How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population.

BACKGROUND: Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group. METHODS: This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used. RESULTS: Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage. CONCLUSIONS: After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

Differences in moral reasoning among medical graduates, graduates with other degrees, and nonprofessional adults.

BACKGROUND: Reasoning and moral action are necessary to resolve day-to-day moral conflicts, and there are certain professions where a greater moral character is expected, e.g., medicine. Thus, it is desirable that medical students develop skills in this field. Some studies have evaluated the level of moral reasoning among medical students; however, there are no comparative studies involving other types of populations. Therefore, the objective of this study was to compare the moral reasoning among medical graduates with that of a group of young graduates with other degrees and of a group of nonprofessional adults. METHODS: An exploratory cross-sectional study was conducted. Pediatric residents and pediatric subspecialty residents at a pediatric hospital were invited to participate, forming the group of "medical graduates". A group of young people from a social program and students with a master's degree in a science from the same pediatric hospital were also invited to participate, comprising the group of "graduates with other degrees". Finally, a group of beneficiaries of a family clinic was invited to participate, which we categorized as "nonprofessionals". To evaluate the differences in moral reasoning between these 3 groups, we applied the Defining Issues Test (DIT), a moral reasoning questionnaire designed by James Rest using Kohlberg's theory of moral development. RESULTS: The moral reasoning of 237 subjects-88 from the "medical graduates" group, 82 from the "graduates with other degrees" group and 67 from the "nonprofessionals" group- was evaluated. We found differences in the profiles of moral development of the groups. The profile of the "nonprofessionals" showed a very high predominance of subjects at the preconventional level, 70%, but only 4.5% at the postconventional level. Among the "medical graduates", we observed 37.5% at the preconventional level and 34% at the postconventional level (X2 p < 0.001); this group had the highest percentage in this category. This large difference could be because the differences in the ages and socioeducational levels of nonprofessionals are much wider than those among medical graduates. However, significant differences were also found when the profiles of medical graduates were compared with those of graduates with other degrees, since the latter demonstrated 56% at the preconventional level and 18% at the postconventional level (X2 test, p = 0.02). CONCLUSIONS: Significant differences were found in moral reasoning among the groups that we evaluated. Among the group of medical graduates, there was a higher percentage of subjects at the postconventional level than among the group of graduates with other degrees and a much higher percentage than among the group of nonprofessionals. Our conclusions give the first evidence that studying medicine seems to influence the development of moral reasoning in its students. Therefore, we consider it relevant to develop educational strategies where the student is involved in simulated but realistic decision-making situations, where there are moral dilemmas to resolve from their early years of training.

Kca3.1 Activation Via P2y2 Purinergic Receptors Promotes Human Ovarian Cancer Cell (Skov-3) Migration.

Disorders in cell signaling mediated by ATP or histamine, activating specific membrane receptors, have been frequently associated with tumorigenesis. Among the elements of response to purinergic (and histaminergic) signaling, ion channel activation controls essential cellular processes in cancer, such as cell proliferation, motility, and death. Here, we studied the effects that ATP had on electrical properties of human ovarian adenocarcinoma cells named SKOV-3. ATP caused increase in intracellular Ca2+ concentration ([Ca2+]i) and, concurrently, it evoked a complex electrical response with a conspicuous outward component. This current was generated through P2Y2 receptor activation and opening of K+ channels, KCa3.1, as indicated by electrophysiological and pharmacological analysis, as well as by immunodetection and specific silencing of P2Y2 or KCa3.1 gene by esiRNA transfection. Low µM ATP concentration increased SKOV-3 cell migration, which was strongly inhibited by KCa3.1 channel blockers and by esiRNA-generated P2Y2 or KCa3.1 downregulation. Finally, in human ovarian tumors, the P2Y2 and KCa3.1 proteins are expressed and co-localized in neoplastic cells. Thus, stimulation of P2Y2 receptors expressed in SKOV-3 cells promotes motility through KCa3.1 activation. Since P2Y2 and KCa3.1 are co-expressed in primary tumors, our findings suggest that they may play a role in cancer progression.

'La fiebre de Malta': An Interface of Farmers and Caprine Brucellosis Control Policies in the Bajío Region, Mexico.

