Validación de escalas multiparamétricas de predicción de riesgo de muerte súbita en pacientes con síndrome de Brugada y estudio electrofisiológico / Validation of multiparametric approaches for the prediction of sudden cardiac death in patients with Brugada syndrome and electrophysiological study

Introducción y objetivos: Se han desarrollado puntuaciones multiparamétricas para una mejor estratificación del riesgo en el síndrome de Brugada (SBr). Nuestro objetivo es validar 3 abordajes multiparamétricos (las escalas Delise, Sieira y Shanghai BrS) en una cohorte de pacientes con síndrome de Brugada y estudio electrofisiológico (EEF). Métodos: Pacientes diagnosticados de SBr y con un EEF previo entre 1998-2019 en 23 hospitales. Se utilizaron análisis mediante estadístico C y modelos de regresión de riesgos proporcionales de Cox. Resultados: Se incluyó en total a 831 pacientes con una media de edad de 42,8±13,1 años; 623 (75%) eran varones; 386 (46,5%) tenían patrón electrocardiográfico (ECG) tipo 1; 677 (81,5%) estaban asintomáticos y 319 (38,4%) tenían un desfibrilador automático implantable. Durante un seguimiento de 10,2±4,7 años, 47 (5,7%) sufrieron un evento cardiovascular. En la cohorte total, un ECG tipo 1 y síncope fueron predictivos de eventos arrítmicos. Todas las puntuaciones de riesgo se asociaron significativamente con los eventos. Las capacidades discriminatorias de las 3 escalas fueron discretas (particularmente al aplicarlas a pacientes asintomáticos). La evaluación de las puntuaciones de Delise y Sieira con diferente número de extraestímulos (1 o 2 frente a 3) no mejoró sustancialmente el índice c de predicción de eventos. Conclusiones: En el SBr, los factores de riesgo clásicos como el ECG y el síncope previo predicen eventos arrítmicos. El número de extraestímulos necesarios para inducir arritmias ventriculares influye en las capacidades predictivas del EEF. Las escalas que combinan factores de riesgo clínico con EEF ayudan a identificar las poblaciones con más riesgo, aunque sus capacidades predictivas siguen siendo discretas tanto en población general con SBr como en pacientes asintomáticos (AU)

Introduction and objectives: Multiparametric scores have been designed for better risk stratification in Brugada syndrome (BrS). We aimed to validate 3 multiparametric approaches (the Delise score, Sieira score and the Shanghai BrS Score) in a cohort with Brugada syndrome and electrophysiological study (EPS). Methods: We included patients diagnosed with BrS and previous EPS between 1998 and 2019 in 23 hospitals. C-statistic analysis and Cox proportional hazard regression models were used. Results: A total of 831 patients were included (mean age, 42.8±13.1; 623 [75%] men; 386 [46.5%] had a type 1 electrocardiogram (ECG) pattern, 677 [81.5%] were asymptomatic, and 319 [38.4%] had an implantable cardioverter-defibrillator). During a follow-up of 10.2±4.7 years, 47 (5.7%) experienced a cardiovascular event. In the global cohort, a type 1 ECG and syncope were predictive of arrhythmic events. All risk scores were significantly associated with events. The discriminatory abilities of the 3 scores were modest (particularly when these scores were evaluated in asymptomatic patients). Evaluation of the Delise and Sieira scores with different numbers of extra stimuli (1 or 2 vs 3) did not substantially improve the event prediction c-index. Conclusions: In BrS, classic risk factors such as ECG pattern and previous syncope predict arrhythmic events. The predictive capabilities of the EPS are affected by the number of extra stimuli required to induce ventricular arrhythmias. Scores combining clinical risk factors with EPS help to identify the populations at highest risk, although their predictive abilities remain modest in the general BrS population and in asymptomatic patients (AU)

Efecto en la vida real sobre el control de los factores de riesgo asociado al inicio con polipíldora cardiovascular a partir de fármacos equipotentes / Real-life effect on the control of risk factors associated with initiation of the cardiovascular polypill created from equipotent drugs

