Style polymorphism in Linum (Linaceae): a case of Mediterranean parallel evolution?

Heterostyly is a sex polymorphism that has challenged evolutionary biologists ever since Darwin. One of the lineages where heterostyly and related stylar conditions appear more frequently is Linum (Linaceae). This group is particularly suitable for testing competing hypotheses about ancestral and transitional stages on the evolutionary building up of heterostyly. We generated a phylogeny of Linum based on extensive sampling and plastid and nuclear DNA sequences, and used it to trace the evolution of character states of style polymorphism. We also revised available data on pollination, breeding systems, and polyploidy to analyse their associations. Our results supported former phylogenetic hypotheses: the paraphyly of Linum and the non-monophyly of current taxonomic sections. Heterostyly was common in the genus, but appeared concentrated in the Mediterranean Basin and the South African Cape. Ancestral character state reconstruction failed to determine a unique state as the most probable condition for style polymorphism in the genus. In contrast, approach herkogamy was resolved as ancestral state in some clades, giving support to recent hypotheses. Some traits putatively related to heterostyly, such as life history and polyploidy, did show marginal or non-significant phylogenetic correlation, respectively. Although pollinator data are limited, we suggest that beeflies are associated with specific cases of heterostyly. The consistent association between style polymorphism and heteromorphic incompatibility points to ecological factors as drivers of the multiple evolution of style polymorphism in Linum. Albeit based on limited evidence, we hypothesised that specialised pollinators and lack of mating opportunities drive evolution of style polymorphism and loss of the polymorphism, respectively.

Caracterización de cánceres de mama sintomáticos invisibles en mamografía digital y tomosíntesis: correlación radiopatológica / Characterization of invisible breast cancers in digital mammography and tomosynthesis: radio-pathological correlation

Objetivo. Revisar las características radiopatológicas de carcinomas mamarios sintomáticos ocultos en mamografía digital (MD) y tomosíntesis (TS). Material y métodos. Análisis retrospectivo de 169 lesiones provenientes de pacientes sintomáticas con diagnóstico histológico de cáncer de mama y que fueron estudiadas con MD, TS, ecografía y resonancia magnética (RM). Se identificaron las lesiones ocultas (falsos negativos verdaderos) en MD y TS. Se analizaron datos clínicos, de densidad, los hallazgos con ecografía y RM, y la histopatología de las lesiones. Resultados. Se detectaron siete lesiones neoplásicas ocultas en MD y TS. El 57% (4/7) se presentó en mamas densas (tipo c y d), y las restantes en mamas de densidad b. Se identificaron seis de los carcinomas por ecografía y RM (masas BI-RADS 4); la lesión restante solo se visualizó en RM. En el 57% de las neoplasias, el tamaño medido con RM fue mayor de 3cm. Todas fueron carcinomas ductales infiltrantes, seis de ellos con alta proporción estromal. En cuanto a los subtipos moleculares, solo una fue triple negativo y las demás fueron de tipo luminal. Se analizaron los márgenes tumorales de dos carcinomas intervenidos sin quimioterapia previa, y ambos presentaban márgenes que desplazaban sin infiltrar el parénquima adyacente. Conclusión. Los carcinomas ocultos en MD y TS representaron el 4% de las lesiones detectadas en pacientes sintomáticas, fueron mayoritariamente masas, todas tuvieron diagnóstico de carcinoma ductal infiltrante (con predominio del inmunofenotipo luminal) y se detectaron en mamas de densidad tipo b, c y d (AU)

Objective. To review the radio-pathologic features of symptomatic breast cancers not detected at digital mammography (DM) and digital breast tomosynthesis (DBT). Material and methods. Retrospective analysis of 169 lesions from symptomatic patients with breast cancer that were studied with DM, DBT, ultrasound (US) and magnetic resonance (MR). We identified occult lesions (true false negatives) in DM and DBT. Clinical data, density, US and MR findings were analyzed as well as histopathological results. Results. We identified seven occult lesions in DM and DBT. 57% (4/7) of the lesions were identified in high-density breasts (type c and d), and the rest of them in breasts of density type b. Six carcinomas were identified at US and MR (BI-RADS 4 masses); the remaining lesion was only identified at MR. The tumor size was larger than 3cm at MRI in 57% of the lesions. All tumors were ductal infiltrating carcinomas, six of them with high stromal proportion. According to molecular classification, we found only one triple-negative breast cancer, the other lesions were luminal-type. We analyzed the tumor margins of two resected carcinomas that were not treated with neoadjuvant chemotherapy, both lesions presented margins that displaced the adjacent parenchyma without infiltrating it. Conclusion. Occult breast carcinomas in DM and DBT accounted for 4% of lesions detected in patients with symptoms. They were mostly masses, all of them presented the diagnosis of infiltrating ductal carcinoma (with predominance of the luminal immunophenotype) and were detected in breasts of density type b, c and d (AU)

Characterization of invisible breast cancers in digital mammography and tomosynthesis: radio-pathological correlation. / Caracterización de cánceres de mama sintomáticos invisibles en mamografía digital y tomosíntesis: correlación radiopatológica.