This article shows that socio-economic factors, defined here as practices, knowledge, interests, beliefs and experiences have a role in the adoption of brucellosis control strategies in the Bajío region, Mexico. We combined qualitative and quantitative methods to show that socio-economic factors with regard to goat husbandry and brucellosis control are not taken into account in the current policy to combat the disease in Mexico. Farmers ranked constraints like the price of goat milk more important than the control of the disease. The impact of brucellosis in goats is hidden to farmers, and the term brucellosis is still a strange name to them; it is better known as 'la fiebre de Malta' (Malta fever), which farmers are aware of and which they avoid by not drinking goat milk. Brucellosis control measures cause losses such as abortion due to vaccination and ear infections due to ear tagging. In the villages of the state of Michoacán, the uptake of a vaccination and testing programme was almost complete because it was offered for free, whereas in villages of Jalisco, vaccination was not adopted thoroughly because the cost of vaccination was high for farmers and because of a lack of veterinarians offering the service. Neither compensation for culling suspected infected goats does exist nor the infrastructure, like slaughterhouses, to ensure that goats that are brucellosis seropositive are not resold to neighbouring farmers. This article disputes the idea that brucellosis is confined to the lack of awareness and participation of farmers in control measures, but rather that policies are promulgated without a good knowledge of goat husbandry and farmers' perceptions. We claim that governmental authorities should reformulate the policy to take into account socio-economic factors shaping farmers' behaviour so that effective control measures will be adopted by goat farmers.

Causas de Óbito en pacientes con Dengue Internados en el Hospital Nacional. Epidemia 2013 / Causes of Deaths in inpatients diagnosed with Dengue at the National Hospital during the 2013 epidemic

El objetivo de este estudio es analizar las causas de muerte en pacientes internados con el diagnóstico de Dengue de la epidemia del año 2013 en el Hospital Nacional de Itauguá. Material y Método: Estudio de casos y controles de pacientes con el diagnóstico de Dengue que fallecieron durante la internación en el Hospital Nacional, en la epidemia del año 2013. El diagnóstico de Dengue fue confirmado por la presencia en sangre del antígeno NS1 o por serología IgM. Las variables analizadas fueron: características demográficas, procedencia, presencia o ausencia de comorbilidad, tiempo de enfermedad, tiempo de internación, causa del óbito: causada por el Dengue (Dengue grave: shock por Dengue, sangrado grave, daño orgánico grave), o muerte con Dengue (óbito desencadenado por descompensación de la comorbilidad o por otra causa), y el nivel de plaquetas en sangre. Resultados: Fueron internados 1554 pacientes adultos con Dengue, fallecieron 67 (4,3%). El 59,7% fallecieron por Dengue y 40,3% con Dengue, mujeres 32 y varones 35, edad media 49 ± 19. No hubo diferencias con relación al sexo (p = 0,149). En relación al tiempo de enfermedad no hubo diferencia significativa entre los fallecidos por Dengue y con Dengue, si hubo diferencia significativa en el tiempo de internación. Hubo mayor proporción de pacientes con co-morbilidad en los fallecidos con Dengue (p<0,001). Las principales patologías subyacentes fueron la Hipertensión Arterial, Insuficiencia Renal Crónica y Diabetes Mellitus tipo 2. Las causas de óbito en los fallecidos por Dengue fue: choque (67,5%), hemorragia (32,5%) y en los fallecidos con Dengue fue la sepsis (29,6%). En los fallecidos por Dengue el promedio de plaquetas en sangre fue inferior con relación a los fallecidos con Dengue. Conclusión: Las muertes se produjeron sobre todo a causa del Dengue, el choque por Dengue fue la causa principal y la mayoría de los fallecidos con Dengue presentaron alguna comorbilidad. Palabras clave: Dengue, causas de óbito, comorbilidad, mortalidad.

