Survival among treated tongue cancer patients: a single-center experience.

OBJECTIVE: To describe overall survival (OS) and disease-free survival (DFS) in a cohort of tongue cancer patients, together with the corresponding demographic, tumor and surgical characteristics. METHODS: A retrospective study was made of 205 consecutive patients with primary tongue cancer subjected to surgery and adjuvant therapy according to the stage of the disease, in Hospital Clínico Universitario Virgen de la Arrixaca (HUVA) (Murcia, Spain) during the period 2000-2020. Survival was evaluated based on the Kaplan-Meier method, and the existence of significant differences between the different study variables was analyzed using the log-rank test. Cox regression analysis was performed for the identification of risk factors. RESULTS: In relation to overall survival, 72.6% of the patients survived for a mean time of 14.43 years [standard error (SE) = 0.74; 95% CI: 12.98-15.87], with a cumulative survival rate of 49.8 ± 3%. Survival was reduced by the presence of tumor adjacent to resection margins [hazard ratio (HR) 2.20; 95% CI 1.09-4.43] (p = 0.028) and infiltrated resection margins (HR 3.86, 95% CI 1.56-9.57) (p = 0.004). Lymphadenectomy in turn increased survival (HR 0.15; 95% CI 0.06-0.42) (p < 0.001). In relation to disease-free survival, 55.3% of the patients suffered no relapse over a mean period of 9.91 years (SE = 0.66; 95% CI: 8.61-11.2), with a cumulative survival rate of 26.6% ± 8.4%. CONCLUSIONS: In tongue cancer patients, overall and specific survival were reduced in the presence of infiltrated resection margins. Lymphadenectomy in turn improved survival compared with patients in which this procedure was not carried out.

In situ correlation between microplastic and suspended particulate matter concentrations in river-estuary systems support proxies for satellite-derived estimates of microplastic flux.

Rivers are key pathways for transporting microplastics from land to the oceans, yet microplastic flux estimates remain uncertain. Remote sensing allows repeated broad-scale measurements and can be used to extrapolate limited in situ observations. This study investigated the relationship between suspended particulate matter (SPM), a satellite-observable water quality parameter, and microplastic concentration in a partially mixed estuary (Tamar, UK). Microplastic concentrations ranged from 0.04 to 0.99 microplastics/m3, decreasing downstream. A significant correlation was found between SPM and microplastic concentration over two seasons. This relationship was used to compute a multiyear timeseries of proxy microplastic concentration from satellite imagery and produce estimates of annual proxy microplastic flux. This approach could be applied to investigate microplastic flux in other major rivers worldwide where such a relationship between microplastics and SPM exists. To apply this workflow elsewhere, the establishment of local SPM-to-microplastic relationships from in situ observations and local validation of remote sensing SPM algorithms are essential.

Long-Term Effects of Imidacloprid, Thiacloprid, and Clothianidin on the Growth and Development of Eisenia andrei.

Recently, the high toxicity of neonicotinoids to the survival and reproduction of adult earthworms has become apparent in standard 56-day toxicity tests. The persistence of some neonicotinoids and/or their repeated application may lead to long-term exposure, possibly also affecting other parts of the life cycle of earthworms. The present study aimed at providing insight into the sublethal effects of imidacloprid, thiacloprid, and clothianidin on juvenile Eisenia andrei exposed for 16 weeks in Lufa 2.2 soil. Significant effects on growth and maturation were observed for all compounds. Exposure to 0.125 mg imidacloprid/kg dry soil and 0.03125 and 0.0625 mg thiacloprid/kg dry soil significantly affected the growth of the earthworms, while significant maturation effects were observed at 0.03125 mg/kg dry soil for imidacloprid and thiacloprid and 0.25 mg clothianidin/kg dry soil. The 16-week no-observed-effect concentrations (NOECs) found in the present study were lower than previously reported NOECs for effects on earthworm reproduction. Predicted environmental concentrations after a single application exceeded the observed NOECs for effects on earthworm maturation in the case of imidacloprid and thiacloprid and for effects on earthworm growth in the case of thiacloprid and clothianidin. Environ Toxicol Chem 2022;41:1686-1695. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Holistic assessment of the microbiome dynamics in the substrates used for commercial champignon (Agaricus bisporus) cultivation.

