Eficacia y seguridad de la ureteroscopia y la cirugía retrógrada intrarrenal sin fluoroscopia para el tratamiento de la urolitiasis: estudio comparativo / Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study

Introducción Las técnicas convencionales de ureteroscopia (URS) y cirugía retrógrada intrarrenal (CRIR) requieren el uso de guía fluoroscópica, pero los riesgos derivados de la exposición a radiaciones ionizantes constituyen un motivo de preocupación entre pacientes y urólogos. El objetivo de este estudio fue evaluar la eficacia y la seguridad de la URS y la CRIR sin fluoroscopia y compararlas con los procedimientos convencionales guiados por fluoroscopia para el tratamiento de litiasis ureterales y renales. Material y métodos Los pacientes tratados con URS o CRIR para litiasis urinaria entre agosto de 2018 y diciembre de 2019 fueron evaluados retrospectivamente y agrupados según el uso de o la ausencia de fluoroscopia. Los datos se recopilaron de las historias individuales de los pacientes. Los criterios de valoración principales fueron la tasa libre de cálculos (TLC) y las complicaciones, comparadas entre los grupos con fluoroscopia y sin fluoroscopia. Se realizó un análisis de subgrupos por tipo de procedimiento (URS y CRIR) y un análisis multivariante para identificar los factores predictivos de litiasis residual. Resultados Un total de 231 pacientes cumplieron los criterios de inclusión: 120 (51,9%) en el grupo tratado con fluoroscopia convencional y 111 (48,1%) en el grupo tratado sin fluoroscopia. No se hallaron diferencias significativas entre los grupos en cuanto a la TLC (82,5% vs. 90,1%; p=0,127) o de complicaciones postoperatorias (35,0% vs. 31,5%; p=0,675). No se hallaron diferencias significativas entre estas variables en el análisis de subgrupos, independientemente del procedimiento considerado (AU)

Introduction Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. Material and methods Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. Results A total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%; P=.127) or postoperative complication rate (35.0% vs 31.5%; P=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR: 0.991; 95%IC: 0.407-2.411; P=.983), when adjusted for procedure type, stone size and stone number. Conclusion URS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure (AU)

Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study.

INTRODUCTION: Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. MATERIAL AND METHODS: Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. RESULTS: A total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%, p=.127) or postoperative complication rate (35.0% vs 31.5%, p=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR 0.991; 95% IC 0.407-2.411; p=.983), when adjusted for procedure type, stone size and stone number. CONCLUSION: URS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.

Analysis of influenza data generated by four epidemiological surveillance laboratories in Mexico, 2010-2016.

The disease caused by the influenza virus is a global public health problem due to its high rates of morbidity and mortality. Thus, analysis of the information generated by epidemiological surveillance systems has vital importance for health decision making. A retrospective analysis was performed using data generated by the four molecular diagnostic laboratories of the Mexican Social Security Institute between 2010 and 2016. Demographics, influenza positivity, seasonality, treatment choices and vaccination status analyses were performed for the vaccine according to its composition for each season. In all cases, both the different influenza subtypes and different age groups were considered separately. The circulation of A/H1N1pdm09 (48.7%), influenza A/H3N2 (21.1%), influenza B (12.6%), influenza A not subtyped (11%) and influenza A/H1N1 (6.6%) exhibited well-defined annual seasonality between November and March, and there were significant increases in the number of cases every 2 years. An inadequate use of oseltamivir was determined in 38% of cases, and the vaccination status in general varied between 12.1 and 18.5% depending on the season. Our results provide current information about influenza in Mexico and demonstrate the need to update both operational case definitions and medical practice guidelines to reduce the inappropriate use of antibiotics and antivirals.

