A shared accretion instability for black holes and neutron stars.

Accretion disks around compact objects are expected to enter an unstable phase at high luminosity1. One instability may occur when the radiation pressure generated by accretion modifies the disk viscosity, resulting in the cyclic depletion and refilling of the inner disk on short timescales2. Such a scenario, however, has only been quantitatively verified for a single stellar-mass black hole3-5. Although there are hints of these cycles in a few isolated cases6-10, their apparent absence in the variable emission of most bright accreting neutron stars and black holes has been a continuing puzzle11. Here we report the presence of the same multiwavelength instability around an accreting neutron star. Moreover, we show that the variability across the electromagnetic spectrum-from radio to X-ray-of both black holes and neutron stars at high accretion rates can be explained consistently if the accretion disks are unstable, producing relativistic ejections during transitions that deplete or refill the inner disk. Such a new association allows us to identify the main physical components responsible for the fast multiwavelength variability of highly accreting compact objects.

A persistent ultraviolet outflow from an accreting neutron star binary transient.

All disc-accreting astrophysical objects produce powerful disc winds. In compact binaries containing neutron stars or black holes, accretion often takes place during violent outbursts. The main disc wind signatures during these eruptions are blue-shifted X-ray absorption lines, which are preferentially seen in disc-dominated 'soft states'1,2. By contrast, optical wind-formed lines have recently been detected in 'hard states', when a hot corona dominates the luminosity3. The relationship between these signatures is unknown, and no erupting system has as yet revealed wind-formed lines between the X-ray and optical bands, despite the many strong resonance transitions in this ultraviolet (UV) region4. Here we report that the transient neutron star binary Swift J1858.6-0814 exhibits wind-formed, blue-shifted absorption lines associated with C IV, N V and He II in time-resolved UV spectroscopy during a luminous hard state, which we interpret as a warm, moderately ionized outflow component in this state. Simultaneously observed optical lines also display transient blue-shifted absorption. Decomposing the UV data into constant and variable components, the blue-shifted absorption is associated with the former. This implies that the outflow is not associated with the luminous flares in the data. The joint presence of UV and optical wind features reveals a multi-phase and/or spatially stratified evaporative outflow from the outer disc5. This type of persistent mass loss across all accretion states has been predicted by radiation-hydrodynamic simulations6 and helps to explain the shorter-than-expected duration of outbursts7.

Immune checkpoint expression on peripheral cytotoxic lymphocytes in cervical cancer patients: moving beyond the PD-1/PD-L1 axis.

Immune checkpoint therapy to reverse natural killer (NK) and T cell exhaustion has emerged as a promising treatment in various cancers. While anti-programmed cell death 1 (PD-1) pembrolizumab has recently gained Food and Drug Administration (FDA) approval for use in recurrent or metastatic cervical cancer, other checkpoint molecules, such as T cell immunoreceptor with immunoglobulin (Ig) and immunoreceptor tyrosine-based inhibition motif (ITIM) domains (TIGIT) and T cell immunoglobulin and mucin-domain containing-3 (Tim-3), have yet to be fully explored in this disease. We report expression of TIGIT, Tim-3 and PD-1 on subsets of peripheral blood NK (CD56dim/neg CD16bright/dim/neg and CD56bright CD16dim/neg ) and T cells. The percentages of these cells were increased in women with cervical cancer and pre-malignant lesions. PD-1+ NK and T cells were likely to co-express TIGIT and/or Tim-3. These cells, with an apparently 'exhausted' phenotype, were augmented in patients. A subset of cells were also natural killer group 2 member D (NKG2D)- and DNAX accessory molecule 1 (DNAM-1)-positive. PD-1int and PD-1high T cells were notably increased in cervical cancer. Soluble programmed cell death ligand 1 (PD-L1) was higher in cancer patient blood versus healthy donors and we observed a positive correlation between sPD-L1 and PD-1+ T cells in women with low-grade lesions. Within the cancer group, there were no significant correlations between sPD-L1 levels and cervical cancer stage. However, when comparing cancer versus healthy donors, we observed an inverse association between sPD-L1 and total T cells and a correlation between sPD-L1 and CD56dim NK cells. Our results may show an overview of the immune response towards pre-cancerous lesions and cervical cancer, perhaps giving an early clue as to whom to administer blocking therapies. The increase of multiple checkpoint markers may aid in identifying patients uniquely responsive to combined antibody therapies.

Extrofia vesical y vejiga rectal / No disponible

No disponible

Budd-Chiari Syndrome in a Patient with JAK-2 V617F and Factor V G1691A Mutations.