Microorganisms strongly influence and are required to generate the selective substrate that provides nutrients and support for fungal growth, and ultimately to induce mushroom fructification under controlled environmental conditions. In this work, the fungal and bacterial microbiota living in the different substrates employed in a commercial crop (compost phase I, II and III, flush 1 and 2, and casing material on day 1, 6 and 8 after compost casing and during flush 1 and 2) have been characterized along the different stages of cultivation by metataxonomic analysis (16S rRNA and ITS2), analysis of phospholipid fatty acid content (PLFAs) and RT-qPCR. Additionally, laccase activity and the content of lignin and complex carbohydrates in compost and casing have been quantified. The bacterial diversity in compost and casing increased throughout the crop cycle boosted by the connection of both substrates. As reflected by the PLFAs, the total living bacterial biomass appears to be negatively correlated with the mycelium of the crop. Agaricus bisporus was the dominant fungal species in colonized substrates, displacing the pre-eminent Ascomycota, accompanied by a sustained increase in laccase activity, which is considered to be a major product of protein synthesis during the mycelial growth of champignon. From phase II onwards, the metabolic machinery of the fungal crop degrades lignin and carbohydrates in compost, while these components are hardly degraded in casing, which reflects the minor role of the casing for nourishing the crop. The techniques employed in this study provide a holistic and detailed characterization of the changing microbial composition in commercial champignon substrates. The knowledge generated will contribute to improve compost formulations (selection of base materials) and accelerate compost production, for instance, through biotechnological interventions in the form of tailored biostimulants and to design environmentally sustainable bio-based casing materials.

Author Correction: Finding Plastic Patches in Coastal Waters using Optical Satellite Data.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Detection of Human p53 In-Vitro Expressed in a Transcription-Translation Cell-Free System by a Novel Conjugate Based on Cadmium Sulphide Nanoparticles.

Here, cadmium sulphide quantum dots (CdS QDs) have been synthetized and functionalized with Bovine Serum Albumin (BSA) in a colloidal aqueous solution with a stability of over 3 months. Specific synthesis conditions, in homogeneous phase and at low temperature, have allowed limitation of S2- concentration, hence, as a consequence, there is restricted growth of the nanoparticles (NPs). This fact allows binding with BSA in the most favorable manner for the biomolecule. The presence of Cd2+ ions on the surface of the CdS nanoparticle is counteracted by the negatively charged domains of the BSA, resulting in the formation of small NPs, with little tendency for aggregation. Temperature and pH have great influence on the fluorescence characteristics of the synthetized nanoparticles. Working at low temperatures (4 °C) and pH 10-11 have proven the best result as shown by hydrolysis kinetic control of the thioacetamide precursor of S2- ion. Biological activity of the coupled BSA is maintained allowing subsequent bioconjugation with other biomolecules such as antibodies. The chemical conjugation with anti-Glutathione S-transferase (α-GST) antibody, a common tag employed in human recombinant fusion proteins, produces a strong quenching of fluorescence that proves the possibilities of its use in biological labelling. Finally, p53, onco-human recombinant protein (GST tagged in COOH terminus), has been in situ IVTT (in vitro transcription-translation) expressed and efficiently captured by the α-GST-CdS QD conjugate as a proof of the biocompatibility on IVTT systems and the functionality of conjugated antibody.

Finding Plastic Patches in Coastal Waters using Optical Satellite Data.

Satellites collecting optical data offer a unique perspective from which to observe the problem of plastic litter in the marine environment, but few studies have successfully demonstrated their use for this purpose. For the first time, we show that patches of floating macroplastics are detectable in optical data acquired by the European Space Agency (ESA) Sentinel-2 satellites and, furthermore, are distinguishable from naturally occurring materials such as seaweed. We present case studies from four countries where suspected macroplastics were detected in Sentinel-2 Earth Observation data. Patches of materials on the ocean surface were highlighted using a novel Floating Debris Index (FDI) developed for the Sentinel-2 Multi-Spectral Instrument (MSI). In all cases, floating aggregations were detectable on sub-pixel scales, and appeared to be composed of a mix of seaweed, sea foam, and macroplastics. Building first steps toward a future monitoring system, we leveraged spectral shape to identify macroplastics, and a Naïve Bayes algorithm to classify mixed materials. Suspected plastics were successfully classified as plastics with an accuracy of 86%.

