Unraveling TAFRO Syndrome: An In-Depth Look at the Pathophysiology, Management, and Future Perspectives.

TAFRO syndrome is a rare and aggressive inflammatory entity characterized by thrombocytopenia, anasarca, fever, renal failure, reticulin fibrosis, and organomegaly. This entity supposes a diagnostic and therapeutic challenge due to its significant overlap with Castleman's disease. However, distinct clinical and histological features warrant its classification as a separate subtype of idiopathic multicentric Castleman's disease (iMCD). While recent modifications have been made to the diagnostic criteria for iMCD, these criteria lack specificity for this particular condition, further complicating diagnosis. Due to its inflammatory nature, several complex molecular signaling pathways are involved, including the JAK-STAT pathway, NF-kB, and signal amplifiers such as IL-6 and VEGF. Understanding the involvement of immune dysfunction, some infectious agents, genetic mutations, and specific molecular and signaling pathways could improve the knowledge and management of the condition, leading to effective treatment strategies. The current therapeutic approaches include corticosteroids, anti-IL6 drugs, rituximab, and chemotherapy, among others, but response rates vary, highlighting the need for personalized strategies. The prognosis is uncertain due to diagnostic difficulties, emphasizing the importance of early intervention and appropriate targeted treatment. This comprehensive review examines the evolving landscape of TAFRO syndrome, including the pathophysiology, diagnostic criteria, treatment strategies, prognosis, and future perspectives.

Outcomes and effect of somatic mutations after erythropoiesis stimulating agents in patients with lower-risk myelodysplastic syndromes.

Background: Erythropoiesis stimulating agents (ESAs) are the first-line therapy in patients with lower-risk myelodysplastic syndromes (LR-MDS). Some predictive factors for ESAs response have been identified. Type and number of somatic mutations have been associated with prognosis and response to therapies in MDS patients. Objectives: The objective was to evaluate the outcomes after ESAs in patients with LR-MDS and to address the potential predictive value of somatic mutations in ESAs-treated patients. Design: Multi-center retrospective study of a cohort of 722 patients with LR-MDS included in the SPRESAS (Spanish Registry of Erythropoietic Stimulating Agents Study) study. Retrospective analysis of 65 patients with next generation sequencing (NGS) data from diagnosis. Methods: ESAs' efficacy and safety were evaluated in patients receiving ESAs and best supportive care (BSC). To assess the potential prognostic value of somatic mutations in erythroid response (ER) rate and outcome, NGS was performed in responders and non-responders. Results: ER rate for ESAs-treated patients was 65%. Serum erythropoietin (EPO) level <200 U/l was the only variable significantly associated with a higher ER rate (odds ratio, 2.45; p = 0.036). Median overall survival (OS) in patients treated with ESAs was 6.7 versus 3.1 years in patients receiving BSC (p < 0.001). From 65 patients with NGS data, 57 (87.7%) have at least one mutation. We observed a trend to a higher frequency of ER among patients with a lower number of mutated genes (40.4% in <3 mutated genes versus 22.2% in ⩾3; p = 0.170). The presence of ⩾3 mutated genes was also significantly associated with worse OS (hazard ratio, 2.8; p = 0.015), even in responders. A higher cumulative incidence of acute myeloid leukemia progression at 5 years was also observed in patients with ⩾3 mutated genes versus <3 (33.3% and 10.7%, respectively; p < 0.001). Conclusion: This large study confirms the beneficial effect of ESAs and the adverse effect of somatic mutations in patients with LR-MDS.

Hemophagocytic Lymphohistiocytosis Secondary to Hodgkin's Lymphoma with Isolated Bone Marrow Involvement in a Newly Diagnosed HIV Patient.

Human immunodeficiency virus (HIV) infection is known to be associated with the development of Hodgkin's lymphoma (HL). Exclusive extranodal bone marrow involvement is less common. Co-infection by other viruses, such as the Epstein-Barr virus (EBV), increases the incidence of a frequent complication denominated by hemophagocytic lymphohistocytosis (HLH). We present the case of a 50-year-old patient with the above clinical spectrum who develops several serious complications during treatment.

Primary Effusion Lymphoma, Multicentric Castleman's Disease, and Kaposi's Sarcoma in an HHV-8 and HIV-Positive Patient: A Case Report.