Myeloproliferative neoplasms (MPN) are considered a risk factor for Budd-Chiari syndrome (BCS). The current classification of MPN by the World Health Organization is based on the presence of JAK-2 V617F somatic mutation, which is present in 40 to 60% of patients with BCS. Factor V Leiden mutation is found in around 53% of patients with BCS, representing the most common prothrombotic disease associated with the disorder. We describe a 48-year old woman with a past medical history of deep venous thrombosis in the left upper extremity and one episode in both lower extremities, one episode of transient ischaemic attack and essential thrombocythemia, who presented with jaundice, ascites and hepatomegaly. Budd-Chiari syndrome was diagnosed based on findings on Doppler ultrasound and liver biopsy. Doppler ultrasound showed narrowness of hepatic veins and inferior vena cava in its hepatic portion, diffuse echotexture and portal hypertension. Liver biopsy showed congestion of sinusoids and portal fibrosis. The patient was found to be a heterozygous carrier of Factor V and homozygous wild type G20210A prothrombin mutations. The JAK-2 V617F mutation was detected by allele-specific polymerase chain reaction (AS-PCR). The association of these mutations is rare, with only a few cases reported in the literature. The patient was treated with oral anticoagulation and antiplatelets with good results and proper follow-up. In conclusion, due to the possible coexistence of multiple prothrombotic factors in patients with Budd-Chiari syndrome, the approach to these patients must be focussed on searching for multiple factors and should include the JAK-2 V617F mutation.

Urinoma secondary to ureteropelvic junction obstruction in the neonate. Presentation of a case and bibliographic review.

OBJECTIVE: To analyze the management of prenatal urinoma and ureteropelvic junction obstruction (UPJO) postnatally by a case report and literature review. METHODS: We report a case of an UPJO and urinoma in a newborn. After birth, renal function was absent, and nephrectomy was performed. The literature from 1985 to date has been reviewed. DISCUSSION: By the analysis of the literature, we can observe mainly, that prenatally diagnosed urinoma and UPJO are managed conservatively. After birth, different attitudes have been carried out, independently of residual renal function, such as radical or reconstructive surgery, or conservative treatment. CONCLUSION: Intrauterine management is not indicated. Urinary diversion is indicated in symptomatic cases secondary to renal trauma or endoscopic procedure. In non-functional kidney, nephrectomy is indicated.

Urinoma secundario a estenosis de la unión pieloureteral en el neonato. Presentación de un caso y revisión de la literatura / Urinoma secondary to ureteropelvic junction obstruction in the neonate. Presentation of a case and bibliographic review

OBJETIVO: Analizar el manejo del urinoma prenatal y de la estenosis de la unión pieloureteral postnatalmente mediante el estudio de un caso y revisión bibliográfica. MÉTODOS: Se presenta el caso de neonato con EUPU y urinoma. Se comprueba función renal anulada, realizándose nefrectomía. Se ha revisado la literatura desde 1985 hasta la actualidad. DISCUSIÓN: Analizando la literatura, se observa mayoritariamente que el tratamiento de la EUPU y urinoma prenatales es conservador. Tras el nacimiento existen diversas actitudes, independientemente de la función renal remanente, como son la cirugía radical, la reconstructiva o el tratamiento conservador. CONCLUSIONES: La manipulación intraútero no está indicada sistemáticamente. La derivación urinaria sólo en casos sintomáticos y los secundarios a traumatismo o manipulación endoscópica. En riñones anulados estaría indicada la nefrectomía (AU)

OBJECTIVE: To analyze the management of prenatal urinoma and Ureteropelvic Junction Obstruction (UPJO) postnatally by a case report and literature review. METHODS: We report a case of an UPJO and urinoma in a newborn. After birth, renal function was absent, and nephrectomy was performed. The literature from 1985 to date has been reviewed. DISCUSSION: By the analysis of the literature, we can observe mainly, that prenatally diagnosed urinoma and UPJO are managed conservatively. After birth, different attitudes have been carried out, independently of residual renal function, such as radical or reconstructive surgery, or conservative treatment. CONCLUSION: Intrauterine management is not indicated. Urinary diversion is indicated in symptomatic cases secondary to renal trauma or endoscopic procedure. In non-functional kidney, nephrectomy is indicated (AU)

Tratamiento conservador de un absceso renal múltiple / Successful conservative management of a multiple renal abscess in a child

Los abscesos renales son poco frecuentes en niños, pero sus consecuencias pueden ser graves, incluyendo sepsis, daños renales graves o la pérdida del riñón. Describimos el caso de una paciente de tres años de edad, diagnosticada de un absceso múltiple en el riñón izquierdo tras un episodio febril. El caso presenta interés debido a la rara forma de presentación de una infección del tracto urinario como absceso renal múltiple, al tamaño y localización diseminada de las lesiones (cuatro abscesos en un riñón) y al tipo de tratamiento realizado, que consistió en antibióticos intravenosos con el fin de preservar el parénquima renal (AU)

Renal abscesses are uncommon in children but their consequences could be serious, including sepsis, severe renal damage or loss of the kidney. The following report describes a three-year-old girl diagnosed of multiple renal abscess in the left kidney after a first episode of fever. The case is significant due to the uncommon presentation of a urinary tract infection as a multiple abscess, the extension of the injuries (there were 4 abscesses in the kidney) and the conservative therapy with intravenous antibiotics which was selected in order to preserve renal tissue (AU)

Inflammatory myofibroblastic tumor of the esophagus treated by endoscopy.