An Ocean-Colour Time Series for Use in Climate Studies: The Experience of the Ocean-Colour Climate Change Initiative (OC-CCI).

Ocean colour is recognised as an Essential Climate Variable (ECV) by the Global Climate Observing System (GCOS); and spectrally-resolved water-leaving radiances (or remote-sensing reflectances) in the visible domain, and chlorophyll-a concentration are identified as required ECV products. Time series of the products at the global scale and at high spatial resolution, derived from ocean-colour data, are key to studying the dynamics of phytoplankton at seasonal and inter-annual scales; their role in marine biogeochemistry; the global carbon cycle; the modulation of how phytoplankton distribute solar-induced heat in the upper layers of the ocean; and the response of the marine ecosystem to climate variability and change. However, generating a long time series of these products from ocean-colour data is not a trivial task: algorithms that are best suited for climate studies have to be selected from a number that are available for atmospheric correction of the satellite signal and for retrieval of chlorophyll-a concentration; since satellites have a finite life span, data from multiple sensors have to be merged to create a single time series, and any uncorrected inter-sensor biases could introduce artefacts in the series, e.g., different sensors monitor radiances at different wavebands such that producing a consistent time series of reflectances is not straightforward. Another requirement is that the products have to be validated against in situ observations. Furthermore, the uncertainties in the products have to be quantified, ideally on a pixel-by-pixel basis, to facilitate applications and interpretations that are consistent with the quality of the data. This paper outlines an approach that was adopted for generating an ocean-colour time series for climate studies, using data from the MERIS (MEdium spectral Resolution Imaging Spectrometer) sensor of the European Space Agency; the SeaWiFS (Sea-viewing Wide-Field-of-view Sensor) and MODIS-Aqua (Moderate-resolution Imaging Spectroradiometer-Aqua) sensors from the National Aeronautics and Space Administration (USA); and VIIRS (Visible and Infrared Imaging Radiometer Suite) from the National Oceanic and Atmospheric Administration (USA). The time series now covers the period from late 1997 to end of 2018. To ensure that the products meet, as well as possible, the requirements of the user community, marine-ecosystem modellers, and remote-sensing scientists were consulted at the outset on their immediate and longer-term requirements as well as on their expectations of ocean-colour data for use in climate research. Taking the user requirements into account, a series of objective criteria were established, against which available algorithms for processing ocean-colour data were evaluated and ranked. The algorithms that performed best with respect to the climate user requirements were selected to process data from the satellite sensors. Remote-sensing reflectance data from MODIS-Aqua, MERIS, and VIIRS were band-shifted to match the wavebands of SeaWiFS. Overlapping data were used to correct for mean biases between sensors at every pixel. The remote-sensing reflectance data derived from the sensors were merged, and the selected in-water algorithm was applied to the merged data to generate maps of chlorophyll concentration, inherent optical properties at SeaWiFS wavelengths, and the diffuse attenuation coefficient at 490 nm. The merged products were validated against in situ observations. The uncertainties established on the basis of comparisons with in situ data were combined with an optical classification of the remote-sensing reflectance data using a fuzzy-logic approach, and were used to generate uncertainties (root mean square difference and bias) for each product at each pixel.

Influence of different agricultural management practices on soil microbial community over dissipation time of two herbicides.

