Distribution of tuberculosis in migrant children and young people in Europe: a retrospective database analysis of European data.

OBJECTIVE: The burden of tuberculosis (TB) in migrant children and young people (CYP) is commonly overlooked, despite the increasing incidence of TB in migrant populations in the European region. This study aimed to examine the distribution and disease characteristics of TB among migrant and native-born CYP through analysis of data from the European Centre for Disease Prevention and Control (ECDC) surveillance system (TESSy). STUDY DESIGN: Retrospective database analysis. METHODS: A retrospective database analysis was conducted on all CYP TB cases (0-17 years) reported to TESSy (1995-2017), exploring distribution, site of TB, and presence of MDR-TB using multivariate analysis in R statistical software. RESULTS: Of the 73,176 CYP TB cases reported in the EU/EFTA (1995-2017), 24.4% (n = 17,879) occurred in migrant CYP and 75.6% (n = 55,297) occurred in native-born CYP. Migrant CYP were more likely (P < 0.001) to have pulmonary TB (OR: 1.90; 95% CI: 1.74-2.09) and unsuccessful treatment outcomes (OR: 2.05; 95% CI: 1.74-2.40) compared to native-born CYP. The proportion of extrapulmonary TB, compared to pulmonary TB across total CYP cases was higher than the existing evidence base. CONCLUSIONS: Overall, there were significant differences in the site of TB and treatment outcomes between migrant and native-born CYP. To improve outcomes, TB screening and detection practices should focus on facilitating care in migrant CYP. However, to better understand the implications of these findings on broader TB control, TB among CYP should be addressed more frequently in reports and research.

Arterial percutaneous angioplasty in hemodialysis access: Endovascular treatment of hand ischemia.

BACKGROUND: Hemodialysis access-induced distal ischemia consists of symptomatic extremity malperfusion after vascular access creation. It is usually caused by discordant vascular resistance, with arteriovenous shunting of a high blood volume from arterial into venous system and subsequent hand hypoperfusion. Less often, hemodialysis access-induced distal ischemia is caused by arterial stenosis. In these cases, access frequently has normal/low flow, radial pulse is usually absent and not recoverable with vascular access digital compression, diabetes is often present, and percutaneous transluminal angioplasty can be critical for access and limb salvage. METHODS: Retrospective study conducted between June 2011 and February 2018 of patients with vascular access submitted to arterial percutaneous transluminal angioplasty for limb-threatening ischemia. RESULTS: Twenty-nine patients were referred for arterial angiography after hemodialysis access-induced distal ischemia diagnosis and physical examination or ultrasound findings suggestive of arterial disease. In 11 patients, percutaneous transluminal angioplasty was not technically feasible. Among 18 treated patients, 83.3% had diabetes and 60% had skin ulcerations. Target arteries were radial (11), brachial (7), axillar (2), ulnar (2), and subclavian (1). Clinical success, defined as arteriovenous maintenance and wound healing/pain resolution, was observed in 12 patients (66.7%). Concomitant procedures included adjuvant banding (n = 2) and finger amputation (n = 1), and one reintervention was performed. No intra- or postoperative complications were reported. CONCLUSION: Hemodialysis access-induced distal ischemia is a serious complication of hemodialysis vascular access, with multifactorial etiology. Correct and timely diagnosis is crucial for maintaining access and limb salvage. Percutaneous transluminal angioplasty is a minimally invasive procedure that may be effective and long-lasting in carefully selected patients with ischemic complaints.

Small bowel occlusion after trans-abdominal preperitoneal hernia approach caused by barbed suture: case report and review of literature.

BACKGROUND: Groin hernioplasty is the most performed intervention in the adults worldwide. Small bowel occlusion after hernioplasty with anterior approach is an unusual complication because the peritoneum is not opened during this procedure. However during TAPP the closure of the peritoneal flap is mandatory. In literature some cases of small bowel occlusion related to the barbed suture for the closure the peritoneum are reported. METHODS: Here we describe a case of a 64-year old male with small bowel obstruction after TAPP caused by the barbed suture used for peritoneal closure. RESULTS: Intrabdominal use of self-anchoring suture is controversial. Some studies reported good results by using this device, while others from gynecologists describe bowel occlusion and volvulus caused by barbed suture. CONCLUSIONS: Self-anchoring device is innovative and reduces operation time. It is most important to know the correct use of this device to reduce some possible troubles.

