Observation of the radiative decay of the 229Th nuclear clock isomer.

The radionuclide thorium-229 features an isomer with an exceptionally low excitation energy that enables direct laser manipulation of nuclear states. It constitutes one of the leading candidates for use in next-generation optical clocks1-3. This nuclear clock will be a unique tool for precise tests of fundamental physics4-9. Whereas indirect experimental evidence for the existence of such an extraordinary nuclear state is substantially older10, the proof of existence has been delivered only recently by observing the isomer's electron conversion decay11. The isomer's excitation energy, nuclear spin and electromagnetic moments, the electron conversion lifetime and a refined energy of the isomer have been measured12-16. In spite of recent progress, the isomer's radiative decay, a key ingredient for the development of a nuclear clock, remained unobserved. Here, we report the detection of the radiative decay of this low-energy isomer in thorium-229 (229mTh). By performing vacuum-ultraviolet spectroscopy of 229mTh incorporated into large-bandgap CaF2 and MgF2 crystals at the ISOLDE facility at CERN, photons of 8.338(24) eV are measured, in agreement with recent measurements14-16 and the uncertainty is decreased by a factor of seven. The half-life of 229mTh embedded in MgF2 is determined to be 670(102) s. The observation of the radiative decay in a large-bandgap crystal has important consequences for the design of a future nuclear clock and the improved uncertainty of the energy eases the search for direct laser excitation of the atomic nucleus.

Rehabilitation After Surgical Treatment of Pectoralis Major Rupture in a CrossFit® Practitioner: A Case Report.

Background and Purpose: The upper limbs are frequently injured during CrossFit® practice, and in some cases, surgical repair is recommended. The purpose of this case report was to describe the rehabilitation process performed after the surgical repair of a pectoralis major rupture in a CrossFit® practitioner. Design: Case report. Case Description: The subject was a 26-year-old man, with 1.75m and 69kg, who practiced CrossFit® for five years and sustained the injury during the execution of the ring dip. The rehabilitation protocol was of 16 weeks duration. Passive modalities and exercises focusing on range of motion, muscle strength, and CrossFit®-specific movements were performed. Shoulder range of motion was assessed through goniometry, and muscle strength was assessed through isometric dynamometry. Outcomes: At week seven the subject had full range of motion, and at week fourteen achieved limb symmetry (Limb Symmetry Index - 84.78 - Abduction; 97.58 - Adduction; 86.15 - Internal Rotation; 85.06 - External Rotation) in muscle strength. The subject returned to his previous level of athletic activities. Conclusions: A 16-week protocol performed with exercises focusing on range of motion, muscle strength, and CrossFit®-specific movements was abe to promote the return to sport at the pre-injury level in a CrossFit® practitioner.

Immediate Breast Reconstruction with Prosthesis and Titanized Mesh Using a Dual-Plane Approach: Complications and Risk Factors Analysis.

INTRODUCTION: The immediate breast reconstruction after mastectomy has gained prominence in recent years and is considered one of the main procedures in oncoplastic surgery. In the case of reconstruction with prostheses, the use of a mesh to extend the pectoralis major muscle is often required to partially cover the implant. The main objective of this study was to determine the percentage of complications in immediate breast reconstructions with a titanized mesh using a dual-plane approach and establish risk factors for prosthesis complications and extrusion. MATERIALS AND METHODS: A retrospective study that included women who received postmastectomy reconstructions from January 2012 to December 2019 in a secondary hospital in Spain. RESULTS: A total of 57 immediate reconstructions were performed in 47 women. There were complications in 16 mastectomies (28.1%), of which seven (12.3%) were Clavien-Dindo ≤ IIIa and nine (15.7%) were IIIb. A total of three patients presented prosthetic extrusion, and the prosthesis was removed in five. The degree of contracture according to the Baker scale was I-II in 50 mastectomies (87.7%) and III-IV in seven (12.3%). CONCLUSION: The immediate breast reconstruction with a titanized mesh using a dual-plane approach is a technique with an acceptable percentage of complications. The need for a Wise pattern and the necrosis of the nipple-areola complex in the postoperative period are risk factors for implant loss. Patients undergoing radiotherapy and/or chemotherapy and with a previous surgery are more likely to present capsular contracture. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors.

Estimación de la prevalencia de los trastornos del espectro autista en centros de atención precoz en Cataluña / Estimation of the prevalence of autism spectrum disorders in early care centres in Catalonia / Estimació de la prevalença dels trastorns de l’espectre autista en centres d’atenció precoç a Catalunya

El objetivo del estudio es realizar una estimación de la prevalencia de los niños y niñas con trastornos del espec­tro autista (TEA) atendidos en ocho Centros de Desarrollo Infantil y de Atención Precoz (CDIAP) en Cataluña y cuantificar los menores de 31 meses que incluimos en el grupo de riesgo de TEA, así como crear una herramienta (APTEA.cat) útil para la recogida de datos de los centros comprendidos en el estudio. La prevalencia obtenida se acerca a los 1:160 según la OMS (2018b). Identificar a la población de riesgo por presencia de signos de alerta pone de manifiesto la necesidad de incrementar los programas de sensibilización y formación de los profesiona­les que atienden al niño o niña para potenciar la detección lo más pronto posible

