Search

The general increase in temperature, together with sudden episodes of extreme temperatures, are increasingly impacting plant species in the present climate change scenario. Limoniastrum monopetalum is a halophyte from the Mediterranean Basin, exposed to broad daily and seasonal changes in temperature and extreme high temperatures. We studied the photosynthetic responses (chlorophyll fluorescence dynamics and gas exchange) of L. monopetalum leaves exposed to temperatures from -7.5°C to +57.5°C under darkness in controlled laboratory conditions. L. monopetalum presented its optimum temperature for photosynthesis around +30°C. The photosynthetic apparatus of L. monopetalum exhibited permanent damages at > +40.0°C. L. monopetalum tolerated, without permanent damages, temperatures as low as -7.5°C in darkness. L. monopetalum appears as a plant species very well adapted to the seasonality of the Mediterranean climate, which may work as a pre-adaptation to stand more extreme temperatures in the actual context of accelerating climate change.

Abstract The DUNE far detector has been designed to detect photons and electrons generated by the charged products of the interaction of neutrinos with a massive liquid argon (LAr) target. The photon detection system (PDS) of the first DUNE far detector (FD1) is composed of 6000 photon detection units, named X-ARAPUCA. The detection of the prompt light pulse generated by the particle energy release in LAr will complement and boost the DUNE LAr Time Projection Chamber. It will improve the non-beam events tagging and enable at low energies the trigger and the calorimetry of the supernova neutrinos. The X-ARAPUCA is an assembly of several components. Its photon detection efficiency (PDE) depends on the design of the assembly, on the grade of the individual components and on their coupling. The X-ARAPUCA PDE is one of the leading parameters for the PDS sensitivity, that in turn determines the sensitivity of the DUNE for the detection of core-collapse supernova within the galaxy and for nucleon decay searches. In this work we present the final assessment of the absolute PDE of the FD1 X-ARAPUCA baseline design, measured in two laboratories with independent methods and setups. Preliminary results were reported in Palomares (JINST 18(02):C02064, https://doi.org/10.1088/1748-0221/18/02/C02064 , 2023). One hundred sixty units of these X-ARAPUCA devices have been deployed in the NP04 facility at the CERN Neutrino Platform, the 1:20 scale FD1 prototype, and will be operated during the year 2024. The assessed value of the PDE is a key parameter both in the NP04 and in the DUNE analysis and reconstruction studies.

A heavily impacted river basin (Caudal River, NW Spain) by Hg and Cu mining activities, abandoned decades ago, was used to evaluate the environmental quality of their river sediments. The obtained results compared with reference values established by the US EPA and the Canadian Council of Ministers of the Environment for river sediments, have shown that the main elements of environmental concern are arsenic (As), mercury (Hg) and, to a lesser extent, copper (Cu), which reach concentrations up to 1080, 80 and 54 mg kg−1, respectively. To understand the role that river sediments play in terms of risk to ecosystem health, a comparison has been made between the total content of metal(oid)s in the sediments and the bioavailable contents of the same elements in pore water, passive DGT (Diffusive Gradients in Thin films) samplers and the sediment extractant using acetic acid. A good correlation between the As and Cu contents in the DGTs and the pore water was found, resulting in a transfer from the pore water to the DGT of at least 47 % of the Cu and more than 75 % of the As when the concentrations were low, with a deployment time of 4 days. When As and Cu concentrations were higher, their transfer was not so high (above 23.6 % for As and 19.3 % for Cu). The transfer of Hg from the pore water to the DGT was practically nil and does not seem to depend on the content of this metal. The fraction extracted with acetic acid, conventionally accepted as bioavailable, was clearly lower than that captured by DGTs for As and Cu (≤5 % and ≤8.5 % of the total amount, respectively), while it was similar for Hg (0.2 %).

Abstract The therapeutic potential of medicinal plants is known as an alternative in treatment of human affections; in effect, the conventional application of these medicinal sources has several limitations like low bioavailability, solubility and stability, which affect its pharmacological efficacy. In recent decades, extraordinary advances have been made in new drug delivery systems using nanocarriers. This work consisted in determining the in vitro antifungal activity of the methanolic extract of Euphorbia tirucalli formulated in polymeric nanoparticles. The antifungal activity was determined by the microdilution method in 96-well microplates, applying nanoparticles loaded with plant extract (NP-Ext) obtained by nanoprecipitation on clinical isolates of Trichophyton rubrum and T. interdigitalis. Regarding the nanoparticles, the lots used did not present significant differences in their physicochemical characteristics, with a size of 91.885 ± 1.621nm, polydispersity index of 0.152 ± 0.025 and Z-potential of -6.047 ± 0.987. The quantification of the extract in the polymeric matrix was determined by infrared spectroscopy (FTIR), where an efficiency and encapsulation percentage of 22.15 ± 0.82 and 2.95 ± 0.11, respectively, were obtained. The in vitro antifungal activity of the crude and formulated extract was obtained calculating the Minimum Inhibitory Concentration (MIC) of each one; a MIC of 125 µg/mL was obtained against T. rubrum and T. interdigitalis with the crude extract, while a MIC value of 55.55 and 0.1 µg/mL was obtained with NP-Ext, respectively, against these same. Conclusions: biological activity is closely linked to the phytochemical profile of the extract; while the improvement of said potential with the NP-Ext with the dosage form was directly related to the physicochemical characteristics of the nanocarrier.

Introduction Limited information is available regarding the clinical features, optimal treatment and prognosis of Paranoid Personality Disorder (PPD) and Delusional Disorder (DD). This is partly due to the low prevalence of cases and poor patient insight. The difference between DD and PPD has been questioned in the literature, as some studies have described them as a continuum, highlighting the role of specific personality traits in the transition to clinical delusions. Nonadherence to pharmacological treatment is one of the most challenging aspects. This further leads to relapses, increased use of emergency psychiatric services, psychiatric admissions, longer periods of hospitalization, and an increased cost of illness to healthcare systems. Objectives The primary goal of this study is to compare the differences between DD and PPD in terms of medication adherence, relapses, lost to follow-up, and costs. Other aims of this study are to analyze the differences in these variables between patients who are adequately adherent and patients who are not Methods An observational, retrospective, and multicenter descriptive epidemiological study was conducted. Patients were selected from four public departments of psychiatry in Madrid, providing an area of roughly one million people. All patients were older than 18 years-old, diagnosed with DD or PPD from 2005 to 2022. Data were extracted from electronic medical records and from electronic prescribing program used in the public health system.The study was approved by the Hospital Fundación Jiménez Díaz Ethics Committee. Results 1227 individuals diagnosed with DD (974 patients,79,3%) or PPD (253 patients, 20.61%). 23.81% (232 patients) of the DD-group did not take out the prescribed medication of the pharmacy, and 16.6% (42 patients) of the PPD-group were considered non-adherent. Adherent patients had greater follow-up (4.02 vs 2.89 years) and shorter hospital stays (5.15 vs 8.6 days, p

