In young patients with stroke of undetermined etiology, large vessel occlusions are less frequent in the group with high-risk patent foramen ovale.

INTRODUCTION: Patent foramen ovale (PFO) is present in a significant proportion of young patients with stroke of undetermined etiology, but is not always causal. Therefore, classifications (RoPE, PASCAL) have been developed to determine the probability that PFO is the stroke cause. However, the presence of an initial arterial occlusion as a prediction factor was not studied when these classifications were built. Our aim was to evaluate the presence of arterial occlusion in young patients with stroke of undetermined etiology with/without high-risk PFO. METHODS: From a prospectively-built monocentric database, we identified patients aged≥18 to<60-years with strokes of undetermined etiology and complete etiological work-up, including transesophageal echocardiography. We divided patients in two groups: (i) with high-risk PFO [i.e. PFO with large interatrial shunt (>30 microbubbles) or associated with atrial septal aneurysm] and (ii) with low-risk/without PFO. We recorded the presence of arterial occlusion and large vessel occlusion (LVO) in the acute phase. RESULTS: We included 96 patients; 55 (57%) had high-risk PFO. Their median age was 48 (40-52) years, and 28 (29%) were women. The percentages of patients with arterial occlusion and with LVO were lower in the high-risk PFO group than in the low-risk/without PFO group: 11 (20%) versus 19 (46%) (P=0.008), and 5 (9%) versus 15 (37%) (P=0.002), respectively. There was no difference in the median RoPE score between groups (P=0.30). CONCLUSION: The presence of LVO could represent a "red flag" of PFO causality in stroke of undetermined etiology, and could be implemented in future PFO-related stroke classifications.

Prevalence of obstructive sleep apnoea in acute coronary syndrome: Routine screening in intensive coronary care units.

INTRODUCTION: Increased evidence has shown that, despite the maximum care afforded to patients admitted with acute coronary syndromes (ACS), a residual risk of mortality remains, in which obstructive sleep apnoea (OSA) appears to be a largely undiagnosed factor, particularly in the intensive cardiac care unit (ICCU). The purpose of this study is to determine whether the systematic screening for sleep-disordered breathing (SDB) is feasible and may be recommended. The aims of our study are to determine: (1) The estimated prevalence of OSA in patients admitted to the ICCU for ACS determined by a validated, user-friendly portable screening device; (2) The feasibility of the screening in this context; (3) To assess any negative impact of OSA on the severity of ACS. PATIENTS AND METHODS: This is an observational study of 101 patients admitted to the ICCU for ACS showing no clinical evidence of heart failure (HF). In the 24-72hours following admission, they underwent an overnight sleep study using a 3-channel portable screening device with automatic analysis. RESULTS: Sixty-two out of the 101 patients proved positive to the screening test, and its feasibility was acceptable. OSA patients tended to have greater peak levels of hs-cTnT (3685±3576ng/L versus 2830±3333ng/L, P=0.08) than the non-OSA group. Compared with the non-OSA group, OSA patients presented more severe ACS, with a greater average GRACE score at admission of 112.2±26.3 (versus 98.4±19.2, P<0.001). In the OSA group, we found a statistically significant inverse correlation between the apnoea-hypopnea index (AHI) and the left ventricular ejection fraction (LVEF) in the linear regression analysis (r=-0.26; P=0.037). CONCLUSIONS: A systematic screening of patients in the ICCU is acceptable. OSA is frequently found in the acute phase of ischaemic heart disease and its presence is associated with more severe ACS and a poorer left ventricle systolic function.

Dealing with the genetic load in bacterial synthetic biology circuits: convergences with the Ohm's law.

Synthetic biology seeks to envision living cells as a matter of engineering. However, increasing evidence suggests that the genetic load imposed by the incorporation of synthetic devices in a living organism introduces a sort of unpredictability in the design process. As a result, individual part characterization is not enough to predict the behavior of designed circuits and thus, a costly trial-error process is eventually required. In this work, we provide a new theoretical framework for the predictive treatment of the genetic load. We mathematically and experimentally demonstrate that dependences among genes follow a quantitatively predictable behavior. Our theory predicts the observed reduction of the expression of a given synthetic gene when an extra genetic load is introduced in the circuit. The theory also explains that such dependence qualitatively differs when the extra load is added either by transcriptional or translational modifications. We finally show that the limitation of the cellular resources for gene expression leads to a mathematical formulation that converges to an expression analogous to the Ohm's law for electric circuits. Similitudes and divergences with this law are outlined. Our work provides a suitable framework with predictive character for the design process of complex genetic devices in synthetic biology.