Soil microbiology could be affected by the presence of pesticide residues during intensive farming, potentially threatening the soil environment. The aim here was to assess the dissipation of the herbicides triasulfuron and prosulfocarb, applied as a combined commercial formulation, and the changes in soil microbial communities (through the profile of phospholipid fatty acids (PLFAs) extracted from the soil) during the dissipation time of the herbicides under field conditions. The dissipation of herbicides and the soil microbial structure were assessed under different agricultural practices, such as the repeated application of herbicides (twice), in unamended and amended soils with two organic amendments derived from green compost (GC1 and GC2) and with non-irrigation and irrigation regimes. The results obtained indicate slower dissipation for triasulfuron than for prosulfocarb. The 50% dissipation time (DT50) decreased under all conditions for the second application of triasulfuron, although not for prosulfocarb. The DT50 values for both herbicides increased in the GC2 amended soil with the highest organic carbon (OC) content. The DT50 values decreased for prosulfocarb with irrigation, but not for triasulfuron, despite its higher water solubility. The herbicides did not have any significant effects on the relative population of Gram-negative and Gram-positive bacteria during the assay, but the relative abundance of Actinobacteria increased in all the soils with herbicides. At the end of the assay (215 days), the negative effects of herbicides on fungi abundance were significant (p < 0.05) for all the treatments. These microbiological changes were detected in non-irrigated and irrigated soils, and were more noticeable after the second application of herbicides. Actinobacteria could be responsible for the modification of herbicide degradation rates, which tend to be faster after the second application. This study makes a useful contribution to the evaluation of the soil environment and microbiological risks due to the long-term repeated application of herbicides under different agricultural management practices.

Arteriovenous Malformations of the Temporalis Muscle: A Comprehensive Review.

Arteriovenous malformations of the temporalis muscle (TM-AVMs) are rare lesions commonly considered as a variant of scalp AVMs. A study was designed in order to analyze TM-AVMs features and to confirm them as a certain entity different from scalp AVMs. Seven TM-AVMs cases (5 from literature plus 2 from our database) were studied. Clinical, epidemiological, radiological, and therapeutic data were analyzed and compared to common scalp AVMs features. All TM-AVMs presented as large soft tumor-like masses on the temporal region (mean diameter: 6 cm). Pain was referred in half of cases, while overlying cutaneous stigmas were described only once. No masticatory malfunction was reported. TM-AVMs tend to appear in young patients (mean: 29 yr), commonly as longstanding and slow-evolving lesions (mean evolution time before diagnosis: 5 yr). All cases displayed a diffuse slow-flow blush on angiogram. All TM-AVMs were completely located within the TM, with no involvement of scalp or bone. The pathological analysis of all cases demonstrated the presence of striate muscular bundles intermingled with fairly mature arterial and venous vessels. No clearly distorted vessel was found within the TM-AVMs. Surgery was performed for all cases with complete removal. Preoperative embolization was done in 4 cases to reduce blood loss during surgery. No clinical/radiological recurrence was reported. Opposite to TM-AVMs, scalp AVMs commonly present as high-flow lesions with no evident tumor mass, mainly located in the subcutaneous tissue. TM-AVMs present clearly distinct features compared to scalp AVMs, for which they should be considered as a certain pathological entity and not as a variant of scalp AVMs.

Coledocolitiasis como causa de elevación importante del marcador tumoral CA 19-9 / Significantly elevated CA 19-9 levels in a patient with choledocholithiasis

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Isquemia hepática aguda tras hemorragia digestiva alta por varices esofagogástricas / Acute liver ischaemia after gastro-oesophageal variceal bleeding

INTRODUCCIÓN: La hemorragia digestiva alta por varices esofagogástricas (HDA por VEG) puede desencadenar una isquemia hepática aguda (IHA). El objetivo de este estudio fue analizar la incidencia de IHA tras una HDA por VEG, los factores de riesgo y su mortalidad. PACIENTES Y MÉTODOS: Estudio retrospectivo sobre pacientes cirróticos con HDA por VEG. Se clasificaron en 2 grupos, determinados por el desarrollo o no de una IHA. Definimos IHA como AST y ALT por encima de 10 veces el valor basal, descartando otras causas de hepatitis aguda. El tratamiento inicial estándar fue soporte hemodinámico, endoscopia urgente con ligadura con bandas y/o escleroterapia, somatostatina y antibióticos. En caso de fracaso de estas medidas, se recurrió a la implantación de una derivación portosistémcica percutánea intrahepática (DPPI). Ambos grupos (IHA y no-IHA) fueron comparados. RESULTADOS: Durante un periodo de 5 años, se recogieron 68 pacientes con HDA por VEG. La incidencia de IHA fue del 16,2%. Tras el análisis univariante, los factores asociados con IHA fueron la diabetes mellitus (OR: 7,5; IC: 1,9-29), shock (OR: 8,5; IC: 2,06-34) y la persistencia de la hemorragia (OR: 9, IC: 1,6-49, p = 0,03). En el análisis multivariante solo mostraron significación estadística la diabetes mellitus (OR: 8,61; IC: 1,4-52,5) y el shock (OR: 7,58; IC: 1,26-45,51). La mortalidad del grupo de IHA fue mayor (45%) que en el grupo no-IHA (10,5%) (p = 0,012). CONCLUSIONES: La IHA tras una hemorragia digestiva por VEG en el paciente cirrótico ocurrió en el 16,2%, asociándose con un peor pronóstico y una mortalidad del 45%. Nuestros resultados sugieren que la diabetes mellitus y el shock hipovolémico son factores de riesgo para el desarrollo de IHA. La detección precoz de estos pacientes en riesgo podría por tanto ayudar a prevenir la IHA

