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To determine in a group of patients with progressive metastatic neuroendocrine tumors (PM-NETs) treated with 177Lu-DOTATATE whether a correlation exists between somatostatin receptor (SSTR)-2 expression in various tumors on baseline 68Ga-DOTATATE PET and their response to therapy. A secondary aim was to determine whether an association exists between tumor product of diameter (POD) and PET-derived Krenning score.Patients treated PM-NETs who had SSTR-2 overexpression (SSTR-RADS 5) on screening 68Ga-DOTATATE PET and CT at baseline and 3 months after therapy completion were included. Marker lesions on baseline CT were reassessed on CT after therapy using adapted Southwest Oncology Group solid tumor evaluation criteria. For each lesion, bidimensional diameter on CT and SSTR expression on PET (SSTR-RADS uptake scorePET-derived Krenning score) were recorded. Logistic regression models fitted through generalized estimating equations were used to assess for an association between SSTR expression and response to therapy, or lesion's POD.Forty-one patients with SSTR-RADS 5 PM-NETs treated with 177Lu-DOTATATE were included. There were 135 marker lesions (mean 3.2 lesions/patient) with Krenning score of 4 (n = 74), 3 (n = 44) or 2 (n = 17). There was no association found between SSTR-2 expression, as determined by SSTR-RADS uptake score or PET-derived Krenning score, and POD or response to therapy.In patients with SSTR-RADS 5 PM-NETs treated with 177Lu-DOTATATE, there was similar response to therapy for all lesions with PET-generated Krenning score ≥2. No correlation was found between lesion's POD and level of tracer uptake.

To determine the prognostic value of sarcopenia measurements done on staging 2-[18F] FDG PET/CT together with metabolic activity of the tumor in patients with adenocarcinoma esophagogastric cancer with surgical treatment. Patients with early-stage, surgically treated esophageal adenocarcinoma and available pre-treatment 2-[18F] FDG PET/CT were included. The standard uptake value (SUV) and SUV normalized by lean body mass (SUL) were recorded. Skeletal muscle index (SMI) was measured at the L3 level on the CT component of the PET/CT. Sarcopenia was defined as SMI

Purpose: To describe the initial experience of an academic center using 18F-DCFPyL PET in managing men with recurrent prostate cancer. Materials &amp, Methods: This prospective, single-arm IRB-approved study included men with biochemical failure after primary therapy for prostate cancer and negative/equivocal CT and bone scintigraphy who were candidates for salvage therapy, as determined by a multidisciplinary panel of experts. 18F-DCFPyL PET was assessed for the presence and extent of recurrence: local, oligometastatic (≤4), or extensive. Post-PET management and clinical outcome, including PSA response, was documented. For patients who received PET-directed ablative therapies, response was categorized as “complete” if PSA became undetectable or “favorable” if PSA decreased ≥50%. Results: Forty-seven men with biochemical failure after radical prostatectomy (n = 29), primary radiotherapy (n = 15) or focal tumor ablation (n = 3) were included. PET was positive in (43/47) 91.5%, including local recurrence in (9/47) 19.2%, oligometastatic disease in (16/47) 34%, and extensive metastatic disease in (18/47) 38.3%. PET-directed focal ablative therapies without systemic therapy were given to (13/29) 44.8% of patients without extensive metastases on PET with a mean PSA response of 69% (median, 74.5%, range: 35–100). Favorable biochemical response was observed in (10/13) 76.9% of patients with limited recurrence on PET, and in 23.1% (3/13), there was complete response. Conclusion: 18F-DCFPyL PET was positive in &gt, 90% of patients with biochemical failure. For those with limited recurrence, PSMA PET-directed local ablative therapies resulted in favorable outcome in more than 3 in 4 patients, and in nearly a quarter of them, there was complete biochemical response.