The objective of this study is to analyze the causes of death in patients hospitalized with the diagnosis of Dengue during the Dengue Epidemic in 2013 at the National Hospital of Itauguá. Material and Methods: Case-control study of patients with the diagnosis of Dengue who died during their hospitalization at the National Hospital during the Dengue epidemic of 2013. The diagnosis of Dengue was confirmed by the presence in blood of NS1 antigen or by positive IgM serology. Variables analyzed included demographic characteristics, place of origin, presence or absence of comorbidity, length of illness, length of stay, cause of death if directly attributed to Dengue (severe Dengue: Dengue shock, severe bleeding, severe organ damage), and death with Dengue as a co-morbidity (death triggered by decompensated comorbidity or other cause), and the level of blood platelets. We included all patients with the diagnosis of Dengue deaths during the epidemic of 2013, classified into two groups: Group 1 being deaths due to Dengue (cases), Group 2 being patients who died with Dengue (the cause of death was not attributed to Dengue infection) as controls. Data were analyzed using EPI INFO 2006 and using descriptive statistics. To establish associations between variables contingency tables and Chi square test were used, the odds ratio, and t test of independent samples for comparison of means were also calculated, both tests at a significance level of 0.05. Results: Of a total of 1554 adult patients hospitalized with Dengue, 67 died (4.3%). 59.7% died of Dengue and 40.3% died with Dengue. 32 were women and 35 were men, mean age 49 ± 19. No differences were noted with respect to sex (p = 0.149). In relation to length of illness there was no significant difference between those killed by Dengue and Dengue, but there was a significant difference in length of stay. There was a higher proportion of co-morbidities in patients who died of Dengue (p<0.001). The main co-morbidities were Hypertension, Chronic Kidney Disease and Type 2 Diabetes Mellitus. Causes of death in patients died from Dengue wereShock (67.5%), hemorrhage (32.5%) and the percentage of those who died with Dengue sepsis was (29.6%). Average blood platelet levels in Dengue deaths were lower than those patients who died with Dengue. Conclusion: Most of the deaths that occurred were directly due to Dengue disease, Dengue shock was the main cause of death in those patients and most of the from Dengue also had co-morbid diseases. Keywords: Dengue, causes of death, morbidity, mortality.

Review of tubulocystic carcinoma of the kidney with focus on clinical and pathobiological aspects.

Tubulocystic carcinoma of the kidney (TCK) is a recently established entity in renal neoplastic pathology. This review aims to give an overview of the clinical and pathobiological aspects of TCK. Grossly, the TCKs are well-demarcated multicystic lesions giving a "wrapped bubble" or "spongy" appearance. Microscopically, the tumors are composed of multiple, variably sized cysts separated by thin fibrous septa lacking ovarian stroma or desmoplastic reaction. The cysts are lined by tumor cells with eosinophilic cytoplasm and nuclear atypia of variable, but not infrequently of high grade corresponding to Fuhrman grade 3. A frequent association with papillary tumors has been reported. Recent molecular genetic studies of TCK have revealed distinct features separating this subset of renal cell carcinomas (RCCs) from other types of renal tumors including collecting duct carcinoma of Bellini and renal medullary carcinoma as well as pointing towards a close kinship with papillary RCC. Tubulocystic carcinoma of the kidney generally pursues an indolent clinical course. However, several cases with aggressive clinical behavior have been reported. We strongly feel that there is enough clinicopathological evidence to corroborate TCK as a separate entity and that it should be incorporated into the next WHO classification of renal tumors as a separate neoplastic category.

Association between ERCC1 and XPA expression and polymorphisms and the response to cisplatin in testicular germ cell tumours.

BACKGROUND: Cisplatin cures over 80% of testicular germ cell tumours (TGCTs), and nucleotide-excision repair (NER) modifies the sensitivity to cisplatin. We explored the association between NER proteins and their polymorphisms with cisplatin sensitivity (CPS) and overall survival (OS) of patients with non-seminomatous (ns)-TGCTs. METHODS: The expression of ERCC1 and XPA and the presence of γH2AX were evaluated in cancer cell lines and in fresh ns-TGCTs. The ERCC1 protein was also determined in ns-TGCTs. The differences between CPS and non-CPS cell lines and patients were analysed by Student's t- or χ(2)-tests. The differences in OS were analysed using the log-rank test, and the hazard ratios (HRs) were calculated using the Cox model. RESULTS: High ERCC1 expression was observed in the non-CPS cells, and both ERCC1 and γH2AX expressions were augmented after cisplatin treatment. Increased ERCC1 expression was also identified in non-CPS patients. Neither polymorphism was associated with either CPS or OS. The presence of ERCC1 was associated with non-CPS (P=0.05) and adjusted in the prognosis groups. The HR in ERCC1-negative and non-CPS patients was >14.43, and in ERCC1-positive and non-CPS patients the HR was >11.86 (P<0.001). CONCLUSIONS: High levels of ERCC1 were associated with non-CPS, suggesting that ERCC1 could be used as a potential indicator of the response to cisplatin and prognosis in ns-TGCTs.

Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2-IIB cervical cancer patients.

BACKGROUND: The aim of the present study was to demonstrate that radical hysterectomy (RH) leads to improved survival outcomes in FIGO stage IB2-IIB cervical cancer when compared with standard brachytherapy (BCT) after identical external beam chemoradiation (EBRT-CT). PATIENTS AND METHODS: EBRT-CT treatment consisted of six courses of cisplatin at 40 mg/m² and gemcitabine at 125 mg/m² per week concurrent with 50.4 Gy of radiation. In the BCT arm, EBRT-CT was followed by BCT to reach a point A dose of 85 Gy, whereas in the experimental arm, a type III RH with bilateral pelvic lymph node dissection and para-aortic lymph node sampling (RH) was carried out within 4-6 weeks after EBRT-CT. RESULTS: Between May 2004 and June 2009, 211 patients were enrolled (BCT, 100 and RH, 111). At a median follow-up time of 36 months (3-80), progression-free survival (PFS) and overall survival (OS) rates were similar in both the arms. PFS rates were 74.8% and 71.7% in the BCT and RH arms [HR 0.6516 (95% confidence interval (CI) 0.3504-1.2116)], P = 0.186. OS rates were 76.3% in the BCT versus 74.5% in the surgical arm [HR 0.6981 (95% CI 0.3106-1.3439)], P = 0.236. No differences were observed in the pattern of local and systemic failures. CONCLUSIONS: This study failed to demonstrate that RH after EBRT-CT is superior to standard BCT.

Differential expression of the P2X7 receptor in ovarian surface epithelium during the oestrous cycle in the mouse.

Purinergic signalling has been proposed as an intraovarian regulatory mechanism. Of the receptors responsible for purinergic transmission, the P2X7 receptor is an ATP-gated cationic channel that displays a broad spectrum of cellular functions ranging from apoptosis to cell proliferation and tumourigenesis. In the present study, we investigated the functional expression of P2X7 receptors in ovarian surface epithelium (OSE). P2X7 protein was detected in the OSE layer of the mouse, both in situ and in primary cultures. In cultures, 2'(3')-O-(4-Benzoylbenzoyl)adenosine-5'-triphosphate (BzATP) activation of P2X7 receptors increased [Ca(2+)]i and induced apoptosis. The functionality of the P2X7 receptor was investigated in situ by intrabursal injection of BzATP on each day of the oestrous cycle and evaluation of apoptosis 24h using the terminal deoxyribonucleotidyl transferase-mediated dUTP-fluorescein nick end-labelling (TUNEL) assay. Maximum effects of BzATP were observed during pro-oestrus, with the effects being blocked by A438079, a specific P2X7 receptor antagonist. Immunofluorescence staining for P2X7 protein revealed more robust expression during pro-oestrus and in OSE regions behind the antral follicles, strongly supporting the notion that the differences in apoptosis can be explained by increased receptor expression, which is regulated during the oestrous cycle. Finally, P2X7 receptor expression was detected in the OSE layer of human ovaries, with receptor expression maintained in human ovaries diagnosed with cancer, as well as in the human ovarian carcinoma SKOV3 cell line.

