Internal and external adenomyosis phenotypes: ultrasound features and association with clinical outcomes.

STUDY QUESTION: What are the sonographic and clinical findings in women diagnosed with external and internal adenomyosis by ultrasound? SUMMARY ANSWER: Patients with external and internal adenomyosis phenotypes, diagnosed by ultrasound, present differences in sonographic features of the disease and demographic characteristics including age, parity, and association with deep endometriosis (DE) and leiomyomas. WHAT IS KNOWN ALREADY: Two different phenotypes of adenomyosis have been described based on the anatomical location of adenomyotic lesions in the myometrium, suggesting that adenomyosis affecting the inner myometrium and that affecting the external myometrial layer may have distinct origins. STUDY DESIGN, SIZE, DURATION: A cross-sectional study including 505 patients with a sonographic diagnosis of adenomyosis was performed between January 2021 and December 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women sonographically diagnosed with adenomyosis in a tertiary referral hospital that serves as a national reference center for endometriosis were included over a 2-year period. Patients were divided into two groups (internal and external adenomyosis) according to the myometrial layer affected by adenomyosis. We compared sonographic and clinical outcomes including a multivariate analysis between the two groups. MAIN RESULTS AND THE ROLE OF CHANCE: According to ultrasound findings, 353 (69.9%) patients presented with internal adenomyosis, while 152 (30.1%) presented with external adenomyosis. Women with internal adenomyosis were significantly older and less frequently nulliparous compared to those with external adenomyosis. Sonographically, internal adenomyosis appeared diffusely, it had a greater number of adenomyosis features, it presented a globular morphology of the uterus more frequently, and it coexisted with leiomyomas more frequently, compared to external adenomyosis. Conversely, the presence of translesional vascularity and associated DE were more common among the external adenomyosis group. No significant differences were found between internal and external adenomyosis groups regarding pain, heavy menstrual bleeding, spotting, or infertility. In the multivariate analysis, nulliparity, the presence of leiomyomas, and the presence of DE were independently associated with adenomyosis phenotypes (the presence of DE and nulliparity increased the risk of external adenomyosis, whereas the presence of leiomyomas was a risk factor for internal adenomyosis). Considering the impact of hormonal treatment, we found that the number of ultrasound adenomyosis criteria was significantly greater in patients without hormonal treatment. Non-treated patients more commonly presented dysmenorrhea or bleeding-associated pain and heavy menstrual bleeding than women on hormonal treatment, although there were no significant differences according to adenomyosis phenotypes. LIMITATIONS, REASONS FOR CAUTION: As the population was selected from the Endometriosis Unit of a tertiary center, there may be patient selection bias, given the high prevalence of individuals with associated endometriosis, previous endometriosis-related surgery, and/or receiving hormonal treatment. WIDER IMPLICATIONS OF THE FINDINGS: Transvaginal ultrasound is the most available and cost-effective tool for the diagnosis of adenomyosis. Adenomyosis phenotypes based on ultrasound findings may be key in achieving an accurate diagnosis and in decision-making regarding the most adequate therapeutic strategy for the management of patients with adenomyosis. Determination of the sonographic features associated with symptoms could help in the evaluation of treatment response. STUDY FUNDING/COMPETING INTEREST(S): No funding was obtained for this study and there are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Difficult intravenous access in a paediatric intensive care unit.

INTRODUCTION: Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES: The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD: A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS: A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30 minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS: We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score ≥ 4, history of difficult intravenous access, complications, number of nurses and time spent.

Difficult intravenous access in a paediatric intensive care unit. / Vía venosa difícil en una unidad de cuidados intensivos pediátricos.

INTRODUCTION: Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES: The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD: A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS: A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS: We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score≥4, history of difficult intravenous access, complications, number of nurses and time spent.

Anti-MDR Effects of Quercetin and its Nanoemulsion in Multidrug-Resistant Human Leukemia Cells.

