Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation

INTRODUCTION

The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation.

METHODS

REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients.

RESULTS

A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases.

CONCLUSIONS

The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

Waldenström's Macroglobulinemia and Cryoglobulinemic Glomerulonephritis: An Unusual Case of Monoclonal Gammopathy of Renal Significance

Cryoglobulins are immunoglobulins that precipitate at temperatures below 37 °C and dissolve upon reheating. They can induce small-vessel vasculitis with renal involvement. Cryoglobulinemic glomerulonephritis is a rare manifestation that occurs in patients with monoclonal gammopathy, specifically Waldenström's macroglobulinemia. We present the case of a 52-year-old patient with a history of cutaneous vasculitis and hypothyroidism, who presented with generalized edema, moderate anemia, hypercholesterolemia, nephrotic range proteinuria of 12.69 g/day, microhematuria, arterial hypertension, and hypocomplementemia via the classical pathway, without acute kidney injury and with negative serological studies and positive cryoglobulins in the second determination. Serum and urine protein electrophoresis and immunofixation studies showed a monoclonal band of IgM and kappa light chain. Renal biopsy was consistent with cryoglobulinemic glomerulonephritis. In the context of dysproteinemia and cryoglobulinemic glomerulonephritis, bone-marrow aspiration and biopsy were performed, leading to the diagnosis of Waldenström's macroglobulinemia. Monoclonal gammopathies have been described in association with type I cryoglobulinemias. This described association is uncommon, which is why we present this case, along with a review of the literature.

Death in the Scottish curriculum: Denying or confronting?

The important role of schools in supporting children experiencing bereavement is established, yet less is known about how school curricula include death as part of life and this limits our understanding of the systemic structures that shape children's knowledge and experience of death. To address this gap, this paper discusses an analysis of the Scottish curriculum to explore the extent to which death features in compulsory education for children aged 3 to 15 years. The findings show that whilst death is present across the curricula, certain types of 'knowing' death are promoted, largely situated across religious teaching, which may limit children's engagement with the multiple and complex ways in which death features across individual, social, physical, and relational domains. By integrating the concepts of death systems and death ambivalence, the paper develops new knowledge on the interplay between curricula and sense making around death in children's lives that has practical utility.

Quantification of Dry Matter Content in Hass Avocado by Near-Infrared Spectroscopy (NIRS) Scanning Different Fruit Zones

Accurate dry matter determination (DM) in Hass avocados is vital for optimal harvesting and ensuring fruit quality. Predictive models based on NIRS need to capture fruit DM gradient. This work aimed to determine the DM content in Hass avocado whole by NIRS scanning different fruit zones. Spectra were recorded for each zone of the fruit: peduncle (P), equator (E), and base (B). The calibration and validation included fruit from different orchards in two harvest cycles. The results show a DM gradient within the fruit: 24.47% (E), 24.68% (B), and 24.79% (P). The DM gradient was observed within the spectra using the RMSi (root mean square) criterion and PCA. The results show that at least one spectrum per fruit zone was needed to represent the variability within the fruit. The performances of the calibration using the whole set of data were R2: 0.74 and standard error of cross-validation (SECV) = 1.18%. In the validation stage using independent validation sets, the models showed similar performance (R2: 0.75, SECV 1.15%) with low values of the standard error of prediction (SEP): 1.62%. These results demonstrate the potential of near-infrared spectroscopy for high-throughput sorting of avocados based on their commercial quality.

Flash vacuum expansion, a low-cost and energy-efficient alternative process to produce high-quality fruit puree: Application to Physalis peruviana

Goldenberry has great potential for the development of high-quality products due to its attractive sensory attributes, bioactive compounds, and health benefits. However, postharvest losses are high due to the lack of processing technologies that can both be adapted to rural conditions in producing countries to generate high-quality products. Flash vacuum expansion coupled with vacuum pulping is a new process that can meet these requirements. In the process, the steam holding time (30, 40, and 50 s/130 kPa) and flash vacuum expansion (5 ± 1.2 kPa) were studied. The logarithmic reduction of microbial load and some quality indicators were analyzed during the process and during storage to assess the shelf life of fruit purées. The FVE process with 40 s steam blanching led to a microbial reduction of over 6 log colony forming units (CFU)/g, increased yield and β-carotene content, and preserved most of the AA content (4-12%). Based on the half-lives of the quality indicators, the shelf life of the purées was between 16 d (20 °C) and 90 d (4 °C). The energy consumption was estimated at approximately 0.30 kWh/kg of product. These results demonstrate that the FVE process, although it includes heat treatment, allows a short exposure to heat of the whole fruits to obtain a high-quality puree with an adequate shelf life in a single step, with a relatively low equipment investment and moderate energy consumption.

Root dentin translucency and age at death estimation in adults using single rooted teeth: Update of the Forensic International Dental Database

Since the publication of Lamendin's age estimation technique, the root dentin translucency has received increasing attention as an important indicator of age. Recently, Parra and colleagues presented the Forensic International Dental Database (FIDB), a proposal to estimate age at death in adults based on Bayes theorem by applying the criteria of Lamendin's technique. The present study aims to update the procedure and to evaluate a new version of the method (named FIDBv2) using two control samples from Colombia and Greece. The performance of this new version was acceptable and suggests that the method is suitable for age at death estimation in adult individuals from different forensic contexts. The best approximations to chronological age were obtained for individuals between 30 and 60 years old, with errors less than 10 years. The age estimations calculated on control samples suggest the adequate performance of FIDBv2 on individuals from varied populations. It can be stated that the FIDBv2 constitutes a solid alternative to be used in contexts where no additional data are available. Here we reinforce the initial idea that this model for estimating age at death in adults may be generalizable to any forensic context in the world.

