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BACKGROUND: Refractory venous leg ulcers (VLUs) often require extended time to heal, and they carry a high risk of recurrence. This case study describes our experiences with a patient with a VLU refractory to multiple treatment strategies who was successfully treated with Manuka honey. CASE: Mr S. was a 76-year-old man with multiple comorbid conditions and hypersensitivity to silver-based compounds, who developed 3 VLUs of his right lower extremity. He experienced 90 days of unsuccessful treatments using an iodized cadexomer ointment, hydrodetersive fiber dressings, hydrocolloid meshes, compression therapy, and antibiotic treatment without progression toward wound healing. We then initiated treatment with Manuka honey and continued compression therapy. His primary VLU was completely epithelialized within 38 days, and an adjacent VLU also showed progression toward healing. Mr S. reported clinically relevant improvement in wound-related pain at 17 days. CONCLUSION: The use of Manuka honey proved effective in this patient with a VLU refractory to other treatment strategies.

The genetic cause for several families with gastric cancer (GC) aggregation is unclear, with marked relevance in early-onset patients. We aimed to identify new candidate genes involved in GC germline predisposition. Whole-exome sequencing (WES) of germline samples was performed in 20 early-onset GC patients without previous germline mutation identified. WES was also performed in nine tumor samples to analyze the somatic profile using SigProfilerExtractor tool. Sequencing germline data were filtered to select those variants with plausible pathogenicity, rare frequency and previously involved in cancer. Then, a manual filtering was performed to prioritize genes according to current knowledge and function. These genetic variants were prevalidated with Integrative Genomics Viewer 2.8.2 (IGV). Subsequently, a further selection step was carried out according to function and information obtained from tumor samples. After IGV and selection step, 58 genetic variants in 52 different candidate genes were validated by Sanger sequencing. Among them, APC, FAT4, CTNND1 and TLR2 seem to be the most promising genes because of their role in hereditary cancer syndromes, tumor suppression, cell adhesion and Helicobacter pylori recognition, respectively. These encouraging results represent the open door to the identification of new genes involved in GC germline predisposition.

Colorectal cancer (CRC) is one of the most frequent neoplasia in developed countries and the second leading cause of cancer death in Spain. It develops through the accumulation of genetic and epigenetic alterations in the normal mucosa, producing advanced adenomas and invasive cancers. This multistep process makes CRC highly traceable, making it a good candidate for the implementation of preventive measures such as screening programs. Although there are different strategies, none of them meet all the criteria for CRC screening purposes. In this context, many molecular alterations involved in CRC carcinogenesis could contribute to the generation of new non-invasive methods with a high sensitivity and specificity. In this review, some of the most promising diagnostic non-invasive biomarkers for CRC will be briefly discussed.

Background: Knowledge of traditional and complementary medicine (TCM) and its use by patients are essential for patient safety. Aims: To examine knowledge of TCM among practitioners in a nephrology unit and their advice to patients. Methods: This was a descriptive, observational, cross-sectional study. Sociodemographic data were collected and an ad hoc closed response survey was used. Findings: This study included 62 practitioners, of whom: 32.26% had been trained in TCM, with no significant differences between professional groups; 41.93% used TCM and 67.74% recommended TCM to patients, with no significant difference between personal use and training received. The majority (62.90%) approved of TCM being included in clinical practice, 77.42% were in favour of it being included in formal health teaching programmes, 27.42% said patients had requested information on TCM and 50% knew it could interact with conventional treatment. Conclusion: Although the majority of practitioners had not been trained in TCM, they were interested in including such treatments in clinical practice. They recommended TCM to patients, but neither training nor personal experience were significant factors in relation to these recommendations. Training in TCM is required to ensure advice is safe.

IntroductionIn the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT (‘Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour’) study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention.Methods and analysesTURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation.Ethics and disseminationThe TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population’s health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.

