Role of ultrasound in detection of lymph-node metastasis in gynecological cancer: systematic review and meta-analysis.

OBJECTIVE: To assess the diagnostic performance of transvaginal sonography (TVS) for the preoperative evaluation of lymph-node metastasis in gynecological cancer. METHODS: This was a systematic review and meta-analysis of studies published between January 1990 and May 2023 evaluating the role of ultrasound in detecting pelvic lymph-node metastasis (index test) in gynecological cancer, using histopathological analysis as the reference standard. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity and diagnostic odds ratio were estimated. RESULTS: The literature search identified 2638 citations. Eight studies reporting on a total of 967 women were included. The mean prevalence of pelvic lymph-node metastasis was 24.2% (range, 14.0-65.6%). The risk of bias was low for most domains assessed. Pooled sensitivity, specificity and diagnostic odds ratio of TVS were 41% (95% CI, 26-58%), 98% (95% CI, 93-99%) and 32 (95% CI, 14-72), respectively. High heterogeneity was found between studies for both sensitivity and specificity. CONCLUSION: TVS showed a high pooled specificity for the detection of pelvic lymph-node metastasis in gynecological cancer, but pooled sensitivity was low. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Morfología de la placenta en recién nacidos con defecto congénito / Morphology of the placenta in newborns with congenital defects

El objetivo del estudio fue comparar el índice de madurez placentaria y las alteraciones histopatológicas en placentas de recién nacidos/óbitos con y sin defecto congénito (DC). Se realizó un estudio tipo casos y controles. Se incluyeron n=25 casos yn=50 controles sin DC. Los casos se clasificaron de acuerdo a la presencia de DC aislado (n=17) omúltiple (n=8). Se incluyeron recién nacidos/óbitos (RN) con una edad gestacional (EG) > 20 semanas. Se excluyeron embarazos gemelares. Se recolectó información sobre las características clínicas del producto y de la madre, antropometría del RN y su evaluación de APGAR. Se examinó la placenta, macroscópica y microscópicamente, para determinar la presencia y extensión de alteraciones histopatológicas. Se determinó el índice de madurez placentaria (IMP), calculado dividiendo el número de membranas vásculo sinciciales en 1 mm2 entre el grosor de las mismas (µ). El IMP (media ±DE) fue de 27.77±14 en el grupo de controles, 30.31±12 en el grupo de casos aislados y 16.76± 1 en el grupo de DC múltiple (p<0.05).El resto de las variables evaluadas no mostraron diferencias significativas entre grupos. En conclusión este trabajo muestra una menor madurez placentaria asociada con la presencia de DC múltiple.

The objective of the study was to compare the placental maturity index (PMI) and pathohistological alterations of placentas from newborn/stillborns (NB) with or without congenital defects (CD). A case control study was carried out. N=25 CD cases and n=50 controls without CD were included. Cases were classified according to the presence of simple (n=17) or multiple (n=8) CD. Newborn/stillborns with gestational age >20 weeks were included. Twin pregnancies were excluded. We collected information on clinical characteristics of the NB and the mother, NB anthropometry and APGAR score. The placenta was macro and microscopically examined to determine the presence and extension of histological alterations. The PMI was obtained by dividing the number of vasculo-syncytial membranes in 1 mm2, by their thickness (µ). The PMI (Mean ± SD) was 27.77 ± 14 in the control group, 30.31 ± 12 in the group diagnosed with simple CD, and 16.76 ± 1 in the group diagnosed with multiple CD (p<0.05. The rest of the assessed variables did not show significant difference between groups. In conclusion, this work shows a lower placental maturity associated with the presence of multiple CD.

Synthetic peptides for the immunodiagnosis of hepatitis A virus infection.

VP1, VP2 and VP3 molecules of hepatitis A virus are exposed capsid proteins that have shown to be antigenic and are used for diagnosis in recombinant-antigen commercial kits. In this study, we developed a sequence analysis in order to predict diagnostic peptide epitopes, followed by their spot synthesis on functionalized cellulose paper (Pepscan). This paper with synthetic peptides was tested against a sera pool of hepatitis A patients. Two peptide sequences, that have shown an antigenic recognition, were selected for greater scale synthesis on resin. A dimeric form of one of these peptides (IMT-1996), located in the C-Terminus region of protein VP1, was antigenic with a recognition frequency of 87-100% of anti-IgG antibodies and 100% of anti-IgM antibodies employing the immunological assays MABA and ELISA. We propose peptide IMT-1996, with less than twenty residues, as a cheaper alternative for prevalence studies and diagnosis of hepatitis A infection.

[Effectiveness and safety of the FLAG-IDA regimen in acute refractory or recurrent leukaemia]. / Efectividad y seguridad del régimen FLAG-IDA en leucemias agudas resistentes o recidivantes.

