Comparative assessment of satellite- and drone-based vegetation indices to predict arthropod biomass in shrub-steppes.

Arthropod biomass is a key element in ecosystem functionality and a basic food item for many species. It must be estimated through traditional costly field sampling, normally at just a few sampling points. Arthropod biomass and plant productivity should be narrowly related because a large majority of arthropods are herbivorous, and others depend on these. Quantifying plant productivity with satellite or aerial vehicle imagery is an easy and fast procedure already tested and implemented in agriculture and field ecology. However, the capability of satellite or aerial vehicle imagery for quantifying arthropod biomass and its relationship with plant productivity has been scarcely addressed. Here, we used unmanned aerial vehicle (UAV) and satellite Sentinel-2 (S2) imagery to establish a relationship between plant productivity and arthropod biomass estimated through ground-truth field sampling in shrub steppes. We UAV-sampled seven plots of 47.6-72.3 ha at a 4-cm pixel resolution, subsequently downscaling spatial resolution to 50 cm resolution. In parallel, we used S2 imagery from the same and other dates and locations at 10-m spatial resolution. We related several vegetation indices (VIs) with arthropod biomass (epigeous, coprophagous, and four functional consumer groups: predatory, detritivore, phytophagous, and diverse) estimated at 41-48 sampling stations for UAV flying plots and in 67-79 sampling stations for S2. VIs derived from UAV were consistently and positively related to all arthropod biomass groups. Three out of seven and six out of seven S2-derived VIs were positively related to epigeous and coprophagous arthropod biomass, respectively. The blue normalized difference VI (BNDVI) and enhanced normalized difference VI (ENDVI) showed consistent and positive relationships with arthropod biomass, regardless of the arthropod group or spatial resolution. Our results showed that UAV and S2-VI imagery data may be viable and cost-efficient alternatives for quantifying arthropod biomass at large scales in shrub steppes. The relationship between VI and arthropod biomass is probably habitat-dependent, so future research should address this relationship and include several habitats to validate VIs as proxies of arthropod biomass.

Disentangling the molecular mechanisms of multiple sclerosis: The contribution of twin studies.

Twin studies of disease concordance are useful to weight the relative contribution of genetic and environmental factors to the cause of common complex disorders. In multiple sclerosis (MS) different twinning rates from geographic areas at different prevalence suggested that heritable and non-heritable factors contribute in different proportions and ways to MS risk in diverse populations. This concept prompted genome-wide association studies, and the implementation of the co-twin control design, that allows stringent experimental approaches in MS-discordant identical pairs, controlling for genetic influences and many other known and unknown factors. The co-twin control design provided important clues on MS molecular model. These studies will be reviewed, focusing on those showing significant differences between affected and healthy co-twins. In some cases, differences that emerged in non-twin patients compared to matched controls were not confirmed in identical MS-discordant pairs, suggesting an 'MS subclinical trait'. Early patterns of magnetic resonance imaging and predictive biomarkers that characterize 'healthy' co-twins may be useful for the identification of a prodromal reversible phase of the disease.

Intestinal Permeability in Relapsing-Remitting Multiple Sclerosis.

Changes of intestinal permeability (IP) have been extensively investigated in inflammatory bowel diseases (IBD) and celiac disease (CD), underpinned by a known unbalance between microbiota, IP and immune responses in the gut. Recently the influence of IP on brain function has greatly been appreciated. Previous works showed an increased IP that preceded experimental autoimmune encephalomyelitis development and worsened during disease with disruption of TJ. Moreover, studying co-morbidity between Crohn's disease and MS, a report described increased IP in a minority of cases with MS. In a recent work we found that an alteration of IP is a relatively frequent event in relapsing-remitting MS, with a possible genetic influence on the determinants of IP changes (as inferable from data on twins); IP changes included a deficit of the active mechanism of absorption from intestinal lumen. The results led us to hypothesize that gut may contribute to the development of MS, as suggested by another previous work of our group: a population of CD8+CD161high T cells, belonging to the mucosal-associated invariant T (MAIT) cells, a gut- and liver-homing subset, proved to be of relevance for MS pathogenesis. We eventually suggest future lines of research on IP in MS: studies on IP changes in patients under first-line oral drugs may result useful to improve their therapeutic index; correlating IP and microbiota changes, or IP and blood-brain barrier changes may help clarify disease pathogenesis; exploiting the IP data to disclose co-morbidities in MS, especially with CD and IBD, may be important for patient care.