INTRODUCTION: Variceal upper gastrointestinal bleeding (UGIB) can trigger acute hypoxic hepatitis (AHH). The aim of this study was to analyse the incidence, associated risk factors and mortality of AHH after variceal UGIB. PATIENTS AND METHODS: Retrospective study of cirrhotic patients with variceal UGIB, classified into 2 groups according to the development of AHH. AHH was diagnosed when AST and ALT reached levels 10 times above the upper limit of normal, after ruling out other causes of hepatitis. The standard initial treatment consisted of haemodynamic support, emergency endoscopy with rubber band ligation, somatostatin and antibiotics. In the case of failure of primary haemostasis, a transjugular intrahepatic portosystemic shunt (TIPS) was implanted. Both groups (AHH and non-AHH) were compared. RESULTS: Sixty-eight cirrhotic patients with variceal UGIB admitted to the gastroenterology department of Hospital Ramón y Cajal between January 2007 and March 2012 were analysed. Eleven of these patients (16.2%) developed AHH. Univariate analysis showed the following items as risk factors: diabetes (OR: 7.5; CI: 1.9-29), shock (OR: 8.5; CI: 2.06-34) and persistent bleeding (OR: 9.0, CI: 1.6-49, P = .03). However, multivariate analysis confirmed only diabetes (OR: 8.61; CI: 1.4-52.5) and shock (OR: 7.58; CI: 1.26-45.51) as risk factors. Mortality rate in the AHH group was 45%, compared to 10.5% in the non-HAA group (P = .012). CONCLUSIONS: AHH after variceal UGIB occurred in 16.2% of cirrhotic patients and was associated with a poorer prognosis, with a mortality rate of 45%. Our findings suggest that diabetes and shock are risk factors for the development of AHH. Early identification of at-risk patients could therefore help prevent AHH

[Acute liver ischaemia after gastro-oesophageal variceal bleeding]. / Isquemia hepática aguda tras hemorragia digestiva alta por varices esofagogástricas.

INTRODUCTION: Variceal upper gastrointestinal bleeding (UGIB) can trigger acute hypoxic hepatitis (AHH). The aim of this study was to analyse the incidence, associated risk factors and mortality of AHH after variceal UGIB. PATIENTS AND METHODS: Retrospective study of cirrhotic patients with variceal UGIB, classified into 2 groups according to the development of AHH. AHH was diagnosed when AST and ALT reached levels 10 times above the upper limit of normal, after ruling out other causes of hepatitis. The standard initial treatment consisted of haemodynamic support, emergency endoscopy with rubber band ligation, somatostatin and antibiotics. In the case of failure of primary haemostasis, a transjugular intrahepatic portosystemic shunt (TIPS) was implanted. Both groups (AHH and non-AHH) were compared. RESULTS: Sixty-eight cirrhotic patients with variceal UGIB admitted to the gastroenterology department of Hospital Ramón y Cajal between January 2007 and March 2012 were analysed. Eleven of these patients (16.2%) developed AHH. Univariate analysis showed the following items as risk factors: diabetes (OR: 7.5; CI: 1.9-29), shock (OR: 8.5; CI: 2.06-34) and persistent bleeding (OR: 9.0, CI: 1.6-49, P=.03). However, multivariate analysis confirmed only diabetes (OR: 8.61; CI: 1.4-52.5) and shock (OR: 7.58; CI: 1.26-45.51) as risk factors. Mortality rate in the AHH group was 45%, compared to 10.5% in the non-HAA group (P=.012). CONCLUSIONS: AHH after variceal UGIB occurred in 16.2% of cirrhotic patients and was associated with a poorer prognosis, with a mortality rate of 45%. Our findings suggest that diabetes and shock are risk factors for the development of AHH. Early identification of at-risk patients could therefore help prevent AHH.

