Search

Zygomatic implant (ZI) is an option of the edentulism. Complications associated with ZI are maxillary sinusitis and soft tissue recession. The Zygoma Anatomy-Guided Approach (ZAGA), reduce the complications of the Original zygomatic intra-sinus Surgical technique (OI-ST). Study Aims: 1) report and compare the prevalence of sinus complications between ZAGA and OI-ST. 2) propose therapeutic guidelines for sinus. Material and Methods: ZAGA has been proposed to reduce the complications of the OI-ST. Results: Statistically significant increase of the "Modified Lund Mackay" (MLM) score (was noted in CT of patients after ZI surgery in comparison with the pre-surgical Lund-Mackay (LM) score (t=5, 0, p

Background Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes. Methods We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010–2017, disaggregated by region, age group, country of birth and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models. Results The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive). Conclusions The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.

Background Population-based studies characterising outcomes of COVID-19 in European settings are limited, and effects of socio-economic status (SES) on outcomes have not been widely investigated. Aim We describe the epidemiological characteristics of COVID-19 cases, highlighting incidence and mortality rate differences across SES during the first wave in Barcelona, Catalonia, Spain. Methods This population-based study reports individual-level data of laboratory-confirmed COVID-19 cases diagnosed from 24 February to 4 May 2020, notified to the Public Health Agency of Barcelona and followed until 15 June 2020. We analysed end-of-study vital status and the effects of chronic conditions on mortality using logistic regression. Geocoded addresses were linked to basic health area SES data, estimated using the composed socio-economic index. We estimated age-standardised incidence, hospitalisation, and mortality rates by SES. Results Of 15,554 COVID-19-confirmed cases, the majority were women (n = 9,028; 58%), median age was 63 years (interquartile range: 46–83), 8,046 (54%) required hospitalisation, and 2,287 (15%) cases died. Prevalence of chronic conditions varied across SES, and multiple chronic conditions increased risk of death (≥ 3, adjusted odds ratio: 2.3). Age-standardised rates (incidence, hospitalisation, mortality) were highest in the most deprived SES quartile (incidence: 1,011 (95% confidence interval (CI): 975–1,047); hospitalisation: 619 (95% CI: 591–648); mortality: 150 (95% CI: 136–165)) and lowest in the most affluent (incidence: 784 (95% CI: 759–809); hospitalisation: 400 (95% CI: 382–418); mortality: 121 (95% CI: 112–131)). Conclusions COVID-19 outcomes varied markedly across SES, underscoring the need to implement effective preventive strategies for vulnerable populations.

BackgroundCurrent strategies for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited to nonpharmacologic interventions. Hydroxychloroquine has been proposed as a postexposure therapy to prevent coronavirus disease 2019 (Covid-19), but definitive evidence is lacking. MethodsWe conducted an open-label, cluster-randomized trial involving asymptomatic contacts of patients with polymerase-chain-reaction (PCR)-confirmed Covid-19 in Catalonia, Spain. We randomly assigned clusters of contacts to the hydroxychloroquine group (which received the drug at a dose of 800 mg once, followed by 400 mg daily for 6 days) or to the usual-care group (which received no specific therapy). The primary outcome was PCR-confirmed, symptomatic Covid-19 within 14 days. The secondary outcome was SARS-CoV-2 infection, defined by symptoms compatible with Covid-19 or a positive PCR test regardless of symptoms. Adverse events were assessed for up to 28 days. ResultsThe analysis included 2314 healthy contacts of 672 index case patients with Covid-19 who were identified between March 17 and April 28, 2020. A total of 1116 contacts were randomly assigned to receive hydroxychloroquine and 1198 to receive usual care. Results were similar in the hydroxychloroquine and usual-care groups with respect to the incidence of PCR-confirmed, symptomatic Covid-19 (5.7% and 6.2%, respectively; risk ratio, 0.86 [95% confidence interval, 0.52 to 1.42]). In addition, hydroxychloroquine was not associated with a lower incidence of SARS-CoV-2 transmission than usual care (18.7% and 17.8%, respectively). The incidence of adverse events was higher in the hydroxychloroquine group than in the usual-care group (56.1% vs. 5.9%), but no treatment-related serious adverse events were reported. ConclusionsPostexposure therapy with hydroxychloroquine did not prevent SARS-CoV-2 infection or symptomatic Covid-19 in healthy persons exposed to a PCR-positive case patient. (Funded by the crowdfunding campaign YoMeCorono and others; BCN-PEP-CoV2 ClinicalTrials.gov number, NCT04304053.) In a trial involving asymptomatic contacts of patients with PCR-confirmed Covid-19 in Spain, the authors compared the use of hydroxychloroquine with usual care. Postexposure therapy with hydroxychloroquine did not prevent SARS-CoV-2 infection or symptomatic Covid-19 in healthy persons.

ObjectivesYoung people are a critical target group for sexually transmitted infections (STI) surveillance due to their particular behavioural and social related vulnerability. The aim of this study was to describe the epidemiological characteristics and trends in the incidence of gonorrhoea, syphilis, HIV and venereal lymphogranuloma (LGV) among 15–24-year-olds in Barcelona, and to determine factors associated with HIV coinfection.DesignWe performed a population-based incidence study covering the 2007–2015 period.ParticipantsAll new cases of STI—HIV, gonorrhoea, infectious syphilis and LGV—notified to the epidemiological surveillance system in Barcelona between 2007 and 2015. 1218 cases were studied: 84.6% were men, 19.3% were 15–19 years old and 50.6% were born in Spain. Among men, 73.7% were men who have sex with men (MSM); among women, 85.6% were women that have sex with men.Primary and secondary outcomesIncidence of HIV, gonorrhoea, infectious syphilis and LGV. HIV coinfection.ResultsThere was an increase in the incidence of gonorrhoea, from 1.9 cases per 10 000 people in 2007 to 7.6/10 000 in 2015 (p10 sexual partners (ORa=4.11, 95% CI 1.53 to 11.01) or STI diagnosis during the previous 12 months (ORa=2.06; 95% CI 1.13 to 3.77).ConclusionsThe incidence of gonorrhoea and syphilis among 15–24-year-olds increased, while HIV infection remained stable but with a high incidence among MSM. Being MSM, having sex with multiple partners and having a diagnosis of an STI in the previous 12 months were factors associated with HIV coinfection.

Soil is fundamental to the needs of human life, and plays a central role in determining the quality of our environment. The importance to preserve soils in some crucial aspects for human life, like food production, earth hydrological cycle, biodiversity, and air composition, will be constantly increasing. The expansion and intensification of agricultural activities and increased number and size of populated areas, results in a changing environment, frequently associated with widespread soil and water degradation, due to inappropriate land use and management. Those degradation processes and the associated hydrological changes may result in increasing risks and problems of food and water supply for mankind, and in more frequent “natural” disasters like droughts, flooding, landslides, sedimentation, and contribute to the loss of biodiversity and global climatic changes. All these problems may be evaluated and previewed through modeling the hydrological and hydro-geochemical processes in order to achieve the required sustainability of the environment. This is possible through the integrated use and management of soil and water resources adapted to new social and economic pressures, and to the previewed climate changes. Some examples of such approach under different social-economical and biophysical conditions, in different parts of the world are presented herein.