OBJECTIVE: To evaluate the effectiveness and safety of the FLAG-IDA regimen in patients with acute refractory and/or recurrent leukaemia. METHOD: Descriptive, retrospective, observational study of the clinical histories of patients with the FLAG-IDA regimen during the period of 2005-2010. Effectiveness was measured using objective response, progression-free interval, and global survival. Safety was measured using the NCI classification system of common toxicity criteria for adverse events. RESULTS: We registered 12 patients (52.17±8.26 years in women, and 54.83±7.22 years in men), 11 cases were acute myeloid leukaemia (5 refractory, 3 in recurrence, 1 secondary to chronic refractory myeloid leukaemia (CML) and 2 secondary to myelodysplastic syndrome (MDS), one of which was refractory and the other had not been previously treated) and one case was acute refractory lymphoblastic leukaemia (ALL). Six patients (50%) reached a complete response (CR). One patient reached a partial response (PR), which was followed by another protocol that produced a CR, two died due to disease progression, and three due to secondary complications from treatment. The progression-free interval for patients that reached a CR was 24.38 weeks (6 months). Median global survival was 8.4 weeks. Mean time needed for the recovery of neutropenia was 23 and 37 days in the first and second cycle, respectively. The mean time required for recuperation of thrombocytopenia was 24 and 35 days in each cycle. CONCLUSIONS: The FLAG-IDA induction regimen for the treatment of high-risk leukaemia patients is an established protocol, with good tolerance and acceptable toxicity levels that offers an opportunity for facilitating the transplantation of haematopoietic progenitors.

Computational macroscopical patterning of the medullary striae of fourth ventricle

The aim of this study was to pattern macroscopically, by use of computational tools, the number and distributionof the medullary striae (MS) of fourth ventricle. After removing 71 fresh human brain stems, each respectiverhomboid fossa was photographed. The MS were carefully identified to be shaped and fulfilled by means ofa digital pen, using the Adobe Photoshop CS3® program. For absolute and relative analyses of number anddistribution, it was considered the maximum and minimum numbers of striae; striae that reached the ipsilaterallateral recess; presence of horizontal or oblique striae, with or without parallelism; and striae located at pontineor bulbar part of the rhomboid fossa. At least two MS per side were macroscopically detectable in 90.6% ofcases; they were bilaterally absent in 5.3% of pieces; and at least one medullary stria was present in both sidesof the rhomboid fossa in 92% of cases. As on the right side (36% of cases) as on the left (26.6%), two MS werefrequently more present. In 60% of cases, striae reached ipsilateral lateral recess on the left, and in 40% of caseson the right. It was detected horizontal, (non-parallel) oblique and parallel striae in 50.7, 86.7 and 26.7%of cases, respectively. Medial medullary striae were observed in the bulbar part of rhomboid fossa in 80% ofpieces, and in 36% of cases in the pontine part. The MS of fourth ventricle show high morphological variabilitydegree in relation to number and distribution.

Success rate and patient satisfaction with the Essure sterilisation in an outpatient setting: a prospective study of 857 women.

After 857 women with Essure system inserted for tubal obstruction as a method of sterilization in an outpatient setting, insertion is achieved in close to 99% of the women. Physician described the procedure as very difficult in 15% of the cases, mainly due to anatomical tubal anomalis or tubal spasm, and women felt highly satisfied in all cases.

Risk-based evaluation of the exposure of children to trace elements in playgrounds in Madrid (Spain).

Eighty samples of sandy substrate were collected in November 2002 and 2003, from 20 municipal playgrounds in Madrid (Spain) to assess the potential adverse health effects of the exposure of children to trace elements in this material during their games. In each playground, two 500 g samples were collected, dried at 45 degrees C for 48 h, sieved below 100 microm, acid digested and analyzed by ICP-MS. Doses contacted through ingestion and inhalation and the dose absorbed through the skin were calculated using USEPAs hourly exposure parameters for children and the results of an in situ survey. The toxicity values considered in this study were mostly taken from the US DoEs RAIS compilation. The results of the risk assessment indicate that the highest risk is associated with ingestion of soil particles and that the trace element of most concern is arsenic, the exposure to which results in a cancer risk value of 4.19 x 10(-6), close to the 1 x 10(-5) probability level deemed unacceptable by most regulatory agencies. Regarding non-cancer effects, exposure to playground substrate yields an aggregate Hazard Index of 0.28, below the threshold value of 1 (with As, again, as the largest single contributor, followed by Pb, Cr, Al and Mn). Although the uncertainties associated with the estimates of toxicity values and exposure factors should be reduced before any definite conclusions regarding potential health effects are drawn, risk assessment has proven to be a very useful tool to identify the contaminants and exposure pathways of most concern in urban environments.

Velopharyngeal motion after sphincter pharyngoplasty: a videonasopharyngoscopic and electromyographic study.

