Transanal endoscopic surgery with a 3D printed device.

BACKGROUND: The aim of this study was to investigate the effectiveness of devices manufactured with 3D printing for performing transanal endoscopic procedures without pneumorectum. METHODS: Functional devices were designed in the Polytechnic School of Engineering of Gijón from 2016 to 2018 using three-dimensional (3D) solid modelling software (Solid-Works®), that allows customization of the device (diameter and length). The devices were made in acrylonitrile butadiene styrene (ABS) by additive manufacturing using an HP Designjet 3D Printer, with fused deposition modelling (FDM) technology. Tests were carried out on mixed simulators (with viscera) and cadavers with a prototype in the form of an open cylindrical base ellipsoid spindle with two bars. In this paper, we present the information of the first series of patients in which this device has been used to perform a full-thikness endoscopic resection of the rectal wall without pneumorectum. The characteristics of the patients, size, and location of the lesion, the type of anesthesia used, the duration of the procedure, hospital stay, complications, and pathology were analyzed. An endoscopic follow-up was also carried out for at least 2 years. RESULTS: Seven interventions were carried out in six patients. The lesions were located at a mean distance of 5 cm from the anal verge and an average area of 11.8 cm2. Four of the procedures were performed with general anesthesia and 3 with spinal anesthesia. Histopathology examination identified 3 adenomas, 3 pT1 and 1 pT2 adenocarcinomas. All excisions were full thickness. En bloc excision was possible in all cases. In only one case of a benign polyp there was a positive lateral margin. As regards complications, there was one case of postoperative rectal bleeding without the need for transfusions. There were no readmissions and no postoperative mortality. CONCLUSIONS: An innovative device made with a 3D printer can be used successfully in transanal endoscopic resections of the rectal wall, with spinal anaesthesia and avoiding the need for pneumorectum.

Broadband, millimeter-wave antireflection coatings for large-format, cryogenic aluminum oxide optics.

We present two prescriptions for broadband ($ {\sim} 77 - 252\;{\rm GHz} $), millimeter-wave antireflection coatings for cryogenic, sintered polycrystalline aluminum oxide optics: one for large-format (700 mm diameter) planar and plano-convex elements, the other for densely packed arrays of quasi-optical elements-in our case, 5 mm diameter half-spheres (called "lenslets"). The coatings comprise three layers of commercially available, polytetrafluoroethylene-based, dielectric sheet material. The lenslet coating is molded to fit the 150 mm diameter arrays directly, while the large-diameter lenses are coated using a tiled approach. We review the fabrication processes for both prescriptions, then discuss laboratory measurements of their transmittance and reflectance. In addition, we present the inferred refractive indices and loss tangents for the coating materials and the aluminum oxide substrate. We find that at 150 GHz and 300 K the large-format coating sample achieves $ (97 \pm 2)\% $ transmittance, and the lenslet coating sample achieves $ (94 \pm 3)\% $ transmittance.

Polymorphisms of pro-inflammatory cytokine genes and the risk for acute suppurative or chronic nonsuppurative apical periodontitis in a Colombian population.

AIM: To determine the association of functional single nucleotide polymorphisms in genes of the pro-inflammatory cytokines tumour necrosis factor-α, interleukin-1ß, interleukin-8 and interleukin-12B with the development of two clinical forms of apical periodontitis (AP): acute suppurative and chronic nonsuppurative. METHODOLOGY: The study included 120 patients from Bucaramanga City, Colombia, 63 diagnosed with acute suppurative AP (ASAP) and 57 diagnosed with chronic nonsuppurative AP (CNAP). Genotyping for IL1B +3954 (rs1143634), IL8 / CXCL8 -251 (rs4073), IL12B +1188 (rs3212227) and TNFA -308 (rs1800629) was performed by the PCR-restriction fragment length polymorphisms method. The statistical analysis was performed using STATA 10.0 and PLINK V1.07 software. RESULTS: Significant differences in the distribution of IL8 / CXCL8 -251 A allele (P adjusted = 0.041; OR adjusted = 0.41, CI adjusted = 0.31-0.97) and IL8 / CXCL -251 TT genotype (P adjusted = 0.04; OR adjusted = 2.24, CI adjusted = 1.04-4.84) were observed comparing patients diagnosed with ASAP and CNAP. No association was observed in genotype and allele distribution for other genetic polymorphisms analysed. CONCLUSION: This study provides molecular epidemiological evidence that suggests in the present cohort that IL8 / CXCL8 -251 T allele, which is associated with higher production of IL8/CXCL8, is also associated with a higher risk of developing acute suppurative form of AP, whereas IL8 / CXCL8 -251 A allele, which is associated with lower production of IL8/CXCL8, is associated with chronic nonsuppurative form of AP. This suggests a pivotal role for IL-8/CXCL8 in periapical disease because of its ability to induce chemotaxis and modulating the directed migration of neutrophils to the site of inflammation in response to microbial infection of pulp.