Genetic consequences of interglacial isolation in a steppe bird.

In response to climate changes that have occurred during Pleistocene glacial cycles, taxa associated to steppe vegetation might have followed a pattern of historical evolution in which isolation and fragmentation of populations occurred during the short interglacials and expansion events occurred during the long glacial periods, in contrast to the pattern described for temperate species. Here, we use molecular genetic data to evaluate this idea in a steppe bird with Palaearctic distribution, the little bustard (Tetrax tetrax). Overall, extremely low genetic diversity and differentiation was observed among eight little bustard populations distributed in Spain and France. Mismatch distribution analyses showed that most little bustard populations expanded during cooling periods previous to, and just after, the last interglacial period (127,000-111,000 years before present), when steppe habitats were widespread across Europe. Coalescent-based methods suggested that glacial expansions have resulted in substantial admixture in Western Europe due to the existence of different interglacial refugia. Our results are consistent with a model of evolution and genetic consequences of Pleistocene cycles with low between-population genetic differentiation as a result of short-term isolation periods during interglacials and long-term exchange during glacial periods.

Clinical case report and literature review: metachronous colorectal splenic metastases.

A 52-year-old woman with a rising carcinoembryonic antigen CEA, no clinical or radiological findings, a negative colonoscopy, and a positron emission tomography (PET) scan that revealed an isolated hypermetabolic lesion in the spleen. The patient underwent splenectomy by laparoscopic surgery. The pathological study confirmed the presence of an isolated metastasis to the spleen. This case reveals the rare occurrence of isolated splenic metastases in the context of colorectal cancer and illustrates the role of PET when a patient shows a rising CEA with negative clinicoradiological studies.

Clinical case report and literature review: metachronous colorectal splenic metastases

A 52-year-old woman with a rising carcinoembryonic antigen CEA, no clinical or radiological findings, a negative colonoscopy, and a positron emission tomography (PET) scan that revealed an isolated hypermetabolic lesion in the spleen. The patient underwent splenectomy by laparoscopic surgery. The pathological study confirmed the presence of an isolated metastasis to the spleen. This case reveals the rare occurrence of isolated splenic metastases in the context of colorectal cancer and illustrates the role of PET when a patient shows a rising CEA with negative clinicoradiological studies (AU)

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Experiencia preliminar en la aplicación del sellado con fibrina humana autóloga tras linfadenectomía axilar / No disponible

Introducción: Presentamos nuestra experiencia en el selladoaxilar con fibrina humana autóloga.Material y métodos: Se trata de un ensayo clínico, prospectivoy con asignación aleatoria de tratamiento de dos cohortesde pacientes diagnosticadas de cáncer de mama y tratadascon linfadenectomía axilar, uno sin sellado (control) y otrocon sellado axilar con fibrina humana autóloga (estudio) obtenidaa partir de sangre total de la paciente. La variable principalestudiada ha sido el flujo de drenaje axilar. Como variablessecundarias hemos valorado el dolor, la presencia de signosinflamatorios y/o de infección en la herida y las característicasmacroscópicas del drenaje así como la presencia de seromasaxilares tras la retirada del drenaje.Resultados: La muestra final estuvo compuesta por 36 pacientes(47,4% con sellado de fibrina, 52,6% sin sellado). En eldébito axilar diario se observó una diferencia importante aunquesin significación estadística en el primer día equilibrándose endías posteriores. Sin embargo, sí se observó un descenso significativodel volumen diario en el 4º y 5º días postoperatorio.Conclusiones: Los resultados de este estudio muestran unatendencia a la reducción de la linforrea a partir del tercer díapostoperatorio con la utilización de la fibrina autóloga frente algrupo sin fibrina. Sin embargo, para matizar a nivel estadísticoestos resultados, es necesario incrementar la muestra, por loque consideramos que este estudio es un preliminar(AU)