To assess whether 18F-DCFPyL PET/multiparametric (mp)MR contributes to the diagnosis of clinically significant (cs) prostate cancer (PCa) compared to mpMR in patients with suspicion of PCa, or patients being considered for focal ablative therapies (FT). This ethics review board–approved, prospective study included 55 men with suspicion of PCa and negative systematic biopsies or clinically discordant low-risk PCa (n = 21) or those being considered for FT (n = 34) who received 18F-DCFPyL PET/mpMR. Each modality, PET, mpMR, and PET/MR (using the PROMISE classification), was assessed independently. All suspicious lesions underwent PET/MR-ultrasound fusion biopsies. There were 45/55 patients (81.8%) that had histologically proven PCa and 41/55 (74.5%) were diagnosed with csPCa. Overall, 61/114 lesions (53.5%) identified on any modality were malignant; 49/61 lesions (80.3%) were csPCa. On lesion-level analysis, for detection of csPCa, the sensitivity of PET was higher than that of mpMR and PET/MR (86% vs 67% and 69% [p = 0.027 and 0.041, respectively]), but at a lower specificity (32% vs 85% and 86%, respectively [p

PURPOSE: To determine whether quantitative PET parameters on baseline 68Ga-DOTATATE PET/CT (bPET) and interim PET (iPET) performed prior to second cycle of therapy are predictive of therapy response and progression free survival (PFS). PATIENTS & METHODS: Ninety-one patients with well-differentiated neuroendocrine tumors (mean Ki67, 8.3%) underwent 68Ga-DOTATATE PET/CT (DT- PET) to determine suitability for peptide receptor radionuclide therapy (PRRT) as part of a prospective multicenter study. Mean follow-up was 12.2 months. Of them, 36 patients had iPET. Tumor metrics evaluated: 1. Marker lesion-based measures: mean SUVmax and ratio to liver/spleen; 2. Segmented DT tumor volume (DTTV) measures: DTTV; SUVmax and SUVmean using liver and spleen as thresholds; 3. Heterogeneity parameters (coefficient of variance, kurtosis, and skewness). Wilcoxon rank sum test was used for association between continuous variables and therapy response as determined by clinical response. Univariable and multivariable Cox proportional hazards model were used for association with PFS. RESULTS: There were 71 responders and 20 non-responders. Using marker lesions, higher mean SUVmax and mean SUVmax(Tumor/Liver) were predictors of therapy response (P = 0.018 & 0.024, respectively). For DTTV, higher SUVmax and SUVmean using liver as threshold and lower kurtosis were predictors of favorable response (P = 0.025, 0.0055 & 0.031, respectively. These also correlated with longer PFS. iPET DTTV SUVmean using liver threshold and ratio iPET mean SUVmax using target lesions correlated with therapy response (P = 0.024 & 0.048, respectively) but not PFS. From the multivariable analysis adjusting for age, primary site and Ki67, mean SUVmax (P = 0.019), SUVmax T/L (P = 0.018), SUVmax T/S (P = 0.041), DTTV SUVmean Liver (P = 0.0052) and skewness (P = 0.048) remain significant predictors of PFS. CONCLUSION: Degree of somatostatin receptor expression and tumor heterogeneity as represented by several metrics in our analysis are predictive of therapy response and/or PFS. Change in these parameters after first cycle of PRRT did not correlate with clinical outcomes.

Background: In many countries, hypertension in the pediatric population is considered a serious risk of mortality and morbidity. In this respect, it is central to design and develop new pharmaceutical forms for pediatric patients with hypertension. The development of Orodispersible Mini-Tablets (ODMTs) for pediatric use has gained importance in recent years. Therefore, regulations for developing suitable and palatable dosage forms for pediatric patients have been established by WHO authorities. Objective: This study aimed to design and develop orodispersible mini tablets of enalapril maleate (EnM ODMTs) for pediatric use. Methods: Five pharmaceutical formulations (A, B, C, D and E, shown in Table 1) were designed. The effects of different co-processed excipients and active pharmaceutical ingredients at different doses were studied. Lactose co-processed excipients selected were the following: Tablettose® 80, Microce- Lac® 100 and StarLac®. The micromeritic properties for all the physical mixtures were examined. The mini tablets were obtained by direct compression. Quality control parameters were determined in accordance with US Pharmacopeia. Results: Three OMDTs with StarLac® showed good results of hardness, flow ability and fast disintegration. The formulation with 0.1 mg of enalapril maleate presented the best results for the official parameters of hardness (4.0 kp), friability (< 1%), disintegration time (28 s), drug content uniformity (103.6 %), and wetting time (23 s). Conclusion: The three OMDTs with StarLac® showed good quality parameters, according to official requirements. Formulation A exhibited the best wetting time, complying with the dose recommended for pediatric patients. This formulation could be considered eligible for being manufactured at industrial scale.