Introduction: Plastic cannulas (PC) have shown efficacy in haemodialysis (HD) and are presented as a positive innovation for patients and vascular access survival. Objective: To analyse Spanish HD nurses' experience of using PC. Design: Cross-sectional observational study. Methods: An ad hoc questionnaire was administered on nurses' experience of PC use. Results: A total of 163 Spanish HD nurses were surveyed, of whom 42.3% had PC in their workplace and 50.9% had used them. In all, 55.8% had received training and 77.9% wished to receive more training. These needles were significantly more available in public institutions than in private centres (p < 0.001). There was no significant difference between years of experience and having received training (p = 0.915). There was a moderate-strong correlation (ρ = 0.659) between greater professional satisfaction with the product and greater patient satisfaction (p < 0.001). The nurses would make a median of two [P25 , 1; P75 , 3] modifications in the product design. The characteristics of the PC were rated positively by 55.8% and negatively by 10.3%. Conclusions: A substantial proportion of the nurses surveyed did not use PC and had not received training in their use. Respondents reported that PC could be improved and a small percentage perceived them negatively.Implications for practice: Based on the evidence presented and available, if we manage to integrate this knowledge and work on the continuum of achieving excellence, we will continue to grow as a profession and provide higher quality care.

INTRODUCTION Metalloproteinases play key roles in health and disease, by generating novel proteoforms with variable structure and function. Areas covered: This review focuses on the role of endogenous [a Disintegrin and Metalloproteinase (ADAMs), ADAMs with thrombospondin motifs (ADAMTS), and matrix metalloproteinases (MMPs)] and exogenous metalloproteinases in various disease conditions, and describes the application of mass spectrometry-based proteomics to detect qualitative and quantitative changes in protein profiles in tissues and body fluids in disease. Emphasis is placed on the proteomic analysis of exudates collected from affected tissues, including methods that enrich newly generated protein fragments derived from proteolysis in cells, stroma, or extracellular matrix. The use of proteomic analysis of exudates in the study of the local tissue damage induced by metalloproteinases derived from viperid snake venoms is discussed, particularly in relation to extracellular matrix degradation and to the overall pathology of these envenomings. Expert commentary: The information provided by these proteomics approaches is paving the way for the identification of biomarkers based on particular proteolytic signatures associated with different pathologies. Together with other methodological approaches, a comprehensive view of the mechanisms and dynamics of diseases can be achieved. Such basis of knowledge allows for the design of novel diagnostic and therapeutic approaches within the frame of 'precision' or 'personalized' medicine.

Background & Aims A significant proportion of colorectal cancer (CRC) cases have familial aggregation but little is known about the genetic factors that contribute to these cases. We performed an exhaustive functional characterization of genetic variants associated with familial CRC. Methods We performed whole-exome sequencing analyses of 75 patients from 40 families with a history of CRC (including early-onset cases) of an unknown germline basis (discovery cohort). We also sequenced specific genes in DNA from an external replication cohort of 473 families, including 488 patients with colorectal tumors that had normal expression of mismatch repair proteins (validation cohort). We disrupted the Fas-associated factor 1 gene (FAF1) in DLD-1 CRC cells using CRISPR/Cas9 gene editing; some cells were transfected with plasmids that express FAF1 missense variants. Cells were analyzed by immunoblots, quantitative real-time polymerase chain reaction, and functional assays monitoring apoptosis, proliferation, and assays for Wnt signaling or nuclear factor (NF)-kappa-B activity. Results We identified predicted pathogenic variant in the FAF1 gene (c.1111G>A; p.Asp371Asn) in the discovery cohort; it was present in 4 patients of the same family. We identified a second variant in FAF1 in the validation cohort (c.254G>C; p.Arg85Pro). Both variants encoded unstable FAF1 proteins. Expression of these variants in CRC cells caused them to become resistant to apoptosis, accumulate beta-catenin in the cytoplasm, and translocate NF-kappa-B to the nucleus. Conclusions In whole-exome sequencing analyses of patients from families with a history of CRC, we identified variants in FAF1 that associate with development of CRC. These variants encode unstable forms of FAF1 that increase resistance of CRC cells to apoptosis and increase activity of beta-catenin and NF-kappa-B.

