Antibiotic degradation and mineralization: efficiency increase on combining different chemical treatment processes.

The goal of this study was to assess the efficiency of antibiotic degradation applying different chemical treatment methods and their combinations. Thus, improvement in the efficiency of these methods when combined was quantified. The methods tested to degrade/mineralize the antibiotics amoxicillin (AMX) and ciprofloxacin (CIP) under different pH conditions (4, 7 and 10) were ultra-violet irradiation (UV254 nm), ultrasound (US), hydrogen peroxide (H2O2) and ozone (O3) alone and in combination. The results showed that individual methods were only partially efficient in the degradation/mineralization of antibiotics, except for ozonation at alkaline pH. In the combined methods, the best performance was obtained with US/UV/H2O2/O3 (pH 10, 20-min treatment), where the degradation rates for the antibiotics were 99.8% for CIP and 99.9% for AMX. For the mineralization efficiency the values obtained were 71.3% for CIP and 79.2% for AMX. The results of this study could contribute to the development and improvement of wastewater treatment aimed at avoiding the presence of residual antibiotics in the environment.

La Medicina Natural y Tradicional en la prevención y el tratamiento de la COVID-19

RESUMEN Hasta hoy no existe cura para la COVID-19. No obstante, se reportan diversos tratamientos encaminados a prevenir el contagio y a tratar los síntomas y complicaciones de la misma. La Medicina Natural y Tradicional ha sido usada frente a diversas dolencias, pero la información de su aplicación en pacientes con infección por SARS-CoV-2 es escasa. El objetivo de este trabajo fue describir el uso de la Medicina Natural y Tradicional en la prevención y el tratamiento de la COVID-19. Para ello, se realizó una búsqueda de información utilizando recursos disponibles a través de Infomed (PubMed, PubMed Central, SciELO, EBSCO, ClinicalKey) y Google Académico, lo que permitió realizar una revisión bibliográfica sobre el uso de la Medicina Natural y Tradicional en la infección por COVID-19. A pesar de los beneficios conocidos de la Medicina Natural y Tradicional, esta ha sido subvalorada como tratamiento frente a la COVID-19. Múltiples ensayos clínicos han tratado el uso de las diferentes terapias de Medicina Natural y Tradicional. Se informa que en los pacientes sometidos a estas terapias se incrementó la tasa de curación, disminuyó el número de casos graves y la tasa de alta hospitalaria mejoró notablemente. La Medicina Natural y Tradicional no protege directamente contra la enfermedad ni causa la curación de la misma, pero sí contribuye a que el organismo esté fortalecido a la hora de enfrentar la infección, y su empleo es eficaz en la reducción y alivio de los síntomas.

ABSTRACT Up today, there is no cure for COVID-19. Nevertheless, several treatments are reported with regard of preventing contagion and treating its symptoms and complications. Natural and traditional medicine has been used against various illnesses, but the information on its application in patients with SARS-CoV-2 is scarce. The aim of this work was to describe the use of Natural and Traditional Medicine in the prevention and treatments of COVID-19. For that, a search of information was conducted using resources available through Infomed (PubMed, PubMed Central, SciELO, EBSCO, ClinicalKey) and Google Academic, what allowed to carry out a bibliographic review on the use of Natural and Traditional Medicine in the infection caused by COVID-19. Despite of the known benefits of the Natural and Traditional Medicine, it has been undervalued as a treatment against COVID-19. Numerous clinical trials have treated the use of the different therapies of Natural and Traditional Medicine. It is reported that in patients undergoing these therapies the cure rate increased, the number of severe cases decreased and the hospital discharge rate improved outstandingly. Natural and traditional medicine does not directly protect against disease, or causes its healing, but it does contribute to the body being strengthened at the time of facing the infection, and its use is efficacious in reducing and alleviating the symptoms.

Effects and Economic Sustainability of Biochar Application on Corn Production in a Mediterranean Climate.

