Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution.

OBJECTIVE: To assess the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids on fertility. MATERIAL AND METHODS: A retrospective observational study was conducted of 560 reproductive-age women with symptomatic uterine fibroids who underwent USgHIFU therapy at Mútua Terrassa University Hospital, Spain, between February 2008 and February 2018. We analyzed pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes and complications during pregnancy and delivery. RESULTS: After USgHIFU treatment, 71 pregnancies were obtained in 55 patients. Of these, 58 (82%) cases were natural pregnancies and 13 (18%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 12 (range 1-72) months. There were 43 (61%) successful deliveries, including a twin gestation, 22 (31%) spontaneous abortions and 6 (8%) therapeutic abortions. The rate of full-term deliveries was 91% (39/43) and the remaining 9% (4/43) were preterm deliveries. Of the 44 live births, 25 (57%) were born vaginally and 19 (43%) by cesarean section. The complications reported included 3 women with retained placenta (7%), 2 with placenta previa (5%) and 1 with severe preeclampsia (2%). The mean birth weight was 3.1 (range: 1.4-4.3) kg, and except for a baby born with a tetralogy of Fallot, all newborns developed well without complications during postpartum and breastfeeding. CONCLUSION: Patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postpartum complications. More studies are required to compare fertility and perinatal outcomes between patients who underwent or not USgHIFU.

Enfermedades reumatológicas en la columna vertebral: diagnóstico radiológico / Rheumatic diseases of the spine: imaging diagnosis

La afectación raquídea es frecuente tanto en las espondiloartritis como en la artritis reumatoide, la cual afecta selectivamente al segmento cervical. La afectación reumatoide de la columna cervical presenta unas manifestaciones radiológicas típicas, fundamentalmente en forma de varios tipos de patrones de inestabilidad articular atloaxoidea. La resonancia magnética (RM) es la técnica de elección para evaluar la posible repercusión mielorradicular de la inestabilidad atloaxoidea en los pacientes con artritis reumatoide, así como para evaluar parámetros indicativos de inflamación activa, como el edema óseo y la sinovitis. La afectación axial es característica en las espondiloartritis y presenta unas manifestaciones radiográficas distintivas, que reflejan fenómenos destructivos y reparativos. El uso de la RM ha cambiado la concepción de la espondiloartritis al conseguir detectar de manera directa los cambios inflamatorios propios de la enfermedad, permitiendo establecer un diagnóstico precoz cuando las radiografías son normales (espondiloartritis axial no radiográfica), evaluar el pronóstico de la enfermedad y contribuir a la planificación del tratamiento (AU)

Spinal involvement is common both in the spondyloarthritides and in rheumatoid arthritis, in which the cervical segment is selectively affected. Rheumatoid involvement of the cervical spine has characteristic radiologic manifestations, fundamentally different patterns of atlantoaxial instability. Magnetic resonance imaging (MRI) is the technique of choice for evaluating the possible repercussions of atlantoaxial instability on the spinal cord and/or nerve roots in patients with rheumatoid arthritis as well as for evaluating parameters indicative of active inflammation, such as bone edema and synovitis. Axial involvement is characteristic in the spondyloarthritides and has distinctive manifestations on plain-film X-rays, which reflect destructive and reparative phenomena. The use of MRI has changed the conception of spondyloarthritis because it is able to directly detect the inflammatory changes that form part of the disease, making it possible to establish the diagnosis early in the disease process, when plain-film X-ray findings are normal (non-radiographic axial spondyloarthritis), to assess the prognosis of the disease, and to contribute to treatment planning (AU)

Rheumatic diseases of the spine: imaging diagnosis. / Enfermedades reumatológicas en la columna vertebral: diagnóstico radiológico.