Made available in DSpace on 2019-10-05T16:54:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-04-01 IRCCS Istituto Giannina Gaslini Background To our knowledge, the characteristics and burden of childhood arthritis have never been studied on a worldwide basis. We aimed to investigate, with a cross-sectional study, the prevalence of disease categories, treatment methods, and disease status in patients from across different geographical areas and from countries with diverse wealth status. Methods In this multinational, cross-sectional, observational cohort study, we asked international paediatric rheumatologists from specialised centres to enrol children with a diagnosis of juvenile idiopathic arthritis, according to International League of Associations for Rheumatology criteria, who were seen consecutively for a period of 6 months. Each patient underwent retrospective and cross-sectional assessments, including measures of disease activity and damage and questionnaires on the wellbeing and quality of life of the children. We qualitatively compared the collected data across eight geographical areas, and we explored an association between disease activity and damage and a country's gross domestic product (GDP) with a multiple logistic regression analysis. Findings Between April 4, 2011, and Nov 21, 2016, 9081 patients were enrolled at 130 centres in 49 countries, grouped into eight geographical areas. Systemic arthritis (125 [33.0%] of 379 patients) and enthesitis-related arthritis (113 [29.8%] of 379) were more common in southeast Asia, whereas oligoarthritis was more prevalent in southern Europe (1360 [56.7%] of 2400) and rheumatoid factor-negative polyarthritis was more frequent in North America (165 [31.5%] of 523) than in the other areas. Prevalence of uveitis was highest in northern Europe (161 [19.1%] of 845 patients) and southern Europe (450 [18.8%] of 2400) and lowest in Latin America (54 [6.4%] of 849), Africa and Middle East (71 [5.9%] of 1209), and southeast Asia (19 [5.0%] of 379). Median age at disease onset was lower in southern Europe (3.5 years, IQR 1.9-7.3) than in other regions. Biological, disease-modifying antirheumatic drugs were prescribed more frequently in northern Europe and North America than in other geographical settings. Patients living in countries with lower GDP had greater disease activity and damage than those living in wealthier countries. Damage was associated with referral delay. Interpretation Our study documents a variability in prevalence of disease phenotypes and disparities in therapeutic choices and outcomes across geographical areas and wealth status of countries. The greater disease burden in lowerresource settings highlights the need for public health efforts aimed at improving equity in access to effective treatments and care for juvenile idiopathic arthritis. Copyright (C) 2019 Elsevier Ltd. All rights reserved. Univ Genoa, Ist Giannina Gaslini, IRCCS, Clin Paediat & Rheumatol, Genoa, Italy Univ Genoa, Ist Giannina Gaslini, IRCCS, Epidemiol & Biostat Serv, Genoa, Italy Univ Genoa, Ist Giannina Gaslini, IRCCS, Sci Directory, Genoa, Italy Univ Genoa, PRINTO, IRCCS, Ist Giannina Gaslini, Genoa, Italy Univ Genoa, Dept Neurosci Rehabil Ophthalmol Genet & Maternal, Genoa, Italy Wilhelmina Childrens Hosp, Dept Pediat Immunol & Rheumatol, Utrecht, Netherlands Sanjay Gandhi Postgrad Inst Med Sci, Lucknow, Uttar Pradesh, India Univ Hosp 12 Octubre, Dept Pediat Rheumatol, Madrid, Spain Alfaisal Univ, Dept Pediat Rheumatol, King Faisal Specialist Hosp, Riyadh, Saudi Arabia Alfaisal Univ, Res Ctr, Riyadh, Saudi Arabia Western Univ Childrens Hosp, Hlth Sci Ctr, London, ON, Canada Oslo Univ Hosp, Dept Rheumatol, Oslo, Norway Oslo Univ Hosp, Med Fac, Oslo, Norway Univ Oslo, Oslo, Norway Oslo Univ Hosp, Norwegian Natl Advisory Unit Rheumat Dis Children, Oslo, Norway Univ Hosp Munster, Dept Pediat Rheumatol & Immunol, Munster, Germany Hosp Sor Maria Ludovica, Rheumatol Serv, La Plata, Buenos Aires, Argentina Bucharest Emergency Hosp, Cluj Napoca, Romania Childrens Emergency Hosp, Cluj Napoca, Romania Cincinnati Childrens Hosp Med Ctr, Div Rheumatol, Cincinnati, OH 45229 USA Alberta Childrens Prov Gen Hosp, Div Pediat Rheumatol, Dept Pediat, Calgary, AB, Canada Sofiamed, Pediat Dept, Sofia, Bulgaria Rigshosp, Juliane Marie Ctr, Paediat Rheumatol Unit, Copenhagen, Denmark Natl Inst Rheumatism & Physiotherapy, Clin Immunol Adult & Paediat Rheumatol Dept, Budapest, Hungary Univ Latvia, Pediat Dept, Riga, Latvia Univ Latvia, Univ Childrens Hosp, Riga, Latvia Univ Estadual Paulista, Botucatu Fac Med, Botucatu, SP, Brazil Shariati Hosp, Rheumatol Res Ctr, Dept Pediat & Rheumatol, Tehran, Iran Inst Rheumatol Belgrade, Div Pediat Rheumatol, Belgrade, Serbia Thessaloniki Univ, Dept Pediat 1, Hippokrat Gen Hosp, Sch Med, Thessaloniki, Greece Univ Estadual Paulista, Botucatu Fac Med, Botucatu, SP, Brazil