The study aims at estimating the prevalence of children with autism spectrum disorders (ASD) in eight of the Catalan Child Deve­lopment and Early Care Centres (CDIAP) and to quantify the children under 31 months included in the ASD risk group, as well as to create a tool (APTEA.cat) to collect data from the centres that took part in the study. The prevalence obtained is close to 1:160 according to the WHO (2018). Identifying the population at risk due to the warning signs highlights the need to increase the number of awareness and training programmes for professio­nals who assist children; so that early detection is enhanced

L'objectiu de l'estudi és realitzar una estimació de la prevalença dels nens I nenes amb trastorns de l'espectre autista (TEA) atesos a vuit centres de desenvolupament infantil I d'atenció precoç (CDIAP) a Catalunya I quantificar els menors de 31 mesos que vam incloure en el grup de risc de TEA, així com crear una eina (APTEA.cat) útil per a la recollida de dades dels centres compresos a l'estudi. La prevalença obtinguda s'apropa als 1:160 segons l'OMS (2018). Identi­ficar la població de risc per la presència de signes d'alerta posa de manifest la necessitat d'incrementar els progra­mes de sensibilització I formació dels professionals que atenen el nen o nena per potenciar la detecció el més aviat posible

Repercusión en el manejo quirúrgico de la ecografía de reevaluación para caracterización de lesiones detectadas en resonancia magnética / Effect on surgical management of second-look ultrasound to characterise lesions detected by magnetic resonance imaging

INTRODUCCIÓN: La ecografía de reevaluación, o de «second-look» (ESL), es útil para caracterizar lesiones de nueva aparición identificadas durante el estudio mediante resonancia magnética (RM). También puede ayudar a optimizar el tratamiento quirúrgico, ya que permite realizar biopsias y obtener un resultado anatomopatológico de las lesiones. El objetivo de este estudio es determinar la utilidad de la ESL para la identificación y la caracterización de lesiones detectadas incidentalmente por RM, así como la repercusión posterior en el manejo quirúrgico. MATERIAL Y MÉTODO: Se realizó un estudio observacional retrospectivo en el que se incluyen mujeres diagnosticadas de cáncer de mama a las que se les realiza ESL tras RM, entre 2013 y 2015. Se recogieron datos epidemiológicos, del tumor primario, características de las lesiones identificadas por RM y posteriormente por ESL, procedimientos quirúrgicos y resultados anatomopatológicos. RESULTADOS: Se identificaron 168 lesiones nuevas mediante RM en 110 pacientes. De ellas, 123 (73,2%) fueron objetivadas posteriormente en la ESL. De acuerdo con el sistema BI-RADS, 88 (71,6%) lesiones se caracterizaron como BI-RADS3 y 24 (19,5%) como BI-RADS4. El resultado de la biopsia tras ESL fue de malignidad en 17 lesiones, lo cual conlleva un cambio de actitud quirúrgica en 15 pacientes. CONCLUSIONES: La ESL puede ser útil para optimizar el tratamiento quirúrgico de las pacientes con cáncer de mama en las que se detecta una nueva lesión mediante RM, permitiendo caracterizar, localizar dicha lesión y realizar biopsias para obtener un resultado anatomopatológico que nos ayude a decidir si es necesaria su exéresis

INTRODUCTION: Second-look ultrasound (SLU) is useful to characterise new lesions identified by magnetic resonance imaging (MRI). SLU may also help to optimise surgical treatment since it allows the performance of biopsies and histopathological analysis of the lesions. The aim of this study was to determine the utility of SLU to identify and characterise lesions initially detected by MRI, as well as its subsequent influence on surgical management. MATERIAL AND METHOD: We performed an observational retrospective study that included women diagnosed with breast cancer who underwent SLU after MRI between 2013 and 2015. We collected data on epidemiological factors, the primary tumour, the characteristics of the lesions identified by MRI and subsequently by SLU, surgical procedures, and histopathological results. RESULTS: A total of 168 new lesions were identified by MRI in 110 patients. Of these, 123 (73.2%) were subsequently identified in SLU. Using the BI-RADS system, 88 (71.6%) lesions were classified as BI-RADS3 and 24 (19.5%) as BI-RADS4. The result of biopsy after SLU was malignancy in 17 lesions, leading to a change of surgical management in 15 patients. CONCLUSIONS: SLU can be useful to optimise the surgical treatment of patients with breast cancer and detection of a new lesion by MRI. SLU allows these lesions to be characterised and localised and biopsies to be taken. This in turn allows histopathological analysis, which helps to determine the need for extirpation of the lesion

El grupo terapéutico con niños pequeños como tránsito entre familia y escuela: Experiencia grupal: historia de la construcción de un tren / Group therapy eith young children as a transition between family and school: Group experience: The history of building a train

En este artículo se reflexiona sobre los grupos terapéuticos en Atención Precoz. Se expone una experiencia grupal llevada a cabo en el CDIAP Equip40 con un grupo de niños pequeños conducido por una psicóloga y una fisioterapeuta. A través de viñetas clínicas, se describe el proceso terapéutico desde una mirada interdisciplinar y se muestran diferentes tipos de intervenciones

This article reflects on therapeutic groups in Early Years. It deals with a group experience carried out at the CDIAP Equip40 with a group of young children conducted by a psychologist and a physiotherapist. Through clinical vignettes, the therapeutic process is described from an interdisciplinary perspective and different types of interventions are shown

Atom-at-a-time laser resonance ionization spectroscopy of nobelium.