NGF-loaded PLGA microparticles for advanced multifunctional regenerative electrodes.

Nerve guide conduits are currently the elective device for peripheral nerve reconstruction applications, as nerve autograft often is hampered by procedure invasiveness and limited nerve availability. Many technological improvements have been approached to enhance nerve regeneration driven by these devices, whose main drawbacks are often disordered sprouting and ineffective axon guidance. Among the adopted solutions to overcome these problems, embedding of extracellular matrix (ECM) proteins and neurotrophic factors (NF) in nerve conduits has been a promising one. Using free NFs, however suffers from different drawbacks mainly due to diffusion, degradation and local concentration boosting. As part of a wider EU-funded program for next gen regenerative electrodes, we developed NGF-loaded PLGA microparticles to use them immersed in a gel biomatrix that is being embedded in nerve conduits before implant, and allow for timed-controlled delivery instead of an initial concentration boost. Here we report the technological steps for the synthesis and initial testing with mouse dorsal root ganglia (DRG) explants, towards their full integration with a complex three-dimensional biomatrix into next-gen regeneration electrodes.

Utilidad de la tinción con laminina-332 para diferenciar queratoacantoma, queratoacantoma con áreas de carcinoma epidermoide y carcinoma epidermoide crateriforme / The Value of Laminin-322 Staining in Distinguishing Between Keratoacanthoma, Keratoacanthoma With Areas of Squamous Cell Carcinoma, and Crateriform Squamous Cell Carcinoma

Introducción: El queratoacantoma (QA) es un tumor cutáneo crateriforme, de crecimiento rápido; aproximadamente el 25% de los QA presentan transformación maligna (QAm), observándose áreas de carcinoma epidermoide (CE). La laminina-332 se ha relacionado con progresión a fases invasoras en diversos CE. El objetivo de este estudio es evaluar si la tinción con laminina-332 es útil para distinguir QA, QAm y CE. Material y métodos: Seleccionamos 74 casos del archivo de Anatomía Patológica. Se analizaron 4 grupos: 20 QA sin CE, 20 QAm con áreas evidentes de CE, 20 CE invasores sin relación con QA (8 con morfología crateriforme) y 14 casos «problema» (QA con «dudosas» áreas de CE). Posteriormente se realizó tinción inmunohistoquímica para laminina-332 a todas estas lesiones. Resultados: En las áreas de CE asociado a QAm y en los CE invasores, la tinción con laminina fue positiva de forma intensa, habitualmente en el frente invasor del CE, a diferencia de los QA, en que la tinción fue positiva solo de forma débil y focal, en células aisladas o en pequeños «grupos» celulares. Los casos «problema» se reexaminaron tras valorar la tinción con laminina-332 (8 se diagnosticaron de QA con CE incipiente, 6 de QA sin CE). Conclusiones: La tinción con laminina-332 es diferente en los QA respecto a los CE, por lo que ayudaría a diferenciar los QA de los CE invasores y de las áreas de CE en QAm, así como en el diagnóstico de QA con «dudosas» áreas de CE y QA con CE incipientes (AU)

