Breast Edema after Conservative Surgery for Early-Stage Breast Cancer: A Retrospective Single-Center Assessment of Risk Factors.

Breast-conserving surgery (BCS) is the standard of care for early-stage breast cancer. We retrospectively enrolled 530 patients (mean age: 62.96 ± 12.69 years) undergoing BCS between January 1, 2018, and December 31, 2019. During the COVID-19 pandemic, all patients with at least 1 year of follow-up were telephonically asked after surgery to provide clinical signs and symptoms attributable to postoperative breast cancer-related lymphedema of the breast (BCRL-B). Thirty-one (5.8%) patients reported breast edema and were visited to measure the tissue dielectric constant (TDC) and to assess the induration of the skin. There was a difference seen in treatment with lumpectomy + ALND performed more frequently in patients with (29%) than without (12%) BCRL-B. In the subgroup of patients with BCRL-B (n=31), significantly higher values of local total water were calculated in the nine patients who underwent Lump + ALND procedure (1.86 ± 0.48 vs. 1.48 ± 0.38; p = 0.046). Among patients with BCRL-B (n=31), in eight patients (25.8%) tissue induration measured with SkinFibroMeter was >0.100 N, thus suggesting tissue fibrosis. Cumulative survival probability at 1-year after surgery was 0.992. No statistical differences in 1-year survival after surgery were found for type of surgery (p = 0.890) or absence/presence of BCRL-B (p = 0.480). In univariate logistic regression, only lumpectomy + ALND surgery (p = 0.009) and any subsequent axillary lymph node removal surgery (p = 0.003) were associated with BCRL-B. Both of these variables were also found to be statistically significant in the multivariate regression model. Further prospective research is warranted to analyze potentential predictors of BCRL-B and to reduce/ prevent this complication.

Depleción del suministro de sangre y costo por donaciones indeterminadas del Hospital Nacional Guillermo Almenara Irigoyen / Depletion of blood supply and cost due to indeterminate donations at the Guillermo Almenara Irigoyen National Hospital

Objetivo: Evaluar la depleción del suministro de sangre y el costo por donaciones indeterminadas del Hospital Nacional Guillermo Almenara Irigoyen durante el 2014. Materiales y métodos: Estudio retrospectivo de corte transversal y análisis de costo-utilidad en donaciones con resultados en zona gris (valor de la muestra/ valor de corte entre los límites > 0.85 y < 1) luego del tamizaje serológico para los siete marcadores infecciosos (HIV, HBsAg, HBcAb, HCV, HTLV-1/2, SÍFILIS y CHAGAS) y la determinación en simultáneo del HIV Ag/Ab combo, por ELISA de cuarta generación. Desde el sistema e-Delphyn® se codificaron y tabularon los datos. El análisis de costos se realizó considerando el tipo de cambio vigente. Resultados: De 9 560 donaciones, el 20.7 % (1977 donaciones) fueron resultados en zona gris lo que ocasionó una pérdida de 863.9 litros de sangre y 92 640 USD. HbcAb con 10.18% (973 resultados indeterminados) y anti-HIV con 0.39% (37 resultados indeterminados) fueron los resultados con mayor y menor seroprevalencia, respectivamente (p<0.05). No se encontró diferencias significativas entre los marcadores anti-HIV y HIV Ag/Ab combo (p=0.776). Conclusiones: Se demostró que >800 litros de sangre descartada generó >90 mil USD de costo por donaciones indeterminadas ocasionando un perjuicio económico al presupuesto hospitalario y una disminución del suministro de sangre disponible para el tratamiento de pacientes en el Hospital Nacional Guillermo Almenara Irigoyen.

