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For patients with a dentofacial deformity undergoing a planned segmentation of the maxilla for the management of a transverse maxillary arch discrepancy, palatal mucosa tearing may occur during sawing or palatal expansion traction, giving rise to an oronasal communication. This technical note describes the covering of a tear in the palatal mucosa using a buccal fat pad (BFP) flap, in the context of maxillary segmentation during Le Fort I osteotomy. Through the limited buccal incision used for the Le Fort I osteotomy, a small incision is made in the right periosteum posteriorly, and a supraperiosteal dissection is performed to access the BFP. After a sufficient amount of flap is made available, it is gently introduced through the osteotomy gap until it reaches the palatal mucosa defect and is then sutured. In the patient case presented, the palatal mucosa healed fully within 18 days, and the patient reported no nasal regurgitation of food, defective speech, fetid odour, bad taste, or upper respiratory tract or ear infection during the postoperative period. This technique using a BFP flap should therefore be considered in the context of unexpected tearing of the palatal mucosa in patients undergoing a segmented Le Fort I osteotomy.

In this paper, we approach the phenomenon of criminal activity from an infectious perspective by using tailored compartmental agent-based models that include the social flavor of the mechanisms governing the evolution of crime in society. Specifically, we focus on addressing how the existence of competing gangs shapes the penetration of crime. The mean-field analysis of the model proves that the introduction of dynamical rules favoring the simultaneous survival of both gangs reduces the overall number of criminals across the population as a result of the competition between them. The implementation of the model in networked populations with homogeneous contact patterns reveals that the evolution of crime substantially differs from that predicted by the mean-field equations. We prove that the system evolves toward a segregated configuration where, depending on the features of the underlying network, both gangs can form spatially separated clusters. In this scenario, we show that the beneficial effect of the coexistence of two gangs is hindered, resulting in a higher penetration of crime in the population.

Employing cutting fluids in machining processes, especially for difficult-to-cut materials, improves machinability through prolonged tool life, improves surface integrity and chip evacuation. However, like oil and water-based cutting fluids are hazardous to the environment and workers’ health, alternative solutions are required. Liquid Nitrogen (LN2) is a cryogenic fluid that can be an option due to its low boiling point (-197oC) and the fact it exists in the atmosphere at room conditions. Nevertheless, the feasibility of cryogenic cooling techniques in machining is not fully understood; this is why the Finite Element Method (FEM) could give an insight into the phenomena happening on the tool-chip/workpiece interface. This research aims to compare fundamental and industrial outputs when turning hardened steel 100Cr6 using Cubic Boron Nitride (CBN) inserts with wiper geometry in dry conditions and with cryogenic cooling. For this purpose, turning experimental tests were performed in both cooling conditions varying the cutting speed (150-550 m/min). Machining forces were measured during the tests, and then tool wear, microstructural damage, and residual stresses of the workpiece were characterised. A nose turning (3D) FEM model was also developed to understand the influence of cooling strategy on the outputs measured experimentally.

Background Longitudinal clinical surveillance by transthoracic echocardiography (TTE) is an established practice in children with repaired tetralogy of Fallot (TOF). Non-Invasive Imaging Guidelines recommends a list of reporting elements that should be addressed during routine TTE in this population. In this study, we assessed the adherence to these recommendations. Methods This was a multi-center (n = 8) retrospective review of TTE reports in children ≤11 years of age who have had complete TOF repair. We included 10 patients from each participating center (n = 80) and scored 2 outpatient follow-up TTE reports on each patient. The adherence rate was based on completeness of TTE reporting elements derived from the guidelines. Results We reviewed 160 TTE reports on 80 patients. Median age was 4.4 months (IQR 1.5-6.6) and 3.6 years (IQR 1.3-6.4) at the time of complete surgical repair and first TTE report, respectively. The median adherence rate to recommended reporting elements was 61% (IQR 53–70). Of the 160 reports, 9 (7%) were ≥80% adherent and 40 (25%) were ≥70% adherent. Quantitative measurements of right ventricular outflow tract (RVOT), right ventricular (RV) size and function, and branch pulmonary arteries were least likely to be reported. Conclusions Overall adherence to the most recent published imaging guidelines for surveillance of children with repaired TOF patients was suboptimal, especially for reporting of RVOT, RV size and function, and branch pulmonary arteries. Further studies are needed to explore the barriers to adherence to guidelines and most importantly, whether adherence is associated with clinical outcomes.