Los medios de comunicación a partir de la implementación de las nuevas Tecnologías de la Información y Comunicación (TIC) se han diversificado conforme a la evolución y adaptación del uso de dispositivos tecnológicos en la vida del hombre. Con la hibridación de los medios surge la ecología mediática en la cual emergen nuevas formas de llevar acabo el acto comunicativo, los medios de comunicación se adaptan a la prácticas comunicativas y en ello se condensan las nuevas formas de comunicar. Estudiar el alcance y los niveles significativos de los modelos convergentes en los procesos de comunicación digital no sólo nos acercan al panorama mediático también nos vislumbra las capacidades de las plataformas y los dispositivos en el contexto social. En el siguiente documento discutiremos como a partir de la implementación de herramientas digitales y las narrativas transmedia podemos generar un aporte significativo a la apropiación del conocimiento por parte de los usuarios. Mediante el reconocimiento de los niveles de significación de todos los actores involucrados en la comunidad, entenderemos como las dinámicas participativas y colaborativas nos acercan a la democratización del conocimiento. Para comprender tanto el proceso apropiación del conocimiento como la relación que existe entre la sociedad y la tecnología es necesario definir de manera conceptual el proceso de apropiación, posteriormente el ecosistema mediático en el que se vinculan la narrativas mediáticas, para así abordar la relación que existe entre la tecnología digital, las narrativas transmedia y los procesos de apropiación del conocimiento en los usuarios.

Our purpose was to determine the effect of a smoothing filter and partial-volume correction (PVC) on measured prostate-specific membrane antigen (PSMA) activity in small metastatic lesions and to determine the impact of these changes on molecular imaging PSMA (miPSMA) scoring. Methods: Men who had biochemical recurrence of prostate cancer with negative findings on CT and bone scintigraphy were referred for 18F-DCFPyL (2-(3-(1-carboxy-5-[(6-18F-fluoro-pyridine-3-carbonyl)-amino]-pentyl) PET/CT. Examinations were performed on 1 of 2 different brands of PET/CT scanner. All suspected tumor sites were manually contoured on coregistered CT and PET images, and each was assigned an miPSMA score as per the PROMISE criteria. The PVC factors were calculated for every lesion using the anatomic CT and then applied to the unsmoothed PET images. The miPSMA scores, with and without the corrections, were compared, and a simplified rule-of-thumb (RoT) correction factor (CF) was derived for lesions at various sizes (

Purpose To determine the prognostic value of sarcopenia measurements done on staging [18F] FDG PET/CT together with metabolic activity of the tumor in patients with adenocarcinoma esophagogastric cancer with surgical treatment. Methods Patients with early stage, surgically treated esophageal adenocarcinoma and available pre-treatment PET/CT were included. The standard uptake value (SUV) and SUV normalized by lean body mass (SUL) were recorded. Skeletal muscle index (SMI) was measured at the L3 level on the CT component of the PET/CT. Sarcopenia was defined as SMI 2/m2 in women and 2/m2 in men. Results Of the included 145 patients. 30% were sarcopenic at baseline. On the univariable Cox proportional hazards analysis, ECOG, surgical T and N staging, Lymphovascular Invasion (LVI) positive lymph nodes and sarcopenia were significant prognostic factors concerning RFS, and OS. On multivariable Cox regression analysis, surgical N staging (p = 0.025) and sarcopenia (p = 0.022) remained significant poor prognostic factors for OS and RFS. Combining the clinical parameters with the imaging derived nutritional evaluation of the patient but not metabolic parameters of the tumor showed improved predictive ability for OS and RFS. Conclusion Combining the patients’ imaging derived sarcopenic status with standard clinical data, but not metabolic parameters offered an overall improved prognostic value concerning OS and RFS.