Is human fibrin sealant a possible choice for the fixation of laparoscopic inguinal hernia repair? A single center experience and the analysis of the results after 326 TAPP in two years.

BACKGROUND: Groin hernioplasty is most intervention performed in the worldwide. The present study aimed to evaluate a combination between ultralight mesh and fibrin human sealant in the laparoscopic treatment of inguinal hernia. PATIENTS AND METHODS: This retrospective study included consecutive patients who underwent laparoscopic transabdominal preperitoneal hernioplasty (TAPP) from 1st of January 2015 to 31st of December 2016. Demographics, surgical data and postoperative outcomes were entered in an anonymized prospective database. Prospective longterm follow-up carried out in all patients. RESULTS: One hundred eighty-four patients with a median age 57.5 (range 19-84) and median BMI (Body Mass Index) of 28.5 (range 18.5-31.5) were included. A median follow-up of 25 months (median 13-35) was carried out. Five recurrences (1.5%) and two cases of missed lipoma were observed and operated. Chronic pain (CP) was observed in eleven (9%) patients but in 9 patients it decreased spontaneously. CONCLUSIONS: Combination of ultralight mesh and Evicel® in TAPP operation is a safe solution for the treatment of groin hernia. Recurrences and chronic pain are similar to other combination of fibrin sealant and meshes. Moreover action of Evicel® may provide to improve the hemostasis and consequently hematoma of the cord.

Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature Review.

Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.

Self-care in Preserving the Vascular Network: Old Problem, New Challenge for the Medical Staff.

Teaching/educating patients with end stage renal disease (ESRD) and identifying their self-care behaviors for vascular network preservation are very important. However, the self-care behaviors regularly performed by patients are still unknown. We compared self-care behaviors for vascular network preservation performed by patients who are/are not followed-up by the nephrologist. The study design was a prospective, observational and comparative study. Inclusion criteria were as follows: ESRD patients (at stages 4 or 5); at least 18 years old; in pre-dialysis with at least a 6-month follow-up period by the nephrologist or who started dialysis in emergency and were not followed-up by the nephrologist; with no memory problems; and medically stable. Primary outcome was the frequency of self-care behaviors for vascular network preservation. Secondary outcome was the comparison between self-care behaviors by ESRD patients who were/were not followed-up by the nephrologist. The study involved 145 patients, 64.1% were female, the mean age was 69.5 years and the self-care behaviors mean score was 36.8% (with a SD of 39.8%). The number of patients followed-up and not followed-up by the nephrologist was 109 (group 1) and 36 (group 2), respectively. Social characteristics were similar in the two groups (P > 0.05). The mean self-care behaviors were 29.4% and 59.2% in groups 1 and 2, respectively (P = 0.000). Patients performed self-care behaviors for vascular network preservation with a relatively low frequency (the mean score was 36.8% only). Patients not followed by the nephrologist performed self-care behaviors more often than those who were followed (59.2% vs. 29.4% respectively, P = 0.000).

Trend of decreasing length of cervical cone excision during the last 20 years.

OBJECTIVE: The aim of the present investigation was to evaluate the cervical conizations performed in the last 20 years in a single institution, with a particular interest in analyzing the trend of the length of cone excisions. PATIENTS AND METHODS: A retrospective cohort study of women who underwent a CO2-laser cervical conization between January 1996 and December 2015. Cytological abnormalities on referral pap smear, colposcopic findings and pertinent clinical and socio-demographic characteristics of each woman were collected. In particular, the length of cone specimen was evaluated, taking into account all the factors potentially influencing the length of excision. RESULTS: A total of 1270 women who underwent cervical conization from January 1996 to December 2015 were included in the analysis. A mean cone length of 15.1 ± 5.7 mm was reported, and we observed a significant decrease in the length of cone excisions over the whole study period. Age (rpartial = 0.1543, p < 0.0001), see & treat procedure (rpartial = -0.1945, p < 0.0001) and grade II colposcopic findings (rpartial = 0.1540, p < 0.0001) were significantly associated with the length of cone excision on multivariate analysis. CONCLUSIONS: In the last 20 years, a significant decrease in the length of cone excision was observed. In our opinion, this can be due to the acquired awareness by the gynecologists of the potential disadvantages of wide cone excision in term of adverse obstetric outcomes in future pregnancies.