Introduction Mental Health problems and substance misuse during pregnancy constitute a serious social problem due to high maternal-fetal morbidity (Cook et al, 2017; JOCG, 39(10) ,906-915) and low detection and treatment rates (Carmona et al. Adicciones. 2022;34(4):299-308) Objectives Our study aimed to develop and test the feasibility and acceptability of a screening and treatment clinical pathway in pregnancy, based on the combination of e-Health tools with in-person interventions and, secondly, describe the prevalence of mental illness and substance use problems in this population. Methods 1382 pregnant women undergoing her first pregnancy visit were included in a tailored clinical pathway and sent a telematic (App) autoapplied questionnaire with an extensive battery of measures (WHO (Five) Well-Being [WHO-5],Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST], Columbia Suicide Severity Rating Scale [C-SSRS] and specifically designed questions on self-harm and psychopharmacological drugs). Patients who did not respond to the questionnaire on their own received a counseling call. Based on the screening results, patients were classified into five groups according to severity (Figure 1) and assigned a specific action pathway (Figure 2) that included a range of intervention intensity that goes from an individual psychiatric appointment to no intervention. Results Of the 1382 women included in the clinical pathway, 565(41%) completed the evaluation questionnaires. Of these, 205 (36%) were screened as positive (Grades III,IV or V. Table 1) and 3(0.5%) were classified as needing urgent care. Of the patients offered on-line groups (100), 40% (40) were enrolled in them. Table 1: Grade distribution of those screened as positives Grade III 97 (17,2%) Grade IV 105 (18,6%) Grade V 3 (0,5%) Concerning prevalence rates, 73 (12,9%) patients endorsed at least moderate anxiety according to GAD-7 (≥10), 65 (11,5%) endorsed at least moderate depression according to PHQ-9 (≥ 10), 17 were positive on DAST (3%) and 63 (11%) patients scored above the threshold in AUDIT-C(≥ 3) for alcohol use. Image: Image 2: Conclusions High prevalence rates suggest that effective detection and treatment mechanisms should be integrated into usual care. The use of standardized clinical pathways can help with this aim, allowing better clinical management and referral to treatment, but still face challengues to increase retention. The use of e-health tools offers the opportunity to improve accessibility and therapeutic outcomes through online interventions. Disclosure of Interest None Declared

The present work introduces a new low-cost prototype® designed for photogrammetric surveys of small objects, using a single photographic shot. The prototype® utilizes the different perspectives of the object presented by a series of mirrors strategically placed in the camera sensor. The set of specular reflections projected on our camera sensor simulates the same effect as taking pictures from equivalent points of each mirror.The v1 prototype® was presented at the 7th International Workshop "Low-Cost 3D Sensors, Algorithms, Applications" in Würzburg on December 15–16, 2022. It consists of a set of eighteen common mirrors conveniently placed around the object to be digitized, making its reflections converge towards the camera lens. The v2 prototype® presented here is an evolution of the previous one, which replaces the common mirrors with precision ones that have a metallic reflective surface on the front. This modification eliminates the double image formed by the reflective layer and the protective glass.These prototypes® allow for faster surveys of small inert objects (such as small cultural heritage artefacts like sculptures, engravings, rings, coins, etc.) as well as photogrammetric surveys of small living beings, such as insects, which cannot remain still during traditional photography.

Drought occurs naturally all over the world. Global warming has led an increase in the areas affected by this phenomenon. The study of drought involves the analysis of indicators and indices used to assess changes in the hydrological cycle of a region. A large number of indices developed for drought monitoring are based on meteorological and hydrological variables. This research has applied the Ombroxeric Index for the first time in California. It is based on the concept of ombroxericity: a condition of the territory characterised from an ombrothermic point of view, which can develop in relatively humid areas/zones, depending on the time scale of the study (i.e. monthly, seasonal or annual basis). Temperatures and precipitation from 180 meteorological stations have been considered for a period of observation from 1980 to 2016. In order to know the evolution of this index, a modified trend analysis based on the Mann-Kendall test and a modified Sen slope analysis were used. Empirical Bayesian Kriging was applied as an interpolation technique. Results are presented in both surface and contour maps. California showed a wide range of ombroxeric levels that went from upper strong dry in northern zones, to lower weak arid. Trend results showed an increase in bioclimatic drought throughout the whole State. In addition, summer showed the highest levels on the Ombroxeric Index. An increase in drought trends was observed at the seasonal level, being more pronounced in summer and spring. In both cases are increases in the central (+5 and +3.6 units year−1 respectively) and the southern (+4 and +4.5 units year−1 respectively) areas of the State. Increasing frequency and severity of droughts could have implications for the management of water resources and the survival of Californian vegetation types, such as conifers.

The present work presents a low-cost prototype® designed for the photogrammetric survey of small objects, from a single photographic shot. To do this, it relies on the different perspectives of the object presented by a series of mirrors conveniently placed in front of the camera lens. The set of specular reflections projected on the sensor of our camera simulates the same effect as having taken these photographs from the equivalent points for each mirror. A small script for dividing the image taken by the sensor into as many images as there are reflections, allows us to work with the usual shape from stereo photogrammetry procedure.This prototype® allows, not only to photograph small inert objects more quickly but also enables the photogrammetric survey of small living beings, such as an insect, that cannot remain still during the traditional photographic image taking.

The academic dropout of higher education students represents one of the most significant challenges that university institutions have to face today. This research analysed the university academic trajectory of students who dropped out of university for good. The aim of this paper is to examine in depth the factors that influence the idea of the construction of academic dropout and its relationship with the difficulties of adaptation to the university training system. A qualitative study was carried out in which the interview technique was applied to n = 34 dropout students belonging to three Spanish autonomous communities. The results made it possible to identify and examine students' difficulties in adapting to university studies in greater depth. The interviews revealed contextual and emotional details that contributed to dropout, such as personal and professional challenges and a lack of emotional support. The findings lead to the need to approach the issue from a holistic viewpoint in order to address the different reasons behind university dropouts. This broad view of the academic trajectories of university students who drop out is a benchmark for strategies to improve student retention and success in higher education.

The coastal with its geographical elements are modified over time, changes that may occur in the long or short term so, shoreline represented in the cartographic documents does not always match with reality. Also, the coastline does not have a well-defined length as results from the fractal-like properties of coastlines, i.e., the fact that a coastline typically has a fractal dimension so, its representation depends to many factors like the cartographic method used, the resolution of the image and the scale of the map. On the other hand, the shoreline is general use to estimate the surface of the landmass, so is important to get a cartographic product with accuracy in a time. Taking into account these elements, this paper is focus in a surface estimation of total Cuban island and keys. To achieved, an expeditious method was used, from the application of geometric corrections to multispectral SENTINEL-2 images, followed by a band algebra using the NDWI index. After those process the automated extraction of shoreline was conducted and finally, refining the vectors by cartographic editing without compromising the accuracy of the results. As a result, two coast lines were obtained from the territory, one in the rainy season and the other in the dry season. The spatial analyses were oriented to surface determination and they were carried out over shoreline in dry season and rainy season, the results were contrasted with the official data published in 2016.