Artificial intelligence (AI) algorithms based on deep convolutional networks have demonstrated remarkable success for image transformation tasks. State-of-the-art results have been achieved by generative adversarial networks (GANs) and training approaches which do not require paired data. Recently, these techniques have been applied in the medical field for cross-domain image translation. This study investigated deep learning transformation in medical imaging. It was motivated to identify generalizable methods which would satisfy the simultaneous requirements of quality and anatomical accuracy across the entire human body. Specifically, whole-body MR patient data acquired on a PET/MR system were used to generate synthetic CT image volumes. The capacity of these synthetic CT data for use in PET attenuation correction (AC) was evaluated and compared to current MR-based attenuation correction (MR-AC) methods, which typically use multiphase Dixon sequences to segment various tissue types. This work aimed to investigate the technical performance of a GAN system for general MR-to-CT volumetric transformation and to evaluate the performance of the generated images for PET AC. A dataset comprising matched, same-day PET/MR and PET/CT patient scans was used for validation. A combination of training techniques was used to produce synthetic images which were of high-quality and anatomically accurate. Higher correlation was found between the values of mu maps calculated directly from CT data and those derived from the synthetic CT images than those from the default segmented Dixon approach. Over the entire body, the total amounts of reconstructed PET activities were similar between the two MR-AC methods, but the synthetic CT method yielded higher accuracy for quantifying the tracer uptake in specific regions. The findings reported here demonstrate the feasibility of this technique and its potential to improve certain aspects of attenuation correction for PET/MR systems. Moreover, this work may have larger implications for establishing generalized methods for inter-modality, whole-body transformation in medical imaging. Unsupervised deep learning techniques can produce high-quality synthetic images, but additional constraints may be needed to maintain medical integrity in the generated data.

Background: Autoimmune encephalitis occurs as a subacute condition with a strong infectious association in children. In the last 20 years, the frequency of non-infectious cases has increased significantly Clinical case: A previously healthy eight-year-old male child with normal neurodevelopment, without a history of consanguinity, manifested progressive neurological deterioration with autoimmune encephalitis-limbic encephalitis up to hypothalamic dysfunction. Conclusion: In the mentioned case, it was documented that an inborn error of the immune system generated a severe neurological clinical picture, with permanent and irreversible damage, secondary to lack of immunological memory in the broad clinical context of a common variable immunodeficiency.

Goal PET is a relatively noisy process compared to other imaging modalities, and sparsity of acquisition data leads to noise in the images. Recent work has focused on machine learning techniques to improve PET images, and this study investigates a deep learning approach to improve the quality of reconstructed image volumes through denoising by a 3D convolution neural network. Potential improvements were evaluated within a clinical context by physician performance in a reading task. Methods A wide range of controlled noise levels was emulated from a set of chest PET data in patients with lung cancer, and a convolutional neural network was trained to denoise the reconstructed images using the full-count reconstructions as the ground truth. The benefits, over conventional Gaussian smoothing, were quantified across all noise levels by observer performance in an image ranking and lesion detection task. Results The CNN-denoised images were generally ranked by the physicians equal to or better than the Gaussian-smoothed images for all count levels, with the largest effects observed in the lowest-count image sets. For the CNN-denoised images, overall lesion contrast recovery was 60% and 90% at the 1 and 20 million count levels, respectively. Notwithstanding the reduced lesion contrast recovery in noisy data, the CNN-denoised images also yielded better lesion detectability in low count levels. For example, at 1 million true counts, the average true positive detection rate was around 40% for the CNN-denoised images and 30% for the smoothed images. Conclusion Significant improvements were found for CNN-denoising for very noisy images, and to some degree for all noise levels. The technique presented here offered however limited benefit for detection performance for images at the count levels routinely encountered in the clinic.

