueda en las bases de datos PubMed, Scopus, SciELO y Web of Science hasta el 9 de abril de 2020, utilizando las palabras: COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia. Se incluyeron 48 artículos con información sobre el manejo del paciente en el perioperatorio o en la unidad de cuidados intensivos ante la sospecha o confirmación de infección por SARS-CoV-2. En general, se recomienda el aplazamiento de las cirugías electivas por no más de seis a ocho semanas, de acuerdo a las condiciones clínicas de los pacientes. En el caso de cirugías de urgencia o emergencia, se revisan tópicos del sistema de protección personal así como las estrategias recomendadas para la realización de los procedimientos.
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Anestesiología/normas , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Enfermedades Profesionales/prevención & control , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Aerosoles , Anestesia de Conducción/métodos , Anestesia Epidural/métodos , Anestesia General/métodos , Anestesia Raquidea/métodos , Anestesiología/organización & administración , Betacoronavirus/genética , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Procedimientos Quirúrgicos Electivos , Humanos , Unidades de Cuidados Intensivos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/normas , Bloqueo Nervioso/métodos , Pandemias , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Respiración Artificial/métodos , Respiración Artificial/normas , SARS-CoV-2 , Procedimientos Quirúrgicos Operativos , Evaluación de Síntomas/métodosRESUMEN
El objetivo de este artículo es revisar las características del SARS-CoV-2, los aspectos clínico-epidemiológicos de COVID-19 y las implicaciones que tienen para los anestesiólogos al realizar procedimientos generadores de aerosoles. Se realizó una búsqueda en las bases de datos PubMed, Scopus, SciELO y Web of Science hasta el 9 de abril de 2020, utilizando las palabras: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Se incluyeron 48 artículos con información sobre el manejo del paciente en el perioperatorio o en la unidad de cuidados intensivos ante la sospecha o confirmación de infección por SARS-CoV-2. En general, se recomienda el aplazamiento de las cirugías electivas por no más de seis a ocho semanas, de acuerdo a las condiciones clínicas de los pacientes. En el caso de cirugías de urgencia o emergencia, se revisan tópicos del sistema de protección personal así como las estrategias recomendadas para la realización de los procedimientos.
The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.
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Humanos , SARS-CoV-2/genética , COVID-19/complicaciones , COVID-19/epidemiología , Anestesiología/normas , Enfermedades Profesionales/prevención & control , Respiración Artificial/métodos , Respiración Artificial/normas , Procedimientos Quirúrgicos Operativos/métodos , Procedimientos Quirúrgicos Electivos , Aerosoles , Pandemias , Evaluación de Síntomas/métodos , Equipo de Protección Personal , COVID-19/diagnóstico , COVID-19/transmisión , Unidades de Cuidados Intensivos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/normas , Anestesia de Conducción/métodos , Anestesia Epidural/métodos , Anestesia General/métodos , Anestesia Raquidea/métodos , Anestesiología/organización & administración , Bloqueo Nervioso/métodosRESUMEN
BACKGROUND: Surgical site infection (SSI) occurs in 11-12% of surgeries. The glycosylated hemoglobin (HbA1c) has been found to be significantly elevated in those who presented infection. OBJECTIVE: To compare the concentration of HbA1c between patients with and without SSI after hysterectomy. METHOD: In healthy, postoperative women with total abdominal (open) hysterectomy, the HbA1c serum concentration was measured (normal <5.7%) and the difference between those who presented SSI and other risk factors for SSI were compared with Mann Whitney U test was used. The HbA1c values were stratified as normal or abnormal and were contrasted with the presence or absence of SSI by means of X2. RESULTS: 27 women without SSI and 20 with SSI were studied. The preoperative glucose was and 88 (70-99) mg/dl and 86 (70-99) mg/dl for the groups with and without SSI respectively. The HbA1c was significantly higher in the group with ISQ 5.6% (5-8) vs. 6.5% (5.2-8.2). The sensitivity of HbA1c with cut point <5.7 was 80% and the specificity was 51.9%. CONCLUSION: HbA1c can serve as a prognostic criterion of ISQ.
