Reliability, repeatability, and accordance between three different corneal diagnostic imaging devices for evaluating the ocular surface.

Purpose: To evaluate repeatability, reproducibility, and accordance between ocular surface measurements within three different imaging devices. Methods: We performed an observational study on 66 healthy eyes. Tear meniscus height, non-invasive tear break-up time (NITBUT) and meibography were measured using three corneal imaging devices: Keratograph 5M (Oculus, Wetzlar, Germany), Antares (Lumenis, Sidney, Australia), and LacryDiag (Quantel Medical, Cournon d'Auvergne, France). One-way ANOVAs with post hoc analyses were used to calculate accordance between the tear meniscus and NITBUT. Reproducibility was assessed through coefficients of variation and repeatability with intraclass correlation coefficients (ICC). Reliability of meibography classification was analyzed by calculating Fleiss' Kappa Index and presented in Venn diagrams. Results: Coefficients of variation were high and differed greatly depending on the device and measurement. ICCs showed moderate reliability of NITBUT and tear meniscus height measurements. We observed discordance between measurements of tear meniscus height between the three devices, F2, 195 = 15.24, p < 0.01. Measurements performed with Antares were higher; 0.365 ± 0.0851, than those with Keratograph 5M and LacryDiag; 0.293 ± 0.0790 and 0.306 ± 0.0731. NITBUT also showed discordance between devices, F2, 111 = 13.152, p < 0.01. Measurements performed with LacryDiag were lower (10.4 ± 1.82) compared to those of Keratograph 5M (12.6 ± 4.01) and Antares (12.6 ± 4.21). Fleiss' Kappa showed a value of -0.00487 for upper lid and 0.128 for inferior lid Meibography classification, suggesting discrete to poor agreement between measurements. Conclusion: Depending on the device used and parameter analyzed, measurements varied between each other, showing a difference in image processing.

A new graph of soil Rn-gas transport: Radon-rose plot.

Soil radon gas movement depends on soil geology, environmental thermodynamic parameters and, micro-seismic telluric activity. Mapping radon time dependent concentration at the relaxation depth in a selected area, provide transport direction in a seismically high-risk region. Nuclear track methodology is employed to determine main gradient vector for radon transport. Applying the gradient definition, a "radon rose" graph is constructed from which prone area can be promptly identified. Results show that short time interval, Rn-transport direction may change unpredictably, however, the length of each "spoke" around the circle provides information on the soil Rn-gas probable shifts towards or from a direction per time interval. The new graph is a novelty and provide improved approach for environmental protection and radon dosimetry.

Reproductive biology in cassava: stigma receptivity and pollen tube growth.

Knowledge on the reproductive biology of cassava, relevant to breeders and molecular geneticists, is still limited. Therefore, different studies were carried out to determine the duration of stigma receptivity and the rate of pollen tube growth. Inflorescences were covered for up to 3 days after the first opening of the bracts (e.g. anthesis day) to prevent open pollination. Results indicate that fruit and seed set are drastically reduced when flowers were covered for 2 or 3 days. However, fruits and seeds were obtained even from flowers that had been covered for 3 days after anthesis, although at low frequency. The rate of pollen tube growth was assessed in many combinations of female and male progenitors crossed through controlled pollinations and collecting the pistils at varying hours after pollination (HAP). Pollen tube growth is fast during the first 6 HAP reaching the tip of the nucellar beak. The growth slows down thereafter, taking 10 additional hours to reach the end of the beak. The growth of pollen tubes slows down even further until they enter the embryo sac. Only 10% of samples showed pollen tubes entering the embryo sac between 48 and 66 HAP. Although several tubes may reach the nucellar beak, only one was observed entering the embryo sac. Results, across the different experiments, were highly variable suggesting that the timeline of fertilization is influenced both by genotypic and environmental factors as well as the manual manipulation of inflorescences and cyathia.

A comprehensive analysis of factors related to carmustine/bevacizumab response in recurrent glioblastoma.