Objective: To evaluate the depletion of blood supply and the cost due to indeterminate donations at Hospital Nacional Guillermo Almenara Irigoyen during 2014. Materials and methods: A retrospective cross-sectional study and a cost-utility analysis were conducted in donations showing results in the gray zone (sample value/cutoff value between >0.85 and <1) after a serological screening of seven infectious markers (HIV, HBsAg, HBcAb, HCV, HTLV-1/2, syphilis and Chagas disease) and the simultaneous determination of the HIV Ag/Ab combo by means of a fourth generation ELISA. Data was encoded and tabulated using the e-Delphyn® system. The cost-utility analysis was performed considering the current exchange rate. Results: Out of 9,560 donations, 20.7% (1977 donations) showed results in the gray zone which caused a loss of 863.9 liters of blood and USD 92,640. The highest and lowest rate of seroprevalence were observed in HBcAb with 10.18% (973 indeterminate test results) and anti-HIV with 0.39% (47 indeterminate test results), respectively (p<0.05). No significant differences were found between the anti-HIV y HIV Ag/Ab combo screening methods (p=0.776). Conclusions: It was demonstrated that more than 800 liters of discarded blood generated a more than USD 90,000 cost due to indeterminate donations causing economic damages to the hospital budget and a depletion of blood supply available for patients at Hospital Nacional Guillermo Almenara Irigoyen.

Sistema web de apoyo a las asignaciones de interconsultas para pacientes con riesgo de cáncer mamario utilizando árboles de decisión / Web system to support consultation assignments for patients at risk of breast cancer using decision trees

Se desarrolló una herramienta de tipo WEB para apoyar a los profesionales de la salud encargados de asignar interconsultas médicas a pacientes con riesgo de cáncer mamario, ocupando árboles de decisión como método para clasificar si el paciente cumple o no los requisitos para que su solicitud sea aceptada según criterios establecidos. Esta clasificación permite generar una lista de pacientes que necesitan una atención médica oportuna, información que es recopilada por el sistema para desplegar una lista ordenada según el resultado de una mamografía y la fecha de la solicitud de interconsulta. Conociendo esta lista, el profesional encargado podrá enviarla al Servicio de Orientación Médico Estadístico (SOME), entidad encargada de asignar hora y fecha a cada solicitud de interconsulta, cuya respuesta también podrá ser almacenada en el sistema. Conclusión: Mediante una demostración y posterior encuesta, el proyecto se califica como un aporte al proceso de asignación de interconsultas médicas a pacientes con riesgo de cáncer mamario.

A Web tool which is described was developed in order to give support to health care professionals which assign consultations to people in risk of breast cancer. They use the decision tree as the method to classify patients and also to determine if they meet the requirements in order to approve their application according to the criteria established by health care professionals. This classification allows generating a list of patients who need medical assistance as soon as possible. This information is gathered by the system in order to display an organized list according to the mammogram results and the date of the consultation in the application form. Once the list is done, the person in charge will be able to send the list to "Servicio de Orientación Médico Estadístico", an organization who assigns the date of consultations for each application form and also stores the answer in the system if needed. Conclusion: Through a demonstration and subsequent survey, the project qualifies as a contribution to the process of assigning medical interconsultations patients with breast cancer risk.

Advertising in Actas Dermosifiliográficas, 1909-1939.

We review advertisements published in the journal Actas Dermosifiliográficas between 1909 and 1939. Treatments for sexually transmitted diseases were advertised with particular frequency, and they offer a case in point that exemplifies the close relationship between the pharmaceutical industry and medical journals.

[Usefulness of electroencephalograms in evaluating transient global amnesia]. / Utilidad de la electroencefalografia en la valoracion de la amnesia global transitoria.

INTRODUCTION: Transient global amnesia (TGA) is a perfectly well defined clinical picture, but nevertheless even today its aetiology remains unknown. The three most widely accepted theories suggest it has a vascular origin, it is related with the pathophysiology of migraine or it is of an epileptiform nature. AIM: To analyse whether there is an electroencephalographic pattern that is consistently repeated in a series of electro-encephalograms (EEG) carried out on patients with TGA. PATIENTS AND METHODS: The study consists in a retrospective analysis of a sample of 345 patients referred to have an EEG after an episode of TGA. RESULTS: In almost 20% of the EEGs something that could be considered abnormal was found, although most of these findings (64%) were of little pathological significance. Of the remaining 26%, attention should be drawn to the cases of two patients with subclinical rhythmic electroencephalogram discharges of adults (a pattern with a meaning that is not altogether clear and which has previously been associated with TGA). CONCLUSIONS: A considerable percentage of patients have TGA and EEG alterations, although most of them are of scarce pathological significance or can be attributed to some other underlying condition. We have not succeeded in identifying any pattern that is consistently repeated. Our results suggest that the EEG is a test with low diagnostic effectiveness in this pathology and it is necessary to reconsider the need to systematically perform such tests in suspected cases of TGA.