ANTECEDENTES: La infección del sitio quirúrgico (ISQ) se presenta en el 11-12% de las cirugías. La hemoglobina glucosilada (HbA1c) se ha encontrado significativamente elevada en los pacientes que presentan infección. OBJETIVO: Comparar la concentración de HbA1c entre pacientes con y sin ISQ posterior a una histerectomía. MÉTODO: En mujeres sanas posoperadas de histerectomía total abdominal (abierta) se midió la concentración sérica de HbA1c (normal < 5.7%) y se comparó la diferencia entre las que presentaron ISQ y las que no. Se investigaron también otros factores de riesgo para ISQ. Se utilizó la prueba U de Mann Whitney. Los valores de HbA1c se estratificaron como normales o anormales, y se contrastaron con la presencia o no de ISQ por medio de la prueba ji al cuadrado. RESULTADOS: Se estudiaron 27 mujeres sin ISQ y 20 con ISQ. La glucosa preoperatoria fue de 88 (70-99) y 86 (70-99) mg/dl para los grupos con y sin ISQ, respectivamente. La HbA1c fue significativamente mayor en el grupo con ISQ (5.6%; 5-8) que en el grupo sin ISQ (6.5%; 5.2-8.2). La sensibilidad de la HbA1c con un punto de corte < 5.7 fue del 80% y la especificidad fue del 51.9%. CONCLUSIÓN: La HbA1c puede servir como criterio pronóstico de ISQ.
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Hemoglobina Glucada/análisis , Histerectomía/efectos adversos , Infección de la Herida Quirúrgica/sangre , Adulto , Profilaxis Antibiótica , Biomarcadores , Recuento de Células Sanguíneas , Índice de Masa Corporal , Estudios Transversales , Femenino , Hemoglobinas/análisis , Humanos , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
The objective of this study was to determine the frequency of expression of GRP78 and BIK/NBK proteins, as well as to evaluate their correlation with prognostic factors for clinical use in patients with locally advanced breast cancer (LABC) or preoperative chemotherapy (PC). An observational, analytical and retrospective study that evaluated the expression of BIK/NBK and GRP78 by means of immunohistochemistry in paraffin-embedded tumour tissue samples obtained before the start of PC was executed. GRP78 was positive in 93.3% and BIK/NBK was positive in 40% of the samples analysed. Correlation of GRP78 expression with Ki67 expression (Rho = 0.732, p = .039), and of BIK/NBK expression with Ki67 expression (Rho = 0.777, p = .023) and number of residual lymph nodes (Rho = 0.619, p = .014) was observed. Given the correlation observed, association studies of the expression of GRP78 and BIK/NBK with clinical and pathological response, recurrence and survival should be carried out in a greater number of patients with LABC or PC.Impact StatementWhat is already known on this subject? There are reports of the overexpression of GRP78 in various types of cancer cell lines and tumour biopsies, including breast cancer, with participation in resistance to adjuvant chemotherapeutic agents (topoisomerase inhibitors including Adriamycin). On the other hand, BIK/NBK has been observed expressed associated with poor outcomes in breast cancer. There are no studies of the expression of both biomarkers in patients with preoperative chemotherapy, including locally advanced breast cancer (LABC) or their correlation with prognosis markers of clinical use.What the results of this study add? We observed a correlation of higher expression percentage of GRP78 and BIK/NBK with higher expression of Ki67, a marker of poor prognosis in breast cancer, in addition to a significant correlation of higher percentage of BIK/NBK expression with a greater number of residual nodes in patients with LABC or PC.What the implications are of these findings for clinical practice and/or further research? There is a potential prognostic value of GRP78 and BIK/NBK in the pathological response that merits further study addressing their interaction with other proteins, their cellular location in relation to the clinical stages of breast cancer, and their association with prognosis (clinical and pathological response, recurrence, disease free period and survival) in a greater number of patients with LABC or PC.
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Antineoplásicos/uso terapéutico , Proteínas Reguladoras de la Apoptosis/análisis , Neoplasias de la Mama/genética , Neoplasias de la Mama/terapia , Proteínas de Choque Térmico/análisis , Proteínas Mitocondriales/análisis , Adulto , Anciano , Biomarcadores de Tumor/análisis , Quimioterapia Adyuvante , Chaperón BiP del Retículo Endoplásmico , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Antígeno Ki-67/análisis , Persona de Mediana Edad , Terapia Neoadyuvante , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Breast cancer is a public health problem in Mexico and the world, being the first cause of cancer death in women. Even though scientific advances have allowed the identification of several risk factors, the use of screening and detection techniques, as well as the therapeutic approach, since breast cancer is a heterogeneous entity, it is necessary to carry out studies that increase the knowledge about its epidemiological, clinical, histopathological and molecular characteristics that allow improving the strategies of prevention, diagnosis, treatment and reduction of complications in order to improve the quality of life and the survival of patients.