Genetic monitoring on the world's first MSC eco-labeled common octopus (O. vulgaris) fishery in western Asturias, Spain.

Octopus vulgaris (Cuvier, 1797) is a cephalopod species with great economic value. In western Asturias (northwest of Spain), O. vulgaris artisanal fisheries are relatively well monitored and conditionally eco-labeled by the Marine Stewardship Council (MSC). Despite this, the Asturian octopus stocks have not been genetically assessed so far. In order to improve the current fishery plan and contrast the octopus eco-label validity in Asturias, 539 individuals from five regions of the O. vulgaris geographic distribution, including temporal samplings in Asturias, were collected and genotyped at thirteen microsatellite loci. All the samples under analysis were in agreement with Hardy-Weinberg expectations. Spatial levels of genetic differentiation were estimated using F-statistics, multidimensional scaling, and Bayesian analyses. Results suggested that the O. vulgaris consists of at least four genetically different stocks coming from two ancestral lineages. In addition, temporal analyses showed stability in terms of genetic variation and high NE (> 50) for several generations in different localities within Asturias, pointing out to indeed sustainable fishery exploitation levels. Even though, the current Asturias fishery plan shows no significant genetic damages to the stocks, the regional-specific management plans need systematic genetic monitoring schemes as part of an efficient and preventive regional fishery regulation strategy.

Management of tubal ectopic pregnancy with methotrexate in the setting of symptomatic Coronavirus disease 2019 (COVID-19): A case report.

Background: Coronavirus Disease 2019 (COVID-19) represents a complex therapeutic challenge. As the pandemic progresses, patients are presenting with ectopic pregnancies (EPs) and symptomatic COVID-19. Objective: We present the management of a patient with multiple medical comorbidities and tubal EP in the setting of severe symptomatic COVID-19 infection where all management options were precluded. Methods: Case report with literature review of management of tubal EP in the setting of severe symptomatic COVID-19 infection. Result: After careful consideration of options, the patient underwent successful medical management with methotrexate while receiving supportive care for COVID-19. Conclusions: Methotrexate proved to be the safest therapeutic option in this patient. Management of patients with severe COVID-19 and gynaecologic emergencies should be individualised and carefully reviewed with evolving knowledge of COVID-19.

Transvaginal specimen extraction in a laparoscopic anterior resection of a sigmoid colon neoplasia with en bloc right salpingo-oophorectomy.

Laparoscopic colorectal surgery has well-known benefits. However, an abdominal incision, albeit much smaller than conventional surgery, is still needed. A transvaginal extraction of a sigmoid colon neoplasia with en bloc salpingo-oophorectomy and colorectal mechanical anastomosis is described. The technique is feasible and safe. The excellent recovery of the 86-year-old patient shows the potential future of the natural orifices endoscopic surgery.

Ultrasound measurement of femoral cartilage thickness in the knee of healthy young university students. / Medición ecográfica del grosor del cartílago femoral en rodilla de jóvenes universitarios sanos.

BACKGROUND AND OBJECTIVE: Articular cartilage (AC) is always affected in any joint with osteoarthritis. Ultrasound can be a useful tool in monitoring changes in the AC. The purpose of the present study is to ultrasound measure the thickness of the AC in the distal femur in young students and determine its relationship with body mass index (BMI), muscle mass, body fat and sports practice. MATERIALS AND METHODS: An observational cross-sectional study was conducted with healthy volunteers, between 15 and 25 years old. Anthropometric data were collected and the thickness of the femoral cartilage of the knee was measured at 5 points. In addition, the percentage of muscle and body fat was measured in a subgroup. RESULTS: 100 subjects were included in the study. The average age was 20 years (± 2.5). The average BMI was 23 kg/m2 (± 3.1). AC was thicker in men and sportsmen, versus women and sedentary people, with a statistically significant difference. When comparing BMI with AC thickness no significant relationship was found; however, only 2 participants had BMI > 30. CONCLUSIONS: Cartilage thickness has a direct relationship with the percentage of muscle, and inversely with the percentage of fat. BMI is not a good parameter when evaluating the dynamic behaviour of cartilage in non-obese youths.