Nocardiosis pulmonar en un paciente con diabetes mellitus / Pulmonary nocardiosis in patient with diabetes mellitus

La enfermedad pulmonar es el hallazgo clínico predominante, casi el 90% de estos casos son causados por N. asteroides. Las manifestaciones clínicas de la infección instalada incluyen masa inflamatorias endobronquiales, neumonía, absceso pulmonar y enfermedad cavitaria. Se presenta un paciente con Nocardiosis pulmonar internado en el Hospital Nacional de Itauguá. Varón de 51 años, con antecedentes de Diabetes Mellitus de 6 mese de evolución, hipertenso conocido con enalapril. A las 2 semanas de internación se realiza broncoscopía con lavado bronqui alveolar, en donde se aisla N. asteroides, el paciente es tratado con trimetropin - sulfametoxazol con buena evolución del cuadro pulmonar...

[Lipid profile in untreated HIV positive patients. HIV infection: cardiovascular risk factor?]. / Perfil lipídico en pacientes VIH (+) no tratados. Infección VIH: ¿factor de riesgo cardiovascular?

INTRODUCTION: Some cases of HIV+ patients with unexplained vascular disease have been reported and many studies are being performed to determine whether HIV infected individuals have an increased cardio-vascular risk (CVR). We propose: to describe lipid profile of untreated HIV+ patients and to compare it with the HIV- and to assess whether any of the lipid abnormalities influence in CVR estimation. MATERIAL AND METHODS: 407 homosexual males: 251 untreated HIV+ and 156 HIV-. Biochemistry parameters: Total cholesterol (CHOL), HDL-cholesterol (HDL), VLDL-cholesterol, LDL-cholesterol (LDL), triglycerides (TG), apolipoproteins A1 and B (ApoA1 y ApoB) and lipoprotein A. Atherogenic rates: CHOL/HDL, LDL/HDL and log (TG/HDL). HIV+ patients were classified into three groups according to CD4 lymphocytes number. RESULTS: HIV+ patients had lower CHOL, HDL, and ApoA1 and higher CVR rates. These differences showed also between each HIV+ group according to CD4 number and control group HIV-. 76% of the HIV+ patients showed low levels of HDL (less than 40 mg/dL) as compared with 31% of HIV- subjects. CONCLUSION: Untreated HIV+ patients' lipid profile is different from the HIV- subjects; one. There are decreases in HDL and ApoA1 from the beginning of the infection that persis along all the CD4 levels. HDL decrease in HIV infection multiplies global CVR in HIV infected individuals, independently of other risk factors.

Perfil lipídico en pacientes VIH (+) no tratados. Infección VIH: ¿factor de riesgo cardiovascular? / Lipid profile in untreated HIV positive patients. HIV infection: cardiovascular risk factor?

Introducción: La publicación de casos de pacientes VIH (+) con enfermedad vascular inexplicada, ha puesto en marcha múltiples estudios para tratar de conocer si los pacientes VIH (+) presentan un incremento del Riesgo Cardiovascular (RCV). Nos hemos propuesto: caracterizar el perfil lipídico de pacientes VIH (+) no tratados comparándolo con el que presentan sujetos VIH (-) y valorar si alguna de las alteraciones halladas influye de forma directa sobre la estimación del RCV. Pacientes y métodos: 407 varones homosexuales: 251 VIH (+) no tratados, y 156 VIH (-). Determinaciones bioquímicas: colesterol total (COL), HDL-colesterol (HDL), VLDL-colesterol, LDL-colesterol (LDL), triglicéridos (TG), apolipoproteínas A1 y B (ApoA1 y ApoB) y Lipoproteína a. Cocientes de aterogénicos: COL/HDL, LDL/HDL y log (TG/HDL). Los pacientes VIH (+) se dividieron en 3 grupos según recuento de linfocitos CD4. Resultados: Los pacientes VIH (+) presentaron COL, HDL, y ApoA1 menores y cocientes de RCV mayores. Estas diferencias también se mostraron entre cada grupo de pacientes VIH (+) según recuento de CD4 y el grupo control VIH (-). Un 76% de los pacientes VIH (+) presentaban concentraciones bajas de HDL (menor de 40 mg/dL), frente a un 31% de los sujetos VIH (-). Conclusiones: El perfil lipídico de los pacientes VIH (+) no tratados difiere del que presentan sujetos VIH (-). Desde los estadios mas inmunoconservados de la infección existe una disminución marcada del HDL, paralela a la disminución de ApoA1 que se mantiene a lo largo de todos los niveles de CD4. El descenso de HDL en la infección VIH multiplica el RCV global de los sujetos infectados, independientemente de la presencia de otros factores de riesgo