A blind field test with 136 independent measurements of radon (222Rn) in soil air retrieved from a depth of 0.8 m in a decommissioned lindane (γ-hexachlorocyclohexane) production plant was undertaken to evaluate the performance of the 222Rn-deficit technique as a screening methodology for the location and delineation of subsurface accumulations of complex mixtures of organic contaminants. Maps of 222Rn iso-concentrations were drawn and interpreted before direct analytical information regarding concentrations of hexachlorocyclohexanes, chlorobenzenes and BTEX compounds in soil, groundwater and soil air were disclosed to the authors. The location and extension of pollution hot spots inferred from the 222Rn campaigns agrees remarkably well with the analytical data obtained from the intrusive sampling campaigns and with the location of contaminant source zones (chemical reactor and waste-storage area) and geological sinks of those contaminants (paleochannel). Two main limitations to the applicability of the 222Rn-deficit technique were identified and assessed: The statistically significant variation of 222Rn concentrations with diurnal changes of ground-level air temperature and the maximum depth of investigation in the absence of significant advective and co-advective transport of radon. If the influence of those two factors is accounted for and/or minimized (by averaging replicated measurements during the workday and in different days), the 222Rn-deficit technique has the potential to be an efficient technique which delivers information in quasi-real time, with a much higher spatial density than that of intrusive techniques, at a much faster rate and at a significantly lower cost. Main findings: The 222Rn-deficit technique is an effective tool for real-time site characterization only limited by diffusion length of radon and diurnal temperature variations. Keywords: Site characterization, Natural tracer, Lindane, Uncertainties

Studies aimed to assess up to what extent farming and transport previous to slaughtering might affect physiology and meat quality in young goat kids are needed, with the ultimate purpose of promoting practices that minimize stress in these animals. In this regard the effects of on-farm management and transport duration on some physiological responses and meat quality parameters in goat kids were assessed. Two farms representing ‘high’ and ‘low’ welfare-friendly management practices were selected. In total, 32 suckling kids were withdrawn from each farm, transported by road for 2 or 6 h, and then slaughtered. Blood samples were collected both on-farm and in the slaughterhouse, and biochemistry, cell counts and haematocrit were determined. After slaughtering, carcass quality parameters were measured. Longissimus dorsi muscle was dissected and pH, colour parameters, water holding capacity and shear force were measured throughout 8-day ageing period. Results indicate that, regardless its duration, transport caused significant effects on some blood parameters suggesting stress in live animals, like glucose, cortisol or creatine kinase. Despite the marked stress status in animals, this condition was not decisively reflected on L. dorsi quality parameters, but some effects were observed regarding fat cover in carcasses and colour parameters. The results suggest that postmortem changes throughout ageing were more decisive in terms of meat quality than stressful management either on-farm or during transport.

Como resultado de las directrices del Espacio Europeo de Educación Superior (EEES) de un sistema educativo basado en el aprendizaje más que en la enseñanza, este estudio surge con el objetivo de evaluar el rendimiento de los estudiantes en el aprendizaje teórico y práctico en Grado en Ingeniería Química y Grado en Ciencias Ambientales. El estudio se llevó a cabo con 208 estudiantes en total y seleccionando dos prácticas comunes de labo ratorio y clases teóricas en ambos grados. La investigación concluyó la existencia de diferencias estadísticamente significativas entre los estudiantes de ambos grados en todos los aspectos evaluados, incluyendo tanto el aprendizaje teórico como práctico. En este sentido, los estudiantes del Grado en Ingeniería Química mostraron una tasa de éxito que duplicaba la obtenida por los estudiantes del Grado en Ciencias Ambientales, con una mayor valoración en el rendimiento académico por parte de los estudiantes del Grado en Ingeniería Química. En general, los estudiantes obtuvieron mejores resultados en la evaluación de la práctica docente que en la teórica, lo que refuerza el concepto de EEES consistente en introducir una enseñanza más aplicada y enfocada en la obtención de competencias con futura aplicación en el mercado laboral.