In Latin America (LA), as well as in other parts of the world, salt-affected soils, both saline and sodic, are found under dryland and irrigated conditions, with negative consequences for the environment, for crop productivity and for animal and human health. Additionally, some tropical coastal and river delta areas have developed saline acid soils. Most of the salt-affected areas have extended under natural conditions. However, the development of affected areas as a result of human-induced processes, mainly associated with hydrological changes caused by irrigation and drainage practices, is increasing. This process negatively affects, sometimes irreversibly, the productive capacity of some of the best soils in many countries of LA, with important economic impacts and social consequences. Although recent estimates of the extension and distribution of human-induced salt-affected soils in LA are not available, there are clear indications that both problems, salinity and sodicity, under dryland and irrigated conditions, have been and are presently increasing in many LA countries. A country-by-country overview of soil and water salinity and sodicity is presented in this chapter, focusing mainly on irrigation and drainage problems.

Background Current strategies for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are limited to non-pharmacological interventions. Hydroxychloroquine (HCQ) has been proposed as a postexposure therapy to prevent Coronavirus disease 2019 (Covid-19) but definitive evidence is lacking. Methods We conducted an open-label, cluster-randomized trial including asymptomatic contacts exposed to a PCR-positive Covid-19 case in Catalonia, Spain. Clusters were randomized to receive no specific therapy (control arm) or HCQ 800mg once, followed by 400mg daily for 6 days (intervention arm). The primary outcome was PCR-confirmed symptomatic Covid-19 within 14 days. The secondary outcome was SARS-CoV-2 infection, either symptomatically compatible or a PCR-positive result regardless of symptoms. Adverse events (AEs) were assessed up to 28 days. Results The analysis included 2,314 healthy contacts of 672 Covid-19 index cases identified between Mar 17 and Apr 28, 2020. A total of 1,198 were randomly allocated to usual care and 1,116 to HCQ therapy. There was no significant difference in the primary outcome of PCR-confirmed, symptomatic Covid-19 disease (6.2% usual care vs. 5.7% HCQ; risk ratio 0.89 [95% confidence interval 0.54-1.46]), nor evidence of beneficial effects on prevention of SARS-CoV-2 transmission (17.8% usual care vs. 18.7% HCQ). The incidence of AEs was higher in the intervention arm than in the control arm (5.9% usual care vs 51.6% HCQ), but no treatment-related serious AEs were reported. Conclusions Postexposure therapy with HCQ did not prevent SARS-CoV-2 disease and infection in healthy individuals exposed to a PCR-positive case. Our findings do not support HCQ as postexposure prophylaxis for Covid-19., This study was mainly supported by the crowdfunding campaign JoEmCorono (https://www.yomecorono.com/) with the contribution of over 72,000 citizens and corporations. The study also received financial support from Laboratorios Rubió, Gebro Pharma, Zurich Seguros, SYNLAB Barcelona, and Generalitat de Catalunya. Laboratorios Rubió also contributed to the study with the required doses of hydroxychloroquine (Dolquine®).

No effective treatments for coronavirus disease 2019 (COVID-19) exist. We aimed to determine whether early treatment with hydroxychloroquine (HCQ) would be efficacious for outpatients with COVID-19., The authors thank Gerard Carot-Sans, PhD, for providing medical writing support during the revisions of the subsequent drafts of the manuscript; the personnel from the Fights Aids and Infectious Diseases Foundation for their support in administration, human resources and supply chain management; Eric Ubals (Pierce AB) and Òscar Palao (Opentic) for website and database management; Óscar Camps and OpenArms nongovernmental organization for nursing home operations; and Anna Valentí and the Hospital Germans Trias i Pujol Human Resources Department for telephone monitoring. We thank Consorci Sanitari del Maresme, Centre Sociosanitari El Carme, l'Hospital General de Granollers and occupational hazards department of Hospital Germans Trias i Pujol for their contribution with patient enrollment. We are very grateful to Marc Clotet and Natalia Sánchez who coordinated the JoEmCorono crowd-funding campaign. We thank the Hospital Germans Trias Pujol Institutional Review Board and the Spanish Agency of Medicines and Medical Devices for their prompt action for consideration and approvals to the protocol. Financial support. This work was mainly supported by the crowd-funding campaign JoEmCorono (https://www.yomecorono.com/) with contributions from more than 72 000 citizens and corporations. The study also received financial support from Laboratorios Rubió, Laboratorios Gebro Pharma, Zurich Seguros, SYNLAB Barcelona, and Generalitat de Catalunya. Laboratorios Rubió also contributed to the study with the required doses of hydroxychloroquine (Dolquine®). Foundation Dorneur partly funded lab equipment at Irsi-Caixa.

Objective To compare the pharmacokinetic profile of gadobutrol versus Gd-DTPA in dynamic contrast-enhanced MRI (DCE-MRI) in patients with breast cancer. Secondary objectives included comparing the safety profiles and diagnostic efficacy of the two contrast agents for detecting additional malignant lesions. Material and methods This retrospective observational study included 400 patients with histologically confirmed breast cancer; 200 underwent DCE-MRI with Gd-DTPA (Magnevist ® ) and 200 underwent DCE-MRI with gadobutrol (Gadovist ® ). Pharmacokinetic parameters and signal intensity were analyzed in a region of interest placed in the area within the lesion that had greatest signal intensity in postcontrast sequences. We compared the two groups on pharmacokinetic variables ( K trans , K ep , and V e ), time-signal intensity curves, and the number of additional malignant lesions detected. Results The relative signal intensity (enhancement) was higher with gadobutrol than with Gd-DTPA. Washout was lower with gadobutrol than with Gd-DTPA (46% vs. 58.29%, respectively; p = 0.0323). Values for K trans and K ep were higher for gadobutrol ( p = 0.001). There were no differences in the number of histologically confirmed additional malignant lesions detected ( p = 0.387). Conclusions Relative enhancement is greater with gadobutrol, but washout is more pronounced with Gd-DTPA. The number of additional malignant lesions detected did not differ between the two contrast agents. Both contrasts are safe.