Spinal involvement is common both in the spondyloarthritides and in rheumatoid arthritis, in which the cervical segment is selectively affected. Rheumatoid involvement of the cervical spine has characteristic radiologic manifestations, fundamentally different patterns of atlantoaxial instability. Magnetic resonance imaging (MRI) is the technique of choice for evaluating the possible repercussions of atlantoaxial instability on the spinal cord and/or nerve roots in patients with rheumatoid arthritis as well as for evaluating parameters indicative of active inflammation, such as bone edema and synovitis. Axial involvement is characteristic in the spondyloarthritides and has distinctive manifestations on plain-film X-rays, which reflect destructive and reparative phenomena. The use of MRI has changed the conception of spondyloarthritis because it is able to directly detect the inflammatory changes that form part of the disease, making it possible to establish the diagnosis early in the disease process, when plain-film X-ray findings are normal (non-radiographic axial spondyloarthritis), to assess the prognosis of the disease, and to contribute to treatment planning.

Using microbubble sonographic contrast agent to enhance the effect of high intensity focused ultrasound for the treatment of uterine fibroids.

OBJECTIVE: To evaluate the effects of the ultrasound contrast agent SonoVue in enhancing the ablative effects of Ultrasound-Guided high-intensity focused ultrasound (HIFU) on different sub-types of uterine fibroids. MATERIALS AND METHODS: In this study, 390 fibroids from 319 patients were retrospectively evaluated, among which 155 were treated with SonoVue and 235 were without SonoVue during HIFU ablation. The efficacy of HIFU was evaluated using magnetic resonance scanning (MRI) in all patients. RESULTS: The total ablation time to achieve the same non-perfused volume was significantly shortened with SonoVue. The average energy used and the acoustic energy for treating 1 mm(3) (EEF) was less when SonoVue is used as enhancing agent. The non-perfused volume (NPV) was measured by post-HIFU MRI and the mean fractional ablation was calculated. Mean NPV was 74% (range: 15%-100%) in the HIFU-only group and 75% (range: 17%-100%) in the HIFU+ SonoVue group. However, for T2 MRI low intensity signal fibroids, NPV in the SonoVue group reached 83% (range: 20%-100%) that was significantly higher than in the HIFU-only group, which was 76% (range: 15%-100%). No differences in adverse events were observed between the two groups. CONCLUSIONS: Our observations demonstrate that the use of therapeutic SonoVue during the HIFU procedure can significantly decrease the ablation time and the energy requirement for the treatment of the same fibroid volume in all types of fibroids.

Cobalt-56 γ-ray emission lines from the type Ia supernova 2014J.

A type Ia supernova is thought to be a thermonuclear explosion of either a single carbon-oxygen white dwarf or a pair of merging white dwarfs. The explosion fuses a large amount of radioactive (56)Ni (refs 1-3). After the explosion, the decay chain from (56)Ni to (56)Co to (56)Fe generates γ-ray photons, which are reprocessed in the expanding ejecta and give rise to powerful optical emission. Here we report the detection of (56)Co lines at energies of 847 and 1,238 kiloelectronvolts and a γ-ray continuum in the 200-400 kiloelectronvolt band from the type Ia supernova 2014J in the nearby galaxy M82. The line fluxes suggest that about 0.6 ± 0.1 solar masses of radioactive (56)Ni were synthesized during the explosion. The line broadening gives a characteristic mass-weighted ejecta expansion velocity of 10,000 ± 3,000 kilometres per second. The observed γ-ray properties are in broad agreement with the canonical model of an explosion of a white dwarf just massive enough to be unstable to gravitational collapse, but do not exclude merger scenarios that fuse comparable amounts of (56)Ni.

Sistemas de distribución de enrgía en grandes coplejos hospitalarios: criterios de decisióne estratégicos / Power distribution systems in large hospital complexes: strategic decision criteria

La estrategia de prodcción y distribución de energía es una de las primeras decisiones que hay que tomar en el planteamiento de las soluciones técnicas de losg randes complejos hospitalarios, pues tendrá afectaciones importantes en la reserva de espacio, inraestructuras de ocmunicaciones y gestiónenergética y en las condiciones de explotación del centro hospitalario. Esta decisión es más compleja cuanto mayor es el centro hospitalario y mucha veces se resuelve sin un análisis completo de alternativas y de su impacto en la futura operación del edificio. Se presenta en este artículo el proceso seguido para un caso particular: el nuevo hospital San Pedro de Logroño, de 126.000 m2 y 630 cmas, exponiendo los criterios seguidos para la definición del sistema, así ocmo su posible generalización a otros casos. El artículo se centra en el sistemas de distribución energético y no aborda el sisema de producción. El “nuevo” hospital es, de hecho el resultado de la reforma y ampliación del hospital existente, de mcha menor dimensión y del que básicamente se han conservad s´lo las plantas de hospitalización. A partir de una solución inical planteada desde una centraliación eergética y dsribucióna puntos de consumo se trabajan dos posibles alternativas: la producción localizada en los diferentes edificios del complejo (eliminando así los sistemas de distribución) y la producción cnetralizada pero con doble sistema de dsitribución: anillo promario y conexiones secundarias. Se analizan los diferentes criterios de decisión a tener en cuenta: criterios funcionales y criterios económicos (AU)