Introduction: Keratoacanthoma is a fast-growing crateriform skin tumor. Approximately 25% of such tumors undergo malignant transformation and develop areas of squamous cell carcinoma (SCC). The presence of laminin-322 has been associated with progression to invasive forms of SCC. The aim of this study was to determine whether or not immunohistochemical staining for laminin-322 would be of value in distinguishing between keratoacanthomas, keratoacanthomas with areas of squamous cell carcinoma, and SCCs. Material and methods: Seventy-four lesions were selected from the pathology archives of our hospital and divided into 4 groups: 20 keratoacanthomas without SCC, 20 keratoacanthomas with areas of squamous cell carcinoma, 20 invasive SCCs (8 with crateriform morphology) unrelated to keratoacanthoma, and 14 problem lesions (keratoacanthomas with areas suggestive of SCC). All 74 lesions were stained for laminin-322. Results: Laminin-322 staining was strongly positive both in areas of SCC in keratoacanthomas with malignant transformation and in invasive SCCs (mostly at the invasive front of the SCC). However, in benign keratoacanthomas, it was only weakly positive and furthermore it was confined to isolated cells or small groups of cells. The 14 problem lesions were reexamined after laminin-322 staining and 8 were diagnosed as keratoacanthomas with incipient SCC and 6 as keratoacanthomas without SCC. Conclusions: Laminin-322 staining is different in keratoacanthomas and SCCs and would thus be a useful test for differentiating keratoacanthomas from both invasive SCCs and keratoacanthomas with areas of squamous cell carcinoma. It would also be of value in diagnosing keratoacanthomas with areas suggestive of SCC or with incipient SCC (AU)

[The value of laminin-322 staining in distinguishing between keratoacanthoma, keratoacanthoma with areas of squamous cell carcinoma, and crateriform squamous cell carcinoma]. / Utilidad de la tinción con laminina-332 para diferenciar queratoacantoma, queratoacantoma con áreas de carcinoma epidermoide y carcinoma epidermoide crateriforme.

INTRODUCTION: Keratoacanthoma is a fast-growing crateriform skin tumor. Approximately 25% of such tumors undergo malignant transformation and develop areas of squamous cell carcinoma (SCC). The presence of laminin-322 has been associated with progression to invasive forms of SCC. The aim of this study was to determine whether or not immunohistochemical staining for laminin-322 would be of value in distinguishing between keratoacanthomas, keratoacanthomas with areas of squamous cell carcinoma, and SCCs. MATERIAL AND METHODS: Seventy-four lesions were selected from the pathology archives of our hospital and divided into 4 groups: 20 keratoacanthomas without SCC, 20 keratoacanthomas with areas of squamous cell carcinoma, 20 invasive SCCs (8 with crateriform morphology) unrelated to keratoacanthoma, and 14 problem lesions (keratoacanthomas with areas suggestive of SCC). All 74 lesions were stained for laminin-322. RESULTS: Laminin-322 staining was strongly positive both in areas of SCC in keratoacanthomas with malignant transformation and in invasive SCCs (mostly at the invasive front of the SCC). However, in benign keratoacanthomas, it was only weakly positive and furthermore it was confined to isolated cells or small groups of cells. The 14 problem lesions were reexamined after laminin-322 staining and 8 were diagnosed as keratoacanthomas with incipient SCC and 6 as keratoacanthomas without SCC. CONCLUSIONS: Laminin-322 staining is different in keratoacanthomas and SCCs and would thus be a useful test for differentiating keratoacanthomas from both invasive SCCs and keratoacanthomas with areas of squamous cell carcinoma. It would also be of value in diagnosing keratoacanthomas with areas suggestive of SCC or with incipient SCC.

Tinción inmunohistoquímica p16 en carcinomas epidermoides del área genital y extragenital / Immunohistochemical Staining of p16 in Squamous Cell Carcinomas of the Genital and Extragenital Area

Introducción: La proteína p16 es una proteína supresora tumoral. El objetivo del estudio era comprobar si la tinción p16 se relaciona con la presencia de papilomavirus (subtipos mucosos o α, VPH-mc) en carcinomas epidermoides (CE) extragenitales (como ocurre en el cérvix y en CE genitales). Material y método: Se realizó tinción inmunohistoquímica con p16 a diversas lesiones incluidas en parafina del área genital (8 condilomas, tres CE intraepidérmicos y 7 CE invasores) y del área extragenital (20 CE intraepidérmicos tipo enfermedad de Bowen [EB] y 10 CE invasores). La detección de VPH-mc se realizó mediante reacción en cadena de la polimerasa (PCR). Resultados: En el área genital la tinción p16 fue negativa en los condilomas y positiva en los tres CE intraepidérmicos y en dos CE invasores (29%). Se detectó VPH-mc en 6 condilomas y dos CE intraepidérmicos (100%, excluyendo tres lesiones que no se pudieron estudiar con PCR) y en los dos CE invasores positivos para p16. En el área extragenital la tinción p16 fue positiva en 19 EB (95%) y en dos CE invasores (20%). Se detectó VPH-mc en 4 EB (tinción p16 positiva) y en un CE invasor (p16 negativa). En los CE intraepidérmicos la tinción p16 fue útil para objetivar si existían focos de microinfiltración dérmica o invasión de estructuras anexiales normales. Conclusiones: Según nuestros resultados la positividad de p16 es independiente de la detección de VPH en los CE extragenitales, al contrario de lo observado en CE genitales. En el área extragenital la pérdida de proteína p16 en los CE invasores respecto a los CE intraepidérmicos indicaría progresión tumoral (AU)