Introduction: The purpose of this study was to determine ifthe use of human autologous fibrin decreases the incidence ofdrainage in patients with axillary lymphadenectomy operatedfor breast cancer.Material and methods: Prospective clinical trial with twocohorts of patients diagnosed with breast cancer and treatedwith axillary lymphadenectomy, one cohort without seal (controlgroup) and the other one (study group) with autologous fibrinsealant obtained from the patient’s whole blood. Themain variable was amount of axillary drainage. Secondary variableswere: pain, presence of inflammation and/or infectionsigns, and macroscopic characteristics of the drainage.Results: The final sample was constituted by 36 patients(47.4% with fibrin sealant and 52.6% without it). We observedan important difference in drainage volume the first day, but withoutstatistical significance. The following days the volume inboth groups leveled. However, we observed a significance decreasein the drainge volume in the 4º y 5º postoperative days.Conclusions: Our results indicate a trend towards a decreaseof lymphorrhea in the group with autologous fibrin fromthe third day, as opposed to the group without it. Nevertheless,we deem it necessary to increase the sample size to givefurther statistical evidence. Therefore we consider this a preliminarystudy(AU)

Parotid gland metastasis of a breast cancer.

Parotid gland metastases from malignant tumors are extremely rare. A 61-year-old woman was diagnosed with an early breast cancer with no expression of oestrogen and progesterone receptors. Five years later the patient presented a tumour in parotid gland. After total parotidectomy, microscopic analysis of the gland demonstrated an invasive duct carcinoma (IDC) with positive expression of oestrogen receptor. The patient was treated with chemotherapy followed by complementary local radiotherapy. Diagnosis of a metastasic tumour in parotid gland poses a challenge. In our case an immunohistochemical study of oestrogen receptor was fundamental to establish a diagnosis.

Parotid gland metastasis of a breast cancer

Parotid gland metastases from malignant tumors are extremely rare. A 61-year-old woman was diagnosed with an early breast cancer with no expression of oestrogen and progesterone receptors. Five years later the patient presented a tumour in parotid gland. After total parotidectomy, microscopic analysis of the gland demonstrated an invasive duct carcinoma (IDC) with positive expression of oestrogen receptor. The patient was treated with chemotherapy followed by complementary local radiotherapy. Diagnosis of a metastasic tumour in parotid gland poses a challenge. In our case an immunohistochemical study of oestrogen receptor was fundamental to establish a diagnosis (AU)

[Transitional carcinoma of the ureter and ipsilateral synchronous renal cell carcinoma in hydronephrotic atrophic kidney: infrequent association]. / Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente.

We report a new case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma into ipsilateral ureter. A review of the literature to date indicates this is the 45 world-wide case and the 8 in the Spanish publications.

Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente / Transitional cell carcinoma of the ureter and sinchronous ipsilateral renal cell carcinoma in hydronephrotic-atrophic kidney: an infrequent association

Presentamos un nuevo caso de aparición simultánea de adenocarcinoma de células renales y carcinoma urotelial del uréter ipsilateral. La revisión de la literatura indica que éste es el caso 45 mundial y 8 en publicaciones españolas (AU)

A comparative study of magnetic resonance cholangiography and direct cholangiography.

OBJECTIVE: Magnetic resonance cholangiopancreatography (MRCP) is a rapidly developing method for the noninvasive assessment of the biliary tree and pancreatic duct that obviates the need for contrast medium. We describe our experience with this new diagnostic imaging method in patients with obstruction of the biliary tree. We assessed both the location and cause of obstruction, and compared the results with direct cholangiography. METHODS: Between 1997 and 1998, 81 patients underwent MRCP at our facility. Two different image acquisition protocols (half-Fourier acquisition single-shot turbo spin-echo -HASTE- and rapid acquisition with relaxation enhancement -RARE-) for T2-weighted turbo spin echo sequences as well as cross-sectional fast multiplanar gradient-echo pulse (T1-weighted FL2D) and T2-weighted fast spin echo (T2 TSE) sequences were used. All patients underwent direct (either percutaneous or endoscopic retrograde) cholangiography or surgery for confirmation and/or treatment. The images obtained with MRCP were evaluated by two radiologists with expertise in biliary tree imaging who were unaware of the patient's clinical characteristics, and their diagnostic interpretations were compared with the findings obtained upon surgery or direct cholangiography. RESULTS: The sensitivity and specificity of MRCP in ruling out pathologies and detecting the presence of dilatation of the biliary tree were 100%. In assessing the level of the obstruction, sensitivity and specificity varied with location (intrahepatic/hilar, suprapancreatic, intrapancreatic or ampullary). Sensitivity in these locations was 100, 92, 69 and 86%, respectively, whereas specificity was 100, 94, 92 and 91%, respectively. In determining the cause of the obstruction, the results were variable depending on the cause: choledocholithiasis (sensitivity, 89%; specificity, 90%) malignant obstruction (sensitivity, 92%; specificity, 88%), benign stricture (sensitivity, 63%; specificity, 90%), and chronic pancreatitis (sensitivity, 50%; specificity, 99%). CONCLUSIONS: MRCP offered high diagnostic accuracy in the assessment of the occurrence and location of biliary obstruction. Sensitivity and specificity in establishing the cause varied, and were highest for choledocholithiasis and malignant obstruction. MRCP may be used instead of ERCP, which may then be reserved for patients who are likely to require surgery.