Introduction: Some cases of HIV (+) patients with unexplained vascular disease have been reported and many studies are being performed to determine whether HIV infected individuals have an increased cardiovascular risk (CVR). We propose: to describe lipid profile of untreated HIV (+) patients and to compare it with the HIV (-) and to assess whether any of the lipid abnormalities influence in CVR estimation. Material and Methods: 407 homosexual males: 251 untreated HIV (+),and 156 HIV (-). Biochemistry parameters: Total Cholesterol (CHOL), HDL-Cholesterol (HDL), VLDL-Cholesterol, LDL-Cholesterol (LDL), Triglycerides (TG), Apolipoproteins A1 and B (ApoA1 y ApoB) and Lipoprotein a. Atherogenic rates: CHOL/HDL, LDL/HDL and log (TG/HDL). HIV (+) patients were classified into three groups according to CD4 lymphocytes number. Results: HIV (+) patients had lower CHOL, HDL, and ApoA1 and higher CVR rates. These differences showed also between each HIV (+) group according to CD4 number and control group HIV (-). 76% of the HIV (+) patients showed low levels of HDL (less than 40 mg/dL) as compared with 31% of HIV (-) subjects. Conclusion: Untreated HIV(+) patients´lipid profile is different from the HIV (-) subjects´one. There are decreases in HDL and Apo A1 from the beginning of the infection that persist along all the CD4 levels. HDL decrease in HIV infection multiplies global CVR in HIV infected individuals, independently of other risk factors

Factores que interactúan con la dominancia global en el procesamiento de estímulos jerárquicos / Factors influence the global dominance with hierarchical stimuli

Navon (1977) enunció la hipótesis de la precedencia global, la cual propone que el procesamiento de un patrón visual se produce desde desde una codificación inicial de la forma global hasta un análisis consecutivo y más detallado de las partes locales. Esta hipótesis ha abierto una línea de investigación para analizar su veracidad y generalización. El objetivo del presente trabajo es realizar una revisión del concepto de precedencia global, presentando los estímulos, medidas empíricas y tareas que generalmente se utilizan en la experimentación. Igualmente, se efectúa una revisión de los trabajos significativos más recientes que han manipulado variables del estímulo, de los estudios realizados en el contexto neuropsicológico, así como los llevados a cabo con el objeto de analizar diferencias individuales en el procesamiento global y local en función de distintas características de los sujetos

Navon (1977), on the basis of hierarchical network model, suggested the processing of a visual pattern proceeds from global level towards analysis of more local details which he termed global precedence hypothesis. His experiments formed the basis for a line of research directed towards setting limits or generalization of global precedence. The aim of this paper is to realize a theoretical review of the concept of global precedence, empirical measures and task used in experimentation. In addition to this, a review of results obtained in subsequent studies is presented. This includes investigations with experimental manipulation of stimuli variables, studies with neuropsychological approach and studies exploring individual differences

Quantitative characterization of changes in dynamical behavior for single-particle tracking studies.

Single-particle tracking experiments have been used widely to study the heterogeneity of a sample. Segments with dissimilar diffusive behaviors are associated with different intermediate states, usually by visual inspection of the tracking trace. A likelihood-based, systematic approach is presented to remove this incertitude. Maximum likelihood estimators are derived for the determination of diffusion coefficients. A likelihood ratio test is applied to the localization of the changes in them. Simulations suggest that the proposed procedure is statistically robust and is able to quantitatively recover time-dependent changes in diffusion coefficients even in the presence of large measurement noise.

Primary malignant lymphoma of uterine cervix.

Primary malignant lymphoma of the uterine cervix is a rare disease. Malignant lymphoma can be clinically and histopathologically misdiagnosed for the infrequent presentation in this are. A case of 56-year-old woman with uterine cervical tumor with infiltration to both parametria is presented. A biopsy was performed and histopathological studies reported a large cell B lymphoma. After the diagnosis CT abdominal, pelvic and thoracic scan was performed and shows infiltration to posterior bladder without evidence of disease in lymph nodes or another organ. The patient was treated with chemotherapy and radiotherapy. Six month after finish the treatment is well and free of disease.