Colposcopic patterns of vaginal intraepithelial neoplasia: a focus on low-grade lesions.

OBJECTIVE: The aim of this study was to evaluate the colposcopic patterns observed in women with a histopathological diagnosis of vaginal intraepithelial neoplasia, with a particular interest in analyzing the colposcopic characteristics of low-grade squamous intraepithelial lesions (LSIL). PATIENTS AND METHODS: Medical charts and colposcopy records of women diagnosed with vaginal intraepithelial neoplasia from January 1995 to December 2015, were analyzed in a multicenter retrospective case series. The abnormal colposcopic patterns observed in women with vaginal LSIL and vaginal high-grade SIL (HSIL) were compared. The vascular patterns and micropapillary pattern were considered separately. RESULTS: Regardless the histopathological grading, in women with vaginal SIL, the grade I abnormal colposcopic findings were more frequent than grade II abnormalities. However, a grade I colposcopy was more commonly observed in women with a biopsy diagnosis of LSIL rather than HSIL (p<0.0001). Similarly, the micropapillary pattern was more frequently observed in women with LSIL (p=0.004), while vascular patterns were observed more frequently in women diagnosed with vaginal HSIL (p<0.0001). In women with grade I colposcopy, the menopausal status and a previous hysterectomy appeared to be associated with the diagnosis of vaginal HSIL. CONCLUSIONS: Grade I abnormal colposcopic findings were more commonly observed in women with vaginal LSIL, as well as the micropapillary pattern. On the other hand, grade II abnormal colposcopy and the presence of vascular patterns were more frequently observed in women with vaginal HSIL.

Arteriovenous access banding revisited.

PURPOSE: The aim of this study is to validate the current applicability of arteriovenous access banding in high flow access (HFA) and/or haemodialysis access-induced distal ischaemia (HAIDI). METHODS: This retrospective study was conducted at the GEV (Grupo de Estudos Vasculares) vascular access centre. The clinical records of consecutive patients undergoing banding for HAIDI and HFA symptoms, between June 2011 and January 2015, were reviewed until April 2015. All vascular access patients' consultation records and surgical notes were reviewed. We analysed and compared patients' age, gender, comorbidities, symptoms and intraoperative ultrasound control. We defined technical failure as recurrence of symptoms, requiring new banding. Excessive banding, access thrombosis, rupture and false aneurysm development were registered as complications. Primary clinical success was defined as improvement of symptoms or effective flow reduction after banding, with no need for reintervention. If one reintervention was necessary, we have defined it as secondary clinical success. RESULTS: Overall, 119 patients underwent banding: 64 (54%) with HAIDI and 55 (46%) with HFA. The HAIDI group was significantly older (65 ± 13 years compared with 56 ± 22 years, p = 0.001) and had significantly greater number of patients with diabetes (56% vs 24%, p = 0.004). Primary success was achieved in 85 patients (71.4%) and the secondary success rate was 84.9%. Older age (p = 0.016) and intraoperative ultrasound control (p = 0.012) were significantly associated with primary success. CONCLUSIONS: Our results do not corroborate the high incidence of thrombosis previously reported as associated with AV access banding and suggest that ultrasound control is crucial for preventing technical failure. The procedure was effective on both compared groups.

Detection of occult endocervical glandular dysplasia in cervical conization specimens for squamous lesions.

The aim of this work was to evaluate the incidence of occult cervical glandular intraepithelial neoplasia (CGIN) and adenocarcinoma of the cervix (AC) in women treated with CO2-laser conization for cervical intraepithelial neoplasia (CIN) or squamocellular cervical cancer (SCC). The medical records of all women with a histological diagnosis of squamous lesions of the uterine cervix (persistent CIN1, CIN2, CIN3 and SCC) who were subsequently treated with CO2-laser conization at our institution, during the period from January 1991 to December 2014, were analyzed in a retrospective case series. Among the 1004 women fulfilling the study inclusion/exclusion criteria, 77 cases (7.7%) of occult glandular lesions (CGIN and AC) were detected on the final cone specimen (48 cases of occult low-grade cervical glandular intraepithelial neoplasia (LCGIN), 25 cases of occult high-grade cervical glandular intraepithelial neoplasia (HCGIN), and four cases of occult "usual-type" AC). No difference in the mean age between women diagnosed with occult glandular lesions and women without occult glandular lesions on the final specimen emerged (39.1±9.3 vs 38.4±9.4, p=0.5). In women with occult LCGIN on cone specimen, mean follow-up of 48 months was reported (range 7-206 months) and no cases of progression to HCGIN or AC were observed. In conclusion, a relatively high rate of occult glandular lesions was found in women treated for squamous lesions. The natural history of CGIN is still uncertain and, in particular, there are some controversies as to whether LCGIN is a precursor lesion of HCGIN or AC. In this context the role of pathologists become very important since the appropriate diagnosis of these lesions could have potential implications in the clinical management of these patients.