The effects of two types of biochar on corn production in the Mediterranean climate during the growing season were analyzed. The two types of biochar were obtained from pyrolysis of Pinus pinaster. B1 was fully pyrolyzed with 55.90% organic carbon, and B2 was medium pyrolyzed with 23.50% organic carbon. B1 and B2 were supplemented in the soil of 20 plots (1 m2) at a dose of 4 kg/m2. C1 and C2 (10 plots each) served as control plots. The plots were automatically irrigated and fertilizer was not applied. The B1-supplemented plots exhibited a significant 84.58% increase in dry corn production per square meter and a 93.16% increase in corn wet weight (p << 0.001). Corn production was no different between B2-supplemented, C1, and C2 plots (p > 0.01). The weight of cobs from B1-supplemented plots was 62.3%, which was significantly higher than that of cobs from C1 and C2 plots (p < 0.01). The grain weight increased significantly by 23% in B1-supplemented plots (p < 0.01) and there were no differences between B2-supplemented, C1, and C2 plots. At the end of the treatment, the soil of the B1-supplemented plots exhibited increased levels of sulfate, nitrate, magnesium, conductivity, and saturation percentage. Based on these results, the economic sustainability of this application in agriculture was studied at a standard price of €190 per ton of biochar. Amortization of this investment can be achieved in 5.52 years according to this cost. Considering the fertilizer cost savings of 50% and the water cost savings of 25%, the amortization can be achieved in 4.15 years. If the price of biochar could be reduced through the CO2 emission market at €30 per ton of non-emitted CO2, the amortization can be achieved in 2.80 years. Biochar markedly improves corn production in the Mediterranean climate. However, the amortization time must be further reduced, and enhanced production must be guaranteed over the years with long term field trials so that the product is marketable or other high value-added crops must be identified.

HIV-1 Nef counteracts autophagy restriction by enhancing the association between BECN1 and its inhibitor BCL2 in a PRKN-dependent manner.

Macroautophagy/autophagy is an auto-digestive pro-survival pathway activated in response to stress to target cargo for lysosomal degradation. In recent years, autophagy has become prominent as an innate antiviral defense mechanism through multiple processes, such as targeting virions and viral components for elimination. These exciting findings have encouraged studies on the ability of autophagy to restrict HIV. However, the role of autophagy in HIV infection remains unclear. Whereas some reports indicate that autophagy is detrimental for HIV, others have claimed that HIV deliberately activates this pathway to increase its infectivity. Moreover, these contrasting findings seem to depend on the cell type investigated. Here, we show that autophagy poses a hurdle for HIV replication, significantly reducing virion production. However, HIV-1 uses its accessory protein Nef to counteract this restriction. Previous studies have indicated that Nef affects autophagy maturation by preventing the fusion between autophagosomes and lysosomes. Here, we uncover that Nef additionally blocks autophagy initiation by enhancing the association between BECN1 and its inhibitor BCL2, and this activity depends on the cellular E3 ligase PRKN. Remarkably, the ability of Nef to counteract the autophagy block is more frequently observed in pandemic HIV-1 and its simian precursor SIVcpz infecting chimpanzees than in HIV-2 and its precursor SIVsmm infecting sooty mangabeys. In summary, our findings demonstrate that HIV-1 is susceptible to autophagy restriction and define Nef as the primary autophagy antagonist of this antiviral process.Abbreviations: 3-MA: 3-methyladenine; ACTB: actin, beta; ATG16L1: autophagy related 16 like 1; BCL2: bcl2 apoptosis regulator; BECN1: beclin 1; cDNA: complementary DNA; EGFP: enhanced green fluorescence protein; ER: endoplasmic reticulum; Gag/p55: group-specific antigen; GFP: green fluorescence protein; GST: glutathione S transferase; HA: hemagglutinin; HIV: human immunodeficiency virus; IP: immunoprecipitation; MAP1LC3B/LC3B: microtubule associated protein 1 light chain 3 beta; Nef: negative factor; PRKN: parkin RBR E3 ubiquitin ligase; PtdIns3K: phosphatidylinositol 3 kinase; PtdIns3P: phosphatidylinositol 3 phosphate; PTM: post-translational modification; RT-qPCR: reverse transcription followed by quantitative PCR; RUBCN: rubicon autophagy regulator; SEM: standard error of the mean; SERINC3: serine incorporator 3; SERINC5: serine incorporator 5; SIV: simian immunodeficiency virus; SQSTM1/p62: sequestosome 1; TFEB: transcription factor EB; UVRAG: UV radiation resistance associated gene; VSV: vesicular stomatitis virus; ZFYVE1/DFCP1: zinc finger FYVE-type containing 1.