Background: Prenatal and postnatal exposure to air pollution has been linked to cognitive impairment in children, but very few studies have assessed its association with attentional function. Objectives: To evaluate the association between prenatal and postnatal exposure to nitrogen dioxide (NO2) and attentional function in children at 4–5 years of age. Methods: We used data from four regions of the Spanish INMA—Environment and Childhood—Project, a population-based birth cohort. Using land-use regression models (LUR), we estimated prenatal and postnatal NO2 levels in all of these regions at the participants' residential addresses. We assessed attentional function using the Kiddie-Conners Continuous Performance Test (K-CPT). We combined the region-specific adjusted effect estimates using random-effects meta-analysis. Results: We included 1298 children with complete data. Prenatal exposure to NO2 was associated with an impaired standard error of the hit reaction time (HRT(SE)) (increase of 1.12 ms [95% CI; 0.22 a 2.02] per 10 μg/m3 increase in prenatal NO2) and increased omission errors (6% [95% CI; 1.01 to 1.11] per 10 μg/m3 increase in prenatal NO2). Postnatal exposure to NO2 resulted in a similar but borderline significant increase of omission errors (5% [95% CI; =0.99 to 1.11] per 10 μg/m3 increase in postnatal NO2). These associations did not vary markedly between regions, and were mainly observed in girls. Commission errors and lower detectability were associated with prenatal and postnatal exposure to NO2 only in some regions. Conclusions: This study indicates that higher exposure to ambient NO2, mainly during pregnancy and to a lesser extent postnatally, is associated with impaired attentional function in children at 4–5 years of age., This study was funded by grants from the Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041 and PI031615; PI041931; PI041112; PI041436; PI041509; PI042018; PI051079; PI051052; PI060867; PI061213; PI070314; CP1100178; PI081151 incl. FEDER funds; PS0900090 incl. FEDER funds; PI0902311 incl. FEDER funds; PI0902647 incl. FEDER funds; PI1102591 incl. FEDER funds; PI1102038 incl. FEDER funds; PI131944 incl. FEDER funds; PI132032 incl. FEDER funds; PI1302429 incl. FEDER funds; PI1302187 incl. FEDER funds; PI140891 incl. FEDER funds; PI141687 incl. FEDER funds and MS13/00054), Generalitat de Catalunya-CIRIT 1999SGR 00241, Fundació La marató de TV3 (090430), Department of Health of the Basque Government (2005111093, 2009111069 and 2013111089), the Provincial Government of Gipuzkoa (DFG06/002 and DFG08/001), Convenios anuales con los ayuntamientos de la zona del estudio (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia y Beasain), from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), from the European Research Council under the ERC Grant Agreement number ERC-AdG 2010 GA#268479 – the BREATHE project, from the Conselleria de Sanitat of Generalitat Valenciana (AP212/11, 002/008, 012/009, 013/2009, 014/009, 015/008, 016/009, 021/007, 021/008, 023/008 and 024/007) and from Obra Social Cajastur/Fundación Liberbank and Universidad de Oviedo. ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya.

Introduction The main objective of this study is to describe qualitatively and quantitatively the different immune lymphocyte phenotypes of patients with renal disease after treatment with anti-CD20. Material and methods Two cohorts of transplanted and autoimmune kidney patients were compared: (1) Those who began treatment with Rituximab, matched (for sex, age and general clinical parameters) with (2) Non-treated control kidney patients. Different analyses were performed: (A) B-lymphocyte subpopulations; (B) T-cell subpopulations; (C) serum levels of BAFF, APRIL, Rituximab and anti-Rituximab; (D) rs396991 polymorphism of CD16a and at different time points for each type of analysis: (i) at baseline, (ii) day 15, (iii) at three and (iv) six months post-antiCD20. Results (A) A depletion of all B cell subsets analysed was observed preferentially decreasing the CD40 + memory B-cells, switched memory cells and plasmablasts. (B) A significant decreased percentage of CD4 + T-lymphocytes was observed. A significant decrease of the percentage of memory T-cells and an increase in naive T-cells was also observed. (C) A significant increase for APRIL was observed, as well as a positive correlation between the APRIL levels, and the differential of B-cells. (D) The presence of CD16a Valine-variant induced greater changes in the variations of total T-cell and T-naive subpopulations. Conclusion Our results highlight that the treatment of renal disease with Rituximab affects T-cells, particularly naive/memory balance, while APRIL could be also a secondary marker of this treatment. The sequential analysis of phenotypic alterations of B- and T-cells could help patient management, although further studies to identify periods of remission or clinical relapse are warranted.

Background: No therapeutics have yet been proven effective for the treatment of mild-illness caused by SARS-CoV-2. We assessed the efficacy and safety of hydroxychloroquine (HCQ) alone or in combination with cobicistat-boosted darunavir (DRVc) for treating patients with mild Covid-19. Methods: We conducted a randomized, prospective, controlled, open-label trial in three health regions of Catalonia. After confirmation of a case of Covid-19 disease, we enumerated on a list a ring of the case and all their contacts and randomly assigned the ring to either control or intervention arm on a 1:1 ratio. Here we present the methods concerning eligible index cases, which involved non-hospitalized adult patients with recently confirmed SARS-CoV-2 infection and less than seven days of symptoms. Patients were assigned to receive HCQ (800 mg on day 1, followed by 400 mg once daily for six days) in combination with DRVc (800 mg/150 mg tablets, once daily for seven days) or no antiviral treatment. The protocol was adapted during the course of the trial to use HCQ alone after findings of no benefit of the protease inhibitor lopinavir-ritonavir. Study outcomes were the reduction of viral RNA load in nasopharyngeal swabs and time to clinical improvement within 28 days of follow-up in the per-protocol population. Adverse events were assessed up to 28 days. Findings: Between Mar 17 and Apr 28, 2020, 353 Covid-19 patients met the criteria for the per-protocol analysis: 165 in the control arm and 142 in the intervention arm. The median time from symptom onset to treatment start was 3 days (IQR 2–4). The per-protocol analysis revealed no significant differences in the mean reduction of viral load in nasopharyngeal swabs at day-3 compared to baseline between the control group (-1·28 Log 10 copies/mL, SD 1·68) and the intervention group (-1·47, SD 1·50); difference -0·18 [95% CI -0.59 to 0·22]. The same pattern was observed at day-7 and -14 after treatment. Time to complete alleviation of symptoms was similar in both groups (22 vs. 20·5 days, p = 0·37). Adverse events included self-limited nausea and diarrhea. Twenty patients required hospitalization, all due to Covid-19 progression. No patients died during the study. Interpretation: In patients with mild Covid-19, no benefit was observed with HCQ alone or in combination with DRVc beyond the usual care. Future testing of other agents in randomized trials may help to identify other drugs that provide a treatment benefit., Crowdfunding campaign YoMeCorono (https://www.yomecorono.com/), Laboratorios Rubió, Laboratorios Gebro Pharma, Zurich Seguros, SYNLAB Barcelona, and Generalitat de Catalunya. Laboratorios Rubió also contributed to the study with the required doses of hydroxychloroquine (Dolquine®).

To evaluate the presence of a parallel artery and vein on color Doppler ultrasound as a predictor of benignity in solid breast masses. This prospective study included all patients with solid breast masses identified by ultrasound at our center from January 2012 through December 2015. All masses were studied with B mode and color Doppler ultrasound. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value, and their respective 95% confidence intervals for the parallel vessel sign against the histologic findings or 2 years' follow-up without changes. A total of 526 solid masses were included in the 3-year period; the parallel vessel sign was observed in 377 (71.6%). We found 74.8% (95% CI: 70.9-78.7) sensitivity, 65% (95% CI: 50.2-79.7) specificity, 96.2% (95% CI: 94.3-98.1) positive predictive value, and 17.5% (95% CI: 11.4-23.6) negative predictive value. Of the 379 masses classified as breast imaging reporting and data system (BI-RADS) 3, the parallel vessel sign was observed in 275 (72.5%); all of these were definitively benign. Of the 109 masses classified as BI-RADS 4, the parallel vessel sign was observed in 89 (80.7%); 88 (98.8%) of these were definitively benign. Of the 38 masses classified as BI-RADS 5, the parallel vessel sign was observed in 13 (34.2%); all of these were definitively malignant. The parallel artery and vein sign is a good predictor of benignity, although it must be analyzed together with other morphologic descriptors.