Effect of available space and previous contact in the social integration of Saint Croix and Suffolk ewes.

Reproduction in tropical sheep is not affected by season, whereas the reproductive cycle of temperate-climate breeds such as Suffolk depends on the photoperiod. Close contact with tropical ewes during the anestrous period might induce Suffolk ewes to cycle, making the use of artificial light or hormonal treatments unnecessary. However, the integration of both breeds within the social group would be necessary to trigger this effect, and so the aim of the experiment was to determine the speed of integration of 2 groups of Saint Croix and Suffolk ewes into a single flock, according to space allowance and previous experience. For this, 6 groups of 10 ewes (half from each breed) from both breeds, housed at 2 or 4 m/ewe (3 groups/treatment) and with or without previous contact with the other breed, were monitored for 3 d. Each observation day, the behavior, movement, and use of space of ewes were collected during 10 min at 1-h intervals between 0900 and 1400 h. Generalized linear mixed models were used to test the effects of breed, space allowance, and previous experience on behavior, movement, and use of space. Net distances, interbreed farthest neighbor distance, mean interbreed distance, and walking frequencies were greater at 4 m/ewe ( < 0.05). Intrabreed nearest neighbor, mean intrabreed neighbor, and interbreed nearest neighbor distances and minimum convex polygons at 4 m/ewe were greatest for Saint Croix ewes, whereas the opposite was found for lying down ( < 0.05). Experienced ewes showed larger intrabreed nearest neighbor distances, minimum convex polygons, and home range overlapping ( < 0.05). Experienced ewes at 4 m/ewe showed longest total distances and step lengths and greatest movement activity ( < 0.05). Experienced ewes walked longer total distances during Day 1 and 2 ( < 0.05). Lying down frequency was greater for Day 3 than Day 1 ( < 0.05), and Suffolk ewes kept longer interindividual distances during Day 1 ( < 0.05). After 3 d of cohabitation, Suffolk and Saint Croix ewes did not fully integrate into a cohesive flock, with each breed displaying specific behavioral patterns. Decreasing space allowance and previous experience resulted in limited benefits for the successful group cohesion. Longer cohabitation periods might result in complete integration, although practical implementation might be difficult.

High-grade vaginal intraepithelial neoplasia and risk of progression to vaginal cancer: a multicentre study of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV).

OBJECTIVE: The aim of this study was to analyse the women with high grade vaginal intraepithelial neoplasia (HG-VaIN), in order to identify a subset of women at higher risk of progression to invasive vaginal cancer. MATERIALS AND METHODS: The medical records of all the women diagnosed with HG-VaIN, and subsequently treated, from January 1995 to December 2013 were analyzed in a multicentre retrospective case series. The rate of progression to invasive vaginal cancer and the potential risk factors were evaluated. RESULTS: 205 women with biopsy diagnosis of HG-VaIN were considered, with a mean follow up of 57 months (range 4-254 months). 12 cases of progression to vaginal squamocellular cancer were observed (5.8%), with a mean time interval from treatment to progression of 54.6 months (range 4-146 months). The rate of progression was significantly higher in women diagnosed with VaIN3 compared with VaIN2 (15.4% vs. 1.4%, p < 0.0001). Women with HG-VaIN and with previous hysterectomy showed a significantly higher rate of progression to invasive vaginal cancer compared to non-hysterectomised women (16.7% vs. 1.4%, p < 0.0001). A higher risk of progression for women with VaIN3 and for women with previous hysterectomy for cervical HPV-related disease was confirmed by multivariable logistic regression analysis. CONCLUSIONS: A higher rate of progression to vaginal cancer was reported in women diagnosed with VaIN3 on biopsy and in women with previous hysterectomy for HPV-related cervical disease. These patients should be considered at higher risk, thus a long lasting and accurate follow up is recommended.