Carcinoma medular de tiroides estadio IV y gestación / Medullary thyroid carcinoma stage IV and pregnancy

El carcinoma medular de tiroides (CMT) es un tumor maligno poco frecuente, con relativa agresividad debido a la existencia de metástasis a distancia en el momento del diagnóstico. Se considera como tratamiento de primera línea la cirugía, aunque existen otras opciones de tratamiento en los casos de recurrencia o enfermedad persistente, como los inhibidores de la tirosin-kinasa. El impacto del embarazo en mujeres con CMT es desconocido. Presentamos un caso inédito de una paciente diagnosticada de CMT con gestación posterior exitosa

Medullary thyroid carcinoma is an uncommon malignant tumour that behaves aggressively due to frequent distant metastases at the time of diagnosis. Surgery is considered as first-line treatment, although other treatment options are available for patients with recurrent or residual disease, such as a tyrosine kinase inhibitors. The impact of pregnancy on women with medullary thyroid carcinoma is unknown. We present the case of a woman with medullary thyroid carcinoma whose subsequent pregnancy was successful

Autodisplay of an avidin with biotin-binding activity on the surface of Escherichia coli.

OBJECTIVES: To display a recombinant avidin fused to the autotransporter ShdA to bind biotinylated molecules on the surface of Escherichia coli. RESULTS: Two chimeric protein constructs containing avidin fused to the autotransporter ShdA were expressed on the surface of Escherichia coli DH5α. One fusion protein contained 476 amino acids of the ShdA α and ß domains, whereas the second consisted of a 314 amino acid from α and truncated ß domains. Protein production was verified by SDS-PAGE using an antibody to the molecular FLAG-tag. The surface display of the avidin-shdA fusion protein was confirmed by confocal microscopy and flow cytometry analysis, and the biotin-binding activity was evaluated by fluorescence microscopy and flow cytometry using biotin-4-fluorescein and biotinylated-ovalbumin (OVA). CONCLUSIONS: Expression of a recombinant avidin with biotin-binding activity on the surface of E. coli was achieved using the autotransporter ShdA. This system is an alternative to bind biotinylated molecules to E. coli.

Relaxation dynamics of glasses along a wide stability and temperature range.

While lots of measurements describe the relaxation dynamics of the liquid state, experimental data of the glass dynamics at high temperatures are much scarcer. We use ultrafast scanning calorimetry to expand the timescales of the glass to much shorter values than previously achieved. Our data show that the relaxation time of glasses follows a super-Arrhenius behaviour in the high-temperature regime above the conventional devitrification temperature heating at 10 K/min. The liquid and glass states can be described by a common VFT-like expression that solely depends on temperature and limiting fictive temperature. We apply this common description to nearly-isotropic glasses of indomethacin, toluene and to recent data on metallic glasses. We also show that the dynamics of indomethacin glasses obey density scaling laws originally derived for the liquid. This work provides a strong connection between the dynamics of the equilibrium supercooled liquid and non-equilibrium glassy states.

Ultrastable glasses portray similar behaviour to ordinary glasses at high pressure.

Pressure experiments provide a unique opportunity to unravel new insights into glass-forming liquids by exploring its effect on the dynamics of viscous liquids and on the evolution of the glass transition temperature. Here we compare the pressure dependence of the onset of devitrification, Ton, between two molecular glasses prepared from the same material but with extremely different ambient-pressure kinetic and thermodynamic stabilities. Our data clearly reveal that, while both glasses exhibit different dTon/dP values at low pressures, they evolve towards closer calorimetric devitrification temperature and pressure dependence as pressure increases. We tentatively interpret these results from the different densities of the starting materials at room temperature and pressure. Our data shows that at the probed pressures, the relaxation time of the glass into the supercooled liquid is determined by temperature and pressure similarly to the behaviour of liquids, but using stability-dependent parameters.

Complete Genome Sequence of Human Respiratory Syncytial Virus Isolated in Mexico.

Human respiratory syncytial virus (HRSV) is a member of the Paramyxoviridae family, which causes lower respiratory tract infections in neonates and children younger than 5 years. Here, we report the complete genome sequence of HRSV, isolated from a nasopharyngeal swab of a pregnant woman with cardiac complications.