OBJECTIVE: To review the radio-pathologic features of symptomatic breast cancers not detected at digital mammography (DM) and digital breast tomosynthesis (DBT). MATERIAL AND METHODS: Retrospective analysis of 169 lesions from symptomatic patients with breast cancer that were studied with DM, DBT, ultrasound (US) and magnetic resonance (MR). We identified occult lesions (true false negatives) in DM and DBT. Clinical data, density, US and MR findings were analyzed as well as histopathological results. RESULTS: We identified seven occult lesions in DM and DBT. 57% (4/7) of the lesions were identified in high-density breasts (type c and d), and the rest of them in breasts of density type b. Six carcinomas were identified at US and MR (BI-RADS 4 masses); the remaining lesion was only identified at MR. The tumor size was larger than 3cm at MRI in 57% of the lesions. All tumors were ductal infiltrating carcinomas, six of them with high stromal proportion. According to molecular classification, we found only one triple-negative breast cancer, the other lesions were luminal-type. We analyzed the tumor margins of two resected carcinomas that were not treated with neoadjuvant chemotherapy, both lesions presented margins that displaced the adjacent parenchyma without infiltrating it. CONCLUSION: Occult breast carcinomas in DM and DBT accounted for 4% of lesions detected in patients with symptoms. They were mostly masses, all of them presented the diagnosis of infiltrating ductal carcinoma (with predominance of the luminal immunophenotype) and were detected in breasts of density type b, c and d.

¿Es posible individualizar el tratamiento farmacológico del tabaquismo? / Is it possible to individualize drug treatment for smoking cessation?

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Vías neurofisiológicas de la dependencia a la nicotina. Oportunidades terapéuticas / Neurophysiological pathways of nicotine dependence. Therapeutic opportunities

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[Transitional cell tumor in a 12-year-old patient]. / Urotelioma vesical en paciente de 12 años.

Transitional cell papillomas, which are tumors of epithelial origin, are the most common urinary tract neoplasm in adults but are extremely rare in children. In both groups the main location is the bladder, often around one of the ureteric orifices. Symptoms vary widely but the most frequent is gross hematuria. Transitional cell papillomas are histologically low-grade tumors and total excision is considered curative. However the rate of recurrence in the literature is high, and there is a potential for a more aggressive type of tumor. We report the case of a 12-year-old girl who presented with a transitional cell papilloma near the right ureteric orifice and describe the etiopathogenesis, diagnosis, treatment and outcome of this entity.

Urotelioma vesical en paciente de 12 años / Transitional cell tumor in a 12-year-old patient

Los papilomas de células transicionales son tumores de origen epitelial, y forman las neoplasias del tracto urinario más frecuentes en los adultos, sin embargo su incidencia en la infancia es muy baja. La localización más común en ambos grupos es la vesical, a menudo en la proximidad de los orificios ureterales. La clínica posible es muy variable, siendo la más frecuente la hematuria macroscópica. Histológicamente son de bajo grado de malignidad, y la escisión radical es considerada curativa; sin embargo, la tasa de recurrencia en la literatura especializada es alta, y existe la posibilidad de un tipo tumoral más agresivo. Presentamos el caso de una niña de 12 años de edad que presenta esta rara lesión cercana al orificio ureteral derecho y se revisa la etiopatogenia, diagnóstico, tratamiento y evolución de esta entidad

Transitional cell papillomas, which are tumors of epithelial origin, are the most common urinary tract neoplasm in adults but are extremely rare in children. In both groups the main location is the bladder, often around one of the ureteric orifices. Symptoms vary widely but the most frequent is gross hematuria. Transitional cell papillomas are histologically low-grade tumors and total excision is considered curative. However the rate of recurrence in the literature is high, and there is a potential for a more aggressive type of tumor. We report the case of a 12-year-old girl who presented with a transitional cell papilloma near the right ureteric orifice and describe the etiopathogenesis, diagnosis, treatment and outcome of this entity