Nifedipine versus fenoterol in the management of preterm labor: a randomized, multicenter clinical study.

PURPOSE: To compare the efficacy of nifedipine and fenoterol in the management of threatened preterm labor (TPL). METHODS: A randomized and multicenter study assessing the tocolytic effect of nifedipine versus fenoterol in patients admitted to the participating maternity units with a diagnosis of TPL and a cost-savings study for economic assessment. For a power of 80% and an α error equal to 0.05, 132 consecutive patients were recruited during the study period; 66 patients were assigned to each group. A χ(2) analysis and a mean differences test were performed according to variable types and survival curves per intention-to-treat. RESULTS: Demographics were similar in both groups. The latency period was similar in both groups (26.7 vs. 25.6; p = 0.3). There were no differences in the results obtained. Nifedipine failed more frequently to obtain tocolysis when used as a first-line agent (80 vs. 90%, p = 0.0001). The group treated with fenoterol showed more drug adverse events (57.8 vs. 19.0%, p = 0.0001). The economic assessment did not evidence a significant difference in terms of cost savings between groups treated with either drug. CONCLUSION: The present study failed to demonstrate either clinical or economic superiority of any of the two drugs used in TPL management. The highest failure percentage of nifedipine when used as a first-line agent should encourage further research.

Mass spectrometric characterization of urinary toremifene metabolites for doping control analyses.

Toremifene is a selective estrogen receptor modulator included in the list of prohibited substances in sport by the World Anti-doping Agency. The aim of the present study was to investigate toremifene metabolism in humans in order to elucidate the structures of the most abundant urinary metabolites and to define the best marker to detect toremifene administration through the analysis of urine samples. Toremifene (Fareston) was administered to healthy volunteers and the urine samples were subjected to different preparation methods to detect free metabolites as well as metabolites conjugated with glucuronic acid or sulphate. Urinary extracts were analyzed by LC-MS/MS with triple quadrupole analyzer using selected reaction monitoring mode. Transitions for potential metabolites were selected by using the theoretical [M+H](+) as precursor ion and m/z 72 or m/z 58 as product ions for N,N-dimethyl and N-desmethyl metabolites, respectively. Toremifene and 20 metabolites were detected in excretion study samples, excreted free or conjugated with glucuronic acid or sulphate. Structures for most abundant phase I metabolites were proposed using accurate mass measurements performed by QTOF MS, based on fragmentation pattern observed for those metabolites available as reference standards. Several metabolic pathways including mono- and di-hydroxylation, N-desmethylation, hydroxymethylation, oxidation, dehalogenation and combinations were proposed. All metabolites were detected up to one month after toremifene administration; the most abundant metabolites were detected in the free fraction and they were metabolites resulting from dehalogenation. Several of the metabolites elucidated in this work have not been reported until now in the scientific literature.

Incidence, management, and results of vascular complications after liver transplantation.

INTRODUCTION: Vascular complications show an 8%-15% incidence after liver transplantation and represent an important cause of mortality. An aggressive policy is necessary for an early diagnosis and treatment. PATIENTS AND METHODS: From 2001 to 2009, we performed 240 liver transplantations in 232 patients. We employed Doppler ultrasonography on days 1 and 4 as well as before hospital discharge and always try a radiological approach. RESULTS: The incidence of vascular complications was 7.2% (n = 18) including arterial (n = 12, 4.8%) of early thrombosis (n = 4), late thrombosis (n = 4), and stenosis (n = 4) or portal (n = 3; 1.2%) of thrombosis (n = 2) or stenosis (n = 1); or caval complications (n = 3, 1.2%). Radiologic therapy was effective in 1 patient with arterial stenosis, in the 3 patients with portal complications, and in 2 patients with caval complications. All patients with early thrombosis and 2/4 with late thrombosis required retransplantation. Surgical treatment was effective in 1 patient with late thrombosis, 3 with stenosis, and 2 with caval complications. The overall mortality rate was 16.6%; 2 patients with arterial complications and 1 with a caval complications. CONCLUSION: Vascular complications, mainly artery complications, represent serious problem after liver transplantation, which often requires retransplantation. With an aggressive policy of diagnosis and treatment, we can decrease the mortality rate from these adverse events.

