Diphtheritic angina in the tongue and floor of the mouth: unusual presentation.

Diphtheria is an infectious disease caused by Corynebacterium diphtheriae, and is generally characterised by proliferation of the bacteria in the upper respiratory tract, formation of a pseudomembrane, and systemic diffusion of the diphtheria toxin throughout the body. We present the case of a young man with pseudomembranous plaques on the tongue and floor of the mouth, who received systemic and locoregional medical treatment, with a satisfactory outcome after 14 days.

[New case of intradural extramedullary capillary haemangioma]. / Nuevo caso de hemangioma capilar intradural extramedular.

TITLE: Nuevo caso de hemangioma capilar intradural extramedular.

Disrupting LXRα phosphorylation promotes FoxM1 expression and modulates atherosclerosis by inducing macrophage proliferation.

Macrophages are key immune cells for the initiation and development of atherosclerotic lesions. However, the macrophage regulatory nodes that determine how lesions progress in response to dietary challenges are not fully understood. Liver X receptors (LXRs) are sterol-regulated transcription factors that play a central role in atherosclerosis by integrating cholesterol homeostasis and immunity. LXR pharmacological activation elicits a robust antiatherosclerotic transcriptional program in macrophages that can be affected by LXRα S196 phosphorylation in vitro. To investigate the impact of these transcriptional changes in atherosclerosis development, we have generated mice carrying a Ser-to-Ala mutation in myeloid cells in the LDL receptor (LDLR)-deficient atherosclerotic background (M-S196ALdlr-KO). M-S196ALdlr-KO mice fed a high-fat diet exhibit increased atherosclerotic plaque burden and lesions with smaller necrotic cores and thinner fibrous caps. These diet-induced phenotypic changes are consistent with a reprogramed macrophage transcriptome promoted by LXRα-S196A during atherosclerosis development. Remarkably, expression of several proliferation-promoting factors, including the protooncogene FoxM1 and its targets, is induced by LXRα-S196A. This is consistent with increased proliferation of plaque-resident cells in M-S196ALdlr-KO mice. Moreover, disrupted LXRα phosphorylation increases expression of phagocytic molecules, resulting in increased apoptotic cell removal by macrophages, explaining the reduced necrotic cores. Finally, the macrophage transcriptome promoted by LXRα-S196A under dietary perturbation is markedly distinct from that revealed by LXR ligand activation, highlighting the singularity of this posttranslational modification. Overall, our findings demonstrate that LXRα phosphorylation at S196 is an important determinant of atherosclerotic plaque development through selective changes in gene transcription that affect multiple pathways.

The Boltzmann project.

The International Committee for Weights and Measures (CIPM), at its meeting in October 2017, followed the recommendation of the Consultative Committee for Units (CCU) on the redefinition of the kilogram, ampere, kelvin and mole. For the redefinition of the kelvin, the Boltzmann constant will be fixed with the numerical value 1.380 649 × 10-23 J K-1. The relative standard uncertainty to be transferred to the thermodynamic temperature value of the triple point of water will be 3.7 × 10-7, corresponding to an uncertainty in temperature of 0.10 mK, sufficiently low for all practical purposes. With the redefinition of the kelvin, the broad research activities of the temperature community on the determination of the Boltzmann constant have been very successfully completed. In the following, a review of the determinations of the Boltzmann constant k, important for the new definition of the kelvin and performed in the last decade, is given.

Tratamiento de la artrosis escafotrapeciotrapezoidea aislada con artroplastia de recubrimiento con anclaje escafoideo / Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage

Objetivo. El propósito de este estudio es mostrar los resultados obtenidos con el empleo de la artroplastia de recubrimiento con anclaje escafoideo en el tratamiento de la artrosis escafotrapeciotrapezoidea (ETT) aislada. Material y método. Se realiza un estudio observacional, descriptivo y retrospectivo del tratamiento de 10 pacientes con artrosis ETT aislada sintomática durante los años 2013 a 2015. El seguimiento medio es de 26meses (12-50). Se han evaluado los resultados clínicos, los funcionales y la satisfacción del paciente. Resultados. Los pacientes se encuentran satisfechos, obteniendo una media de 2,1 (0-3) en la escala VAS y de 16 (2-28) en el cuestionario DASH, reincorporándose a las actividades laborales en los primeros 3meses posquirúrgicos. La recuperación del arco de movilidad en comparación con la muñeca contralateral es del 96% en extensión, del 95% en flexión, del 87% en inclinación cubital y del 91% en inclinación radial. La fuerza puño media es del 95% y la fuerza de pinza, del 95%, en comparación con el lado contralateral. No han surgido complicaciones intraoperatorias ni alteraciones en la alineación carpiana posquirúrgicas. Conclusiones. La artroplastia de recubrimiento con anclaje escafoideo supone una alternativa novedosa y satisfactoria en el tratamiento de la artrosis ETT aislada. Lograr un balance adecuado entre la fuerza y la movilidad de la muñeca, sin producir una desestabilización carpiana, es importante para obtener resultados clínicos y funcionales satisfactorios (AU)

