Progressive plasticity during colorectal cancer metastasis.

Metastasis is the principal cause of cancer death, yet we lack an understanding of metastatic cell states, their relationship to primary tumor states, and the mechanisms by which they transition. In a cohort of biospecimen trios from same-patient normal colon, primary and metastatic colorectal cancer, we show that while primary tumors largely adopt LGR5 + intestinal stem-like states, metastases display progressive plasticity. Loss of intestinal cell states is accompanied by reprogramming into a highly conserved fetal progenitor state, followed by non-canonical differentiation into divergent squamous and neuroendocrine-like states, which is exacerbated by chemotherapy and associated with poor patient survival. Using matched patient-derived organoids, we demonstrate that metastatic cancer cells exhibit greater cell-autonomous multilineage differentiation potential in response to microenvironment cues than their intestinal lineage-restricted primary tumor counterparts. We identify PROX1 as a stabilizer of intestinal lineage in the fetal progenitor state, whose downregulation licenses non-canonical reprogramming.

The 2021 SIIM-FISABIO-RSNA Machine Learning COVID-19 Challenge: Annotation and Standard Exam Classification of COVID-19 Chest Radiographs.

We describe the curation, annotation methodology, and characteristics of the dataset used in an artificial intelligence challenge for detection and localization of COVID-19 on chest radiographs. The chest radiographs were annotated by an international group of radiologists into four mutually exclusive categories, including "typical," "indeterminate," and "atypical appearance" for COVID-19, or "negative for pneumonia," adapted from previously published guidelines, and bounding boxes were placed on airspace opacities. This dataset and respective annotations are available to researchers for academic and noncommercial use.

Influence of high power ultrasound on natural microflora, pathogen and lactic acid bacteria in a raw meat emulsion.

Raw meat emulsions may have natural, spoilage and pathogenic microorganisms due to the origin and characteristics of this food matrix. All of these microorganisms must be minimized during industrial processing to make food consumption safe and meet quality regulations. Therefore, in this research, the effect of probe ultrasound on the inactivation of three kinds of microorganisms in a raw meat emulsion is evaluated. The microorganisms are: natural microflora NAM, Listeria monocytogenes LIS, and Lactobacillus delbrueckii LAC. A high-intensity probe ultrasound system was used, during 1.0, 2.5, 5.0, 7.5 and 10 min, with pulsed waves of 0.0, 10, 20 and 30 seg, and 200, 250, 300, 350 and 400 W of power. The interrelation between time, wave pulse cycle, and power factors was assessed. The results showed a positive linear independence effect in the treatments without wave pulse for each microorganism, and a quadratic interaction with the time and the ultrasound power for the inactivation of the three kinds of microorganisms. Besides, the desirability function for the inactivation reached up to 60% of the microbial population with the probe ultrasound treatment, with 10 min, a 7.56 s wave pulse and 400 W of power. Thus, these results could be useful to decide the incorporation of mild and emerging technologies in a meat industry line process.

Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación / Surgical treatment of periprosthetic humerus fractures and algorithm

