Banner Estrella Medical Center

Metastasis to the breast from extramammary tumors are rare, and the most common cancer that metastasizes to this site is malignant melanoma (MM). Unfortunately, metastases from malignant melanoma reveal a widespread of the disease and a high likeliness of poor diagnosis. In this study, a case of left breast metastasis of MM in a young pregnant woman, with a fast progression of the mammary and systemic course of pathology and unfortunately poor prognosis is presented. Despite the role of pregnancy in MM has yet to be unraveled, our study encourages the theory that immunosuppression and hormonal changes due to pregnancy may aggravate melanoma prognosis.

Autism Spectrum Disorders (ASDs) are a group of neurodevelopmental disorders that can severely compromise social and cognitive functions in childhood. Magnetic Resonance Imaging (MRI) currently represents the gold standard as an in vivo and non-invasive study of the human brain morphology. This work aims to search for possible links between clinical phenotypes and radiological anomalies that may be relevant and pathognomonic in the subsequent diagnosis of ASDs. This is a retrospective study in which 132 patients (112 males and 20 females) with neurodevelopment disorders, including ASDs, were enrolled. The population study was divided into three groups considering their own pathological diagnosis. All patients included in this population underwent genetic screening and one or multiple 1.5T MRI scans were performed to evaluate potential anomalies of the corpus callosum, periventricular white matter, ventricular space, cerebellum, subarachnoid space and thalamus. Univariate analysis showed that the presence of MRI brain abnormalities was a significant variable in predicting the presence of ASDs. Increased ventricular volume was one of the most replicated findings in ASDs patients since it was reported to be statistically significant both in uni- and multivariate analysis, resulting even as a potentially predictive factor of diagnosis. This study can represent a starting point for the research of new radiological evidence that might be important to early diagnose ASDs and for making a differential diagnosis with all those conditions that mimic autistic traits, but which are not clinically connected to the spectrum disorder itself.

Background:Schools play a key role in detecting early signs of autism and creating a targeted pathway of study and inclusion. This becomes complicated when faced with unknown situations, such as managing a student with Autism Spectrum Disorders (ASD).Materials and Methods:A nationwide study involving teachers (n=235) was conducted from March to August 2021. The survey instrument consisted of a questionnaire administered online through social networks containing socio-demographic data, attitudes, knowledge and inclusion plans from school teachers towards students with ASD.Results:Statistical significant differences were registered for the item no.13: among the main deficits caused by ADS are reduced social cognition, language abnormalities, and impaired sensory functioning. (p=.025); the item no.8 (p=.011): if an intervention works for one child with ASD, it is certain to work on another child with ASD; the item no.3(p=.002): genetic factors play an important role in the causes of ASD. By also considering teacher’s attitudes towards ASD according to the presence of a healthcare worker in the school environment, significant differences were registered for the item no.1 (p=.032): the interpretation that the diagnostic criteria for Asperger’s syndrome are the same as for high-functioning autism; the item no.6 (p=.025): children with ADS are very similar to each other, and the item no.7(p=.015): early intervention does not lead to additional benefits for children with ASD.Conclusions:The presence of professionals with advanced skills could be a benefit and represent a strong point in the application of measures of prevention and containment of community pathologies. (www.actabiomedica.it)