The aim of this paper is to evaluate the spatial glandular volumetric tissue distribution as well as the density measures provided by Volpara™ using a dataset composed of repeated pairs of mammograms, where each pair was acquired in a short time frame and in a slightly changed position of the breast. Materials and methods We conducted a retrospective analysis of 99 pairs of repeatedly acquired full-field digital mammograms from 99 different patients. The commercial software Volpara™ Density Maps (Volpara Solutions, Wellington, New Zealand) is used to estimate both the global and the local glandular tissue distribution in each image. The global measures provided by Volpara™, such as breast volume, volume of glandular tissue, and volumetric breast density are compared between the two acquisitions. The evaluation of the local glandular information is performed using histogram similarity metrics, such as intersection and correlation, and local measures, such as statistics from the difference image and local gradient correlation measures. Results Global measures showed a high correlation (breast volume R = 0.99, volume of glandular tissue R = 0.94, and volumetric breast density R = 0.96) regardless the anode/filter material. Similarly, histogram intersection and correlation metric showed that, for each pair, the images share a high degree of information. Regarding the local distribution of glandular tissue, small changes in the angle of view do not yield significant differences in the glandular pattern, whilst changes in the breast thickness between both acquisition affect the spatial parenchymal distribution. Conclusions This study indicates that Volpara™ Density Maps is reliable in estimating the local glandular tissue distribution and can be used for its assessment and follow-up. Volpara™ Density Maps is robust to small variations of the acquisition angle and to the beam energy, although divergences arise due to different breast compression conditions This work was partially funded by the Ministry of Economy and Competitiveness of Spain grant under project reference DPI2015-68442-R and by Universitat de Girona by UdG grant MPCUdG2016/022. Eloy Garcıa holds a FPI grant BES-2013-065314. Oliver Diaz is funded by the SCARtool project (H2020-MSCA-IF-2014, reference 657875), a research funded by the European Union within the Marie Sklodowska-Curie Innovative Training Networks

Background To determine the risk of hospital readmission and associated factors in patients with a positive sample for multidrug-resistant microorganisms (MRM) and to analyze whether there is a higher risk of hospital readmission with some of the more common MRM. Methods Retrospective cohort study (2012–16) performed in a tertiary-care teaching hospital in Barcelona. Patients were divided into two groups, depending on the presence or absence of an MRM-positive sample during hospital admission. Logistic regression models were used to estimate the risk of hospital readmission in the first 30 and 90 days, and the first year for patients with an MRM-positive sample compared with those without. The models were stratified by the presence or absence of an MRM-positive sample and by grouped Charlson comorbidity index. Results We included 983 patients with an MRM-positive sample and 39 323 patients without. The risk of hospital readmission in the first 30 days was 41% higher in admitted patients with an MRM-positive sample (95%CI=1.17 to 1.69) than in those without. Stratified models showed similar results to the overall results for all Charlson comorbidity index groups. When the models were stratified by the presence of an MRM-positive sample, methicillin-resistant Staphylococcus aureus showed the highest risk of readmissions within the more common MRM [103% (95%CI=1.10 to 3.75)]. Conclusion MRMs seem to be an important risk factor for hospital readmissions both among patients with and without comorbidities. Specific types of MRM may represent a higher risk for hospital readmissions than other MRMs, depending on the particular environment or hospital.

International audience; This paper studies the impact of the aging on power GaN transistors in switching conditions. The devices under test are commercial discrete enhancement mode gallium-nitride HEMT. We present a power cycling test platform that controls the switching conditions such as frequency , duty cycle, and gate voltage; as well as drain current and drain voltage. We have measured specific parameters before and after the power cycling in order to detect indicators for each drift effect. We measure not only the electrical parameters given by datasheet, but also the traps causing Dynamic On-State Resistance, an specific drift effect of this technology which compromises high frequency efficiency in switching power converters.

Objectives To evaluate the morphokinetic, pharmacokinetic, and diffusion characteristics of triple-negative breast cancers on magnetic resonance (MR) imaging and to analyze whether there is a relation between these parameters and the time to progression. Material and methods This was a retrospective observational study of a consecutive series of 100 patients with histologically confirmed triple-negative breast cancer studied at our center between January 2005 and December 2010. We reviewed the findings on MR locoregional extension studies, the histological findings, and the follow-up of patients until August 2014. Results The most common MR findings for these tumors were a rounded mass (47.3%), well-defined borders (53.7%), ring enhancement (46.2%), type 3 curves (50.5%), hyperintensity within the tumor on T2-weighted sequences, high ADC values (1.04 × 10 −3 mm 2 /s), and increased capillary permeability (Kep) (0.94 min −1 ). No significant association was observed between the morphokinetic or pharmacokinetic characteristics and the time to progression. The in situ component in the surgical specimens was high, although its expression was low. During follow-up, 25% of patients had metastases, with a predilection for the visceral organs, and survival was low. Conclusion Tumors with the triple-negative phenotype mostly presented in MR as rounded tumors with well-defined borders and ring enhancement. We found no significant association between the morphokinetic or pharmacokinetic characteristics and the time to progression.

Breast density is a strong risk factor for breast cancer. In this paper, we present an automated approach for breast density segmentation in mammographic images based on a supervised pixel-based classification and using textural and morphological features. The objective of the paper is not only to show the feasibility of an automatic algorithm for breast density segmentation but also to prove its potential application to the study of breast density evolution in longitudinal studies. The database used here contains three complete screening examinations, acquired 2 years apart, of 130 different patients. The approach was validated by comparing manual expert annotations with automatically obtained estimations. Transversal analysis of the breast density analysis of craniocaudal (CC) and mediolateral oblique (MLO) views of both breasts acquired in the same study showed a correlation coefficient of ρ = 0.96 between the mammographic density percentage for left and right breasts, whereas a comparison of both mammographic views showed a correlation of ρ = 0.95. A longitudinal study of breast density confirmed the trend that dense tissue percentage decreases over time, although we noticed that the decrease in the ratio depends on the initial amount of breast density This work was partially funded by the Spanish R+D+I grant no. TIN2012-37171-C02-01

(a) To compare the axillary tumor burden detected by fine-needle aspiration cytology (FNAC) versus sentinel lymph node biopsy (SLNB). (b) To evaluate the relationship between axillary tumor burden and the number of suspicious lymph nodes detected by axillary ultrasonography (US). (c) To calculate the false-positive and false-negative rates for FNAC in patients fulfilling ACOSOG Z0011 criteria.Retrospective multicenter cross-sectional study of 355 pT1 breast cancers. SLNB and axillary lymph node dissection (ALND) were gold standards. Low axillary burden (≤2 positive lymph nodes); high burden (2 positive lymph nodes). Patients ACOSOG Z0011: false-positive (positive FNAC+low burden), false-negative (negative FNAC+high burden).High axillary burden: in entire series 38.5% FNAC+ vs. 5.7% SLNB+ (p0.0001). In subgroup fulfilling ACOSOG Z0011 criteria: 45.5% vs 6.7%, respectively (p0.001). 61 positive axillary US. With 1 suspicious node on axillary US: 95.6% had ≤2 involved nodes (including pN0); with 2 suspicious nodes: 60% had2 involved nodes. In ACOSOG Z0011 patients, with 1 suspicious node, 93.7% had ≤2 involved nodes. Of the 37 FNAC in ACOSOG Z0011patients: 54.5% false-positives for high burden; 3.8% false-negatives.FNAC-positive tumors have greater axillary burden, even in patients fulfilling ACOSOG Z0011 criteria. Using axillary US/FNAC to triage patients meeting Z0011 criteria may result in axillary overtreatment. The number of suspicious nodes seen in axillary US is related with the final axillary burden and should be taken into account when deciding to do FNAC in patients fulfilling ACOSOG Z0011 criteria.

