Emerging Hyalomma lusitanicum: From identification to vectorial role and integrated control

In the Mediterranean basin, the tick species Hyalomma lusitanicum Koch stands out among other species of the Hyalomma genus due to its wide distribution, and there is great concern about its potential role as a vector and/or reservoir and its continuous expansion to new areas because of climate warming and human and other animal movements. This review aims to consolidate all the information on H. lusitanicum, including taxonomy and evolution, morphological and molecular identification, life cycle, sampling methods, rearing under laboratory conditions, ecology, hosts, geographical distribution, seasonality, vector role and control methods. The availability of adequate data is extremely relevant to the development of appropriate control strategies in areas where this tick is currently distributed as well as in new areas where it could become established in the near future.

Invariant representations in deep learning for optoacoustic imaging

Image reconstruction in optoacoustic tomography (OAT) is a trending learning task highly dependent on measured physical magnitudes present at sensing time. A large number of different settings and also the presence of uncertainties or partial knowledge of parameters can lead to reconstruction algorithms that are specifically tailored and designed to a particular configuration, which could not be the one that will ultimately be faced in a final practical situation. Being able to learn reconstruction algorithms that are robust to different environments (e.g., the different OAT image reconstruction settings) or invariant to such environments is highly valuable because it allows us to focus on what truly matters for the application at hand and discard what are considered spurious features. In this work, we explore the use of deep learning algorithms based on learning invariant and robust representations for the OAT inverse problem. In particular, we consider the application of the ANDMask scheme due to its easy adaptation to the OAT problem. Numerical experiments are conducted showing that when out-of-distribution generalization (against variations in parameters such as the location of the sensors) is imposed, there is no degradation of the performance and, in some cases, it is even possible to achieve improvements with respect to standard deep learning approaches where invariance robustness is not explicitly considered.

On the robustness of model-based algorithms for photoacoustic tomography: Comparison between time and frequency domains

For photoacoustic image reconstruction, certain parameters such as sensor positions and speed of sound have a major impact on the reconstruction process and must be carefully determined before data acquisition. Uncertainties in these parameters can lead to errors produced by a modeling mismatch, hindering the reconstruction process and severely affecting the resulting image quality. Therefore, in this work, we study how modeling errors arising from uncertainty in sensor locations affect the images obtained by matrix model-based reconstruction algorithms based on time domain and frequency domain models of the photoacoustic problem. The effects on the reconstruction performance with respect to the uncertainty in the knowledge of the sensors location are compared and analyzed both in a qualitative and quantitative fashion for both time and frequency models. Ultimately, our study shows that the frequency domain approach is more sensitive to this kind of modeling errors. These conclusions are supported by numerical experiments and a theoretical sensitivity analysis of the mathematical operator for the direct problem.

Seasonal Dynamics of Fleas (Siphonaptera: Pulicidae, Ceratophyllidae and Leptopsyllidae) on Oryctolagus cuniculus in a Meso-Mediterranean Area of Central Spain

Flea infestations of wild rabbits were examined monthly in central Spain in a meso-Mediterranean area for 5 yr. A total of 1,180 wild rabbits were trapped and 7,022 fleas were collected from them. Overall, the prevalence was 74.1% with a mean flea index of 5.95 fleas per rabbit. Four flea species were identified: Spilopsyllus cuniculi (Dale, 1878) was the most abundant species (accounting for 74.3% of fleas collected) followed by Xenopsylla cunicularis (Smit, 1957), Odontopsyllus quirosi (Gil Collado, 1934), and Nosopsyllus fasciatus (Bosc, 1800) (18.9, 6.7, and 0.1%, respectively). The highest prevalence was observed in S. cuniculi (48.6%) followed by X. cunicularis, O. quirosi, and N. fasciatus (34.3, 20.0, and 0.6%, respectively). Odontopsyllus quirosi and S. cuniculi were mainly collected from autumn to spring with the peak of infestation in winter, while X. cunicularis was mainly found from spring to autumn with maximum levels of infestation during the summer months. The relevance of these findings is discussed.

A method for the calibration of wideband ultrasonic sensors for optoacoustics

A method for calibration of ultrasonic sensors for optoacoustics that provides both frequency response and sensitivity is presented. In order to obtain the bandwidth and the frequency response of an uncalibrated sensor, a point source with broadband spectra generated by a laser-induced bubble on a copper wire submerged in water is employed. On the other hand, the sensitivity measurement relies on the spatial symmetry of the pressure pulse and on a calibrated transducer. Therefore, two sensors are employed to detect the pressure pulse at the same distance from the source. The symmetry of the acoustic field that arrives at both transducers is adjusted and verified by means of an optical interferometer that provides a null signal when the copper wire is placed at the right position. The method is tested on the characterization of a thin-film polymeric piezoelectric transducer with a cylindrical focused shape.