El cáncer de mama es un problema de salud pública en México y en el mundo, pues se trata de la primera causa de muerte por cáncer en las mujeres. Aun cuando los avances científicos han permitido la identificación de diversos factores de riesgo, el uso de técnicas de tamizaje y detección, así como el abordaje terapéutico, como el cáncer de mama es una entidad heterogénea, es necesaria la realización de estudios que incrementen el conocimiento sobre sus características epidemiológicas, clínicas, histopatológicas y moleculares, los cuales permitan mejorar las estrategias de prevención, diagnóstico, tratamiento y reducción de complicaciones con la finalidad de mejorar la calidad de vida y la supervivencia de las pacientes.
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Breast cancer is the most frequent cancer in women. Even though most women diagnosed with breast cancer survive, many of them experience pain as part of the disease process or as a side effect of diagnostic or therapeutic procedures. Given that chronic pain in patients with breast cancer is a complex experience, the objective of this article was to conduct a systematic review of the scientific literature available in the PubMed database in English language between January 2000 and September 2019 on the epidemiology, risk factors, clinical characteristics, preventive strategies and treatment of chronic pain in patients with breast cancer, since the knowledge of these aspects is transcendental to identify, treat and monitor patients in the long term, in order to avoid further impact on their quality of life, already altered.
El cáncer de mama es el cáncer más frecuente en la mujer. Aun cuando la mayoría de las mujeres diagnosticadas con cáncer de mama sobreviven, muchas de ellas experimentan dolor como parte del proceso de enfermedad o como un efecto colateral de los procedimientos diagnósticos o terapéuticos. Dado que el dolor crónico en las pacientes con cáncer de mama es una experiencia compleja, el objetivo de este artículo fue realizar una revisión narrativa de la literatura científica disponible en la base datos PubMed en idioma inglés entre enero de 2000 y septiembre de 2019 sobre la epidemiología, factores de riesgo, características clínicas, estrategias preventivas y tratamiento del dolor crónico en pacientes con cáncer de mama, ya que el conocimiento de estos aspectos es trascendental para identificar, tratar y vigilar a las pacientes a largo plazo, a fin de evitar una mayor afectación en su calidad de vida, ya de por sí alterada.
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Breast cancer is the most recurrent cancer in female population, its mortality is related to the presence of distant metastases. Distant metastasis begins as a small group of cells that spread regionally and remotely from the site of primary origin. Circulating tumor cells (CTC) are present in the blood of cancer patients and are therefore considered disease markers and precursors of metastasis. It is trascendental the review of the molecular aspects of the metastatic process, the available techniques for the enrichment, identification and molecular characterization of CTC, as well as some examples of its usefulness and clinical application in patients with breast cancer, including aspects related to perioperative management during breast cancer surgery.
El cáncer de mama es el cáncer más recurrente en la población femenina, su mortalidad se relaciona con la presencia de metástasis a distancia. La metástasis a distancia inicia como un pequeño grupo de células que se diseminan a nivel regional y a distancia del sitio de origen primario. Las células tumorales circulantes (CTC) están presentes en la sangre de las pacientes con cáncer, por lo que se consideran marcadores de enfermedad y precursoras de metástasis. Es transcendental la revisión de los aspectos moleculares del proceso metástasico, las técnicas disponibles para el enriquecimiento, identificación y caracterización molecular de CTC, así como algunos ejemplos de su utilidad y aplicación clínica en pacientes con cáncer de mama, incluyendo aspectos relacionados con el manejo perioperatorio durante la cirugía oncológica mamaria.
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Breast cancer is the most frequent type of cancer in women in the world. In Mexico, since 2006, this disease has become the leading cancer-related cause of death in women. It is estimated that incidence and mortality will continue to rise due to population aging, to changes in reproductive patterns, to a higher prevalence of risk factors and to limited access to medical care, resulting in delayed early diagnosis and timely treatment. The latter factors are the ones to improve in developing countries to decrease the high incidence and mortality associated with this disease. Recently, there is a great interest regarding breast cancer heterogeneity, and it is anticipated that the application of new technologies will improve our comprehension of this disease and will be reflected in a benefit for patients in the short term. Here, we review updated information on molecular diagnosis and therapeutics, as well as recent highlights in the biology of breast cancer.