Table of contents O1 Tumour heterogeneity: what does it mean? Dow-Mu Koh O2 Skeletal sequelae in adult survivors of childhood cancer Sue Creviston Kaste O3 Locoregional effects of breast cancer treatment Sarah J Vinnicombe O4 Imaging of cancer therapy-induced CNS toxicity Giovanni Morana, Andrea Rossi O5 Screening for lung cancer Christian J. Herold O6Risk stratification of lung nodules Theresa C. McLoud O7 PET imaging of pulmonary nodules Kirk A Frey O8 Transarterial tumour therapy Bernhard Gebauer O9 Interventional radiology in paediatric oncology Derek Roebuck O10 Image guided prostate interventions Jurgen J. Fütterer O11 Imaging cancer predisposition syndromes Alexander J. Towbin O12Chest and chest wall masses Thierry AG Huisman O13 Abdominal masses: good or bad? Anne MJB Smets O14 Hepatobiliary MR contrast: enhanced liver MRI for HCC diagnosis and management Giovanni Morana O15 Role of US elastography and multimodality fusion for managing patients with chronic liver disease and HCC Jeong Min Lee O16 Opportunities and challenges in imaging metastatic disease Hersh Chandarana O17 Diagnosis, treatment monitoring, and follow-up of lymphoma Marius E. Mayerhoefer, Markus Raderer, Alexander Haug O18 Managing high-risk and advanced prostate cancer Matthias Eiber O19 Immunotherapy: imaging challenges Bernhard Gebauer O20 RECIST and RECIST 1.1 Andrea Rockall O21 Challenges of RECIST in oncology imaging basics for the trainee and novice Aslam Sohaib O22 Lymphoma: PET for interim and end of treatment response assessment: a users’ guide to the Deauville Score Victoria S Warbey O23 Available resources Hebert Alberto Vargas O24 ICIS e-portal and the online learning community Dow-Mu Koh O25 Benign lesions that mimic pancreatic cancer Jay P Heiken O26 Staging and reporting pancreatic malignancies Isaac R Francis, Mahmoud, M Al-Hawary, Ravi K Kaza O27 Intraductal papillary mucinous neoplasm Giovanni Morana O28 Cystic pancreatic tumours Mirko D’Onofrio O29 Diffusion-weighted imaging of head and neck tumours Harriet C. Thoeny O30 Radiation injury in the head and neck Ann D King O31 PET/MR of paediatric brain tumours Giovanni Morana, Arnoldo Piccardo, Maria Luisa Garrè, Andrea Rossi O32 Structured reporting and beyond Hebert Alberto Vargas O33 Massachusetts General Hospital experience with structured reporting Theresa C. McLoud O34 The oncologist’s perspective: what the oncologist needs to know Nick Reed O35 Towards the cure of all children with cancer: global initiatives in pediatric oncology Carlos Rodriguez-Galindo O36 Multiparametric imaging of renal cancers Hersh Chandarana O37 Linking imaging features of renal disease and their impact on management strategies Hebert Alberto Vargas O38 Adrenals, retroperitoneum and peritoneum Isaac R Francis, Ashish P Wasnik O39 Lung and pleura Stefan Diederich O40 Advances in MRI Jurgen J. Fütterer O41 Advances in molecular imaging Wim J.G. Oyen O42 Incorporating advanced imaging, impact on treatment selection and patient outcome Cheng Lee Chaw, Nicholas van As S1 Combining ADC-histogram features improves performance of MR diffusion-weighted imaging for Lymph node characterisation in cervical cancer Igor Vieira, Frederik De Keyzer, Elleke Dresen, Sileny Han, Ignace Vergote, Philippe Moerman, Frederic Amant, Michel Koole, Vincent Vandecaveye S2 Whole-body diffusion-weighted MRI for surgical planning in patients with colorectal cancer and peritoneal metastases R Dresen, S De Vuysere, F De Keyzer, E Van Cutsem, A D’Hoore, A Wolthuis, V Vandecaveye S3 Role of apparent diffusion coefficient (ADC) diffusion-weighted MRI for predicting extra capsular extension of prostate cancer. P. Pricolo (paola.pricolo@ieo.it), S. Alessi, P. Summers, E. Tagliabue, G. Petralia S4 Generating evidence for clinical benefit of PET/CT – are management studies sufficient as surrogate for patient outcome? C. Pfannenberg, B. Gückel, SC Schüle, AC Müller, S. Kaufmann, N. Schwenzer, M. Reimold,C. la Fougere, K. Nikolaou, P. Martus S5 Heterogeneity of treatment response in skeletal metastases from breast cancer with 18F-fluoride and 18F-FDG PET GJ Cook, GK Azad, BP Taylor, M Siddique, J John, J Mansi, M Harries, V Goh S6 Accuracy of suspicious breast imaging—can we tell the patient? S Seth, R Burgul, A Seth S7 Measurement method of tumour volume changes during neoadjuvant chemotherapy affects ability to predict pathological response S Waugh, N Muhammad Gowdh, C Purdie, A Evans, E Crowe, A Thompson, S Vinnicombe S8 Diagnostic yield of CT IVU in haematuria screening F. Arfeen, T. Campion, E. Goldstraw S9 Percutaneous radiofrequency ablation of unresectable locally advanced pancreatic cancer: preliminary results D’Onofrio M, Ciaravino V, Crosara S, De Robertis R, Pozzi Mucelli R S10 Iodine maps from dual energy CT improve detection of metastases in staging examinations of melanoma patients M. Uhrig, D. Simons, H. Schlemmer S11Can contrast enhanced CT predict pelvic nodal status in malignant melanoma of the lower limb? Kate Downey S12 Current practice in the investigation for suspected Paraneoplastic Neurological Syndromes (PNS) and positive malignancy yield. S Murdoch, AS Al-adhami, S Viswanathan P1 Technical success and efficacy of Pulmonary Radiofrequency ablation: an analysis of 207 ablations S Smith, P Jennings, D Bowers, R Soomal P2 Lesion control and patient outcome: prospective analysis of radiofrequency abaltion in pulmonary colorectal cancer metastatic disease S Smith, P Jennings, D Bowers, R Soomal P3 Hepatocellular carcinoma in a post-TB patient: case of tropical infections and oncologic imaging challenges TM Mutala, AO Odhiambo, N Harish P4 Role of apparent diffusion coefficient (ADC) diffusion-weighted MRI for predicting extracapsular extension of prostate cancer P. Pricolo, S. Alessi, P. Summers, E. Tagliabue, G. Petralia P5 What a difference a decade makes; comparison of lung biopsies in Glasgow 2005 and 2015 M. Hall, M. Sproule, S. Sheridan P6 Solid pseudopapillary tumour of pancreas: imaging features of a rare neoplasm KY Thein, CH Tan, YL Thian, CM Ho P7 MDCT - pathological correlation in colon adenocarcinoma staging: preliminary experience S De Luca, C Carrera, V Blanchet, L Alarcón, E Eyheremnedy P8 Image guided biopsy of thoracic masses and reduction of pneumothorax risk: 25 years experience B K Choudhury, K Bujarbarua, G Barman P9 Tumour heterogeneity analysis of 18F-FDG-PET for characterisation of malignant peripheral nerve sheath tumours in neurofibromatosis-1 GJ Cook, E Lovat, M Siddique, V Goh, R Ferner, VS Warbey P10 Impact of introduction of vacuum assisted excision (VAE) on screen detected high risk breast lesions L Potti, B Kaye, A Beattie, K Dutton P11 Can we reduce prevalent recall rate in breast screening? AA Seth, F Constantinidis, H Dobson P12 How to reduce prevalent recall rate? Identifying mammographic lesions with low Positive Predictive Value (PPV) AA Seth (archana.seth@nhs.net), F Constantinidis, H Dobson P13 Behaviour of untreated pulmonary thrombus in oncology patients diagnosed with incidental pulmonary embolism on CT R. Bradley, G. Bozas, G. Avery, A. Stephens, A. Maraveyas P14 A one-stop lymphoma biopsy service – is it possible? S Bhuva, CA Johnson, M Subesinghe, N Taylor P15 Changes in the new TNM classification for lung cancer (8th edition, effective January 2017) LE Quint, RM Reddy, GP Kalemkerian P16 Cancer immunotherapy: a review of adequate imaging assessment G González Zapico, E Gainza Jauregui, R Álvarez Francisco, S Ibáñez Alonso, I Tavera Bahillo, L Múgica Álvarez P17 Succinate dehydrogenase mutations and their associated tumours O Francies, R Wheeler, L Childs, A Adams, A Sahdev P18 Initial experience in the usefulness of dual energy technique in the abdomen SE De Luca, ME Casalini Vañek, MD Pascuzzi, T Gillanders, PM Ramos, EP Eyheremendy P19 Recognising the serious complication of Richter’s transformation in CLL patients C Stove, M Digby P20 Body diffusion-weighted MRI in oncologic practice: truths, tricks and tips M. Nazar, M. Wirtz, MD. Pascuzzi, F. Troncoso, F. Saguier, EP. Eyheremendy P21 Methotrexate-induced leukoencephalopathy in paediatric ALL Patients D.J. Quint, L. Dang, M. Carlson, S. Leber, F. Silverstein P22 Pitfalls in oncology CT reporting. A pictorial review R Rueben, S Viswanathan P23 Imaging of perineural extension in head and neck tumours B Nazir, TH Teo, JB Khoo P24 MRI findings of molecular subtypes of breast cancer: a pictorial primer K Sharma, N Gupta, B Mathew, T Jeyakumar, K Harkins P25 When cancer can’t wait! A pictorial review of oncological emergencies K Sharma, B Mathew, N Gupta, T Jeyakumar, S Joshua P26 MRI of pancreatic neuroendocrine tumours: an approach to interpretation D Christodoulou, S Gourtsoyianni, A Jacques, N Griffin, V Goh P27 Gynaecological cancers in pregnancy: a review of imaging CA Johnson, J Lee P28 Suspected paraneoplastic neurological syndromes - review of published recommendations to date, with proposed guideline/flowchart JA Goodfellow, AS Al-adhami, S Viswanathan P29 Multi-parametric MRI of the pelvis for suspected local recurrence of prostate cancer after radical prostatectomy R Bradley P30 Utilisation of PI-RADS version 2 in multi-parametric MRI of the prostate; 12-months experience R Bradley P31 Radiological assessment of the post-chemotherapy liver A Yong, S Jenkins, G Joseph P32 Skeletal staging with MRI in breast cancer – what the radiologist needs to know S Bhuva, K Partington P33 Perineural spread of lympoma: an educational review of an unusual distribution of disease CA Johnson, S Bhuva, M Subesinghe, N Taylor P34 Visually isoattenuating pancreatic adenocarcinoma. Diagnostic imaging tools. C Carrera, A Zanfardini, S De Luca, L Alarcón, V Blanchet, EP Eyheremendy P35 Imaging of larynx cancer: when is CT, MRI or FDG PET/CT the best test? K Cavanagh, E Lau

Background and aims: To specify the prevalence of patients diagnosed with CF at age of ≥60 year-old and to analyze their characteristics. Patients and methods: Observational study of CF patients which were diagnosed at age ≥60 year-old. The analyzed variables were: age, sex, nationality, lung function parameters, conditions present at diagnosis, microbiological characteristics and genetic findings. Results: eight patients were included. 7 patients were female (87.5%) with a mean age of 70.6 years (median 71.5 years, range 60–78 years). The most important findings were: sweat test >60 mEq/l; heterozygotes F508del; bronchiectasis in CT; methicillin-sensitive Staphylococcus aureus (50%) in sputum. The most patients presented a normal or mild obstructive lung function. Conclusions: CF must also be considered a disease diagnosed in adulthood, incorporating the sweat test within the usual techniques of differential diagnosis in patients with different diseases associated with CF, because genetic counselling is esencial.