FORGE (Fate of Repository Gases) is an international research project supported by funding under the European Commission FP7 Euratom program and lasting four years from 2009 to 2013. The project is dedicated to understanding gas generation and migration as part of the quantitative assessment of a geological repository for radioactive waste. Within the FORGE project, Work Package 1 is dedicated to numerical modeling of a two-phase flow system (hydrogen gas due to corrosion and groundwater) in a geological repository for radioactive waste. Several benchmark exercises were proposed that cover the modeling of a deep geological repository from the disposal cell scale to the repository scale with different codes. During the definition of the exercises, special emphasis was given to the roles of the excavation-disturbed zone and of the interfaces between materials, which could act as a conduit for preferential flow. Some changes were made in the TOUGH2 code to enable the implementation of the prescribed ...

Digital mammograms may present an overexposed area in the peripheral part of the breast, which is visually shown as a darker area with lower contrast. This has a direct impact on image quality and affects image visualisation and assessment. This paper presents an automatic method to enhance the overexposed peripheral breast area providing a more homogeneous and improved view of the whole mammogram. The method automatically restores the overexposed area by equalising the image using information from the intensity of non-overexposed neighbour pixels. The correction is based on a multiplicative model and on the computation of the distance map from the breast boundary. A total of 334 digital mammograms were used for evaluation. Mammograms before and after enhancement were evaluated by an expert using visual comparison. In 90.42% of the cases, the enhancement obtained improved visualisation compared to the original image in terms of contrast and detail. Moreover, results show that lesions found in the peripheral area after enhancement presented a more homogeneous intensity distribution. Hence, peripheral enhancement is shown to improve visualisation and will play a role in further development of CAD systems in mammography This work was partially funded by the Spanish R+D+I Grant no. TIN2012-37171-C02-01. M. Tortajada holds a UdG BR-GR10 grant

CodiP2P and DisCoP are two peer-to-peer (P2P) computing overlays aimed at sharing computing resources (CPU, Memory, etc.) to execute parallel applications. Their component nodes are basically PC's and a wide range of computer servers, desktops or laptops. This paper joins these two platforms into a new one, DisCoP2P, to combine the features from both overlays. CodiP2P is highly scalable, and DisCoP has an efficient searching mechanism and the ability to classify computing resources. The new platform takes advantage of these features and uses them to offer new facilities to schedule and execute parallel applications efficiently. This is accomplished at null cost because the platform is made up of nodes that share resources for free. This research field can also be classified in desktop computing. The success of this platform depends greatly on the added overhead. This overhead is produced mainly in searching for resources and system administration. The obtained results in a preliminary prototype, although not sufficiently conclusive, demonstrate the applicability of DisCoP2P in the real world, i.e. Internet.

Este artículo contiene 13 páginas, 6 figuras, 1 tabla., Background: On February 1st 2016 the WHO declared the Zika Virus (ZIKV) infection a worldwide public health emergency because of its rapid expansion and severe complications, such as Guillain-Barré Syndrome or microcephaly in newborn. The huge amount of people traveling to endemic areas and the presence of Aedes albopictus in Barcelona increase the risk of autochtonous transmission. The objective of this study was to describe the first ZIKV cases diagnosed in our city and to analyze the surveillance, prevention, and control measures implemented to avoid autochthonous transmission. Methods: An observational cross-sectional population-based study in Barcelona, Spain was performed.An analysis of the socio-demographic, epidemiological, clinical characteristics, and mosquito control activities of the ZIKV cases detected between January 1st and December 2016 was carried out using a specific ZIKV epidemiological survey of the Barcelona Public Health Agency. Results: A total of 118 notifications of possible ZIKV infections were received, and 44 corresponded to confirmed cases in Barcelona residents.Amongst these, the median age was 35 years and 57% were women. All cases were imported, 48% were Spanish-born and 52% foreign-born. Dominican Republic was the most visited country amongst foreign-born patients and Nicaragua amongst Spanish-born. The most frequent symptoms were exanthema, fever, and arthralgia. Among the 24 diagnosed women, 6 (25%) were pregnant. There was one case of microcephaly outside Barcelona city. Entomological inspections were done at the homes of 19 cases (43.2% of the total) and in 34 (77.3%) public spaces. Vector activity was found in one case of the 44 confirmed cases, and 134 surveillance and vector control were carried out associated to imported ZIKV cases. In all cases prevention measures were recommended to avoid mosquito bites on infected cases.Conclusion: Epidemiological and entomological surveillance are essential for the prevention of autochthonous transmission of arbovirosis that may have a great impact on Public Health.The good coordination between epidemiologists, entomologists, microbiologists, and clinicians is a priority in a touristic city with an intense relationship with endemic countries to minimize the risk of local transmission by competent vectors., MJ, JG, NR, and JM receives funds from 2014 SGR 26 grant from the Department d’Universitats, Recerca i Societat de la Informacio de la Generalitat de Catalunya (AGAUR) and from RD12/0018/0010 grant, ISCIII RETIC (MICINN, Spain). PROSICS authors are supported by the 6th National Plan (PN) of Research + Development + Innovation (I + D + I) 2008–2011, ISCIII-General Division Networks and Cooperative Research Centres + FEDER funds + Collaborative Research Network on Tropical Diseases (RICET): RD12/0018/0020.

Introduction: Prenatal and postnatal air pollution exposure has been related to cognitive impairment in children but very few studies have assessed its association with attentional function. The ai...

The main objective of this article is to review the various radiological findings that appear in mammography, ultrasound and magnetic resonance after conservative surgery and radiotherapy for breast cancer, and in particular lesions mimicking malignancy. Identification of the benign changes and their progression frequently associated with conservative treatments will enable physician to provide the optimal follow-up to these patients, and allow the different patterns of local recurrence to be detected early. Diagnostic Radiology Department teaching files were used to select the most illustrative images. © 2012 SESPM. Published by Elsevier Espana, S.L. All rights reserved.

Resumen El cancer de mama triple negativo es un subtipo tumoral que puede no visualizarse en la mamografia y en la ecografia, donde frecuentemente presenta hallazgos indicativos de benignidad, mientras que todas las lesiones se visualizan en la resonancia magnetica con hallazgos asociados a malignidad y con caracteristicas morfologicas diferentes en otros subtipos tumorales. El patron de recidiva de estos tumores tambien es distinto, por lo que cabe plantearse un esquema de seguimiento diferente del utilizado de otros subtipos tumorales.