Leukocytes segmentation using Markov random fields.

The segmentation of leukocytes and their components plays an important role in the extraction of geometric, texture, and morphological characteristics used to diagnose different diseases. This paper presents a novel method to segment leukocytes and their respective nucleus and cytoplasm from microscopic bone marrow leukemia cell images. Our method uses color and texture contextual information of image pixels to extract cellular elements from images, which show heterogeneous color and texture staining and high-cell population. The CIEL ( ∗ ) a ( ∗ ) b ( ∗ ) color space is used to extract color features, whereas a 2D Wold Decomposition model is applied to extract structural and stochastic texture features. The color and texture contextual information is incorporated into an unsupervised binary Markov Random Field segmentation model. Experimental results show the performance of the proposed method on both synthetic and real leukemia cell images. An average accuracy of 95% was achieved in the segmentation of real cell images by comparing those results with manually segmented cell images.

A Compact and Low-Cost MEMS Loudspeaker for Digital Hearing Aids.

A microelectromechanical-systems (MEMS)-based electromagnetically actuated loudspeaker to reduce form factor, cost, and power consumption, and increase energy efficiency in hearing-aid applications is presented. The MEMS loudspeaker has multilayer copper coils, an NiFe soft magnet on a thin polyimide diaphragm, and an NdFeB permanent magnet on the perimeter. The coil impedance is measured at 1.5 Omega, and the resonant frequency of the diaphragm is located far from the audio frequency range. The device is driven by a power-scalable, 0.25-mum complementary metal-oxide semiconductor class-D SigmaDelta amplifier stage. The class-D amplifier is formed by a differential H-bridge driven by a single bit, pulse-density-modulated SigmaDelta bitstream at a 1.2-MHz clock rate. The fabricated MEMS loudspeaker generates more than 0.8-mum displacement, equivalent to 106-dB sound pressure level (SPL), with 0.13-mW power consumption. Driven by the SigmaDelta class-D amplifier, the MEMS loudspeaker achieves measured 65-dB total harmonic distortion (THD) with a measurement uncertainty of less than 10%. Energy-efficient and cost-effective advanced hearing aids would benefit from further miniaturization via MEMS technology. The results from this study appear very promising for developing a compact, mass-producible, low-power loudspeaker with sufficient sound generation for hearing-aid applications.

Valoración objetiva del estilo de crianza y las expectativas de parejas con niños pequeños / Objective assessment of parenting styles and expectations of couples with young children

Los propósitos de este estudio consistieron en conocer la frecuencia de estilos de crianza en parejas con estilo común versus con estilo diferente, analizar sus diferencias, y conocer susexpectativas. Se eligió un modelo de exigencias-responsividad que se operacionalizó con una medida objetiva de prácticas disciplinarias y de crianza. Se evaluaron 485 parejas con niñospequeños. Los resultados indicaron que en parejas con estilo común el estilo predominante fue el indulgente, pero en parejas con estilo diferente, predominó el estilo autoritario en las madresy el autorizativo en los padres. Las parejas autorizativas, con excepción de las parejasindulgentes, tuvieron más prácticas de crianza y las más altas expectativas. Se resalta la necesidad de más investigación con muestras latinoamericanas.

The purposes of the present study were to determine the frequency of parenting styles in couples with same style versus different style, to analyze differences between these groups, and to explore their parental expectations. A demandingness-responsiveness model was chosen, and it was operationalized by means of an objective measure of discipline and nurturing practices. In the study participated 485 couples with young children. Results revealed moreindulgent parents in couples with the same style. Among parents who didn’t share parenting style, there were more authoritarian mothers and more authoritative fathers. Authoritativecouples, with the exception of indulgent couples, had more nurturing practices and the highest developmental expectations among styles and groups. This study highlights the need of moreLatin-American research.