Primary effusion lymphoma (PEL), Kaposi's sarcoma (KS), and multicentric Castleman's disease (MCD) is an uncommon group of diseases included in the same spectrum with related characteristics. The coexistence of all of them in the same individual is a rare occurrence. We present the case of a 25-year-old patient diagnosed with human immunodeficiency virus (HIV) and the development of all these related pathologies. Despite the use of intensive treatment according to the latest recommendations, the evolution was unfavorable. This case reflects the need for new therapies and research in this field.

[Impact of vaccination against SARS-CoV-2 on the incidence of infection in school settings]. / Impacto de la vacunación contra SARS-CoV-2 en la incidencia de infección en ámbito escolar.

Background: The SARS-CoV-2 pandemic affected the school-aged population because of the disease itself and due to the measures applied for prevention and control of the infection. The aim of the study was to evaluate the effect of population-based vaccination against COVID-19 on the incidence of infection in school settings. Material and Methods: A retrospective descriptive study of COVID-19 cases and school outbreaks was carried out at the province level. Students, teachers and staff from different educational stages of the schools were included. The outcome measure was the incidence according to educational stage, case profile and clinic during the first of the academic year 2020/2021 versus the same period 2021/2022. Results: The total incidence of SARS-CoV-2 in classrooms was 2,470 cases per 100,000 population in the first trimester of the academic year 2020/2021 and 2,720 cases per 100,000 population in the same period 2021/2022. The number of reported school outbreaks was 7 times higher in this second period; and the risk of infection in classrooms over 12 years of age (students and teachers) was reduced by 43.1% (vaccinated in high percentage). Conclusions: This study shows a reduction in transmission of SARS-CoV-2 infection in students of higher educational stages (secondary and high school) during the first of the academic year 2021/2022 (group with high vaccination coverage at the beginning of the period) compared to the previous school year (without vaccination).

Invasive Cutaneous Candidiasis, Autoimmune Hemolytic Anemia and Pancytopenia: A Challenging Scenario for Waldenström Macroglobulinemia in an Elderly Patient.

Waldenström macroglobulinemia (WM) is a slowly progressive hematologic malignancy that usually responds rapidly to treatment. Being a lymphoplasmacytoid neoplasm, it is associated with a monoclonal IgM component, which may be associated with multiple manifestations and symptoms. We report the case of a 77-year-old woman diagnosed with WM following the development of severe and sudden pancytopenia associated with a cold agglutinin syndrome. In order to treat the WM and the underlying hemolysis, treatment with rituximab, corticosteroids and cyclophosphamide was started. Despite the improvement in hemolysis parameters, pancytopenia persisted, and we started a second line with ibrutinib. During treatment the patient developed an uncommon invasive fungal infection (IFI) with bone marrow granulomatosis and myelofibrosis. This case shows an unusual clinical course with a poor hematopoietic response to treatment and a large number of intercurrent complications.

Clinical, biological, and prognostic implications of SF3B1 co-occurrence mutations in very low/low- and intermediate-risk MDS patients.

SF3B1 is a highly mutated gene in myelodysplastic syndrome (MDS) patients, related to a specific subtype and parameters of good prognosis in MDS without excess blasts. More than 40% of MDS patients carry at least two myeloid-related gene mutations but little is known about the impact of concurrent mutations on the outcome of MDS patients. In applying next-generation sequencing (NGS) with a 117 myeloid gene custom panel, we analyzed the co-occurrence of SF3B1 with other mutations to reveal their clinical, biological, and prognostic implications in very low/low- and intermediate-risk MDS patients. Mutations in addition to those of SF3B1 were present in 80.4% of patients (median of 2 additional mutations/patient, range 0-5). The most frequently mutated genes were as follows: TET2 (39.2%), DNMT3A (25.5%), SRSF2 (10.8%), CDH23 (5.9%), and ASXL1, CUX1, and KMT2D (4.9% each). The presence of at least two mutations concomitant with that of SF3B1 had an adverse impact on survival compared with those with the SF3B1 mutation and fewer than two additional mutations (median of 54 vs. 87 months, respectively: p = 0.007). The co-occurrence of SF3B1 mutations with specific genes is also linked to a dismal prognosis: SRSF2 mutations were associated with shorter overall survival (OS) than SRSF2wt (median, 27 vs. 75 months, respectively; p = 0.001), concomitant IDH2 mutations (median OS, 11 [mut] vs. 75 [wt] months; p = 0.001), BCOR mutations (median OS, 11 [mut] vs. 71 [wt] months; p = 0.036), and NUP98 and STAG2 mutations (median OS, 27 and 11 vs. 71 months, respectively; p = 0.008 and p = 0.002). Mutations in CHIP genes (TET2, DNMT3A) did not significantly affect the clinical features or outcome. Our results suggest that a more comprehensive NGS study in low-risk MDS SF3B1mut patients is essential for a better prognostic evaluation.