Objective. The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. Material and method. An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. Results. The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. Conclusion. Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results (AU)

Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage. / Tratamiento de la artrosis escafotrapeciotrapezoidea aislada con artroplastia de recubrimiento con anclaje escafoideo.

OBJECTIVE: The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. MATERIAL AND METHOD: An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. RESULTS: The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. CONCLUSION: Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results.

Highly accurate intensity factors of pure CO2 lines near 2 µm.

Line intensities for carbon dioxide are measured with a novel spectroscopic approach, assisted by an optical frequency comb synthesizer for frequency calibration purposes. The main feature of the spectrometer consists in the exploitation of optical feedback from a V-shaped high-finesse optical resonator to effectively narrow a distributed feedback diode laser at the wavelength of 2 µm. Laser-gas interaction takes place inside an isothermal cell, which is placed on the transmission from the cavity. High quality, self-calibrated, absorption spectra are observed in pure CO2 samples at different gas pressures, in coincidence with three lines of the R-branch of the ν1 + 2ν2 + ν3 band. Line intensities are determined using a global fitting approach in which a manifold of spectra are simultaneously analyzed across the range of pressures between 5 and 100 Torr, sharing a restricted number of unknown parameters. Various sources of uncertainty have been identified and carefully quantified, thus leading to an overall uncertainty ranging between 0.17% and 0.23%. The measured values are in a very good agreement with recent ab initio predictions.

Gait Disorder in a Cohort of Patients With Mild and Moderate Alzheimer's Disease.

Gait disturbance results in an increase in the risk of falls in patients with Alzheimer's disease (AD). The falls are events that might be related to an increase in the number of fractures, loss of mobility, being bedridden, early institutionalization, and increased use of medication. Therefore, the reduction in the number of falls is important for the maintenance of the functional independence of the patients as well as for the prevention of sequelae resulting from those events. Alterations in the gait occur very frequently in AD, and the gait disturbance occurs relatively early in the course of the disease. This study has important implications for public health and clinical practice. This study and previous studies have reported that abnormal gait predicts greater risk of falls, dementia, institutionalization, and death. The high prevalence and incidence of abnormal gait and its association with multiple adverse outcomes in older adults require urgent attention. Our results allow us to identify the risk factors.

A prospective, active haemovigilance study with combined cohort analysis of 19,175 transfusions of platelet components prepared with amotosalen-UVA photochemical treatment.

BACKGROUND AND OBJECTIVES: A photochemical treatment process (PCT) utilizing amotosalen and UVA light (INTERCEPT(™) Blood System) has been developed for inactivation of viruses, bacteria, parasites and leucocytes that can contaminate blood components intended for transfusion. The objective of this study was to further characterize the safety profile of INTERCEPT-treated platelet components (PCT-PLT) administered across a broad patient population. MATERIALS AND METHODS: This open-label, observational haemovigilance programme of PCT-PLT transfusions was conducted in 21 centres in 11 countries. All transfusions were monitored for adverse events within 24 h post-transfusion and for serious adverse events (SAEs) up to 7 days post-transfusion. All adverse events were assessed for severity (Grade 0-4), and causal relationship to PCT-PLT transfusion. RESULTS: Over the course of 7 years in the study centres, 4067 patients received 19,175 PCT-PLT transfusions. Adverse events were infrequent, and most were of Grade 1 severity. On a per-transfusion basis, 123 (0.6%) were classified an acute transfusion reaction (ATR) defined as an adverse event related to the transfusion. Among these ATRs, the most common were chills (77, 0.4%) and urticaria (41, 0.2%). Fourteen SAEs were reported, of which 2 were attributed to platelet transfusion (<0.1%). No case of transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, transfusion-transmitted infection or death was attributed to the transfusion of PCT-PLT. CONCLUSION: This longitudinal haemovigilance safety programme to monitor PCT-PLT transfusions demonstrated a low rate of ATRs, and a safety profile consistent with that previously reported for conventional platelet components.