Optical spectroscopy of a primordial isotope has traditionally formed the basis for understanding the atomic structure of an element. Such studies have been conducted for most elements and theoretical modelling can be performed to high precision, taking into account relativistic effects that scale approximately as the square of the atomic number. However, for the transfermium elements (those with atomic numbers greater than 100), the atomic structure is experimentally unknown. These radioactive elements are produced in nuclear fusion reactions at rates of only a few atoms per second at most and must be studied immediately following their production, which has so far precluded their optical spectroscopy. Here we report laser resonance ionization spectroscopy of nobelium (No; atomic number 102) in single-atom-at-a-time quantities, in which we identify the ground-state transition 1S01P1. By combining this result with data from an observed Rydberg series, we obtain an upper limit for the ionization potential of nobelium. These accurate results from direct laser excitations of outer-shell electrons cannot be achieved using state-of-the-art relativistic many-body calculations that include quantum electrodynamic effects, owing to large uncertainties in the modelled transition energies of the complex systems under consideration. Our work opens the door to high-precision measurements of various atomic and nuclear properties of elements heavier than nobelium, and motivates future theoretical work.

Tratamiento laparoscópico del quiste esplénico primario / Laparoscopic treatment of primary splenic cyst

No disponible

Mastopatía fibrosa diabética: descripción de un caso con afectación bilateral y regresión espontánea evolutiva / Diabetic fibrous breast disease: description of a case with bilateral involvement and gradual spontaneous regression

Describimos los hallazgos clínicos, radiológicos e histopatológicos de esta rara enfermedad benigna de la mama en una paciente de 28 años de edad con diabetes mellitus insulino-dependiente de larga evolución. La paciente presentó tumoraciones mamarias bilaterales. La mamografía demostró mamas densas, y el examen ecográfico puso de manifiesto masas bilaterales anecoicas de bordes irregulares con sombra acústica posterior. Mediante punción aspiración con aguja fina se obtuvo un material hialino amorfo y acelular. Se practicó biopsia quirúrgica extrayendo muestras en ambas mamas, objetivando en el análisis histológico una fibrosis queloide con lobulitis linfocítica. Los hallazgos clínicos e histológicos sugirieron el diagnóstico de mastopatía fibrosa diabética. En el seguimiento clínico en un período de ocho años, se constató la regresión espontánea de las masas mamarias. Confirmamos los hallazgos publicados previamente en la bilbiografía, sugiriendo que aquellos pacientes que cumplan los criterios clínicos, citológicos y de imagen de mastopatía fibrosa diabética puedan ser controlados clínicamente, evitándose la biopsia quirúrgica. (AU)

Eritroplasia de la cavidad oral. Una lesión precancerosa agresiva: presentación de seis casos clínicos / Erythroplakia of the oral cavity. An aggressive premalignant lesion: presentation of six case reports

La eritroplasia es la lesión precancerosa más agresiva de la cavidad oral. Es una lesión poco frecuente y existen pocas series descritas en la literatura. Se caracteriza por la presencia de una placa de color rojo vivo, plana o ligeramente elevada, de superficie aterciopelada y de bordes irregulares aunque bien definidos. El diagnóstico se realiza por la clínica y debe realizarse siempre una biopsia. Presentamos seis casos de eritroplasia oral con el estudio histopatológico, la clínica y la evolución. La eritroplasia es una lesión con un altísimo potencial de transformación maligna; en ocasiones, en el momento del diagnóstico es ya un carcinoma epidermoide. El tratamiento de elección es la resección quirúrgica y eliminación de los posibles factores etiológicos (AU)

La red asistencial de salud y el papel de los jefes de servicios clínicos en su gestión: un punto de vista desde el Hospital Clínico San Borja Arriarán / Health assistance net and the role of the clinical services chiefs in it management: a point of view under the San Borja Arriarán clinical hospital

Se analizan los niveles de atención en las áreas de Salud de Chile, y en especial los problemas del nivel primario. Entre estos problemas se destacan: los" de naturaleza médica profesional; la administración municipal, que ha desmembrado la red de atención; y la insuficiencia de acciones de promoción basadas en el modelo biopsicosocial de la persona. Se examina la realidad de las relaciones entre el nivel primario y el secundario; el rol de los Centros de Diagnóstico y Tratamiento (CDT) y el de atención cerrada. Se concluye, sobre la base de la experiencia de los autores, que los jefes de servicios clínicos, o el profesor universitario, o ambos en el marco de un consejo técnico de la red deben planificar, supervisar y evaluar todos los niveles de la red local, incluyendo los consultorios o centros de salud y los CDT, con el objeto de entregar una atención médica integrada, continua y de calidad