COVID-19 and Multisystem Inflammatory Syndrome in Latin American Children: A Multinational Study.

BACKGROUND: To date, there are no comprehensive data on pediatric COVID-19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Latin American children, to appropriately plan and allocate resources to face the pandemic on a local and international level. METHODS: Ambispective multicenter cohort study from 5 Latin American countries. Children 18 years of age or younger with microbiologically confirmed SARS-CoV-2 infection or fulfilling MIS-C definition were included. FINDINGS: Four hundred nine children were included, with a median age of 3.0 years (interquartile range 0.6-9.0). Of these, 95 (23.2%) were diagnosed with MIS-C. One hundred ninety-one (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a pediatric intensive care unit. Ninety-two (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure and 29 (7%) on mechanical ventilation. Thirty-five (8.5%) patients required inotropic support. The following factors were associated with pediatric intensive care unit admission: preexisting medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P < 0.0001), gastrointestinal symptoms (P = 0.006), radiologic changes suggestive of pneumonia and acute respiratory distress syndrome (P < 0.0001) and low socioeconomic conditions (P = 0.009). CONCLUSIONS: This study shows a generally more severe form of COVID-19 and a high number of MIS-C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hispanic children or in people of lower socioeconomic level. The findings highlight an urgent need for more data on COVID-19 in Latin America.

Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-Cell Lymphoma.

The biology and clinical impact of bone marrow (BM) infiltration in patients with diffuse large B-cell lymphoma (DLBCL) remains unclear in the rituximab era. We retrospectively analyzed 232 patients diagnosed with DLBCL at our center between 1999 and 2014. Concordant-presence of large cells similar to those of the lymph node biopsy- and discordant-infiltration by small cells forming lymphoid aggregates, lacking cytological atypia-BM infiltration was defined by histological criteria and further characterized by flow cytometry (FCM). Cell of origin (COO) was determined using Hans' algorithm. For the clonal relationship between tumor and discordant BM, the VDJH rearrangement was analyzed. Survival analyses were restricted to 189 patients treated with rituximab and chemotherapy. Thirty-six (16%) had concordant, and 37 (16%) discordant BM infiltration. FCM described different indolent lymphomas among discordant cases, clonally related with DLBCL in 10/13 available samples. Median follow-up was 58 months. 5-year-progression-free survival (PFS) for non-infiltrated, discordant and concordant groups was 68%, 65% and 30%, respectively (p < 0.001). Combining COO and BM infiltration, patients with discordant BM and non-germinal center B-cell COO also had decreased 5-year-PFS (41.9%). In multivariate analysis, concordant BM had an independent effect on PFS (HR 2.5, p = 0.01). Five-year cumulative incidence of central nervous system (CNS) relapse was 21%, 4% and 1% in concordant, discordant and non-infiltrated groups, respectively (p < 0.001). In conclusion, concordant BM infiltration represents a subset with poor prognosis, whereas the prognostic impact of discordant BM infiltration could be limited to non-CGB cases.

Chronic graft-versus-host disease could ameliorate the impact of adverse somatic mutations in patients with myelodysplastic syndromes and hematopoietic stem cell transplantation.

Somatic mutations in patients with myelodysplastic syndromes (MDS) undergoing allogeneic hematopoietic stem cell transplantation (HSTC) are associated with adverse outcome, but the role of chronic graft-versus-host disease (cGVHD) in this subset of patients remains unknown. We analyzed bone marrow samples from 115 patients with MDS collected prior to HSCT using next-generation sequencing. Seventy-one patients (61%) had at least one mutated gene. We found that patients with a higher number of mutated genes (more than 2) had a worse outcome (2 years overall survival [OS] 54.8% vs. 31.1%, p = 0.035). The only two significant variables in the multivariate analysis for OS were TET2 mutations (p = 0.046) and the development of cGVHD, considered as a time-dependent variable (p < 0.001), correlated with a worse and a better outcome, respectively. TP53 mutations also demonstrated impact on the cumulative incidence of relapse (CIR) (1 year CIR 47.1% vs. 9.8%, p = 0.006) and were related with complex karyotype (p = 0.003). cGVHD improved the outcome even among patients with more than 2 mutated genes (1-year OS 88.9% at 1 year vs. 31.3%, p = 0.02) and patients with TP53 mutations (1-year CIR 20% vs. 42.9%, p = 0.553). These results confirm that cGVHD could ameliorate the adverse impact of somatic mutations in patients with MDS with HSCT.