Inflammatory myofibroblastic tumors are rare lesions that have been described in virtually every organ including the gastrointestinal tract. The esophagus is an extremely unusual site for these tumors, with only a few cases described in the literature. Surgery has been the most common therapeutic approach used for the resection of these lesions. In the present case, a patient diagnosed with an inflammatory myofibroblastic tumor of the upper esophagus was reported, and it was successfully removed by endoscopy with no complications.

[Successful conservative management of a multiple renal abscess in a child]. / Tratamiento conservador de un absceso renal múltiple.

Renal abscesses are uncommon in children but their consequences could be serious, including sepsis, severe renal damage or loss of the kidney. The following report describes a three-year-old girl diagnosed of multiple renal abscess in the left kidney after a first episode of fever. The case is significant due to the uncommon presentation of a urinary tract infection as a multiple abscess, the extension of the injuries (there were 4 abscesses in the kidney) and the conservative therapy with intravenous antibiotics which was selected in order to preserve renal tissue.

Hipospadias / Hypospadias

El hipospadias es la malformación congénita más frecuente de la uretra. Es una alteración de etología desconocida aunque en los últimos años se han identificado posibles factores de riesgo y predisponentes, como los genéticos, hormonales o farmacológicos. Es importante el diagnóstico temprano; en la primera visita la información a los padres es fundamental, explicando el plan a seguir, los objetivos, el tipo de intervención y las posibles complicaciones. Se descartarán anomalías urológicas que pueden estar asociadas como criptorquidia, hernia inguinal o alteraciones en el tracto urinario superior. No existe consenso sobre la edad más adecuada de corrección, pero se recomienda realizarla en la edad preescolar. Con el fin de facilitar la intervención quirúrgica puede administrarse previamente tratamiento hormonal. Los objetivos de la corrección quirúrgica son conseguir un pene sin incurvaciones, una función miccional y reproductiva adecuada y el mejor resultado estético posible. Existen múltiples técnicas quirúrgicas, siendo necesario dominar las más utilizadas, ya que no existen dos casos iguales y cada uno precisa una técnica concreta, sobre todo en reintervenciones. ES frecuente la aparición de complicaciones postquirúrgicas, como fístulas o estenosis uretrales que obliguen a la reintervención (AU)

Hypospadias is the most common congenital malformation of the urethra. The ethiology is unknown, but recently several studies have identified some risk factors like genetic, hormonal or pharmacological factors. Early diagnosis is important; In the first clinic visits the information is essential for parents, explaining the action plan, objectives, type of surgery and most frequent complications. Associated urological abnormalities like cryptorchidism, inguinal hernia or alterations in upper urinary tract should be diagnosed, There is no consensus on the appropriate age at surgery, but we recommended performing it before the start of the school. In order to facilitate surgical intervention may be given hormonal therapy. The objetives of surgical correction are gettinga penis with-out incurvations, normal urinary and reproductive function and obtain a good cosmetic result. There are several surgical techniques and we need to know the most used, because each case requires a specific technique, especially in reoperations. Postoperative complications are common. The most frequent complications are fistula and urethral stricture and they require reoperation (AU)

Is a third endoscopic treatment for vesicoureteral reflux indicated if previous attempts have failed?

OBJECTIVE: To evaluate the efficacy of a third endoscopic injection to correct vesicoureteral reflux (VUR). PATIENTS AND METHODS: This was a prospective study of 605 patients, of whom 42 (6.4%), involving 44 (4%) ureteral units, received a third injection. The results were analysed regarding VUR grade and aetiology, substance used, volume, location and morphology of the mound, presence of poor prognostic factors, the urologist's experience, and complications. RESULTS: The treatment resolved the VUR in 38 (86.4%) units, 22 of primary cause (91.6%) and 16 with anatomical/functional abnormalities (80%) (no significant difference; P = 0.26). There was also no significant difference in success rate with regard to the substance injected (P = 0.23), the degree of VUR (P = 0.76) or the volume injected (P = 0.17). The success rate was higher (96.9%) if a less experienced urologist had performed the previous procedure versus a more experienced urologist (54.5%), and this difference was significant (P < 0.005). There was one complication (haematuria) (2.3%). CONCLUSION: Third treatment presents a similar efficacy to first and second treatments, with a very low rate of complications, and could be indicated before open surgery.