Changes in Health Insurance Coverage Over Time by Immigration Status Among US Older Adults, 1992-2016

IMPORTANCE

Disparities in health insurance coverage by immigration status are well documented; however, there are few data comparing long-term changes in insurance coverage between immigrant and nonimmigrant adults as they age into older adulthood.

OBJECTIVE

To compare longitudinal changes in insurance coverage over 24 years of follow-up between recent immigrant, early immigrant, and nonimmigrant adults in the US.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study used data from the nationally representative Health and Retirement Study. Data were collected biennially from 1992 to 2016. The population included community-dwelling US adults born between 1931 and 1941 and aged 51 to 61 years at baseline. Statistical analysis was performed from February 3, 2017, to January 10, 2020.

EXPOSURES

Participants were categorized as nonimmigrants (born in the US), early immigrants (immigrated to the US before the age of 18 years), and recent immigrants (immigrated to the US from the age of 18 years onward).

MAIN OUTCOMES AND MEASURES

Self-reported data on public, employer, long-term care, and other private insurance were used to define any insurance coverage. Longitudinal changes in insurance coverage were examined over time by immigration status using generalized estimating equations accounting for inverse probability of attrition weights. The association between immigration status and continuous insurance coverage was also evaluated.

RESULTS

A total of 9691 participants were included (mean [SD] age, 56.0 [3.2] years; 5111 [52.6%] female). Nonimmigrants composed 90% (n = 8649) of the cohort; early immigrants, 2% (n = 201); and recent immigrants, 8% (n = 841). Insurance coverage increased from 68%, 83%, and 86% of recent immigrant, early immigrant, and nonimmigrant older adults, respectively, in 1992 to 97%, 100%, and 99% in 2016. After accounting for selective attrition, recent immigrants were 15% less likely than nonimmigrants to have any insurance at baseline (risk ratio, 0.85; 95% CI, 0.82-0.88), driven by lower rates of private insurance. However, disparities in insurance decreased incrementally over time and were eliminated, such that insurance coverage rates were similar between groups as participants attained Medicare age eligibility. Furthermore, recent immigrants were less likely than nonimmigrants to be continuously insured (risk ratio, 0.89; 95% CI, 0.85-0.94).

CONCLUSIONS AND RELEVANCE

Among community-dwelling adults who were not age eligible for Medicare, recent immigrants had lower rates of health insurance, but this disparity was eliminated over the 24-year follow-up period because of uptake of public insurance among all participants. Future studies should evaluate policies and health care reforms aimed at reducing disparities among vulnerable populations such as recent immigrants who are not age eligible for Medicare.

Generation of sub-microsecond quasi-unipolar pressure pulses

We present a method to generate sub-microsecond quasi-unipolar pressure pulses. Our approach is based on the laser irradiation of a thin copper wire submerged in water. The acoustic waveforms were recorded using two different, well characterized, wideband detection techniques: piezoelectric and optical interferometry. The results show that the irradiated target behaves as an omnidirectional source. Moreover, the peak pulse pressure linearly depends on the laser fluence and the source size. From the results, we propose an empirical equation for the spatial and temporal profile of the pressure pulse. The method has several advantages: ease of implementation, high repeatability, wide ultrasonic bandwidth and quasi-unipolar time profile. These features lead to potential applications of this acoustic source in ultrasonic characterization such as transducer systems, materials or passive devices.

Spirocercosis in red fox (Vulpes vulpes) in a natural reserve located in a meso-Mediterranean area