Hemodialysis (HD) has a significant impact on health-related quality of life (HRQoL). We performed an observational study to assess the mental and physical status of 41 patients on chronic HD treatment. We planned and launched a program of recreational and therapeutic intradialysis activities to reduce patients' boredom due to inactivity. Patients' mental and physical status was reassessed at 12 months. Our initial attempt to introduce these recreational activities as intradialysis therapy has been rated positively by all patients. After one year, anxiety decreased (without statistical significance) and willingness to participate in activities increased from 50.00% to 85.71% (p=0.019). No improvement was observed on the remaining studied variables. This preliminary initiative is promising. We plan to maintain these successful therapies and include others to help consolidate this program.

Snake venom metalloproteinases (SVMPs) affect the extracellular matrix (ECM) in multiple and complex ways. Previously, the combination of various methodological platforms, including electron microscopy, histochemistry, immunohistochemistry, and Western blot, has allowed a partial understanding of such complex pathology. In recent years, the proteomics analysis of exudates collected in the vicinity of tissues affected by SVMPs has provided novel and exciting information on SVMP-induced ECM alterations. The presence of fragments of an array of ECM proteins, including those of the basement membrane, has revealed a complex pathological scenario caused by the direct action of SVMPs. In addition, the time-course analysis of these changes has underscored that degradation of some fibrillar collagens is likely to depend on the action of endogenous proteinases, such as matrix metalloproteinases (MMPs), synthesized as a consequence of the inflammatory process. The action of SVMPs on the ECM also results in the release of ECM-derived biologically-active peptides that exert diverse actions in the tissue, some of which might be associated with reparative events or with further tissue damage. The study of the effects of SVMP on the ECM is an open field of research which may bring a renewed understanding of snake venom-induced pathology.

JJX12 is an engineered bispecific antibody against ricin, a member of the medically important A-B family of toxins that exploits retrograde transport as means to gain entry into the cytosol of target cells. JJX12 consists of RTA-D10, a camelid single variable domain (VHH) antibody directed against an epitope on ricin’s enzymatic subunit (RTA), linked via a 15-mer peptide to RTB-B7, a VHH against ricin’s bivalent galactose binding subunit (RTB). We previously reported that JJX12, but not an equimolar mixture of RTA-D10 and RTB-B7 monomers, was able to passively protect mice against a lethal dose ricin challenge, demonstrating that physically linking RTB-B7 and RTA-D10 is critical for toxin-neutralizing activity in vivo. We also reported that JJX12 promotes aggregation of ricin in solution, presumably through the formation of intermolecular crosslinking. In the current study, we now present evidence that JJX12 affects the dynamics of ricin uptake and trafficking in human epithelial cells. Confocal microscopy, as well as live cell imaging coupled with endocytosis pathway-specific inhibitors, revealed that JJX12-toxin complexes are formed on the surfaces of mammalian cells and internalized via a pathway sensitive to amiloride, a known inhibitor of macropinocytosis. Moreover, in the presence of JJX12, retrograde transport of ricin to the trans-Golgi network was significantly reduced, while accumulation of the toxin in late endosomes was significantly enhanced. In summary, we propose that JJX12, by virtue of its ability to crosslink ricin toxin, alters the route of toxin uptake and trafficking within cells.