Objetivo: Analizar el impacto del inicio del tratamiento con la polipíldora-cardiovascular (CV) del Centro Nacional de Investigaciones Cardiovasculares (CNIC-Ferrer), en las cifras de presión arterial (PA) y colesterol ligado a lipoproteínas de baja densidad (LDL), de los pacientes de nuestra área sanitaria que previamente recibían dosis equipotentes de estatinas y antihipertensivos. Material y métodos: Se registraron todos los pacientes de nuestra área sanitaria (Santiago de Compostela) que a 31 de diciembre de 2019 tenían una prescripción activa de polipíldora-CV (CNIC-Ferrer), desde el 16 de enero de 2015. La fecha índice fue la fecha de inicio de prescripción de polipíldora-CV, y se analizaron los fármacos que previamente recibía el paciente para dislipemia e hipertensión arterial, clasificándose por equipotencias con atorvastatina y ramipril. Se analizó mediante la prueba t-Student para muestras apareadas las variaciones de colesterol LDL y PA. Resultados: Analizamos 547 pacientes con una edad media de 71,5±11,5 años y la mayoría varones (60,6%). Observamos un descenso del colesterol LDL (−10,6 [IC95%: −7,0, −14,3], p<0,001) en los pacientes (n=471) que iniciaron la polipíldora-CV con dosis previas equipotentes de atorvastatina. Documentamos una reducción de la PA sistólica (−3,7 [IC95%: −0,4, −6,9], p=0,029) en los pacientes (n=360) con inicio a partir de dosis equipotentes de ramipril. En 88 pacientes, el inicio de la polipíldora-CV se hizo a partir de dosis equipotentes de atorvastatina y ramipril observándose un descenso del colesterol LDL (−8,7 [IC95%: −3,8, −13,6], p=0,001) y de la PA sistólica (−3,6 [IC95%: −7,8, 0,5], p=0,085). Conclusiones: El inicio del tratamiento con la polipíldora-CV, en pacientes que previamente recibían tratamientos equipotentes de atorvastatina y ramipril, se asoció a una mayor reducción del colesterol LDL y la PA sistólica (AU)

Objective: This work aims to analyze the impact of Spain's National Center for Cardiovascular Research (CNIC-Ferrer)’s cardiovascular (CV)-polypill on blood pressure (BP) and low-density lipoprotein cholesterol (cLDL) levels in patients in our healthcare area who previously took equipotent doses of statins and antihypertensives. Material and methods: All patients in our healthcare area (Santiago de Compostela, Spain) who, as of December 31, 2019, had an active prescription for the CV-polypill (CNIC-Ferrer) since January 16, 2015 were registered. The index date was the start date of the CV-polypill prescription. The drugs the patient had previously received for dyslipidemia and hypertension were analyzed, classifying them by their equivalent potency to atorvastatin and ramipril. Changes in cLDL and BP were analyzed by means of Student's t-test for paired samples. Results: We analyzed 547 patients with a mean age of 71.5±11.5 years. The majority were men (60.6%). We observed a decrease in cLDL (−10.6 [95% CI: −7.0, −14.3], p<.001) in patients who started taking the CV-polypill who had previously taken equally potent doses of atorvastatin (n=471). We documented a reduction in systolic BP (−3.7 [95% CI: −0.4, −6.9], p=.029) in patients who had previously taken equally potent doses of ramipril (n=360). In 88 patients, the CV-polypill was started via equally potent doses of atorvastatin and ramipril, with a decrease in cLDL (−8.7 [95% CI: −3.8, −13.6], p=.001) and systolic BP (−3.6 [95% CI: −7.8, 0.5], p=.085). Conclusions: The initiation of treatment with the CV-polypill in patients who previously received equally potent treatment with atorvastatin and ramipril was associated with a greater reduction in cLDL and systolic BP (AU)

Real-life effect on the control of risk factors associated with initiation of the cardiovascular polypill created from equipotent drugs.