Spirocerca lupi Rudolphi 1809 (Nematoda Spirocercidae) has an indirect cycle involving intermediate and paratenic hosts, having domestic or wild canids as the main definitive hosts. The most frequent pathology affecting dogs is a granulomatous tumor-like growth containing adults in the oesophagus and aorta. There are very few references about the presence of nodules in the stomach. There is scant information about the epidemiology of this disease in wild red foxes in meso-Mediterranean areas. In this work we report on the natural infection of wild red foxes by Spirocerca lupi and the damage produced in the stomach wall in an area where contact with other potential definitive hosts (canids) is very rare. From July 2015 to November 2016, 61 red foxes were sampled. 18.03% of the stomach walls examined had nodules containing Spirocerca lupi adults and eggs. The prevalence of infection was similar for young and adult groups (23.81 and 18.18%; χ2 = 0.25; df = 1; P = 0.6171) and it was higher in females than in males (25.81 versus 10.00%, χ² = 2.58; df = 1; P = 0.1082). The red fox population in the area seems to be well established judging from their age distribution and the fact that they could be captured all year round. It would appear that in the absence of other main definitive host S. lupi population is able to survive just parasitizing red foxes. Pathologic effects of this parasite on red foxes seems to show some differences related to domestic dogs. These results also indicates as predator control programs can maintain suitable host populations with reduced level of infection.

Patient Perspectives on Transitions of Surgical Care: Examining the Complexities and Interdependencies of Care

This study examined a thematic network aimed at identifying experiences that influence patients' outcomes (e.g., patients' satisfaction, anxiety, and discharge readiness) in an effort to improve care transitions and reduce patient burden. We drew upon the Sociology and Complexity Science Toolkit to analyze themes derived from 61 semistructured, longitudinal interviews with 20 patients undergoing either a benign or malignant colorectal resection (three interviews per patient over a 30-day after hospital discharge). Thematic interdependencies illustrate how most outcomes of care are significantly influenced by two cascades identified as patients' medical histories and home circumstances. Patients who reported previous medical or surgical histories also experienced less distress during the discharge process, whereas patients with no prior experiences reported more concerns and greater anxiety. Patient dissatisfactions and challenges were due in large part to the contrasts between hospital and home experiences. Our hybrid approach may inform patient-centered guidelines aimed at improving transitions of care among patients undergoing major surgery.

Parametric modeling of wideband piezoelectric polymer sensors: Design for optoacoustic applications

In this work, we present a three-dimensional model for the design of wideband piezoelectric polymer sensors which includes the geometry and the properties of the transducer materials. The model uses FFT and numerical integration techniques in an explicit, semi-analytical approach. To validate the model, we made electrical and mechanical measurements on homemade sensors for optoacoustic applications. Each device was implemented using a polyvinylidene fluoride thin film piezoelectric polymer with a thickness of 25 μm. The sensors had detection areas in the range between 0.5 mm² and 35 mm² and were excited by acoustic pressure pulses of 5 ns (FWHM) from a source with a diameter around 10 μm. The experimental data obtained from the measurements agree well with the model results. We discuss the relative importance of the sensor design parameters for optoacoustic applications and we provide guidelines for the optimization of devices.

Evaluating the Prognostic Role of Elevated Preoperative Carcinoembryonic Antigen Levels in Colon Cancer Patients: Results from the National Cancer Database

OBJECTIVES

Carcinoembryonic antigen (CEA) is a reliable tumor marker for the management and surveillance of colon cancer. However, limitations in previous studies have made it difficult to elucidate whether CEA should be established as a prognostic indicator. This study examines the association between elevated preoperative CEA levels and overall survival in colon cancer patients using a national population-based registry.

METHODS

Stage I-III colon cancer patients were identified from the 2004-2006 National Cancer Database. A multivariable Cox proportional hazards model was used to estimate the association between elevated CEA levels and overall survival after controlling for important patient, hospital, and tumor characteristics. A Monte Carlo Markov Chain was used to impute the large degree of missing CEA data. All models controlled for the propensity score in order to account for selection bias.

RESULTS

A total of 137,381 patients met the inclusion criteria. Overall, 34 % of patients had an elevated CEA level and 66 % had a normal CEA level, with a median survival of 70 and 100 months, respectively. Patients with an elevated CEA level had a 62 % increase in the hazard of death (HR 1.62, 95 % CI 1.53-1.74) compared with patients with a normal CEA level.

CONCLUSIONS

Preoperative CEA was an independent predictor of overall survival across all stages. The results support recommendations to include CEA levels as another high-risk feature that clinicians can use to counsel patients on adjuvant chemotherapy, especially for stage II patients.

Watch and Wait?--Elevated Pretreatment CEA Is Associated with Decreased Pathological Complete Response in Rectal Cancer

INTRODUCTION

Between 10 and 30% of rectal cancer patients experience pathological complete response after neoadjuvant treatment. However, physiological factors predicting which patients will experience tumor response are largely unknown. Previous single-institution studies have suggested an association between elevated pretreatment carcinoembryonic antigen and decreased pathological complete response.

