Heterogeneous Predisposing Factors and Etiology of Edema of the Uvula in a Spanish Population.

BACKGROUND AND OBJECTIVE: Edema of the uvula (EU) may appear in isolation or in association with clinical manifestations such as urticaria, angioedema, and anaphylaxis. EU may lead to upper airway obstruction, provoking obstructive respiratory distress and asphyxia. Objective: We sought to investigate the etiology of and predisposing factors for EU in a large population of patients referred to an outpatient clinic. METHODS: In this 3-year follow-up cohort study, 171 patients presenting with EU were identified and classified as having isolated EU or nonisolated EU. The etiology of each patient's condition was studied, and possible predisposing factors were recorded. An allergology work-up and a statistical study (bivariate/multivariate analyses) were performed. RESULTS: The predisposing factors for both groups of EU patients were found to be different. The etiology of the problem was identified for most patients; allergy to Anisakis simplex was the most common cause in both groups. Nonsteroidal anti-inflammatory drugs and antibiotics were also found to be triggers in both groups. CONCLUSIONS: Isolated EU was associated with snoring, an elongated uvula, and having experienced previous episodes of EU. We found no associations between groups of EU patients and gender, obesity, smoking, alcohol consumption, personal and family history of atopy, and obstructive sleep apnea. Allergy to A simplex was the most commonly recorded cause.

Factors affecting the precision of lesion sizing with contrast-enhanced spectral mammography.

AIM: To evaluate the precision of the pre-surgical measurement of the size of breast cancer by contrast-enhanced spectral mammography (CESM). MATERIAL AND METHODS: This was a retrospective study of 204 breast cancers. Variables related to tumour biology and anthropometric variables were recorded and considered when evaluating the efficacy of CESM in predicting tumour size. Microscopic measurement of the largest diameter of the tumour at pathology was chosen as the reference standard. RESULTS: The mean size of tumours at pathology was 20.7±15.8 mm, while at CESM it was 23.6±16.7 mm (Bland-Altman 2.9 mm overestimation, 2.9 mm; 95% confidence interval [CI]: -10.3-16.2 mm). Spearman's correlation coefficient was 0.83 (p<0.0001). The concordance analysis indicated that 37.8% of the measurements were concordant, 47% were overestimated, and 15.2% were underestimated. Tumour size, nodal involvement, breast density, and breast size significantly modified the sizing accuracy. CONCLUSION: Quality of tumour size prediction with CESM is good, and this appears to be a promising imaging technique in the surgical planning of breast cancer. Biological tumour features, and anthropological characteristics of the patients do, however, affect the diagnostic precision and should be taken into account.

Component-resolved diagnosis in hymenoptera allergy.

Component-resolved diagnosis based on the use of well-defined, properly characterised and purified natural and recombinant allergens constitutes a new approach in the diagnosis of venom allergy. Prospective readers may benefit from an up-to-date review on the allergens. The best characterised venom is that of Apis mellifera, whose main allergens are phospholipase A2 (Api m1), hyaluronidase (Api m2) and melittin (Api m4). Additionally, in recent years, new allergens of Vespula vulgaris have been identified and include phospholipase A1 (Ves v1), hyaluronidase (Ves v2) and antigen 5 (Ves v5). Polistes species are becoming an increasing cause of allergy in Europe, although only few allergens have been identified in this venom. In this review, we evaluate the current knowledge about molecular diagnosis in hymenoptera venom allergy.

Dynamic point shifting with null screens using three LCDs as targets for corneal topography.

In this paper, the use of three liquid crystal displays (LCDs) as targets for an experimental corneal topographer is proposed. The main advantage is that the geometrical pattern in the target can be modified without moving any mechanical part to apply the dynamic point shifting (DyPoS) method. Some results on the capabilities of the LCDs, obtained with photo frames, for measuring a 6.37 mm radius of curvature calibration sphere, and applying the DyPoS method, are presented. It is shown that the error in measuring the radius of curvature with DyPoS is reduced to 3% of the real value and the RMS in elevation or sagitta differences is around 15 µm, 30% or 66% of the values obtained without DyPoS, respectively.

Allergic reaction to polyethylene glycol in a painter.

We report a case of a male painter who visited our outpatient clinic after developing a distinct skin reaction 15 min after the ingestion of a laxative solution containing polyethylene glycol (PEG) prior to colonoscopy. He described suffering from the same skin reaction when he was previously exposed to paints that contained PEG-4000. An exposure challenge test with pure PEG-4000, simulating his workplace conditions, elicited a generalized urticarial reaction. Allergy to PEG should be considered in painters who develop urticarial or other systemic symptoms after handling PEG-containing products.

Dual-energy contrast-enhanced mammography.

The degree of vascularization in breast lesions is related to their malignancy. For this reason, functional diagnostic imaging techniques have become important in recent years. Dual-energy contrast-enhanced mammography is a new, apparently promising technique in breast cancer that provides information about the degree of vascularization of the lesion in addition to the morphological information provided by conventional mammography. This article describes the state of the art for dual-energy contrast-enhanced mammography. Based on 15 months' clinical experience, we illustrate this review with clinical cases that allow us to discuss the advantages and limitations of this technique.

Hydrological modelling and evolution of lakes and playa-lakes in southern Spain constrained by geology, human management and climate change.