Background and objectives: Positive immunostaining for the tumor suppressor protein p16 is associated with the presence of mucosal or alfa subtypes of human papillomavirus (HPV) in cervical and genital squamous cell carcinoma (SCC). The aim of this study was to determine whether p16 immunostaining is also associated with mucosal HPV in extragenital SCC. Material and methods: Paraffin sections of lesions located in the genital region (8 genital warts, 3 intraepidermal SCCs, and 7 invasive SCCs) and extragenital area (29 intraepidermal SCCs corresponding to Bowen disease and 10 invasive SCCs) were stained for p16 by immunohistochemistry. Mucosal HPV was detected by polymerase chain reaction (PCR). Results: In the genital area, p16 immunostaining was negative in genital warts and positive in all 3 intraepidermal SCCs and 2 invasive SCCs (29%). Mucosal HPV was detected in 6 genital warts and 2 intraepidermal SCCs (100% after exclusion of 3 lesions that could not be analyzed by PCR) and in the 2 invasive SCCs that were positive for p16. In the extragenital area, 19 intraepidermal SCCs (95%) and 2 invasive SCCs (20%) were immunopositive for p16. Mucosal HPV was detected in 4 intraepidermal SCCs (p16 immunopositive) and 1 invasive SCC (p16 immunonegative). In intraepidermal SCCs, p16 immunostaining facilitated the identification of dermal microinfiltration or invasion of normal skin appendages. Conclusions: According to our results, unlike in genital SCCs, p16 immunopositivity is independent of the presence of HPV in extragenital SCCs. Compared with intraepidermal SCCs, the absence of p16 protein in invasive SCCs in the extragenital area would indicate progression of the disease (AU)

[Immunohistochemical staining of p16 in squamous cell carcinomas of the genital and extragenital area]. / Tinción inmunohistoquímica p16 en carcinomas epidermoides del área genital y extragenital.

BACKGROUND AND OBJECTIVES: Positive immunostaining for the tumor suppressor protein p16 is associated with the presence of mucosal or αsubtypes of human papillomavirus (HPV) in cervical and genital squamous cell carcinoma (SCC). The aim of this study was to determine whether p16 immunostaining is also associated with mucosal HPV in extragenital SCC. MATERIAL AND METHODS: Paraffin sections of lesions located in the genital region (8 genital warts, 3 intraepidermal SCCs, and 7 invasive SCCs) and extragenital area (29 intraepidermal SCCs corresponding to Bowen disease and 10 invasive SCCs) were stained for p16 by immunohistochemistry. Mucosal HPV was detected by polymerase chain reaction (PCR). RESULTS: In the genital area, p16 immunostaining was negative in genital warts and positive in all 3 intraepidermal SCCs and 2 invasive SCCs (29%). Mucosal HPV was detected in 6 genital warts and 2 intraepidermal SCCs (100% after exclusion of 3 lesions that could not be analyzed by PCR) and in the 2 invasive SCCs that were positive for p16. In the extragenital area, 19 intraepidermal SCCs (95%) and 2 invasive SCCs (20%) were immunopositive for p16. Mucosal HPV was detected in 4 intraepidermal SCCs (p16 immunopositive) and 1 invasive SCC (p16 immunonegative). In intraepidermal SCCs, p16 immunostaining facilitated the identification of dermal microinfiltration or invasion of normal skin appendages. CONCLUSIONS: According to our results, unlike in genital SCCs, p16 immunopositivity is independent of the presence of HPV in extragenital SCCs. Compared with intraepidermal SCCs, the absence of p16 protein in invasive SCCs in the extragenital area would indicate progression of the disease.