OBJECTIVE: This work aims to analyze the impact of Spain's National Center for Cardiovascular Research (CNIC-Ferrer)'s cardiovascular (CV)-polypill on blood pressure (BP) and low-density lipoprotein cholesterol (cLDL) levels in patients in our healthcare area who previously took equipotent doses of statins and antihypertensives. MATERIAL AND METHODS: All patients in our healthcare area (Santiago de Compostela, Spain) who, as of December 31, 2019, had an active prescription for the CV-polypill (CNIC-Ferrer) since January 16, 2015 were registered. The index date was the start date of the CV-polypill prescription. The drugs the patient had previously received for dyslipidemia and hypertension were analyzed, classifying them by their equivalent potency to atorvastatin and ramipril. Changes in cLDL and BP were analyzed by means of Student's t-test for paired samples. RESULTS: We analyzed 547 patients with a mean age of 71.5 ± 11.5 years. The majority were men (60.6%). We observed a decrease in cLDL (-10.6 [95% CI: -7.0, -14.3], p < 0.001) in patients who started taking the CV-polypill who had previously taken equally potent doses of atorvastatin (n = 471). We documented a reduction in systolic BP (-3.7 [95% CI: -0.4, -6.9], p = 0.029) in patients who had previously taken equally potent doses of ramipril (n = 360). In 88 patients, the CV-polypill was started via equally potent doses of atorvastatin and ramipril, with a decrease in cLDL (-8.7 [95% CI: -3.8, -13.6], p = 0.001) and systolic BP (-3.6 [95% CI: -7.8, 0.5], p = 0.085). CONCLUSIONS: The initiation of treatment with the CV-polypill in patients who previously received equally potent treatment with atorvastatin and ramipril was associated with a greater reduction in cLDL and systolic BP.

Role of sCD40L in the prediction of super response to cardiac resynchronization therapy / Rol de sCD40L en la predicción de súper respuesta a la terapia de resincronización cardiaca

Background: The aim of this paper is to analyze the roleof the biomarkers Interleukin 6, Tumoral Necrosis Factor α,sCD40L, high sensitive Troponin T, high sensitive C-ReactiveProtein and Galectin-3 in predicting super response (SR) toCardiac Resynchronization Therapy (CRT), as they have notbeen studied in this field before. Methods: Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year.SR was defined as reduction in LVESV ≥ 30% at one yearfollow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed. Results: 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p = 0.04),suffering from less ischemic cardiomyopathy (13 vs. 63%,p < 0.0001) and lateral (0 vs. 18%, p = 0.03), inferior (4 vs.33%, p = 0.01) and posterior infarction (0 vs. 22%, p = 0.01);absence of mitral regurgitation (47% vs. 22%, p = 0.04), wider QRS width (157.7 ± 22.9 vs. 140.8 ± 19.2ms, p = 0.01), higher concentrations of sCD40L (6.9 ± 5.1 vs. 4.4 ± 3.3 ng/mL,p = 0.02), and left ventricular lead more frequent in lateralmedial position (69 vs. 26%, p = 0.002). QRS width, lateralmedial position of the lead and absence of mitral regurgitation were independent predictors of SR. sCD40L showeda moderate direct correlation with SR (r = 0.39, p = 0.02) andwith the reduction of LVESV (r = 0.44, p = 0.02). Conclusion: sCD40L correlates significantly with SR to CRT.QRS width, absence of mitral regurgitation and lateral medial position of the lead are independent predictors of SRin this cohort.(AU)