INTRODUCCIÓN: Las fracturas periprotésicas de húmero son infrecuentes y su manejo, difícil. La bibliografía es limitada y no existe consenso sobre su tratamiento. MATERIAL Y MÉTODO: Hemos realizado un estudio observacional retrospectivo de 10pacientes con fractura periprotésica de húmero con un seguimiento de 25,1 meses (6-87). Valoramos los resultados clínicos, radiológicos y funcionales, como las complicaciones. Utilizamos el cuestionario Quick-DASH y UCLA Shoulder Score (UCLASS). Realizamos una búsqueda sistemática para comparar la serie presentada y los protocolos de tratamiento publicados. RESULTADOS: Diez pacientes con una media de edad de 69,4 años (37-91) fueron intervenidos quirúrgicamente: 8 mediante reducción abierta y fijación interna (RAFI), en otro se realizó un recambio protésico colocando una nueva prótesis con un vástago más largo, y en el último se retiró la prótesis y se realizó una osteosíntesis con un clavo endomedular. Nueve de 10 pacientes consolidaron en un tiempo de 6,2 meses (rango 5-12); el restante sufrió una nueva fractura 5 meses después, siendo reintervenido, realizándole una nueva osteosíntesis, con aporte de aloinjerto óseo, que consolidó a los 8meses de la última fractura. En relación con la situación previa a la fractura, los pacientes tenían como promedio un descenso notable de la función, que era de 10,66 puntos en el test de UCLASS y un ascenso de 27,3 puntos en el cuestionario Quick-DASH. CONCLUSIONES: Nuestra serie tiene similitudes con las publicadas en relación con los aspectos demográficos, las complicaciones y el tiempo de consolidación. Sin embargo, en otros aspectos, como el dolor y los resultados funcionales, encontramos gran variabilidad

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10 cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23 months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10 patients with an average age of 69.4 years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5 months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66 points, and an increase of 27.3 points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients

Surgical treatment of periprosthetic humerus fractures and algorithm. / Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación.

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10patients with an average age of 69.4years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66points, and an increase of 27.3points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients.

Could land cover influence Aedes aegypti mosquito populations?

Aedes aegypti is mainly found in urban environments, where human activity guarantees the permanent availability of potential larval habitats. The present study aimed to test for a possible association between Ae. aegypti infestation and land cover classes. From 23 February to 22 May 2015, immature mosquitoes (except eggs) were sampled in artificial containers identified in dwellings in Córdoba city, Argentina. The proportion of each land cover class was determined by SPOT-5 (Satellites Pour 1'Observation de la Terre or Earth-observing Satellites) image classification. Generalized linear models were developed to assess a suite of predetermined hypotheses and identified cover class variables associated with Ae. aegypti infestation. Arboreal vegetation was identified as the land cover with the greatest relative importance, negatively associated with Ae. aegypti mosquitoes. More infestation was find in areas with less arboreal vegetation, which corresponds to more urbanized areas.

Structure and evolution of magnetohydrodynamic solitary waves with Hall and finite Larmor radius effects.

Nonlinear and low-frequency solitary waves are investigated in the framework of the one-dimensional Hall-magnetohydrodynamic model with finite Larmor effects and two different closure models for the pressures. For a double adiabatic pressure model, the organization of these localized structures in terms of the propagation angle with respect to the ambient magnetic field θ and the propagation velocity C is discussed. There are three types of regions in the θ-C plane that correspond to domains where either solitary waves cannot exist, are organized in branches, or have a continuous spectrum. A numerical method valid for the two latter cases, which rigorously proves the existence of the waves, is presented and used to locate many waves, including bright and dark structures. Some of them belong to parametric domains where solitary waves were not found in previous works. The stability of the structures has been investigated by performing a linear analysis of the background plasma state and by means of numerical simulations. They show that the cores of some waves can be robust, but, for the parameters considered in the analysis, the tails are unstable. The substitution of the double adiabatic model by evolution equations for the plasma pressures appears to suppress the instability in some cases and to allow the propagation of the solitary waves during long times.

Evaluación in Vitro de la Biocompatibilidad de Cuatro Cementos Selladores con Osteoblastos Humanos / In vitro Evaluation of Four Sealer Cements Biocompatibility with Human Osteoblasts