Through this article and the particular case of the new Hospital San Pedro de Logroño, set out the criteria for defining the system and its possible generalization to other cases focusing on the energy distribution system (AU)

De la anatomía patológica convencional a los nuevos perfiles genéticos del cáncer de mama / No disponible

La mortalidad por cáncer de mama se ha reducido graciasal diagnóstico precoz y a los tratamientos adyuvantes. Losefectos secundarios, toxicidades potenciales y el coste de lostratamientos sistémicos condicionan la individualización terapéuticacon una mejor selección de las pacientes. La heterogeneidaddel cáncer de mama nos obliga a considerar los factorespronósticos y predictivos.Desde hace 25 años clasificamos el cáncer de mama según sutipo histológico, grado y expresión de los receptores hormonales.Desde hace 15 años, gracias a la aplicación de las técnicas dehibridación in situ de los ácidos nucleicos, los tumores se clasificanen HER2 sobre-expresado o no sobre-expresado. Desdehace menos de 5 años se han definido distintos patrones de expresióngenética que nos aportan una nueva clasificación molecular.Perou y Sorlie publicaron el estudio pionero en Nature2000, demostrando que la heterogeneidad morfológica de los tumoresmamarios puede reclasificarse en 4 grupos principales: luminalA, luminal B, HER2 amplificado y similar a basal (basallike)en base a los estudios de reordenamiento genético. Los dosprimeros son de mejor pronóstico y el basal-like está relacionadocon un comportamiento más agresivo, con tendencia a desarrollarmetástasis y con un fenotipo “triple negativo” (para los receptoresde estrógenos, de progesterona y para el HER2), quelos excluye de las terapias diana hormonal y anti HER2, y aunquepueden responder bien a la quimioterapia neoadyuvante yadyuvante, su pronóstico es malo.De la misma manera la cuantificación de ciertos genes y suponderación según el impacto en su valor predictivo, ha sidocrucial para obtener los llamados tests genéticos predictivos...(AU)

Breast cancer mortality has declined as a result of early detectionand application of adjuvant systemic therapy. Individualisationof this therapy regarding the selection of patientsmay avoid side effects, potential toxicities and cost of adjuvanttherapy. The heterogenecity of breast cancer oblige us to considerprognostic and predictive factors.Invasive breast carcinomas were classified, since 25 yearsago, according to histological type, grade and expression ofhormone receptors. Fifteen years ago and thanks to the introductionof the hybridization in situ of nucleic acids techniques,we could classify breast tumors in HER2 amplified and not amplifiedHER2. More recently, the molecular portraits or variationin gene expression patterns by Perou and Sorlie (Nature2000), have demonstrated that the morphological heterogenecityof breast cancer could be reclassified based in theDNA microarrays analysis studies. These studies have shownthat the expression profiles of breast cancer display a systematicvariation and allowed the classification of breast cancer into4 main groups: luminal A, luminal B, amplified Her2 and basallikebreast carcinomas. The first two groups have better prognosisand the latter group is reported to have a more aggressiveclinical behaviour. In addition, the majority of basal-like breastcancers are hormone receptors and HER2 negative (triple-negative),and thus cannot be targeted with current tailored therapies(i.e. endocrine and anti-HER2 therapies), but they oftenrespond to conventional neoadjuvant and adjuvant chemotherapyregimes, furthermore their prognosis remains poor.In the same way the quantification of certain genes andtheir weighting according to their impact on predictive value,has been crucial to obtain the so-called predictive genetic test.The diagnostic and therapeutic challenge posed by this newapproach has captured the attention of specialist implied inbreast cancer research(AU)