[Epidemiology and costs of severe sepsis in Madrid. A hospital discharge study]. / Epidemiología y costes de la sepsis grave en Madrid. Estudio de altas hospitalarias.

BACKGROUND AND OBJECTIVE: Severe sepsis is a complex syndrome to define, diagnose and treat. This population-based study describes the epidemiology of sepsis in the Region of Madrid, estimates its incidence and mortality, and assesses its impact on hospital stays and costs. PATIENTS AND METHODS: The source of information was the Minimum Basic Hospital Data Set from the Region of Madrid in 2001. Severe sepsis cases were defined as discharges with a combination of organic failure and presence or suspicion of infection through a combination of codes previously proposed and utilized. A descriptive study was performed, incidence rates were calculated, lengths of stay and costs were estimated, and mortality was analyzed. RESULTS: 6,968 episodes were identified. Mean age was 62.5 year. 59.7% were male. Annual incidence was 14.1/10,000 inhabitants, being highest for those 84 and older (230.8/10,000). 1.7 infections per episode were detected. More frequently identified microorganisms were Streptococcus sp., Staphylococcus sp., Escherichia coli and Candida sp. The most frequent organic dysfunctions were renal (39.7%) and respiratory (35.7%). Mortality was 33%. Mortality was higher in cases with more than one organic failure, hepatic dysfunction or cancer. Mean length of stay was 28.9 day. Annual overall costs were 70 million euros. CONCLUSIONS: Severe sepsis is a frequent process, with a high mortality and a significant impact on health care resource utilization.

Life-cycle assessment of municipal solid wastes: development of the WASTED model.

This paper describes the development of the Waste Analysis Software Tool for Environmental Decisions (WASTED) model. This model provides a comprehensive view of the environmental impacts of municipal solid waste management systems. The model consists of a number of separate submodels that describe a typical waste management process: waste collection, material recovery, composting, energy recovery from waste and landfilling. These submodels are combined to represent a complete waste management system. WASTED uses compensatory systems to account for the avoided environmental impacts derived from energy recovery and material recycling. The model is designed to provide solid waste decision-makers and environmental researchers with a tool to evaluate waste management plans and to improve the environmental performance of solid waste management strategies. The model is user-friendly and compares favourably with other earlier models.

[Predicted duration of protective anti-HBs antigens in Peruvian health care workers after six years of vaccination]. / Pronóstico de duración de títulos protectores anti-HBs ag en trabajadores de la salud del perú luego de 6 años de vacunados.

Given the importance attributed to the protection of health care workers against viral Hepatitis B (VHB) by the World Health Organization (WHO) and the Center for Disease Control (CDC), in 1993, the Instituto Peruano del Seguro Social (Social Security Peruvian Institute), today known as ESSALUD, ruled the vaccination of personnel in risk working in the 4 national hospitals, using Cuban vaccine Heberbiovac HB (20mg, schedule 0, 1, 2 months). Our purpose was to evaluate the antibody persistence in the vaccinated individuals after six years from immunization, and the possible presence of HB virus infection markers. Sera from 144 health care workers were studied, for a 70.24% coverage, in relation to the initially seroprotected in the 1993 study. For markers detection, commercial immunoenzymatic methods were used. HBsAg and anti-HBc were negative in all the serology samples studied, thus we conclude that no evidence of infection by this virus was found in any of the vaccinated subjects. AntiHBs was positive, being all of them seroconverted, with seroprotection and hyperresponse as of 91.6% and 43.7% respectively. The mean life time of antiHBs (t 1/2) is three years,predicting that the antibodies level will be over 10 IU/l until after 15 years from the end of the schedule. The subjects under 40 had significantly higher levels of seroprotection and hyperresponse, being the females those that stayed in the upper categories of response. Evaluation of the post-reinforcement memory in the seroconverted, not protected cases, is recommended, as well as extend the work with ESSALUD to other hospitals in the country.

Manifestations of slow site exchange processes in solution NMR: a continuous Gaussian exchange model.