RESUMEN: El correcto sellado apical es un paso importante durante el tratamiento de conductos, para esto, se utilizan puntas de gutapercha y cemento sellador, de este último existen diversas formulaciones químicas en el mercado, por lo cual es importante tomar en cuenta los efectos que estas pueden tener en el proceso de cicatrización periapical. El propósito de este estudio fue evaluar la biocompatibilidad de cuatro cementos selladores con diferente composición química con osteoblastos humanos. Se prepararon extractos de cementos selladores a con dos concentraciones (10 mg/mL y 40 mg/mL) y dos tiempos de exposición (10 min y 8 h), estos fueron colocados en contacto con osteoblastos humanos para evaluar la proliferación y citotoxicidad a 24, 72 y 96 h con sus respectivos controles y blancos. Se realizó un análisis estadístico con ANOVA de un factor y la prueba de comparaciones múltiple de Bonferroni. Los resultados obtenidos, tanto en el ensayo de citotoxicidad como en el de proliferación, indicaron que el cemento a base de resina no es biocompatible con osteoblastos. El cemento a base de poli-dimetilxilosano fue el único que no mostró citotoxicidad a ningún de tiempo de exposición y concentración examinadas en este estudio.

ABSTRACT: Correct apical sealing is an important step during root canal treatment, hence, gutta-percha points and sealant are used. There are several chemical compositions on the market, so it is important to evaluate the effects of these in the periapical healing process. The aim of this study was to evaluate the biocompatibility of four sealer cements with different chemical composition placed in contact with human osteoblast. Different extracts were prepared at two concentrations (10 mg/mL and 40 mg/mL) and two exposure times (10 min and 8 h) these were placed in contact with human osteoblast to evaluate cytotoxicity and proliferation at 24, 48 and 72 h with their respective controls and blanks. A statistical analysis was performed with ANOVA of one factor and Bonferroni post hoc. Results obtained in cytotoxicity and proliferation assays, indicated that the resinbased cement is not biocompatible with osteoblast. The poly-dimethylxilosanbased cement was the only that did not show cytotoxicity at any time of exposure and concentration examined in this study.

Selecting native perennial plants for ecological intensification in Mediterranean greenhouse horticulture.

Natural control by predators and parasitoids provides an important and often unnoticed ecosystem service to agricultural landscapes by reducing pest populations in crops. The current model of horticultural intensification in south-eastern Spain produces high yields but has also resulted in a landscape almost completely covered by plastic. Promoting natural areas among greenhouses could enhance biodiversity, by being beneficial insects, and reduce pest pressure outdoors. The first step is to ascertain how pests and their natural enemies (NEs) use Mediterranean vegetation for selecting the best plants for pest suppression outdoors. The abundance of the two major horticultural pests, the tobacco whitefly, Bemisia tabaci, and the western flower thrips, Frankliniella occidentalis, together with their NEs, were assayed in 22 flowering perennial plants, which were newly planted in an experimental field surrounded by greenhouses. Eight plant species were identified as the most critical species for sustaining pest populations outdoors. A set of five plant species supported a medium level of pests, and another set of ten plant species supported the lowest level of both pests. Tobacco whitefly occurred in a few plants species, whereas western flower thrips occurred on almost all the plant species studied, and was favoured by the presence of flowers in perennial plants. The results suggest that plant diversity may provide relatively few acceptable host plants for tobacco whitefly than for western flower thrips. NEs were generally collected in plants that also supported abundance of pests, indicating that host/prey availability, more than food resources from flowers, was a stronger predictor of NE abundance in perennial plants. Field trials using the plants with the lowest host acceptance by pests are needed in order to ascertain whether pest abundance outdoors is reduced.

Blazar spectral variability as explained by a twisted inhomogeneous jet.