Carotenoids are important for human health because of their provitamin A function among other biological actions. Their implication on consumer point of view of cattle products have been widely studied, but very little information is available for horse products. The aim of this study was to study the accumulation of carotenoids, retinoids and tocopherol by HPLC and HPLC-MS analysis in different horse tissues (plasma, milk, adipose tissue and liver) and compare it with that of cattle. Fat color was also studied. Four groups of animals were studied (15 animals within each group): lactating mares (709.82±23.09 kg) and cows (576.93±31.94 kg) reared outdoors; and foals (556.8±25.9 kg, 14 months old) and calves (474.7±36.2 kg, 14 months old) reared indoors. Both mares and foals were from the Hispano–Breton breed, whereas both cows and calves belonged to the commercial crossbred Limousine–Retinta. Differences in plasma and milk carotenoids (P0.05). Both species showed different levels of accumulation of retinoids in the liver, with the foal having better accumulation (P

El angiosarcoma radioinducido de mama es una patología poco frecuente que se da en pacientes sometidas a radioterapia después de un proceso tumoral maligno tratado con cirugía, ya sea radical con mastectomía o conservadora. Presentamos 2 casos con diferentes características. El primero corresponde a una paciente joven sometida a cirugía conservadora, radioterapia y reconstrucción, y el segundo una paciente de edad avanzada con desarrollo de angiosarcoma sobre lecho de radioterapia preoperatoria y mastectomía. En ambos casos detallamos la actitud quirúrgica llevada a cabo de forma conjunta por los Servicios de Cirugía Plástica y Cirugía General y el tratamiento adyuvante por parte del Servicio de Oncología.

Este artículo revisa algunas diferencias que Platón va abriendo dialécticamente, desde el interior, en la apreciación de la maldad, la mentira y el discurso, y de modo paulatino, a lo largo de sucesivas obras. El objeto sería desbaratar dicotomías equívocas así como poner los moldes filosóficos del mito y la imitación artística que producen los propios diálogos. Como resultado del hechizo platónico, la filosofía desplaza los métodos arcaicos de educación entre las élites griega se instaura un modelo trágico, mítico y de discurso operativo todavía en el presente.Palabras clave: mentira, mito, imitación, discurso falso, ficción, Platón.AbstractThis paper revises some differences that Plato opens dialectically, from inside, in the appreciation of evil, lie, and discourse, and in a gradual way, throughout successive works. The claim would be to disrupt equivocal dichotomies as well as to put the philosophical molds of myth and artistic imitation which the dialogues themselves produce. As a result of platonic charm, philosophy displaces the archaic methods of education prevalent among Greek elites and establishes a tragical, mythical, and discursive pattern still operative in the present.Keywords: lie, myth, imitation, false discourse, fiction, Plato

El Virus de la tristeza de los cítricos (VTC) causa una enfermedad de interés regulatorio para la citricultura mexicana. El diagnóstico y un muestreo oportuno y confiable es esencial para aplicar estrategias de manejo ante el avance en territorio nacional del pulgón café, su principal vector. Con el fin de contar con un método eficaz y eficiente para el muestreo y detección del VTC, se evaluó el desempeño del método de inmunoimpresión-ELISA con respecto a DAS-ELISA, el método oficial de diagnóstico, debido a su economía, facilidad y rapidez. Con este propósito se evaluaron 7,421 árboles, considerando la edad del brote y de infección, provenientes de 11 huertos comerciales de Tamaulipas. El método de inmunoimpresión-ELISA superó en sensibilidad y capacidad de pronóstico de positivos a DAS-ELISA en el diagnóstico de árboles con infección reciente o desconocida del VTC (P¿0.028). La disposición de brotes positivos en el dosel fue heterogénea siendo descrita por la función beta binomial (P¿0.16-0.23). Con base en esta función y la reproducción de los resultados de impresiones dobles por pecíolo (93.2 %) se sugiere un tamaño óptimo de muestra de 10 pecíolos por árbol en impresiones simples. Este método fue 54.9 % más económico que DAS-ELISA y los diagnósticos se realizaron en una sexta parte del tiempo requerido en esta última prueba. Sin embargo, por el requerimiento de la norma oficial mexicana vigente (NOM- 031-FITO-2000), se recomienda el método de inmunoimpresión-ELISA como un método rápido para discriminar árboles positivos en muestreos de campo que deben posteriormente ser verificados por el método oficial de diagnóstico.

The purpose of this study was to evaluate the productivity on agar-agar of two species of red algae of thegenera Gracilaria belonging from the Colombiam Caribean coast (G. cylindrica and G. mammillaris)obtained in laboratory. Productivity of culture media elaborated with base agar - agar was determinedusing the ecometric method with 20 different bacterial species. Results obtained from ICA and ICRshowed that agar extracted from Gracilaria cylindrica and Gracillaria mammillaris are equally productive,this shows that both species can be used for agar production. For better results, it is still necessary tooptimize extraction processes and purification of agar in both species of algae.