The effects of site exchange due to slow conformational changes in rapidly rotating molecules in solution are examined in detail. Significant gaps in the currently available theory are filled. The effects of site exchange on the lineshape, decay of a simple spin-echo, decay of the even echoes in a Carr-Purcell-Meiboom-Gill (CPMG) pulse-sequence, and decay of the transverse magnetization in a resonant spin-locking field are investigated. Both trajectory and stochastic operator approaches are formulated and shown to be completely equivalent whenever the dynamics of population transfers among the inequivalent sites is governed by either a stationary or a nonstationary Markov process. A nonstationary Markov process may result from Brownian dynamics (a stationary Markov process) in a larger conformational space that contains the subspace of inequivalent sites. A continuous Gaussian exchange model is formulated in which a nucleus undergoes continuous one-dimensional motion in a harmonic potential well that is located in a linear chemical shift gradient. The effects of this Gaussian exchange model on the lineshape, simple spin-echo decay, and decay of the even echoes of a CPMG pulse train are treated rigorously via the trajectory approach. Compact analytical expressions are obtained for the relevant correlation functions in each case. The relevant decays are found to be exponential in the very short time and long time limits, which are not necessarily experimentally significant in any given case. In the fast exchange limit the relevant decays are exponential at all times, and explicit formulas are given for their decay rates. In the long time limit, all discrete multisite models with the same intrinsic Ro2 at every site are shown to be completely equivalent to a continuous Gaussian model with appropriate relaxation time and variance of the Larmor frequency. The effects of this Gaussian exchange model on the decay of the transverse magnetization in a resonant spin-locking field are treated heuristically by a trajectory approach. The intrinsic contribution (Ro1rho) of rapid rotations and dipole-dipole interactions to relax the transverse magnetizations of two nuclei of the same kind in the presence of a (nearly) resonant spin-locking field is also derived and found to be practically the same as the intrinsic contribution, Ro2, of those same rotations to the simple and CPMG spin-echo decay rates and linewidth. Literature data for the linewidth, decay rate of the CPMG even spin-echoes, and R(1rho) decay rate for the A9-H2 protons of adenines at the central TpA step in the sequence, 5'-GCAGGTTTAAACCTCG-3', are analyzed using the Gaussian exchange model to assess the time-scale and variance of the site exchange process as well as the intrinsic Ro2 rate. Although a single Gaussian exchange process with appropriate parameters can fit these three A9-H2 data rather well, this particular "solution" cannot be reconciled with NMR relaxation data on other protons in the same DNA molecule. Rather good agreement with all of the observations is obtained by using a model of two concurrent Gaussian exchange processes, whose relaxation times, tau = 7 and 460 micros, differ in time-scale by a factor of 65. The insensitivity of R1rho in the presence of a fast site exchange process to much slower concurrent site exchange processes is explicitly demonstrated. Protocols for detecting and characterizing a second slow site exchange process are suggested.

[Assessment of the cellular immune response induced in Balb/C mice with dengue virus 2 envelope protein]. / Evaluación de la respuesta inmune celular inducida en ratones Balb/C por la proteína de envoltura del virus dengue 2.

The cellular immune response to dengue type 2 virus envelope protein was studied. To this end, the lympho-proliferative capacity of T-lymphocytes obtained from splenocytes of animals immunized with the protein when they were stimulated by such protein and dengue 2 virus. It was realized that splenocytes proliferated significantly in response to both types of viral antigens and that the values of stimulation indexes were higher in response to the whole virus than to the protein alone. Based on the above-mentioned, it was concludes that purified dengue 2 virus envelope protein was capable of generating specific and memory responses of antigen T-cell to dengue 2 type virus.

Safety climate and attitude as evaluation measures of organizational safety.

The main aim of this research is to develop a set of evaluation measures for safety attitudes and safety climate. Specifically it is intended: (a) to test the instruments; (b) to identify the essential dimensions of the safety climate in the airport ground handling companies; (c) to assess the quality of the differences in the safety climate for each company and its relation to the accident rate; (d) to analyse the relationship between attitudes and safety climate; and (e) to evaluate the influences of situational and personal factors on both safety climate and attitude. The study sample consisted of 166 subjects from three airport companies. Specifically, this research was centered on ground handling departments. The factor analysis of the safety climate instrument resulted in six factors which explained 69.8% of the total variance. We found significant differences in safety attitudes and climate in relation to type of enterprise.