Background There are few data on practice patterns and trends for cardiovascular magnetic resonance (CMR) in pediatric and congenital heart disease. The Society for Cardiovascular Magnetic Resonance (SCMR) sought to address this deficiency by performing an international survey of CMR centers. Methods Surveys consisting of 31 (2014) and 33 (2018) items were designed to collect data on the use of CMR for the evaluation of pediatric and congenital heart disease patients. They were sent to all SCMR members in 2014 and 2018. One response per center was collected. Results There were 93 centers that responded in 2014 and 83 in 2018. The results that follow show data from 2014 and 2018 separated by a dash. The median annual number of pediatric/congenital CMR cases per center was 183–209. The median number of scanners for CMR was 2–2 (range, 1–8) with 58–63% using only 1.5T scanners and 4–4% using only 3T scanners. The mean number of attending/staff reading CMRs was 3.7–2.6; among them, 52–61% were pediatric or adult cardiologists and 47–38% were pediatric or adult radiologists. The median annual case volume per attending was 54–86. The median number of technologists per center doing CMRs was 4–5. The median scanner time allocated for a non–sedated examination was 75–75 min (range, 45–120). Among the 21 centers responding to both surveys, the mean annual case volume increased from 320 in 2014 to 445 in 2018; 17 (81%) of the centers had an increase in annual case volume. For this subgroup, the median attending/staff per center was 4 in both 2014 and 2018. The median scanner time allotted per study was unchanged at 90 min. The mean time for an attending/staff physician to perform a typical CMR examination including reporting was 143–141 min. Conclusion These survey data provide a novel comprehensive view of CMR practice in pediatric and congenital heart disease. This information is useful for internal benchmarking, resource allocation, addressing practice variation, quality improvement initiatives, and identifying unmet needs.

International audience; Surface integrity directly affects the mechanical behavior of the workpiece, which is especially relevant on fatigue behavior. To characterize the quality of the machined surface, aspects such as material damage, roughness or residual stress are considered. Measurement of the material damage of the surface is characterized in some cases as surface drag, depth of the affected machining zone, a phenomenon which takes place due to plastic strain in the surface layer caused by machining stress which could have an influence on residual stress. Surface drag measurement done with optical microscopes has relevant uncertainty. In this paper, a methodology to measure the surface drag with lower uncertainty is proposed. The method consists of measuring the deformation of a grid as a result of the machining process. The grid was created with micromilling. The method was applied to analyze the effect of feed on the surface integrity after orthogonal cutting of Ti-6Al-4V. The depth of the affected layer was measured using a 3D optical measuring device (Alicona Infinite Focus IFG4) and compared with numerical simulations and a good agreement was achieved. In comparison with optical microscope results, it can be concluded that traditional method underestimates surface drag

Introduction Appropriate use criteria (AUC) guide initial transthoracic echocardiogram (TTE) use in outpatient pediatrics. We sought to improve pediatric cardiologist TTE ordering appropriateness (mean AUC score) with a quality improvement initiative. Methods The outcome of interest was the prospective AUC score for all initial outpatient TTEs ordered between November 2016 and August 2017, categorized per the AUC: "appropriate" (score 7-9), "may be appropriate" (4-6), "rarely appropriate" (1-3). Interventions included a didactic review of 2014 AUC and participant documentation of AUC criteria for each TTE. Participants met quarterly to evaluate outcome, process, and balancing measures, intervention effectiveness, and to identify and mitigate barriers. Results Twenty-two pediatric cardiologists participated. TTE appropriateness level before (n = 216) and after (n = 557) intervention was high. There was no significant difference in mean baseline and post-intervention AUC score (7.42 ± 1.87 versus 7.16 ± 2.87, P = 0.1), nor in TTE sensitivity (27% versus 25%, P > 0.1) as a balancing measure. Among baseline studies, 81% were "appropriate," and 6% "rarely appropriate." Among post-intervention studies, 76% were "appropriate," and 11% "rarely appropriate." Barriers identified to implementing AUC include TTE indications not specified by current AUC, expectations of referring provider or parent to perform TTE, consistent provider application of AUC, and ability of AUC to capture comprehensive clinical judgment. Conclusions Although the mean AUC appropriateness level was high, we were able to identify significant barriers to the implementation of AUC. Future efforts should focus on the reduction of "rarely appropriate" TTE ordering.

Adenovirus 5 (Ad-5) infection is a common cause of acute respiratory infections and the main vector used in gene therapy. There are few studies on the relationship of Ad-5 to obesity. In the present study, we evaluated the chronic effects of Ad-5 infection on golden (Syrian) hamsters fed either a balanced diet (BD) or a high-fat diet (HFD). After a single inoculation with Ad-5 (1 × 107 pfu), the body weight of the animals was measured weekly. Medium-term (22 weeks) serum biochemical analyses and long-term (44 weeks) liver morphology, adiposity, and locomotive functionality (movement velocity) assessments were carried out. In the animals fed the BD, adenovirus infection produced hyperglycemia and hyperlipidemia. In the long term, it produced a 57% increase in epididymal pad fat and a 30% body weight gain compared with uninoculated animals. In addition, morphological changes related to non-alcoholic fatty liver disease (NAFLD) were observed. The animals fed the HFD had similar but more severe changes. In addition, the hamsters presented an obesity paradox: at the end of the study, the animals that had the most morphological and functional changes (significantly reduced movement velocity) had the lowest body weight. Despite the fact that an HFD appears to be a more harmful factor in the long term than adenovirus infection alone, infection could increase the severity of harmful effects in individuals with an HFD. Epidemiological studies are needed to evaluate the effect of adenovirus as a precursor of chronic liver and cardiovascular diseases, including the chronic effects of gene therapy.