Searching for a prognostic index in lupus nephritis

BACKGROUND

Currently we do not have an ideal biomarker in lupus nephritis (LN) that should help us to identify those patients with SLE at risk of developing LN or to determine those patients at risk of renal progression. We aimed to evaluate the development of a prognostic index for LN, through the evaluation of clinical, analytical and histological factors used in a cohort of lupus. We have proposed to determine which factors, 6 months after the diagnosis of LN, could help us to define which patients will have a worse evolution of the disease and may be, more aggressive treatment and closer follow-up.

METHODS

A retrospective study to identify prognostic factors was carried out. We have included patients over 18 years of age with a clinical diagnosis of systemic lupus erythematosus (SLE) and kidney involvement confirmed by biopsy, who are followed up in our centre during the last 20 years. A multi-step statistical approach will be used in order to obtain a limited set of parameters, optimally selected and weighted, that show a satisfactory ability to discriminate between patients with different levels of prognosis.

RESULTS

We analysed 92 patients with LN, although only 73 have been able to be classified according to whether or not they have presented poor renal evolution. The age of onset (44 vs. 32; p = 0.024), the value of serum creatinine (1.41 vs. 1.04; p = 0.041), greater frequency of thrombocytopenia (30 vs. 7%; p = 0.038), higher score in the renal chronicity index (2.47 vs. 1.04; p = 0.015), proliferative histological type (100%) and higher frequency of interstitial fibrosis (67 vs. 32%; p = 0.017) and tubular atrophy (67 vs. 32%; p = 0.018) was observed between two groups. The multivariate analysis allowed us to select the best predictive model for poor outcome at 6 months based on different adjustment and discrimination parameters.

CONCLUSION

We have developed a prognostic index of poor renal evolution in patients with LN that combines demographic, clinical, analytical and histopathological factors, easy to use in routine clinical practice and that could be an effective tool in the early detection and management.

Primeros estudios sobre fluorosis dental en poblaciones arqueológicas de la provincia de Córdoba (Argentina)

El fluoruro (F-) posee propiedades de gran interés en relación con la salud humana. En concentraciones menores a 1mgF-/L favorece la mineralización de los tejidos duros. Sin embargo, la ingesta prolongada de agua con concentraciones superiores a 1 mg F-/L produce el cuadro clínico denominado fluorosis. En la provincia de Córdoba, estudios en poblaciones actuales detectaron esta patología en diferentes localidades. Los valores más elevados de F- en agua se hallaron en las zonas sur, noroeste y noreste, en contraste con los de la zona centro-oeste, lo cual permitió delimitar zonas con alto contenido de fluoruro en los cursos hídricos. Este trabajo se propone evaluar el impacto de la fluorosis dental en restos humanos de sitios arqueológicos de la provincia y relacionarlo con el contenido de F- en las aguas de regiones cercanas a los hallazgos. Se analizaron 38 individuos (27 masculinos y 11 femeninos) de diferentes regiones de la provincia de Córdoba y se registraron indicadores de fluorosis dental como hipoplasias y alteraciones en la coloración del esmalte. Además, se relevaron las frecuencias de caries, los restos radiculares, las fracturas del esmalte, las secuelas de procesos periapicales y el estado de las tablas alveolares, para evaluar la salud bucal de los individuos. Los resultados muestran que 21 individuos (55,3%) presentan signos de fluorosis dental, 13 masculinos (34,2%) y 8 femeninos (21,0%). La procedencia de los individuos afectados sugiere una relativa correspondencia con resultados de estudios clínicos actuales y con los niveles de fluoruros en las aguas de la provincia.

Evaluation of the role of lisdexamfetamine on attention-deficit/hyperactivity disorder common psychiatric comorbidities: mechanistic insights on binge eating disorder and depression

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric condition in which children suffer from inattentiveness, hyperactivity, and or impulsivity. ADHD patients frequently present comorbid psychiatric disorders: in adults, the most common are depression, substance-related disorders, anxiety, and eating disorders. Children and adolescents present conduct disorders, learning disorders, anxiety and depression. Since ADHD and its psychiatric comorbidities share similarities, a partial overlap of their pathophysiological mechanisms has been suggested. ADHD, can be treated with lisdexamfetamine (LDX), a prodrug indicated by the FDA as treatment for binge eating disorder (BED) and ADHD.

Objectives

To evaluate, through a systems biology-based in silico method, the efficacy of LDX as first-line ADHD treatment to improve ADHD psychiatric comorbidities. Furthermore, we explored the molecular mechanisms behind LDX’s action.

Methods

We used the systems biology- and artificial intelligence-based Therapeutic Performance Mapping System (TPMS) technology to characterise and model ADHD comorbidities. Artificial neural networks (ANNs) algorithms were used to identify specific relationships between protein sets. Finally, we modelled the mechanisms of LDX for the most relevant comorbidities by using sampling methods and comorbidity-specific virtual patients in each case.

Results

This study predicts a strong relationship between LDX’s targets and proteins involved in BED and depression (Fig 1). Our results could be explained not only by LDX role in neurotransmitter regulation, but also by modulation of neuroplasticity (BDNF/NTRK2, GSK3), neuroinflammation (interleukins, inflammasome), oxidative stress (NOS2, SOD), and the hypothalamic-pituitary-adrenal (HPA) axis (CRH, CRHR1).

Conclusions

These findings could be used in pre-clinical and clinical future investigations to assess optimal treatment for ADHD patients with psychiatric comorbidities.

