Low temperature nucleation of thermochromic VO2crystal domains in nanocolumnar porous thin films.

The low temperature formation of monoclinic VO2crystal domains in nanocolumnar vanadium/oxygen thin films prepared by magnetron sputtering at oblique angles is analyzed. The synthesis procedure involved the deposition of amorphous nanocolumnar VO1.9thin films at room temperature and its subsequent annealing at temperatures between 250 °C and 330 °C in an oxygen atmosphere. The thermochromic transition of these films was found at a temperature of 47 °C when the annealing temperature was 270 °C and 58 °C when the annealing temperature was 280 °C and 290 °C, presenting a clear drop of the optical transmittance in the infrared region of the spectrum. The significant downshift in the temperature window to obtain VO2in comparison with compact films and other strategies in literature is explained by the particular morphology of the nanocolumnar structures, which contains numerous defects along with open and embedded porosity.

COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease?

IMPORTANCE: COVID-19 is caused by SARS-CoV-2, a betacoronavirus that uses the angiotensin-converting enzyme-related carboxypeptidase (ACE2) receptor to gain entry into cells. ACE2 receptor is widely expressed in multiple organs, including the retina, an extension of the central nervous system. The ACE2 receptor is involved in the diabetic and hypertensive retinopathy. Additionally, coronaviruses cause ocular infections in animals, including retinitis, and optic neuritis. OBJECTIVE: To assess whether there is any retinal disease associated with COVID-19. DESIGN: We have evaluated 27 asymptomatic subjects, with retinal fundoscopic, optical coherence tomography (OCT) and OCT angiography fourteen days after hospital discharge due to COVID-19 bilateral pneumonia. RESULTS: Cotton wool exudates were evident in six out of 27 patients evaluated, a 22%. Cotton wool exudates are a marker vascular disease severity in other medical context, that is diabetes and hypertension, and are associated with increased risk for acute vascular events. Whether antiaggregation therapy may play a role on fundoscopic-selected patients with COVID-19 requires prospective trials.

Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study.

BACKGROUND: SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient's basal clinical conditions. METHODS: We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with prolonged viral shedding and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS: Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhinosinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89-90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION: We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospective trials, this finding might have clinical implications for quarantine duration due to increased risk of pandemic spread.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography.

OBJECTIVE: Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. METHODS: We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. RESULTS: Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%-98%) and 83% (95% CI: 65%-92%), respectively. CONCLUSION: Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

[Intermittent use of etanercept in psoriasis]. / Uso intermitente de etanercept en psoriasis.

Systemic treatment for psoriasis has radically changed since the emergence of new biological therapies. One of these biological agents is etanercept. Until recently, the use of etanercept for treatment of moderate-to-severe psoriasis in Spain was only approved in an intermittent way or in cycles of treatment (not exceeding 24 weeks). However, from September 2009, its administration has been also approved in a continuous way for patients who require it. This decision is based on the results of several studies that evaluate the efficacy and safety of etanercept administrated in short and long term and in a continuous or intermittent therapy. One of these studies is Crystel study, what evaluates the efficacy and safety of continuous and paused etanercept regimens in psoriasis patients for 54-week-period. Crystel study results showed that both continuous and paused etanercept therapies improved PGA and PASI scores and patient satisfaction rates, no unexpected adverse effects were observed. Therefore, doctors may use one treatment or another according to patients needs.

Amicrobial pustulosis of the folds associated with Hashimoto's thyroiditis.

Neutrophilic dermatoses comprise a wide spectrum of diseases characterized histologically by the presence of an aseptic neutrophilic infiltrate in the skin. The neutrophilic infiltrate may move from the epidermis to the dermis and the subcutis, resulting in distinct clinicopathological conditions. There have been a few reports on a peculiar pustular dermatosis involving the cutaneous flexures and arising in patients with autoimmune diseases or immunological abnormalities. We report a patient who developed amicrobial pustulosis of the folds soon after she was diagnosed with Hashimoto's thyroiditis (HT). To our knowledge, the association of APF with HT is a novel finding that has not previously been described. We believe that this combination is not just coincidental, but may share similar immunopathological mechanisms.

Dealkylation of 24-ethylsterols by Tetrahymena pyriformis.