The ploughing force related with action of edge radius is an important factor which influences flow stress, chip formation or surface integrity. Some fraction of the cutting forces are called parasitic (additional) forces and they do not contribute on chip formation process. These forces are usually assumed to be the cutting force (constant value) for zero feed. However, this effect is related with the edge radius. To improve force modelling prediction, a new mechanistic model to predict cutting force considering edge radius is presented. The model was developed for two cutting speeds and in a wide range of feeds for three edge radii. The model was validated with additional experimental tests, achieving relative errors lower than 3%.

Objectives To report the results of the Nit‐Occlud PDA prospective postapproval study (PAS) along with a comparison to the results of the pivotal and continued access trials. Background The Nit‐Occlud PDA (PFM Medical, Cologne, Germany), a nitinol coil patent ductus arteriosus (PDA) occluder, was approved by the Food and Drug Administration in 2013. Methods The PAS enrolled a total of 184 subjects greater than 6 months of age, weighing at least 5 kg, with PDAs less than 4 mm by angiography at 11 centers. Patients were followed prospectively at 2 months, 12 months, and 24 months postprocedure. These outcomes were compared to the 357 subjects enrolled in the pivotal and continued access protocols. Efficacy and safety data were reported. Results Among 184 subjects enrolled for the PAS between 2014 and 2017, 180 (97.8%) had successful device implantation. After 12 months, 98.7% (150/152) had trivial or no residual shunt by echocardiography and two subjects had only small residual shunts. There were three device embolizations that were all retrieved by snare without clinical consequence. Together with the pivotal and continued access study, 97.4% (449/461) had complete echocardiographic closure at 12 months in 541 enrolled subjects. The composite success was 94.4%. There were no mortalities and no serious device‐related adverse events. Conclusions The Nit‐Occlud PDA is a safe and effective device for closure of a small to moderate sized PDA. There were no serious device‐related adverse events in a large cohort of three clinical trials.

BackgroundA promising novel cell-free bioactive formulation for articular cartilage regeneration, called BIOF2, has recently been tested in pre-clinical trials. The aim of the present study was to evaluate the efficacy and safety of BIOF2 for intra-articular application in patients with severe osteoarthritis of the knee.MethodsA prospective, randomized, 3-arm, parallel group clinical trial was conducted. It included 24 patients with severe osteoarthritis of the knee (WOMAC score 65.9 ± 17). Before they entered the study, all the patients were under osteoarthritis control through the standard treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), prescribed by their family physician. Patients were distributed into three groups of 8 patients each (intra-articular BIOF2, total joint arthroplasty, or conservative treatment with NSAIDs alone). The WOMAC score, RAPID3 score, and Rasmussen clinical score were evaluated before treatment and at months 3, 6, and 12. BIOF2 was applied at months 0, 3, and 6. Complete blood count and blood chemistry parameters were determined in the BIOF2 group before treatment, at 72 h, and at months 1, 3, 6, and 12. In addition, articular cartilage volume was evaluated (according to MRI) at the beginning of the study and at month 12.ResultsThe NSAID group showed no improvement at follow-up. Arthroplasty and BIOF2 treatments showed significant improvement in all the scoring scales starting at month 3. There were no statistically significant differences between the BIOF2 group and the arthroplasty group at month 6 (WOMAC score: 19.3 ± 18 vs 4.3 ± 5;P = 0.24) or month 12 (WOMAC score: 15.6 ± 15 vs 15.7 ± 17;P = 1.0). Arthroplasty and BIOF2 were successful at month 12 (according to a WOMAC score: ≤ 16) in 75% of the patients and the daily use of NSAIDs was reduced, compared with the group treated exclusively with NSAIDs (RR = 0.33, 95% CI 0.12–0.87,P = 0.02. This result was the same for BIOF2 vs NSAIDs and arthroplasty vs NSAIDs). BIOF2 significantly increased the articular cartilage by 22% (26.1 ± 10 vs 31.9 ± 10 cm2,P ConclusionsThe intra-articular application of the new bioactive cell-free formulation (BIOF2) was well tolerated and showed no significative differences with arthroplasty for the treatment of severe osteoarthritis of the knee. BIOF2 can regenerate articular cartilage and is an easily implemented alternative therapy for the treatment of osteoarthritis.Trial registrationCuban Public Registry of Clinical Trials (RPCEC) Database RPCEC00000250. Registered 08/15/2017—Retrospectively registered,http://rpcec.sld.cu/en/trials/RPCEC00000250-En.