Blazars are active galactic nuclei, which are powerful sources of radiation whose central engine is located in the core of the host galaxy. Blazar emission is dominated by non-thermal radiation from a jet that moves relativistically towards us, and therefore undergoes Doppler beaming. This beaming causes flux enhancement and contraction of the variability timescales, so that most blazars appear as luminous sources characterized by noticeable and fast changes in brightness at all frequencies. The mechanism that produces this unpredictable variability is under debate, but proposed mechanisms include injection, acceleration and cooling of particles, with possible intervention of shock waves or turbulence. Changes in the viewing angle of the observed emitting knots or jet regions have also been suggested as an explanation of flaring events and can also explain specific properties of blazar emission, such as intra-day variability, quasi-periodicity and the delay of radio flux variations relative to optical changes. Such a geometric interpretation, however, is not universally accepted because alternative explanations based on changes in physical conditions-such as the size and speed of the emitting zone, the magnetic field, the number of emitting particles and their energy distribution-can explain snapshots of the spectral behaviour of blazars in many cases. Here we report the results of optical-to-radio-wavelength monitoring of the blazar CTA 102 and show that the observed long-term trends of the flux and spectral variability are best explained by an inhomogeneous, curved jet that undergoes changes in orientation over time. We propose that magnetohydrodynamic instabilities or rotation of the twisted jet cause different jet regions to change their orientation and hence their relative Doppler factors. In particular, the extreme optical outburst of 2016-2017 (brightness increase of six magnitudes) occurred when the corresponding emitting region had a small viewing angle. The agreement between observations and theoretical predictions can be seen as further validation of the relativistic beaming theory.

Evaluación de la influencia del estrés térmico en el absentismo laboral de los trabajadores de una factoría de acero inoxidable / Evaluation of the influence of heat stress in the absenteeism of the employees of an stainless steel factory

Objetivo: Evaluar la influencia del Estrés Térmico en el Absentismo Laboral de los trabajadores de una empresa dedicada a la fabricación de acero inoxidable, conocer la situación actual de la factoría respecto a número de incapacidades temporales tanto por contingencias comunes como profesionales y su distribución por edad del trabajador y por su experiencia en el puesto de trabajo y medir la diferencia de riesgos de presentar una incapacidad temporal ya sea por contingencias comunes, por contingencias profesionales o por la suma de ambas entre expuestos y no expuestos a riesgo de estrés térmico en su puesto de trabajo. Material y método: Estudio analítico observacional de tipo cohorte histórica desde el año 1974 hasta 2016, sobre una muestra de 1609 trabajadores de una empresa dedicada a la fabricación de acero inoxidable. Resultados: Nos encontramos con una plantilla joven en cuanto a la antigüedad ya que más del 56% lleva menos de 15 años trabajando (grupo más numeroso), lo que contrasta con la edad de los trabajadores, en la que casi un 35% es mayor de 50 años. Los resultados apuntan a la existencia de una relación estadística entre el riesgo de estrés térmico y el número de incapacidades temporales por contingencias profesionales. Conclusiones: La Incidencia acumulada por cada 100 trabajadores de Incapacidades temporales debidas a contingencias comunes en el periodo comprendido entre 1974 y 2016 no es superior en el grupo de trabajadores expuestos a estrés térmico que en aquellos que no lo están. En el caso de las contingencias profesionales sí es superior en el grupo de trabajadores expuestos a estrés térmico. El Riesgo relativo de sufrir una Incapacidad Temporal de origen no laboral no es mayor en aquellos trabajadores sometidos a estrés térmico, pero sí cuando la contingencia es profesional. El Riesgo atribuible al estrés térmico en el grupo de trabajadores expuestos es del 32% en las incapacidades temporales por contingencias profesionales y del 44% en el total de la población para este mismo tipo de incapacidades temporales (AU)

Objective: To evaluate the influence of Thermal Stress on Occupational Absenteeism of the workers of a company dedicated to the manufacture of stainless steel, to know the current situation of the factory regarding the number of temporary incapacities for both common and professional contingencies and their distribution by age of the worker and his / her experience in the workplace and to measure the difference in risks of presenting a temporary incapacity either by common contingencies, by professional contingencies or by the sum of both exposed and not exposed to risk of thermal stress in their position of work. Material and method: An observational, historical ohort-type analytical study from 1974 to 2016 on a sample of 1609 workers from a company dedicated to the manufacture of stainless steel. Results: We have a young workforce in terms of seniority, since more than 56% work less than 15 years (larger group), which contrasts with the age of the workers, in which almost 35% is greater of 50 years. The results point to the existence of a statistical relationship between the risk of thermal stress and the number of temporary incapacities due to professional contingencies. Conclusions: The cumulative incidence for each 100 temporary incapacity workers due to common contingencies in the period between 1974 and 2016 is not higher in the group of workers exposed to thermal stress than in those who are not. In the case of professional contingencies, it is higher in the group of workers exposed to thermal stress. The relative risk of suffering a Temporary Incapacity of non-labor origin is not greater in those workers subjected to thermal stress, but when the contingency is professional. The risk attributable to thermal stress in the group of exposed workers is 32% in temporary incapacities due to professional contingencies and 44% in the total population for this same type of temporary incapacities (AU)