Measurements of cosmic-ray proton and helium spectra from the BESS-Polar long-duration balloon flights over Antarctica.

The BESS-Polar Collaboration measured the energy spectra of cosmic-ray protons and helium during two long-duration balloon flights over Antarctica in December 2004 and December 2007, at substantially different levels of solar modulation. Proton and helium spectra probe the origin and propagation history of cosmic rays in the galaxy, and are essential to calculations of the expected spectra of cosmic-ray antiprotons, positrons, and electrons from interactions of primary cosmic-ray nuclei with the interstellar gas, and to calculations of atmospheric muons and neutrinos. We report absolute spectra at the top of the atmosphere for cosmic-ray protons in the kinetic energy range 0.2-160 GeV and helium nuclei 0.15-80 GeV/nucleon. The corresponding magnetic rigidity ranges are 0.6-160 GV for protons and 1.1-160 GV for helium. These spectra are compared to measurements from previous BESS flights and from ATIC-2, PAMELA, and AMS-02. We also report the ratio of the proton and helium fluxes from 1.1 GV to 160 GV and compare to ratios from PAMELA and AMS-02.

A mutation in caspase-9 decreases the expression of BAFFR and ICOS in patients with immunodeficiency and lymphoproliferation.

Lymphocyte apoptosis is mainly induced by either death receptor-dependent activation of caspase-8 or mitochondria-dependent activation of caspase-9. Mutations in caspase-8 lead to autoimmunity/lymphoproliferation and immunodeficiency. This work describes a heterozygous H237P mutation in caspase-9 that can lead to similar disorders. H237P mutation was detected in two patients: Pt1 with autoimmunity/lymphoproliferation, severe hypogammaglobulinemia and Pt2 with mild hypogammaglobulinemia and Burkitt lymphoma. Their lymphocytes displayed defective caspase-9 activity and decreased apoptotic and activation responses. Transfection experiments showed that mutant caspase-9 display defective enzyme and proapoptotic activities and a dominant-negative effect on wild-type caspase-9. Ex vivo analysis of the patients' lymphocytes and in vitro transfection experiments showed that the expression of mutant caspase-9 correlated with a downregulation of BAFFR (B-cell-activating factor belonging to the TNF family (BAFF) receptor) in B cells and ICOS (inducible T-cell costimulator) in T cells. Both patients carried a second inherited heterozygous mutation missing in the relatives carrying H237P: Pt1 in the transmembrane activator and CAML interactor (TACI) gene (S144X) and Pt2 in the perforin (PRF1) gene (N252S). Both mutations have been previously associated with immunodeficiencies in homozygosis or compound heterozygosis. Taken together, these data suggest that caspase-9 mutations may predispose to immunodeficiency by cooperating with other genetic factors, possibly by downregulating the expression of BAFFR and ICOS.

Osteopontin induces soluble urokinase-type plasminogen activator receptor production and release.

BACKGROUND: Osteopontin (OPN) and soluble urokinase plasminogen activator receptor (suPAR) have been proposed as markers of disease severity and risk-stratification in infection and inflammation. In breast cancer, OPN and the membrane bound form of urokinase plasminogen activator receptor (uPAR) are functionally related, as OPN-induced cell migration depends on uPAR triggering by urokinase plasminogen activator (uPA). The aim of this study was to prospectively evaluate the kinetic of OPN and suPAR blood levels in patients developing septic shock (SS) compared to those not developing SS, and to investigate the relationships between these two biomarkers in immune cells in vitro. METHODS: We measured the levels of OPN and suPAR for 15 days in forty-three patients, defined a priory as at risk to develop septic shock. Moreover, we investigated in vitro the effect of recombinant OPN on uPAR and suPAR expression in monocytes. RESULTS: We found that OPN and suPAR levels were directly correlated to each other both at intensive care unit admission and on the day patients met SIRS/sepsis or septic shock criteria. In patients developing septic shock, OPN increased prior to suPAR and was already detectable up to 4 days before the shock development. In vitro, OPN induced suPAR production in monocytes by increasing both uPAR gene expression, and suPAR release from the cell surface. CONCLUSION: These data suggest that OPN is partly responsible for the increased plasma levels of suPAR and might be a valuable tool to predict the occurrence of septic shock.