Trabecular bone score improves fracture risk assessment in glucocorticoid-induced osteoporosis.

OBJECTIVE: To analyse the clinical utility of trabecular bone score (TBS) evaluation for fracture risk assessment in glucocorticoid (GC)-treated patients compared with BMD assessment. METHODS: One hundred and twenty-seven patients on GC treatment were included [mean age 62 (18) years, 63% women] in this cross-sectional study. The medical history, anthropometric data, lumbar and femoral BMD (DXA) [considering osteoporosis (OP): T-score ⩽-2.5], TBS (considering degraded microarchitecture: <1.230) and dorsolumbar X-ray [to assess vertebral fractures (VF)] were evaluated. BMD and TBS sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were evaluated to determine the diagnostic accuracy of the two methods. RESULTS: All patients were receiving GC treatment for autoimmune diseases during 47.7 (68.9) months at a mean daily dose of 14.5 mg; 17% had VF, 28% any type of fragility fracture (VF + non-VF), 29% OP and 52% degraded microarchitecture. Degraded microarchitecture was significantly more frequent than densitometric OP in patients with VF (76% vs 38%) and with any fragility fracture (69% vs 36%). For VF, TBS and BMD sensitivity, specificity, PPV, and NPV were 0.76, 0.53, 0.25 and 0.92, and 0.38, 0.72, 0.22 and 0.85, respectively. Specificity increased to 0.89 for VF and 0.9 for any fragility fracture on combining BMD+TBS. TBS had better ability than BMD to discriminate between patients with fracture, especially VF (area under the curve = 0.73). CONCLUSION: TBS seems to have greater discriminative power than BMD for fracture risk assessment in GC-treated patients, confirming the utility of this method as a complementary tool in the diagnosis of GC-induced OP.

Biological treatments in giant cell arteritis & Takayasu arteritis.

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are the two main large vessel vasculitides. They share some similarities regarding their clinical, radiological and histological presentations but some pathogenic processes in GCA and TAK are activated differently, thus explaining their different sensitivity to biological therapies. The treatment of GCA and TAK essentially relies on glucocorticoids. However, thanks to major progress in our understanding of their pathogenesis, the role of biological therapies in the treatment of these two vasculitides is expanding, especially in relapsing or refractory diseases. In this review, the efficacy, the safety and the limits of the main biological therapies ever tested in GCA and TAK are discussed. Briefly, anti TNF-α agents appear to be effective in treating TAK but not GCA. Recent randomized placebo-controlled trials have reported on the efficacy and safety of abatacept and mostly tocilizumab in inducing and maintaining remission of GCA. Abatacept was not effective in TAK and robust data are still lacking to draw any conclusions concerning the use of tocilizumab in TAK. Furthermore, ustekinumab appears promising in relapsing/refractory GCA whereas rituximab has been reported to be effective in only a few cases of refractory TAK patients. If a biological therapy is indicated, and in light of the data discussed in this review, the first choice would be tocilizumab in GCA and anti-TNF-α agents (mainly infliximab) in TAK.

Efficacy of 8- and 4-Session Mindfulness-Based Interventions in a Non-clinical Population: A Controlled Study.