Disclosure

JRGC: speaker for Takeda and Shire, research funding from Shire and Lumbeck, collaborations with Laboratoires Servier JQ: speaker or scientific advisor for Takeda, Janssen, Rubio. Investigation funding: Instituto de Salud Carlos III. PR, CM, TPR: full-ti

Innovative Process Coupling Short Steam Blanching with Vacuum Flash-Expansion Produces in One Single Stage High-Quality Purple Passion Fruit Smoothies

Short steam blanching coupled with flash-vacuum expansion (FVE) and de-pulping was used to obtain purée from purple passion fruits discarded from the export chain. Different steam blanching holding times (80, 95, 110 s) were tested at pressure of 130 kPa. After FVE and vacuum de-pulping, fibers, anthocyanins, carotenoids, rheological properties, and microbial reduction were evaluated in the purées. Fruit purées are obtained with a much higher content of cell-wall and bioactive compounds compared to the fresh arils since part of the fruit shell is incorporated into the purée (approximately 20%), which greatly increases the yield of production. Purées exhibited increasing shear-thinning flow behavior with blanching holding time, resulting in a smoothie-like beverage. A reduction greater than 5 log10 CFU/mL was obtained for molds, yeasts, aerobic mesophilic, and coliforms for all the treatments. The shelf life of smoothies based on nutritional and sensorial quality was extended up to 90 days at refrigeration temperature.

MRI-guided focal boost to dominant intraprostatic lesion using volumetric modulated arc therapy in prostate cancer. Results of a phase II trial

OBJECTIVE

To determine morphological and biological control as well as toxicity and quality of life (QoL) of men with localized prostate cancer (PCa) treated with MRI-guided focal boost radiotherapy.

MATERIAL AND METHODS

30 patients with PCa and a visible dominant intraprostatic lesion (DIL) identified on mpMRI were included in a prospective Phase II trial. Matching point registration of planning CT and T2W, diffusion-weighted and a gradient-recalled echo (GRE) MRI images made in treatment position was used for prostate and tumour delineation. Treatment consisted on 35 daily fractions of 2.17 Gy with a concomitant focal boost to the DIL of 2.43 Gy using volumetric modulated arc therapy (VMAT) and image-guided radiation therapy (IGRT) with intraprostatic fiducial markers. Biochemical failure was analysed using PSA nadir +2 ng/mL criteria and local control using mpMRI evaluation at 6-9 months following RT. Acute and late toxicity were defined according to CTCAE v.4.0 and RTOG/EORTC scales and QoL was assessed using IPSS, EPIC short-form and UCLA-PCI questionnaires.

RESULTS

The median radiation dose to the prostate was 77.6 Gy (IQR 77.3-78.1), and to the DIL was 85.5 Gy (IQR 85.0-86.0). With a median follow up of 30.0 months (IQR 25.5-40.27), all patients remain free of biochemical relapse. An mpMRI complete response was observed in 25 patients during the first post-treatment evaluation at 6 months. The remaining five patients achieved a complete disappearance of the DIL both on T2 and DWI on the second mpMRI performed at 9 months following treatment. Six out of 30 (20%) patients presented acute Grade 2 urinary toxicity with no Grade 3 acute complications. Acute rectal toxicity was only found in 2 (6.6%) patients (both Grade 1). Only late Grade 1 urinary and rectal complications were observed in 3/30 patients, respectively, with no Grade 2 or more late toxicity. The urinary, bowel and sexual bother EPIC scores were slightly and insignificantly increased in the first 3 months post-treatment, returning to normal afterwards.

CONCLUSIONS

mpMRI-guided focal boost using VMAT hypofractionated technique is associated with an excellent morphological and functional response control and a safe toxicity profile.

ADVANCES IN KNOWLEDGE

In the present trial, we examined the potential role of mpMRI for radiological assessment (functional and morphological) of treatment response in high-risk prostate cancer patients treated with MRI-guided focal radiotherapy dose intensification to dominant Intraprostatic lesion.

Malignant prediction in paragangliomas: analysis for clinical risk factors

INTRODUCTION

Paragangliomas are infrequent neuroendocrine tumours whose only criterion for malignancy is presence of metastases; thus, all paragangliomas show malignant potential. Actually, different risk factors have been analyzed to predict metastases but they remain unclear.

PURPOSE

To analyze clinical, histological, and genetic factors to predict the occurrence of metastasis.

PATIENTS AND METHOD

A multicentre retrospective observational analysis was performed between January 1990 and July 2019. Patients diagnosed with paraganglioma were selected. Clinical, histological, and genetic features were analyzed for the prediction of malignancy.

RESULTS

A total of 83 patients diagnosed with paraganglioma were included, of which nine (10.8%) had malignant paraganglioma. Tumour size was greater in malignant tumours than in benign (6 cm vs. 4 cm, respectively; p = 0.027). The most frequent location of malignancy was the thorax-abdomen-pelvis area observed in six cases (p = 0.024). No differences were observed in histological differentiation, age, symptoms, and catecholaminergic production. The most frequent genetic mutation was SDHD followed by SDHB but no differences were observed between benign and malignant tumours. In the univariate analysis for predictive factors for malignancy, location, tumour size, and histological differentiation showed statistical significance (p = 0.025, p = 0.014, and p = 0.046, respectively); however, they were not confirmed as predictive factors for malignancy in the multivariate analysis.

CONCLUSION

In this study, no risk factors for malignancy have been established; therefore, we recommend follow-up of all patients diagnosed with paraganglioma.