Metabolic syndrome (MS) has been associated with testicular damage. Nonalcoholic fatty liver disease (NAFLD) is a multisystemic disease that affects different organs, but its effect on the testes is unknown. A study analyzing germ cell involvement on BALB/c mice was carried out. A parallel comparative study was conducted that investigated alterations in the germinal epithelium of male humans that died from an unrelated acute event. The complete medical histories and histologic samples of the thoracic aorta, liver tissue, and testicular tissue from the deceased subjects were collected. The degree of germinal epithelial loss (DGEL) was evaluated and the clinical and histologic data were compared between individuals with and without NAFLD. The only metabolic or morphologic variable that caused a significant difference in the DGEL, in both the animal model and humans, was the presence of liver steatosis. The percentage of steatosis was also correlated with the percentage of the DGEL. In humans, steatosis (greater than 20%) increased the risk 12-fold for presenting with a severe DGEL (OR: 12.5; 95% CI [1.2, 128.9]; p = .03). There was no association with age above 50 years or MS components. Steatosis grade was also correlated with atherosclerosis grade. NAFLD was a strongly associated factor implicated in severe DGEL, as well as the testis was identified as a probable target organ for damage caused by the disease. This finding could result in the search for new approach strategies in the management of men with fertility problems. Further studies are required to confirm these results.

[EN] Porous Clays Heterostructures (PCH) from natural pillared clays (bentonite with a high proportion of montmorillonite) have been used as supports of iron oxide for two reactions of environmental interest: i) the elimination of toluene (a representative compound of one of the most toxic subsets of volatile organic compounds, aromatics) by total oxidation and ii) the selective oxidation of H2S to elemental sulfur. For both reactions these catalysts have resulted to be remarkably more efficient than similar catalysts prepared using conventional silica as a support. Thus, in the total oxidation of toluene it has been observed that the catalytic activity obtained using siliceous PCH is two orders of magnitude higher than that with conventional silica. The catalytic activity has shown to be dependant of the capacity of the support for dispersing iron oxide in a way that the higher the dispersion of iron oxide on the surface of the support, the higher is the activity. In the case of the selective oxidation of H2S to S both higher catalytic activity and higher selectivity to S have been observed using siliceous porous clays heterostructures than using conventional silica. Highly dispersed FeOx species have been shown as highly selective towards elemental sulfur whereas more aggregated FeOx species favour the formation of sulphur oxides decreasing the selectivity to S. Analyses of the surface by XPS have shown the predominance of sulfate species in the catalysts presenting low selectivity to elemental sulfur., The authors would like to acknowledge the DGICYT in Spain (CTQ2015-68951-C3-1-R, CTQ2015-68951-C3-3-R, CTQ2012-37925-C03-2, CTQ2012-37925-C03-3 and CTQ2012-37984-C02-01) and FEDER for financial support. We also thank the University of Valencia for funding (UV-INV-AE-16-484416) and SCSIE-UV for assistance.

Background Echocardiogram has limitations in effectively assessing right ventricular (RV) function in children post tetralogy of Fallot (TOF) repair. We evaluated the utility of speckle tracking echocardiography (STE)-based RV global longitudinal strain (GLS) for the assessment of RV systolic function. Methods All patients with repaired TOF who had both echocardiograms and cardiac MRI (CMR) within a 6-month interval were included. RV volumes and ejection fraction (EF) were obtained by CMRs. Traditional echocardiographic function parameters and RV GLS were compared to CMR-derived RV EF. Subjects were divided into two groups based on CMR RV EF (group I: RV EF ≥45%; and group II: RV EF

Centruroides tecomanus is a medically important scorpion of the state of Colima (Mexico). This communication reports the identification of venom components of this scorpion with biological activity over insects/crickets (Acheta domestica), crustaceans/fresh water shrimps (Cambarellus montezumae), and mammalians/mice (Mus musculus, strain CD1). It also describes the pharmacological effects on cell lines in culture (L5178Y cells, HeLa cells, HuTu cells and Jurkat E6-1 cells), as well as on several types of bacteria (see below). The soluble venom of this scorpion was fractionated by high-performance liquid chromatography (HPLC) and collected separately in twelve independent fractions collected over 60 min run (5 min time apart each other). The HPLC components of fraction VII were lethal to all three species used for assay. The IVth fraction had a toxic effect on freshwater shrimps. In this species, fractions VI, VII and VIII were all lethal. For crickets, fractions V and VI were toxic and fraction VII was lethal. In mouse, the lethal components were found in fraction VII, whereas fraction VIII was toxic, but not lethal, at the doses assayed. The molecular weight of peptides from the various group of fractions were identified by mass spectrometry determination. Components lethal to mice showed molecular weights from 7013 to 7487 Da. Two peptides were obtained in homogeneous form and shown to be lethal to the three species of animal used for assay. The soluble venom tested on L5178Y cell line survival was shown to be cytotoxic, at 10-100 μg/mL concentration, when compared to control murine splenocytes (p = 0.007). The soluble venom applied to Hela, Hutu and Jurkat cell lines did not show cytotoxic effects at these concentrations. On the contrary, it seems to have a proliferative effect. However the HPLC fractions I, III, VI and XII do have a cytotoxic effect on Jurkat E06-1 cells in culture at 200 μg/mL concentration. The antimicrobial activity of the venom fractions on Staphylococcus aureus (gram-positive), Escherichia coli, Pseudomonas aeruginosa y Salmonella spp (gram-negative) was measured, using the liquid inhibition growth system. The four strains of bacteria used were susceptible to fractions III and IV, affecting all four bacterial strains at concentrations below 5 μg/mL.