Las inmunoglobulinas son proteínas heterodiméricas compuestas de 2 cadenas pesadas y 2 cadenas ligeras. La inmunoglobulina G humana es un derivado del plasma y contiene más de 95 % de IgG. La composición de las subclases de IgG es similar a la del plasma humano normal. El tratamiento con inmunoglobulina comenzó hace más de 50 años y su uso se ha descrito en numerosas enfermedades. En Colombia, la importancia de este recurso inmunomodulador condujo a la necesidad de contar con una guía de práctica clínica para su uso, para lo cual se reunió un grupo multidisciplinario de expertos, quienes se distribuyeron en mesas de trabajo, por especialidad, para redactar un texto base. Se llevaron a cabo búsquedas bibliográficas sistemáticas; las evidencias identificadas se valoraron y clasificaron para sustentar un texto preliminar que fue discutido, analizado y corregido. Se emitieron recomendaciones de uso de la inmunoglobulina intravenosa en patologías que abarcan inmunodeficiencias primarias y secundarias, enfermedades autoinmunes, alteraciones neurológicas, infecciones, trasplantes y enfermedades misceláneas; se asignaron calificaciones según el sistema GRADE para cada una. El resultado final se tradujo en las recomendaciones que se presentan con la finalidad de informar, orientar y apoyar en el uso óptimo de dicho recurso inmunomodulador.

Treatment of hyper IgE syndrome (HIES) is directed towards prevention and management of infections by using sustained systemic antibiotics and antifungals

Aim: Investigate efficacy, safety and quality of life of Gammanorm®16.5% (subcutaneous immunoglobulin [SCIG]) in patients with primary immunodeficiencies (PIDs) and safety and to lesser extent efficacy in autoimmune diseases. Patients & methods: Medical records were extracted from 31 pediatric and 12 adult patients who received SCIG as part of the Personalized Program at University Children's Hospital, Bogotá, Colombia. Results: Mean SCIG dose was 28.7 g/month. Serious bacterial infections were observed in 7/33 patients in the PID group, most often bacterial pneumonia (3/33). There were no serious adverse events related to SCIG treatment. Drug-related adverse reactions were reported in 2/43 patients. Conclusion: Self-administration of SCIG provided effective protection, favorable tolerability and improved quality of life in patients with PIDs and autoimmune diseases from Colombia.

ResumenLa Enfermedad Granulomatosa Crónica, es una Inmunodeficiencia Primaria (IDP), clasificada dentro de los defectos funcionales de fagocitos, asociada a mutaciones en el complejo multiprotéico NADPH oxidasa, las cuales se asocian con el patrón de herencia de la enfermedad, siendo más frecuente los casos ligados al cromosoma X con una frecuencia del 60%, en donde es importante encontrar a las madres portadoras de la enfermedad. Las manifestaciones clínicas de esta enfermedad son infecciones recurrentes y severas generadas por bacterias catalasa positivas, además de levaduras. Los hallazgos clínicos más frecuentes son infecciones severas en piel, adenitis, hepatoesplenomegalia, neumonía recurrente, formación de granulomas y en aproximadamente un 40% de los pacientes BCGitis.El diagnóstico de la enfermedad granulomatosa crónica se ha realizado tradicionalmente con la técnica colorimétrica de nitro azul tetrazolium (NBT). Sin embargo, actualmente se dispone del ensayo de Dihidrorodamina 1,2,3 el cual se caracteriza por ser más sensible y específico además de permitir la detección del fenómeno de Lyonización en madres portadoras de la enfermedad como la actividad residual de la enzima.El objetivo de este estudio es describir el reporte de un caso clínico de EGC y la importancia del ensayo de Dihidrorodamina 1,2,3 por citometrìa de flujo, como apoyo en el diagnóstico de la EGC. Se trata de un estudio de reporte de caso, descriptivo, en el cual se realizó una búsqueda en la literatura científica, encontrando una correlación con los hallazgos clínicos y de laboratorio del paciente y su progenitora. Como resultado final del estudio, se observó una disminución severa en la producción de especies reactivas del oxígeno (EROs) en el paciente, además del fenómeno de Lyonización en su progenitora.Frente a la sospecha clínica de alteración funcional de fagocitos, la prueba de oxidación de Dihidrorodamina permite detectar la alteración en la producción especies reactivas del oxígeno (EROs) como el fenómeno de Lyonización.AbstractChronic granulomatous disease is a primary immunodeficiency (PID) classified within the phagocytes functional defects associated with mutations in the multi-protein enzyme complex, NADPH oxidase, which are associated with the pattern of inheritance of the disease. X-linked cases have a frequency of 60%, which makes it important to find surrogates of the disease. The clinical manifestations of this disease are recurrent, and with severe infections generated by catalase positive bacteria, as well as yeasts. The most common clinical findings are severe skin infections, lymphadenitis, hepatosplenomegaly, recurrent pneumonia, and granuloma formation in approximately 40% of patients with BCGitis.The diagnosis of chronic granulomatous disease has traditionally been made with the colorimetric nitro blue tetrazolium (NBT) technique. However, the currently available 1,2,3 dihydrorhodamine assay, which has shown to be more sensitive and specific, in addition to enable detection of the lyonisation phenomenon in mothers carrying the disease, as well as the residual activity of the enzyme.The aim of this study was to report a case of CGD, and the importance of 1,2,3 dihydrorhodamine test by flow cytometry, as support in its diagnosis. It is a descriptive study case report, and includes a search in the scientific literature, and finding a correlation with clinical and laboratory findings of the patient and the mother.The end result of the study, a severe decrease was observed in the production of reactive oxygen species (ROS) in the patient, in addition to the lyonisation phenomenon in the mother.Faced with clinical suspicion of functional impairment of phagocytes, the dihydrorhodamine oxidation test can detect the alteration in the production of reactive oxygen species (ROS) as well as the lyonisation phenomenon.