Fundamento: Analizar los biomarcadores Interleuquina 6,factor de necrosis tumoral α, sCD40L, troponina T hipersensible, proteína Creactiva hipersensible y galectina-3 en lapredicción de súper-respuesta (SR) a la terapia de resincronización cardiaca (TRC), ya que no han sido valorados conanterioridad. Material y métodos: Se recopilaron datos clínicos, electrocardiográficos y ecocardiográficos preimplante y al año.Se definió SR como disminución del VTSVI ≥ 30% al añode seguimiento. Las muestras sanguíneas fueron extraídaspreimplante. Se realizó regresión logística multivariante ycurvas ROC. Resultados: Se incluyeron 50 pacientes, 23 (46%) fueronSR.Las características relacionadas con la SR fueron: ser mujer (35 vs. 11%, p = 0,04), sufrir menos cardiopatía isquémica(13 vs. 63%, p < 0,0001) e infarto lateral (0 vs. 18%, p = 0,03),inferior (4 vs. 33%, p = 0,01) y posterior (0 vs. 22%, p = 0,01); ausencia de insuficiencia mitral (47% vs. 22%, p = 0,04), mayor anchura del QRS (157,7 ± 22,9 vs. 140,8 ± 19,2 ms, p = 0,01), mayorconcentración de sCD40L (6,9 ± 5,1 vs. 4,4 ± 3,3 ng/mL, p = 0,02),y electrodo ventricular izquierdo más frecuentemente en posición lateral media (69 vs. 26%, p = 0,002). El QRS, la posiciónlateral media del electrodo y la ausencia de insuficiencia mitral fueron predictores independientes de SR. sCD40L mostróuna correlación moderada directa con SR (r = 0,39, p = 0,02) ycon la disminución del VTSVI (r = 0,44, p = 0,02). Conclusiones: sCD40L se correlaciona significativamentecon SR a la TRC. El QRS, la ausencia de insuficiencia mitraly la posición lateral media del electrodo son predictores independientes de SR en esta cohorte.(AU)

Role of sCD40L in the prediction of super-response to cardiac resynchronization therapy.

BACKGROUND: The aim of this paper is to analyze the role of the biomarkers Interleukin 6, Tumoral Necrosis Factor a, sCD40L, high sensitive Troponin T, high sensitive C-Reactive Protein and Galectin-3 in predicting super response (SR) to Cardiac Resynchronization Therapy (CRT), as they have not been studied in this field before. METHODS: Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year. SR was defined as reduction in LVESV = 30% at one year follow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed. RESULTS: 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p?=?0.04), suffering from less ischemic cardiomyopathy (13 vs. 63%, p?

Gestación heterotópica abdominal tras fecundación in vitro y transferencia embrionaria. Reporte de un caso y discusión sobre el diagnóstico y manejo / Abdominal heterotopic pregnancy after IVF and embryo transfer. A case report and a review of the diagnosis and management

La coexistencia de una gestación intrauterina y una extrauterina se denomina gestación heterotópica. Es una condición poco frecuente, que ocurre en un 0,001-0,006% de las gestaciones espontáneas y hasta en un 1% de las gestaciones conseguidas mediante técnicas de reproducción asistida.Presentamos un caso de gestación heterotópica con implantación pélvica, una circunstancia extremadamente rara, y discutimos sobre su diagnóstico y su manejo clínico insistiendo en la necesidad de pensar en esta entidad aunque se objetive una gestación intrauterina tras una técnica de reproducción asistida y aunque no existan otros factores de riesgo. Un diagnóstico y tratamiento precoces serán claves para evitar las graves complicaciones asociadas a este tipo de gestación.(AU)

The coexistence of an intrauterine pregnancy and an extra-uterine one is called a heterotopic pregnancy. It is a rare condition that occurs in 0.001-0.006% of spontaneous pregnancies, and in up to 1% of pregnancies achieved through assisted reproduction treatments.The case is presented of a heterotopic pregnancy with pelvic implantation, an extremely uncommon event, followed by a discussion on its diagnosis and clinical management. There must be awareness of this disorder, even if an intra-uterine pregnancy is observed after an assisted reproduction treatment, and although there are no other risk factors.Early diagnosis and treatment is essential to avoid the serious complications associated with this type of pregnancy.(AU)

Sex-related differences of fatty acid-binding protein 4 and leptin levels in atrial fibrillation.