Functional morphology of the gonoduct of the viviparous teleost Poeciliopsis gracilis (Heckel, 1848) (Poeciliidae).

Female teleosts do not develop Müllerian ducts; consequently, the ovary of teleosts contains two zones: germinal and gonoduct. The gonoduct lacks germinal cells, but has relevant functions in the reproductive process. We describe the functional morphology of the gonoduct in the viviparous teleost Poeciliopsis gracilis during nongestation and gestation stages. This study tests the hypothesis that the gonoduct functions as a barrier between the germinal zone and the exterior. By providing information about morphology and function of the gonoduct we show that this part of the ovary has an essential role in the reproduction of teleosts. The ovaries were processed by histological technique and stained with hematoxylin-eosin (H-E), Masson's trichrome, toluidine blue and periodic acid-Schiff (PAS). The gonoduct is divided into three regions: cephalic, middle, and caudal. In the cephalic and middle regions there are mucosal folds that extend into the gonoductal lumen, forming structures similar to a cervix. The caudal region has two portions: the anterior contains a dorsal invagination and exocrine glands among columnar cells; the posterior has a ventral flexion and stratified epithelium with apical secretory cells. The morphology of this epithelium indicates two functions: (a) secretory by the apical columnar cells, and (b) protection through the stratification. Another peculiarity of the caudal region is that both ducts, reproductive and digestive, converge in a common cavity at their caudal ends, forming a cloacal region. The histology of the gonoduct indicates relevant functions including: (1) the control of the luminal diameter by the muscle and the presence of mucosal folds, like a cervix; (2) the relationship with the spermatozoa during insemination and storing them in mucosal folds; (3) the support of immunological processes; (4) secretory activities; (5) forming the duct during birth; and (6) possibly, acts as a barrier against parasite infestations.

Late differentiation syndrome in acute promyelocytic leukemia: a challenging diagnosis.

Detailed knowledge about differentiation syndrome (DS) has remained limited. There are 2 large studies conducted by the Spanish workgroup PETHEMA (Programa Español de Tratamientos en Hematología; Spanish Program on Hematology Treatments) and the European group trial (LPA 96-99 and APL 93) in which the incidence, characteristics, prognostic factors and outcome of patients developing DS are evaluated. Both have described the median time of DS development between 10 and 12 days. The severity of the DS has been evaluated in the study conducted by PETHEMA, and severe DS usually occurs at the beginning of the treatment (median of 6 days), as compared with moderate DS (median of 15 days). We report here in two cases of late severe DS, with late diagnosis due to both time and form of presentation. We discuss the physiopathology, clinical presentation, prophylaxis and treatment of DS.

Structure of the female gonoduct of the viviparous teleost Poecilia reticulata (Poeciliidae) during nongestation and gestation stages.

Female teleosts do not have oviducts because Müllerian ducts do not develop. Instead, the caudal region of the ovary, the gonoduct, connects to the exterior. Because of the lack of oviducts in viviparous teleosts, the embryos develop in the ovary, as an intraovarian gestation, unique in vertebrates. This is the first study to address the histology of the gonoduct in a viviparous teleost. The gonoduct of Poecilia reticulata was analyzed during previtellogenesis, vitellogenesis, and gestation. The gonoduct lacks germinal cells. From deep to superficial, the wall has simple cuboidal or columnar epithelium, loose connective tissue, longitudinal layer of smooth muscle, and visceral peritoneum. Cells of the immune system occur in the lumen and in the mucosa. The gonoduct was divided in three regions: 1) cephalic, 2) middle, and 3) caudal. At the initial part of each region, thin mucosal folds extend into the lumen. The cephalic region forms a tubular structure with light and irregular folds. The middle region has a wider lumen and is more irregular due to ventral invaginations and irregular and short mucosal folds; beneath the epithelium there are melano-macrophage centers. The caudal region is delimited from the middle region by folds; however, they are thinner than these of the other regions. Ventral invaginations form exocrine glands, and the smooth muscle is thicker than in the other regions. During gestation, cells of the immune system are abundant; melano-macrophage centers become larger and the glands exhibit desquamated cells. These observations suggest roles of the gonoduct in reducing the diameter of the lumen; receiving sperm during vitellogenesis; producing secretions, more abundant during vitellogenesis; and in immunological activity throughout the reproductive cycle. The ciliated epithelium and the thick muscle of the caudal region may be involved during birth.