Fundamento: Cada vez son más frecuentes los dilemas éticos en la práctica clínica. No existe acuerdo unánime, en especial en lo relativo a la hidratación y nutrición artificial, sobre que medida debe ser considerada como un cuidado básico. Objetivo: Conocer la opinión del personal sanitario, diferenciando la titulación universitaria, sobre que medidas de cuidado paliativo, incluyendo la hidratación y la nutrición artificial, deben ser consideradas como cuidado paliativo. Material y metodos: Se ha diseñado un estudio de campo descriptivo transversal, en el que se analiza la opinión de 256 individuos mediante las respuestas a un cuestionario: 91 usuarios del Sistema Nacional de Salud, 80 enfermeras, 38 médicos y 47 farmacéuticos sobre qué medida de las siguientes debe ser considerada como cuidado paliativo: higiene, analgesia, cuidado de las escaras, cambios posturales, sedación, oxigenoterapia, sondaje urinario, hidratación intravenosa, nutrición enteral y nutrición parenteral. Resultados: Más del 50% de los encuestados valora todas las medidas interrogadas como paliativas, a excepción de la nutrición parenteral. Entre los diversos grupos no existen diferencias en considerar a la analgesia, cuidado de escaras, cambios posturales, sueroterapia y administración de nutrición enteral como un cuidado básico, pero sí existen diferencias de opinión sobre la higiene (p = 0,000), sedación (p = 0,005), oxigenoterapia (p = 0,007), sondaje urinario (p = 0,011) y nutrición parenteral (p = 0,000). La edad, sexo, creencia religiosa y años de experiencia profesional en el ámbito sanitario del encuestado no influyen los resultados obtenidos. Conclusiones: No existe unanimidad entre los individuos, en qué medida debe ser considerada como cuidado paliativo. Se discrepa en relación a la higiene, la sedación, la oxigenoterapia, el sondaje urinario y la nutrición parenteral. Esta última medida se considera más como una opción terapéutica que la nutrición enteral. La opinión no depende de las características sociodemográficas de la población estudiada.Background: Ethical considerations are becoming more and more common in clinical practice. There is no unanimous agreement on which measures should be deemed as basic care, specially regarding hydration and artificial nutrition. Aim: To know the opinion of lay people and health professionals, stratified according to their university degree, about which palliative measures, including hydration and artificial nutrition, should be judged as palliative care. Methods: A descriptive transversal study has been designed to know the opinion of 256 subjects: 91 users of the National Health System (NHS), 80 nurses, 47 pharmacists and 38 physicians. A questionnaire examined which of the following measures should be considered as palliative care: hygiene, analgesia, pressure ulcer care, position change, sedation, oxygen administration, urinary catheter, hydration, enteral and parenteral nutrition. Results: More than 50% of the participants think that all the proposed measures can be considered as a palliative care, except parenteral nutrition. There is unanimous agreement to accept analgesia, pressure ulcer care, position change and enteraL nutrition as basic care, but there is disagreement in relation to hygiene (p = 0.000),sedation (p = 0.005), oxygen administration (p = 0.007), urinary catheter (p = 0.011) and parenteral nutrition (p = 0.000). There were not differences of opinion after adjusting for age, sex, religious beliefs, and length of professional experience among the individuals that answered the questionnaire. Conclusion: There is no agreement on which measures should be considered as palliative care. Opinions differ regarding hygiene, sedation, oxygen administration, urinary catheterisation and parenteral nutrition. In comparison to enteral nutrition, many responders believe that parenteral nutrition is a therapeutic option. The opinions shown in this questionnaire were independent from the demographic characteristics of the subjects that answered it.

La resistencia mecánica en frío del coque siderúrgico -evaluada mediante el ensayo IRSID-, la reactividad frente al CO2 (CRI) y la resistencia mecánica post-reacción (CSR) son los parámetros más importantes empleados para controlar la calidad del coque en España. En el INCAR, antes del cierre de la Coquería Experimental en Julio de 1999, se ha realizado un estudio para determinar la correlación existente entre la calidad del coque obtenido a escala semi-industrial -homo de 6 t - y a escala piloto -horno de pared móvil (HPM) de 250 kg-. En este trabajo se describen los estudios realizados y los resultados obtenidos, los cuales permiten predecir la calidad del coque que se vaya a obtener a escala industrial a partir de los datos obtenidos en el HPM.

Para el funcionamiento del Horno Alto el coque es imprescindible. Sin embargo, la ausencia de construcción de nuevas plantas de coquización a lo largo de los últimos años ha producido un envejecimiento de las infraestructuras existentes para la producción de coque siderúrgico. De esta forma, el desafío al que se enfrenta la industria de coquización ante el nuevo milenio es la modernización de las viejas estructuras de producción de coque. En cuanto a los sistemas de coquización alternativos, en la Unión Europea se ha desarrollado el reactor Jumbo o Single Chamber System (SCS); en EE.UU. se tiende a emplear hornos no recuperadores basados en los primitivos hornos de colmena; y en Japón se está desarrollando el proyecto SCOPE 21.

La lixiviación de oro en medio tiosulfato es una de las alternativas propuestas a la lixiviación en medio cianuro, especialmente cuando se consideran algunas menas auríferas. A su vez, se han considerado distintas tecnologías para la recuperación del metal de las disoluciones de lixiviación y, de estas, la cementación con cinc es una de las menos estudiadas. En el presente trabajo, se han aplicado distintos modelos cinéticos a los resultados experimentales de cementación de oro con cinc en polvo, siendo el modelo cinético de pasivación el que mejor ajusta estos. Se considera que la cementación del oro responde a un régimen de control difusivo (15,4 kj/mol), estando favorecida la cementación del metal precioso al emplear mayores temperaturas o valores de pH/concentración de amoniaco en el medio acuoso.

The most common postoperative complications of total gastrectomy are esophagojejunal anastomotic leakage and subphrenic abscess. These complications are a cause of morbility and mortality, relaparotomy, and longer postoperative stay. The use of abdominal drains is useful for the early diagnosis and management of anastomotic leaks. The aim of this study was to analyze our experience with total gastrectomy for gastric cancer in patients with and without abdominal drains, and to evaluate the results regarding postoperative morbidity, postoperative hospital stay, postoperative days for oral intake, relapatorotomy and mortality. This prospective and randomized study examines the results in 60 consecutive patients (43 males and 17 females) with gastric cancer who underwent total gastrectomy in the Regional Clinical Hospital of Concepción, Chile, between 2000 and 2003. Patients were divided into two groups: group I (without drains) and group II (two drains). We found 31 patients in group I and 29 patients in group II. The mean length of postoperative stay was 12.9 days in group I and 18.8 days in group II (p = 0.0242, s.). Morbidity was 9.7% in group I and 37.9% in group II (p = 0.0242, s.). Re-explorations were more frequent in group II (24.1%) versus group I (9.7%) (p = 0.1239, n.s.). Postoperative days for oral intake were 9.4 in group I and 12.8 in group II (p = 0.0514, n.s.) Mortality was 0% in group I and 3.4% in group II (p = 0.4833, n.s.). In our experience, morbidity and postoperative hospital stay were statistically higher in the group of patients with abdominal drains.

La utilización del mercurio para la extracción de oro es, todavía, una práctica habitual en las pequeñas instalaciones mineras, especialmente en los países en desarrollo, debido a la baja inversión requerida y a la facilidad de operación. Pero la falta de medidas de seguridad hace inevitable una importante contaminación de los rios, de los suelos y también de los trabajadores. Se han realizado algunos avances, sobre el terreno, como en lo relativo a la eliminación de mercurio de la amalgama que se realizaba al aire y ahora se utilizan sencillas y baratas retortas de hierro que disminuyen mucho la emisión de vapores de mercurio a la atmósfera, pero sigue habiendo muchas pérdidas de mercurio en los residuos o estériles del proceso de amalgamación que es, fundamentalmente, casi todo el peso de mineral tratado. Para la reducción de estas pérdidas de mercurio en los estériles del proceso se ha realizado esta investigación, utilizando procesos muy baratos, asequibles a los mineros aislados, demostrando que es posible lograr una disminución muy importante de dichas pérdidas y de la contaminación consiguiente. Para ello se han utilizado técnicas de lavado con detergentes alcalinos de la mena y de purificación electrólitica del mercurio con un sencillo y barato equipo que puede ser construido por los propios mineros, así como la demostración de que un sencillo ensayo de control de los tiempos de amalgamación y proporción de mercurio utilizado puede disminuir también las pérdidas, conjuntamente con un aumento de la recuperación de oro. De esta forma, es posible alcanzar pérdidas totales de mercurio de 2,4 g por cada 100 g de oro producido para menas muy ricas y recuperación de oro del 94 % (La Bruja), y de 8,6 g de pérdidas de mercurio por 100 g de oro producido en menas tipo medio de la zona y recuperación de oro del 92 % (La Gruesa), que son del orden de 20 a 100 veces menores que las pérdidas corrientes de los pequeños mineros, reflejadas en la bibliografía. La introducción de una fase previa de concentración gravimétrica en mesas de sacudidas disminuye hasta un 70 % la cantidad de material a amalgamar y, por lo tanto, los residuos sólidos contaminados, mejorando en el caso de la mena rica utilizada la recuperación de oro y empeorándola en el caso de la mena menos rica, en la que con un tratamiento combinado de concentración en mesas y flotación de los estériles de mesa se logran recuperaciones mejores que con la amalgamación directa pero,, en este caso, especialmente por la flotación, el proceso no será de uso general entre los pequeños mineros por su mayor dificultad de utilización y de coste de equipamiento.