Background: On March 11th 2020, COVID-19 was categorized as a pandemic Risk factors for poor outcomes in COVID-19 disease include a personal history of cancer The purpose of this research is to explore what cancer patients (pts) know about COVID-19 and their perception of the risk of infection Methods: From 14th March until 4th May, a total of 33 cancer pts from the 167 admitted in the hospitalisation ward of the Medical Oncology Department of University Hospital La Fe were included Our questionnaire is a psychometric five points Likert scale with 25 questions and 5 additional open questions A stratified analysis by age, gender, marital status, educational background, number of previous systemic treatments and cause of hospitalisation was carried out χ2 test, Fisher’s exact test, Spearman's rank correlation coefficient and Kendall rank correlation coefficient (Tau-b statistic or Tau-c) were performed when indicated for each category The time delay between the appearance of symptoms and the seeking of medical help at our Hospital, due to fear of COVID-19, was also analyzed Results: Of the 33 pts included in the study, 22 were male and 11 female 20 pts received one or more previous systemic therapy Median age was 57 years old Their responses indicated that cancer pts felt they needed more information about COVID-19 and how it could affect them When asked about the perception of the risk of infection, most pts were afraid of coronavirus disease (63 7%) but did feel safe in both the emergency department (57 6%) and the hospitalisation area (81 8%) When pts were asked about how they felt during this hospitalisation period compared with previous ones, they claimed that the quality of care received in the hospitalisation area by both nurses and doctors had not changed from other times (84 9%), in spite of the strict measures being implemented Previously treated cancer pts were more aware of secondary effects of antineoplastic treatment than those pts who had not received any treatment, including the possibility of a SARS-CoV-2 infection with atypical symptoms (p = 0 005) About 50% of pts did delay seeking medical help;these pts were admitted in a poorer physical condition, their hospital stays were longer and more difficulties were found in treating the oncological process;a higher risk of death was also seen Conclusions: We are experiencing an extraordinary scenario have never seen before Now, cancer patients have spoken and it is our responsibility to solve their problems, listen to their fears and help them in these difficult months we are facing Legal entity responsible for the study: Benjamin Domingo Arrue Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest

[EN] Porous clay heterostructures (PCH) have shown to be highly efficient supports for nickel oxide in the oxidative dehydrogenation of ethane. Thus NiO supported on silica with a PCH structure shows productivity towards ethylene three times higher than if NiO is supported on a conventional silica. This enhanced productivity is due to the increase in the catalytic activity and especially to the drastic increase in the selectivity to ethylene. Additionally, PCH silica partially modified with titanium in the columns (PCH-Ti) have also been synthesized and used as supports for NiO. An enhanced activity and selectivity to ethylene was found over NiO supported over PCH-Ti compared to the corresponding catalysts supported over the Ti-free PCH. The enhanced catalytic performance has been related to the high dispersion of nickel oxide particles on the support, which leads to a lower reducibility of the nickel oxide, hindering the oxidation of ethane into carbon oxides. More interestingly, the particle morphology plays an important role on the catalyst selectivity since a higher distortion of the NiO crystal lattice parameter meant an enhanced selectivity to ethylene., The authors would like to acknowledge the DGICYT in Spain (CTQ2012-37925-C03-1, CTQ2012-37925-C03-2 and CTQ2012-37925-C03-3) and the FEDER for financial support. We also thank the University of Valencia and SCSIE-UV for assistance.

Background/Aims: Breast cancer is the most common gynecologic malignancy known worldwide. The consumption of certain foods may modify the risk for its development. Peanuts and other seeds have shown anticarcinogenic effects in vitro, but there are a few studies that evaluate the effect of their consumption on the development of breast cancer. The aim of the present study was to determine whether there is an association between the consumption of peanuts, walnuts, and almonds and the development of breast cancer. Methods: We analyzed 97 patients presenting with breast cancer and 104 control subjects that did not have the pathology (BIRADS 1-2). An analysis of the main clinical characteristics and lifelong seed consumption was carried out. The association between the consumption of these foods and the risk for breast cancer was estimated by odds ratios and 95% confidence intervals, controlling other risk factors, using the Mantel-Haenszel analysis. Results: The high consumption of peanuts, walnuts, or almonds significantly reduced the risk for breast cancer by 2-3 times. This protective effect was not found with low or moderate seed consumption when compared with null consumption. Conclusions: High consumption of peanuts, walnuts, and almonds appears to be a protective factor for the development of breast cancer.

Large monoliths of silicon oxycarbide (SiOC) glasses have been prepared from sol–gel derived hybrids. SiOC powders were shaped by using different binders, pressing techniques and with varying dwelling times at the sintering temperature. The influence of the sintering conditions has been studied. The resulting sintered materials are comprised by a strong glassy matrix where amorphous silica, glassy carbon and amorphous and crystalline SiC coexist. The carbon phase presents three-dimensional ordering formed by nanodomains of glassy carbon of 1.5–2.0 nm. Silicon carbide presents nanodomains of 2.2–2.4 nm independently of the processing conditions. The data obtained from characterization suggest that the use of either the uniaxial die pressing technique or PARALOID leads to a bond redistribution and phase separation before the carbothermal reduction, a fact that has been attributed to the presence of defects in the green bodies.