AIMS: Adiposity plays a key role in the pathogenesis of atrial fibrillation (AF). Our aim was to study the sex differences in adipokines levels according to AF burden. METHODS AND RESULTS: Two independent cohorts of patients were studied: (i) consecutive patients with AF undergoing catheter ablation (n = 217) and (ii) a control group (n = 105). (i) Adipokines, oxidative stress, indirect autonomic markers, and leucocytes mRNA levels were analysed; (ii) correlation between biomarkers was explored with heatmaps and Kendall correlation coefficients; and (iii) logistic regression and random forest model were used to determine predictors of AF recurrence after ablation. Our results showed that: (i) fatty acid-binding protein 4 (FABP4) and leptin levels were higher in women than in men in both cohorts (P < 0.01). In women, FABP4 levels were higher on AF cohort (20 ± 14 control, 29 ± 18 paroxysmal AF and 31 ± 17 ng/mL persistent AF; P < 0.01). In men, leptin levels were lower on AF cohort (22 ± 15 control, 13 ± 16 paroxysmal AF and 13 ± 11 ng/mL persistent AF; P < 0.01). (ii) In female with paroxysmal AF, there was a lower acetylcholinesterase and higher carbonic anhydrase levels with respect to men (P < 0.05). (iii) Adipokines have an important role on discriminate AF recurrence after ablation. In persistent AF, FABP4 was the best predictor of recurrence after ablation (1.067, 95% confidence interval 1-1.14; P = 0.046). CONCLUSION: The major finding of the present study is the sex-based differences of FABP4 and leptin levels according to AF burden. These adipokines are associated with oxidative stress, inflammatory and autonomic indirect markers, indicating that they may play a role in AF perpetuation.

Estudio piloto sobre el efecto de la vitamina D en la patogenia de los miomas uterinos: influencia de la terapia con vitamina D en el volumen uterino y en la angiogénesis de los miomas determinados por ECO3DPW y niveles séricos de VEGF / Pilot study on the effect of vitamin D on the pathogenesis of uterine fibroids: Influence of vitamin D therapy on volume and vascularisation of uterine fibroids, determined by 3DPW ultrasound and VEGF serum levels

Los miomas uterinos son una de las patologías ginecológicas más comunes encontrándose hasta en el 70% de las mujeres de raza caucásica y en el 80% de las mujeres de raza negra1,2. En los últimos años, la angiogénesis y la vascularización se han convertido en pieza fundamental de estudio del crecimiento de los tumores. En el caso de los miomas uterinos se ha descubierto que existen diferencias en la vascularización cuando se compara con el tejido uterino adyacente. La patogenia de los miomas es multifactorial existiendo varias vías que intervienen en el crecimiento de los mismos como la vía estrogénica, la progestagénica y la de los factores de crecimiento3. Otra de las vías qué influyen en su desarrollo es la vía de la vitamina D. Niveles inadecuados de dicha vitamina pueden favorecer el crecimiento de los mismos. En nuestro trabajo hemos analizado cómo influye la terapia con vitamina D en el volumen de los miomas y en su vascularización mediante el análisis sérico de VEGF y ecografía 3 DPW

Uterine fibroids are one of the most common gynaecological disorders, being found in 70% of Caucasian women and 80% of Afro-Caribbean women 1,2. In recent years, angiogenesis and vascularisation have become a key part of study of tumour growth. Differences in vascularisation have been discovered in uterine fibroids when compared to adjacent uterine tissue. The pathogenesis of uterine fibroids is multifactorial. Several pathways are involved in their growth have been described, such as the oestrogen pathway, the gestagen pathway, and the pathway of the growth factors. Another of the pathways that influences their development is the vitamin D pathway, as inadequate levels of this vitamin may favour the growth of uterine fibroids3. In this work, an analysis is made on how vitamin D therapy influences the volume and vascularity of uterine fibroids, using serum VEGF levels and 3DPW Ultrasound

No todo es lo que parece: miastenia gravis, una rara manifestación paraneoplásica del cáncer de ovario: caso clínico / Not all is what it seems: Myasthenia gravis, a rare paraneoplastic manifestation of ovarian cancer: Clinical case