[Are patients undergoing coronary angiography well-informed? Prospective evaluation of the effectiveness of written information]. / Les patients bénéficiant d'une coronarographie sont-ils bien informés ? Évaluation de l'efficacité de l'information écrite. Étude prospective unicentrique.

INTRODUCTION: Prior information in the realization of an invasive intervention is crucial. Indeed, the patient has to know theoretically his disease, diagnostic and therapeutic means, but also the risks of the used technique. The habits of information vary many from one center to another, in spite of the proposition of an information leaflet written by the French Society of Cardiology. Our aim was to evaluate the effectiveness of written information for patients hospitalized for coronary arteriography. METHODS: Among patients hospitalized for realization of a programmed coronarography, a questionnaire was delivered before the information leaflet. The knowledge of the patients was so tested (27 items) before and after the reading of the information sheet (not limited time). The knowledge of the patients concerning coronarography indication, modalities, benefits, possible complications or still later possibilities was informed. RESULTS: Thirty-four patients were included: all knew hospitalization reason, 86% were men, middle-aged 65 (IC 95% 60-70). Thirty-four percent (15-54) had studied in higher education. Ninety-seven percent had had information before. Only 56% (38-74) were informed about the mode of anesthesia, 36% (19-53) duration, 69% (53-86) the injection of iodine, 44% the risk of allergy, 53% the risk of bruise, 15% of the cardiac risks, 21% the renal risks. Seventy-one percent knew the diagnostic benefits, 44% the possible coronary angioplasty, 17% the eventuality of a bypass surgery. The delivery of the information leaflet did not modify the knowledge on most of these items, in particular the modalities and the profits. The risks were known significantly better for the allergy (P=0.019), the bruise (P=0.018), the cardiac risks (0.001). CONCLUSIONS: The population benefiting from a coronarography considers to be enough informed. However, knowledge of the modalities, profits and risks is very low. The delivery of the consensual leaflet does not allow improving the situation, except as far as concerned the complications. Better information is so indispensable, not only to obtain a better support of the patient in the treatment, but also to prevent the forensic implications. The improvement of the information must be multifactorial, but usually used means could be not sufficient.

[Solar elastosis in cutaneous squamous cell carcinoma]. / Elastosis solar en carcinomas espinocelulares cutáneos.

INTRODUCTION: Solar elastosis, or basophilic degeneration of collagen, may be a histologic sign of chronic sun damage. MATERIAL AND METHODS: We reviewed 222 cases of squamous cell carcinoma (SCC) to identify the presence of solar elastosis and its possible invasion of the upper, middle, or deep reticular dermis. We also analyzed clinical variables such as SCC location, location in exposed areas of the skin, age, sex, and immunosuppression. Patients included had undergone surgical excision of an SCC. RESULTS: Severe solar elastosis was found in most cases (182 patients, 82%): 87 extended to the middle reticular dermis and 95 had reached the deep reticular dermis. Only 6 (2.7%) patients had no solar elastosis. In some cases elastosis was so severe that it had affected the subcutaneous cellular tissue or venous or arteriolar walls. Deeper solar elastosis was significantly associated with older age and female sex. CONCLUSIONS: Solar elastosis was found in most patients with SCC and seems to indicate chronic severe solar damage. Exposure to ultraviolet radiation would be the main cause of SCC, although other factors might also be implicated, particularly in patients who did not have severe solar elastosis. Systemic or localized immunosuppression was associated with nearly all the SCC cases studied, consistent with the marked immunosuppressant effects of sun exposure, the aging process, or both.