Background. Longer and more frequent dialysis sessions have demonstrated excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment. The aim of this study was to evaluate the beneficial effects of a longer (nocturnal) and more frequent (every-other-day) dialysis schedule with OL-HDF at the same or the highest convective volume. Methods. This prospective, in-centre crossover study was carried out in 26 patients, 18 males and 8 females, 49.2 6 14 years old, on 4–5 h thrice-weekly post-dilution OL-HDF, switched to nocturnal every-other-day OL-HDF. Patient inclusion criteria consisted of stable patients with good vascular access and with good prospects for improved occupational, psychological and social rehabilitation. Patients were randomly assigned into two groups: Group A received the same convective volume as previously for 6 months followed by a higher convective volume for a further 6 months, while Group B received the same schedule in reverse order. Results. Nocturnal every-other-day OL-HDF was well tolerated and 56% of patients who were working during the baseline period continued to work throughout the study with practically no absenteeism. The convective volume was 26.7 6 2 L at baseline, 27.5 6 2 with the unchanged volume and 42.9 6 4 L with the higher volume. eKt/V increased from 1.75 6 0.4 to 3.37 6 0.9. Bicarbonate, blood urea nitrogen (BUN) and creatinine values decreased, while phosphate levels fell markedly with a 90% reduction in phosphate binders. Blood pressure and left ventricular hypertrophy (LVH) improved and the use of anti-hypertensive drugs decreased. In both groups, BUN, creatinine and b2-microglobulin reduction ratios improved. Different removal patterns were observed for myoglobin, prolactin and a1-acid glycoprotein. Conclusions. Nocturnal every-other-day OL-HDF could be an excellent therapeutic alternative since good tolerance and occupational rehabilitation, marked improvement in dialysis dose, nutritional status, LVH, phosphate and hypertension control and a substantial reduction in drug requirements were observed. In this crossover study, different removal patterns of large solutes were identified.

et al., [Background]: Osteoarthritis is the most prevalent joint disease and a frequent cause of joint pain, functional loss, and disability. Osteoarthritis often becomes chronic, and conventional treatments have demonstrated only modest clinical benefits without lesion reversal. Cell-based therapies have shown encouraging results in both animal studies and a few human case reports. We designed a pilot study to assess the feasibility and safety of osteoarthritis treatment with mesenchymal stromal cells (MSCs) in humans and to obtain early efficacy information for this treatment. [Methods]: Twelve patients with chronic knee pain unresponsive to conservative treatments and radiologic evidence of osteoarthritis were treated with autologous expanded bone marrow MSCs by intra-articular injection (40×10 cells). Clinical outcomes were followed for 1 year and included evaluations of pain, disability, and quality of life. Articular cartilage quality was assessed by quantitative magnetic resonance imaging T2 mapping. [Results]: Feasibility and safety were confirmed, and strong indications of clinical efficacy were identified. Patients exhibited rapid and progressive improvement of algofunctional indices that approached 65% to 78% by 1 year. This outcome compares favorably with the results of conventional treatments. Additionally, quantification of cartilage quality by T2 relaxation measurements demonstrated a highly significant decrease of poor cartilage areas (on average, 27%), with improvement of cartilage quality in 11 of the 12 patients. [Conclusions]: MSC therapy may be a valid alternative treatment for chronic knee osteoarthritis. The intervention is simple, does not require hospitalization or surgery, provides pain relief, and significantly improves cartilage quality.

Introduction The spontaneous pneumomediastinum is an extremely rare condition. We hereby present a case of this pathology. Clinical case 17 year-old man who suffered a low-energy motorcycle accident and came into the emergency department complaining of headache and neck pain. Physical examination showed echolalia and retrograde amnesia and crepitation on the anterior and right lateral part of the neck. No other physical signs were found. Plain radiographs and a CT-scan showed air in the right jugular vein. With the diagnosis of spontaneous pneumomediastinum, the patient remained under observation. With rest and analgesia the patient improved within the next hours and was discharged without any complication. The case is presented and the literature is reviewed. Conclusions Spontaneous pneumomediastinum is a normally benign pathology that tends to resolve favorably without any treatment.

The costs and benefits of vaccinating a theoretical cohort of 1000 preschool and school age children (3-14 years) with one dose of inactivated virosomal subunit influenza vaccine in primary health care centers of the Catalan Health Service during the fall annual health examination were compared with the current strategy of no routine vaccination. The economic analysis was carried out from the provider perspective (cost-effectiveness analysis) and from the societal perspective (cost-effectiveness and cost-benefit analysis). The time horizon of the study was established at 6 months. In the base case (cost of vaccination of euro 9.425, cost of paediatric visit plus antibiotic and antipyretic treatment of euro 42.50, cost of 1 day of hospital stay of euro 454.25, cost of the work lost by the mother to take care of her ill child of euro 29.2 and cost of 1 year of quality adjusted life year lost of euro 10,662), the vaccination does not save money from the provider perspective (net present value=euro-1460.51), but the cost-effectiveness ratios are very reasonable (euro 5.80 per episode of acute febrile respiratory process avoided and euro 18.26 per quality adjusted life year saved). From the societal perspective, the vaccination saves money (net present value=euro+7587.03) and the benefit-cost ratio is 1.80, meaning that euro 0.80 is saved per euro invested. Our study shows that vaccination of children 3-14 years old with a single dose of inactivated subunit influenza vaccine in primary health care centers during the fall annual health examination provides socioeconomic benefits to the society in addition to substantial health benefits for the child.

Objectives To identify and quantify the variables and their influence on postoperative morbidity in dental treatment under general anesthesia (GA) in pediatric patients with and without an underlying disease. Methods A prospective, descriptive, and comparative analysis was conducted of healthy (n = 49) and disabled/medically compromised (n = 81) children treated under GA. Intra-/post-surgical, clinical epidemiology, technical, care-related, and pharmacologic data were gathered, as were postoperative complications. Results The average age of ASA I patients (6.7 ± 4.4 years) was younger than that of ASA II-III patients (9.0 ± 4.5 years). Average hospitalization time was 4.27 ± 6.5 h in ASA I and 7.41 ± 6.8 h in ASA II-III. Significant differences were found between the two groups in fillings, pulpotomies, oral surgery, and scaling. Postoperative morbidity in ASA I and ASA II-III was similar both in frequency and severity and decreased during the first 72 h. The most common complication in both groups was toothache. Conclusion Postoperative morbidity is high after dental treatment under GA, but it is not higher in disabled/medically compromised patients.