PURPOSE: Patients with recurrent glioblastoma (rGBM) have a poor prognosis, with survival ranging from 25 to 40 weeks. Antiangiogenic agents are widely used, showing a variable response. In this study, we explored the efficacy of carmustine plus bevacizumab (BCNU/Bev) for treating rGBM. METHODS/PATIENTS: In this study, we assessed 59 adult patients with histologically confirmed rGBM who were treated with BCNU/Bev as second-line regimen. The response rate (RR), progression-free survival (PFS) and overall survival (OS) were evaluated according to their molecular expression profile, including CD133 mRNA expression, MGMT methylation (pMGMT), PDGFR amplification, YKL40 mRNA expression, IDH1/2 condition, p53 and EGFRvIII mutation status. RESULTS: Median follow-up was 18.6 months, overall RR to the combination was 56.3%, and median PFS was 9.0 months (95% CI 8.0-9.9). OS from time of diagnosis was 21.0 months (95% CI 13.2-28.7) and from starting BCNU/Bev it was 10.7 months (95% CI 9.5-11.8). IDH1/2 mutations were found in 30.5% of the patients, pMGMT in 55.9% and high CD133 mRNA expression in 57.6%. Factors which positively affected PFS included performance status (p = 0.015), IDH+ (p = 0.05), CD133 mRNA expression (p = 0.009) and pMGMT+ (p = 0.007). OS was positively affected by pMGMT+ (p = 0.05). Meanwhile, YKL40 negatively affected PFS (p = 0.01) and OS (p = 0.0001). Grade ≥ 3 toxicities included hypertension (22%) and fatigue (12%). CONCLUSIONS: BCNU/Bev is a safe and tolerable treatment for rGBM. Patients with MGMT+/IDH+ derive the greatest benefit from the treatment combination in the second-line setting. Nonetheless, high YKL40 expression discourages the use of antiangiogenic therapy.

[Dual kidney transplant: the E. Herriot Hospital Lyon experience]. / Bitransplantation rénale : expérience du protocole lyonnais de l'hôpital E.-Herriot.

INTRODUCTION: In the current context of a high incidence end-stage kidney disease and a shortage of organs for kidney transplantation, the increasing use of transplants considered to be "borderline" represents a potential source of transplants. Over the last 10 years, some centers have developed a transplantation strategy, which consists of transplanting two borderline kidneys that cannot be proposed separately in a single recipient. The authors report their experience of dual kidney transplant. MATERIALS AND METHODS: Since 2001, 15 dual kidney transplants have been performed in a single centre according to a local protocol based on the correspondence between the weight of the donor kidney and the recipient's weight, weighted by the number of fibrotic glomeruli observed on the initial biopsy. In this study, the authors analyze the postoperative complications and functional results observed in patients transplanted according to this protocol. RESULTS: Dual kidney transplants represented less than 5% of all transplants performed during the study period concerned, which remained lower than the objectives initially announced by the ABM. The surgical technique was left to the surgeon's discretion. The mean follow-up was 26.3 months. Fourteen of the 15 recipients were alive with a functional graft. Surgical complications were globally more frequent when kidneys were transplanted on the same side (versus transplanted on both sides). Mean serum creatinine was 119.4 mol/l at six months (creatinine clearance according to MDRD formula: 57.3 ml/min per 1.73 m2), 118.8 mol/l at 12 months (creatinine clearance: 55.8) and 132.4 mol/l at 24 months (creatinine clearance: 44.2). One year post-transplant, mean renal function measured by inulin clearance was 55.5 ml/min per 1.73 m2. Four of the 15 patients had experienced an episode of acute rejection and three patients experienced delayed return of transplant function. CONCLUSION: In view of the results obtained, the authors consider that dual kidney transplant could be a reasonable and effective option for selected patients. Positioning of the transplants in each iliac fossa limited the surgical complication rate.

A Note on the bias in SVMs for multiclassification.

During the usual SVM biclassification learning process, the bias is chosen a posteriori as the value halfway between separating hyperplanes. A note on different approaches on the calculation of the bias when SVM is used for multiclassification is provided and empirical experimentation is carried out which shows that the accuracy rate can be improved by using bias formulations, although no single formulation stands out as providing better performance.

[Diagnosis and management of cystic dysplasia of the seminal vesicle]. / Sobre el diagnóstico y tratamiento de la displasia quística de la vesícula seminal.