The goal in this article is to examine social problems associated with highly active antiretroviral therapy (HAART) adherence in Mexico and the related challenges for Mexican persons living with HIV/AIDS (PLWHAs). The study was conducted from the perspective of infected and affected individuals. The authors completed 64 in-depth interviews with heterosexual male and female PLWHAs, as well as with some key individuals from their social network. Following the principles of grounded theory, they carried out inductive analysis to create codes and organize central themes. The authors identified problems related to accessing HAART and found that conditions for implementing recommendations made in the international literature to improve adherence are poor. The findings highlight the importance of social factors, such as health care system irregularities, ineffective physician—patient communication, and availability of family and other sources of social support such as self-help groups for PLWHAs' access and adherence to antiretroviral therapy in Mexico.

CPT-11 is a potent inhibitor of topoisomerase I and has shown antitumor activity in brain xenografts and in clinical trials in recurrent/progressive malignant glioma. VM-26 and VP-16 are topoisomerase II inhibitors and have also shown activity in phase II trials. We performed a phase II trial of intravenous CPT-11 (125 mg/m2) followed 24 h later by VM-26 (125 mg/m2). VP-16 (125 mg/m2) was later substituted for VM-26 due to drug shortage. For patients on anticonvulsants, the starting dose for all drugs was 150 mg/m2. Drugs were given weekly for 3 weeks followed by 1-week rest. Twenty-five patients were entered into the study. Three patients (12%) had improvement in CAT/MRI brain scans (95% confidence interval 3-31%). Fatigue and myelosuppression, mainly leukopenia, were the main toxicities. This combination of the topoisomerase I inhibitor CPT-11 followed by the topoisomerase II inhibitor, VM-26 or VP-16, has shown modest antitumor activity comparable to that reported for each drug singly. Myelosuppression is the main toxicity when topoisomerase I and II inhibitors are combined together.

This study aims to explore adolescents' intentions related to the early formation of a family.We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974).Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents' expectations for their child's education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (β=0.13).In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

To describe condom use among Mexican women living with HIV and analyze factors that facilitate or impede its utilization.Qualitative analysis of 55 interviews with women of reproductive age living with HIV.Inconsistent condom use and non-use at last sexual intercourse was common, and not clearly related to the male partners' HIV-status. Factors that influenced condom use included perceptions of health benefits, symbolic meaning assigned to the condom within the relationship, and the transformation or persistence of inequitable gender norms.Gender norms and male partners' attitudes strongly influence condom use among women living with HIV. To increase consistent condom use the health system must implement counseling and service delivery with a gender perspective and innovative actions to involve male partners.

Ricin, a member of the A-B family of ribosome-inactivating proteins, is classified as a Select Toxin by the Centers for Disease Control and Prevention because of its potential use as a biothreat agent. In an effort to engineer therapeutics for ricin, we recently produced a collection of alpaca-derived, heavy-chain only antibody VH domains (VHH or "nanobody") specific for ricin's enzymatic (RTA) and binding (RTB) subunits. We reported that one particular RTB-specific VHH, RTB-B7, when covalently linked via a peptide spacer to different RTA-specific VHHs, resulted in heterodimers like VHH D10/B7 that were capable of passively protecting mice against a lethal dose challenge with ricin. However, RTB-B7 itself, when mixed with ricin at a 1 ∶ 10 toxin:antibody ratio did not afford any protection in vivo, even though it had demonstrable toxin-neutralizing activity in vitro. To better define the specific attributes of antibodies associated with ricin neutralization in vitro and in vivo, we undertook a more thorough characterization of RTB-B7. We report that RTB-B7, even at 100-fold molar excess (toxin:antibody) was unable to alter the toxicity of ricin in a mouse model. On the other hand, in two well-established cytotoxicity assays, RTB-B7 neutralized ricin with a 50% inhibitory concentration (IC50) that was equivalent to that of 24B11, a well-characterized and potent RTB-specific murine monoclonal antibody. In fact, RTB-B7 and 24B11 were virtually identical when compared across a series of in vitro assays, including adherence to and neutralization of ricin after the toxin was pre-bound to cell surface receptors. RTB-B7 differed from both 24B11 and VHH D10/B7 in that it was relatively less effective at blocking ricin attachment to receptors on host cells and was not able to form high molecular weight toxin:antibody complexes in solution. Whether either of these activities is important in ricin toxin neutralizing activity in vivo remains to be determined.