METHODS

Clinical stage II-III rectal cancer patients undergoing neoadjuvant chemoradiotherapy and surgical resection were selected from the 2006-2011 National Cancer Data Base. Multivariable analysis was used to examine the association between elevated pretreatment carcinoembryonic antigen and pathological complete response, pathological tumor regression, tumor downstaging, and overall survival.

RESULTS

Of the 18,113 patients meeting the inclusion criteria, 47% had elevated pretreatment carcinoembryonic antigen and 13% experienced pathological compete response. Elevated pretreatment carcinoembryonic antigen was independently associated with decreased pathological complete response (OR = 0.65, 95% CI = 0.52-0.77, p < 0.001), pathological tumor regression (OR = 0.74, 95% CI = 0.67-0.70, p < 0.001), tumor downstaging (OR = 0.77, 95% CI = 0.63-0.92, p < 0.001), and overall survival (HR = 1.45, 95% CI = 1.34-1.58, p < 0.001).

CONCLUSION

Rectal cancer patients with elevated pretreatment carcinoembryonic antigen are less likely to experience pathological complete response, pathological tumor regression, and tumor downstaging after neoadjuvant treatment and experience decreased survival. These patients may not be suitable candidates for an observational "watch-and-wait" strategy. Future prospective studies should investigate the relationships between CEA levels, neoadjuvant treatment response, recurrence, and survival.

Modeling thin-film piezoelectric polymer ultrasonic sensors

This paper presents a model suitable to design and characterize broadband thin film sensors based on piezoelectric polymers. The aim is to describe adequately the sensor behavior, with a reasonable number of parameters and based on well-known physical equations. The mechanical variables are described by an acoustic transmission line. The electrical behavior is described by the quasi-static approximation, given the large difference between the velocities of propagation of the electrical and mechanical disturbances. The line parameters include the effects of the elastic and electrical properties of the material. The model was validated with measurements of a poly(vinylidene flouride) sensor designed for short-pulse detection. The model variables were calculated from the properties of the polymer at frequencies between 100 Hz and 30 MHz and at temperatures between 283 K and 313 K, a relevant range for applications in biology and medicine. The simulations agree very well with the experimental data, predicting satisfactorily the influence of temperature and the dielectric properties of the polymer on the behavior of the sensor. Conversely, the model allowed the calculation of the material dielectric properties from the measured response of the sensor, with good agreement with the published values.

Testing satisfaction of basic psychological needs as a mediator of the relationship between socioeconomic status and physical and mental health

This research applied self-determination theory to examine the degree to which satisfaction of basic psychological needs for autonomy, relatedness, and competence explained the association between socioeconomic status and physical and mental health outcomes, while controlling for age, exercise, and smoking status. This was a survey research study with 513 full-time employees in professions representative of a hierarchal organization. The results of the structural equation model verify that psychological need satisfaction mediates the inverse association between socioeconomic status and physical and mental health. Self-determination theory contributes to understanding the psychosocial roots of the uneven distribution of health across the socioeconomic gradient.

Stereodynamics of the photodissociation of nitromethane at 193 nm: unravelling the dissociation mechanism

The photodissociation of nitromethane at 193 nm is reviewed in terms of new stereodynamical information provided by the measurement of the first four Dixon's bipolar moments, β0(2)(20), β0(0)(22), β0(2)(02), and β0(2)(22), using slice imaging. The measured speed-dependent β0(2)(20) (directly related with the spatial anisotropy parameter β) indicates that after one-photon absorption to the S3(2 (1)A″) state by an allowed perpendicular transition, two reaction pathways can compete with similar probability, a direct dissociation process yielding ground-state CH3 and NO2(1 (2)A2) radicals and a indirect dissociation through conical intersections in which NO2 radicals are formed in lower-lying electronic states. A particularly important result from our measurements is that the low recoil energy part of the methyl fragment translational energy distribution presents a contribution with parallel character, irrespective of the experimental conditions employed, that we attribute to parent cluster dissociation. Moreover, the positive values found for the β0(0)(22) bipolar moment indicates some propensity for the fragment's recoil velocity and angular momentum vectors to be parallel.