Gestación interrumpida del segundo trimestre complicada con miocardiopatía dilatada / A pregnancy interrupted in the second trimester complicated by dilated myocardopathy

Presentamos un caso de miocardiopatía dilatada asociada a interrupción de la gestación en la semana 19, que requirió la evacuación inmediata de los restos ovulares mediante microcesárea ante el deterioro progresivo cardiorrespiratorio desde el ingreso. Se llegó al diagnóstico tras no encontrar causa evidenciable alguna a pesar de toda la batería de pruebas de laboratorio realizadas. El ecocardiograma reveló la dilatación del ventrículo izquierdo con hipocinesia generalizada y disfunción sistólica. La paciente precisó de tratamiento intensivo similar al de la insuficiencia cardíaca para estabilizarla. La evolución favorable fue sorprendente y a los 6 meses no presenta secuelas (AU)

We report a case of dilated cardiomyopathy linked to a missed abortion in the 19th week, requiring immediate evacuation of products of pregnancy by means of a microcaesarean because of cardiorespiratory deterioration following admission to hospital. Diagnosis was made excluding other possibilities in spite of extensive laboratory tests, as there was no obvious cause for this. Echocardiogram showed left ventricular dilatation with general hypokinesis and systolic dysfunction. The patient required intensive care to stabilize her cardiac insufficiency. Surprisingly, her evolution was favourable, and after six months she has no sequelae (AU)

Chromophobe renal cell carcinoma with microcystic and adenomatous arrangement and pigmentation--a diagnostic pitfall. Morphological, immunohistochemical, ultrastructural and molecular genetic report of 20 cases.

We present clinical, morphological, immunohistochemical, ultrastructural and molecular genetic features of 20 cases of a peculiar form of chromophobe renal cell carcinoma (CRCC) with morphology differing from that of conventional CRCC. Microscopically, the typical features of the tumors were microcystic arrangement and formation of adenomatous structures. Microcystic areas were composed of smaller eosinophilic and bigger pale cells having cytological appearance typical of conventional CRCC. Cytological features of the adenomatous structures were mostly different from those of conventional CRCC. They had a typical columnar arrangement with nuclei positioned at the base of the glandular structures and a small amount of a deeply eosinophilic cytoplasm often endowed with brush border facing the lumen of the glands. In addition, all the tumors showed a brown pigmentation. The pigmentation was located mostly extracellularly, where it formed pools of heavy deposits. Microscopic calcifications present in all cases formed psammoma bodies or else the calcifications were more extensive and amorphous in shape. Ultrastructurally, the cells showed features characteristic of CRCC: typical cytoplasmic vesicles were 100-700 nm in size and mitochondria had tubulovesicular, lamellar or circular cristae. Some tumor cells contained dark, variously sized electron-dense pigment granules. Neither melanosomes nor membrane-bound neurosecretory granules were seen. Using fluorescence in-situ hybridization probes for chromosomes 1, 2, 6, 10, 13, 17 and 21, the tumors revealed massive loss of tested chromosomes typical for conventional CRCC. Monosomy of chromosomes 1, 2, 6, 10, 13 and 21 was found in 100, 36, 91, 82, 82, 82 and 64% of cases, respectively. None of the cases showed mutation of exons 9, 11, 13 and 17 of the c-kit gene. The important feature of pigmented microcystic chromophobe renal cell carcinoma is a relatively benign biological behavior and the absence of distant metastases and sarcomatoid transformation.

[Spindle cell and cuboidal renal cell carcinoma (loopoma). 10 case reports]. / Vretenobunecný a kuboidální renální karcinom (loopom). Popis 13 prípadu.