INTRODUCTION AND OBJECTIVES: Cystic dysplasia of the seminal vesicle represents a rare congenital urologic anomaly of which elective treatment is controversial. We present our experience in the diagnosis and management of this uncommon pathology. PATIENTS AND METHOD: During the last twelve years we have managed eight patients affected by this pathology. The diagnosis was incidental in the three asymptomatic patients, while the other five consulted because of low urinary tract sympthoms. Ectopic drainage of the ureter in the pathological seminal vesicle was found in three of the patients. Two of these patients presented large pelvic and ureteral ectasy. Other five patients presented renal agenesis. RESULTS: In asymptomatic patients we adopted an expectant attitude, while the other five patients underwent surgical treatment. We performed open surgery in the two cases presenting ureterohydronephrosis, whereas in the other three we performed transurethral incision of the seminal vesicle. We obtained excellent results in all of them, with no evidence of symptomatic pseudodiverticulum. CONCLUSIONS: Transurethral incision of the seminal vesicle cyst is a minimal invasive procedure with low morbidity. We have proved in all of our cases that the retraction of the cyst was practically complete, this has led us into believing that transurethral incision is the elective treatment. Therefore, open surgery would only be indicated in cases of failure of the procedure due to existence of symptomatic pseudodiverticulum, or in patients presenting renoureteral ectasy associated.

Sobre el diagnóstico y tratamiento de la displasia quística de la vesícula seminal / Diagnosis and management of cystic dysplasia of the seminal vesicle

Introducción y objetivo: La displasia quística de la vesícula seminal representa una rara anomalía congénita urológica cuyo tratamiento de elección es controvertido. Presentamos nuestra experiencia en el diagnóstico y tratamiento de esta infrecuente entidad. Pacientes y método: Durante los últimos 12 años hemos atendido a 8 pacientes afectos de esta patología. En 3 de ellos, asintomáticos, el diagnóstico fue incidental, mientras que los 5 restantes consultaron por síntomas del tracto urinario inferior. En 3 pacientes se halló desembocadura ectópica de un uréter remanente en la vesícula patológica, 2 de ellos con importante ectasia renoureteral. Los otros 5 pacientes presentaron agenesia renal. Resultados: En los pacientes asintomáticos adoptamos una actitud expectante, optando por la cirugía en los otros 5. Realizamos cirugía exerética en los 2 casos que presentaban ureterohidronefrosis, mientras que en los otros 3 realizamos incisión endoscópica de la vesícula seminal, obteniendo excelentes resultados en todos ellos, sin evidenciarse aparición de pseudodivertículo sintomático. Conclusiones: La incisión transuretral endoscópica del quiste de la vesícula seminal es un procedimiento mínimamente invasivo y con escasa morbilidad, habiendo constatado la retracción prácticamente completa del quiste en todos nuestros casos, por lo que la consideramos de elección para el tratamiento de los pacientes afectos de dicha entidad, reservando la cirugía abierta para los casos en los que fracase la técnica por aparición de un pseudodivertículo sintomático y en los pacientes que presenten asociada ectasia del remanente renoureteral

Introduction and objectives: Cystic dysplasia of the seminal vesicle represents a rare congenital urologic anomaly of which elective treatment is controversial. We present our experience in the diagnosis and management of this uncommon pathology. Patients and method: During the last twelve years we have managed eight patients affected by this pathology. The diagnosis was incidental in the three asymptomatic patients, while the other five consulted because of low urinary tract sympthoms. Ectopic drainage of the ureter in the pathological seminal vesicle was found in three of the patients. Two of these patients presented large pelvic and ureteral ectasy. Other five patients presented renal agenesis. Results: In asymptomatic patients we adopted an expectant attitude, while the other five patients underwent surgical treatment. We performed open surgery in the two cases presenting ureterohydronephrosis, whereas in the other three we performed transurethral incision of the seminal vesicle. We obtained excellent results in all of them, with no evidence of symptomatic pseudodiverticulum. Conclusions: Transurethral incision of the seminal vesicle cyst is a minimal invasive procedure with low morbidity. We have proved in all of our cases that the retraction of the cyst was practically complete, this has led us into believing that transurethral incision is the elective treatment. Therefore, open surgery would only be indicated in cases of failure of the procedure due to existence of symptomatic pseudodiverticulum, or in patients presenting renoureteral ectasy associated

Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period.