A population-based controlled experiment assessing the epidemiological impact of digital contact tracing

While Digital contact tracing (DCT) has been argued to be a valuable complement to manual tracing in the containment of COVID-19, no empirical evidence of its effectiveness is available to date. Here, we report the results of a 4-week population-based controlled experiment that took place in La Gomera (Canary Islands, Spain) between June and July 2020, where we assessed the epidemiological impact of the Spanish DCT app Radar Covid. After a substantial communication campaign, we estimate that at least 33% of the population adopted the technology and further showed relatively high adherence and compliance as well as a quick turnaround time. The app detects about 6.3 close-contacts per primary simulated infection, a significant percentage being contacts with strangers, although the spontaneous follow-up rate of these notified cases is low. Overall, these results provide experimental evidence of the potential usefulness of DCT during an epidemic outbreak in a real population.

Public Health Academic Alliance for COVID-19 Response: The Role of a National Medical Task Force in Puerto Rico

Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios.

Image quality eigenfunctions for the human eye

This work presents a compact statistical model of the retinal image quality in a large population of human eyes following two objectives. The first was to develop a general modal representation of the optical transfer function (OTF) in terms of orthogonal functions and construct a basis composed of cross-correlations between pairs of complex Zernike polynomials. That basis was not orthogonal and highly redundant, requiring the application of singular value decomposition (SVD) to obtain an orthogonal basis with a significantly lower dimensionality. The first mode is the OTF of the perfect system, and hence the modal representation, is highly compact for well-corrected optical systems, and vice-versa. The second objective is to apply this modal representation to the OTFs of a large population of human eyes for a pupil diameter of 5 mm. This permits an initial strong data compression. Next, principal component analysis (PCA) is applied to obtain further data compression, leading to a compact statistical model of the initial population. In this model each OTF is approximated by the sum of the population mean plus a linear combination of orthogonal eigenfunctions (eigen-OTF) accounting for a selected percentage (90%) of the population variance. This type of models can be useful for Monte Carlo simulations among other applications.

Blood pressure control and cardiovascular risk profile in hypertensive patients under specialist care in Argentina: Results from the CHARTER study

Worldwide, hypertension control rate is far from ideal. Some studies suggest that patients treated by specialists have a greater chance to achieve control. The authors aimed to determine the BP control rate among treated hypertensive patients under specialist care in Argentina, to characterize patients regarding their cardiovascular risk profile and antihypertensive drug use, and to assess the variables independently associated with adequate BP control. The authors included adult hypertensive patients under stable treatment, managed in 10 specialist centers across Argentina. Office BP was measured thrice with a validated oscillometric device. Adequate BP control was defined as an average of the three readings <140/90 mm Hg (and <150/90 in patients older than 80 years). The authors estimated the proportion of adequate BP control and the variables independently associated with it through a multiple conditional logistic regression model. Among the 1146 included patients, 48.2% were men with a mean age of 63.5 (±13.1) years old. Mean office BP was 135.3 (±14.8)/80.8 (±10) mm Hg, with a 64.8% (95% CI: 62%-67.6%) of adequate control. The mean number of antihypertensive drugs was 2.1 per participant, the commonest being angiotensin receptor blockers and calcium channel blockers. In multivariable analysis, only female sex was a predictor of adequate BP control (OR 1.33 [95% CI 1.02-1.72], P = .04). In conclusion, almost 65% of hypertensive patients treated in specialist centers in Argentina have adequate BP control. The challenge for future research is to define strategies in order to translate this control rate to the primary care level, where most patients are managed.

Valorisation of biowaste digestate through solid state fermentation to produce biopesticides from Bacillus thuringiensis

The main goal of this work is the production of a biopesticide through solid-state fermentation of biowaste digestate inoculated with Bacillus thuringiensis (Bt) at pilot scale using different configurations of reactors. Fermentations were carried out using insulated and non-insulated, stirred and non-stirred reactors at different scales (10, 22 and 100 L) in order to assess the influence of the reactor configuration on the biopesticide production process. A maximum temperature of 60 °C was reached in 10-L insulated non-stirred reactors where increments of Bt viable cells and spores with respect to initial values of 1.9 and 171.6 respectively, were attained. In contrast, when temperature was regulated by using 22-L non-insulated stirred reactors the increment of viable cells and spores were 0.8 and 1.9, respectively, at a stable temperature of 27 °C. When the non-insulated stirred reactor was scaled up to 100-L, the increase of viable cells and spore counts were 1.2 and 3.8 respectively, with an average temperature of 28 °C. These results demonstrated that the election of a proper reactor configuration is important when considering the development of a new SSF process, especially when dealing with non-conventional substrates as digestate.

Blow flies as urban wildlife sensors

Wildlife detection in urban areas is very challenging. Conventional monitoring techniques such as direct observation are faced with the limitation that urban wildlife is extremely elusive. It was recently shown that invertebrate-derived DNA (iDNA) can be used to assess wildlife diversity in tropical rainforests. Flies, which are ubiquitous and very abundant in most cities, may also be used to detect wildlife in urban areas. In urban ecosystems, however, overwhelming quantities of domestic mammal DNA could completely mask the presence of wild mammal DNA. To test whether urban wild mammals can be detected using fly iDNA, we performed DNA metabarcoding of pools of flies captured in Berlin, Germany, using three combinations of blocking primers. Our results show that domestic animal sequences are, as expected, very dominant in urban environments. Nevertheless, wild mammal sequences can often be retrieved, although they usually only represent a minor fraction of the sequence reads. Fly iDNA metabarcoding is therefore a viable approach for quick scans of urban wildlife diversity. Interestingly, our study also shows that blocking primers can interact with each other in ways that affect the outcome of metabarcoding. We conclude that the use of complex combinations of blocking primers, although potentially powerful, should be carefully planned when designing experiments.

Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group

OBJECTIVE

To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain.

PATIENTS AND METHODS

Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D'Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests.