A nivel mundial, el cáncer de mama es el tipo de cáncer más frecuente en la mujer. En México, a partir del año 2006, esta enfermedad se ha convertido en la primera causa de muerte por cáncer en las mujeres. Se estima que la incidencia y mortalidad seguirán aumentando debido al envejecimiento poblacional, a los cambios en los patrones reproductivos, a una mayor prevalencia de los factores de riesgo y a los problemas para el acceso inmediato a la atención médica, teniendo como consecuencia retrasos para el diagnóstico temprano y el tratamiento oportuno. Estos últimos parecen ser los factores más importantes por mejorar en los países en desarrollo para tratar de disminuir la alta incidencia y mortalidad asociadas a la enfermedad. En años recientes, se ha generado un gran interés sobre la heterogeneidad del cáncer de mama y se anticipa que la aplicación de nuevas tecnologías pueda mejorar nuestra comprensión de cada uno de los subtipos de la enfermedad y lograr así un beneficio para las pacientes a corto plazo. Esta revisión pretende recopilar información actualizada sobre los avances en diagnósticos moleculares y terapéuticos, así como en la comprensión de la biología de la enfermedad.
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COVID-19 is an infectious disease caused by the coronavirus called SARS-CoV-2, which was unknown until in December 2019, when the outbreak of viral pneumonia in Wuhan, China, was reported. Since different age groups are susceptible to this infection, including newborns, the objective of this article is to review scientific literature published in English language and available in PubMed database until April 21, 2020, related to epidemiological and clinical aspects in newborns with suspected or confirmed SARS-CoV-2 infection, as well as the recommendations for their management. In general, symptoms in newborns are milder (may even be asymptomatic) and compared to adults, their prognosis is more favorable. However special precautions are required to reduce the potential mother-to-child transmission, and to reduce the possibility of complications in symptomatic neonates.
La COVID-19 es una enfermedad infecciosa causada por el coronavirus SARS-CoV-2, desconocido hasta diciembre de 2019, cuando se reportó el brote de neumonías virales en Wuhan, China. Dado que diferentes grupos de edad son susceptibles a la infección, incluyendo los recién nacidos, el objetivo de este artículo es revisar la literatura científica disponible en la base de datos PubMed en idioma inglés hasta el 21 de abril de 2020, sobre los aspectos epidemiológicos y clínicos en recién nacidos con sospecha o confirmación de infección por SARS-CoV-2, así como las recomendaciones para su manejo. En general, los síntomas en los recién nacidos son más leves (incluso pueden ser asintomáticos) y, en comparación con los adultos, el pronóstico más favorable. Sin embargo, se requieren precauciones especiales para reducir el potencial de transmisión madre-hijo y reducir la posibilidad de complicaciones en los neonatos sintomáticos.
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Many changes occur in the physiology of the maternal thyroid gland to maintain an adequate level of thyroid hormones (THs) at each stage of gestation during normal pregnancy, however, some factors can produce low levels of these hormones, which can alter the onset and progression of pregnancy. Deficiency of THs can be moderate or severe, and classified as overt or clinical hypothyroidism, subclinical hypothyroidism, and isolated hypothyroxinemia. Overt hypothyroidism has been reported in 0.3-1.9% and subclinical hypothyroidism in approximately 1.5-5% of pregnancies. With respect to isolated hypothyroxinemia, the frequency has been reported in approximately 1.3% of pregnant women, however it can be as high as 25.4%. Worldwide, iodine deficiency is the most common cause of hypothyroidism, however, in iodine-sufficient countries like the United States, the most common cause is autoimmune thyroiditis or Hashimoto's thyroiditis. The diagnosis and timely treatment of deficiency of THs (before or during the first weeks of gestation) can significantly reduce some of the related adverse effects, such as recurrent pregnancy loss, preterm delivery, gestational hypertension, and alterations in the offspring. However, so far there is no consensus on the reference levels of thyroid hormones during pregnancy to establish the diagnosis and there is no consensus on universal screening of women during first trimester of pregnancy to identify thyroid dysfunction, to give treatment and to reduce adverse perinatal events, so it is necessary to carry out specific studies for each population that provide information about it.