When Tetrahymena pyriformis was incubated with sitosterol ([24R]-24-ethylcholest-5-en-3 beta-ol]) or its trans-delta22-derivative (stigmasterol), the C-24-dealkylated product, cholesta-5,7,trans-22-trien-3 beta-ol, was obtained in both cases. 24(S)-24-Ethylcholesta-5,7,trans-22-trien-3 beta-ol also was found to be a metabolite. When sitosterol was the substrate, 24(R)-24-ethylcholesta-5,7-dien-3 beta-ol was obtained as a third product. Identifications were made by mass spectroscopy, quantitative chromatography, labeling with 14C, and by other means. The dealkylated product (cholestratrienol) represented 30 percent of the sterols isolable after incubation. The administration of sterols to this organism did not induce sterol biosynthesis, since 2-14C-mevalonate failed to yield radioactive sterol in the presence of added stigmasterol.

Single and concurrent infections of the golden hamster, Mesocricetus auratus, with Echinostoma revolutum and E. liei (Trematoda: Digenea).

Single or concurrent infections of the intestinal trematodes Echinostoma revolutum and E. liei were studied in the golden hamster (Mesocricetus auratus). In single infections, some hamsters were fed 25 +/- 5 metacercarial cysts and others 100 +/- 25 cysts of either E. revolutum or E. liei. In concurrent infections, hamsters were fed simultaneously 20 +/- 5 metacercarial cysts of E. revolutum and 20 +/- 5 cysts of E. liei or 100 +/- 25 cysts each of both trematodes. All hamsters exposed singly to E. revolutum or E. liei were infected. In concurrent infections, 9 of 10 hamsters were infected with both species of echinostomes, and the ratio of E. revolutum to E. liei was 3:1. In single infections, 80% of the E. liei and 60% of the E. revolutum were in the posterior third of the small intestine. In concurrent infections, 80% of the E. liei were in the posterior third and 57% of the E. revolutum in the middle third of the small intestine. The histopathological response of E. liei and E. revolutum in single and concurrent infections showed erosion of intestinal villi with lymphocytic infiltration as the primary response. Extraintestinal echinostomiasis occurred in 2 of the infection groups. Differences in hemoglobin and packed cell volume occurred in the different infection groups.

Comparative study of the clinical efficacy of two different coumarin dosages in the management of arm lymphedema after treatment for breast cancer.

In a randomized, double-blind, parallel group study, we compared the clinical efficacy of coumarin 90 mg/day (Group A) with 135 mg/day (Group B) in 77 women (age 35-65 years) with lymphedema of the upper limb secondary to surgery and irradiation for treatment of breast cancer. During 12 months of coumarin therapy, the arm volume of lymphedema and a clinical score (degree of arm edema, heaviness, hardness, and neuralgia/dysesthesia) were determined. In both groups, the volume of arm lymphedema decreased (14.9% in Group A and 13.2% in Group B) (N.S.), the overall clinical score improved (12.9 +/- 4.3 to 5.7 +/- 3.5 in Group A and from 11.7 +/- 3.7 to 4.7 +/- 3.9 in Group B) (N.S.), and the overall efficacy of coumarin was similarly good or excellent (71.9% in Group A and 68.6% in Group B) (N.S.). Only mild to moderate side effects of drug therapy were recorded. Coumarin prevents a spontaneous trend toward an increase in arm lymphedema after treatment of breast cancer, decreases the severity of local symptoms, and overall improves the quality of life. No difference was found between the apparent benefits of coumarin at 90 mg/day compared with 135 mg/day.

[Diagnostic criteria of infective endocarditis: from Von Reyn to Duke. Transthoracic and transesophageal echocardiography]. / Criterios diagnósticos de endocarditis infecciosa de Von Reyn a Duke. Ecocardiografía transtorácica y transesofágica.

The Von Reyn criteria determine only a small number of definitive diagnoses of infectious endocarditis, while it is mainly diagnosed by histopathological confirmation in surgery or autopsy. This necessitates carrying out a new diagnostic scheme with accurate sensitivity and specificity based on rigorous clinical support. This scheme is provided by the Duke University criteria, which enhance the role of conventional and transesophageal echocardiography, in the diagnosis of infectious endocarditis. Echocardiography is the only accurate procedure for a non invasive diagnosis of vegetation, the main lesion in this pathology. Often, tissue destruction causes regurgitation, which is responsible for hemodynamic impairment or allows the spread of the infectious process to perivalvular tissue and can form an abscess. These complications and many others, which are difficult to treat, require an early diagnosis of this disease. Sensitivity of transesophageal technique to detect vegetations and complications is higher than that observed in conventional echocardiography, above all in patients with prosthetic valves. If the transesophageal study is negative, the existence of an infectious endocarditis is quite unlikely. Nevertheless, we need to consider clinical features, as the specificity of this technique is moderate.