RESULTS

Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients' age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n=521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT.

CONCLUSIONS

Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319).

Root surface temperature variation during mechanical removal of root canal filling material. An in vitro study

The aim of this study was to analyze in vitro temperature changes on the outer surface of the dental root during mechanical filling removal procedures. Thirty recently extracted single-rooted lower premolars were cut transversally at 16 mm from the apex in order to standardize sample length. Endodontic treatment was performed on them. The filling material was subsequently removed using Gates Glidden (G1, G2, G3); Peeso (P1, P2, P3) and PostecPlus FRC (FRC) reamers while temperatures were measured on the outer surface using a digital device with thermocouple at 0, 2, 4, 6, 8, 10 and 15 seconds. Temperatures were compared using repeated measures ANOVA followed by pairwise comparison with Tukey's test. All reamers caused significant temperature variation between different times (p<0.05). Pairwise comparisons indicated that temperature increased with time for all reamers (p<0.05). Significant differences in temperature were found between different reamers after 0, 2, 4, 6, 8,10 and 15 seconds (p<0.05). Temperature at the root surface increased considerably. Values higher than 50°C were recorded, the greatest increase from baseline being 16°C. Accordingly, if the procedure were begun at 37°C (physiological temperature), the temperature in the surrounding tissues - cementum, periodontium and bone - would rise to 53°C. An increase in 10°C above body temperature at the root surface may cause lesions in surrounding tissues. While removing filling material, it is essential to cool, control action time and use instruments in perfect condition, all of which may contribute to reducing the heat generated and transmitted to the outer root surface.

Omalizumab in the Treatment of Chronic Inducible Urticaria

Omalizumab is a recombinant humanized monoclonal antibody that inhibits immunoglobulin E. It has been approved for the treatment of severe asthma and chronic spontaneous urticaria refractory to other treatments. Its use in the management of chronic inducible urticaria (a type triggered by certain stimuli) is still considered off-label, although this use has been discussed in some consensus papers. This review brings together case reports and case series describing the use of omalizumab to treat chronic inducible urticaria. We analyze the most important aspects of the cases and the outcomes reported. The results seem to position omalizumab as a potentially effective, safe treatment alternative in some cases of chronic inducible urticaria.

Perception of lactose intolerance impairs health-related quality of life

BACKGROUND/OBJECTIVES

Chronic conditions impair perception of well-being. Malabsorption of lactose is the most frequent form of malabsorption and manifests as lactose intolerance. There is a lack of information regarding their impact on self-perception of health. The objective of this study is to determine the subjective impact of self-reported lactose intolerance or objective lactose malabsorption on patient health by using a patient-reported outcome to measure health-related quality of life (HRQOL) and modification of lactose-containing food diet.

SUBJECTS/METHODS

A 3-year prospective, cross-sectional study was performed in patients referred for a lactose hydrogen breath test. Patients were asked about their subjective opinion relative to their lactose tolerance and completed a validated, specific questionnaire to determine symptoms of intolerance during habitual consumption of dairy. A 50-g lactose breath test was then performed. Patients were grouped as absorbers vs malabsorbers and tolerant vs intolerants.

RESULTS

A total of 580 patients were included (median age 30 years, 419 female). Overall, 324 patients (56%) considered themselves lactose intolerant and that perception was associated with avoidance of dairy consumption (55% vs only 9% of self-defined tolerants). Self-perception of intolerance was associated with lower HRQOL scores (median, 60 vs 70, P<0.01). In contrast, lactose objective malabsorption was not clearly associated with dairy avoidance (41% of malabsorbers avoided dairy vs 31% of absorbers). However, HRQOL scores were also significantly lower in malabsorbers than in absorbers (60 vs 70 respectively, P<0.001).

CONCLUSIONS

Subjective perception of lactose intolerance affects the decision to avoid dairy even more than objective malabsorption. However, both self-perception of lactose intolerance and objective lactose malabsorption are associated with poorer perceived quality of life.

Treatment trends for clinically localised prostate cancer. National population analysis: GESCAP group

OBJECTIVES

To describe the established therapies for localised prostate cancer (PC) in Spain and to assess compliance with the 2010 UAE guidelines.

PATIENTS AND METHODS

This was an epidemiological, observational, prospective and multicentre study. Of the 3,918 patients diagnosed with PC during 2010, only those patients with localised PC were included. Follow-up was ultimately conducted for a minimum of one year from the diagnosis for 3,713 patients (94.77%). The treatment groups assessed were as follows: radical prostatectomy, radiation therapy, hormone therapy, brachytherapy, active surveillance or observation and experimental local treatment (cryotherapy or other treatment). Compliance with the recommendations of the EAU guidelines was studied, describing the treatment groups according to D'Amico risk stratification criteria (localised [low, intermediate and high risk] and locally advanced), age, PSA and Gleason score.

RESULTS

By applying the D'Amico criteria, we included 3,641 (92.93%) patients. Based on the UAE recommendations: 1) 68.87% of the patients at low-intermediate risk aged≤65 years underwent radical prostatectomy; 2) 34.51% of the patients>65 years at high risk with locally advanced disease were administered radiation therapy and hormone therapy; 3) 30.36% of the patients at high risk with locally advanced disease were only treated with hormone therapy; 4) 15.20% of the patients at low risk were only treated with brachytherapy; 5) active surveillance or observation was selected for 2.44% of the patients aged≤65 years and for 10.63% of the patients at low-intermediate risk who were>65 years. Lastly, 86.5% of the patients at low risk underwent a single treatment, and 43.62% of the patients at high risk with locally advanced disease underwent combined treatments.