Does the tumour microenvironment alter tumorigenesis and clinical response in transmissible venereal tumour in dogs?

The canine transmissible venereal tumour (CTVT) is a transmissible cancer that is spread naturally between dogs, with the ability to develop and evade the immune system, despite strict immune surveillance of the host. Furthermore, molecular signalling between cells of the immune system and the tumour microenvironment appear to influence the behaviour and development of the tumour. Thus, this study aimed to quantify the expression of genes related to the immune system such as IL-6, IFN-γ, and TGF-ß, as well as angiogenic factors (VEGF, CXCR4), in CTVT cells in vivo and in vitro (primary culture), correlating with the clinical response of the animals treated with vincristine. As expected, the most prevalent subtype was plasmacytoid cells, although lymphocytic cells were also found, indicating the possibility of polyclonality. When we compared the gene expressions of IFN-γ and IL-6, we mostly found low expression, concluding that MHC expression was probably not occurring in tumour cells, and no activation of immune cells to eliminate the tumour. The TGF-ß gene was normal in the majority of animals but demonstrated decreased expression in vincristine resistant animals, leading to the hypothesis that the concentration of tumour-derived TGF-ß was affecting and even suppressing the real TGF-ß expression, favouring tumour proliferation and progression in these cases. VEGF expression was extremely high, demonstrating its angiogenic role in tumour growth, while CXCR4 was decreased, possibly because of CTVT's low metastatic potential. Thus, we concluded that the tumour microenvironment, together with the immune system of the host, influences CTVT, presumably altering its tumorigenesis and the animal's clinical response to treatment.

[Factors related with post-surgical complications in elderly patients with glioblastoma multiforme]. / Factores relacionados con complicaciones posquirurgicas en pacientes de edad avanzada con glioblastoma multiforme.

INTRODUCTION: Glioblastoma multiforme is the most frequent malignant tumour of the central nervous system, and its incidence reaches 80% in those over 50 years of age. Life expectancy has increased in the population in recent times and an analysis of the post-surgical complications affecting elderly patients is of great importance for a correct surgical indication. AIMS: To analyse the factors related with post-surgical complications in elderly patients. PATIENTS AND METHODS: A sample of 88 patients diagnosed with glioblastoma multiforme between 31 and 78 years of age was analysed retrospectively. The variables taken into consideration in the study were: personal medical history, age, functional status, pre-anaesthetic status, tumour characteristics, type of surgery and post-surgical complications. RESULTS: Age was observed to have an influence on local (p = 0.006) and systemic surgical complications (p = 0.034), and on the Clavien-Dindo scale (p = 0.001). Persons with a poorer functional status and cardiovascular risk presented more systemic complications (p = 0.006 and 0.044) and a lower score on the Clavien-Dindo scale (p = 0.024 and 0.025) respectively. Likewise, more local complications are found in the case of excisional procedures than in biopsies (p = 0.027). The pre-anaesthetic status and anti-haemostatic treatments were not related with such events. CONCLUSIONS: Patients over 65 years of age present a higher incidence of pathological antecedents and a poorer pre-surgical functional status. Age, cardiovascular risk, functional status and the type of surgical procedure have significantly increased the occurrence of post-surgical complications.

TITLE: Factores relacionados con complicaciones posquirurgicas en pacientes de edad avanzada con glioblastoma multiforme.Introduccion. El glioblastoma multiforme es el tumor maligno mas frecuente del sistema nervioso central, y su incidencia es del 80% en los mayores de 50 años. En los ultimos tiempos se ha producido un aumento en la esperanza de vida de la poblacion, y el analisis de las complicaciones posquirurgicas en pacientes de edad avanzada resulta de gran relevancia para una correcta indicacion quirurgica. Objetivo. Analizar factores relacionados con las complicaciones posquirurgicas en pacientes de edad avanzada. Pacientes y metodos. Se analizan retrospectivamente 88 pacientes diagnosticados de glioblastoma multiforme entre 31 y 78 años. Las variables estudiadas son: antecedentes personales, edad, estado funcional, estado preanestesico, caracteristicas tumorales, tipo de cirugia y complicaciones posquirurgicas. Resultados. Se observa una influencia de la edad en las complicaciones quirurgicas locales (p = 0,006) y sistemicas (p = 0,034) y en la escala de Clavien-Dindo (p = 0,001). Las personas con peor estado funcional y riesgo cardiovascular presentaron mas complicaciones sistemicas (p = 0,006 y 0,044) y peor graduacion en dicha escala (p = 0,024 y 0,025). Asimismo, hallamos mas complicaciones locales en las cirugias de exeresis que en las biopsias (p = 0,027). El estado preanestesico y los tratamientos antihemostaticos no se relacionaron con dichos eventos. Conclusiones. Los pacientes mayores de 65 años presentan una mayor incidencia de antecedentes patologicos y peor estado funcional prequirurgico. La edad, el riesgo cardiovascular, el estado funcional y el tipo de cirugia han aumentado de manera significativa las complicaciones posquirurgicas.