PURPOSE: To assess the incidence of complications of conservative renal surgery for renal cell carcinoma in both elective and imperative indications, and its evolution over a 15 year period. PATIENTS AND METHODS: From 1988 to 2003, 127 patients underwent partial nephrectomy or tumorectomy for renal cell carcinoma in our department. INDICATIONs were imperative in 42% (n = 53) and elective in 58% (n=74) of cases. Morbidity was retrospectively assessed according to four parameters: 1- Period of surgery: A, from 1988 to 1999 and B, from 2000 to 2003. 2- INDICATION: elective vs. imperative. 3- experience of surgeon: senior vs. junior. 4- Nature of complications: minor or major. Comparative analysis was conducted using Chi-square and Fischer exact tests. RESULTS: Global incidence of complications was 30.7% (n = 39) corresponding to 18.1% minor (n = 23) and 12.6% (n = 16) major complications. Results show a moderate decrease of complication rate during Period B: 28.1% versus 32.9% during period A (p = 0.69). Complications occurred more frequently in imperative indications (49.1%) than in elective indications (17.6%) (p = 0.002), mostly regarding major complications (respectively 28.3% and 1.4%. (p < 0.001)). Overall re-intervention rate was 15.7%: 22.6% in imperative and 10.8% in elective indications (p = 0.008). Mean length of hospital stay was 14.1 days and significantly longer during period A (p = 0.003) and in imperative indications (p = 0.009). CONCLUSION: In our study, conservative renal surgery has a significant rate of complications which is extremely variable regarding to different parameters. Most discriminating factor was indication: in imperative indications, we observed a high rate of major complications (28.3%) that we consider acceptable to prevent anephria in clearly informed patients. Major complications are exceptional in elective indications. Decreased incidence of complications during the later period (B) is modest, and the role played by systematic pedicular clampage is discussed. As results published in medical literature are difficult to compare, we agree with authors who recently proposed to standardize complications data analysis, using a gravity scale, in order to provide relevant information to patients about statistical risks before surgery.

[Correction of the penile curvature in ambulatory surgery]. / Corrección del pene curvo en cirugía mayor ambulatoria.

OBJECTIVE: To evaluate the results obtained in the correction of the curved penis by means of Nesbit's technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital. PATIENTS AND METHOD: From January of 2000 to April of 2004 we intervened in ambulatory regime 21 patient suffering from curved penis (12 congenital and 9 with Peyronie's disease) by means of Nesbit's technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire. RESULTS: None of the patients needed entrance for intrasurgery nor postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patient's process. The degree of satisfaction with the received treatment has been superior to 95%. CONCLUSIONS: The practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patient's satisfaction.

Corrección del pene curvo en cirugía mayor ambulatoria / Correction of the penile curvature in ambulatory surgery

Objetivo: Evaluar los resultados obtenidos en la corrección del pene curvo mediante la técnica de Nesbit durante los cuatro primeros años de integración de nuestro Servicio en la Unidad de Cirugía Mayor Ambulatoria (CMA) de nuestro Hospital. Pacientes y método: Desde enero de 2000 hasta abril de 2004 hemos intervenido en régimen ambulatorio a 21 pacientes afectos de pene curvo (12 congénito y 9 con enfermedad de Peyronie) mediante la técnica de Nesbit. Se describe el procedimiento quirúrgico-anestésico realizado y también se evalúan los criterios de inclusión y alta, así como los resultados obtenidos y el grado de satisfacción mediante la elaboración de un cuestionario. Resultados: Ninguno de los pacientes precisó ingreso por complicación intra ni postoperatoria. Así, hemos tenido una nula incidencia de complicaciones a excepción del inevitable acortamiento del pene, claramente independiente del régimen de ambulatorización del proceso. El grado de satisfacción con el tratamiento recibido ha sido superior al 95%. Conclusiones: La práctica totalidad de los pacientes susceptibles de corrección quirúrgica de incurvación peneana son candidatos a ser incluidos en un programa de CMA, mejorando ostensiblemente la relación costo-eficacia, no disminuyendo por ello la calidad asistencial ni el grado de satisfacción de los pacientes (AU)

Objective: To evaluate the results obtained in the correction of the curved penis by means of Nesbit’s technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital. Patients and method: From January of 2000 to April of 2004 we intervened in ambulatory regime21 patient suffering from curved penis (12 congenital and 9 with Peyronie´s disease) by means of Nesbit’s technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire. Results: None of the patients needed entrance for intrasurgery or postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patient’s process. The degree of satisfaction with the received treatment has been superior to 95%. Conclusions: The practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patients’s satisfaction (AU)

[Schoenlein-Henoch purpura associated with spiramycin and with important digestive manifestations]. / Púrpura de Schönlein-Henoch asociada a espiramicina y con importantes manifestaciones digestivas.

Schönlein-Henoch purpura is a vasculitis due to hypersensitivity characteristic of the infancy that affects preferably small vessels. The etiology is unknown, although it has been related to allergic reactions to drugs, infections, vaccines and insecta bites. An adult with a Schönlein-Henoch purpura after receiving spiramicin is presented, beginning with epigastric pain and vomiting and the purpura appearing subsequently.