Background: Many attempts have been made to abbreviate mindfulness programmes in order to make them more accessible for general and clinical populations while maintaining their therapeutic components and efficacy. The aim of this study was to assess the efficacy of an 8-week mindfulness-based intervention (MBI) programme and a 4-week abbreviated version for the improvement of well-being in a non-clinical population. Method: A quasi-experimental, controlled, pilot study was conducted with pre-post and 6-month follow-up measurements and three study conditions (8- and 4-session MBI programmes and a matched no-treatment control group, with a sample of 48, 46, and 47 participants in each condition, respectively). Undergraduate students were recruited, and mindfulness, positive and negative affect, self-compassion, resilience, anxiety, and depression were assessed. Mixed-effects multi-level analyses for repeated measures were performed. Results: The intervention groups showed significant improvements compared to controls in mindfulness and positive affect at the 2- and 6-month follow-ups, with no differences between 8- vs. 4-session programmes. The only difference between the abbreviated MBI vs. the standard MBI was found in self-kindness at 6 months, favoring the standard MBI. There were marginal differences in anxiety between the controls vs. the abbreviated MBI, but there were differences between the controls vs. the standard MBI at 2- and 6-months, with higher levels in the controls. There were no differences in depression between the controls vs. the abbreviated MBI, but differences were found between the controls vs. the standard MBI at 2- and 6-months, favoring the standard MBI. There were no differences with regard to negative affect and resilience. Conclusion: To our knowledge, this is the first study to directly investigate the efficacy of a standard 8-week MBI and a 4-week abbreviated protocol in the same population. Based on our findings, both programmes performed better than controls, with similar effect size (ES). The efficacy of abbreviated mindfulness programmes may be similar to that of a standard MBI programme, making them potentially more accessible for a larger number of populations. Nevertheless, further studies with more powerful designs to compare the non-inferiority of the abbreviated protocol and addressing clinical populations are warranted. Clinical Trials.gov Registration ID: NCT02643927.

Percutaneous Tibial Nerve Stimulation Therapy for Overactive Bladder Syndrome: Clinical Effectiveness, Urodynamic, and Durability Evaluation.

OBJECTIVE: To evaluate percutaneous tibial nerve stimulation (PTNS) effectiveness, durability, and impact on the pathophysiology of overactive bladder syndrome (OAB) in patients who have been previously treated with antimuscarinics without success. MATERIALS AND METHODS: A prospective study that included 200 women diagnosed with OAB between 2007 and 2015 at Virgen de la Victoria University Hospital (Málaga, Spain) was conducted. OAB patients were treated with PTNS therapy after antimuscarinic treatment failed. To evaluate OAB symptoms, clinical and urodynamic studies were performed before and after PTNS treatment. Treatment's success was defined as a reduction of clinical parameters by >50% and an improvement of at least 2 urodynamic parameters by >50%. The Kolmogorov-Smirnov test and Student's t test or Wilcoxon test were used based on the data. A linear correlation analysis and a multivariate linear regression analysis were performed to determine factors associated with the success of PTNS therapy. RESULTS: Of the patients, 94% experienced a positive response to PTNS considering clinical and urodynamic parameters. PTNS benefits were extended by 24 months. We identified daytime urinary frequency (r = -0.165; P = .024; 95% confidence interval, -0.248 to -0.018) and first sensation of bladder filling (r = 0.208; P = .030; 95% confidence interval, 0.001-0.028) as significant independent predictor factors for PTNS success. CONCLUSION: The current data confirmed a high effectiveness of PTNS improving OAB symptoms through 24 months. Furthermore, daytime urinary frequency and first sensation of bladder filling act as a significant independent predictor factors for PTNS success.

Blocking mitochondrial calcium release in Schwann cells prevents demyelinating neuropathies.

Schwann cells produce myelin sheath around peripheral nerve axons. Myelination is critical for rapid propagation of action potentials, as illustrated by the large number of acquired and hereditary peripheral neuropathies, such as diabetic neuropathy or Charcot-Marie-Tooth diseases, that are commonly associated with a process of demyelination. However, the early molecular events that trigger the demyelination program in these diseases remain unknown. Here, we used virally delivered fluorescent probes and in vivo time-lapse imaging in a mouse model of demyelination to investigate the underlying mechanisms of the demyelination process. We demonstrated that mitochondrial calcium released by voltage-dependent anion channel 1 (VDAC1) after sciatic nerve injury triggers Schwann cell demyelination via ERK1/2, p38, JNK, and c-JUN activation. In diabetic mice, VDAC1 activity was altered, resulting in a mitochondrial calcium leak in Schwann cell cytoplasm, thereby priming the cell for demyelination. Moreover, reduction of mitochondrial calcium release, either by shRNA-mediated VDAC1 silencing or pharmacological inhibition, prevented demyelination, leading to nerve conduction and neuromuscular performance recovery in rodent models of diabetic neuropathy and Charcot-Marie-Tooth diseases. Therefore, this study identifies mitochondria as the early key factor in the molecular mechanism of peripheral demyelination and opens a potential opportunity for the treatment of demyelinating peripheral neuropathies.