[Spontaneous hematoma of the transverse mesocolon]. / Hematoma espontáneo de mesocolon transverso.

A case of spontaneous rupture of an aneurysm of a colic artery is presented. A large hematoma in the transverse mesocolon was found. The case is interesting because of its rarity and its preoperative angiographic diagnosis.

[Epidemiology of exocrine pancreatic cancer in the Principality of Asturias, 1973-1992]. / Epidemiología del cáncer exocrino de páncreas en el Principado de Asturias 1973-1992.

Pancreatic adenocarcinoma continues increasing in frequency, its diagnosis is usually realized very late and the results of the surgery, that is the only possibility of cure, gives often a feeling of frustration. During the period between 1973 and 1992, 1032 patients were diagnosed of pancreatic carcinoma at the different hospital institutions of our region. The incidence has increased from 1.28 to 6.42 cases/100,000. The proportion male/female was 1.5/1. Mean age of the patients was 67.5 +/- 11.35 and the median age was 65 years. In relation with the sex, the women age was higher: 70.2 +/- 11.81 (p < 0.01). The best diagnostic test was the CAT scan with 87.5 sensitivity. The overall resectability rate was low (11%), but there is a large difference between the beginning and the end of the period (6.8% and 14.1% respectively). Staging of the disease was stage IV in 36.4% of the cases. The 66.5% of the patients underwent palliative surgery. Cholecystojejunostomy was the most frequent operation. It wasn't possible any surgical management at the 3.5% of the cases cause of the disease was very extended; laparotomy was the only method used in 18.7%. The average survival rate with exeresis surgery was 18 months; with palliative surgery, it was only of eight months. The natural history of pancreatic carcinoma was situated at 5.57 +/- 2.63.

Giant diverticulum of the sigmoid colon.

The giant colonic diverticulum is a very rare clinical entity usually located in the sigmoid colon of elderly patients. A case of an 87-year-old woman recently treated in our hospital is reported hereinafter. The patient was non-surgically treated due to her advanced age and high surgical risk.

[Digestive hemorrhage caused by jejunoileal tumors]. / Hemorragia digestiva por tumoraciones yeyunoileales.

Between January-73 and February-92 twelve patients with digestive hemorrhage due to primary jejunoileal tumors were treated. Eight cases had rectal bleeding and four chronic gastrointestinal hemorrhage as first clinical manifestation. Patients underwent upper endoscopy, colonoscopy and barium enema. Three out of nine barium meals (33%), two out of four ultrasonographies (50%) and eight out of nine arteriographies (89%) were abnormal. The barium meals showed submucosal lesions on two occasions and a jejunal luminal mass. The ultrasonography detected two intrabdominal masses. All arteriographies, except one with extravased intestinal contrast and other which showed a hypovascular zone, depicted homogeneous hypervascular images. All patients were operated on. Seven segmental enterectomies, four limited resections and a polipectomy were performed. Seven tumours were found in the jejunum, three in the jejunoleum and two in the ileum. There were four leiomyosarcomas, three leiomyomas, two polyps, one leiomyoblastoma, one adenocarcinoma and one lymphoma. Rebleeding and mortality were absent.

[Cervical adenocarcinoma as a rare cause of vaginal bleeding in a young woman]. / El adenocarcinoma de cérvix como causa infrecuente de sangrado vaginal en la mujer joven.

Cervical adenocarcinoma is a less frequent variant than squamous carcinoma. The incidence of cervical adenocarcinoma has been increasing over the last several years. Villoglandular papillary adenocarcinoma usually affects young women and generally has a good prognosis. The treatment of this adenocarcinoma is surgical, with conisation being sufficient in localised cases, but a hysterectomy is often necessary to try and preserve the ovaries and maintain endocrine function.