[The imaging diagnosis of pericardial agenesis]. / Diagnóstico de imagen de la agenesia de pericardio.

Pericardial agenesis is a rare anomaly, difficult to diagnose. Its evolution is usually benign. However, on rare occasions, partial defects have been the cause of sudden death. Therefore, surgical treatment has sometimes been indicated, even though in the cases were asymptomatic. We report the case of a 50 year-old woman with partial pericardial agenesis and herniation of left atrial appendage trough. The defect was discovered by a routine chest x-ray and treated in a conservative way. Current diagnostic and therapeutic techniques are reviewed.

[Diastolic dysfunction, left ventricular hypertrophy, and microalbuminuria in mild to moderate essential arterial hypertension]. / Disfunción diastólica, hipertrofia ventricular izquierda y microalbuminuria en la hipertensión arterial esencial ligera-moderada.

INTRODUCTION: It is known, that there is a high prevalence of left ventricular diastolic disfunction, which precedes left ventricular hypertrophy in hypertensive people, but there is little published in literature about the relationship between these findings and the presence of microalbuminuria. OBJECTIVE: In our study, we pretend to evaluate prevalence and eventual relation among microalbuminuria, diastolic disfunction and left ventricular hypertrophy, in young mild to moderate hypertensive patients, non diabetic and without previous treatment. MATERIAL AND METHODS: We studied prospectively 80 untreated hypertensive patients, with normal serum creatinine, and non diabetic (52.5% women and 47.5% men, mean age 41.4 +/- 9.6 years). We evaluated filling indexes by Doppler Echocardiography: Ratio of early to late diastolic peak filling velocity and early filling deceleration time. Left ventricular hypertrophy was defined by Devereux's criteria. Microalbuminuria in twenty four hours was measured by radioimmunoassay in hypertensive patients (microalbuminuria: 30-300 mg/24 hours). RESULTS: Microalbuminuria occurred in 23.7%, left ventricular hypertrophy 40%, and diastolic disfunction 48.8%, no significant correlation existed between the same. Only 29.5% had no cardiac or renal disease. Statistically significant differences were found in ratio of early to late diastolic peak filling velocity and microalbuminuria, between the two study populations, but multiple regression analysis didn't prove such correlation. Ratio of early to late diastolic peak filling velocity was independently related to age and diastolic blood pressure. CONCLUSIONS: There is a high prevalence of cardiac and/or renal disease in mild hypertensive patients, only 29.5% of these patients are free of disease. We don't find relation between lesions in these organs.

[Actuarial follow-up after percutaneous mitral valvulotomy. Incidence and event-predicting factors]. / Seguimiento actuarial tras valvulotomía mitral percutánea. Incidencia y factores predictores de eventos.

INTRODUCTION: The goal of this study is to analyse the follow-up of patients who underwent percutaneous mitral valvuloplasty and the predicting factors of event-free survival. METHODS: We analysed 220 consecutive valvuloplasty performed between 1988 and 1996 in order to establish the incidence of events (death, restenosis, mitral valve surgery, New York Heart Association class IV, new valvuloplasty or systemic embolia) and the baseline and postprocedural characteristics predicting events, during a mean follow-up of 42 months (range 1-96 months). RESULTS: Overall survival was 94.7%, and event-free survival was 59.2% at 96 months. We analyzed the baseline characteristics in order to predict the mid-term outcome (actuarial survival Kaplan-Meier method) that atrial fibrillation (p < 0.01), age > or = 56 years (p < 0.005), and echocardiographic score > or = 9 (p < 0.005) were baseline characteristics related to adverse events in follow up. An index based on the number of adverse factors in the baseline characteristics provided a significant difference in concerning the number of follow up to even-free between the group without baseline adverse characteristics and the group with two (p = 0.008, OR = 4.5), or three adverse characteristics (p = 0.005, OR 6.4). Among the postprocedural characteristics, while patients with mitral valve area after valvuloplasty > or = 1.5 cm2 had an event-free survival of 72.9% at 96 months, those with postprocedural mitral valve area < 1.5 cm2 had an event-free survival of 10.5% (log-rank test p < 0.0001). CONCLUSIONS: Mid-term event-free survival after percutaneous mitral balloon valvuloplasty can be predicted by baseline and postprocedural characteristics. Age > or = 56, echocardiographic score > or = 9 and atrial fibrillation are baseline factors related with adverse events. Patients with 0 or 1 baseline adverse factors do not have significant differences concerning mid-term outcome while, those with 2, and above all, 3 adverse baseline characteristics have a poorer event-free survival. Mitral valve area > or = 1.5 cm2 is the only postprocedural independent predictor of event-free survival.