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Hipotiroidismo/sangre , Complicaciones del Embarazo , Hormonas Tiroideas/sangre , Biomarcadores/sangre , Femenino , Humanos , Embarazo , Resultado del Embarazo , Pronóstico , Hormonas Tiroideas/deficienciaRESUMEN
Although significant progress has been made in the implementation of new breast cancer treatments over the last three decades, this neoplasm annually continues to show high worldwide rates of morbidity and mortality. In consequence, the search for novel therapies with greater effectiveness and specificity has not come to a stop. Among the alternative therapeutic targets, the human gonadotropin-releasing hormone type I and type II (hGnRH-I and hGnRH-II, respectively) and its receptor, the human gonadotropin-releasing hormone receptor type I (hGnRHR-I), have shown to be powerful therapeutic targets to decrease the adverse effects of this disease. In the present review, we describe how the administration of GnRH analogs is able to reduce circulating concentrations of estrogen in premenopausal women through their action on the hypothalamus-pituitary-ovarian axis, consequently reducing the growth of breast tumors and disease recurrence. Also, it has been mentioned that, regardless of the suppression of synthesis and secretion of ovarian steroids, GnRH agonists exert direct anticancer action, such as the reduction of tumor growth and cell invasion. In addition, we discuss the effects on breast cancer of the hGnRH-I and hGnRH-II agonist and antagonist, non-peptide GnRH antagonists, and cytotoxic analogs of GnRH and their implication as novel adjuvant therapies as antitumor agents for reducing the adverse effects of breast cancer. In conclusion, we suggest that the hGnRH/hGnRHR system is a promising target for pharmaceutical development in the treatment of breast cancer, especially for the treatment of advanced states of this disease.
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BACKGROUND: Comparing techniques of general anesthesia and regional anesthesia in arthroscopic shoulder surgery, some studies have shown differences in the intensity of immediate postoperative pain and neuroendocrine response, but the inflammatory response when using balanced general anesthesia (BGA) vs. an ultrasound-guided (USG) single-dose interscalene block (SDIB) has not been compared. MATERIALS AND METHODS: In a single-center, prospective, randomized clinical trial, the inflammatory response of 2 groups of 10 patients scheduled to undergo arthroscopic shoulder surgery was evaluated through measurement of a panel of cytokines that act on cells of the adaptive immune response to promote or inhibit inflammation, chemokines involved in chemotaxis, the erythrocyte sedimentation rate (ESR), the high-sensitivity C-reactive protein (CRP) level, and the white blood cell (WBC) count in 3 blood samples (before anesthesia, immediately postoperatively, and 24 hours postoperatively) with 2 types of anesthesia (BGA vs. USG SDIB). Postoperative pain intensity (immediately, at 12 hours, and at 24 hours) was also assessed. RESULTS: The ESR and CRP level increased significantly at 24 hours after surgery; however, the increase in ESR (P < .0001) and CRP level (P < .0001) was lower in the USG SDIB group. Significant increases in the levels of soluble interleukin 2 receptor α (P = .022) and interleukin 12p40 (P = .016) occurred in the immediate postoperative period in the USG SDIB group. Immediate postoperative pain showed a significant increase (P < .001) in the BGA group. CONCLUSIONS: In arthroscopic shoulder surgery, the use of a USG SDIB compared with the use of BGA is possibly associated with improved pain control in the immediate postoperative period and lower immunosuppression, even at 24 hours after surgery.