BACKGROUND: Current classification systems of neoplasms arising from renal parenchyma distinguish 5 categories of renal cell carcinoma (RCC), i.e. conventional RCC, papillary RCC, chromophobe RCC, collecting duct/medullary RCC and unclassified RCC. We present 13 cases of unusual and unclassified spindle and cuboidal renal cell carcinomas. METHODS AND RESULTS: The studied group consisted of 13 patients (7 men and 6 women). They ranged in age from 22 to 65 years (mean 57.3). Generally, the tumours were well circumscribed and confined to the kidney, whitish to grey on section with a diameter 4.5-13 cm (mean 8.6 cm). One patient was investigated for loin pain and nocturia. Three patients had staghorn nephrolithiasis and vague sonographic findings in renal parenchyma. In one patient the renal tumour was found when examined on follow-up examination for prostatic adenocarcinoma. None of our patients was known to have elevated levels of parathyroid hormone due to hyperplasia, adenoma or carcinoma of the parathyroid gland. Clinical follow-up of the patients ranged from 9 months to 8 years (mean 2.3 years). Microscopically, the tumours were composed of two main populations of cells: flattened, spindle cells with sparse cytoplasm and small cuboidal cells with clear to light eosinophilic cytoplasm. Eight patients are currently well without signs of recurrence or metastasis, one had metastasis in the regional lymph node at the time of nephrectomy, one died of unrelated cause, and three were lost to follow-up. CONCLUSIONS: We present 13 cases of unclassified RCC. Our cases were histologically, immunohistochemically and ultrastructurally similar to the hitherto reported case reports of this variant of RCC. It is obvious, that that variant of RCC should be recognised as a new subtype of RCC.

Metastases to the breast.

AIM: The aim of this study was to report the clinico-pathological features of a series of patients with metastatic neoplasms to the breast. METHODS: A 10-year archive of surgical material was reviewed. A search was performed on all 10,650 breast neoplastic cases in the files of the Pathology Department from 1990 to 2000. RESULTS: There were 22 women and two men. The most common primary sites for solid tumours were cutaneous melanoma and ovarian carcinoma. Two of the 24 patients had no prior history of malignant disease. There was a solitary nodule in 17 cases; in seven cases there were multiple lesions in the same breast. Sixteen patients had a rapidly fulminating course and died of disease. Six patients are alive with disease and two patients were lost to follow-up. CONCLUSION: Recognition of these lesions as being metastatic may pre-empt radical surgery.

Spindle and cuboidal renal cell carcinoma, a tumour having frequent association with nephrolithiasis: report of 11 cases including a case with hybrid conventional renal cell carcinoma/ spindle and cuboidal renal cell carcinoma components.

AIMS: We present the largest series of an unclassified subtype of renal cell carcinoma, which seems to be a distinct morphological entity and which is sometimes designated as spindle and cuboidal renal cell carcinoma. METHODS AND RESULTS: Eleven cases of spindle and cuboidal renal cell carcinoma were found among 7000 primary renal cell tumours in Pilsen's routine and consultation files. The patients were five men and six women. They ranged in age from 22 to 65 years (mean 56.8). Microscopically, the tumours were composed of two main populations of cells. First, the preponderant type of cells was formed by flattened, spindle cells with sparse cytoplasm. The second cell type was a small cuboidal cell with clear to light eosinophilic cytoplasm. Spindle-shaped cells were arranged in a fascicular pattern often reminiscent of low-grade smooth muscle tumours. Solid areas of spindle cells were also present. Small cuboidal cells formed sparse tubular structures lined by a row of single cells. In addition to all previous published cases of spindle and cuboidal renal cell carcinoma we observed an association of nephrolithiasis in our cases. It was seen in 3/11 of our patients. A previously unreported feature is the occurrence of a conventional renal cell carcinoma component in one of our cases. Seven of our patients are currently well without signs of recurrence or metastasis, one had metastasis in a regional lymph node at the time of nephrectomy, one died of an unrelated condition, and two were lost to follow-up. CONCLUSIONS: We present 11 cases of spindle and cuboidal renal cell carcinoma, which is believed to be a distinctive morphological entity. Our cases were histologically, immunohistochemically and ultrastructurally similar to the previously reported cases of spindle and cuboidal renal cell carcinoma. In contrast to all previously reported cases of spindle and cuboidal renal cell carcinoma, we observed an association with nephrolithiasis in three of our cases; moreover, one of our tumours had a conventional renal cell carcinoma component and another revealed a metastatic focus in a regional lymph node. None of our patients died of the disease. This study confirms that spindle and cuboidal renal cell carcinoma has a low malignant potential.