Estrategias en el uso de las patentes para la protección de productos farmacéuticos / Strategy on the use of patents for the protection of pharmaceutical products

No disponible

No disponible

Morfina tópica en úlceras dolorosas: a propósito de un caso / Topical opioids in painful skin ulcers: revies of a case

Presentamos un caso de dolor crónico de difícil control secundario a úlceras vasculares de extremidades inferiores como consecuencia de una micoangiopatía diabética. La paciente, a pesar del tratamiento analgésico sistémico, presentaba dolor severo que duraba más de noventa minutos después de la cura. Con morfina tópica al 0,1% se consigue un excelente control, mejora la calidad de vida y su retirada a los tres meses no supone una reaparición del dolor (AU)

We report an incidental painful ulcers case in a patient with diabetic microangiopaty in legs. There was no response to sistemic analgesia and the patient shows acute pain that lasted more than ninety minutes after detreatment. We decided to administrate topical morphine 0.1% with excellent results. Three months latter we remove the topical morphine opioids without increasing the pain (AU)

[Respiratory orofacial and occlusion disorders associated with adenotonsillar hypertrophy]. / Alteraciones respiratorias, bucofaciales y de la oclusión asociadas a la hiperplasia adenoamigdalar.

AIM: Describe the effects of tonsil hyperplasia on the respiratory system, orofacial structures and the occlusion in children who present with it, showing the recognizable signs and symptoms for the dentist, the pediatrician and the otorhinolaryngologist to carry out an early diagnosis and proper treatment. MATERIAL AND METHOD: A bibliographical review of the topic has been performed by means of search in Medline, using as key words "tonsil hypertrophy" or "tonsil hyperplasia" and limiting the search to the last 10 years, studies in human beings and articles in English language whenever these included an abstract. RESULTS: The tonsil hyperplasia is the most frequent cause of the obstructive sleep apnea syndrome (OSAS) and snoring in children. These patients often present swallowing and speech problems, oral breathing, "adenoidal face", elongated and narrow face, small and triangular chin, mandibular retrognathia, highly-arched palate, decrease of the intermolar distance and protrusion of superior incisor teeth, with several types of dental malocclusion. CONCLUSIONS: It is very important to bear in mind that a multidisciplinary approach, specially amongst otorhinolaryngologists, pediatricians and dentists, is necessary for the diagnosis and treatment of a patient with adenotonsillar hyperplasia.

Alteraciones respiratorias, bucofaciales y de la oclusion asociadas a la hiperplasia adenoamigdalar / Respiratory orofacial and occlusion disorders associated with adenotonsillar hypertrophy

Objetivo: Describir las repercusiones de la hiperplasia adenoamigdalar a nivel respiratorio, bucofacial y de la oclusión en los niños que la presentan, mostrando los signos y síntomas reconocibles por el odontólogo, el pediatra y el otorrinolaringólogo para efectuar un diagnóstico precoz y un tratamiento adecuado. Material y Método: Se realizó una revisión bibliográfica del tema mediante búsquedas en Medline, utilizando como palabras clave "tonsil hypertrophy or tonsil hyperplasia" y limitando la búsqueda a los últimos 10 años, estudios en humanos y artículos en idioma inglés y que incluyeran resumen. Resultados: La hiperplasia adenoamigdalar es la causa más frecuente del síndrome de apnea obstructiva del sueño (SAOS) y del ronquido en niños. Estos pacientes presentan con frecuencia problemas deglutorios, del habla, respiración bucal y "facies adenoidea", con cara alargada y estrecha, barbilla pequeña y triangular, retrognatia mandibular, paladar ojival, disminución de la distancia intermolar y vestibulo-versión de incisivos superiores, acompañada de diversas formas de maloclusión dentaria. Conclusiones: Es muy importante tener en cuenta que en el proceso de diagnóstico y tratamiento del paciente con hiperplasia adenoamigdalar es necesaria la colaboración multidisciplinaria, especialmente entre otorrinolaringólogos, pediatras, odontólogos y neurofisiólogos (AU)