BACKGROUND: Quercetin has potential against the Multidrug Resistance (MDR) phenotype, but with low bioavailability. The increase in the bioavailability can be obtained with nanostructures. OBJECTIVE: To analyze the effects of quercetin and its nanoemulsion on MDR and non-MDR cells. METHODS: We used high-pressure homogenization for nanoemulsion production; Trypan Blue for cytostatic/cytotoxicity assays; Epifluorescence microscope (with specific probes) for apoptosis and DNA damage; Real-Time PCR for gene expression; AutoDock Vina for docking and Flow Cytometry for efflux analysis. Quercetin exerted antiproliferative impact, induced apoptosis, necrosis and DNA damage on cells. RESULTS: Quercetin combined with vincristine showed an effect similar to verapamil (an ABCB1 inhibitor), and docking showed that it binds to ABCB1 in a similar region. Quercetin was also capable of altering ABCB1 gene expression. Quercetin in nanoemulsion maintained the cytotoxic and cytostatic effects of quercetin, which may increase bioavailability. Besides, the unloaded nanoemulsion was able to inhibit per se the efflux activity of ABCB1, demonstrating pharmacological action of this structure. CONCLUSION: Quercetin may be considered as a prospective drug to overcome resistance in cancer cells and its nanoemulsion can be an alternative for in vivo application.

Cerebrospinal fluid and blood lactate concentrations as prognostic biomarkers in dogs with meningoencephalitis of unknown origin.

Meningoencephalitis of unknown origin (MUO) is a common inflammatory disease of the central nervous system. Several studies investigated finding prognostic factors, but results are contradictory. The aim of this study was to determine the concentrations of blood lactate (Blood-L) and cerebrospinal fluid lactate (CSF-L) in dogs with MUO for prognostic purposes. A total of 45 dogs with MUO (MUO group) and 11 with idiopathic epilepsy (IE group) were included. In the MUO group, 22 dogs were treated with prednisolone + cytosine arabinoside, 17 with prednisolone ± cyclosporine, and six received no treatment. In the MUO group, there was a strong-moderate positive correlation between Blood-L and CSF-L (ρ = 0.63557; P < 0.0001), a strong-moderate negative correlation between survival and CSF-L (ρ= -0.50210; P < 0.0004), and a weak negative correlation between survival and Blood-L (ρ= -0.35685; P < 0.0220). Dogs with a favourable response to treatment at 1 month had lower initial concentrations of Blood-L and CSF-L (P < 0.0010; P < 0.0037), and those with a worse response had higher values (P < 0.0497; P < 0.0004). Dogs that remained stable with treatment showed lower CSF-L concentrations (P < 0.0013). Dogs with Blood-L>4 mmol/L (P < 0.03) and/or CSF-L> 4 mmol/L (P < 0.009) had lower survival rates with the latter also showing more severe signs, probably indicating severe neuronal damage. These findings suggest that concentrations of CSF-L and Blood-L in dogs with MUO could be used as prognostic indicators.

Osteonecrosis del maxilar inferior por bifosfonatos: Presentación de caso / Osteonecrosis of the jaw secondary to bisphosphonates. A case report

La osteonecrosis del maxilar inferior secundaria a la administración de bifosfonatos es una patología infrecuente. Se produce en los pacientes medicados con esta droga, ya sea por vía oral o endovenosa, que luego de realizarse un procedimiento odontológico presentan necrosis ósea en la mandíbula. Desde el primer reporte en el año 2003, se evidenció un crecimiento exponencial de esta patología. Presentamos dos casos clínicos de osteonecrosis del maxilar inferior por la administración de bifosfonatos, con el objetivo de difundir y crear conciencia entre los profesionales de la salud, considerando que no existe un tratamiento efectivo para esta entidad.

The osteonecrosis of the jaw originated by the biphosphonate administration is an infrequent pathology in patients under treatment with biophosphonates given orally or through parenteral administration after some odontological treatment. These patients manifested osteonecrosis of the jaw. Since the first case of osteonecrosis of the maxilar bone was reported in 2003, the number of patients with osteonecrosis of the jaw who have been treated with these drugs has increased notoriously. We report 2 clinical cases of patients with osteonecrosis of the jaw treated with bifosfonatos, in order to make this pathology known among the health professionals and raise awareness considering that there is no effective treatment.

Prevalence and factors linked to allergic rhinitis in 10 and 11-year-old children in Almería. Isaac Phase II, Spain.