Relación de la calidad de vida y satisfacción laboral del personal de enfermería de un hospital de alta especialidad / Relation of the quality of life at work with the job satisfaction of the nursing staff in a High Specialty Hospital

Introducción: El conocimiento de la calidad de vida en el trabajo (CVT) y de la satisfacción laboral (SL), así como de los factores que influyen en ambas, resulta significativo para las instituciones de salud. La CVT inadecuada y la insatisfacción laboral originan que el personal con elevado nivel de insatisfacción limite sus habilidades, su disponibilidad y sus conocimientos lo cual pone en peligro el clima de trabajo en una organización. Objetivo: Evaluar la relación de la calidad de vida en el trabajo y la satisfacción laboral del personal de enfermería de un hospital de alta especialidad. Método: Se realizó un estudio observacional, prolectivo, transversal, analítico en una población de enfermeras(os) del área clínica. Previo consentimiento informado, se recolectaron los datos con los cuestionarios validados CVT-GOHISALO con alfa de Cronbach 0.956 y el Cuestionario Font Roja con alfa de Cronbach de 0.751. Se utilizó el programa SPSS v 21.0 para el análisis estadístico de los datos, con pruebas de estadística descriptiva, frecuencias, porcentajes, valores promedio, desviación estándar, pruebas de comparación X2 con una p<0.05 y correlación de Pearson. Para el cálculo de riesgos se utilizó razón de momios con un intervalo de confianza al 95%. Resultados: Se evaluó a 357 enfermeras(os); de las cuales, 323 (91%) son mujeres y 34 (9%) hombres, con un promedio de edad de 41±8 años. El 62% es personal profesional, cuya distribución por turnos es: nocturno, 34%; vespertino, 27%; matutino, 25%, y en la jornada acumulada, 14%. Con una antigüedad laboral media de 18±8.4 años. Por servicios: urgencias, 37%; hospitalización adultos, 35%, y hospitalización pediátrica, 18%. Del total de la población, 86% reportó una satisfacción laboral de buena a muy buena y 14% de mala a regular. El 62% refiere tener una CVT de mala a regular, siendo las dimensiones con mayor insatisfacción la seguridad en el trabajo, 65%; satisfacción por el trabajo, 66%; el bienestar logrado a través del trabajo, 70%, y el desarrollo personal, 60%. En relación con la CVT, se encontró que la monotonía laboral es un factor de riesgo con significancia estadística: p=<0.05 (RM=1.04, IC95%,1.14-3.66). Así mismo, la satisfacción por el trabajo (RM=1.30, IC95% 1.11-4.78) y el bienestar logrado a través del trabajo (RM=1.16, IC95%,1.014-4.63) para la SL siendo estadísticamente significativo: p=<0.05. Conclusiones: Los hallazgos sugieren que la SL del personal de enfermería es un determinante en la CVT. De igual manera, las dimensiones reportadas con mayor insatisfacción repercuten en la adecuada gestión de la calidad del cuidado.