Valoración actual de la colangiografia por resonancia magnética. Estudio comparativo con la colangiografía directa / A comparative study of magnetic resonance cholangiography and direct cholangiography

Objetivo: la colangiopancreatografía por resonancia magnética (CPRM) es una técnica en rápido desarrollo que permite valorar la vía biliar y pancreática de forma no invasiva sin necesidad de administrar contraste. Describimos nuestra experiencia en la utilización de este nuevo método de imagen en el diagnóstico de la obstrucción de la vía biliar, de su localización y de su causa comparándolo con la conlangiografía directa. Material y métodos: durante el período 1997-1998 se estudiaron en nuestro Servicio 81 pacientes con CPRM mediante dos formas distintas de adquisición de imágenes turbo spin echo en T2 (HASTE y RARE), junto a secuencias T1 F12D y T2 TSE transversas de abdomen. Todos ellos tuvieron confirmación diagnóstica posterior mediante colangiografía directa (retrógrada endoscópica o percutánea) o cirugía. Las imágenes de CPRM fueron evaluadas de forma ciega por dos radiólogos expertos en imagen de la vía biliar y su impresión diagnóstica comparada con el resultado de las pruebas confirmatorias. Resultados: la sensibilidad y especificidad de la CPRM para descartar patología y para detectar la presencia de dilatación de la vía biliar fueron del 100 por ciento. Para localizar el nivel de obstrucción, dependiendo de la localización; intrahepática/hiiar, suprapancreática, intrapancreática y ampular la sensibilidad fue del 100, 92, 69 y 86 por ciento y la especificidad del 100, 94, 92 y 91 por ciento, respectivamente. Para definir la causa de la obstrucción los resultados dependieron de las distintas etiologías: coledocolitiasis (S: 89 por ciento; E:90 por ciento), obstrucción maligna (S: 92 por ciento; E:88 por ciento), estenosis inflamatoria (S: 63; E:90 por ciento) y pancreatitis crónica (S: 50 por ciento; E:99 por ciento). Conclusiones: la CPRM posee una alta fiabilidad diagnóstica para evaluar la presencia y el nivel de obstrucción maligna. Puede utilizarse en el lugar de la CPRE diagnóstica, quedando esta última técnica reservada para cuando se tenga una alta sospecha de que será necesario realizar un procedimiento terapéutico (AU)

[Self-training in needle-knife sphincterotomy]. / Aprendizaje no tutelado de la esfinterotomía de aguja.

AIM: To analyze our experience in self-training in needle-knife sphincterotomy and to estimate the number of procedures necessary to reach competence in this technique. METHOD: Retrospective analysis of the first 60 needle-knife sphincterotomies performed, paying attention to success rates, the need for one or two attempts and the incidence and severity of early complications. The results were analyzed and divided into 2-year periods. The training period was subsequently determined using a qualitative method which combines the three above-mentioned criteria and sets competence level at 90%. RESULTS: Of the 60 attempted needle-knife sphincterotomies (five in Billroth-II patients), 54 (90%) were completed. The procedure was required in 20% of all the sphincterotomies completed. Needle-knife sphincterotomy was completed at the first attempt in 39 (65%) patients and complications appeared in 13 (22%), three (5%) of which were serious but not fatal. Analysis of 2 year periods showed an almost 100% increase in the total number of needle-knife sphincterotomies completed and in those completed at the first attempt, as well as a reduction in the complication rate, which subsequently stabilized at below 15%. Forty needle-knife sphincterotomies were needed to reach competence level. CONCLUSION: Needle-knife sphincterotomy can be learned without training from an endoscopist with experience in this technique. Competence can be reached after 40 procedures. Nevertheless, we propose an alternative method to our own to achieve competence in less time and with fewer complications.