Alternativa para la enseñanza de la física en las tecnologías de la salud: una propuesta desde la experiencia / Alternative to teaching physics in health technologies: a proposal from the experience

Se empleó la investigación de acción participativa, como referente teórico y metodológico, la cual permitió la preparación de los profesores de la asignatura Física General para la transformación de su práctica docente en la Facultad de Tecnología de la Salud "Dr. Juan Manuel Páez Inchausti" de Santiago de Cuba, durante el curso académico 2011-2012. La alternativa propuesta transitó por 3 fases fundamentales que coinciden con las etapas del estudio. La muestra estuvo constituida por 10 docentes y 100 estudiantes de las especialidades de Rehabilitación Integral en Salud, Nutrición e Imagenología y Radiofísica Médica. La profundización y sistematización de los contenidos biomédicos y físicos, respectivamente, así como su actualización y aplicación tecnológica desde el enfoque ciencia-tecnología-sociedad, constituyeron opciones viables para un mejor desarrollo del proceso enseñanza-aprendizaje de dicha asignatura.

Participatory action research was used as theoretical and methodological reference that allowed the qualifications of teachers of the General Physics subject for transforming their teaching practice in "Dr. Juan Manuel Páez Inchausti" Faculty of Health Technology of Santiago de Cuba during 2011-2012. The alternative proposed were divided into 3 main phases that coincide with the stages of study. The sample was formed by 10 teachers and 100 students of the specialties of Comprehensive Rehabilitation in Health, Nutrition and Imaging and Medical Radiophysics. The deepening and systematizating the biomedical and physical contents, respectively, as well as their updating and technological implementation from the scientific, technological and societal approach, were viable options for a better development of the teaching - learning process of this subject.

Alternativa para la enseñanza de la física en las tecnologías de la salud: una propuesta desde la experiencia / Alternative to teaching physics in health technologies: a proposal from the experience

Se empleó la investigación de acción participativa, como referente teórico y metodológico, la cual permitió la preparación de los profesores de la asignatura Física General para la transformación de su práctica docente en la Facultad de Tecnología de la Salud Dr Juan Manuel Páez Inchausti de Santiago de Cuba, durante el curso académico 2011-2012. La alternativa propuesta transitó por 3 fases fundamentales que coinciden con las etapas del estudio. La muestra estuvo constituida por 10 docentes y 100 estudiantes de las especialidades de Rehabilitación Integral en Salud, Nutrición e Imagenología y Radiofísica Médica. La profundización y sistematización de los contenidos biomédicos y físicos, respectivamente, así como su actualización y aplicación tecnológica desde el enfoque ciencia-tecnología-sociedad, constituyeron opciones viables para un mejor desarrollo del proceso enseñanza-aprendizaje de dicha asignatura(AU)

Participatory action research was used as theoretical and methodological reference that allowed the qualifications of teachers of the General Physics subject for transforming their teaching practice in Dr Juan Manuel Páez Inchausti Faculty of Health Technology of Santiago de Cuba during 2011-2012. The alternative proposed were divided into 3 main phases that coincide with the stages of study. The sample was formed by 10 teachers and 100 students of the specialties of Comprehensive Rehabilitation in Health, Nutrition and Imaging and Medical Radiophysics. The deepening and systematizating the biomedical and physical contents, respectively, as well as their updating and technological implementation from the scientific, technological and societal approach, were viable options for a better development of the teaching - learning process of this subject(AU)

Refractive results of cataract surgery using optical biometry and Haigis formula in eyes with refractive keratotomy

OBJECTIVE: To analyze refractive results in postoperative cataract surgery in eyes previously submitted to keratotomy using Haigis formula and data provided by IOL Master®optical biometer. METHODS: The measurements for IOL calculation were obtained through optical biometry by partial coherence interferometry (IOL Master®- Zeiss, 5.4 and 5.5 version) that provides us with the axial length, the central keratometry of 2.5mm, white-to-white diameter and anterior chamber anatomical depth. The formula chosen was Haigis. The surgical technique applied was with the scleral incision at 1.5 mm from the limbus, with scleral-corneal tunnel of 2.2 mm wide, phacoemulsification using INFINITI Ozil®- Alcon and implantation of hydrophobic acrylic aspheric intraocular lens - SN60WF®- Alcon. RESULTS: We studied 20 eyes submitted to keratotomy in the past and currently with cataract with indication for cataract surgerywith intraocular lens implantation using phacoemulsification. Postoperative spherical equivalent was plano in 40% of the eyes and lower than -1.00 in 85% of the eyes. CONCLUSION: The optical biometry by partial coherence interferometry associated with Haigis formula is a valid alternative in IOL calculation for eyes submitted to keratotomy. The refractive results are highly predictable and reproducible.