Postpartum development of endothelial dysfunction and oxidative stress markers in women with previous gestational diabetes mellitus.

BACKGROUND: Relationships between adhesion molecules (AM), oxidative stress, gestational diabetes mellitus (GDM) and future development of type 2 diabetes mellitus are unclear. AIM: We investigated AM and oxidant/antioxidant markers in women with previous history of GDM. SUBJECTS AND METHODS: Postpartum women with GDM (cases; n = 41) and healthy women (controls; n = 21) had clinical and laboratory variables measured, including indicators of vascular damage (ICAM-1, VCAM-1 and E-selectin), oxidative stress (LPO, GSH and GST) and antioxidant markers (catalase, SOD, GPX and TAC). RESULTS: Previous GDM versus control women presented higher body mass index: 27.4 ± 5.6 versus 23.9 ± 3.6 (p = 0.013); waist circumference: 85.2 ± 12.9 versus 77.5 ± 9.0 (p = 0.017); MetS (WHO definition): 14.6 versus 0 % (p = 0.012); MetS (NCEP-ATPIII definition): 22 versus 0 % (p = 0.002); low HDL: 36.6 versus 9.5 % (p = 0.024); fasting glucose (mmol/L): 5.4 ± 0.6 versus 4.9 ± 0.2 (p < 0.001); glucose 120 min (mg/dL): 105.0 ± 30.2 versus 85.1 ± 14.2 (p = 0.007); fasting insulin (µU/mL): 13.4 ± 8.1 versus 8.4 ± 4.3 (p = 0.004); HOMA index: 3.3 ± 2.3 versus 1.8 ± 1.0 (p = 0.002); HbA1c (%/mmol/mol): 5.4 ± 0.2 versus 5.2 ± 0.2/36 ± 1.4 versus 33 ± 1.4 (p = 0.021); uric acid (mg/dL): 4.1 ± 1 versus 3.5 ± 0.6 (p = 0.009); catalase (nmol/min/mL): 38.7 ± 15.6 versus 28.9 ± 11.1 (p = 0.013). There were no significant differences in hypertension prevalence, lipid fractions, albumin/creatinine ratio and AM. CONCLUSIONS: Women with previous GDM have high catalase levels which correlate positively with glucose intolerance, indicating the potential effect of oxidative stress on postpartum dysglycemic status.

Acoustic-like dynamics of amorphous drugs in the THz regime.

The high frequency dynamics of Indomethacin and Celecoxib glasses has been investigated by inelastic x-ray scattering, accessing a momentum-energy region still unexplored in amorphous pharmaceuticals. We find evidence of phonon-like acoustic dynamics, and determine the THz behavior of sound velocity and acoustic attenuation. Connections with ordinary sound propagation are discussed, along with the relation between fast and slow degrees of freedom as represented by non-ergodicity factor and kinetic fragility, respectively.

Correction of distal limb prolapse of a diverting colostomy by stapling under sedation.

AIM: To describe a surgical technique to treat colostomy prolapse as a day case procedure with the patient under sedation and analgesia. METHOD: A 60-mm GIA Universal Stapler is inserted into the lumen of the prolapsed colon at right angles to the contour of the abdominal wall. Several firings are then made to completely divide the prolapsed colon. The instrument is then placed parallel to the skin to remove the prolapsed portion leaving 1-2 cm of bowel above the level of the skin. RESULTS: Two patients underwent the procedure. The operation times were 30 and 13 min. Both took oral liquids 2 h after surgery and solids 2 h later. They were discharged at 24 and 4 h after surgery, respectively. No postoperative pain was reported in either case. At 14 and 6 months of follow-up there has been no recurrence. CONCLUSION: Stapling treatment of prolapsed colostomies has the advantage of being an extra-abdominal procedure. It is performed under sedation and analgesia, the operation time is very short, recovery to normal life is rapid and there is less likelihood of complications by avoiding a laparotomy.