Papel de la determinación de cotinina en orina en el tratamiento farmacológico del tabaquismo / Role of the measurement of cotinine in urine in the smoking cessation drug treatment

Objetivo: Analizar el factor predictivo de éxito que tiene el estudio de los porcentajes de sustitución de cotinina en orina, obtenidos con parches, en el tratamiento del tabaquismo. Métodos: Un total de 187 fumadores en tratamiento con parches denicotina han sido seguidos durante 12 semanas. A lo largo de este periodo fueron vistos en 8 ocasiones (visita basal, y a la 1, 2, 4, 6, 8, 10 y12 semanas después del día de abandono del tabaco). Antes de instaurar tratamiento se realizaron diversos procedimientos diagnósticos (test de Fagerström, cooximetría y estudio semicuantitativo de cotinina en orina mediante el sistema NicAlert). El análisis semicuantitativo permite conocer esos niveles en una escala comprendida entre 0 y 6.Se utilizaron parches de nicotina de 16 h a diferentes dosis dependiendode los niveles basales de cotinina en orina. El objetivo fundamental del tratamiento fue alcanzar, con los parches de nicotina, los mismos niveles de cotinina en orina que se habían tenido con el consumo de cigarrillos. Las determinaciones de cotinina se realizaron durante las siguientes visitas: basal, y en las de la 1, 2 y 4 semanas después de dejar de fumar. Se definió abstinencia completa como la ausencia total del consumo de cigarrillos desde el día del abandono que se acompañase de niveles de CO en aire espirado iguales o menores de 10 ppm. Resultados: Un total de 187 fumadores han sido incluidos en el estudio.103 mujeres y 84 hombres. Edad media 44,5. Índice abstinencia completa. De los 187 fumadores que comenzaron el estudio, 156 (83%) permanecieron abstinentes a las 4 semanas, 140 (74,8%) a las 8 semanas y 125 (66,8%) a las 12 semanas. Relación entre el índice de abstinencia y la obtención de correctos % de sustitución: a los tres meses de seguimiento en 129 sujetos se habían obtenido correctos porcentajes de sustitución. 106 de los 129 (82,1%) sujetos que obtuvieron adecuados niveles de sustitución cumplieron criterios de abstinencia completa al cabo de las 12 semanas y 23 (17,9%) fracasaron. En tanto que, 19 de los 58 (32,7%) sujetos que no obtuvieron adecuados niveles de sustitución cumplieron criterios de abstinencia completa al cabo de las 12 semanas de seguimiento y 39 (67,3%) fracasaron. Odds ratio 0,17 (0,07-0,33), p menor de 0,0001. Conclusiones: en el tratamiento farmacológico del tabaquismo, la adecuada sustitución nicotínica, se asocia de forma significativa a la probabilidad de cesación. El 70% de los que tienen controlada la cotinina en orina dejan de fumar a las 12 semanas. A nivel global, la fracción prevenible por tener ajustados los niveles de cotinina durante el tratamiento es un 50% superior de éxito comparado con los que no la tienen controlada (AU)

Objective: Analyze the predictive factor of success of the study of the percentages of cotinine replacement in urine, obtained with patches, in the treatment of smoking cessation. Methods: A total of 187 smokers under treatment with nicotine patches were followed-up for 12 weeks. During this period, they were seen on8 occasions (baseline visit, and at 1,2,4,6,8,10 and 12 weeks after the smoking cessation day). Before treatment was initiated, several diagnostic procedures were performed (Fagerström test, Cooximetry and semiquantitative study of cotinine in using the NicAlert system). The semiquantitative analysis makes it possible to know these levels on a scale from 0 to 6.The 16-hour nicotine patches were used at different doses, depending on the baseline levels of cotinine in urine. The fundament objective of treatment was to reach the same levels of cotinine in urine with the nicotine patches that had existed with the consumption of cigarettes. Cotinine was measured in the following visits: baseline, and at 1, 2 and 4weeks after quitting smoking. Complete abstinence was defined as the total abstinence of smoking cigarettes from the day of cessation that is accompanied by CO levels in expired air equal to or less than 10 ppm. Results: A total of 187 smokers were included in the study: 103 women and 84 men. Mean age was 44.5. Complete abstinence index - of the 187 smokers who began the study, 156 (83%) remained abstinent at 4 weeks, 140 (74.8%) at 8 weeks and 125 (66.8%) at 12 weeks. The relationship between the abstinence index and obtaining of correct percentage of replacement was: at 3 months of follow-up in 129 subjects. A total of 106 out of the 129 (82.1%) subjects who obtained adequatere placement levels fulfilled complete abstinence criteria at the end of the 12 weeks and 23 (17.9%) failed. Nineteen out of 58 (32.7%) of the subjects who did not obtain adequate levels of replacement fulfilled complete abstinence criteria at the end of the 12 weeks of follow-up and 39 (67.3%) failed. Odds ratio 0.17 (0.07-0.33), p less than 0.0001. Conclusions: Adequate nicotine replacement in drug treatment of smoking cessation is associated significantly to the likelihood of cessation. A total of 70% of those in whom corinne was controlled in urine quit smoking at 12 weeks. Over all, the fraction that can be prevented by adjusting the cotinine levels during treatment has a 50% greater success compared to those in which it is not controlled (AU)