Item does not contain fulltext STUDY QUESTION: What is the optimal management of women with endometriosis based on the best available evidence in the literature? SUMMARY ANSWER: Using the structured methodology of the Manual for ESHRE Guideline Development, 83 recommendations were formulated that answered the 22 key questions on optimal management of women with endometriosis. WHAT IS KNOWN ALREADY: The European Society of Human Reproduction and Embryology (ESHRE) guideline for the diagnosis and treatment of endometriosis (2005) has been a reference point for best clinical care in endometriosis for years, but this guideline was in need of updating. STUDY DESIGN, SIZE, DURATION: This guideline was produced by a group of experts in the field using the methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to January 2012 and consensus within the guideline group on all recommendations. To ensure input from women with endometriosis, a patient representative was part of the guideline development group. In addition, patient and additional clinical input was collected during the scoping and review phase of the guideline. PARTICIPANTS/MATERIALS, SETTING, METHODS: NA. MAIN RESULTS AND THE ROLE OF CHANCE: The guideline provides 83 recommendations on diagnosis of endometriosis and on the treatment of endometriosis-associated pain and infertility, on the management of women in whom the disease is found incidentally (without pain or infertility), on prevention of recurrence of disease and/or painful symptoms, on treatment of menopausal symptoms in patients with a history of endometriosis and on the possible association of endometriosis and malignancy. LIMITATIONS, REASONS FOR CAUTION: We identified several areas in care of women with endometriosis for which robust evidence is lacking. These areas were addressed by formulating good practice points (GPP), based on the expert opinion of the guideline group members. WIDER IMPLICATIONS OF THE FINDINGS: Since 32 out of the 83 recommendations for the management of women with endometriosis could not be based on high level evidence and therefore were GPP, the guideline group formulated research recommendations to guide future research with the aim of increasing the body of evidence. STUDY FUNDING/COMPETING INTEREST(S): The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the implementation of the guideline. The guideline group members did not receive payment. All guideline group members disclosed any relevant conflicts of interest (see Conflicts of interest). TRIAL REGISTRATION NUMBER: NA.

[EN] Present paper describes the influence of the incorporation of alkali metal cations (AM = Li, Na, K, Cs; and an AM/V ratio of 0.04) and Na-content (Na/V ratio of 0.02-0.30) in alkali metal promoted V2O5 catalyst on both the catalyst structure and the catalytic performance in H2S partial oxidation reactions. The catalytic activity depends on the alkali metal and the amount of alkali metal added, although Na-containing catalysts seem to be the more active ones. However, selectivity to sulphur higher than 98% is achieved in the main of catalysts when working at reaction temperature lower than 220 degrees C. According to the characterization results of used catalysts, V4O9 is selectively formed during the catalytic tests on catalysts presenting V2O5 crystallites. In catalysts with Na/V ratios higher than 0.04, V4O9 and Na0.33V2O5 are observed, the presence of Na0.33V2O5 increasing when increasing the Na/V ratio. Accordingly, V4O9 and Na0.33V2O5 can be proposed as the active and selective crystalline phase in Na-containing catalysts. The role of the presence of V4+-O-V5+ pairs in partial oxidation of H2S is also discussed. (c) 2012 Elsevier B.V. All rights reserved., Financial support from DGICYT in Spain through Project CTQ2009-14495 and Project MAT2009-10481 and FEDER funds are gratefully acknowledged. MDS thanks a fellowship from the Universidad Politecnica of Valencia.

Background Kawasaki disease (KD) is a multisystem vasculitis affecting coronary arteries in children. Patients, refractory to standard treatment with intravenous immunoglobulin and aspirin, show higher rates of coronary artery dilation. Early tumor necrosis factor α receptor antagonism in KD may provide effective adjunctive therapy. Study Design The EATAK trial is a multicenter, double-blind, randomized, and placebo-controlled trial intended to assess the efficacy of etanercept in reducing the intravenous immunoglobulin refractory rate during treatment of acute KD. Each arm will enroll 110 patients who will receive 3 doses of study drug over 2 weeks in conjunction with standard therapy. Coronary artery dilation parameters will serve as secondary end points. Discussion The EATAK trial will test a new paradigm for treatment of acute KD involving tumor necrosis factor α antagonism by etanercept.