Introduction: The knowledge of the quality of work life (QWL) and job satisfaction (JS), as well as the factors that influence it, is significant for health institutions. Inadequate QWL and job dissatisfaction cause staff with a high level of dissatisfaction by limiting their skills, availability and knowledge, endangering the working climate in an organization. Objective: To evaluate the relationship of work quality of life and job satisfaction of nursing staff of a high specialty hospital. Method: An observational, prolective, transversal, analytical study was carried out in a population of nurses in the clinical area. Prior informed consent, data were collected with validated questionnaires QWL-GOHISALO with Cronbach's alpha 0.956; and the Red Font Questionnaire with Cronbach's alpha 0.751. We used the SPSS v 21.0 program for the statistical analysis of the data, with descriptive statistical tests, frequencies, percentages, mean values, standard deviation, X2 comparison tests with a p <0.05, Pearson correlation. For the calculation of risks, we used the odds ratio with a 95% confidence interval. Results: A total of 357 evaluated nurses, 323 (91%) women, and 34 (9%) men; with a mean age of 41±8 years, and 62% the professional staff. Thirty four percent distributed in the night shift; 27% in the evening; 25% in the morning and 14% in the working day. With an average working period of 18±8.4 years; 37% are in the emergency department, 35% in adult hospitalization and 18% in pediatric hospitalization. Of the total population, 86% reported a job satisfaction from good to very good, and 14% from bad to regular. 62% report having a QWL from bad to regular, being the dimensions with the greatest dissatisfaction. Work safety in (65%), work satisfaction (66%), welfare achieved through work (70%) and personal development (60%). Regarding the QWL, it was found that monotony at work is a risk factor with statistical significance: p=<0.05 (RM=1.04, 95% CI, 1.14-3.66). Likewise, work satisfaction with (RM=1.30, IC95% 1.11-4.78) and well-being achieved through work (RM=1.16, 95% CI, 1014-4.63) were statistically significant for p=0.05. Conclusions: These findings suggest that the JS of the nursing staff is a determinant in the QWL. Likewise, the dimensions reported with greater dissatisfaction have an impact on the adequate management of the quality of care.

Embarazo molar con feto vivo y éxito perinatal. Reporte de un caso y revisión bibliográfica / Molar pregnancy with live fetus, and perinatal success. Case report and bibliographical review

Resumen ANTECEDENTES: la mola parcial o incompleta representa 30% de las enfermedades trofoblásticas gestacionales; sin embargo, la incidencia de mola parcial con feto vivo es una manifestación poco frecuente, que ocurre en 1 de cada 100,000 embarazos. CASO CLÍNICO: paciente de 27 años de edad, con antecedentes ginecoobstétricos de 3 embarazos y 2 partos, sin comorbilidades ni alteraciones de importancia para el padecimiento actual; embarazo de 30.1 semanas según la fecha de la última menstruación y diagnóstico de enfermedad trofoblástica gestacional (mola parcial), placenta previa y útero arcuato. El ultrasonido evidenció vesículas hidrópicas, compatibles con enfermedad trofoblástica gestacional (mola parcial), por lo que se realizó amniocentesis a las 16.3 semanas del embarazo, sin incidentes ni complicaciones. Se encontró el cariotipo 46,XX. Se decidió la interrupción del embarazo por cesárea de urgencia. Puesto que se trataba de un embarazo con alta morbilidad y mortalidad, y la paciente tenía paridad satisfecha, se decidió realizar cesárea-histerectomía con la técnica de Esperanza-Bautista. Nació una niña de 1416 g, Capurro de 3 semanas y Apgar 7/9. El reporte de patología fue: proliferación anormal del trofoblasto, vesículas y vellosidades hidrópicas. La paciente continuó en seguimiento semanal sin complicaciones aparentes. CONCLUSIONES: el embarazo molar con feto vivo es una alteración poco frecuente. El diagnóstico temprano, seguimiento prenatal estrecho y tratamiento multidisciplinario representan factores importantes para la viabilidad del recién nacido.