BACKGROUND: Allergic rhinitis affects 10-30% of children in developed countries and has increased in frequency over the last few decades, probably due to changes in the environment and life style. AIM: To assess the prevalence, severity, and factors linked to rhinitis in 10 and 11-year-old children from Almeria (Spain). METHODS: As part of ISAAC II, a cross-sectional survey was conducted among a representative sample of 1143 schoolchildren in spring and autumn of 2001, using homologated questionnaires and skin-prick testing. RESULTS: The overall prevalence of rhinitis and rhinoconjunctivitis were 38.9% and 24.8%, respectively, 17.9% had medically diagnosed rhinitis. During the previous year symptoms disturbed daily activities and school attendance in some measure in 40% and 26% of children with rhinitis, respectively. The risk factors found in the multiple logistic regression analysis were atopy (OR 2.57; 95% CI 1.92-3.42); cat contact at home during first year of life (OR 2.4 95% CI 1.13-5.12); prior medical diagnosis of asthma (OR 2.2; 95% CI 1.22-4.02); nocturnal cough in absence of colds (OR 1.9; 95% CI 1.25-2.97); diagnosis of rhinitis in one of the parents (OR 1.8; 95% CI 1.31-2.59); wheezing at any time (OR 1.6; 95% CI 1.18-2.28); and nursery school attendance (OR 1.5; 95% CI 1.21-2.5). CONCLUSIONS: The prevalence of rhinitis found is superior to that of other centres participating in the ISAAC Phases I and II, and coexists with asthma and eczema in many children. The independent risk factors associated to rhinitis are in accordance with previous reports.

Prevalence and factors linked to atopy in 10-and 11-year-old children in Almería, Spain.

BACKGROUND: During the last decades there has been an increase in both allergic diseases and allergic sensitisation, probably due to changes in the environment and living habits. ISAAC Phase II was designed to establish the prevalence and associated factors to asthma and allergic disorders in childhood. AIM: To assess the prevalence and factors linked to atopy in 10-11 year-old children from Almería (Spain). METHODS: As a part of ISAAC II, a survey was conducted among a sample of 1143 schoolchildren using standardised questionnaires and skin-prick testing. RESULTS: The overall prevalence of atopy was 42.5%. Most common sensitisations were to Dermatophagoides pteronyssinus (36.2%), D. farinae (32.3%), cat (10.8%), Alternaria (7%), grass (6%), and tree pollen (1.7%). 34.9% of these sensitisations could be regarded as subclinical sensitisations. The fractions of asthma, rhinitis and eczema attributable to atopy were 49.2%, 40.4% y 18.6%, respectively. After multivariate analysis, the risk of atopy was significantly lower among females (OR 0.62, CI 95% 0.45-0.86); children with older siblings (OR 0.67; CI 95% 0.49-0.92); intestinal parasites (OR 0.68; CI 95% 0.48-0.97); contact with farm animals in the past (OR 0.48 CI 95% 0.23-0.99); or other animals at present (OR 0.53 CI 95% 0.30-0.95). To have an allergic father (OR 2.96 CI 95% 1.77-4.94) was the only significant risk factor. CONCLUSIONS: We found several independent factors which significantly protect against atopic sensitisation. These protective factors were not the same for asthma, rhinitis or eczema, suggesting that other factors could interact to influence atopy and act against such protective factors.

Toxicity mechanisms of onion (Allium cepa) extracts and compounds in multidrug resistant erythroleukemic cell line.

Onion (Allium cepa) is being studied as a potential anticancer agent, but little is known regarding its effect in multidrug resistance (MDR) cells. In this work, the cytotoxicity of crude onion extract (OE) and fractioned extract (aqueous, methanolic and ethyl acetate), as well as some onion compounds (quercetin and propyl disulfide) were evaluated in Lucena MDR human erythroleukemic and its K562 parental cell line. The capacity of OE to induce apoptosis and/or necrosis in these cells, the possible participation of oxidative stress and DNA damage were also assessed. Similar sensitivities were obtained for both tumoral cells, however only OE caused significant effects in the cells. In K562 cells, a significant increase of apoptosis was verified while the Lucena cells experienced a significant increase of necrosis. An antioxidant capacity was verified for OE discarding oxidative damage. However, OE provoked similar significant DNA damage in both cell lines. Thus, the OE capacity to overcome the MDR phenotype suggests anti-MDR action of OE.