Los síndromes neurológicos paraneoplásicos son un conjunto de trastornos, raramente asociados a tumores ginecológicos. Su presencia debe alertarnos sobre la posible existencia de un tumor maligno subyacente. Presentamos un caso de miastenia gravis, como manifestación paraneoplásica de un cáncer de ovario primario avanzado

Paraneoplastic neurological syndromes are an unusual diseases rarely associated with gynaecological tumours. Their presence must alert on the possible existence of an underlying malignant tumour. A rare case is presented of myasthenia gravis as a paraneoplastic manifestation of an advanced primary ovarian cancer

Transition metals-incorporated zeolites as environmental catalysts for indoor air ozone decomposition.

The present study aimed to prepare catalysts of Fe- and Cu-loaded zeolite via ion-exchange technique using dilute solutions of metal nitrate precursors followed by calcination at 600°C in the air for 4 h. Commercial zeolite ZSM-5 with specific surface area of 400 m2/g and diameter particle of 1.2-2 mm was used as a parent support. The prepared catalysts were characterized by Fourier transform infrared spectroscopy analysis. The IR absorbed bands of Cu-ZSM-5 and Fe-ZSM-5 revealed a shift in the frequency and a reduction in the intensity framework. This indicates that both catalysts have a significant change in the number of the zeolite structure bonds. The catalytic activity of the prepared materials compared to the parent zeolite was evaluated for the catalytic ozone decomposition. The ozone stream of the initial concentration (13 g/m3) with air flow rate (Q) of 0.18 m3/h was passed through a glass jacket column reactor filled with a fixed bed of 40 g zeolites. It was showed that the ozone removal efficiency by Cu-ZSM-5 and Fe-ZSM-5 was obviously higher than that found with the parent ZSM-5. In terms of O3 removal efficiency, zeolite samples could be ranked as follows: Fe-ZSM-5 > Cu-ZSM-5> parent ZSM-5. The results revealed about 90% O3 removal efficiency for Fe-ZSM-5 and 70% for Cu-ZSM-5 as compared to nearly 40% for the parent zeolite. Consequently, the incorporation of Fe and Cu metals onto the zeolite surface plays a key role for enhancing the gaseous ozone elimination.

BTX abatement using Chilean natural zeolite: the role of Brønsted acid sites.

In wastewater treatment facilities, air quality is not only affected by conventional unpleasant odour compounds; toxic volatile organic compounds (VOCs) are also found. In this study, the adsorptive capacity of Chilean natural zeolite toward VOC removal was evaluated. Moreover, the influence of zeolite chemical surface properties on VOC elimination was also investigated. Three modified zeolite samples were prepared from a natural Chilean zeolite (53% clinoptilolite, 40% mordenite and 7% quartz). Natural and modified zeolite samples were characterised by nitrogen adsorption at 77 K, elemental analyses and X-ray fluorescence (XRF). Chemical modifications of natural zeolite showed the important role of Brønsted acid sites on the abatement of VOCs. The presence of humidity has a negative effect on zeolite adsorption capacity. Natural zeolites could be an interesting option for benzene, toluene and xylene vapour emission abatement.

Oxidation of nitrobenzene by ozone in the presence of faujasite zeolite in a continuous flow gas-liquid-solid reactor.

This work investigates the oxidation of nitrobenzene (NB) by ozone in the presence of faujasite zeolite. Experiments were carried out in a gas-liquid-solid reactor were ozone transfer and NB oxidation took place at the same time. Three configurations of the reactor were compared: empty, filled with inert glass beads and filled with faujasite pellets. First, ozone transfer coefficient (k(L)a) and decomposition rate constant (k(C)) were determined for each configuration. In presence of solid, k(L)a was 2.0 to 2.6 times higher and k(C) was 5.0 to 6.4 times higher compared to the empty reactor. Then, the various configurations were evaluated in terms of NB removal and chemical oxygen demand (COD) decrease. The faujasite reactor showed higher removal of NB and decrease of COD compared to other configurations under the same conditions suggesting that the faujasite increases the oxidation rate of NB. Oxidation of NB in presence of faujasite also proved to be limited by the transfer of ozone from the gas to the liquid phase.