Asunto(s)
Anestesia General , Bloqueo del Plexo Braquial/métodos , Citocinas/sangre , Inflamación/sangre , Adulto , Anciano , Artroscopía/efectos adversos , Sedimentación Sanguínea , Proteína C-Reactiva/metabolismo , Femenino , Humanos , Inflamación/etiología , Subunidad p40 de la Interleucina-12/sangre , Subunidad alfa del Receptor de Interleucina-2/sangre , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Manejo del Dolor , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Hombro/cirugía , Ultrasonografía IntervencionalRESUMEN
La secuencia de bandas amnióticas es un desorden congénito caracterizado por anomalías craneofaciales, de la pared corporal y de las extremidades que pueden asociarse con bandas fibrosas fetoplacentarias. Su prevalencia ha sido reportada entre 0,19 y 8,1 por 10 000 nacimientos. Diversas teorías han tratado de explicar su etiología, sin embargo, ninguna, en forma individual, sustenta todas y cada una de las anomalías observadas, por lo que se ha considerado una entidad multifactorial. La identificación de anomalías (pre-yposnatalmente) sugestivas de secuencia de bandas amnióticas permite el abordaje diagnóstico para efectuar intervenciones terapéuticas oportunas que posibiliten la liberación de bandas amnióticas mediante fetoscopia con recuperación de la perfusión de la porción distal de la extremidad involucrada o bien la reparación quirúrgica posnatal y para otorgar asesoramiento genético. Este artículo ofrece una actualización sobre aspectos epidemiológicos, teorías etiológicas, factores de riesgo, características clínicas, diagnóstico (que incluye el diagnóstico prenatal), asesoramiento genético, abordaje terapéutico y pronóstico de esta entidad.
Amniotic bands sequence is a congenital disorder characterized by craniofacial, body wall, and limb anomalies that may be associated with fetal-placental fibrous bands. Its prevalence has been reported to range from 0.19 to 8.1 per 10 000births. Different theories have attempted to explain the etiology of amniotic band sequence; however, none has individually been able to support each and every defect observed, so it has been considered to be a multifactorial condition. The (pre- and post-natal) identification of anomalies suggestive of amniotic band sequence is useful for the diagnostic approach and implementation of timely therapeutic interventions favoring the release of the amniotic bands using fetoscopy with recovery of the involved distal limb perfusion, or else the possibility of performing a post-natal surgical repair. It is also helpful to provide genetic counseling. This article offers an update on the epidemiological aspects, etiological theories, risk factors, clinical characteristics, diagnosis (including antenatal diagnosis), genetic counseling, therapeutic approach, and prognosis of amniotic bands sequence.
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Diagnóstico Prenatal/métodos , Fetoscopía/métodos , Síndrome de Bandas Amnióticas/diagnóstico , Pronóstico , Prevalencia , Factores de Riesgo , Asesoramiento Genético/métodos , Síndrome de Bandas Amnióticas/cirugía , Síndrome de Bandas Amnióticas/epidemiologíaRESUMEN
Amniotic bands sequence is a congenital disorder characterized by craniofacial, body wall, and limb anomalies that may be associated with fetalplacental fibrous bands. Its prevalence has been reported to range from 0.19 to 8.1 per 10 000 births. Different theories have attempted to explain the etiology of amniotic band sequence; however, none has individually been able to support each and every defect observed, so it has been considered to be a multifactorial condition. The (pre- and post-natal) identification of anomalies suggestive of amniotic band sequence is useful for the diagnostic approach and implementation of timely therapeutic interventions favoring the release of the amniotic bands using fetoscopy with recovery of the involved distal limb perfusion, or else the possibility of performing a post-natal surgical repair. It is also helpful to provide genetic counseling. This article offers an update on the epidemiological aspects, etiological theories, risk factors, clinical characteristics, diagnosis (including antenatal diagnosis), genetic counseling, therapeutic approach, and prognosis of amniotic bands sequence.
La secuencia de bandas amnióticas es un desorden congénito caracterizado por anomalías craneofaciales, de la pared corporal y de las extremidades que pueden asociarse con bandas fibrosas fetoplacentarias. Su prevalencia ha sido reportada entre 0,19 y 8,1 por 10 000 nacimientos. Diversas teorías han tratado de explicar su etiología, sin embargo, ninguna, en forma individual, sustenta todas y cada una de las anomalías observadas, por lo que se ha considerado una entidad multifactorial. La identificación de anomalías (pre- y posnatalmente) sugestivas de secuencia de bandas amnióticas permite el abordaje diagnóstico para efectuar intervenciones terapéuticas oportunas que posibiliten la liberación de bandas amnióticas mediante fetoscopia con recuperación de la perfusión de la porción distal de la extremidad involucrada o bien la reparación quirúrgica posnatal y para otorgar asesoramiento genético. Este artículo ofrece una actualización sobre aspectos epidemiológicos, teorías etiológicas, factores de riesgo, características clínicas, diagnóstico (que incluye el diagnóstico prenatal), asesoramiento genético, abordaje terapéutico y pronóstico de esta entidad.