No disponible

Radioterapia antiálgica y compresión medular. Efectividad y seguridad de Fentanilo TTS / Analgesic radiotherapy and medullar compression. Effectiveness and safety of fentanyl-TTS

Propósito: Se analizan los resultados de un estudio llevado a cabo en pacientes remitidos a varios Servicios de Oncología Radioterápica para tratamiento del dolor causado por procesos oncológicos. Se estudian las características del dolor, tratamiento analgésico previo, su modificación y la efectividad y seguridad de Fentanilo TTS cuando fue pautado. Material y métodos: Se analizan los datos recogidos en un periodo de 1 mes de 274 pacientes. Los tumores más prevalentes en el estudio fueron: Cáncer de pulmón en el 25 por ciento, de mama en el 16.8 por ciento y de próstata en el 14 por ciento. El 50 por ciento de los pacientes presentaban dolor somático sin componente neuropático, el 28 por ciento dolor somático con componente neuropático y en el 19 por ciento como parte de una compresión medular. Resultados: En el 8 por ciento de los pacientes se registraron intensidades de dolor menores a 3 en la escala analógica visual (EVA), entre 3 y 6 en el 42 por ciento y mayores de 6 en el 51 por ciento. En 155 pacientes, el 56 por ciento del total, se modificó el tratamiento analgésico, indicando Fentanilo-TTS. Después del tratamiento RT-Fentanilo se produjo una reducción media de la EVA de cuatro puntos. Los fenómenos secundarios, náuseas, vómitos, estreñimiento y somnolencia, se identificaron en un 30 por ciento de los pacientes y fueron considerados como moderados en la totalidad de los casos, salvo constipación que se valoró como grave en el 7 por ciento de los pacientes. Conclusiones: Los pacientes que llegan a las consultas de Oncología Radioterápica presentan dolor deficientemente controlado y lo hacen con intensidades de dolor consideradas como severas en el 50 por ciento de los casos. El tratamiento Radioterapia (RT) - Fentanilo fue muy efectivo reduciendo cuatro puntos la EVA quedando como controlado el dolor en la mayoría de los pacientes. Los efectos secundarios fueron moderados (AU)

Functional analysis and androgen-regulated expression of mouse organic anion transporting polypeptide 1 (Oatp1) in the kidney.

Mouse Oatp1 was recently identified as a new murine member of the organic anion transporting polypeptide (Oatp) family and suggested to represent the counterpart of rat Oatp1. Northern blot analysis detected expression of several mouse Oatp-transcripts predominantly in liver and kidney. In the present study we describe the strict androgen-dependent expression of mouse Oatp1 mRNA in kidney and obtained further information about its substrate specificity using Xenopus oocytes. In addition to the previously reported estrone-3-sulfate, we demonstrate that mouse Oatp1 mediates sodium-independent uptake of the anionic steroid conjugates dehydroepiandrosterone sulfate (K(m) approximately 8 microM) and estradiol-17-glucuronide (K(m) approximately 5 microM) and also of the prostaglandin PGE(2).

Estimation of the hydrophobic effect in an antigen-antibody protein-protein interface.