Interventions to promote self-care of people with arteriovenous fistula.

AIMS AND OBJECTIVES: The literature shows many self-care behaviours related to people with end-stage renal disease (ESRD). Our aim is to identify interventions within the 'teaching' that promote self-care (behaviour) with arteriovenous fistula (AVF). BACKGROUND: The development of self-care behaviours with the AVF allows the access to maintain the best possible conditions, because its state influences the efficacy of the dialysis treatment. However, few studies assess self-care behaviours that people with ESRD have with the AVF, as well as interventions that promote this self-care. DESIGN: Discursive paper. METHODS: Our research was conducted in MEDLINE, Health Nursing and Allied Literature (CINAHL), Web of Science and SCOPUS using three search expressions, between the period of 2000-2010. We selected studies that identified interventions that promote self-care with AVF. RESULTS: No study has shown in detail the interventions that aimed at promoting self-care behaviours with the AVF for patients with ESRD. We verify that the interventions that promote self-care are directed mostly to the moments after AVF construction. CONCLUSIONS: This paper reinforces the need to develop guidelines that provide guidance for self-care with the AVF to be developed by people with ESRD. We also found that self-care behaviours directed to the AVF are mostly associated with postconstruction of the access. RELEVANCE TO CLINICAL PRACTICE: Based on these results, it is necessary to delineate clear intervention programmes and objectives, in order to assess self-care with the AVF by people with ESRD, as well as to develop guidelines that provide guidance for self-care for the person with an AVF.

Effects of granulated baits on meso and macrofauna in soybean soil system.

Studies were done to see the effects of five toxic baits based on metaldehyde and/or carbaryl on the taxonomic composition of soil meso and macrofauna, and determined the density of beneficial organisms in soybean under no tillage. Six treatments were tested and soil monoliths were taken before application and at 45 and 75 days after application (DAA). Before application, 1601 individuals were recorded, belonging 1086 to mesofauna and 515 to macrofauna. In soil mesofauna such as Annelida: Enchytraeidae (44%), Nematoda (33%) and Arthropoda (23%) were found. In the macrofauna Arthropoda 93% and Annelida: Oligochaeta, Megadrilli 7% were observed. No differences were observed among the treatments (p>0.05) in the total mesofauna density, at 45 and 75 DAA. The density of enchytraeids, mites, collembolans and symphylids showed no differences at45 and 75 DAA (p > 0.05). The total macrofauna density showed differences (p < 0.05) at 45 and 75 DAA. The highest density was obtained with 4 kg ha(-1) MataBibos Acay at 45 and 75 DAA. Earthworm and diplopod densities at45 and 75 DAA showed no differences (p>0.05). The diversity of meso and macrofauna was not affected at 45 and 75 DAA. Bait application did not affect either the abundance or the diversity of soil beneficial invertebrates.

[Sentinel lymph node biopsy in patients with melanoma]. / La técnica del ganglio centinela en pacientes con melanoma.

INTRODUCTION AND OBJECTIVES: The incidence of melanoma is currently increasing worldwide. One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis. MATERIAL AND METHODS: Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics: Breslow thickness > or =1mm, Breslow thickness <1mm with ulceration, Clark level IV-V, or regression. Lymphadenectomy was performed in patients with positive sentinel node biopsy. Data were also collected on the following variables: sex, age, skin phototype, site and type of melanoma, Breslow depth, Clark level, ulceration, regression, cancer stage at diagnosis, TNM classification, change in cancer stage during follow-up, and death due to melanoma. RESULTS: Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables: nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33-8.90); Breslow thickness >2.0, for a thickness of 2.1-4.0 (ORc, 21.12; 95% CI, 2.60-172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44-221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03-74.12); ulceration (ORc, 4.86; 95% CI, 1.58-14.90); T3 (ORc, 4.20; 95% CI, 1.52-11.63) and T4 (ORc, 4.67; 95% CI, 1.27-17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25-22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62-96.15). CONCLUSIONS: These results confirm the prognostic importance of sentinel lymph node biopsy, which facilitates identification of patients with a greater tendency towards disease progression and death due to melanoma.