Fotoféresis en el tratamiento de Síndrome de Sézary: Caso clínico / Sézary syndrome treated with extracorporeal photopheresis: Report of one case

Sézary syndrome (SS) is an unusually aggressive T- cell lymphoma characterized by the triad of erythroderma, the presence of more than 1,000 Sézary cells in peripheral blood and lymphadenopathies. It is accompanied by generalized pruritus and poor quality of life. The management of SS depends on its stage, patient comorbidities, and treatment availability. Extracorporeal photopheresis (ECP) is the first line of treatment for patients with T-cell lymphomas in stage IVA1, IVA2 or SS. This treatment comprises three phases: leukapheresis, photoactivation and subsequent reinfusion of lymphocytes. As it is an immunomodulatory therapy it does not produce generalized immunosuppression. We report a 76 year-old male with SS stage IIIb initially treated with 12 sessions of ultraviolet phototherapy without response. After 10 well-tolerated sessions of ECP, itching and skin lesions eventually disappeared.

[Sézary syndrome treated with extracorporeal photopheresis: Report of one case]. / Fotoféresis en el tratamiento de Síndrome de Sézary: Caso clínico.

Sézary syndrome (SS) is an unusually aggressive T- cell lymphoma characterized by the triad of erythroderma, the presence of more than 1,000 Sézary cells in peripheral blood and lymphadenopathies. It is accompanied by generalized pruritus and poor quality of life. The management of SS depends on its stage, patient comorbidities, and treatment availability. Extracorporeal photopheresis (ECP) is the first line of treatment for patients with T-cell lymphomas in stage IVA1, IVA2 or SS. This treatment comprises three phases: leukapheresis, photoactivation and subsequent reinfusion of lymphocytes. As it is an immunomodulatory therapy it does not produce generalized immunosuppression. We report a 76 year-old male with SS stage IIIb initially treated with 12 sessions of ultraviolet phototherapy without response. After 10 well-tolerated sessions of ECP, itching and skin lesions eventually disappeared.

Acute dilated cardiomyopathy in a patient with beriberi and cryoglobulinaemic vasculitis: an unusual potential complication of two rare disorders.

We report the case of a 45-year-old patient who presented with acute dilated cardiomyopathy. During admission the patient was consecutively diagnosed with cryoglobulinaemic vasculitis and beriberi. In both diseases, cardiac involvement may occur as dilated cardiomyopathy. Thiamin deficiency was the final cause for the severe cardiac manifestations (cardiac acute beriberi or Shoshin syndrome), which returned to normal after thiamin supplementation.

Changes in biomarkers after therapeutic intervention in temporal arteries cultured in Matrigel: a new model for preclinical studies in giant-cell arteritis.