Photodissociation of pyrrole-ammonia clusters below 218 nm: quenching of statistical decomposition pathways under clustering conditions

The excited state hydrogen transfer (ESHT) reaction in pyrrole-ammonia clusters (PyH·(NH(3))(n), n = 2-5) at excitation wavelengths below 218 nm down to 199 nm, has been studied using a combination of velocity map imaging and non-resonant detection of the NH(4)(NH(3))(n-1) products. Special care has been taken to avoid evaporation of solvent molecules from the excited clusters by controlling the intensity of both the excitation and probing lasers. The high resolution translational energy distributions obtained are analyzed on the base of an impulsive mechanism for the hydrogen transfer, which mimics the direct N-H bond dissociation of the bare pyrrole. In spite of the low dissociation wavelengths attained (~200 nm) no evidence of hydrogen-loss statistical dynamics has been observed. The effects of clustering of pyrrole with ammonia molecules on the possible statistical decomposition channels of the bare pyrrole are discussed.

Slice imaging and wave packet study of the photodissociation of CH3I in the blue edge of the A-band: evidence of reverse 3Q0 ← 1Q1 non-adiabatic dynamics

The photodissociation of CH(3)I in the blue edge (217-230 nm) of the A-band has been studied using a combination of slice imaging and resonance enhanced multiphoton ionization (REMPI) detection of the CH(3) fragment in the vibrational ground state (ν = 0). The profiles of the CH(3) (ν = 0) kinetic energy distributions and the photofragment anisotropies are interpreted in terms of the contribution of the excited surfaces involved in the photodissociation process, as well as the probability of non-adiabatic curve crossing between the (3)Q(0) and (1)Q(1) states. In the studied region, unlike in the central part of the A-band where absorption to the (3)Q(0) state dominates, the I((2)P(J)), with J = 1/2, 3/2, in correlation with CH(3) (ν = 0) kinetic energy distributions show clearly two contributions of different anisotropy, signature of the competing adiabatic and non-adiabatic dynamics, whose ratio strongly depends on the photolysis wavelength. The experimental results are compared with multisurface wave packet calculations carried out using the available ab initio potential energy surfaces, transition moments, and non-adiabatic couplings, employing a reduced dimensionality model. A good qualitative agreement is found between experiment and theory and both show evidence of reverse (3)Q(0)←(1)Q(1) non-adiabatic dynamics at the bluest excitation wavelengths both in the fragment kinetic energy and angular distributions.

Background subtraction in pulsed photoacoustics through neural-network processing

We report on the application of neural-network processing to pulsed photoacoustics for improving the detection limit by subtracting the window-heating-associated background. This technique was applied to the measurement of ethylene traces excited by a TEA (transverse electrical discharge in gas at atmospheric pressure) CO(2) laser. The signal contains a term that shows absorption saturation, characteristic of the absorbing gas, and another, generated by window heating, linearly dependent on laser energy. At low concentrations, normalization to laser energy is not possible owing to the different absorption mechanisms. To overcome this problem we relied on a neural-network filter, trained with experimentally obtained patterns, that subtracts the background and returns the sample concentration. This way, we reduced the detection limit to 20% of the previous limit obtained by reading the main resonance peak amplitude.

Evaluation of the quality of the water in El Hondo natural park located in the east of Spain

The purpose of the present work was to evaluate the quality of the water in El Hondo Park, an important wetland located in the east of Spain (province of Alicante) and included on the Ramsar List. The influence of the input of pollutants was assessed over a 14-month period in order to propose remedial action. Three different sources of waters were studied: irrigation water, brackish water and reservoir water. The irrigation water was found to have a high value of conductivity with high concentrations of Cl-, SO(4)2-, Na+ and K+ due to the influence of the brackish water. The concentration of organic matter given as CODT (total chemical oxygen demand) was found to be in the range of 70-600 mg/L of CODT, which was comparable to low-middle strength wastewater. A high concentration of Chlorophyll (a) was found in samples of reservoir water and the eutrophication of this water was thus observed. A high linear relationship was found among CODT, CODF (filtered COD) and BOD5; among electrical conductivity (E.C.), Cl-, SO4(-2), Na+, K+, Ca2+ and Mg2+ and among pH, CO3H- and CO(3)2- in all the samples evaluated. Taking this fact into consideration, a simplified water quality index (WQI) was calculated. Using this parameter, the quality of the water from different sources and its variation during the period evaluated was determined to be at a maximum during the months of December to February, which coincided with the period of high precipitations and low temperature. The highest values of this parameter were found in the samples corresponding to the reservoir water while the lowest values were found in the samples of the brackish water. By determination of the WQI, the influence of the brackish water on the quality of water for irrigation and reservoir waters was confirmed.