Transplant glomerulitis, observed in T cell-mediated and antibody-mediated rejection, is histologically characterized by intracapillary mononuclear cell infiltration. However, the prognostic value of counting various glomerular inflammatory cells during rejection has not been elucidated, which is a key step for the introduction of novel biomarkers in the clinics. We immunophenotyped glomerulitis during episodes of acute rejection in order to investigate their predictive value for transplant outcomes. To do so, we included 57 transplant biopsies of 57 renal transplant recipients with biopsy-proven acute rejection with a median follow-up of 4.2 years. We determined average glomerular cell counts for T cells, B cells, Tregs, IL-17(+) cells, neutrophils and macrophages. Logistic and Cox regression models were used to investigate the association of glomerular inflammatory cells with response to therapy and graft failure on a population level. We used novel time-dependent ROC curve analyses to investigate the value of glomerular inflammatory cell infiltrates for the prediction of transplant outcomes, applicable to the individual patient. We identified three cell types that were responsible for glomerulitis during rejection: macrophages, T cells and neutrophils. By quantification of glomerular macrophages, an emerging cell type associated with antibody-mediated rejection, we were able to predict the progression towards death-censored graft failure within the first 500 days after the initial episode of rejection. With the use of novel time-dependent ROC analyses, we propose dynamic sensitivities, specificities, and positive and negative predictive values with their corresponding cut-off values for the average amount of glomerular macrophages, depending on what time after rejection death-censored graft failure needs prediction.

To (a) determine the diagnostic validity of axillary ultrasound (AUS) in pT1 tumours and whether fine-needle aspiration (FNA) improves its diagnostic performance, and (b) determine the negative predictive value (NPV) of AUS in a simulation environment (cutoff: two lymph nodes with macrometastases) in patients fulfilling American College of Surgeons Oncology Group (ACOSOG) Z0011 criteria. This retrospective multicentre cross-sectional study analysed diagnostic accuracy in 355 pT1 breast cancers. All patients underwent AUS; visible nodes underwent FNA regardless of their AUS appearance. Sentinel node biopsy and axillary lymph node dissection (ALND) were gold standards. Data were analysed considering micrometastases ‘positive’ and considering micrometastases ‘N negative’. The simulation environment included all patients fulfilling ACOSOG Z0011 criteria. Axillary involvement: 22.8 %; AUS sensitivity: 46.9 % (Nmic positive)/66.7 % (Nmic negative); AUS+FNA sensitivity: 52.6 % (pNmic positive)/72.0 % (pNmic negative). In the simulation environment, AUS had 75.0 % sensitivity, 88.9 % specificity and 99.2 % NPV. AUS has moderate sensitivity in T1 tumours. As ALND is unnecessary in micrometastases, considering micrometastases ‘N negative’ increases the practical impact of AUS. In patients fulfilling ACOSOG Z0011 criteria, AUS alone can predict cases unlikely to benefit from ALND. • AUS+FNA can predict axillary involvement, thus avoiding SNB. • Not all patients with axillary involvement need ALND. • Axillary tumour load determines axillary management. • AUS could classify patients according to axillary load.

Dear-Mama ( D etection of Ear ly Ma rkers in Ma mmography) is an EU funded project devoted to develop an X-ray Medical imaging device based on room temperature solid-state pixel detector coupled to photon counting readout electronics via bump bonding. The technology being used leads to signal-to-noise ratio enhancement and thus the ability to detect low contrast anomalies such as micro-calcifications. The Dear-Mama machine is currently being evaluated and preliminary results show an excellent MTF response. Dear-Mama consortium is made up from six European institutions, the project runs from December 2001 to March 2006.

Objetivos Revisar nuestra experiencia en los hallazgos de imagen del carcinoma metaplasico, su presentacion clinica y los hallazgos histopatologicos. Material y metodos Revision retrospectiva de ocho casos de carcinoma metaplasico de mama confirmados histopatologicamente. Se analizan los hallazgos ecograficos, mamograficos y por resonancia magnetica, asi como los estudios inmunohistoquimicos de la biopsia prequirurgica. Se determinan factores pronosticos convencionales, marcadores de diferenciacion condral, marcadores de musculo liso y esqueletico, marcadores neurales, citoqueratina, vimentina y filamentos intermedios. Resultados Ocho pacientes con edades entre 41-72 anos. En cinco casos el carcinoma metaplasico se presenta como un nodulo palpable, en uno como retraccion del pezon y dos casos fueron hallazgos incidentals en mamografia de control. Mamograficamente, en siete casos aparece un nodulo redondo, hiperdenso, de 10-50 mm, de margenes variables, en un caso distorsion de la arquitectura, en tres casos calcificaciones. Solo dos pacientes tienen retraccion de piel y de pezon. Ecograficamente se manifestaron como nodulos mal delimitados, hipoecogenicos y heterogeneos. En la resonancia magnetica se muestran como masas relativamente bien definidas, hiperintensas en T2 y con curvas intensidad de senaltiempo similares a las del carcinoma infiltrante de mama. Histopatologicamente hay diferentes variantes de carcinoma metaplasico: un carcinoma metaplasico escamoide, un sarcoide, tres condroides, un fusocelular, una variante de celulas gigantes y un acantolitico, todos con un alto grado histologico. Conclusiones El carcinoma metaplasico debe incluirse en el diagnostico diferencial de un nodulo mamograficamente hiperdenso y de margenes variables, ecograficamente hipoecogenico y mal delimitado, hiperintenso en T2 y con captacion en el rango de malignidad en RM T2. Para el diagnostico final son necesarios los estudios inmunohistoquimicos. Las pruebas de imagen pueden sugerir este subtipo particular.

Fundamento y objetivo Las hospitalizaciones evitables (HE) son un conjunto de diagnosticos enlos que una atencion primaria de salud efectiva y adecuada hubiera evitado su ingreso hospitalario.Por tanto, su control sirve como medida del grado de calidad obtenido en los centros de salud.El objetivo del estudio fue establecer los factores que determinan el grado de HE en loshospitales publicos espanoles. Material y metodo Se estudiaron todos los pacientes ingresados en hospitales publicos de Espanaen el ano 2000 en relacion con la HE. Se identificaron las caracteristicas de dichos ingresospor HE. Resultados Los ingresos por HE alcanzaron el 15,8% del total de pacientes ingresados y el16,6% del total de las estancias hospitalarias. La edad media fue alta, de 54 anos, frecuentementevarones (odds ratio [OR] ajustada por edad = 1,54), con mayor estancia media y estanciapreoperatoria, con mayor comorbilidad (0,63 [0,8]); ingresados fundamentalmente por urgenciasy en hospitales de alta complejidad. Se observo una relacion directa entre frecuentacion por HEy complejidad del hospital. Conclusiones Se destaca la importancia del control de la HE dada la repercusion que tiene enel total de la casuistica hospitalaria. Parece observarse un efecto de induccion de la oferta hospitalaria.

The physiological changes which take place during pregnancy and lactation could make evaluating breast lesions difficult for both for the clinical physician and radiologist. Lactating adenoma, a benign breast lesion which presents itself as a solid palpable mass, is among those specific lesions which might appear during such periods. Herein we present two cases, along with a discussion of management, radiological findings and differential diagnosis. Pertinent bibliography is also reviewed.