Background— Quantitative assessment of ventricular volumes and mass in pediatric patients with single-ventricle physiology would aid clinical management, but it is difficult to obtain with 2-dimensional echocardiography. The purpose of the present study was to compare matrix-array 3-dimensional echocardiography (3DE) measurements of single-ventricle volumes, mass, and ejection fraction with those measured by cardiac magnetic resonance (CMR) in young patients. Methods and Results— Twenty-nine patients (median age, 7 months) with a functional single ventricle undergoing CMR under general anesthesia were prospectively enrolled. The 3DE images were acquired at the conclusion of the CMR. Twenty-seven of 29 3DE data sets (93%) were optimal for 3DE assessment. Two blinded and independent observers performed 3DE measurements of volume, mass, and ejection fraction. The 3DE end-diastolic volume correlated well ( r =0.96) but was smaller than CMR by 9% ( P P P Conclusions— In young pediatric patients with a functional single ventricle, matrix-array 3DE measurements of mass and volumes compare well with those obtained by CMR. 3DE will provide an important modality for the serial analysis of ventricular size and performance in young patients with functional single ventricles.

A study is presented on polymetallic remains from several phases of production, refining and moulding processes from metals recovered in Lixus (bronze 6th and iron 2nd century b.c.). SEM/EDX and metallographic techniques are used in a typographical study comparing chemical and microstructural information so that the hypothesis on metallurgical activity can be verified in a technological context (furnace types and construction materials, fuels, alloys, tools, etc) and the socioeconomic context. A re-casting metallurgical furnace is studied to obtain alloys and proof of their use, for instance from the fuel charge of charcoal and bronze nodules recovered from around the furnace. The set of iron material represents practically the whole process of iron production in an ancient smelting furnace. After cleaning the samples, macroscopic analyses permit to differentiate three kinds of materials from the direct reduction process for iron: cast slags, remains of the ancient smelting furnace wall, and metallic iron product resulting from iron mineral reduction.

Matrix metalloproteinase-2 (MMP-2) is an enzyme with proteolytic activity on matrix proteins, and previous studies have revealed a strong association between the MMP-2 -1306C--T polymorphism and the risk of several types of cancer. Our study looked at whether this polymorphism contributed to the development of cervical neoplasia by analyzing 54 patients with invasive squamous cell cervical cancer, 100 patients with cervical intraepithelial neoplasia, and 126 control subjects. The MMP-2 CC genotype was more frequent in the cancer patients when compared with the control group (OR 2.57; 95% CI 1.15-5.86). The association of cervical cancer with the CC genotype was more pronounced in women who had first coitus at an early age (OR 3.96; 95% CI 1.46-11.06). The CC genotype was associated with intraepithelial neoplasia only in women with first coitus at 19 years old or younger. The data suggest that the MMP-2 -1306C--T polymorphism contributes to the development of squamous cell cervical cancer in the population studied, especially in women who had first coitus at an early age.

During a 6-week period, three groups of 10 cows were fed a total mixed ration (TMR) only or fed the TMR plus access to mixed grass/clover pastures for 8 h after the morning (PAM) or afternoon (PPM) milking to determine the influence of voluntary pasture intake on profiles of biohydrogenation intermediates in milk fat. Cows in PAM had access to paddocks (0.2 ha per day) from 03:00 to 11:00 h, whereas cows in PPM were allowed to graze from 15:00 to 22:00 h. Estimated intake of dry matter (DM) from the TMR by cows within groups was 25, 20, or 16 kg per day, respectively, for TMR, PAM, or PPM. Milk yield was not affected by treatments averaging 31 kg per day, and concentrations and yields of milk components were also unaffected. Milk fat concentration of trans 10-18:1 was higher for cows fed TMR compared with PAM or PPM. In contrast, concentrations of trans 11-18:1 in milk fat from cows fed PAM (20 mg/g total fatty acids) or PPM (24 mg/g) was higher compared with those fed the TMR (14 mg/g). Cows fed PAM or PPM also had greater concentrations of cis 9, trans 11-18:2 (9 or 10 mg/g) compared with those fed TMR (6 mg/g). Thus, daily yields of trans 11-18:1 averaged 17, 20, and 13 g per day and yields of cis 9, trans 11-18:2 were 8, 8, and 5 g per day, respectively, for cows fed PAM, PPM, or TMR. Responses (except for cis 9, trans 11-18:2 yield) were higher when PPM was fed, compared with PAM. Concentration of 18:3 n −3 in milk fat from cows fed PAM or PPM increased by 60% compared with cows fed TMR only. Pasture intake also resulted in two-fold increases in concentrations of trans 11, cis 15-18:2, an intermediate of 18:3 n −3 hydrogenation, in milk fat. Milk fat concentrations of trans 11-18:1, cis 9, trans 11-18:2, and trans 11, cis 15-18:2 were positively correlated with 18:3 n −3 concentration. Results suggest daily access to pasture for 8 h can substantially increase concentrations of 18:3 n −3, trans 11, cis 15-18:2, cis 9, trans 11-18:2, and trans 11-18:1 in milk fat of cows dependent on a TMR for the majority of their nutrients. Although desaturation of rumen-derived vaccenic acid seems to account for the majority of milk fat cis 9, trans 11-18:2 in grazing cows, data also showed that vaccenic acid desaturation may be independent of its concentration.