Abstract BACKGROUND: The partial or incomplete mole represents 30% of gestational trophoblastic diseases. However, the incidence of partial mole with a viable fetus is an uncommon presentation, with an incidence of 1 per 100,000 pregnancies. CASE REPORT: a 27-year-old female with a gyneco-obstetric history of 3 pregnancies and 2 births, without comorbidities or alterations of importance for the current condition; pregnancy of 30.1 weeks according to the date of last menstruation and diagnosis of gestational trophoblastic disease (partial spring), placenta previa and arcuate uterus. The ultrasound evidenced hydropic vesicles, compatible with gestational trophoblastic disease (incomplete mole). The amniocentesis was performed at 16.3 weeks of pregnancy. The karyotype 46, XX was found. It was decided to terminate the pregnancy by emergency cesarean section. Since it was a pregnancy with high morbidity and mortality, and the patient had parity satisfied, it was decided to perform a cesarean-hysterectomy using the Esperanza-Bautista technique. A female newborn was born, weighing 1416 g, Capurro 3 weeks and APGAR 7/9. The pathology report was abnormal proliferation of the trophoblast, vesicles and villi. At the moment the patient remains in weekly follow-up with no apparent complications. CONCLUSIONS: Molar pregnancy with a viable fetus has an infrequent presentation. Early diagnosis, close prenatal follow-up, and multidisciplinary management condition perinatal success.

Imagen de esofagitis en el inmunocompetente: posibilidades diagnósticas / Esophagitis imaging in the immunocompetent: Diagnostic possibilities

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Secuela de fractura de pelvis. A propósito de un caso y revisión de la literatura / Pelvis fracture sequelae. A case report and literature review

Objetivos: Presentación y análisis crítico de paciente con secuela post-fractura de pelvis que permita exponer la complejidad de su manejo y tratamiento. Caso clínico: Mujer de 29 años con dolor invalidante en región sacroilíaca a la sedestación y la marcha. Exploración: Deformidad externa pélvica con repercusión estética, dismetría de miembro inferior izquierdo de 4 cm y dolor sacroilíaco a la apertura pélvica o al apoyo monopodal izquierdo. Limitación funcional a la marcha con cojera y problemas de sedestación (sitting imbalance). Estudio radiográfico convencional y TAC con signos de asimetría pélvica, elevación de hemipelvis izquierda y pseudoartrosis sacra y de ramas ilioisquiopubianas izquierdas post-fractura. Diagnóstico: Secuela compleja de Fractura de Pelvis con deformidad, tipo III de Mears y Velyvis. Tratamiento: Secuenciado en 2 fases. (1) Liberación Anterior: Desarticulación sinfisaria, esqueletización de ramas y osteotomía sacra anterior. Liberación Posterior: Liberación ligamentos suelo pélvico y osteotomía sacra posterior. Tracción progresiva de la extremidad izquierda 2 semanas. (2) Osteosíntesis Anterior: Fijación sacroilíaca anterior con placa de reconstrucción, doble placa anterior sinfisaria y aporte de autoinjerto. Osteosíntesis Posterior: Fijación posterior mediante barra transilíaca. Evolución: Infección herida quirúrica posterior que se resolvió con curas quirúrgicas y antibioterapia. Se consiguió disminución del nivel de dolor, resolución del trastorno de sedestación y mejora de la cojera. SF-36 con PCS 60 y MCS de 50, Majeed-Score excelente. Discusión: La pseudoartrosis y la deformidad son entidades infrecuentes generadas por tratamientos conservadores o inadecuados en lesiones con gran inestabilidad pélvica. El tratamiento puede ser realizado de forma directa o en varias fases. Los pacientes deben ser informados de que el tratamiento implica riesgos más elevados que respecto a la cirugía aguda convencional. Suele obtener mejoras en resultados de consolidación y funcionalidad. El paciente aquí referido ha sido tratado de forma análoga a lo establecido por la comunidad científica, a pesar de ello, no existe evidencia clínica respecto a protocolos de manejo en dicha enfermedad. La realización de estudios multicéntricos ayudaría a la comprensión de los patrones lesionales y al desarrollo de herramientas estandarizadas de tratamiento. Conclusión: La secuela de la fractura pélvica es una entidad compleja de dificultosa resolución y difícil manejo incluso para expertos en dicha materia. Es preciso un abordaje multidisciplinar de dichos paciente en centros de tercer nivel para la obtención de los mejores resultados en esta patología (AU)