Myeloid mixed chimerism is associated with relapse in bcr-abl positive patients after unmanipulated allogeneic bone marrow transplantation for chronic myelogenous leukemia

BACKGROUND AND OBJECTIVE

Although bcr-abl polymerase chain reaction (PCR) positivity after bone marrow transplantation (BMT) for chronic myelogenous leukemia (CML) is significantly related to relapse, the predictive value of the assay is not very high and therefore most investigators consider that qualitative RT-PCR data alone are too imprecise to enable clinical decisions to be taken in individual cases. To define the clinical outcome of bcr-abl positive patients after unmanipulated BMT better, we sought the origin of hematopoiesis and traced its evolution over time.

DESIGN AND METHODS

Forty-nine patients received allogeneic BMT for CML (39 in chronic phase and 10 in accelerated phase/blast crisis). Median follow-up was 61 months (range 4-92). mRNA and DNA were used to assess bcr-abl and chimerism status respectively. Quantitative VNTR-PCR on total cells and lymphoid or myeloid population allowed us to assign and measure the origin of hematopoiesis.

RESULTS

Both bcr-abl positivity and the presence of mixed chimerism (MC) were significantly associated with relapse (p = 0.0009 and p < 0.0001 respectively). Relapse was observed in one of 39 patients with complete donor chimerism and in 6 of 9 patients with MC. These six cases showed increasing levels of host hemopoiesis and bcr-abl positivity in the CD15-positive population prior to relapse. The other three cases had decreasing or stable low-level MC which was restricted to the T-cells as well as bcr-abl negativity.

INTERPRETATION AND CONCLUSIONS

Whereas the simple detection of bcr-abl fails to identify patients who will relapse with certainty, the assessment of MC by VNTR-PCR does identify patients headed to relapse. Confirmation of myeloid involvement and increasing levels over time further elucidates the clinical outcome of bcr-abl positive patients after BMT.

Increasing mixed haematopoietic chimaerism after BMT with total depletion of CD4+ and partial depletion of CD8+ lymphocytes is associated with a higher incidence of relapse

In this study we analysed the incidence and clinical impact of the persistence of host haemopoiesis (mixed chimaerism, MC) after allogeneic BMT in 35 consecutive patients with haematologic malignancies using a total CD4+ cell-depleted graft with an adjusted dose of CD8+ cells (1x10(8)/kg). Chimaerism was assessed by PCR amplification of VNTRs in 30 evaluable patients: 19 non-CML and 11 CML cases which were also evaluated for the BCR-ABL transcript by RT-PCR. All but one had complete engraftment with a donor profile early post-BMT. At the end of the study period, 12 of 30 patients displayed MC (40%). The overall disease-free survival for MC patients was clearly unfavourable when compared to those who exhibited a donor profile (24.7% vs. 100%, P = 0.005). However, we found that only two of five patients with MC in the non-CML group relapsed, whereas a clear correlation could be made between MC and relapse in CML (seven showed MC, preceding cytogenetic or haematological relapse in six of them, which displayed a prior BCR-ABL mRNA positivity). In addition, a quantitative-PCR approach enabled us to demonstrate that increasing amounts of MC are invariably associated with subsequent relapse, whereas a low stable level of host or complete donor haemopoiesis is consistent with clinical complete remission. Although these results suggest that the clinical impact of MC may depend on the underlying disease, it is compatible with the concept that the graft-versus-leukaemia effect against CML is mainly exerted by donor CD4+ lymphocytes. Elimination of this cellular subset may be responsible for the inability of the graft to prevent a progressive increase in the tumor cell burden.

[Right ventricle with double outlet associated to total anomalous pulmonary venous drainage to innominate vein]

The clinical findings of 2 patients are studied with an association of malformations not previously reported: double outlet right ventricle and total anomalous pulmonary venous connection to the innominate vein. The following features are worth while to be underlined: 1. Both patients showed a discordance between viscero-atrial situs and direction of the apex; 2. In both cases, particularly in case 2, there existed a very unusual spacial relationship between ventricles, the right ventricle being superior with respect to the left ventricular cavity; 3. From the embryological viewpoint, this ventricular arrangement is supposed to be due to an arrest of the development of the heart in the straight tube stage, there being, however, an upwards expansion of the atrioventricular canal and common atrium; 4. An accurate diagnosis of the common or divided nature of the atrioventricular valves has been impossible in these cases; 5. These combination of lesions constitutes a challenge to cardiologists and surgeons as far as the surgical indication is concerned. In that sense, the simple anastomosis of the common pulmonary vein to the left atrium, although is not a radical cure, may be a feasible and beneficial procedure.