La técnica del ganglio centinela en pacientes con melanoma / Sentinel Lymph Node Biopsy in Patients With Melanoma

Material y métodos: Se realizó biopsia del ganglio centinela a los pacientes con melanomas de espesor Breslow ≥1mm o con Breslow <1mm y ulceración, nivel de Clark IV–V o regresión. Aquellos con biopsia positiva fueron sometidos a linfadenectomía.Material y métodos: Además, se recogieron las siguientes variables: sexo, edad, fototipo, localización y tipo de melanoma, niveles Breslow y Clark, ulceración, regresión, estadio inicial, TNM, cambio de estadio y fallecimiento por melanoma. Resultados: El 19,44% de los pacientes presentó ganglios positivos. Esta positividad se presentó asociada con el melanoma nodular (odds ratio cruda [ORc]: 3,44; intervalo de confianza al 95% [IC 95%]: 1,33–8,90) con respecto al melanoma de extensión superficial Breslow superior a 2,0 (nivel 2,1–4,0: ORc: 21,14; IC 95%: 2,60–172,03, nivel >4,0: ORc: 23,25; IC 95%: 2,44–221,73), nivel Clark IV (ORc: 8,73; IC 95% 1,03–74,12), ulceración (ORc: 4,86; IC 95%: 1,58–14,90), estadios T3 y T4 (T3: ORc: 4,20; IC 95%: 1,52–11,63; T4: ORc: 4,67; IC 95% 1,27–17,15), cambio de estadio (ORc: 7,20; IC 95%: 2,25–22,99) y fallecimiento por melanoma (ORc: 8,67; IC 95%: 3,62–96,15). Conclusiones: Estos resultados confirman la importancia pronóstica de la biopsia del ganglio centinela, que permite identificar a los pacientes con mayor tendencia a la progresión de la enfermedad y fallecimiento por melanoma (AU)

Introduction and objectives: The incidence of melanoma is currently increasing worldwide. One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis. Material and methods: Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics: Breslow thickness ≥1mm, Breslow thickness <1mm with ulceration, Clark level IV–V, or regression. Lymphadenectomy was performed in patients with positive sentinel node biopsy. Data were also collected on the following variables: sex, age, skin phototype, site and type of melanoma, Breslow depth, Clark level, ulceration, regression, cancer stage at diagnosis, TNM classification, change in cancer stage during follow-up, and death due to melanoma. Results: Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables: nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33–8.90); Breslow thickness >2.0, for a thickness of 2.1–4.0 (ORc, 21.12; 95% CI, 2.60–172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44–221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03–74.12); ulceration (ORc, 4.86; 95% CI, 1.58–14.90); T3 (ORc, 4.20; 95% CI, 1.52–11.63) and T4 (ORc, 4.67; 95% CI, 1.27–17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25–22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62–96.15). Conclusions: These results confirm the prognostic importance of sentinel lymph node biopsy (AU)

Diet and prevalence of atopic eczema in 6 to 7-year-old schoolchildren in Spain: ISAAC phase III.

BACKGROUND: The prevalence of atopic dermatitis (AD), a chronic skin disease, has increased substantially in recent decades, and different factors have been implicated in its etiology. Although dietary habits are being investigated, few conclusive findings have been reported. Nevertheless, increased consumption of polyunsaturated fatty acids (PUFA) and a diet poor in antioxidants have been related to AD. OBJECTIVES: The objectives of this study were to investigate the association between AD, the intake of different foods, and the effect of a Mediterranean diet among Spanish schoolchildren aged 6 to 7. METHODS: We performed a cross-sectional study with 20 106 schoolchildren aged 6-7 years from 10 different areas of Spain. The participation rate was 76.50%. The prevalence of AD was assessed using the International Study of Asthma and Allergies in Childhood questionnaire and the criteria of the Spanish Academy of Dermatology. To calculate the Mediterranean diet score, we classified food into 2 groups: Mediterranean food, including fruit, seafood, vegetables, pulses, cereals, pasta, rice, and potatoes; and non-Mediterranean food, including meat, milk, and fast food. RESULTS: Milk was negatively associated with AD. Butter and nuts also were negatively associated, although statistical significance was only reached when these foods were consumed 3 or more times a week. CONCLUSIONS: We found no association between the Mediterranean diet score and AD and a positive association between AD and obesity.