Comparative Analysis of Different Definitions of Amyloid-ß Positivity to Detect Early Downstream Pathophysiological Alterations in Preclinical Alzheimer.

Amyloid-ß (Aß) positivity is defined using different biomarkers and different criteria. Criteria used in symptomatic patients may conceal meaningful early Aß pathology in preclinical Alzheimer. Therefore, the description of sensitive cutoffs to study the pathophysiological changes in early stages of the Alzheimer's continuum is critical. Here, we compare different Aß classification approaches and we show their performance in detecting pathophysiological changes downstream Aß pathology. We studied 368 cognitively unimpaired individuals of the ALFA+ study, many of whom in the preclinical stage of the Alzheimer's continuum. Participants underwent Aß PET and CSF biomarkers assessment. We classified participants as Aß -positive using five approaches: (1) CSF Aß42 < 1098 pg/ml; (2) CSF Aß42/40 < 0.071; (3) Aß PET Centiloid > 12; (4) Aß PET Centiloid > 30 or (5) Aß PET Positive visual read. We assessed the correlations between Aß biomarkers and compared the prevalence of Aß positivity. We determined which approach significantly detected associations between Aß pathology and tau/neurodegeneration CSF biomarkers. We found that CSF-based approaches result in a higher Aß-positive prevalence than PET-based ones. There was a higher number of discordant participants classified as CSF Aß-positive but PET Aß-negative than CSF Aß-negative but PET Aß-positive. The CSF Aß 42/40 approach allowed optimal detection of significant associations with CSF p-tau and t-tau in the Aß-positive group. Altogether, we highlight the need for sensitive Aß -classifications to study the preclinical Alzheimer's continuum. Approaches that define Aß positivity based on optimal discrimination of symptomatic Alzheimer's disease patients may be suboptimal for the detection of early pathophysiological alterations in preclinical Alzheimer.

Inserción velamentosa de cordón umbilical. Rotura intraparto / Velamentous insertion of umbilical cord. Intrapartum rupture

La inserción velamentosa de cordón es aquella situación en la que los vasos umbilicales se separan en las membranas a cierta distancia del margen placentario, que alcanzan rodeados sólo por un pliegue del amnios. Su desgarro o rotura suponen una urgencia obstétrica. Ante la sospecha diagnóstica se debe realizar una extracción fetal inmediata. Presentamos un caso de rotura intraparto de vasos umbilicales en una inserción velamentosa de cordón, con buen resultado perinatal (AU)

Umbilical cord insertion in the placenta is considered normal if it occurs inside the placental tissue. When this insertion is just in the edge (marginal) or beyond (velamentous), the umbilical cord is connected to the placenta only through its blood vessels, coated by the amniotic membrane, without the protection of Wharton's gelatin. Because of this lack of protection, the umbilical vessels may tear before or during delivery, provoking an obstetric emergency. We present a case of velamentous insertion of umbilical vessels and rupture during delivery with a favorable perinatal outcome (AU)

Carcinoma metaplásico de mama: estudio clínico-histológico de siete casos / Metaplastic breast carcinoma: a clinical-histological study of seven cases

El carcinoma metaplásico es un tumor poco frecuente que a menudo se confunde con otras afecciones, tanto benignas como malignas. Es un tumor heterogéneo que se caracteriza por contener áreas de adenocarcinoma combinadas con otras de tejido mesenquimal no glandular, de fenotipo generalmente fusiforme, escamoso, condroide o con diferenciación ósea. A pesar de ser tumores de tamaño grande, en el momento del diagnóstico no suelen presentar afección metastásica axilar ni a distancia (AU)

Ultrasound-guided embryo transfer improves pregnancy rates and increases the frequency of easy transfers.

BACKGROUND: Recent reports have suggested that ultrasound (US) guidance during embryo transfer might improve pregnancy rates. METHODS: A prospective randomized (computer-generated random table) trial was performed to compare embryo transfer under abdominal US guidance (n = 255 women) with clinical touch embryo transfer (n = 260). RESULTS: The clinical pregnancy rate was 26.3% (67/255) in the US-guided transfer group compared with 18.1% (47/260) in the clinical touch transfer group (P < 0.05). The implantation rate was 11.1% (100/903) in the US group compared with 7.5% (66/884) in the clinical touch group (P < 0.05). US-guided transfer was associated with a decrease in the difficulty of the transfers: 97% of transfers were easy in the US-guided group compared with 81% in the clinical touch group (P < 0.05). CONCLUSIONS: US-guided embryo transfer increased pregnancy and implantation rates in IVF cycles, as well as the frequency of easy transfers. It is suggested that the decrease in cervical and uterine trauma can play a role in the increase in pregnancy rates associated with US-guided transfer. It is recommended that embryo transfer should be performed under US guidance.

Radioquimioterapia en el tratamiento del carcinoma localmente avanzado o recurrente de vulva / Chemoradiation therapy in the treatment of locally advanced or recurrent vulvar carcinoma

Se trata a 3 pacientes con carcinomas localmente avanzados de vulva, y otras seis con carcinoma recurrente vulvar o inguinal mediante radioquimioterapia. Como agentes quimioterápicos se utilizan mitomicina C y 5-fluorouracilo. El tratamiento radioterápico alcanzó, por lo menos, 60 Gy. Todas las pacientes con carcinoma avanzado obtuvieron una respuesta clínica completa, y en el momento de la última revisión estaban vivas y sin evidencia de enfermedad. De las pacientes con recidiva, dos (33,3%) consiguieron una respuesta completa, dos (33,3%) una respuesta parcial (que posibilitó la cirugía de rescate), y dos (33,3%) no obtuvieron respuesta. De este grupo, el 66,6% estaban vivas y sin enfermedad. La radioquimioterapia es un excelente método de tratamiento del carcinoma vulvar localmente avanzado que evita cirugías mutilantes, y también es efectivo en el tratamiento de la recidiva tumoral (AU)

Carcinoma mamario con células gigantes osteoclast-like / Breast cancer with osteoclast-like giant cells

Presentamos un caso de carcinoma mamario con células gigantes multinucleadas tipo osteoclast-like en el estroma tumoral. Mostramos iconografía y comentamos las características clínicas, anatomopatológicas, inmunohistoquímicas, fisiopatológicas y pronósticas de este tipo de carcinoma mamario poco frecuente (AU)