Introduction People with cancer are at increased risk of incidental venous thromboembolism (VTE) and PET-CT imaging is commonly used in this population. However, the prevalence of incidental VTE detected by PET-CT in patients with cancer and its impact on survival are unknown. Materials and Methods This retrospective study was approved by the local Institutional Review Board. 1331 consecutive adult patients with cancer who underwent PET-CT examination between 2009 and 2012 were included in the study (mean age: 57 ± 15 years). PET-CT reports were reviewed to identify patients with incidental VTE at the time of examination. Survival rates were assessed with Kaplan-Meier curves. The Cox proportional hazards model was used to determine the association between incidental VTE and overall survival, after controlling for clinical variables. Results Incidental VTE was detected in 19 patients (1.4%). Patients with genitourinary malignancies, colorectal cancer and lung cancer had the highest rates of incidental VTE at PET-CT. At multivariate analysis, incidental VTE detected by PET-CT was associated with worse overall survival independently of patient age, hospitalization status at time of PET-CT examination, and the presence of metastatic disease (Hazard ratio = 2.03; 95% confidence interval = 1.08-3.81, p = 0.028). Conclusion Incidental VTE was detected in 1.4% of adult patients with cancer undergoing PET-CT imaging. Diagnosis of incidental VTE at PET-CT imaging was associated with worse overall survival in this population.

Systemic treatment for cancer including chemotherapy or biologic agents can cause different changes in the skin or mucous membranes. These changes may represent a known adverse reaction to these drugs, although other etiologies should be considered. One of these, radiation recall dermatitis, is a rare and unpredictable phenomenon. Herein, we report two cases of this condition in women with metastatic breast cancer secondary to gemcitabine and the combination of capecitabine and ixabepilone.

International audience; Background : Chronic granulomatous disease (CGD) is a rare primary immunodeficiency caused by inborn errors of the phagocyte nicotinamide adenine dinucleotide phosphate oxidase complex. From the first year of life onward, most affected patients display multiple, severe, and recurrent infections caused by bacteria and fungi. Mycobacterial infections have also been reported in some patients.Objective : Our objective was to assess the effect of mycobacterial disease in patients with CGD.Methods : We analyzed retrospectively the clinical features of mycobacterial disease in 71 patients with CGD. Tuberculosis and BCG disease were diagnosed on the basis of microbiological, pathological, and/or clinical criteria.Results : Thirty-one (44%) patients had tuberculosis, and 53 (75%) presented with adverse effects of BCG vaccination; 13 (18%) had both tuberculosis and BCG infections. None of these patients displayed clinical disease caused by environmental mycobacteria, Mycobacterium leprae, or Mycobacterium ulcerans. Most patients (76%) also had other pyogenic and fungal infections, but 24% presented solely with mycobacterial disease. Most patients presented a single localized episode of mycobacterial disease (37%), but recurrence (18%), disseminated disease (27%), and even death (18%) were also observed. One common feature in these patients was an early age at presentation for BCG disease. Mycobacterial disease was the first clinical manifestation of CGD in 60% of these patients.Conclusion : Mycobacterial disease is relatively common in patients with CGD living in countries in which tuberculosis is endemic, BCG vaccine is mandatory, or both. Adverse reactions to BCG and severe forms of tuberculosis should lead to a suspicion of CGD. BCG vaccine is contraindicated in patients with CGD.