OBJETIVO: Analisar os resultados refracionais no pós-operatório de cirurgia de catarata em olhos previamente submetidos à ceratotomia, utilizando a fórmula Haigis e os dados fornecidos pelo biômetro óptico IOL Master®. MÉTODOS: As medidas para o cálculo da LIO foram obtidas por meio da biometria óptica por interferometria de coerência parcial (IOL Master® - Zeiss, versão 5.4 e 5.5) que nos fornece o comprimento axial, a ceratometria central de 2.5mm, o diâmetro branco-a-branco e a profundidade anatômica da câmara anterior. A fórmula escolhida foi a Haigis. A técnica cirúrgica aplicada foi com incisão escleral a 1.5mm do limbo, com túnel esclero-corneal de 2.2mm de largura, facoemulsificação com equipamento INFINITI Ozil® - Alcon e implante de lente intraocular acrílica hidrofóbica asférica - SN60WF® - Alcon. RESULTADOS: Foram estudados 20 olhos submetidos à ceratotomia no passado e atualmente portadores de catarata com indicação de facectomia com implante de lente intraocular por meio da facoemulsificação. O equivalente esférico pós-operatório foi plano em 40% dos olhos e menor que -1.00 em 85% dos olhos. CONCLUSÃO: A biometria óptica por interferometria de coerência parcial associada à fórmula Haigis se apresenta como uma alternativa válida no cálculo da LIO em olhos submetidos à ceratotomia. Os resultados refrativos são altamente previsíveis e reproduzíveis.

A capsulotomia descontínua durante a facoemulsificação / Discontinuous capsulotomy during phacoemulsification

OBJETIVO: Descrever a prevalência, localização e causas da capsulotomia descontínua durante a cirurgia de catarata por facoemulsificação. MÉTODOS: Estudo retrospectivo, consecutivo, não comparativo de 971 cirurgias de catarata com capsulotomia descontínua no per-cirúrgico entre janeiro de 2009 a junho de 2010. RESULTADOS: Observou-se uma prevalência de 0,02 por cento e a descontinuação da cápsula ocorreu em 100 por cento das vezes durante o tratamento do núcleo. Em 58.33 por cento dos olhos o implante foi realizado no saco capsular e em 41.67 por cento no sulco ciliar. A AV > 20/30 em 100 por cento dos olhos. CONCLUSÃO: apesar de ser uma intercorrência pouco frequente, pode comprometer o resultado final.

OBJECTIVE: To describe the prevalence, location and causes of discontinuous capsulotomy during phacoemulsification cataract surgery. METHODS: Retrospective, consecutive, non-comparative study of 971 cataract surgeries - with discontinuous capsulotomy during surgery - performed from January 2009 to June 2010. RESULTS: it was observed a prevalence of 0.02 percent and capsule discontinuation occurring 100 percent of the time during the treatment of the nucleus. In 58.33 percent of the eyes the implant was done in the capsular bag and in 41.67 percent in the ciliary sulcus. VA > 20/30 in 100 percent of the eyes. CONCLUSION: despite the fact that it is a not too frequent event, it may compromise the final result.

Sensitivity versus accuracy in multiclass problems using memetic Pareto evolutionary neural networks.

This paper proposes a multiclassification algorithm using multilayer perceptron neural network models. It tries to boost two conflicting main objectives of multiclassifiers: a high correct classification rate level and a high classification rate for each class. This last objective is not usually optimized in classification, but is considered here given the need to obtain high precision in each class in real problems. To solve this machine learning problem, we use a Pareto-based multiobjective optimization methodology based on a memetic evolutionary algorithm. We consider a memetic Pareto evolutionary approach based on the NSGA2 evolutionary algorithm (MPENSGA2). Once the Pareto front is built, two strategies or automatic individual selection are used: the best model in accuracy and the best model in sensitivity (extremes in the Pareto front). These methodologies are applied to solve 17 classification benchmark problems obtained from the University of California at Irvine (UCI) repository and one complex real classification problem. The models obtained show high accuracy and a high classification rate for each class.