Using a general and simple algebraic approach, some results on Krall-type orthogonal polynomials and some of their extensions are obtained.

The effects of ENSO 1997-1998 off the southwest coast of Mexico are evaluated, by comparing sea surface temperature (SST) anomalies from satellite observation over a 4-year period, from 1996 to 1999. We find an increment of sea surface temperatures of 3° to 5° C during ENSO, and an inhibition of the upwelling event off Cabo Corrientes.

En este trabajo se describe la puesta a punto de un método a escala de laboratorio, que permite evaluar la cohesión y abrasión de coques obtenidos a escala piloto. Se definen dos índices de resistencia mecánica en frío, CS10 y CS1, como la cantidad de coque de tamaño mayor de 10 mm y menor de 1 mm, respectivamente, que se obtiene después de someter una muestra de 200 g de coque, con tamaño de partícula 19-22,4 mm, a 1.200 vueltas en un tambor que gira a 20 rpm. Los nuevos índices están relacionados con los derivados del ensayo normalizado IRSID, 120 e 110, utilizados por la industria siderúrgica para el control de la calidad de coque de horno alto. Los coques estudiados se obtuvieron en un horno de pared móvil de 250 kg de capacidad, a partir, tanto de carbones individuales como de mezclas industriales de carbones. De los resultados, se deduce que el método desarrollado utilizando el tambor descrito en el método NSC de resistencia mecánica después de reacción con dióxido de carbono, puede usarse en la valoración de coques obtenidos en hornos de menor escala, en los que la cantidad de coque producida es insuficiente para llevar a cabo ensayos normalizados que requieren una mayor cantidad de muestra.

There are not many articles about the chronic bronchial infection/colonization in patients with underlying lung disease other than cystic fibrosis (CF), especially with non-CF bronchiectasis (NCFBQ). The prevalence of B. cepacia complex is not well known in NCFBQ. The vast majority of published clinical data on Burkholderia infection in individuals with CF is comprised of uncontrolled, anecdotal, and/or single center experiences, and no consensus has emerged regarding treatment. We present two cases diagnosed with bronchiectasis (BQ) of different etiology, with early pulmonary infection by B. cepacia complex, which was eradicated with inhaled aztreonam lysine.

Se presenta el estudio de la alteración meteórica de dos carbones bituminosos con contenido medio de materia volátil y de diferente origen geográfico, que han sido almacenados a la intemperie en el Parque del INCAR. Ambos carbones son constituyentes de las mezclas de carbones coquizables utilizadas por la Corporación Siderúrgica Integral (CSI) para la producción de coque de horno alto. Entre las técnicas utilizadas para detectar el grado de meteorización de dichos carbones, la fluidez máxima Gieseler es el indicador más sensible para detectar la pérdida de propiedades plásticas. Ambas series de carbones presentan diferente comportamiento frente a la meteorización. Si bien la alteración meteórica provoca una pérdida de fluidez máxima con el tiempo de almacenamiento, debido a una pérdida de hidrógeno alifático en los dos carbones, ésta se produce a diferente velocidad. Estas diferencias se ponen de manifiesto en la calidad de los coques producidos en la planta de coquización del INCAR (escala semiindustrial). La serie de coques producidos a partir del carbón inicialmente menos fluido y que experimenta una pérdida a mayor velocidad empeora claramente, mientras que los coques producidos a partir del carbón más fluido presentan una ligera mejora inicial, para terminar empeorando. Estos resultados ponen en evidencia que la alteración meteórica no sólo afecta positivamente en el caso de algunos carbones con contenido elevado de materia volátil, como ya se había detectado en estudios realizados por otros autores, sino también a determinados carbones con contenido medio de materia volátil.

Se estudia la influencia que la adición de un coque verde de petróleo a mezclas coquizables tiene sobre la calidad de los coques metalúrgicos resultantes. Se midieron propiedades mecánicas (ensayo IRSID), reactividad (ensayos CEE y NSC) y textura (porosidad y distribución del tamaño de poros). En general, la adición de coque de petróleo da lugar a una disminución de la porosidad de los coques obtenidos tanto a escala de laboratorio como semiindustrial. Dicha disminución se debe, en gran medida, a la disminución de microporos, lo cual contribuye a explicar la de la reactividad frente al CO2 de los coques metalúrgicos. Se desarrolla una metodología para la obtención y evaluación de las propiedades de coques metalúrgicos a escala de laboratorio, cuyos resultados se comparan con los obtenidos a escala semiindustrial.

Las técnicas conservadoras en cirugía valvular aórtica ofrecen una alternativa terapéutica a la prótesis en la insuficiencia aórtica. La técnica de David o reimplante valvular es una técnica establecida con buenos resultados pero de difícil reproducción en centros con menor experiencia. Analizar los resultados iniciales de la cirugía de reimplante valvular aórtico (RVA). Material y métodos: Análisis retrospectivo de los primeros 5 pacientes en los que se realizó RVA en nuestro centro entre marzo-noviembre de 2011. Resultados: La edad media del grupo es 66 ± 10 años, el 20% son mujeres y el EuroSCORE medio es 10,2 ± 3,7. El 40% presentaban dilatación de raíz aórtica y aorta ascendente y el 60% ectasia anuloaórtica. El grado de insuficiencia era III (40%) y IV (60%). El 40% recibió bypass coronario asociado. Tras RVA la insuficiencia era grado 0 (40%), grado I (40%) y grado II (20%); en este paciente se implantó prótesis aórtica en la misma cirugía. No hubo reoperación por sangra-do ni mortalidad postoperatoria El seguimiento medio de 4,8 ± 3,5 meses mostró una mejoría del grado funcional pasando de grado II (40%), grado III (40%) y grado IV (20%) precirugía a grado II (20%) y grado I (80%) poscirugía. No hubo reoperación por reaparición de insuficiencia aórtica durante el seguimiento. Conclusiones: a) los resultados iniciales en nuestro centro del reimplante valvular aórtico son óptimos a corto plazo, y b) la curva de aprendizaje ha sido rápida, con escasa repercu-sión en los pacientes.