Background: Papular urticaria by flea bite is a chronic allergic condition in which clinical improvement may occur at the age of 7 years, thus representing a natural model of acquired immunologic tolerance in humans. The aim of this study was to characterize regulatory cells and specific responses to flea antigens of CD4+ T lymphocytes expressing cutaneous migration markers in patients with papular urticaria caused by flea bite and with different disease evolution times. Methods: Cell populations were characterized by flow cytometry in samples from patients and healthy controls. Specific cell stimulation was performed with a complete flea body extract. The Mann-Whitney U test was used for comparisons. Results: Total dendritic cells were lower in patients than in healthy controls. No quantitative differences were found in CD4 regulatory T cells. CD4+ T cells from patients produced more IL-4, lL-10, IL-17, and IFN-γ. Patients who experienced the onset of symptoms within the first 5 years of age showed a greater percentage of local (cutaneous lymphocyte antigen +) IL-4- and IL-17-producing cells, while patients who experienced the onset of symptoms after the age of 5 years had a higher percentage of systemic (cutaneous lymphocyte antigen –) IL-10-producing cells. Conclusion: Analysis of the cellular immune response against whole flea antigen in patients with papular urticaria by flea bites suggests a possible participation of inflammatory cytokines in the skin reaction (Th17) and a systemic control mechanism (IL-10). This pattern of cytokine production in patients could be a consequence of an impaired dendritic cell population.

Las reacciones de choque e hipersensibilidad a los anestésicos locales y generales y a otros medicamentos utilizados durante los procedimientos quirúrgicos, continúan siendo un reto en la práctica clínica. Las reacciones de hipersensibilidad alérgica pueden variar en su presentación e intensidad, y pueden producir desde síntomas leves en la piel hasta la muerte.

Presentamos a los médicos generales y especialistas de América Latina y el Caribe, la Guía colombiana de práctica clínica para el uso de inmunoglobulinas en tratamiento de reposición e inmunomodulación, como herramienta útil para que la aplicación de inmunoglobulinas en las diferentes patologías que como substrato biológico —plasma humano purificado— tenga probada indicación.

Recombinant protein expression has become an invaluable tool for academic and biotechnological projects. With the use of high-throughput screening technologies for soluble protein production, uncountable target proteins were produced in a soluble and homogeneous state enabling the realization of further studies. Evaluation of hundreds conditions requires the use of high-throughput cloning and screening methods. Here we describe a new versatile vector suite dedicated to the expression improvement of recombinant proteins with solubility problems. This vector suite allows the parallel cloning of the same PCR product into the 12 different expression vectors evaluating protein expression under different promoter strength, different fusion tags as well as different solubility enhancer proteins. Additionally, we propose the use of a new fusion protein which appear to be a useful solubility enhancer. Overall in this work we propose an economic and useful vector suite to fast track the solubility of different recombinant proteins and we propose a new solubility enhancer protein that can be included in the evaluation of the expression of recombinant proteins that are insoluble in classical expression conditions.

Se presenta un caso clínico de paciente con linfoma no Hodgkin tratado; en control tomográfico habitual se le solicitó PET-CT para complementar su estudio, que demuestra un foco metabólicamente activo en el espesor de músculo aductor izquierdo sin traducción tomográfica evidente. La lesión fue estudiada con ultrasonografia de partes blandas y biopsia dirigida, que resultó positiva para infiltración secundaria por linfoma. Este caso demuestra la utilidad de las técnicas complementarias en el manejo de estos pacientes, en especial la utilidad del PET-CT en el estudio de sitios inhabituales de diseminación. En este examen existe la posibilidad de identificar con precisión la localización de las lesiones mediante la TC complementaria, lo que permite efectuar posteriormente el estudio dirigido.