CONCLUSIONS

This is the first national European study to evaluate the therapeutic management of localised PC based on the risk group to which the patient belonged. Most young patients (≤65 years) with low-intermediate risk localised PC were treated with surgery, which adheres to the recommendations of the 2010 UAE guidelines. Various therapeutic combinations have been employed for patients with high-risk, locally advanced localised tumours, revealing the need for a multidisciplinary approach (Controlled-trials.com number: ISRCTN19893319).

Relation between periodontal disease and arterial stiffness

BACKGROUND AND OBJECTIVE

Periodontal disease has been described as playing a role in the atherosclerosis process, and its relation with intimal thickness and vascular endothelial function (EF) has been investigated. The present study sought to determine whether there are differences in parameters of arterial stiffness and EF between patients with and without severe periodontal disease (SPD).

MATERIAL AND METHODS

Patients referred to the School of Dentistry University of Buenos Aires, were assessed. Demographic characteristics, atherogenic risk factors and concomitant pathologies were recorded. Patients with known cardiovascular pathology were excluded. Using carotid Doppler ultrasound an operator assessed arterial stiffness parameters: compliance, elastic modulus (EM), β stiffness index (βSI) and vascular EF by brachial artery flow-mediated dilatation. The patients were divided into two groups: with and without SPD.

RESULTS

Forty patients were included; 60% were women; 15 were in the SPD group and 25 in the group without SPD. Respective results of the studied variables were: age 56.53 ± 17.58 vs. 51.12 ± 12.97 years (NS); probing depth 2.53 ± 1.30 (95% CI 1.81-3.25) vs. 1.25 ± 0.51 (95% CI 1.31-1.73) p = 0.02; clinical attachment level 4.80 ± 2.00 (95% CI 3.69-5.91) vs. 1.72 ± 0.93 (95% CI 1.33-2.11) p = 0.001; intimal thickness 0.10 ± 0.17 (95% CI 0.095-0.11) vs. 0.82 ± 0.18 (95% CI 0.074-0.98) (NS); EM 48.33 ± 12.53 vs. 38.86 ± 7.69 (p = 0.005); βSI 4.21 ± 1.03 vs. 3.64 ± 1.02 (p = 0.004); EF 16.13 ± 5.02 vs. 22.76 ± 4.50 (p = 0.0003). Correlation between: EM and clinical attachment level r = 0.58 (p < 0.001), βSI and clinical attachment level r = 0.66 (p < 0.001), EF and clinical attachment level 0.59 (p < 0.001).

CONCLUSIONS

Parameters of arterial stiffness and EF were worse in patients with SPD and correlated moderately with clinical attachment level. Correlation with compliance and EF was negative.

VIVENCIAS DE PERSONAS QUE OPTARON POR LA PARENTALIDAD ADOPTIVA

En esta investigación se abordan las vivencias de un grupo de personas que optaron por la parentalidad adoptiva, tras no poder concebir un hijo de forma biológica, por lo que deciden iniciar el proceso de adopción en Chile. Este trabajo adquiere relevancia pues aborda un área de estudio donde se requiere mayor profundidad de análisis y conocimientos: identificar las necesidades de los padres adoptivos, expectativas, sentimientos, y evaluación de lo vivido en torno al proceso de adopción. Se abordó desde el paradigma fenomenológico pues permite conocer las vivencias de las personas a través de los fenómenos que se producen en la interacción entre investigador/investigado (Lyotard, 1960). De esta forma al entrevistar las personas que lograron finalizar su proceso de adopción, se pudo concluir que los padres al inicio del proceso poseen sentimientos positivos asociados a la posibilidad de poder tener un hijo. Sin embargo, a medida que avanzan en las distintas etapas del proceso, la emocionalidad se torna negativa producto de la extensa espera que deben afrontar, reconociendo la rabia, la frustración, la tristeza, como los más recurrentes. Finalmente, una vez que el menor es recibido por su nueva familia los sentimientos que afloran se asocian con el amor, la alegría y el compromiso que les genera el hecho de ejercer la deseada parentalidad.

From the radiologic pathology archives: gastrointestinal lymphoma: radiologic and pathologic findings

Gastrointestinal (GI) lymphoma encompasses a heterogeneous group of neoplasms that have a common lymphoid origin but variable pathologic and imaging features. Extranodal marginal zone B-cell lymphoma (ENMZL) and diffuse large B-cell lymphoma (DLBCL) are the most common. ENMZL usually occurs in the stomach, where it is associated with chronic infection by Helicobacter pylori, and is typically a superficial spreading lesion that causes mucosal nodularity or ulceration and mild wall thickening. DLBCL may arise de novo or from transformation of ENMZL or other low-grade lymphomas. This form of lymphoma produces extensive wall thickening or a bulky mass, but obstruction is uncommon. Mantle cell lymphoma is the classic cause of lymphomatous polyposis, but multiple polyps or nodules can also be seen with ENMZL and follicular lymphoma. Burkitt lymphoma is usually characterized by an ileocecal mass or wall thickening in the terminal ileum in young children, often in the setting of widespread disease. Primary GI Hodgkin lymphoma, which is rare, may be manifested by a variety of findings, though stenosis is more common than with non-Hodgkin lymphoma. Enteropathy-associated T-cell lymphoma is frequently associated with celiac disease and is characterized by wall thickening, ulceration, and even perforation of the jejunum. Accurate radiologic diagnosis of GI lymphoma requires a multifactorial approach based on the clinical findings, site of involvement, imaging findings, and associated complications.