Characterization of the frequency stability of an optical frequency standard at 1.39 µm based upon noise-immune cavity-enhanced optical heterodyne molecular spectroscopy.

Frequency fluctuations of an optical frequency standard at 1.39 µm have been measured by means of a highly-sensitive optical frequency discriminator based on the fringe-side transmission of a high finesse optical resonator. Built on a Zerodur spacer, the optical resonator exhibits a finesse of 5500 and a cavity-mode width of about 120 kHz. The optical frequency standard consists of an extended-cavity diode laser that is tightly stabilized against the center of a sub-Doppler H(2) (18)O line, this latter being detected by means of noise-immune cavity-enhanced optical heterodyne molecular spectroscopy. The emission linewidth has been carefully determined from the frequency-noise power spectral density by using a rather simple approximation, known as ß-line approach, as well as the exact method based on the autocorrelation function of the laser light field. It turns out that the linewidth of the optical frequency standard amounts to about 7 kHz (full width at half maximum) for an observation time of 1 ms. Compared to the free-running laser, the measured width corresponds to a line narrowing by a factor of ~220.

La cirugía del síndrome del túnel carpiano en pacientes de edad avanzada / The surgery of carpal tunnel syndrome in elderly patients

Objetivo: Presentamos los resultados a largo plazo de la cirugía de descompresión del nervio mediano en la muñeca en pacientes de edad avanzada. Métodos: Estudio prospectivo histórico, de larga evolución, en 98 pacientes intervenidos de síndrome del túnel carpiano, considerados por grupos de edad, con un tiempo postoperatorio medio de diez años. Se realizó la valoración con el cuestionario clínico-funcional de Levine, electromiografía y dinamometría de los pacientes estudiados. Resultados: Para la mayor parte de las preguntas del cuestionario de Levine, así como para los valores de velocidad sensitiva y latencia motora del nervio mediano, encontramos diferencias favorables con respecto a la valoración preoperatoria. Sin embargo, los datos de fuerza de presión manual fueron desfavorables. Conclusiones: En pacientes de edad avanzada, la sección completa del ligamento transverso del carpo permite mantener diferencias favorables en la mayoría de los parámetros estudiados tras diez años desde la cirugía, siendo el tratamiento quirúrgico una opción recomendable(AU)

Purpose: We present in this article the long term outcomes of median nerve release at the wrist in elderly patients. Methods: Historical prospective long term study over 98 patients that received surgical treatment of carpal tunnel syndrome considered by aging and with a mean follow-up of ten years. A clinical-functional (with the Levine Questionnaire), electromyographic and dynamometric evaluation of the patients studied have been carried out. Results: For most of the items of the Questionnaire of Levine, as well as for the values of sensitive velocity and motor latency of the median nerve, we have found favourable differences with respect to the preoperative evaluation. The data of grip strength are unfavourable. Conclusions: In elderly patients, complete section of the carpal transverse ligament, allows maintaining favourable differences in most of the parameters studied, after ten years from the surgery, being the surgical treatment a recommendable option(AU)

Determination of the Boltzmann constant by means of precision measurements of H2(18)O line shapes at 1.39 µm.

We report on a new implementation of Doppler broadening thermometry based on precision absorption spectroscopy by means of a pair of offset-frequency locked extended-cavity diode lasers at 1.39 µm. The method consists in the highly accurate observation of the shape of the 4(4,1)→4(4,0) line of the H2(18)O ν1+ν3 band, in a water vapor sample at thermodynamic equilibrium. A sophisticated and extremely refined spectral analysis procedure is adopted for the retrieval of the Doppler width as a function of the gas pressure, taking into account the Dicke narrowing effect, the speed dependence of relaxation rates, and the physical correlation between velocity-changing and dephasing collisions. A spectroscopic determination of the Boltzmann constant with a combined (type A and type B) uncertainty of 24 parts over 10(6) is reported. This is the best result obtained so far by means of an optical method. Our determination is in agreement with the recommended CODATA value.

Velocity effects on the shape of pure H2O isolated lines: complementary tests of the partially correlated speed-dependent Keilson-Storer model.