[Urethral polyposis in adolescence]. / Poliposis ureteral en la adolescencia.

Polyps in the urinary tract are a rare entity in infants and children. The most frequent location when they appear is the ureter. These benign lesions with no malignant potential have a varied form of presentation and in most cases must be distinguished from malignancy. The suspected diagnosis is due to urinary obstruction; nevertheless radiological evidence played a key role in the final diagnosis. The management is as less invasive as possible, with endoscopy resection or minimally invasive surgery.

[Congenital fibroepithelial polyps of the urethra]. / Pólipos fibroepiteliales congénitos de uretra.

Urethral polyps are a rare pathology that is usually diagnosed in childhood hematuria and obstructive urinary symptoms are the most common findings and transurethral resection is the best choice of the treatment. We report three cases, a 6-years-old boy and 9-years-old boy diagnosed and treated of posterior urethral polyp after showing hematuria and obstructive urinary symptoms, and a 2-years-old girl that showed to prolapse of urethral polyp.

Pólipos fibroepiteliales congénitos de uretra / Congenital fibroepithelial polyps of the urethra

Los pólipos fibroepiteliales de uretra comprenden una patología infrecuente, suelen ser diagnosticados en edad pediátrica por hematuria o síndrome obstructivo bajo y requieren tratamiento quirúrgico para su resolución. Presentamos tres casos clínicos, dos varones de seis y nueve años que fueron diagnosticados y tratados de esta patología tras presentar un cuadro de hematuria franca y dificultad miccional, y una niña de dos años que debutó con clínica de prolapso de masa polipoide por uretra (AU)

Urethral polyps are a rare pathology that is usually diagnosed in childhood hematuria and obstructive urinary symptoms are the most common findings and transurethral resection is the best choice of the treatment .We report three cases, a 6-years-old boy and 9-years-old boy diagnosed and treated of posterior urethral polyp after showing hematuria and obstructive urinary symptoms, and a 2-years-old girl that showed to prolapse of urethral polyp (AU)

The discovery of 2,5-dialkylcyclohexan-1,3-diones as a new class of natural products.

Orchids employing sexual deceit attract males of their pollinator species through specific volatile signals that mimic female-released sex pheromones. One of these signals proved to be 2-ethyl-5-propylcyclohexan-1,3-dione (chiloglottone1), a new natural product that was shown to be most important in the relations between orchids of the genus Chiloglottis, native to Australia, and corresponding pollinator species. Systematic investigations on the mass spectrometric fragmentation pattern of 2,5-dialkylcyclohexan-1,3-diones identified key ions providing information about the structures of the substituents at positions 2 and 5. Results enabled us to identify 2-ethyl-5-pentylcyclohexan-1,3-dione (chiloglottone2) and 2-butyl-5-methylcyclohexan-1,3-dione (chiloglottone3) as new natural products that play a decisive role in the pollination syndrome of some Chiloglottis species. During field bioassays, pure synthetic samples of chiloglottone1-3 or mixtures thereof proved to be attractive to the corresponding orchid pollinators. Because of their likely biogenesis from ubiquitous fatty acid precursors, 2,5-dialkylcyclohexan-1,3-diones may represent a hitherto overlooked, widespread class of natural products.

[Cost of therapeutic failure of ampicillin plus amikacin in the treatment of early neonatal sepsis]. / Costo económico marginal del fracaso terapéutico con ampicilina más amikacina en el tratamiento de la sepsis neonatal temprana.

OBJECTIVE: To evaluate the marginal cost of therapeutic failure with Ampicillin/amikacin as the first-line antibiotic treatment of early-onset neonatal sepsis (ENS). METHODS: Out of a total of 121 newborns, 86 failed to respond to Ampicillin/amikacin when it was used as first-line treatment within their first 72h of life. All of them were admitted to the NICU between 2001 and 2005 with suspicion of sepsis. After this failure to respond, vancomycin and/or cefotaxime were used as the second treatment option for these newborns. Using a full cost method we performed a cost analysis with an activity-based-costing (ABC) perspective, identifying the costs generated by these 86 patients. RESULTS: The costs comprising medication, hospitalization, supplies and clinical staff salaries were higher when vancomycin and/or cefotaxime were used (350,924 dollars or 275,116 euros) compared to those generated with an Ampicillin/amikacin regimen (159,251 dollars or 124,878 euros). When compared as protective factors, the relative risk was 1.09 (95% CI; 0.39-2.1 P=0.8) for Ampicillin/amikacin vs. 0.02 (95% CI; 0.04-0.32 P<0.05) for vancomycin and/or cefotaxime. CONCLUSIONS: Even though vancomycin and/or cefotaxime are initially more costly, there is a cost saving derived from the use of this antibiotic treatment as the first-line therapeutic option instead of as a rescue therapy when a lower-efficacy regimen (Ampicillin/amikacin) has failed.