Continuous-flow system and monitoring tools for the dielectrophoretic integration of nanowires in light sensor arrays

Although nanowires (NWs) may improve the performance of many optoelectronic devices such as light emitters and photodetectors, the mass commercialization of these devices is limited by the difficult task of finding reliable and reproducible methods to integrate the NWs on foreign substrates. This work shows the fabrication of zinc oxide NWs photodetectors on conventional glass using transparent conductive electrodes to effectively integrate the NWs at specific locations by dielectrophoresis (DEP). The paper describes the careful preparation of NW dispersions by sedimentation and the dielectrophoretic alignment of NWs in a home-made system. This system includes an impedance technique for the assessment of the alignment quality in real time. Following this procedure, ultraviolet photodetectors based on the electrical contacts formed by the DEP process on the transparent electrodes are fabricated. This cost-effective mean of contacting NWs enables front-and back-illumination operation modes, the latter eliminating shadowing effects caused by the deposition of metals. The electro-optical characterization of the devices shows uniform responsivities in the order of 106 A W(-1) below 390 nm under both modes, as well as, time responses of a few seconds.

Electrical stunning effectiveness with current levels lower than 1 A in lambs and kid goats

An experiment with 360 lambs grouped into three Spanish commercial categories, (Pascual, 13-16 kg; Recental, 9-13 kg and Lechal <7 kg carcass weight) and kid goats (7 kg) was performed to assess stunning effectiveness after head-only (HO) and head-to-body (HB) electrical stunning with intensity currents of 0.3, 0.5 and 0.7 Amperes (A) compared to 1.0 A. After stunning, all animals showed tonic-clonic muscular activity and epileptiform EEG, absence of rhythmic breathing, corneal reflex, spontaneous blinking and pain sensibility. The quiescent EEG occurred earlier (P < 0.05) in HB compared to HO in all categories. More animals recovered corneal reflex and rhythmic breathing before onset of the quiescent activity after HO (from 15 to 50%) compared to HB (from 0 to 15%) (P < 0.05). Concluding, HO and HB electrical stunning with 0.3, 0.5 and 0.7 A induce effective stunning similar to 1.0 A in lambs and kid goats. After stunning and sticking, brain failure occurs earlier in HB than HO system.

Sediment toxicity and bioaccumulation assessment in abandoned copper and mercury mining areas of the Nalón River basin (Spain)

Sediment toxicity and metal bioaccumulation were assessed at sites affected by historical copper (Cu) and mercury (Hg) mining activities in the Nalón River basin, Asturias, Spain. Toxicity assessment of stream sediments was based on a 28-day oligochaete Tubifex tubifex sediment bioassay, which allowed the classification of sites into three levels of toxicity: 11 sites were classified as nontoxic (including Cu mine sites), three sites as potentially toxic, and seven sites as toxic (all located in Hg mine districts). The greatest levels of arsenic (As), chromium, Hg, lead (Pb), and zinc (Zn) in T. tubifex were measured at sites affected by Hg mining and the highest Cu levels in tissues at Cu mining sites. Chronic toxicity responses were best explained by As and Hg sediment concentrations and by As, Pb, and Zn tissue residues. Residue levels of As, Hg, Zn, and Pb were successfully used to predict sediment chronic toxicity and estimate effective tissue residues.

Eigencorneas: application of principal component analysis to corneal topography

PURPOSE

To determine the minimum number of orthonormal basis functions needed to accurately represent the great majority of corneal topographies from a normal population.

METHODS

Principal Component Analysis was applied to the elevation topographies of the anterior and posterior corneal surfaces and central thickness of 368 eyes of 184 healthy subjects. PCA was applied directly to the input elevation data points and after fitting them to Zernike polynomials (up to 8th order, 8 mm diameter). The anterior and posterior surfaces, as well as right eye and left eye data, were analysed both separately and jointly. A threshold based on the amount of explained variance (99%) was applied to determine the minimum number of basis functions (eigencorneas) or degrees of freedom (DoF) in the population.

RESULTS

The eigenvectors directly obtained from elevation data resemble Zernike polynomials. The separate principal component analysis on the Zernike coefficients of anterior and posterior surfaces yielded 5 and 9 DoF, respectively. An additional reduction to 11 DoF (instead of 15 DoF) was achieved when performing a joint PCA that included both surfaces as well as central thickness. Finally, a further reduction was obtained by pooling right and left eye data together, to only 18 DoF.

CONCLUSIONS

The combination of Zernike fit and Principal Component Analysis yields a strong reduction of dimensionality of elevation topography data, to only 19 independent parameters (18 DoF plus population average), which indicates a high degree of correlation existing between anterior and posterior surfaces, and between eyes. The resulting eigencorneas are especially well suited for practical applications, as they are uncorrelated and orthonormal linear combinations of Zernike polynomials.

[Vascular rings, our experience with 18 cases]

AIM

Vascular rings are a rare cause of compression of the trachea and/or the esophagus, causing stridor and/or severe dysphagia. We present our experience in the diagnosis and management of vascular rings.

METHODS

Retrospective study in which we analyzed clinical history, diagnosis and management of 18 patients diagnosed with vascular ring between January 1985 and December 2013. We evaluate endoscopy as a diagnostic method.

RESULTS

A total of 18 patients were included, with a median age of 2 years. 83.3% (15/18) had some type of symptom: 46.7% (7/15) had respiratory symptoms such as respiratory distress, stridor, recurrent respiratory infections, bronchospasm with wheezing or asthma in older children; 20% (3/15) had digestive symptoms such as dysphagia, vomiting and regurgitation; and 33.3% (5/15) combined respiratory and digestive symptoms. The remaining patients, 16.7% (3/18) were asymptomatic and the diagnosis was casual. The most common types of vascular rings were double aortic arch (27.8%) and aberrant subclavian right artery (27.8%). In 3 cases (16.7%) a Kommerell diverticulum was associated. 44.4% (n = 8) was operated on, the remaining did not present symp- toms which justify the intervention (n = 10). 37.5% of patients had postoperative complications (iatrogenic recurrent paralysis and persistent tracheomalacia). There was no mortality in our series. The median follow-up was 6.4 years. At the moment, 88.9% of patients are asymptomatic, and 33.3% have been definitely discharged.