Effect of drug precursor in cell uptake and cytotoxicity of redox-responsive camptothecin nanomedicines.

Novel redox-responsive nanomedicines have been synthesized by conjugating camptothecin prodrugs ((pyridine-2-yldisulfanil)alkyl carbonate derivatives) to hybrid porous silica nanoparticles through disulfide bond. After disulfide reduction, camptothecin may be released by an intramolecular cyclization mechanism or by carbonate bond hydrolysis. Samples have been characterized by physico-chemical techniques, and stability and drug release in PBS and human serum have been determined. Moreover, cell uptake was studied by fluorescence microscopy and flow cytometry, whilst cytotoxic activity was validated by MTT test. Obtained results indicate that prodrug side chain carbon number (n=1,2,3) determines material hydrophobic properties and, as a consequence, its stability in aqueous medium. When n value increases, the negative surface charge decreases dramatically due to a shielding effect provoked by hydrophobic ligands, which promotes particle aggregation and favors cell internalization. Furthermore, the n value determines the type of products released and, subsequently, the cytotoxic activity. Full disulfide bridge reduction takes place in all cases, but quick delivery of the free drug by intramolecular cyclization is only possible with the shortest linker (n=1), whereas other nanomedicines only present slow discharge of camptothecin by carbonate hydrolysis. Overall, the drug precursor incorporated to the inorganic nanoplatform modulates both cell uptake rate and cytotoxicity according to the different functionalization.

¿Es posible suspender el tratamiento con antivirales orales en los pacientes con hepatitis crónica B antígeno e negativa? Experiencia y nuevas expectativas / Is it possible to stop treatment with nucleos(t)ide analogs in patients with e-antigen negative chronic hepatitis B? Experience and new expectations

INTRODUCCIÓN: El tratamiento de la hepatitis crónica B antígeno e negativa (HCB HBeAg negativa) con antivíricos orales (AO) suele prolongarse de forma indefinida debido a que la pérdida del antígeno de superficie como objetivo para su suspensión es un hecho infrecuente. Recientemente han aparecido las primeras evidencias que sugieren finalizar la terapia con AO en casos seleccionados. OBJETIVOS: Analizar la tasa de rebote virológico en pacientes con HCB Age negativa que suspendieron el tratamiento con AO. MATERIAL Y MÉTODOS: Estudio retrospectivo observacional que incluyó 140 casos de HCB HBeAg negativa. Veintidós pacientes, que recibieron exclusivamente AO, los suspendieron por diversos motivos realizándose un seguimiento posterior. Todos presentaban transaminasas normales, ADN indetectable y ausencia de cirrosis o comorbilidades importantes al finalizar el tratamiento. RESULTADOS: Doce pacientes presentaron rebote virológico (54,54%), transcurriendo una media de 6,38 meses (± 1,9) desde la suspensión hasta el rebote (el 75% dentro de los 12 primeros meses tras la suspensión). Cinco recibieron adefovir, uno lamivudina más adefovir, uno tenofovir y 5 lamivudina. La duración media del tratamiento, desde el inicio hasta la suspensión, fue de 38,5 meses (± 4,5). El grupo con respuesta sostenida presentaba una edad media y duración del tratamiento superior a los sujetos con rebote, si bien estas diferencias no resultaron estadísticamente significativas. CONCLUSIONES: Los resultados sugieren que es posible suspender la terapia con AO en casos seleccionados de HCB Age negativa, siempre que no exista cirrosis, se cumpla un tiempo mínimo de tratamiento, las transaminasas sean normales y el ADN indetectable de forma mantenida. En estos casos, se debe realizar un seguimiento estrecho durante el primer año y posteriormente de forma indefinida