Snakebite envenoming by Bothrops caribbaeus, an endemic viperid from the Lesser Antillean island of Saint Lucia, is clinically characterized by local tissue damage and systemic thrombosis that can lead to cerebral, myocardial or pulmonary infarctions and venous thromboses. Systemic effects (lethality, pulmonary hemorrhage, thrombocytopenia and coagulopathy) induced by intravenous (i.v.) administration of B. caribbaeus venom were studied in mice. The role of snake venom metalloproteinases (SVMPs) in these systemic alterations was assessed by inhibition with the chelating agent calcium disodium ethylenediaminetetraacetic acid (CaNa2EDTA). A snake C-type lectin-like (snaclec) and a type P-III hemorrhagic SVMP were isolated and characterized from this venom, and the effect of venom and the isolated snaclec on human platelet aggregation was studied in vitro. Results indicate that SVMPs play an important role in the overall toxicity of B. caribbaeus venom, being responsible for systemic hemorrhage and lethality, but not thrombocytopenia, whereas the isolated snaclec is involved in the thrombocytopenic effect. Both venom and snaclec induce platelet aggregation/agglutination. Moreover, the snaclec binds directly to glycoprotein Ib (GPIb) and induces agglutination in washed fixed platelets. On the other hand, B. caribbaeus venom hydrolyzed fibrinogen in vitro and induced a partial drop of fibrinogen levels with an increase in fibrin/fibrinogen degradation products (FDP) levels in vivo. The negative result for D-dimer (DD) in plasma is consistent with the lack of microscopic evidence of pulmonary thrombosis and endothelial cell damage. Likewise, no increments in plasma sE-selectin levels were detected. The absence of thrombosis in this murine model suggests that this effect may be species-specific. Universidad de Costa Rica/[741-B0-606]/UCR/Costa Rica UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP)

Transforming growth factor beta-1 (TGF-β1) participation in breast cancer development and metastasis is well-established, however, the clinical meaning of its circulating levels in women with breast cancer is poorly understood.To characterize the levels of TGF-β1 in plasma from women with breast cancer and to associate them with the main clinical factors associated with disease prognosis.TGF-β1 levels were measured by Enzyme-linked immunoassay (ELISA). Clinicopathological data were also assessed.Women bearing triple-negative tumors presented significantly reduced levels of this cytokine when compared to the other subtypes (p=0.0338). Patients with metastases exhibited lower levels of TGF-β1 than the non-metastatic cohort (p=0.0442). Patients with early-onset disease had the highest plasma TGF-β1 levels (p=0.0036). Doxorubicin chemotherapy induced a reduction in TGF-β1 level, promptly after drug infusion (p=0.0494). Patients with TGF-β1 levels lower than 20 pg/ml exhibited a tendency to have a reduced overall survival in a 40-month follow-up.Lower levels of circulating TGF-β1 are associated with a poor disease prognosis.

To analyze experiences of heterosexual Mexican people living with HIV (PLWHA) related to the exercise of their sexual and reproductive rights.Qualitative study based on 40 in-depth interviews with PLWHA in four Mexican States.Lack of support and counseling limits the exercise of sexual and reproductive rights by PLWHA, especially women. Principal limitations include feelings of frustration and confusion, fear of re-infection, scanty information, lack of power to negotiate condom use, social stigma and discrimination, and limited access to services and adequate technologies.To increase awareness and exercise of rights by PLWHA it is necessary to: improve sexual education; promote processes of cultural change to combat gender inequality and stigma and discrimination; and provide timely and scientific information about HIV prevention.

Research into intimate partner violence has shown that social isolation constitutes a risk factor, and the presence of social networks can be an important source of social support. This research note presents some results of an empirical study carried out in Mexico into women's social relations, especially their family relations, and their role in the promotion of traditional gender norms. Findings indicate that some of the main conditions that are associated with the production of violence against women are either generated or reinforced within the realm of what can be regarded as women's “strong ties.”