BACKGROUND: Search for therapeutic targets in giant-cell arteritis (GCA) is hampered by the scarcity of functional systems. We developed a new model consisting of temporal artery culture in tri-dimensional matrix and assessed changes in biomarkers induced by glucocorticoid treatment. METHODS: Temporal artery sections from 28 patients with GCA and 22 controls were cultured in Matrigel for 5 days in the presence or the absence of dexamethasone. Tissue mRNA concentrations of pro-inflammatory mediators and vascular remodelling molecules was assessed by real-time RT-PCR. Soluble molecules were measured in the supernatant fluid by immunoassay. RESULTS: Histopathological features were exquisitely preserved in cultured arteries. mRNA concentrations of pro-inflammatory cytokines (particularly IL-1ß and IFNγ), chemokines (CCL3/MIP-1α, CCL4/MIP-1ß, CCL5/RANTES) and MMP-9 as well as IL-1ß and MMP-9 protein concentrations in the supernatants were significantly higher in cultured arteries from patients compared with control arteries. The culture system itself upregulated expression of cytokines and vascular remodelling factors in control arteries. This minimised differences between patients and controls but underlines the relevance of changes observed. Dexamethasone downregulated pro-inflammatory mediator (IL-1ß, IL-6, TNFα, IFNγ, MMP-9, TIMP-1, CCL3 and CXCL8) mRNAs but did not modify expression of vascular remodelling factors (platelet derived growth factor, MMP-2 and collagens I and III). CONCLUSIONS: Differences in gene expression in temporal arteries from patients and controls are preserved during temporal artery culture in tri-dimensional matrix. Changes in biomarkers elicited by glucocorticoid treatment satisfactorily parallel results obtained in vivo. This may be a suitable model to explore pathogenetic pathways and to perform preclinical studies with new therapeutic agents.

Cryptogenic organizing pneumonitis during oxaliplatin chemotherapy for colorectal cancer: case report.

The patient presented here is a 30-year-old woman who underwent anterior resection for the initial treatment of rectal cancer. A postoperative study showed a single liver metastasis. The patient received adjuvant pelvic radiotherapy with concomitant 5-fluorouracil (5-FU) treatment followed by liver metastasectomy 6 weeks after the completion of radiation therapy and chemotherapy. Adjuvant therapy with 5-FU, leucovorin, and oxaliplatin (FOLFOX 4 regimen) was continued. The initial five cycles were well tolerated with the occurrence of only paresthesia that did not interfere with function. After the sixth cycle of the treatment, progressive dyspnea and persistent cough developed in the patient, although her clinical history was negative for lung disease. A chest radiograph revealed diffuse bilateral interstitial infiltrates, and a chest CT scan showed bilateral alveolar infiltrates predominant in the right lung. Lung biopsy by video-assisted thoracoscopy was performed, and the histologic report showed cryptogenic organizing pneumonitis (COP). Prednisone therapy (1 mg/kg/d) resulted in a very good clinical response. In fact, the patient had complete remission of respiratory symptoms including cough and dyspnea after 4 days of treatment, and the chest CT scan showed complete resolution of lung infiltrates after 4 weeks. One month later, the patient continued adjuvant treatment with six cycles of 5-FU, leucovorin, and irinotecan (ie, the FOLFIRI regimen) without complications. Thus, oxiplatin was implicated as the likely cause of this drug-induced lung toxicity, which is a very rare complication associated with platins. Diffuse interstitial lung disease, particularly COP, has been described following the administration of the cytotoxic agents bleomycin and busulfan, but a connection to oxaliplatin has not been reported before this case.

Wide phylogenetic distribution of Scorpine and long-chain beta-KTx-like peptides in scorpion venoms: identification of "orphan" components.

Scorpine and toxins specific for potassium channels of the family beta (beta-Ktx) are two types of structurally related scorpion venom components, characterized by an unusually long extended N-terminal segment, followed by a Cys-rich domain with some resemblance to other scorpion toxins. In this communication, we report evidence supporting the ubiquitous presence of Scorpine and beta-KTx-like polypeptides and their precursors in scorpions of the genus Tityus of the family Buthidae, but also included is the first example of such peptides in scorpions from the family Iuridae. Seven new beta-KTxs or Scorpine-like peptides and precursors are reported: five from the genus Tityus (T. costatus, T. discrepans and T. trivittatus) and two from Hadrurus gertschi. The cDNA precursors for all of these peptides were obtained by molecular cloning and their presence in the venoms were confirmed for various peptides. Analysis of the sequences revealed the existence of at least three distinct groups: (1) beta-KTx-like peptides from buthids; (2) Scorpine-like peptides from scorpionid and iurid scorpions; (3) heterogeneous peptides similar to BmTXKbeta of buthids and iurids. The biological function for most of these peptides is not well known; that is why they are here considered "orphan" peptides.