The audibility of patient clinical alarms to nursing personnel was tested during the first shift on a medical/surgical in-patient ward at William Beaumont Army Medical Center. This study was conducted during normal hospital operations, and we tested the Joint Commission on Accreditation of Healthcare Organizations 2004 National Patient Safety Goal, Section 6b to determine whether patient alarms could sufficiently compete against environmental background noises. Patient clinical alarms were audible at distances ofor = 95 feet with room doors open but were not sufficiently audible to hospital staff members when room doors were closed or during floor-buffing activities. This study suggests that, under these circumstances, hospitals may not meet Joint Commission on Accreditation of Healthcare Organizations 2004 National Patient Safety Goal, Section 6b. Because the audibility of patient clinical alarms directly affects patient safety, satisfaction, and quality of care, we provide recommendations for engineering controls and modifications to work routines.

La intususcepción de colon es una patología infrecuente en los adultos. En un 20 a 50% de los casos es secundaria a una enfermedad maligna. Sin embargo, en un número no despreciable, puede ser secundario a un lipoma. Como esta asociación es poco frecuente el diagnóstico preoperatorio sólo se realiza en pocos pacientes. El tratamiento en general es quirúrgico y depende de la presentación clínica. El presente trabajo describe las características clínicas, radiológicas y anatomopatológicas de dos pacientes que consultaron por un cuadro compatible con una obstrucción intestinal incompleta del colon. Se sospechó por las características de la tomografía computada en el primer enfermo y por los hallazgos de la colonoscopía en el segundo, la presencia de un lipoma de colon. Ambos pacientes fueron sometidos en forma electiva, a una resección del segmento de colon comprometido. Los dos enfermos evolucionaron sin complicaciones y fueron dados de alta al 10° y 8º día, posterior a la cirugía. El estudio anatomopatológico confirmó el diagnóstico preoperatorio de lipoma de colon en los 2 enfermos Colonic intussusception is uncommon among adults. In 20 to 50% of cases, it is secondary to malignant tumors. However, occasionally, it can be secondary to a lipoma. We report a 46 years old female and a 76 years old male with a colonic intussusception. The diagnosis was made in the female with an abdominal CAT scan that showed the lesion in the transverse colon, associated to an image with the density of fat. In the male, the diagnosis was made with a colonoscopy that showed a polypoid lesion that partially obstructed the ileocecal valve. Both patients were operated and the lesions were excised. The postoperative period was uneventful and they were discharged at the tenth and eighth postoperative day, respectively. The pathological study of the surgical piece confirmed the diagnosis of lipoma

El fenómeno de invaginación en el adulto es un evento poco frecuente, con una amplia variedad de presentación, que va desde síntomas agudos de obstrucción intestinal, hasta síntomas abdominales crónicos inespecíficos. Puede ocurrir tanto en intestino delgado como colon, siendo frecuente encontrar lesiones orgánicas subyacentes, en su mayoría procesos neoplásicos, tanto benignos como malignos Estos últimos son la etiología principal de invaginaciones en intestino grueso. El diagnóstico se puede realizar de forma confiable con el uso de tomografía computada al identificarse características imagenológicas particulares a esta patología. Reportamos dos casos en pacientes que se presentan con síntomas de obstrucción intestinal, con lesiones subyacentes en ambos casos, un lipoma y una neoplasia maligna Intussusception is an uncommon event in adults, with different clinical presentations, which range from bowel obstruction symptoms to nonspecific abdominal pain. Can occur in the small or large bowel. In adults there is usually an underlying cause, usually benign or malignant neoplasms, being the latter the main cause of this disease in the colon. The diagnosis with CT is usually straightforward, with a very typical appearance. We report two cases of patients with bowel obstruction and diagnosis of intussusception caused by a lipoma and colon cancer respectively

La listeriosis es un enfermedad bacteriana poco frecuente con una susceptibilidad mayor por mujeres embarazadas y especialmente por la unidad feto-placentaria. A continuación presentamos un caso ocurrido en el Hospital Central de la Policía, en que se logró confirmar el diagnóstico. Se reviso el tema y se estableció la diferencia en lo que respecta al manejo de este y otro tipo de corioamnionitis.