INTRODUCTION: Liver transplant (LT) is curative in patients with cirrhosis complicated by hepatocellular cancer (HCC) within T2/Milan Criteria. Microvascular invasion (MVI) of HCC portends poor prognosis and is associated with higher risk of recurrence post LT; however, is often undetectable with multiphasic imaging modalities during pre-LT staging. Factors associated with the presence of MVI at LT remain poorly defined. Our aim is to examine pre-LT clinical demographic and tumor related factors and their association with MVI on explant at LT. METHODS: Retrospective evaluation identifying 154 consecutive patients undergoing LT with HCC over a 5-year timeframe (2012-2017). HCC explant pathologic specimen reports reviewed identifying tumor focality, site, size (greatest dimension), histologic type and grade; and presence/absence of microvascular and perineural invasion. Review allowed for stratification into MVI on explant and no MVI on explant groups. Demographic and tumor variables were collected for the MVI and no MVI groups assessing for differences in: age, days on wait-list ( > or < 365) , gender, race, BMI, etiology of cirrhosis, biologic model for end-stage liver disease (MELD) score, number of presenting lesions, tumor volume, type of locoregional therapy (LRT), response to initial and number of bridging therapies; categorical variables analyzed using Fisher’s exact test; continuous variables compared using Levine’s t-test for equal variances and student’s t-test; P < 0.05, significant. RESULTS: 154 LT recipients for HCC reviewed with 16 (10.4%) demonstrating MVI on explant. No significant demographic differences between MVI and non MVI groups apart from age 59 +/- 6 years vs 60+/- 6 years (P < 0.0001) [Table 1]. No significant differences in LRT modality or number of presenting lesions. Although trends associated with presence of MVI were seen (shorter wait times for LT, larger total tumor volume, and increased number of LRT sessions); differences did not reach significance between cohorts. CONCLUSION: Demographic and current staging modalities for HCC do not reliably capture or predict the phenomenon of MVI on explant. Presence of MVI may be associated with larger tumor volumes and shorter wait times. Results support the current approach of 6 month wait times for MELD exception points and call further attention to the unmet need for tissue or serum-based biomarkers in HCC prognosis.Table 1.: Characteristics of liver transplant patients

El comercio internacional presenta gran cantidad de ventajas, entre las que se encuentran, en primer lugar, la promoción de la diversificación de la oferta exportable. De manera significativa, la inserción de productos locales en nuevos mercados significa mayor crecimiento económico. Sin duda, la implementación del Tratado de Libre Comercio Perú - Estados Unidos en el 2009 consolidó el libre acceso para productos agrícolas. Para ello, el instrumento de política comercial como el Tratados de Libre Comercio presente, permitió al Perú el acceso comercial a uno de los mercados más grande del mundo. Se destaca la importancia del libre comercio y acceso para productos agrícolas, los cuales acercan al Perú a distintas cadenas de producción mundial y, de esta manera, se presenta “La gran oportunidad para el Agro”. Ello es certificado e impulsado por el sector agroempresarial e instituciones del sector público con sus mecanismos de legitimación de libre comercio que dan apoyo y acceso para implementar la operalización del mismo. El objetivo de la presente investigación es analizar los factores comerciales que influyeron en las exportaciones de la partida arancelaria 20.05.99.1000, alcachofas preparadas o en conserva, durante los años 2008 - 2019, en el marco del TLC Perú - Estados Unidos. Para ello se hace uso de un enfoque de investigación mixto. Por un lado, se hace uso del enfoque cualitativo, en el cual se analiza la influencia del Tratado de Libre Comercio Perú – Estados Unidos y los sistemas de certificación como factores que influyeron en el flujo de las exportaciones de las alcachofas en conserva. Por otro lado, se hace uso del enfoque cuantitativo causal y correlacional utilizando técnicas econométricas en base a series de tiempo con información mensual desde 2008 hasta el 2019. Los hallazgos de la presente investigación muestran que la variación en las exportaciones de alcachofas en conserva se debe principalmente a la firma del acuerdo comercial TLC Perú – Estados Unidos, los sistemas de certificación y determinantes del mercado internacional como la demanda del producto por parte de Estados Unidos y la producción nacional del mismo.

ObjectiveTo demonstrate the cochlear turns area changes among patients with a history of meningitis, through otopatologic study.MethodsWe performed an analysis of the area of the bony cochlear turns and the cochlear lumen of the horizontal sections containing the modiolus and the area of the basal turn at the level of round window, in temporal bones obtained from patients with a history of meningitis and compared to a nondiseased control group.ResultsThe mean area of the bony walls and the lumen of all cochlear turns are reduced within the meningitis group. Patients who presented a time from the diagnosis of meningitis to death longer than 30 days had a significant reduction in the cochlear turns area, as compared to the control group.ConclusionFuture studies may further correlate audiologic outcomes, cochlear volume, and cochlear area among patients with meningitis.