Glass transition in ultrathin films of amorphous solid water.

Nanocalorimetry at ultrafast heating rates is used to investigate the glass transition of nanometer thick films of metastable amorphous solid water grown by vapor deposition in an ultrahigh vacuum environment. Apparent heat capacity curves exhibit characteristic features depending on the deposition temperature. While films grown at T ≥ 155 K are completely crystallized, those deposited at 90 K show a relaxation exotherm prior to crystallization. Films grown between 135 and 140 K and subsequently cooled down to 90 K reveal a clear endothermic feature before crystallization, which is compatible with a glass-to-liquid transition. The onset temperature is located at 174 K at a heating rate of 2.4 × 10(4) K/s and is independent of film thickness in the range of 16-150 nm. Comparison of our data with other calorimetric measurements at various heating rates suggests that water is a strong glass former in the deeply supercooled state.

Colorectal cancer in nonagenarians.

AIM: The aim of the study was to analyze the short-term and long-term outcomes of nonagenarians treated for colorectal cancer. METHOD: A retrospective analysis was performed of 74 patients, ≥ 90 years of age, diagnosed with colorectal cancer during the period 1986-2009. Comorbidity, American Society of Anesthesiology (ASA) grade, symptoms, diagnosis, treatment, mortality, morbidity and survival were analyzed. RESULTS: Of the 74 patients, 48 (65%) were women. Twenty-two patients were classified as ASA grade I-II, 26 as ASA grade III and 26 as ASA grade IV-V. Thirty-one (42%) had intestinal obstruction at the time of diagnosis. Twenty-two (30%) patients were diagnosed during the period 1986-2000 and 52 (70%) were diagnosed between 2001 and 2009. Forty-four (59%) patients underwent surgery, of whom 19 (49%) were treated as an emergency. Eleven (25%) patients died postoperatively, with mortality rates of 12% (3/25) for elective surgery and 42% (8/19) for emergency surgery. Surgical mortality for ASA grade I and grade II patients was 5% (1/20) and their 5-year survival rate (postoperative mortality excluded) was 44%, whereas 5-year survival for ASA grade III patients who underwent surgery was 12.5% and surgical mortality was 25% (4/16). There were no survivors beyond 36 months among patients who did not receive surgery. CONCLUSION: Our results indicate that elective and emergency colorectal surgery can be performed with acceptable rates of mortality and morbidity on nonagenarian patients in good general condition with low perioperative risk. The 5-year survival rate was related to ASA grade and to the use of surgery.

Cytokine profile, metabolic syndrome and cardiovascular disease risk in women with late-onset gestational diabetes mellitus.

Inflammation is an important component of the metabolic syndrome (MetS) which could be the link between the metabolic and the cardiovascular consequences of this condition. Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for MetS and an inflammation component has been described in this disease. The aim of the study was to evaluate the relationships between cytokine concentrations, components of MetS and cardiovascular risk markers in women with late-onset GDM. Women (n=63) with late-onset GDM and 63 controls were enrolled. Clinical variables, and obstetrics and perinatal outcomes were recorded. Relationships between cytokines (TNF-α, leptin, IL6, adiponectin) and endothelial injury markers (VCAM, ICAM and selectine) were analyzed. Control vs. patient data indicated: pre-gestational body mass index (BMI) 23.46±3.73 vs. 26.97±5.07kg/m(2) (p=0.001); TNF-α 2.2±0.8 vs. 3.1±1.5pg/mL (p=0.002); leptin 18714.78±8859.08 vs. 27365.79±16209.67pg/mL (p=0.001); adiponectin 162.42±34.19 vs. 141.54±41.33ng/mL (p=0.04). Multivariate analyses showed that adiponectin had a protective effect (OR=0.9; p=0.02) and BMI carried a significant risk (OR=8.4; p=0.01) for GDM. No differences were found in endothelial injury markers. In conclusion, the cytokine profile in women with late-onset GDM is characterized by high concentrations of TNF-α and leptin and low adiponectin. This profile is related, in large extent, to an increased pregravid BMI which, potentially, may be linked to the future development of both metabolic and cardiovascular disease.