Elastosis solar en carcinomas espinocelulares cutáneos / Solar Elastosis in Cutaneous Squamous Cell Carcinoma

Introducción: El hallazgo de elastosis solar (degeneración basófila del colágeno) se podría considerar como un signo histológico del daño solar crónico. Material y método: Se ha realizado un estudio retrospectivo sobre 222 carcinomas espinocelulares (CE). Se ha valorado si existía elastosis solar y si esta se extendía hasta la dermis reticular superficial, media o profunda. También se han analizado otras variables clínicas como la localización, la ubuicación en áreas fotoexpuestas, así como la edad, el sexo y la inmunodepresión de los pacientes a los que se extirparon estos CE. Resultados: En la mayoría de CE (182CE, un 82%) se observa una intensa elastosis solar: 87CE presentaban elastosis solar hasta la dermis reticular media y 95CE hasta la dermis reticular profunda. Sólo hubo 6CE (2,7%) que no presentaban elastosis solar. En algunos CE la elastosis solar era tan intensa que se extendía hasta el tejido celular subcutáneo o afectaba a la pared de venas y/o arteriolas. Existía una relación significativa entre la observación de elastosis solar a más profundidad y una edad mayor, así como con el sexo femenino. Conclusiones: En la mayoría de CE se observa elastosis solar, lo que podría traducir un intenso daño solar crónico. La radiación ultravioleta sería el principal factor etiopatogénico en la mayoría de CE, aunque también podrían estar implicados otros factores etiopatogénicos, sobre todo en aquellos CE sin una elastosis solar intensa. Casi todos estos CE estudiados se asociarían a inmunodepresión (sistémica o localizada), basándonos en los importantes efectos inmunosupresores que producen las radiaciones solares, la edad avanzada o ambas (AU)

Introduction: Solar elastosis, or basophilic degeneration of collagen, may be a histologic sign of chronic sun damage. Material and methods: We reviewed 222 cases of squamous cell carcinoma (SCC) to identify the presence of solar elastosis and its possible invasion of the upper, middle, or deep reticular dermis. We also analyzed clinical variables such as SCC location, location in exposed areas of the skin, age, sex, and immunosuppression. Patients included had undergone surgical excision of an SCC. Results: Severe solar elastosis was found in most cases (182 patients, 82%): 87 extended to the middle reticular dermis and 95 had reached the deep reticular dermis. Only 6 (2.7%) patients had no solar elastosis. In some cases elastosis was so severe that it had affected the subcutaneous cellular tissue or venous or arteriolar walls. Deeper solar elastosis was significantly associated with older age and female sex. Conclusions: Solar elastosis was found in most patients with SCC and seems to indicate chronic severe solar damage. Exposure to ultraviolet radiation would be the main cause of SCC, although other factors might also be implicated, particularly in patients who did not have severe solar elastosis. Systemic or localized immunosuppression was associated with nearly all the SCC cases studied, consistent with the marked immunosuppressant effects of sun exposure, the aging process, or both (AU)

Routinely-feasible multiple biomarkers score to predict prognosis after revascularized STEMI.

INTRODUCTION: We assessed the long-term prognostic value of an easy-to-do multiple cardiac biomarkers score after a revascularized acute myocardial infarction (MI) in order to evaluate a multimarker approach to risk stratification, based on routine biomarkers. MATERIAL AND METHODS: Blood samples from 138 patients hospitalized with acute myocardial infarction and successfully treated by primary coronary intervention (with TIMI 3 flow) were subsequently tested for creatinin level at admittance and then BNP, hsCRP, troponin I from Day 0 to day 7. The primary endpoint was a clinical evaluation comprising: new hospitalization for cardiac reasons, acute coronary events (acute coronary syndrome), and death. RESULTS: During the median follow-up period of 11.01 months [9.44-12.59], 47 events were recorded. All the following markers were able to predict events: creatinemia on admission (p=0.0057), CRP on day 3 (p, troponin I on day 1 (p<0.001), BNP (p<0.0001) and biological multimarker score (p<0.0001). Clinical events were predicted with a hazard ratio (HR) of respectively 3.30 [2.88-12.30] in BNP Q4 as compared to the three lower quartiles (Q1-3), and 3.15 [2.75-21.00] for the Multimarker approach. The multimarker score was not significantly better than BNP on day 1 alone (p=0.77), troponin on day 1 alone (p=0.43), creatininemia on admission (p=0.19) or CRPhs on day 3 alone (p=0.054). Nevertheless, the Multimarker approach leads to the selection of a smaller, hence more manageable, high-risk population (13% versus 25%). CONCLUSION: Among 138 subjects admitted for acute MI, and all successfully revascularized, a routinely multimarker approach with BNP, hsCRP, creatininemia, troponin I, is feasible. BNP is the most powerful marker, and this multimarker approach renders additional prognostic information helping to identify patients with high-risk to clinical events.