Prospective studies focusing on the relationship between diabetic retinopathy and the presence of microalbuminuria are lacking. The objective of the present study was to determine the potential relationship between both forms of diabetic microangiopathy by means of a five-year long prospective study in which 104 patients with type 1 diabetes mellitus and with no retinal involvement at the beginning of the study were included. At the end of the study four groups of patients emerged: group 1, made up of 63 patients without both retinal involvement and microalbuminuria; group 2, made up of 17 patients with both retinopathy and microalbuminuria; group 3, with 16 patients with retinopathy but without microalbuminuria, and group 4, with eight patients with microalbuminuria only. In the statistical study, a direct significance was observed for both increased levels of HbA1c and total cholesterol; and a reverse significance for increased levels of HDL-cholesterol as well as the presence of diastolic arterial hypertension, for group 2 (patients with both retinopathy and microalbuminuria). For group 3, increased levels of triglycerides and evolution time (patients with retinopathy but without microalbuminuria) were significant. In the present study we conclude that microalbuminuria is not a good marker for diabetic microangiopathy defined as renal and retinal involvement, although its presence prompt us to watch more frequently the ocular fundus in diabetic patients.

Primary non-Hodgkin's lymphoma (NHL) of the breast are rare and represent less than 0.6% of all mammary malignancies. Secondary involvement of the breast in patients with diffuse disease occurs more frequently. The radiologic features of breast lymphoma are nonspecific, and the diagnosis is based on histologic criteria. We present the MR-imaging features of a case of primary NHL of the breast.

Mediastinoscopic injuries to the tracheobronchial tree are rare. We report 2 (0.1%) cases of injury to the right main bronchus in 1743 mediastinoscopies. Both injuries, of 1 cm and 0.3 cm in size, were caused by the bipolar scissors used at initial staging mediastinoscopy and at remediastinoscopy. The larger lesion was sutured through a bi-valved mediastinoscope, and fibrin glue was spread over the suture line; the smaller one was covered with haemostatic tissue. No complications such as pneumomediastinum, pneumothorax, or mediastinitis occurred. Bipolar scissors should be used with caution. Mediastinoscopic repair of injuries to the right main bronchus is possible and should be attempted before relying to thoracotomy.

We present three cases of breast lesions labeled as probable intramammary lymph nodes that showed an increase in size on follow-up mammography. Contrast-enhanced MRI was performed and the three lesions showed strong and rapid uptake of the intravenous contrast. Core needle biopsy established the diagnosis of lymphoid hyperplasia in all three patients. Because intramammary lymph nodes affected by benign processes can present findings similar to malignant lesions, the usefulness of contrast-enhanced MRI in these cases is controversial.

The objective of this study was to assess the usefulness of stereotactic large-core needle biopsy (LCNB) in the management of nonpalpable breast lesions (NBL) and compare it with stereotactic fine-needle aspiration biopsy (SFNA) performed simultaneously in a significant number of cases. From November 1993 through June 1997, 510 consecutive patients with NBL underwent 14-gauge LCNB with 354 women undergoing simultaneous 21-gauge SFNA in the same lesion. Mammographic findings, lesion size, number of core biopsy specimens, complications and diagnoses of both techniques were analysed. Surgical biopsy, tumorectomy or mastectomy was indicated for malignancy or poor correlation between SFNA or LCNB results and clinical or radiological findings. Values of diagnostic accuracy of both LCNB and SFNA were determined. The ratio benign surgical biopsies/malignant surgical biopsies (BB/CB) of the series was calculated. A total of 171 patients underwent surgical treatment; in 31 (18.1 %) a benign process or atypical ductal hyperplasia was the final diagnosis. The ratio BB/CB was 0.22. Sensitivity and specificity were 93.2 and 100 %, respectively, for LCNB, and 77.2 and 92.3 %, respectively, for SFNA with cytological analysis. Large-core needle biopsy provides more accurate diagnosis than SFNA in the management of nonpalpable breast lesions and obviates a surgical diagnostic procedure in a significant number of cases.

Two HLA-identical twin sisters are reported, of whom one has remained essentially asymptomatic, and an episode of hypotonia and decreased level of conciousness being the only relevant clinical finding in the other. Organic acid analysis revealed that ethylmalonate was constantly, although sometimes only slightly, increased. No abnormal acylglycines or acylcarnitines could be detected. Enzyme assay in cultured skin fibroblasts confirmed short-chain acyl-CoA dehydrogenase deficiency. Conclusion The lack of appropriate biochemical markers for this deficiency makes the diagnosis difficult and consequently, the low number of patients described may be the result of underdiagnosis.

The transcervical route is a traditional approach to the mediastinum for staging of non-small cell lung cancer, diagnosis of masses of unknown origin, and resection of the thymus. Also, the transcervical approach may be an adequate surgical access either alone or in combination with different techniques in the management of other mediastinal disorders. This procedure can be used to total removal of tumors located in the middle and anterosuperior mediastinum, such as cysts or ectopic parathyroid adenomas. Cervical and mediastinal debridement and drainage is the first therapeutic option and, sometimes, the only elective treatment in patients with descending necrotizing mediastinitis confined to the superior mediastinum. The transcervical approach is considered to be a safe and minimally invasive procedure, but a thoracic surgeon with experience in both open and endoscopic access to the mediastinum is required for success.

Ultrasound imaging is considered an important complementary technique for the screening of dense breasts. Detection of lesions at an early stage is a key step in which computerized lesion detection systems could play an important role in the analysis of US images. In this article, we propose adaptation of a generic object detection technique, deformable part models, to detect lesions in breast US images. The data set used in this study included 326 images, all from different patients (54 malignant lesions, 109 benign lesions and 163 healthy breasts). In terms of lesion detection, our proposal outperformed some of the most relevant approaches described in the literature; we obtained a sensitivity of 86% with 0.28 false-positive detection per image and an Az value of 0.975. In the detection of malignant lesions, our proposed approached had an Az value of 0.93 and a sensitivity of 78% at a 1.15 false-positive detections per image.

et al., [Background]: Osteoarthritis is the most prevalent joint disease and a frequent cause of joint pain, functional loss, and disability. Osteoarthritis often becomes chronic, and conventional treatments have demonstrated only modest clinical benefits without lesion reversal. Cell-based therapies have shown encouraging results in both animal studies and a few human case reports. We designed a pilot study to assess the feasibility and safety of osteoarthritis treatment with mesenchymal stromal cells (MSCs) in humans and to obtain early efficacy information for this treatment. [Methods]: Twelve patients with chronic knee pain unresponsive to conservative treatments and radiologic evidence of osteoarthritis were treated with autologous expanded bone marrow MSCs by intra-articular injection (40×106 cells). Clinical outcomes were followed for 1 year and included evaluations of pain, disability, and quality of life. Articular cartilage quality was assessed by quantitative magnetic resonance imaging T2 mapping. [Results]: Feasibility and safety were confirmed, and strong indications of clinical efficacy were identified. Patients exhibited rapid and progressive improvement of algofunctional indices that approached 65% to 78% by 1 year. This outcome compares favorably with the results of conventional treatments. Additionally, quantification of cartilage quality by T2 relaxation measurements demonstrated a highly significant decrease of poor cartilage areas (on average, 27%), with improvement of cartilage quality in 11 of the 12 patients. [Conclusions]: MSC therapy may be a valid alternative treatment for chronic knee osteoarthritis. The intervention is simple, does not require hospitalization or surgery, provides pain relief, and significantly improves cartilage quality.