[EN] Na-containing V2O5 materials have been prepared hydrothermally from gels with Na/V ratios of 0.02-0.26, and calcined at 500 degrees C. The calcined samples have been characterized and tested as catalysts in the partial oxidation of H2S to elemental sulfur. At low Na-contents, V2O5 and NaV6O15 bronze are formed, with the NaV6O15/V2O5 ratio increasing with the Na-content. Pure NaV6O15 bronze is mainly formed from gels containing a Na/V ratio of 0.18. However, NaV6O15 and Na1.164V3O8 are formed from gels with Na/V ratio higher than 0.35. NaV6O15 based catalyst shows high conversion for the oxidation of H2S with a high selectivity into elemental sulfur. These catalysts are more active and stable than pure or Na-doped V2O5 catalysts. V4O9 is observed after reaction in both pure Na-doped V2O5 catalysts but also in NaV6O15/V2O5 mixed catalysts. However, no changes in the NaV6O15 crystalline structure are observed in the Na-promoted catalysts. Accordingly, NaV6O15 crystalline phase is stable for several hours of catalysisat a difference with V2O5. The active sites in V-containing vanadium catalysts are probably V5+-O-V4+ pairs as previously proposed for V4O9 crystalline phase. The best catalytic performances were achieved on V2O5-NaV6O15 mixtures which are transformed into V4O9-NaV6O15 mixtures during the catalytic tests. These catalytic results could be due to the intrinsic physical properties of both phases but also because of the optimal dispersion obtained in the synthesis procedure. (C) 2014 Elsevier B.V. All rights reserved., The authors would like to thank the DGICYT in Spain (Projects CTQ2012-37925-C03-01, CTQ2012-37925-C03-03 and MAT2010-19837-C06-05) for financial support.

We present the case of a woman born with transposition of the great arteries, who was surgically repaired with the Mustard technique. Because of interatrial shunting, she was brought to the cardiac catheterization laboratory for device closure. Matrix-array 3D transesophageal echocardiography enabled visualization of both baffle leaks and demonstrated its orientation in a fashion superior to 2D imaging, had it been used alone. The leaks were successfully closed with a single transcatheter device.

To assess the relationship between gestational age and sonographic appearance of the various sternal components and establish growth during human gestation.A prospective cross-sectional study.The study was performed on 252 consecutive normal singleton pregnancies from 19 weeks of gestation until term, using transabdominal high-resolution ultrasound techniques. The sternal length, as well as the number of ossification centers at each gestational age, were recorded.The first occasion at which a fetal human sternum could be visualized with two to three ossification centers was at 19 weeks' gestational age. The fifth ossification center was first visualized at 29 weeks' gestation. The mean +/- SE of sternal length varied from 15 +/- 0.98 mm (95% confidence interval (CI) 12.79-17.21) at 19-20 weeks, to 36.50 +/- 0.29 mm (95% CI 35.58-37.42) at 37-38 weeks' gestation. Sternal length as a function of gestational age was expressed by the regression equation: sternal length (mm) = -11.06 + 1.39 x gestational age (weeks). The correlation coefficient, r = 0.924 for sternal length, was found to be highly statistically significant (p0.0001).The presented data offer normative measurements of the fetal sternum which may be helpful in the prenatal diagnosis of congenital syndromes that include, among other manifestations, abnormalities of sternal development.

Acute intermittent porphyria (AIP) is a rare disorder of heme metabolism, which usually presents with abdominal pain, gastrointestinal symptoms and autonomic nervous system disturbances. Exacerbations first presenting during pregnancy can mimic various neuropsychiatric disorders and presents a challenging diagnosis. Furthermore, factors precipitating AIP attacks may be associated with pregnancy, including exposure to certain drugs, hyperemesis gravidum induced starvation, dieting and infection. The present case demonstrates the need for a high level of suspicion in order to diagnose this disorder in pregnancy and prevent further morbidity.

The most common anomalies of the fetal ventral abdominal wall include omphalocele and gastroschisis. Umbilical cord hernia is another abdominal wall defect that is poorly defined and usually mistakenly considered as a small omphalocele. The present report describes the sonographic features and clinical significance of four cases of umbilical cord hernia identified transvaginally in the early second trimester of pregnancy. These cases seemed to present a different entity from that of simple omphalocele. The transvaginal sonographic approach provided a clear image of the midgut protruding into the umbilical cord, precise localization of cord insertion in the region of the umbilical ring. Doppler flow evaluation of the umbilical vessels and their relation to the protruding mass. Serial sonographic observations revealed a stable umbilical cord mass in three fetuses, and an enlarging mass in one. Normal karyotype was determined and no associated malformations were detected prenatally. However, in one case that underwent immediate correction of the hernia after delivery at term, the neonate was subsequently found to have pulmonic stenosis and severe neonatal seizures developed at 4 months of age. In two cases, pregnancy was terminated due to parental request. The fourth fetus was delivered vaginally at term and catastrophic division of the umbilical cord containing a loop of small intestine was avoided only by the diligent observation of the midwife. We suggest that umbilical cord hernia is a distinct anomaly originating at a different stage of embryogenesis, thereby having a unique clinical significance, unlike simple omphalocele. Umbilical cord hernia should therefore be defined and considered as a separate entity.