Medición ecográfica del grosor del cartílago femoral en rodilla de jóvenes universitarios sanos / Ultrasound measurement of femoral cartilage thickness in the knee of healthy young university students

ANTECEDENTES Y OBJETIVO: El cartílago articular (CA) siempre está afectado en cualquier articulación con artrosis (A). La ecografía puede ser una herramienta útil en la monitorización de los cambios en el CA. El propósito del presente estudio es medir ecográficamente el grosor del CA en el fémur distal en jóvenes estudiantes y determinar su relación con el índice de masa corporal (IMC), masa muscular, grasa corporal y la práctica deportiva. MATERIALES Y MÉTODOS: Se realizó un estudio transversal observacional con voluntarios sanos, entre 15 y 25 años. Se recogieron datos antropométricos y se midió el grosor del cartílago femoral de la rodilla en cinco puntos. Además, se midió en un subgrupo el porcentaje de músculo y de grasa corporal. RESULTADOS: En el estudio se incluyeron 100 sujetos. La edad promedio fue de 20 años (± 2,5). El IMC promedio fue 23 kg/m2 (± 3,1). El CA tuvo un mayor grosor en los hombres y en los deportistas vs. las mujeres y los sedentarios, con diferencia estadísticamente significativa. Al comparar el IMC con el grosor del CA no se encontró ninguna relación significativa; sin embargo, sólo dos participantes tenían IMC > 30. CONCLUSIONES: El grosor del cartílago tiene una relación directamente proporcional con el porcentaje de músculo, e inversamente proporcional con el porcentaje de grasa. El IMC no es un buen parámetro al evaluar el comportamiento dinámico del cartílago en jóvenes no obesos

BACKGROUND AND OBJECTIVE: Articular cartilage (AC) is always affected in any joint with osteoarthritis. Ultrasound can be a useful tool in monitoring changes in the AC. The purpose of the present study is to ultrasound measure the thickness of the AC in the distal femur in young students and determine its relationship with body mass index (BMI), muscle mass, body fat and sports practice. MATERIALS AND METHODS: An observational cross-sectional study was conducted with healthy volunteers, between 15 and 25 years old. Anthropometric data were collected and the thickness of the femoral cartilage of the knee was measured at 5 points. In addition, the percentage of muscle and body fat was measured in a subgroup. RESULTS: 100 subjects were included in the study. The average age was 20 years (± 2.5). The average BMI was 23 kg/m2 (± 3.1). AC was thicker in men and sportsmen, versus women and sedentary people, with a statistically significant difference. When comparing BMI with AC thickness no significant relationship was found; however, only 2 participants had BMI > 30. CONCLUSIONS: Cartilage thickness has a direct relationship with the percentage of muscle, and inversely with the percentage of fat. BMI is not a good parameter when evaluating the dynamic behaviour of cartilage in non-obese youths

Reliability and validity of the Smoking and Women Questionnaire among three ethnic groups.

Cigarette smoking among women continues to be a major health risk to the smoker and to those around her. Programs aimed at stopping and maintaining smoking cessation have had very limited success due in part to the failure to individualize smoking cessation programs based on specific characteristics of the smoker. This study presents reliability and validity of a 14-item questionnaire developed to determine the readiness of women from three ethnic groups (non-Hispanic white, black American, and Hispanic American) to stop smoking. The Smoking and Women Questionnaire (SWQ) consists of items representative of core elements conceptualized in the Smoking/Ex-smoking Model for Women. The core factors are: beliefs/attitudes toward smoking, sociability, stress, coping, self-efficacy, motivation, nicotine dependence, and support. The SWQ was completed by both smoking and nonsmoking non-Hispanic white (N = 233), smoking and nonsmoking black American (N = 70), and smoking and nonsmoking Hispanic American (N = 73) women. The test-retest correlation coefficient over a one- to three-week period (N = 53) was .84. Cronbach alphas for whites, blacks, Hispanics, and combined groups were .81, .85, .84 and .83, respectively. Content validity was shown by experts who agreed that the core elements were represented in the SWQ. Construct validity was shown for ethnic groups separately and combined in that smokers had significantly lower SWQ scores than nonsmokers. Items representative of the core elements were rated by smokers in a similar manner irrespective of ethnicity, suggesting similar attitudes and behaviors toward smoking. Further research is needed to determine if the SWQ can predict readiness of women to stop smoking and serve as a basis for developing individualized smoking cessation programs. Implications for smoking cessation programs are reviewed.

Mode-locked all-solid-state diode-pumped Cr:LiSAF laser.

A diode-pumped mode-locked Cr:LiSAF laser is demonstrated for what is to our knowledge the first time. Active mode locking, with an acousto-optic modulator, and resonant passive mode locking, with a multiple-quantum-well absorber in an external cavity, have both yielded cw trains of picosecond pulses.