Comparative bioavailability study of two oral omeprazole formulations after single and repeated administrations in healthy volunteers.

OBJECTIVE: Two oral enteric-coated pellet formulations of omeprazole, Pepticum((R)) (test formulation) and Mopral((R)) (reference), were administered to 24 healthy volunteers for 5 days at a daily dose of 20mg omeprazole in order to investigate the comparative bioavailability of the two formulations. RESULTS: The data obtained in this study demonstrated the bioequivalence of the two formulations. No statistical differences were observed for the area under the plasma concentration-time curve (AUC(0-t)), the parameter to which the inhibition of acid secretion induced by omeprazole is directly related. Differences observed in maximum plasma drug concentration (C(max)) at day 1 for both formulations were not statistically significant. At steady-state, the differences found in C(max) were associated with a p-value <0.05 with the 90% confidence interval lying between the acceptance range (70 to 140%). Regarding time to reach C(max) (t(max)), p < 0.01 was found both after single and repeated doses. In both cases, Pepticum((R)) showed a delay in reaching C(max) compared with Mopral((R)): 2.15 +/- 1.11 vs 1.48 +/- 0.52h (day 1) and 1.94 +/- 0.66 vs 1.31 +/- 0.75h (day 5). CONCLUSION: This study confirmed the reported increases in AUC and C(max) after repeated administrations, the important intersubject variability and the excellent biological and clinical tolerability of both formulations.

Extra-gastrointestinal stromal tumour--semiology and clinical therapy peculiarities.

The gastrointestinal stromal tumor with extragastrointestinal location are very infrequent. We often diagnose them when they show a big size. Their bening or malignant nature is difficult to fix. The best histological parameters to evaluate their prognosis are a high cellularity, the tumor-like necrosis presence and having more than two mitosis per fifty high-power fields. We introduce an asyntomatic patient's case by a routine echographical control for chronic hepatitis by C virus, that has been diagnosed of a mesentery tumor. The patient has been treated surgically. The inmunohistological study of the tumor had confirmed a stromal gastrointestinal tumor. The showed case's analysis and the considered bibliography suggest some clinical discoveries characteristic of this entity. The histogenesis of these neoplasias are examined and made up to date and the usefulness of the new medication to control check the tumor-like progress is emphasized.

Factors determining early adherence to a lung cancer screening protocol.

Lung cancer screening using computed tomography (CT) is effective in detecting early stage disease. However, concerns regarding adherence have been raised. The current authors conducted a retrospective observational study of 641 asymptomatic smokers enrolled in a lung cancer screening programme between 2000 and 2003. Adherent subjects were compared with nonadherent subjects with regard to lung function, sex, age, motivation for enrollment, smoking status, distance to the referral centre, family history of lung cancer, asbestos exposure, education, the presence and type of nodule(s) seen on initial CT, and exposure to a nursing intervention designed to improve adherence. Overall, early adherence to the study protocol was 65%. Multivariate analysis confirmed the importance of sex, proximity to the referral centre, the presence of noncalcified nodules, and the nursing intervention as factors conditioning adherence to the study protocol. Patients encouraged to participate in the study were more adherent, as were former smokers. Sex interactions were observed in multivariate analysis. The nursing intervention was significant for females, while abnormal lung function improved male adherence. Adherence to lung cancer screening is particularly good among females and subjects living near the referral centre. The present study suggests the need to develop new strategies, especially those targeting males and subjects with low risk perception, in order to improve adherence.