Toxicity mechanisms of onion (Allium cepa) extracts and compounds in multidrug resistant erythroleukemic cell line

Onion (Allium cepa) is being studied as a potential anticancer agent, but little is known regarding its effect in multidrug resistance (MDR) cells. In this work, the cytotoxicity of crude onion extract (OE) and fractioned extract (aqueous, methanolic and ethyl acetate), as well as some onion compounds (quercetin and propyl disulfide) were evaluated in Lucena MDR human erythroleukemic and its K562 parental cell line. The capacity of OE to induce apoptosis and/or necrosis in these cells, the possible participation of oxidative stress and DNA damage were also assessed. Similar sensitivities were obtained for both tumoral cells, however only OE caused significant effects in the cells. In K562 cells, a significant increase of apoptosis was verified while the Lucena cells experienced a significant increase of necrosis. An antioxidant capacity was verified for OE discarding oxidative damage. However, OE provoked similar significant DNA damage in both cell lines. Thus, the OE capacity to overcome the MDR phenotype suggests anti-MDR action of OE.

Semantic priming effects from single words in a lexical decision task.

The present research examines the semantic priming effects of a centrally presented single prime word to which participants were instructed to either "attend and remember" or "ignore". The prime word was followed by a central probe target on which the participants made a lexical decision task. The main variables manipulated across experiments were prime duration (50 or 100 ms), the presence or absence of a mask following the prime, and the presence (or absence) and type of distractor stimulus (random set of consonants or pseudowords) on the probe display. There was a consistent interaction between the instructions and the semantic priming effects. Relative to the "attend and remember" instruction, an "ignore" instruction produced reduced positive priming from single primes presented for 100 ms, irrespective of the presence or absence of a prime mask, and regardless of whether the probe target was presented with or without distractors. Additionally, reliable negative priming was found from ignored primes presented for briefer durations (50 ms) and immediately followed by a mask. Methodological and theoretical implications of the present findings for the extant negative priming literature are discussed.

Evaluación del uso de una prueba rápida inmunocromatográfica en promotores de salud para el diagnóstico de la malaria en áreas rurales de la Amazonía peruana / An assessment of an immunochromatographic rapid test for diagnosing malaria in rural areas of the peruvian Amazon jungle

Objetivo: Evaluar la concordancia de los resultados obtenidos por promotores de salud de áreas rurales de la Amazonía peruana con los obtenidos por profesionales de laboratorio, al aplicar una prueba rápida immunocromatográfica para el diagnóstico de la malaria. Material y métodos: Se evaluó la concordancia entre los resultados de la aplicación de una prueba rápida ejecutada por promotores de salud de 20 comunidades rurales de la selva de Iquitos (Loreto), en comparación con la ejecutada por profesionales de laboratorio. Esta evaluación se realizó en dos etapas: la primera en el laboratorio, se examinaron 618 muestras con concentraciones conocidas de parásitos y la segunda en el campo, en donde se examinaron 419 pacientes. La prueba utilizada se basa en la detección de la deshidrogenasa láctica del Plasmodium y del P. vivax, mediante tiras reactivas. Resultados: En la primera etapa de las 618 muestras examinadas 121 fueron negativas y 497 positivas (251 para P. falciparum y 246 para P. vivax). Al comparar los dos grupos, se encontró una sensibilidad de 88,5 por ciento, especificidad de 90,1 por ciento e índice de concordancia Kappa de 0,689. En la segunda etapa, de los 419 pacientes febriles, 156 correpondieron a casos de la malaria (53 por P. falciparum y 103 por P. vivax). La sensibilidad, especificidad e índice Kappa fueron 94,4 por ciento, 96,5 por ciento y 0,99 respectivamente. El tiempo promedio de ejecución de la prueba por parte del promotor de salud fue de 25 minutos. Conclusiones: se encontró concordancia en los resultados de ambos grupos. El estudio muestra que el uso de pruebas rápidas sería una alternativa apropiada y aplicable para el diagnóstico oportuno de la malaria en áreas rurales de la selva con limitado acceso a los servicios de salud.

Perception without awareness: further evidence from a Stroop priming task.

In the present research, we examined the influence of prime-target stimulus onset asynchrony (SOA) on Stroop-priming effects from masked words. Participants indicated the color of a central target, which was preceded by a 33-msec prime word followed either immediately or after a variable delay by a pattern mask. The prime word was incongruent or congruent with the target color on 75% and 25% of the trials, respectively. The words followed by an immediate mask produced reliable Stroop interference at SOAs of 300 and 400 msec but not at SOAs of 500 and 700 msec. The words followed by a delayed mask produced a reversed (i.e., facilitatory) Stroop effect, which reached significance at an SOA of 400 msec or longer, but never at the shorter 300-msec SOA. Such an differential time course of both types of Stroop priming effects provides further evidence for the existence of qualitative differences between conscious and nonconscious perceptual processes.