Vamos por el buen camino / We are on the right track

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Las pruebas de esfuerzo en la cirugía de resección pulmonar / Stress testing and lung resection surgery

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[Septic arthritis caused by S. pneumoniae. Report of 2 cases with unusual location]. / Artritis séptica por S. pneumoniae. A propósito de dos casos de localización inusual.

Arthritis by S. pneumoniae, although no frequent, is a well-known disease in patients with underlying diseases and in which they complaint previous articular disease. In the present article 2 cases of location in shoulder and sacroiliac joints are described respectively in a woman with multiple myeloma and an esplenectomizaded man, associations nondescribed previously in literature. The importance of its suspicion in patients with factors of risk for sepsis by S. pneumoniae is emphasized.

Study of the immunostimulating effect of IM-104 in mice.

The results of this study show that the product IM-104 has a marked immunostimulant effect, when administered intraperitoneally in mice, as seen by the increase in the number of haemolytic plaque-forming cells producing antibodies against sheep erythrocytes, as compared with saline-treated controls.

[Reactive arthritis. Prospective clinico-microbiologic study]. / Artritis reactivas. Estudio prospectivo clínico-microbiológico.

We study with a prospective design all reactive arthritis diagnosed at the Service of Rheumatology in Bellvitge Hospital during a thirty months period, from August 1985 to February 1988; in order to describe its clinical features, etiological factors and prognosis. Thirty patients who fulfilled the admission criteria were admitted to the study. A previously designed protocol of clinical, serological and microbiologic study was applied to all. A microorganism was identified in 21 patients. In 14 cases it was Yersinia enterocolitica, in 4 Chlamydia trachomatis, in 2 Salmonella enteritidis and in 1 a group A beta-hemolytic Streptococcus. The averaged length of the disease was 7.6 +/- 8 months.

Munchausen's syndrome simulating reflex sympathetic dystrophy.

A 15 year old girl who had pain, oedema of her left hand, and fever of four months' duration is described. Marked demineralisation of her hand was shown by radiography, and increased articular uptake by technetium-99m bone scan. All these changes were indistinguishable from reflex sympathetic dystrophy. After two admissions to hospital and multiple explorations we discovered that she had induced her symptoms herself and a diagnosis of Munchausen's syndrome was made. As far as we know this presentation has not been previously reported and might help to explain the physiopathology of some signs of reflex sympathetic dystrophy.

Concept and limits of the reflex sympathetic dystrophy.

Reflex sympathetic dystrophy (RSD) is a clinical syndrome defined in the English literature by pain, dystrophic tissue changes and local disturbance of autonomic function in a limb or part of a limb. Algodystrophy is the common name used for the condition in the French literature, in which the concept also includes the "transient regional osteoporosis" and the "regional migratory osteolysis". We want to discuss three points: 1) Are the RSD, transient regional osteoporosis and migratory osteolysis different diseases or different manifestations of a single condition? We believe that an objective differentiation is not possible between them. Our report about 28 cases of polytopic RSD shows the frequent association in the same patient of these manifestations and we believe that this represents the broad spectrum of a single disease. 2) Is the accepted classic pathophysiologic mechanism of RSD accurate? The conception of a disturbance of autonomic function is not easily linked with its association with conditions such as diabetes, hyperthyroidism, hyperlipidaemia and others. Even more difficult to explain is the association with malignancy and osteomalacia. The deposit of immunoglobulins that we have demonstrated in two cases in the palmar fascia of RSD associated with malignancy suggests a possible immunological mechanism. 3) What are the limits of RSD? The association between RSD and aseptic necrosis of the hip has been reported. Are they two different conditions or is the aseptic necrosis only a more developed form of RSD? Finally, we report the first single case of Munchausen syndrome mimicking a RSD of the hand with the same clinical, radiological and scintigraphic appearance.