Antigen-antibody complexes provide useful models for analyzing the thermodynamics of protein-protein association reactions. We have employed site-directed mutagenesis, X-ray crystallography, and isothermal titration calorimetry to investigate the role of hydrophobic interactions in stabilizing the complex between the Fv fragment of the anti-hen egg white lysozyme (HEL) antibody D1.3 and HEL. Crystal structures of six FvD1.3-HEL mutant complexes in which an interface tryptophan residue (V(L)W92) has been replaced by residues with smaller side chains (alanine, serine, valine, aspartate, histidine, and phenylalanine) were determined to resolutions between 1.75 and 2.00 A. In the wild-type complex, V(L)W92 occupies a large hydrophobic pocket on the surface of HEL and constitutes an energetic "hot spot" for antigen binding. The losses in apolar buried surface area in the mutant complexes, relative to wild-type, range from 25 (V(L)F92) to 115 A(2) (V(L)A92), with no significant shifts in the positions of protein atoms at the mutation site for any of the complexes except V(L)A92, where there is a peptide flip. The affinities of the mutant Fv fragments for HEL are 10-100-fold lower than that of the original antibody. Formation of all six mutant complexes is marked by a decrease in binding enthalpy that exceeds the decrease in binding free energy, such that the loss in enthalpy is partly offset by a compensating gain in entropy. No correlation was observed between decreases in apolar, polar, or aggregate (sum of the apolar and polar) buried surface area in the V(L)92 mutant series and changes in the enthalpy of formation. Conversely, there exist linear correlations between losses of apolar buried surface and decreases in binding free energy (R(2) = 0.937) as well as increases in the solvent portion of the entropy of binding (R(2) = 0.909). The correlation between binding free energy and apolar buried surface area corresponds to 21 cal mol(-1) A(-2) (1 cal = 4.185 J) for the effective hydrophobicity at the V(L)92 mutation site. Furthermore, the slope of the line defined by the correlation between changes in binding free energy and solvent entropy approaches unity, demonstrating that the exclusion of solvent from the binding interface is the predominant energetic factor in the formation of this protein complex. Our estimate of the hydrophobic contribution to binding at site V(L)92 in the D1.3-HEL interface is consistent with values for the hydrophobic effect derived from classical hydrocarbon solubility models. We also show how residue V(L)W92 can contribute significantly less to stabilization when buried in a more polar pocket, illustrating the dependence of the hydrophobic effect on local environment at different sites in a protein-protein interface.

Role of fucosyltransferases in the association between apomucin and Lewis antigen expression in normal and malignant gastric epithelium.

BACKGROUND: In normal gastric epithelium, MUC5AC is detected in superficial epithelium associated with Lewis type 1 antigens and MUC6 is detected in antral glands with Lewis type 2. Therefore, the stomach constitutes an excellent model to examine the role of glycosyltransferases in determining the specificity of apomucin glycosylation. AIMS: To determine the molecular basis of this association and to examine changes in expression of gastric and intestinal apomucins and their association with Lewis antigens during the gastric carcinogenesis process. METHODS: Fucosyltransferase (FUT1, FUT2, FUT3) and mucin (MUC5AC, MUC6) transcripts were detected using reverse transcription-polymerase chain reaction. Apomucin (MUC2, MUC4, MUC5AC, MUC6) and Lewis antigen (types 1 and 2) expression were analysed using single and double immunohistochemistry and in situ hybridisation. RESULTS: In the normal stomach, FUT1 is exclusively detected associated with MUC6; FUT2 is only detected when MUC5AC is present. This co-regulation is lost in gastric tumours, as is differential expression of MUC5AC and MUC6 in normal gastric epithelial cells. In gastric tumours, especially those with the intestinal phenotype, MUC2 and MUC4 genes are upregulated, and gastric-type and intestinal-type mucins are coexpressed. These changes are early events in the gastric carcinogenesis process, as they are detected in intestinal metaplasia. CONCLUSIONS: The glycosylation pattern found in normal gastric epithelium is dictated by the specific set of fucosyltranferases expressed by the cells rather than by the apomucin sequence. The development of intestinal metaplasia and gastric cancer is associated with the appearance of cellular phenotypes that are absent from normal epithelium.

Gamma-Ray Emission from Novae Related to Positron Annihilation: Constraints on its Observability Posed by New Experimental Nuclear Data.

Classical novae emit gamma-ray radiation at 511 keV and below (with a cutoff at around 20-30 keV), related to positron annihilation and its Comptonization in the expanding envelope. This emission has been elusive up to now because it occurs at epochs well before the maximum in optical luminosity, but it could be detected by some sensitive instrument on board a satellite, provided that the nova is close enough and that it is observed at the right moment. The detection of this emission, which is a challenge for current and future gamma-ray instruments, would shed light into the physical processes that occur in the early phases of the explosion, which are invisible in other lower energy ranges. A good prediction of the emitted fluxes and of the corresponding detectability distances with different instruments relies critically on a good knowledge of reaction rates relevant to 18F destruction, which have been subject to strong revision after recent nuclear spectroscopy measurements. With respect to previous results, smaller ejected masses of 18F are predicted, leading to smaller emitted fluxes in the 20-511 keV range and shorter detectability distances.