Infección por VIH, hígado y tracto biliar: evaluación de las complicaciones en los pacientes infectados / HIV infection, liver and biliary tract. Evaluation of complications in infected patients

Liver and biliary tract disease in patients with HIV infection is common and is related to immunosuppression, therapy and coinfection with hepatitis B and/or C virus. In this way, we can observe the development of opportunistic infections or malignancies related or not to HIV, viral hepatitis, drug toxicity, multifactorial hepatic steatosis and cirrhosis. We review each one of these complications and major clinical elements for diagnosis. Finally, an algorithm for the study of the complications of the liver and biliary tract in these patients is proposed.

La enfermedad hepática y de la vía biliar en pacientes con infección por VIH es común y se relaciona con la inmunosupresión, el tratamiento y la coinfección por virus B y/o C. De esta forma, podemos observar el desarrollo de infecciones oportunistas, neoplasias relacionadas o no a VIH, hepatitis virales, toxicidad por drogas, esteatosis hepática multifactorial y cirrosis. Revisamos cada una de estas complicaciones y los elementos clínicos más importantes para su diagnóstico. Finalmente, se propone un algoritmo de estudio de las complicaciones hepáticas y de la vía biliar en estos pacientes.

Accelerated aging in ultrathin films of a molecular glass former.

We report the thermodynamic measurement of the enthalpy released during the aging of supported films of a molecular glass former, toluene, at temperatures well below the glass transition temperature. By using microfabricated devices with very short equilibration times (below 1 s), we evidence a remarkable variation of the relaxation rate on decreasing film thickness from 100 nm down to a 7 nm thick film. Our results demonstrate that surface atoms are more efficient than bulk atoms in attaining low energy configurations within the potential energy landscape.

Hipertiroidismo transitorio tras la curación de una enfermedad de Cushing / Transient hyperthyroidism after curing a Cushing disease

No disponible

[Papilar thyroid carcinoma. An unusual clinic]. / Carcinoma papilar de tiroides de localizacion inusual.

The Papillary carcinoma is the most frequent neoplasic tumour of the thyroid gland. It accounts for 70-75% of all malignant thyroid tumours. In 80-90% of cases it presents as a slow-growing single thyroid node. Nevertheless, in 10-26% of cases, the initial presentation is a lateral neck mass without palpable thyroid mass. We present the case of a 67 year- old patient who attended to the ENT out-patient clinic with a lateral neck mass which had been growing slowly over the course of number of years.

Carcinoma papilar de tiroides de localización inusual / Papilar thyroid carcinoma. An unusual clinic

El carcinoma papilar es el tumor más frecuente de la glándula tiroides, con una frecuencia del 70-75% de todos los cánceres tiroideos. En el 80-90% de los casos se manifesta como un nódulo tiroideo único de crecimiento lento. Sin embargo, en el 10-26%; la forma de presentación es de una tumoración laterocervical aislada en ausencia de una masa tiroidea palpable. Presentamos el caso de un paciente de 67 años de edad que acudió a consulta por tumoración laterocervical de varios años de evolución

The Papillary carcinoma is the most frequent neoplasic tumour of the thyroid gland. It accounts for 70-75% of all malignant thyroid tumours. In 80-90% of cases it presents as a slow-growing single thyroid node. Nevertheless, in 10-26% of cases, the initial presentation is a lateral neck mass without palpable thyroid mass. We present the case of a 67 year- old patient who attended to the ENT out-patient clinic with a lateral neck mass which had been growing slowly over the course of number of years