Background: The association between otitis media and vestibular symptoms has been hypothesized in the past. Thus, in this study, we aimed to critically analyze (based in a systematic review of the literature) whether patients who have otitis media are at greater risk of developing vestibular impairment or not.Methods: We performed a systematic review of the literature and identified potentially relevant articles reporting vestibular symptoms and results of vestibular function tests in patients with otitis media through searches of the PubMED, Web of Science, Scopus, and Google Scholar databases. The quality of the final set of records was assessed using the “Newcaste–Ottawa Scale”.Results: Of the 2334 records searched, 43 met our inclusion and exclusion criteria, and those included 2250 patients. The records comprised 20 longitudinal studies, 21 cross-sectional studies, and 2 case reports. Regarding the type of otitis media studied, 25 examined vestibular impairment in otitis media with effusion, 6 acute otitis media, and 12 chronic otitis media. Results of anamnesis, clinical exams, and several vestibular function tests are reported and critically discussed.Conclusion: Most studies evaluating the association between otitis media and vestibular symptoms have potential methodological flaws. Clinical evidence suggests that patients with otitis media have increased chances for having vestibular symptoms, delayed acquisition of developmental milestones, and abnormalities in several vestibular function tests as compared with controls. Future studies with rigorous methodology aiming to assess the clinical significance (and prognostic factors) of the association between otitis media and vestibular impairment are warranted.Key messageSeveral studies demonstrated long-term sequelae secondary to otitis media. However, the evidence supporting those assumptions are based in low-quality evidence. Thus, better structured studies are warranted to better understand the clinical relevance of such association.

PURPOSE: : The purpose of this study was to examine the effects of acute golden root extract (GRE) supplementation on repeated Wingate exercise performance. METHODS: College aged female participants (age =19.0 yrs ± 0.63, height= 66.3 in ± 1.8, weight= 152.8 lbs ± 19.9) were recruited for this study. In a within groups counterbalanced study design, participants were supplemented with either 1,500 mg/day of GRE or placebo (gluten-free cornstarch) for 3 days. Participants also took an additional 500 mg dose of corresponding treatment 30 minutes prior to testing of each trial. During each exercise trial, participants completed 3x 15 second Wingate cycle tests separated by 2 minute recovery periods. Each exercise trial was separated by a 1 week washout period. RESULTS: Over the 3x 15 second Wingate cycle tests, mean watts (p= 0.01), mean anaerobic capacity (p=0.025), and total work (p=0.018) were higher in the GRE treatment trial versus placebo. However, mean anaerobic power (p= 0.185), mean peak watts (p= 0.078), and fatigue index (p= 0.186) were unaffected regardless of treatment. CONCLUSIONS: This study suggests that acute GRE supplementation improves repeated Wingate performance suggesting a role for GRE as an ergogenic aid.

We hypothesized that there would be significant anatomic differences of the tensor tympani muscle (TTM), tympanic diaphragm, epitympanum, and protympanum in patients with versus without Menière's disease. The effects of tenotomy on Menière's disease suggested it relieves the pressure on the inner ear of the contraction of the TTM and of negative middle ear pressure. Using human temporal bones from patients with Menière's disease, two studies were conducted. We examined the presence of otitis media, cholesteatoma, and endolymphatic hydrops, the length, diameter, configuration, the volume of the TTM and tendon, and the area of the tympanic isthmus (Study 1). We examined the presence of otitis media, cholesteatoma and endolymphatic hydrops, and the area and volume of the protympanum (Study 2). In study 1, we observed no significant differences between the two groups. In study 2, we did not observe a small and narrow protympanum in the Menière's disease group. None of the ears in the Menière's or control groups had otitis media or cholesteatoma in either study. We observed hydrops in all the temporal bones of the Menière's disease group and none in the control groups. The position, configuration, and size of the tensor tympani muscle and tendon do not seem to play a role in the pathogenesis of Menière's disease. Because the tympanic isthmus and protympanum in Menière's disease are not smaller than controls and that none of the temporal bones had otitis media or cholesteatoma, it is unlikely that there was dysventilation in the middle ear.