Coincidence summing corrections for the natural decay series in gamma-ray spectrometry.

Using a Monte Carlo code and a Markov formalism to describe the decay schemes, coincidence-summing correction factors can be calculated with a suitable accuracy. For two different measuring geometries and an HPGe detector, calculated and experimental correction factors have been shown to closely agree for 152Eu. The simulation method has subsequently been applied in assessing the need for coincidence-summing corrections for members of the uranium, thorium and actinium series measurable by gamma-spectrometry. Correction factors were calculated for predominant gamma emissions significantly affected by coincidence-summing effects and the correctness of our calculations tested for environmental samples. The test makes it evident that in order to obtain reliable and unbiased activity values for some natural radionuclides coincidence summing cannot be neglected in environmental measurements at small source-detector distances.

Canine gonadal dysgenesis syndrome: a case of mosaicism (77,XO-78,XX).

A toy poodle bitch had an abnormal oestrus cycle and apparently persistent follicles. Hormonal therapy was unsuccessful. The bitch was ovariohysterectomised and gross and histological evaluation of the ovaries and uterus, together with karyotyping, led to a diagnosis of 77,XO-78,XX mosaicism.

[Intranasal administration of GnRH in the treatment of uterine myomatosis]. / Uso de análogos de GnRH por vía nasal en el tratamiento de miomatosis uterina.

Nine patients in which an intranasal GnRH agonist analog (napharelin acetate) was administered with the purpose of decreasing the size of the myomas, were studied. In all a decrement in uterine and myoma size was observed. The FSH levels decreased since the first treated cycle, whereas LH and E2 levels initially increase, but finally decreased. The patients had menstrual bleeding between four and eight weeks after napharelin withdrawal. The mentioned results elicit the effectivity of GnRH agonist analog for leomyomata treatment.

Combination of preservation factors applied to minimal processing of foods.

Innovative technologies for producing minimally processed (MP) foods that apply the concept of combination of preservation factors are addressed in this article with special emphasis on a new combined approach that has been successfully applied in several Latin American countries for MP high-moisture fruit products (HMFP). HMFP can be regarded as a different approach to the commercially available and widely accepted MP concept for fruits and vegetables (even if developed for the same purpose of obtaining freshlike high-quality products with an extended shelf life) that is better adapted to Latin American countries in terms of independence of the chill chain and the use of simple and energy-efficient technologies. The continuous refrigeration hurdle associated with MP refrigerated fruits is not included in the preservation system of HMFP because a different combination of hurdles must be overcome to enhance the shelf stability of nonrespiring vegetable tissues while preserving freshlike character. Guidelines to obtain safe and high-quality MP fruit products are proposed. Other products preserved by combined factors technology are also discussed, as well as some other classical and new preservation factors whose application could enhance the quality of HMFP.

[Ecological and food safety considerations about products of vegetable origin]. / Consideraciones ecológicas y de inocuidad alimentaria en productos de origen vegetal.

Media have paid much attention in recent years to emerging microbiological problems in foods of plant origin. The potential for contamination of fruits and vegetables is high because of the wide variety of conditions to which produce is exposed during growth, harvest, processing and distribution. These considerations acquire great significance in the current scenario of the new processing techniques that offer attributes of convenience and fresh-likeness in response to changes in consumption patterns and increased demand of fresh and minimally processed fruits and vegetables. Thus, reliance on low temperature storage and on improved packaging materials/techniques have increased. Even if produce had not been considered a major vector for foodborne diseases, technologies that extend shelf-life by decreasing the rate of product deterioration might increase the risks associated with pathogenic microorganisms, especially of psychotropic nature, by allowing sufficient time for their growth when retarding the development of competitive spoilage organisms. Processing steps that modify the food microenvironment open new possibilities to support pathogens that, for ecological reason, would have never been naturally present in produce. Ecological and safety aspects related to fruits and vegetables as well as foodborne disease outbreaks traceable to produce and reportedly due to Salmonella and Shigella spp., Listeria monocytogenes, Clostridium botulinum, Aeromonas hydrophila, Campylobacter jejuni are reviewed.