Can troponin elevation predict worse prognosis in patients with acute pericarditis?

INTRODUCTION: Myopericarditis are common in clinical practice: up to 15% of acute pericarditis have a significant myocardial involvement as assessed by biological markers. This prospective, bicentric study is aimed at describing a myopericarditis population, the clinical and MRI follow-up, and search for prognosis markers. PATIENTS AND METHODS: Between May 2005 and September 2007, 103 patients hospitalised for acute pericarditis were prospectively enrolled. Physical examination, ECG, echocardiography, biological screening and cardiac MRI, in case of myopericarditis defined as acute pericarditis with troponin I elevation, were performed. Between December 2007 and July 2008, patients were contacted for new clinical and MRI evaluation. RESULTS: Among the initial population of 103 patients admitted for acute pericarditis, 14 myopericarditis and 38 pericarditis were included. Compared with pericarditis, the myopericarditis group was associated with the following features: younger age (34.9 years [95% CI 28.3-41.2]; p=0.01), ST-segment elevation (nine patients between 14; p=0.03), higher troponin I (7.3 microg/L [95% CI 4.4-10.2]; p<10(-4)) and lower systemic inflammation (CRP peak 38.1mg/L [95% CI 7-69.2]; p=0.01). In the case of myopericarditis, infectious etiologies were predominant (12 patients among 14; p=0.002) and patients stayed longer in hospital (5.8 days [95% CI 4.7-6.8]; p=0.01). Follow-up showed no difference in terms of functional status (p=0.3) and global complications (p=0.9) between paired myopericarditis and pericarditis. Nevertheless, cardiac mortality was higher for myopericarditis (p=0.04). MRI follow-up showed myocardial sequelae without clinical impact. CONCLUSION: Myopericarditis significantly distinguished from pericarditis. Three years follow-up showed no difference in terms of global complications but a higher cardiac mortality for myopericarditis. MRI myocardial lesions did not develop into symptomatic sequelae.

Medicalización del espeleosocorro. Paciente politraumatizado en espeleología / No disponible

Los sanitarios que asisten heridos en medios hostiles ,como cuevas, precisan de una formación específica que sumen tres aspectos fundamentales: uno es la práctica de una medicina de urgencia de calidad a realizar en la cavidad, sin apoyos y en un medio totalmente ajeno al sanitario habitual que se define como 'difícil, hostil y aislado', otro la capacidad física y los conocimientos técnicos necesarios para poder acceder, por difícil que sea hasta el lugar donde se encuentra el accidentado, para prestarle asistencia sanitaria y, finalmente, la formación necesaria para colaborar con los equipos de rescate, plenamente integrado en ellos, haciéndose cargo al completo de los aspectos médicos y colaborando eficazmente en las tareas de rescate, sin suponer un estorbo, ni un peligro añadido para sus operativos. Es decir, que estos sanitarios deben ser buenos especialistas en medicina de urgencia, acreditados espeleólogos y aceptables rescatadores en los operativos de rescate. Algo que no es fácil de conseguir, pero que es necesario si pretendemos asumir con garantías el reto de la medicalización del rescate en cavidades(AU)

The sanitary staff that assists injured men in hostile enviroments as caves, need a specific formation that should add three fundamental aspects: one is the practice of a medicine of quality urgency to practice in the cavity, without supports and in a way completely foreign to the sanitary habitual one that is defined as 'difficult, hostile and outlying', another one is the physical capacity and the necessary technical knowledge to be able to gain access, for difficult that is up to the place where the eventful one is it, not even a danger added for his operative ones gives him sanitary and, assistance finally, the necessary formation to collaborate with the rescue teams, fully integrated to them, taking charge to the finished one of the medical aspects and collaborating effectively in therescue works, without supposing an obstacle. That is to say, that sanitary staff must be good specialists in medicine of urgency, accredited speleologists and acceptable rescuers. Something that is not easy to obtain, but that is necessary if we try to assume with guarantees the challenge of the medicalization of the rescue in cavities(AU)

[Clear cells in cutaneous squamous cell carcinoma]. / Las células claras en el carcinoma espinocelular cutáneo.