[Endometriosis]. / Endometriosis.

Endometriosis is a common gynaecological disease of unknown aetiology which affects an estimated 10% to 15% of all premenopausal women. It is defined as the presence of endometrial tissue, consisting of both glandular epithelium and stroma, outside the uterine cavity. Three different clinical entities of endometriosis can be distinguished: peritoneal endometriosis, ovarian endometriosis and deep invasive endometriosis. There are several theories to explain their pathogenesis: metaplasia of the mesothelium, in situ development of Müllerian remnants in the rectovaginal area (deep-invasive lesions) or retrograde transplantation of shed menstrual effluent (peritoneal implants). The most widely accepted hypothesis for the development of endometriosis is retrograde menstruation. However, some other factor renders certain women susceptible to the implantation and growth of this ectopic endometrium.

[Proposal for a new microsurgical model for the study of induced endometriosis in Wistar rats. Preliminary results]. / Propuesta de un nuevo modelo microquirúrgico para el estudio de la endometriosis inducida en rata Wistar. Resultados preliminares.

The current knowledge status on the patogenesis of endometriosis as well as devastating consequences of disease evolution in women's reproductive health, have promoted researchers advances in a great manner during last years. The immunologic and neangiogenesis systems implication have opened new ways of knowledge over classic theories from the beginning of the xx century. The experimental resesearch, using animal induction models. Below we explain the first steps a new induction model ("PGR1-HotDog"), based on Wistar rats using a new disease autogeneration system, created for te study of the early stages of the endometriosis.

Ultrasound study of the myoendometrial border.

Abnormal thickening of the Endometrial Subendometrial Myometrium Unit (ESEMy Unit, including basal endometrium and inner myometrium) has been detected on imaging and referred to as "diffuse adenomyosis" in infertile patients with proven endometriosis. However, no robust relationship exists between enlargement of the ESEMy Unit and adenomyosis proven on hysterectomy specimen examination; moreover, if any correlation exists, it lacks histological validation in women wishing to preserve fertility. While adenomyosis effects on fertility, if any, remain elusive, thickening of the ESEMy Unit have been consistently linked to fertility impairment in both experimental and clinical models. The hypothesis tested herein is that a novel condition exists, called "ESEMy Unit disruption disease"; it is epidemiologically different from adenomyosis, diagnosable on imaging and bears a clear impact on human fertility through various mechanisms. A new wave of good quality studies may be elicited by a clear distinction between adenomyosis and the "ESEMy Unit disruption disease".

[Diagnosis of endometriosis]. / Diagnóstico de la endometriosis.

There are no sufficiently sensitive and specific signs and symptoms or diagnostic tests for the clinical diagnosis of endometriosis, and no diagnostic strategy is supported by evidence of effectiveness. Pelvic and rectal examinations should be performed, although the yield of the physical examination is low. Laboratory tests and radiological examinations are usually not warranted. Measurement of CA 125 levels may be useful for monitoring disease progress, and MRI has a high sensitivity in detecting endometrial cysts but poor diagnostic accuracy for endometriosis in general. Patients with persistent symptoms after empirical treatment should be referred for laparoscopy, the preferred method for diagnosis of endometriosis.

[Angiogenesis and endometriosis]. / Angiogenesis y endometriosis.

Endometriosis is a common gynaecological disease of unknown aetiology. Angiogenesis appears to be one of the processes involved in its pathogenesis. Angiogenic factors are increased in the peritoneal fluid of patients with endometriosis (McLaren 1996 et al; Taylor et al, 2002), in peritoneal implants (Ferriani et al, 1993) and in ovarian endometriomas. On the other hand, some researchers have found that angiogenesis is related to pelvic pain. We speculated that ovarian endometriomas in patients presenting with pelvic pain would be more angiogenic than those in asymptomatic women and that their vascular features would therefore be different.