Las consecuencias clínicas del desajuste paciente-prótesis en el paciente joven operado de recambio valvular aórtico por estenosis grave continúan siendo desconocidas. Nuestro objetivo fue evaluar la prevalencia del desajuste paciente-prótesis en una población joven intervenida de recambio valvular aórtico y conocer su influencia en la mortalidad intrahospitalaria y en las complicaciones postoperatorias. Material y métodos: Se analizaron todos los pacientes menores de 70 años a los que se realizó recambio valvular aórtico aislado por estenosis grave desde septiembre de 2007 hasta septiembre de 2011. Se consideró que existía desajuste paciente-prótesis cuando el área indexada del orificio efectivo fue igual o inferior a 0,85 cm2/m2 utilizando los valores del área efectiva in vivo publicados para cada válvula. Se analizó la influencia del desajuste paciente-prótesis en la mortalidad intrahospitalaria y en las complicaciones postoperatorias realizando un análisis ajustado por propensity score. Se realizó un seguimiento a 30 días desde la intervención quirúrgica al 100% de los pacientes. Resultados: De 199 pacientes estudiados, 61 (30,7%) tenían algún grado de desajuste paciente-prótesis. Después de ajustar por propensity score, el desajuste paciente-prótesis se asoció a una mayor mortalidad intrahospitalaria (odds ratio [OR]: 8,71; intervalo de confianza [IC] 95%: 1,67–45,29; p = 0,004) y complicaciones postoperatorias mayores (infarto agudo de miocardio [IAM], accidente cerebrovascular [ACV], reinter-vención por sangrado y nueva necesidad de balón de contra-pulsación) (OR: 2,96; IC 95%: 1,03–8,55; p = 0,044). Sin embargo, este estudio no consiguió demostrar asociación entre desajuste paciente-prótesis y una estancia hospitalaria prolongada (p = 0,81). Conclusiones: El desajuste paciente-prótesis es un hallaz-go frecuente en el paciente joven intervenido de recambio valvular aórtico por estenosis grave. Además, su influencia a los 30 días de seguimiento parece relevante.

La reparación mitral tiene como pilar básico la anuloplastia. La variedad de anillos con diversas características en el mercado es enorme. El anillo-CG-Future® permite el remodelado posterior manteniendo la flexibilidad anterior del anillo mitral. Esto conserva una relación de diámetros del anillo mitral 3:4 en sístole y 4:4 en diástole. Analizar los resultados obtenidos con anillo-CG-Future® en reparación mitral. Material y métodos: análisis retrospectivo de 29 pacientes en los que se utilizó anillo-CG-Future® en nuestro centro entre 2010-2011. Resultados: La edad media del grupo es 68 ± 13 años, el 62% son hombres y el EuroSCORE medio es 9,01 ± 7,3. El origen de la insuficiencia mitral era funcional en el 44,8% y degenerativo mixomatoso en el 48,3%, ninguna de origen isquémico. El grado de insuficiencia era III en el 17,2% y IV en el 69%. El 44,8% presentaban prolapso de algún velo mitral. Junto con anuloplastia se realizó resección cuadrangular (37,9%), Alfieri (3,4%) y neocuerdas (3,4%). Un 31% recibió bypass coronario asociado. Tras reparación mitral la insuficiencia era grado II (10,3%) y trivial-leve (89,7%). No hubo mortalidad postoperatoria. El seguimiento medio de 7,2 ± 6,5 meses mostró una mejoría del grado funcional pasando de grado IV (20,7%) y grado III (62,1%) precirugía a grado II (24,1%) y grado I (75,9%) poscirugía. No hubo reoperación por fracaso de reparación mitral durante el seguimiento. Conclusiones: a) la reparación mitral con anillo-CG-Future® ofrece buenos resultados con durabilidad, y b) la mejoría clínica de la serie es manifiesta.

La miocardiopatía hipertrófica obstructiva (MHO) afecta a 1 de 500 personas. El tratamiento quirúrgico ha demostrado ser efectivo en supervivencia y mejoría clínica, pero no es una patología frecuente y su cirugía requiere un cierto grado de experiencia. Analizar los resultados del tratamiento quirúrgico de la MHO. Material y métodos: Análisis retrospectivo de 10 pacientes operados de MHO en nuestro centro entre 2007–2011. Resultados: La edad media del grupo es 71,2 ± 13 años, el 50% son mujeres, y el EuroSCORE medio es 7,65 ± 5,3. Presentaban 24,9 ± 4,2 mm de septo interventricular, con SAM moderado-grave (80%) e insuficiencia mitral grado III (40%) y grado IV (60%). El 70% tenía enfermedad degenerativa mitral y el 10% prolapso mitral. Un 30% asociaba enfermedad coronaria y un 20% patología valvular aórtica. Todos recibieron miectomía septal. También se practicó bypass coronario (30%), prótesis mitral (20%), anuloplastia mitral (20%) y plastia tricúspide (10%). Un paciente falleció por hemorragia pulmonar y un segundo precisó reoperación por sangrado. El seguimiento medio de 20,7 ± 19,7 meses mostró una mejoría del grado funcional, pasando de grado IV (60%) y grado III (40%) precirugía a grado II (22,2%) y grado I (77,8%) poscirugía. La insuficiencia mitral evolucionó a trivial-leve en el 90% y el gradiente intraventricular descendió de 110 ± 40,4 mmHg a 12,2 ± 10,2 mmHg. Conclusiones: – La cirugía de la MHO ofrece buenos resultados clínicos. – Es segura con baja morbilidad. – La degeneración valvular mitral obliga frecuentemente a implantar prótesis mitral.

El EuroSCORE es un modelo probabilístico de estimación de mortalidad de amplio uso en cirugía cardíaca. Sin embargo, hay una tendencia subjetiva a considerarlo poco eficaz para determinadas poblaciones de enfermos, especialmente los valvulares. Objetivo: Conocer la utilidad del EuroSCORE en nuestra población de aórticos y aorticocoronarios. Material y métodos: Análisis retrospectivo de 529 pacientes operados en nuestro centro entre 2007-2009 divididos en dos grupos: A (aorticocoronarios; n = 143) y B (aórticos; n = 386). Resultados: El EuroSCORE fue superior en A (7,1 ± 52,2 vs 6,3 ± 2,2; p < 0,05) así como la proporción de diabéticos (32,9 vs 18,4%; p < 0,05) e hipertensos (76,9 vs 62,2%; p < 0,05). Las mujeres eran mayoría en B (51,6 vs 37,1%; p < 0,05) y ambos grupos eran homogéneos en edad. La mortalidad observada es similar en los dos grupos: 4,2% en A y 5,2% en B (p no significativa). La discriminación (área bajo curva ROC [AUROC]) del EuroSCORE para mortalidad es inferior a la deseable para finalidades clínicas (0,51 para A y 0,68 para B) (aceptable > 0,7). El subgrupo > 75 años del grupo A es el único que presenta una discriminación aceptable pero para la variable tiempo-ventilación superior a 24 h (área: 0,74). La calibración para la mortalidad (test Hosmer-Lemeshow) es aceptable para el conjunto de los dos grupos: p = 0,566 (a mayor p, mejor calibración). Conclusiones: a) el EuroSCORE no es útil en nuestras poblaciones de aórticos y aorticocoronarios para estimar mortalidad, y b) hasta encontrar un modelo más ajustado para nuestras poblaciones, el EuroSCORE es la mejor aproximación.