INTRODUCTION: Although few cases of squamous cell carcinoma (SCC) with clear cells have been published, we believe that these cells are often present in SCC. MATERIAL AND METHODS: We studied 249 SCCs, analyzing a number of clinical and histological variables. Various immunohistochemical techniques (immunoperoxidase method) were used to determine whether adnexal differentiation was present. RESULTS: There were 96 SCCs with a proportion of clear cells of over 25 %. Advanced or established SCCs and SCCs associated with Bowen disease contained a larger proportion of clear cells. We defined 2 histological patterns: a) clear cells around the keratin pearls of SCCs arising from pre-existing actinic keratosis and with indirect signs of human papilloma virus infection in hair follicles; and b) clear cells that simulate adnexal differentiation in lesions arising on pre-existing Bowen disease lesions. There were also 19 carcinomas with true adnexal differentiation. DISCUSSION: Clear cells are frequently observed in SCC, though large numbers of clear cells are present only in certain SCCs. The appearance of clear cells in SCCs is progressive and they are only present in more advanced SCC. The presence of clear cells is suggestive of adnexal differentiation; however, in the majority of cases, their presence is due to infiltration of normal adnexal structures by the cells of pagetoid Bowen disease. True adnexal differentiation exists only in a small percentage of cases (7.6 % in our study). The histological pattern described as clear cells around keratin pearls practically rules out this differentiation.

Tumor trabecular hialinizante tiroideo: los «cuerpos paranucleares», otra forma aberrantede expresión de Ki-67 (MIB-1) / Hyalinizing trabacular tumor of the thyroid gland: «Paranuclear bodies», aberrant reactivity of MIB-1 antibody

El tumor trabecular hialinizante de tiroides (TTH) es untumor infrecuente y una lesión controvertida en la actualidad.Se caracteriza por un patrón de crecimiento trabecularcon marcada hialinización estromal y con similitudes histológicas,inmunohistoquímicas y moleculares con otras neoplasiastiroideas como el carcinoma papilar (CP). Los cuerposamarillos citoplasmáticos son un hallazgo frecuente eneste tipo de neoplasia. También es característica la expresióncitoplasmática y de membrana con Ki-67 (MIB-1).Describimos una nueva forma de expresión de Ki-67 en losTTH como es la presencia de pequeños cuerpos teñidos condicho anticuerpo de localización paranuclear y revisamos laliteratura al respecto (AU)

The hyalinizing trabecular tumor (HTT) is an unusualtumor of the thyroid gland and controversial lesion. Theyare thyroid lesions with prominent sclerosis or hyalinizationand trabecular architecture and they share several histologic,immunohistochemical and molecular features with anotherthyroid neoplasms like papillary thyroid carcinoma (PTC).Cytoplasmic yellow bodies are a common and frequent histologicalfinding in hyalinizing trabecular adenoma. Membraneand cytoplasmic immunopositivity for the monoclonalantibody MIB-1 is characteristic. In this article wereport a novel expression with Ki-67 immunoreactivity incytoplasmic and paranuclear bodies. A review of literatureis included (AU)

'Bowenoid wart': wart with bowenoid histological changes? Report of 9 cases.

INTRODUCTION: Cases of lesions that simulate Bowen's disease have been previously described in the literature. CASE REPORT: Nine exophytic verruca-like lesions with histological findings of Bowen's disease (BD) are described. All cases had a rapid growth, and were located on the face and neck of elderly patients with chronic solar skin damage. We carried out p16 immunohistochemical staining using the immunoperoxidase technique, which was negative in all cases. DISCUSSION: We think that these 9 lesions are only histologically mimicking BD, and could be a subtype of verruca ('bowenoid wart'). These lesions could be provoked by nononcogenic human papillomavirus (HPV), as in other cases previously described. The p16 staining was negative in all cases, in contrast with most BD cases. It would be interesting to study whether positive p16 staining is related to oncogenic HPV, whereas negative p16 staining could be associated with low or nononcogenic HPV; thus, more studies are needed.