Usefulness of paced activation sequence mapping in catheter ablation of accessory pathways.

INTRODUCTION: Radiofrequency (RF) ablation of accessory pathways (APs) is often a time-consuming procedure, mainly because conventional criteria have modest accuracy. Thus, additional mapping criteria are desirable. Our hypothesis was that comparison of paced atrial activation sequences with that obtained during orthodromic AV reentrant tachycardia might be useful for locating the atrial insertion of single APs. METHODS AND RESULTS: The study included 15 patients with a single AP referred for ablation. Analysis of the atrial activation sequence was simplified by measuring the activation time (AT) that elapsed between two atrial reference points placed next to the AV annulus on either side of the area containing the AP. Ablation was guided by conventional criteria. Before each RF delivery, a short pacing train was delivered from the ablation catheter and, after verification of atrial capture, the AT was compared with the AT obtained during orthodromic tachycardia. Fifty sites of RF delivery were appropriate for analysis. The multivariate model with the highest predictive power included a deviation of AT between pacing and tachycardia < or = 5 msec (P < 0.001), a local AV ratio > or = 1 (P = 0.04), and stability of the local electrogram (P = 0.05). The combination of all these criteria predicted a successful application with high sensitivity, specificity, and positive predictive value (92%, 86%, and 71% respectively). To validate the method prospectively, 10 additional consecutive patients underwent an AP ablation procedure guided by these criteria. CONCLUSION: This technique seems to be highly accurate in selecting the atrial site for RF ablation of single APs.

Carcinoma de células de Merkel de labio / Merkel Cell Carcinoma of the Lip

Paciente de 83 años, insuficiente renal crónica en hemodiálisis que consultó por lesión tumoral, bilobulada, ulcerada de un año de evolución en labio inferior, la cual fue extirpada. La histopatología demostró nidos tumorales epiteliales con atipía, alto índice mitótico y focos necróticos.El estudio inmunohistoquímico fue positivo para neuroenolasa específica y neurofilamentos, compatible con el diagnóstico de Carcinoma de Células de Merkel. El paciente rechazó otras terapias coadyuvantes y falleció un año después por descompensación de su estado de base.Se presenta una revisión bibliográfica de esta infrecuente patología con sólo 13 casos publicados en la literatura médica. (AU)

Carcinoide bronquial: estudio clínico patológico de 10 casos / Bronchial carcinoid: a clinical-pathological study of 10 cases

El carcinoide bronquial representa el 1 a 5 por ciento de todos los tumores pulmonares y es el segundo más frecuente de todos los carcinoides. Constituye un grupo de neoplasias con diferenciación neuroendocrina y potencial maligno con invasión local y metástasis. El presente trabajo tiene como objetivos conocer las características clínicas y tipos de carcinoide en nuestra casuística, así como la utilidad diagnóstica de los estudios histopatológicos complementarios. Se recolectaron los casos del periodo 1988-1996 y se estudiaron con técnicas corrientes, inmunohistoquímica con anticuerpos monoclonales contra enolasa neuronal específica (ENE), sinaptofisina (SIN), cromogranina A (CRO-A) y en cuatro casos con microscopía electrónica. Se encontraron diez casos en el período, 5 mujeres y 5 hombres, con edad que varió de 18 a 74 años; 6 casos fueron formas atípicas y 4 típicas. Las localizaciones más frecuentes fueron lóbulo superior izquierdo y lóbulo inferior derecho. el 50 por ciento fueron uninodulares y el 20 por ciento multinodulares. El diagnóstico clínico se planteó en un caso. El 80 por ciento mostró argentafinidad, 70 por ciento argirofilia; 90 por ciento fueron positivos para ENE, 60 por ciento SIN, 70 por ciento CRO-A. Al microscopio electrónico todos mostraron gránulos neuroendocrinos. Los estudios complementarios utilizados permitieron confirmar el diagnóstico. Tanto la microscopia electrónica como el estudio inmunohistoquímico permiten un diagnóstico específico, especialmente cuando se utiliza un panel de anticuerpos