Complementary tests of the partially correlated speed-dependent Keilson-Storer (pCSDKS) model for the shape of isolated transition of pure water vapor [N. H. Ngo et al., J. Chem. Phys. 136, 154310 (2012)] are made using new measurements. The latter have been recorded using a high sensitivity cavity ring down spectrometer, for seven self-broadened H(2)O lines in the 1.6 µm region at room temperature and for pressures from 0.5 to 15 Torr. Furthermore, the H(2) (18)O spectra of [M. D. De Vizia et al., Phys. Rev. A 83, 052506 (2011)] in the 1.38 µm region, measured at 273.15 K and for pressures from 0.3 to 3.75 Torr have also been used for comparison with the model. Recall that the pCSDKS model takes into account the collision-induced velocity changes, the speed dependences of the broadening and shifting coefficients as well as the partial correlation between velocity and rotational-state changes. All parameters of the model have been fixed at values previously determined, except for a scaling factor applied to the input speed-dependent line broadening. Comparisons between predictions and experiments have been made by looking at the results obtained when fitting the calculated and measured spectra by Voigt profiles. The good agreement obtained for all considered lines, at different temperature and pressure conditions, confirms the consistency and the robustness of the model. Limiting cases of the model have been then derived, showing the influence of different contributions to the line shape.

Neuroimagen en los parkinsonismos: resonancia magnética y sonografía transcraneal / Neuroimaging in parkinsonisms: magnetic resonance imaging and transcranial sonography

Introducción. El diagnóstico diferencial de los síndromes parkinsonianos puede ser difícil, especialmente en las fases iniciales. Diversas pruebas neurorradiológicas podrían ser de ayuda. Objetivo. Describir los hallazgos típicos de la resonancia magnética (RM) craneal y sonografía transcraneal en la parálisis supranuclear progresiva (PSP), degeneración corticobasal (DCB) y atrofia multisistémica (AMS). Desarrollo. El hallazgo más típico de la PSP en los estudios de RM craneal es la atrofia del mesencéfalo. A nivel cerebral se puede observar atrofia talámica, dilatación del tercer ventrículo, y atrofia simétrica del lóbulo frontal, cuerpo estriado y cuerpo calloso. En la DCB es característica la atrofia cortical asimétrica de predominio frontoparietal. Y en la AMS se puede observar atrofia de putamen, cerebelo y tronco encefálico, así como alteraciones en la intensidad de señal en T2 como hipointensidad putaminal, hiperintensidad en el margen posterolateral del putamen, e hiperintensidad en cruz protuberancial. En la sonografía transcraneal la hiperecogenicidad de sustancia negra orientará hacia una enfermedad de Parkinson (EP) o DCB. En la PSP es característica la dilatación del III ventrículo. En la PSP, DCB, y AMS puede haber hiperecogenicidad en los núcleos lenticular y caudado, hallazgos infrecuentes en EP. Conclusión. El conocimiento de estos hallazgos en los estudios de neuroimagen puede aumentar la precisión diagnóstica de los síndromes parkinsonianos atípicos (AU)

Introduction. The differential diagnosis of parkinsonian syndromes can be difficult, especially in the early stages, but there are several different neuroimaging tests that could be a valuable aid. Aims. The purpose of this study is to describe the typical findings in magnetic resonance imaging (MRI) of the head and transcranial sonography in progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and multiple system atrophy (MSA). Development. The most typical finding of PSP in MRI studies of the head is atrophy of the mesencephalon. In the brain, thalamic atrophy, dilatation of the third ventricle and symmetrical atrophy of the frontal lobe, striatum and corpus callosum can all be seen. CBD is characterised by asymmetrical cortical atrophy with frontoparietal predominance. And in MSA it is possible to observe atrophy of the putamen, cerebellum and brain stem, as well as alterations in the T2 signal intensity, such as putaminal hypointensity, hyperintensity in the posterolateral margin of the putamen, and cruciform hyperintensity in the pons. In the transcranial sonography scan the hyperechogenicity of the substantia nigra is suggestive of Parkinson's disease (PD) or CBD. PSP is characterised by dilatation of the 3rd ventricle. In PSP, CBD and MSA there may be hyperechogenicity in the lenticular and caudate nuclei, which are infrequent findings in PD. Conclusions. Knowledge of these findings in neuroimaging studies can increase the accuracy of the diagnoses in the atypical parkinsonian síndromes (AU)

The long-term post-operative electromyographic evaluation of patients who have undergone carpal tunnel decompression.

We present the electromyographic (EMG) results ten years after open decompression of the median nerve at the wrist and compare them with the clinical and functional outcomes as judged by Levine's Questionnaire. This retrospective study evaluated 115 patients who had undergone carpal tunnel decompression at a mean of 10.47 years (9.24 to 11.36) previously. A positive EMG diagnosis was found in 77 patients (67%), including those who were asymptomatic at ten years. It is necessary to include both clinical and functional results as well as electromyographic testing in the long-term evaluation of patients who have undergone carpal tunnel decompression particularly in those in whom revision surgery is being considered. In doubtful cases or when there are differing outcomes, self-administered scales such as Levine's Questionnaire should prevail over EMG results when deciding on the need for revision surgery.