CONCLUSIONS

Vascular rings are rare, and usually presented with common symptoms in childhood. Therefore, in front of a longstanding and recurrent respiratory symptoms, or dysphagia, we should think of a vascular ring. Not all subjects are candidates for surgical correction; therefore a multidisciplinary evaluation is essential.

Nitric oxide from mononuclear cells may be involved in platelet responsiveness to aspirin

BACKGROUND

Several mechanisms have been proposed to explain why some platelets have a reduced response to aspirin (ASA). Among them, it was reported an increased circulating level of vitamin-D-binding protein (DBP). In addition, nitric oxide (NO) released from mononuclear cells was involved in the antiplatelet effects of ASA. The aim was to analyse the relationship between platelet response to ASA and both NO generation and vitamin-D-binding protein content in mononuclear cells.

MATERIALS AND METHODS

Mononuclear cells were obtained from patients with stable coronary artery disease that were divided by a platelet functionality test (PFA-100) as ASA-sensitive (n=23) and ASA resistant (n=27).

RESULTS

Both the release of NO (determined by nitrite+nitrate concentration) and the expression of endothelial-type NO synthase (eNOS) were higher in mononuclear cells from ASA sensitive as compared with those from ASA-resistant patients. There was a positive correlation between either the release of NO and the expression of eNOS protein in mononuclear cells with the ability of ASA to inhibit platelet activity. DBP content in mononuclear cells was higher in ASA resistant than in ASA sensitive. The level of DBP content in mononuclear cells was negatively associated with the ability of ASA to inhibit platelets. However, in vitro experiments suggested that there was no association between DBP and NO production by mononuclear cells.

CONCLUSIONS

Mononuclear cells from patients with platelets with lower responsiveness to ASA showed a reduced ability to produce NO.

Platelet content of nitric oxide synthase 3 phosphorylated at Serine 1177 is associated with the functional response of platelets to aspirin

OBJECTIVE

To analyse if platelet responsiveness to aspirin (ASA) may be associated with a different ability of platelets to generate nitric oxide (NO).

PATIENTS/METHODS

Platelets were obtained from 50 patients with stable coronary ischemia and were divided into ASA-sensitive (n = 26) and ASA-resistant (n = 24) using a platelet functionality test (PFA-100).

RESULTS

ASA-sensitive platelets tended to release more NO (determined as nitrite + nitrate) than ASA-resistant platelets but it did not reach statistical significance. Protein expression of nitric oxide synthase 3 (NOS3) was higher in ASA-sensitive than in ASA-resistant platelets but there were no differences in the platelet expression of nitric oxide synthase 2 (NOS2) isoform. The highest NOS3 expression in ASA-sensitive platelets was independent of the presence of T-to-C mutation at nucleotide position -786 (T(-786) → C) in the NOS3-coding gene. However, platelet content of phosphorylated NOS3 at Serine (Ser)(1177), an active form of NOS3, was higher in ASA-sensitive than in ASA-resistant platelets. The level of platelet NOS3 Ser(1177) phosphorylation was positively associated with the closure time in the PFA-100 test. In vitro, collagen failed to stimulate the aggregation of ASA-sensitive platelets, determined by lumiaggregometry, and it was associated with a significant increase (p = 0.018) of NOS3 phosphorylation at Ser(1177). On the contrary, collagen stimulated the aggregation of ASA-resistant platelets but did not significantly modify the platelet content of phosphorylated NOS3 Ser(1177). During collagen stimulation the release of NO from ASA-sensitive platelets was significantly enhanced but it was not modified in ASA-resistant platelets.

CONCLUSIONS

Functional platelet responsiveness to ASA was associated with the platelet content of phosphorylated NOS3 at Ser(1177).

Microstructural brain and multivoxel spectroscopy in very low birth weight infants related to insulin-like growth factor concentration and early growth

BACKGROUND

Very low birth weight (VLBW) children have higher risk of neurologic disabilities and growth factors are essential for brain maturation.

AIM

To assess whether there are differences in neurologic findings, psychometric parameters and microstructural brain morphology in 1-year-old VLBW infants versus term healthy controls and whether these differences are related to hormonal/growth changes.

METHODS

Prospective anthropometry, prefeed venous blood sample [insulin, insulin-like growth factor-I (IGF-I), insulin-like growth factor-II (IGF-II), leptin, glucose], neurologic and imaging assessment, at age 1 year in 34 VLBW infants (12 SGA; 10 M) and 10 healthy term controls (5 M).

RESULTS

IGF-I concentrations at 1 month of corrected age were 20% lower in SGA versus appropriate for gestational age VLBW (p < 0.02). Gray and white matter volume and fractional anisotropy in 15/27 regions were decreased (p < 0.001). Abnormal spectroscopy was observed in 4 zones in VLBW versus term controls (p < 0.001). Some of these changes were associated with different periods of first-year growth and IGF-I/IGF-II, leptin and HOMA-IR.

CONCLUSIONS

VLBW infants show differences in brain volumes and microstructural brain morphology as compared to term controls, changes related to circulating growth factor and anthropometry changes in the first year. This apparent reorganization of the developing brain offers a unique opportunity to investigate the relationship between changes in cortical anatomy, cognitive and social impairments and periods of early growth.