Estudio Delphi de la Sociedad Valenciana de Cirugía: tratamiento quirúrgico del cáncer gástrico / A Delphi study by the Surgical Society of Valencia, Spain: surgical treatment of gastric cancer

Se presentan los resultados del primer estudio de consenso auspiciado por la Sociedad Valenciana de Cirugía sobre el tratamiento quirúrgico del cáncer gástrico. Se trata de un esudio tipo Delphi, con la participación de 31 expertos pertenecientes a la mayoría de hospitales de la Comunidad Valenciana. Los temas consensuados han versado sobre los siguientes aspectos: nutrición artificial, métodos de estadificación preoperatoria, tipo de resección y de linfadenectomía, técnicas de reconstrucción, criterios de resecabilidad y temas de organización (AU)

Video-laparoscopic staging of gastric cancer. A prospective multicenter comparison with noninvasive techniques.

BACKGROUND: The high proportion of gastric carcinomas present in an unresectable stage, together with the emergence of multimodal treatments, increases the usefulness of objective staging methods that avoid unnecessary laparotomies. METHODS: A prospective evaluation of the accuracy of laparoscopy in the staging of 71 patients with gastric adenocarcinoma is presented. Serosal infiltration, retroperitoneal fixation, metastasis to lymph nodes, peritoneal and liver metastasis, and ascites were determined in the staging workup. Sensitivity, specificity, and predictive values were calculated and compared with those obtained with ultrasonography (US) and computed tomography (CT). RESULTS: The diagnostic accuracy of laparoscopy in the determination of resectability was 98.6%. Consequently, over 40% of patients were spared unnecessary laparotomies. Laparoscopy yielded diagnostic indices superior to US and CT for all the tumoral attributes studied. Our technique permits accurate assessment and pathologic verification of liver and the peritoneal and retroperitoneal extent of tumor invasion in the majority of patients. CONCLUSIONS: Laparoscopy in gastric adenocarcinoma is a reliable technique that provides accurate assessment of resectability and stage, thus avoiding unnecessary laparotomies in patients in whom surgical palliation is not indicated. A stepwise diagnostic workup combining imaging and minimally invasive techniques is proposed.

Total anomalous left pulmonary venous connection with intact atrial septum: surgical treatment of a rare case.

Total anomalous left pulmonary venous connection with intact atrial septum is an extremely rare form of congenital heart disease. We describe a case never reported before in which the left pulmonary veins drained directly into the right atrium through a common vein. Surgical correction was successfully obtained by redirecting the blood flow through a newly created atrial septal defect into the left atrium using a gluteraldehyde-treated autologous pericardial patch. Follow-up at 6 months shows no signs of any complication.

Epidemiology of primary sclerosing cholangitis in Spain. Spanish Association for the Study of the Liver.

The incidence of primary sclerosing cholangitis has been estimated on the basis of its frequent association with ulcerative colitis, but direct epidemiologic studies have not yet been carried out. In the current study we report a survey of clinical and epidemiological aspects of primary sclerosing cholangitis in Spain. A questionnaire was circulated to physicians in 33 hospitals throughout Spain to ascertain the number and the clinical, biochemical and immunologic characteristics of patients with primary sclerosing cholangitis from January 1, 1984 to December 31, 1988. Twenty-three centers, from 12 Spanish regions, covering a population of 19.23 million answered the questionnaire. Forty-three patients (60.5% males) with a mean age of 42.3 years (range 12 to 75 years) were seen during the 5-year period. At presentation, 16% of the cases were asymptomatic. Ulcerative colitis was present in 44.2% of cases, and one patient had Crohn's disease. The overall annual incidence ranged from 0.16 to 0.68 cases/million from 1985 to 1988, and the annual prevalence increased from 0.78 cases/million in 1984 to 2.24 cases/million in 1988. No geographical differences were found, but there was a trend to detect more cases in industrialized regions. In conclusion, there was a continuing rise in the annual incidence and prevalence of primary sclerosing cholangitis in Spain over a 5-year period.