Unprotected sex between men is the major risk factor for HIV infection in Mexico and many other Latin American countries. There is a substantial body of literature demonstrating that the relationship between sexual identity and sexual practice is not binary or causal -- men who have sex with other men do not necessarily perceive themselves as gay -- and there is increasing interest in HIV prevention with men who have sex with both men and women. In Mexico, HIV prevention with men who have sex with women and men and who are not socially affiliated or identified with gay men is lacking. This paper explores the sexual histories and HIV-risk perception of HIV-positive Mexican men who indicated that they have sex with women in a screening interview and then in the context of an in-depth interview also reported having had sex with men. We consider the sexual practices and sexual and social identities of these men, examining their explanations for having sex with other men, the strategies used to affirm their masculinity, the management of their sexual identity in their social networks, HIV-risk perception before diagnosis and sexual practices after diagnosis. Recommendations are made to improve HIV prevention for men who have sex with men as well as women and who do not assume a gay or bisexual identity.

To assess the influence of the relationship between people living with HIV/AIDS and health care providers on treatment adherence and quality of life.Qualitative study conducted in Mexico, in 2003, with informants recruited from HIV/AIDS support groups, non-governmental organizations, and infectious disease clinics in public hospitals. A total of 40 people living with HIV/AIDS and five support group leaders were interviewed. Data were collected using sociodemographic questionnaires and in-depth interviews exploring the experience of living with HIV/AIDS, including treatment, disease perception, quality of life, physical and emotional health, and relationship with physicians. Responses were recorded, transcribed and organized thematically based on codes using an inductive analysis.Most respondents aged between 26 and 45 years. The main obstacles to care were related to lack of risk awareness and information among people living with HIV/AIDS and physicians. Physicians proved not to be well trained on HIV/AIDS care. During the follow-up care, most problems were related to inadequate treatment adherence mainly caused by poor communication with physicians and discrimination in public services.Overall the problems identified were related to information deficiencies, physicians' lack of training and paternalism, and social stigmatization of people living with HIV/AIDS associated with the epidemic.

To increase the knowledge of health care providers' understanding of and practices on domestic violence, in order to improve care.This study was conducted between May and November 2003, In Quintana Roo, Coahuila, and Mexico City, three Mexican states with a high prevalence of domestic violence. Sixty in-depth interviews with health care providers in public health institutions and key informants of health service provision were completed.Health care providers were categorized based on the extent to which they reproduced four"discourses about violence". These discourses influence their daily practice and are related to the informants' gender values and social positions. Most informants expressed their willingness to address the issue of domestic violence. CONCLUSIONS. Attention to and care for domestic violence is insufficient in health services; this may be due more closely related to a predominant discourse tolerating domestic violence among decision-makers, than to the attitudes of health care providers; the latter demonstrated greater awareness of women's rights.

To describe the methodology, the research designs used, the estimation and sample selection, variable definitions, collection instruments, and operative design and analytical procedures for the National Survey Violence Against Women in Mexico.A complex (two-step) cross-sectional study was designed and the qualitative design was carried out using in-depth interviews and participant observation in health care units.We obtained for the quantitative study a total of 26 240 interviews in women users of health services and 2 636 questionnaires for health workers; the survey is representative of the 32 Mexican states. For the qualitative study 26 in-depth interviews were conducted with female users and 60 interviews with health workers in the States of Quintana Roo, Coahuila and the Federal District.

This qualitative study of 30 physicians and nurses from the Mexican public health system aimed to understand their concepts and practices concerning domestic violence. A recent survey showed that most health professionals were unaware of the official criteria and procedures for dealing with cases of domestic violence. Our in-depth interviews failed to show substantial differences between professionals according to level of care, and that treatment was generally inadequate. We also observed a repertoire of ingrained social meanings among the medical staff concerning violence (derived from their own cultural traditions), hindering more effective responses to the problem.

This paper presents some thoughts on the problems endured by women facing HIV/AIDS. World and nationwide statistics show an upward trend of the epidemic among women, calling for the need to address this problem. A case is made for the way in which gender structure and relations facilitate the vulnerability of women to this disease, increasing their risk of infection related with specific factors like migration, employment unsafe conditions, and domestic violence, among others. Emphasis is made on the main obstacles faced by women to flag their concerns and needs in society, as well as on their lack of empowerment to cope effectively with their problems. Some initiatives advanced by the organized civil society and governmental strategies are presented, including accomplishments, deficiencies, needs, and challenges. Finally, conclusions and recommendations are given, highlighting the need to establish and evaluate preventative programs and policies from a gender and human rights perspective, to promote a greater awareness and improved responses to the problems imposed on women by the HIV/AIDS epidemic.