Sphincter pharyngoplasty is a surgical procedure for managing velopharyngeal insufficiency after palatal closure. This procedure is intended to create an active diaphragm for velopharyngeal closure. The purpose of this study was to evaluate velopharyngeal motion after sphincter pharyngoplasty, by using selective electromyography and simultaneous videonasopharyngoscopy. Twenty-five patients who were subjected to sphincter pharyngoplasty from 1985 to 1996 were reviewed. All conditions were evaluated by using electromyography with simultaneous videonasopharyngoscopy. The following velopharyngeal muscles were examined: superior constrictor pharyngeus, palatopharyngeus, and levator veli palatini. The palatopharyngeus was included in the superiorly based surgical flaps inserted at the posterior pharyngeal wall. Twenty-three patients (92 percent) showed complete velopharyngeal closure. The two patients with residual velopharyngeal insufficiency showed a defect size of 20 and 25 percent. None of the patients showed electromyographic activity at the superiorly based flaps, indicating absence of activity of the palatopharyngeus muscles. However, all patients showed normal electromyographic activity at the superior constrictor pharyngeus and the levator veli palatini. Videonasopharyngoscopy demonstrated that lateral pharyngeal wall movements, which ranged from 25 to 40 percent, were related to strong electromyographic activity at the superior constrictor pharyngeus. It is concluded that the superiorly based pharyngeal flaps of the sphincter pharyngoplasty do not seem to create an active diaphragm for velopharyngeal closure. Moreover, the observed sphinctering seems to be passive, caused by the contraction of the superior constrictor pharyngeus.

Lattice-gas model driven by Hubbard electrons.

Self-consistent Monte Carlo simulations are undertaken for a lattice-gas model which is driven by the free energy of electrons described by a Hubbard model with electronic hopping restricted to ions at nearest-neighbor sites. Our previous work, an independent-electron tight-binding lattice-gas model (bcc or fcc), is modified to introduce two effects: the disorder of the dense system and, more importantly, the role of the electronic correlation. The first effect is achieved using an fcc lattice, but restricted so an occupied site can have no more than eight, instead of twelve, occupied nearest-neighbor sites. To treat correlations, the electronic intra-atomic repulsion is, at first, included via the Gutzwiller approximation at finite temperature; this approach is simple enough to be solved for all cases in the large, disordered systems used in our Monte Carlo simulations but can still give a good qualitative representation of the main effects of the electronic correlations. Then, the exact treatment of the Hubbard model for clusters with up to six atoms is integrated into the calculation. We obtain vapor-liquid coexistence curves and then, approximations to the electronic conductivities and paramagnetic susceptibilities at coexistence conditions. This simple model is, in part, motivated by experiments on the alkali-metal fluids.

[Antineutrophil cytoplasmic antibodies in 2 patients with Wegener's granulomatosis]. / Anticuerpos anticitoplasma de neutrófilo en dos pacientes con granulomatosis de Wegener.

We describe two patients with diffuse alveolar hemorrhage and Wegener s Granulomatosis. In both cases, ANCA were demonstrated. We discuss the profit about ANCA s in the diagnosis and management the systemic vasculitis.

"Blind" protected specimen brushing versus bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia.

The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method. This method should be suitable for all mechanically-ventilated patients and all ICUs. The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL). We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects. VAP episodes were also divided into those with (n = 24) and without antibiotic pretreatment (n = 64), and into those with (n = 78) and without (n = 10) right lower lobe infiltrates on chest radiography. No differences were found as regards the bacteriological yield of the three techniques. Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques. The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively. We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available.

A digitized-fluorescence-imaging study of mitochondrial Ca2+ increase by doxorubicin in cardiac myocytes.

The objective of the present study was to investigate the role of mitochondrial Ca2+ in doxorubicin-induced cell injury. The effect of doxorubicin on cultured cells was investigated by digitized fluorescence imaging. The Ca2+ sensitive fluorescent dye fura-2 was used to estimate cytosolic, mitochondrial and total cellular Ca2+. Rhodamine 123 was used to estimate the mitochondrial membrane potential, and cellular ATP was determined by h.p.l.c. The data showed that doxorubicin induced greater-than-2-fold increases in mitochondrial Ca2+ before changes in cytosolic Ca2+ could be detected. An increase in mitochondrial Ca2+ paralleled the observed dissipation in mitochondrial membrane potential. Cellular ATP levels appeared to decrease as a result of mitochondrial dysfunction, which in turn produced greater-than-2-fold increases in cytosolic Ca2+. The data suggest that doxorubicin-induced alterations in mitochondrial Ca2+ homoeostasis are associated with a dissipation in energy conservation, which may result in cell injury.

Radiation-induced syntheses in cometary simulated models.

The behavior of an aqueous-dominant multicomponent cometary model is examined at high doses of ionizing radiation. The system is composed of a water mixture of HCN (0.2 mol dm-3), CH3CN (0.04 mol dm-3), C2H5CN (0.02 mol dm-3), CH3OH (0.12 mol dm-3) and HCO2H (0.01 mol dm-3. It was exposed to gamma rays at doses up to 18.5 MGy. The chemical kinetic database used in the computer treatment of experimental data consists of 79 reactions. A complex mixture of products has been synthesized: gases, amino acids, carboxylic acids and polymeric material. The results suggest that the pristine material in cometary nuclei may have been chemically altered by the action of cosmic rays and embedded radionuclides.