La Clasificación Internacional de Funcionamiento (CIF) en la elaboración de un protocolo de evaluación del daño cerebral / The International Classification of Functioning, Disability and Health (ICF) for the development of an assessment protocol in brain injury patients

Objetivo: Evaluar la eficacia de un programa de rehabilitación individualizado (PRI) basado en la CIF en pacientes con accidentes cerebrovasculares (ACV). Material y método: Treinta y seis pacientes con ACV fueron sometidos a PRI según sus capacidades preservadas y factores personales. Se evaluaron distintas áreas antes y después del PRI con la CIF y otras escalas. Se compararon las diferentes puntuaciones pre y post tratamiento de las funciones corporales, actividades y factores ambientales. La muestra se dividió en dos grupos según tuvieran una evolución del ACV mayor o menor de cinco años. Resultados: Encontramos mejor respuesta al tratamiento en pacientes con menos de cinco años de evolución y obtuvimos correlaciones significativas entre actividades relacionadas con andar, hablar y comer, así como en aquellas funciones implicadas en dichas actividades como la recepción y expresión de lenguaje,las funciones integradoras del lenguaje y la fuerza muscular. Conclusión: Un PRI basado en la CIF como herramienta clínica mejora tanto el grado de funcionalidad como la autonomía en los pacientes con ACV (AU)

Objective: To evaluate the effectiveness of an individualized rehabilitation program (PRI) based on the ICF in stroke patients. Material and method: Thirty-six subjects with stroke underwent a PRI based on their preserved capacities, personal and contextual factors. Assessment was focused on different rehabilitation areas before and after the PRI with the CIF and different scales. We compared pre- and post-treatment punctuations regarding body functions, activities and environmental factors. The sample was divided into two groups: less than five and more than five years after stroke. Results: We observed greater treatment response in patients with less than five years of evolution. It was obtained high correlations between activity items related to walking, speaking and eating, as well as in body function items involved in reception and expression of language, integrative language functions and body muscles strength. Conclusion: The development of a PRI based on the ICF as a clinical tool improves the degree of functionality and autonomy in patients with stroke (AU)

Reproducibility of observables and coherent control in molecular photoionization: from continuous wave to ultrashort pulsed radiation.

One-photon single ionization of molecules has been at the focus of several discussions concerning the reconstruction of observables obtained with ultrashort pulses from those obtained from continuous wave radiation (and vice versa). A related controversy on the conditions and observables that allow for coherent control in one-photon processes has been recently revisited (Science 2006, 313, 1257; J. Chem. Phys. 2010, 133, 151101). Our benchmark to investigate these issues is photoionization of the hydrogen molecule, where the autoionization events are the time-dependent processes in field-free evolution that could serve as a target for coherent control. We show that the variation of one-photon ionization probabilities with pulse duration are solely due to spectral effects and thus cannot be coherently controlled. We then discuss for which observables and under which conditions phase control of autoionization dynamics is possible.

High-precision molecular interrogation by direct referencing of a quantum-cascade-laser to a near-infrared frequency comb.

This work presents a very simple yet effective way to obtain direct referencing of a quantum-cascade-laser at 4.3 µm to a near-IR frequency-comb. Precise tuning of the comb repetition-rate allows the quantum-cascade-laser to be scanned across absorption lines of a CO2 gaseous sample and line profiles to be acquired with extreme reproducibility and accuracy. By averaging over 50 acquisitions, line-centre frequencies are retrieved with an uncertainty of 30 kHz in a linear interaction regime. The extension of this methodology to other lines and molecules, by the use of widely tunable extended-cavity quantum-cascade-lasers, paves the way to a wide availability of high-quality and traceable spectroscopic data in the most crucial region for molecular detection and interrogation.

Observing the intrinsic linewidth of a quantum-cascade laser: beyond the Schawlow-Townes limit.

A comprehensive investigation of the frequency-noise spectral density of a free-running midinfrared quantum-cascade laser is presented for the first time. It provides direct evidence of the leveling of this noise down to a white-noise plateau, corresponding to an intrinsic linewidth of a few hundred hertz. The experiment is in agreement with the most recent theory on the fundamental mechanism of line broadening in quantum-cascade lasers, which provides a new insight into the Schawlow-Townes formula and predicts a narrowing beyond the limit set by the radiative lifetime of the upper level.