The hydrological functioning of wetlands in S Spain is poorly understood. We perform a 22-years hydrological modelling of seven playa-lakes located in a semi-arid region of southern Spain, including dry and wet periods. To do that, we applied a hydrological balance model to reconstruct past lake water levels. In addition, we investigated the hydrochemistry of the water, the basin bathymetry, and the geological setting of the watersheds, acquiring new lithology and active structures data. Once the models were constrained, scenarios considering increases on temperature and human management were implemented, and discussed. The water balance is simplified to precipitation (water input) and basin discharge (evapotranspiration), as the lakes are disconnected from groundwater because of the low-permeability substrate. In addition, unlike in previous studies, we add overflows to the modelling. The results of the model agree with actual lake water monitoring data (R2 > 0.8). We observed that the hydroperiods of some of these lakes vary from permanent lakes to ephemeral, depending strongly on the basin bathymetry. Lakes with steeply margins show longer hydroperiods, whilst it is shorter for low-lying floor playa-lakes. In addition, we observed that steeply lake margins respond to active faults and/or lithological changes. To forecast the effects of climate change on the lake hydroperiods, we applied a 1 °C increase in average temperature in our hydrological modelling. The hydroperiod is significantly reduced for ephemeral playa-lakes, whilst is barely affected in permanent lakes. Moreover, we detected the high sensitivity of ephemeral playa-lakes to the anthropogenic management, including siltation, plant colonization and changes watershed surface.

Control of trace metal distribution and variability in an interdunal wetland.

Trace elements are serious pollutants in the natural environment and are of increasing concern due to the adverse effects at global scale. To refine the current understanding of trace metal distribution and variability in natural environments, concentrations of dissolved trace metals (Ag, Al, As, B, Ba, Be, Co, Cr, Cd, Cu, Fe, Hg, Mo, Ni, Pb, Sb, Se, Th,Tl, U, V, Mn, Zn), major ions, inorganic nutrients (NO3, PO4), TOC and stable isotopes of water were determined in water samples from rainwater, seven piezometers and a pond in the coastal Doñana wetland during four sampling campaigns between 2017 and 2019. Results show clear evaporation signatures of stable isotopes in the pond but not in the groundwater. Hydrochemical analyses yield significant, systematic changes in groundwater trace metal and nutrient composition along the flowpath from the dune belt to the pond, controlled by organic matter in the sediments. Whereas major ions reached maximum concentrations in the pond due to evapoconcentration, most trace metals showed highest concentrations at sites with lower redox levels, except for B, As and U, which showed very high concentrations in the pond. Cu, Zn, Ni, Sb and Tl yielded higher median concentrations in rainwater than in most of the groundwater points and in case of Cu and Zn higher even than in surface water which points to an atmospheric input source of these elements. Temporal variability of trace metals was related to lower hydraulic heads after an elongated dry period which led to lower redox levels and higher concentrations of most of the trace elements whereas major ions showed more constant concentration levels. This is of special concern regarding climate change and the predicted higher frequency of prolonged dry periods, which could modify the natural hydrochemical patterns in undisturbed wetlands systems.

Changes in water level, land use, and hydrological budget in a semi-permanent playa lake, southwest Spain.

Medina playa lake, a Ramsar site in western Andalusia, is a brackish lowland lake of 120 ha with an average depth of 1 m. Water flows into Medina from its 1,748-ha watershed, but the hydrology of the lake has not previously been studied. This paper describes the application of a water budget model on a monthly scale over a 6-year period, based on a conceptual hydrological model, and considers different future scenarios after calibration to improve the understanding of the lake's hydrological functioning. Climatic variables from a nearby weather station and observational data (water-level evolution) were used to develop the model. Comparison of measured and predicted values demonstrated that each model component provided a reasonable output with a realistic interaction among the components. The model was then used to explore the potential consequences of land-use changes. Irrigation of olive groves would significantly reduce both the hydroperiod (becoming dry 15% of the time) and the average depth of the lake (water level <0.5 m 40% of the time). On the other hand, removal of an artificial overflow would double the average flooded surface area during high-water periods. The simulated water balance demonstrates that the catchment outputs are dominated by lake evaporation and surface outflow from the lake system to a creek. Discrepancies between predicted and observed water levels identify key areas of uncertainty for future empirical research. The study provides an improved basis for future hydrological management of the catchment and demonstrates the wider utility of this methodology in simulating this kind of system. This methodology provides a realistic appraisal of potential land-use management practices on a catchment-wide scale and allows predictions of the consequences of climate change.

Daily consumption of milk enriched with fish oil, oleic acid, minerals and vitamins reduces cell adhesion molecules in healthy children.

BACKGROUND AND AIMS: Several studies have suggested that polyunsaturated fatty acids, vitamins and minerals have beneficial effects on lipid profile and systemic inflammation in adults. METHODS AND RESULTS: We examined the effects of a daily intake of milk enriched with longchain polyunsaturated fatty acids, oleic acid, carbohydrates, vitamins, minerals and low in saturated fatty acids (SFAs) for 5 months, on several cardiovascular (CVD) risk biomarkers in healthy children aged 8-14 years. In a randomized double-blind placebo-controlled trial, a total of 107 children of both genders were assigned to two study groups: 1) a supplemented group (SG, n=53) who consumed 0.6 L/day of an enriched dairy product, and 2) a control group (CG, n=54) who consumed 0.6 L/day of standard whole milk. Both groups consumed the dairy drinks for 5 months, in addition to their usual diet. Serum levels of adhesion molecules as indices of vascular endothelial cell activation were assessed in both groups at 0 and 5 months as well as white blood cell counts, lipid profile, serum proteins, total serum calcium, 25-OH vitamin D, glucose, insulin and adiponectin. In the enriched dairy drink supplemented group, adhesion molecules E-selectin and ICAM-1 as well as lymphocyte levels decreased while plasma docosahexaenoic acid (DHA) and serum calcium concentrations increased. In the control group, serum total protein, transferrin, total cholesterol, HDL-cholesterol and adiponectin concentrations decreased. CONCLUSION: The consumption of a milk enriched with fish oil, oleic acid, minerals and vitamins reduced indices of endothelial cell activation in the studied group of healthy children.