Objectives: Critical assessment of a case report related to complications in pelvis fracture. The aim is to determine the complexity in management and treatment of pelvic sequelae. Case Report: 29 years old woman with disabling pain in sacroiliac joint when sitting and walking. External pelvic deformity with aesthetic evidence, left lower limb with 4 cm dysmetria and sacroiliac pain pelvic when examination maneuvers opening pelvis or standing on one foot. Functional limitation with sitting and gait problems. Conventional X-rays and CT-scan reveal pelvic asymmetry, upper left hemipelvis and nonunions in sacrum and left ilioischiopubic ramus fractures. Diagnosis: Pelvic fracture complication Velyvis and Mears type III. A two phases sequenced treatment was performed: (1) Anterior Release: Symphyseal disjoint, branches skeletonization and anterior sacral osteotomy. Posterior Release: Posterior sacroiliac complex and pelvic floor ligaments release with posterior sacral osteotomy. Progressive left extremity traction 2 weeks. (2) Anterior Osteosynthesis: Anterior sacroiliac fixation with reconstruction plate, double symphyseal plate and patient bonegrafting. Posterior Osteosynthesis: Transiliac bar. Outcome with surgical wound infection solved with antibiotics and surgical treatment. A pain decrease, sitting disorder resolution and improvement of lameness was achieved. SF-36 with 60 PCS and 50 MCS. Excelent Majeed-Score. Discussion: Pelvic malalignement and nonunions are rare entities, usually associated with initial conservative or inadequate treatment in pelvic instable fractures. Treatment may be accomplished directly or in stages. Patients should be informed that treatment involves higher risks than over conventional acute surgery. It often obtains improved consolidation and functionality results. The patient here referred has been treated similarly to that established by the scientific community, nevertheless, there is no clinical evidence regarding management protocols in the disease. Multicenter studies would help the understanding about patterns and development of standardized treatment algorithms. Conclusion: Pelvic fracture complications are complex entities. It involves a hard resolution and difficult management even for expert surgeons. A multidisciplinary approach of these patients in tertiary centers is needed to obtain the best results in this pathology (AU)

Anomalía congénita portal como causa de hemorragia digestiva alta / Congenital abnormality of the portal vein as cause of upper digestive tract bleeding

La hemorragia digestiva alta (HDA), es aquella cuyo origen se encuentra en segmentos del tracto digestivo situados por encima del ángulo de Treitz. Entre sus posibles causas, destaca por su importancia la hipertensión portal. Presentamos el caso de un paciente de 4 años que debutó con hemorragia digestiva alta, como consecuencia de hipertensión portal prehepática secundaria a anomalía congénita de ramas portales (AU)

Upper gastrointestinal bleeding is the one whose origin is in the digestive tract segments located above the Treitz angle. Among the possible causes, noted for its importance portal hypertension. We report the case of a male 4 year old with upper gastrointestinal bleeding because of prehepatic portal hypertension secondary to congenital anomaly portal branches (AU)

Colitis ulcerosa: a propósito de un caso / Ulcerative colitis: a case report

La incidencia de la enfermedad inflamatoria intestinal ha experimentado un aumento en los últimos años, y los recientes avances aparecidos, tanto en su diagnóstico como en su tratamiento, obligan a reenfocar el problema desde Atención Primaria. Por eso nos ha parecido oportuno presentar un caso reciente de colitis ulcerosa atendido en nuestro centro (AU)

The incidence of inflammatory bowel disease has increased in the last years. Recent advances that have appeared in diagnosis and treatment make necessary to refocus the problem from primary care. So we felt appropriate to present a recent case of ulcerative colitis treated at our primary health care centre (AU)