BACKGROUND: Treatment of HBeAg-negative chronic hepatitis B (CHB) with nucleos(t)ide analogues (NA) is usually indefinite, since the loss of HBsAg, as a criterion for its discontinuation, is a rare event. Recent evidence suggests that discontinuing NA therapy may be feasible in selected patients. OBJECTIVES: To analyze the rate of virological relapse in patients with HBeAg-negative CHB who discontinued treatment with NAs. METHODS: We performed a single-center observational study that included 140 patients with HBsAg-negative CHB. Twenty-two patients, who received only NAs, discontinued treatment for different reasons and were subsequently monitored. All had normal ALT and AST, undetectable DNA and absence of cirrhosis or significant comorbidities before stopping treatment. RESULTS: Twelve patients showed virologic relapse (54.54%). The mean interval between discontinuation and relapse was 6.38 months (± 1.9) (75% relapsed during the first 12 months after discontinuation). Five received adefovir, 1 lamivudine and adefovir, 1 tenofovir and 5 lamivudine alone. The mean treatment duration in this group was 38.5 months (± 4.5). The sustained response group had a higher mean age and longer treatment duration than patients with virologic relapse but these differences were not statistically significant. CONCLUSIONS: The results suggest that NA treatment can be stopped in selected patients with CHB as long as they are not cirrhotic, have completed a minimum period of treatment, have normal ALT and sustained undetectable DNA. These patients should be closely monitored during the first year and then indefinitely

Orbital metastasis from hepatocellular carcinoma

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Traumatismo penetrante facial por arpón. A propósito de un caso / Penetrating facial injury caused by a speargun: A case presentation

Los traumatismos penetrantes causados por el disparo de un fusil de pesca submarina son extremadamente raros. El tratamiento quirúrgico está condicionado por el «mecanismo de barba», que impide una retirada segura de la flecha en sentido contrario al de su entrada, ya que la aleta del fusil provocaría graves daños. Presentamos un caso clínico y un sistema sencillo de bloqueo del retroceso de la aleta que permitió una retirada segura en sentido retrógrado (AU)

Penetrating injuries caused by firing an underwater speargun are exteremely rare. The surgical treatment is determined by the «barb mechanism», which hinders the safe withdrawal of the spear in the opposite direction to its entrance, since the fin of the spear could cause serious injury. We present a clinical case and a simple system of blocking the backward movement of the fin which allowed the safe withdrawal in the retrograde direction (AU)

[Is it possible to stop treatment with nucleos(t)ide analogs in patients with e-antigen negative chronic hepatitis B? Experience and new expectations]. / ¿Es posible suspender el tratamiento con antivirales orales en los pacientes con hepatitis crónica B antígeno e negativa? Experiencia y nuevas expectativas.

BACKGROUND: Treatment of HBeAg-negative chronic hepatitis B (CHB) with nucleos(t)ide analogues (NA) is usually indefinite, since the loss of HBsAg, as a criterion for its discontinuation, is a rare event. Recent evidence suggests that discontinuing NA therapy may be feasible in selected patients. OBJECTIVES: To analyze the rate of virological relapse in patients with HBeAg-negative CHB who discontinued treatment with NAs. METHODS: We performed a single-center observational study that included 140 patients with HBsAg-negative CHB. Twenty-two patients, who received only NAs, discontinued treatment for different reasons and were subsequently monitored. All had normal ALT and AST, undetectable DNA and absence of cirrhosis or significant comorbidities before stopping treatment. RESULTS: Twelve patients showed virologic relapse (54.54%). The mean interval between discontinuation and relapse was 6.38 months (± 1.9) (75% relapsed during the first 12 months after discontinuation). Five received adefovir, 1 lamivudine and adefovir, 1 tenofovir and 5 lamivudine alone. The mean treatment duration in this group was 38.5 months (± 4.5). The sustained response group had a higher mean age and longer treatment duration than patients with virologic relapse but these differences were not statistically significant. CONCLUSIONS: The results suggest that NA treatment can be stopped in selected patients with CHB as long as they are not cirrhotic, have completed a minimum period of treatment, have normal ALT and sustained undetectable DNA. These patients should be closely monitored during the first year and then indefinitely.