Gamma-ray sources imaging and test-beam results with MACACO III Compton camera.

Hadron therapy is a radiotherapy modality which offers a precise energy deposition to the tumors and a dose reduction to healthy tissue as compared to conventional methods. However, methods for real-time monitoring are required to ensure that the radiation dose is deposited on the target. The IRIS group of IFIC-Valencia developed a Compton camera prototype for this purpose, intending to image the Prompt Gammas emitted by the tissue during irradiation. The system detectors are composed of Lanthanum (III) bromide scintillator crystals coupled to silicon photomultipliers. After an initial characterization in the laboratory, in order to assess the system capabilities for future experiments in proton therapy centers, different tests were carried out in two facilities: PARTREC (Groningen, The Netherlands) and the CNA cyclotron (Sevilla, Spain). Characterization studies performed at PARTREC indicated that the detectors linearity was improved with respect to the previous version and an energy resolution of 5.2 % FWHM at 511 keV was achieved. Moreover, the imaging capabilities of the system were evaluated with a line source of 68Ge and a point-like source of 241Am-9Be. Images at 4.439 MeV were obtained from irradiation of a graphite target with an 18 MeV proton beam at CNA, to perform a study of the system potential to detect shifts at different intensities. In this sense, the system was able to distinguish 1 mm variations in the target position at different beam current intensities for measurement times of 1800 and 600 s.

Evaluación del grado de congestión clínica y hemodinámica como predictores de mortalidad en pacientes ambulatorios con insuficiencia cardíaca de edad avanzada / Assessment of clinical and hemodynamic congestion as predictors of mortality in elderly outpatients with heart failure

Introducción El objetivo del estudio fue evaluar si la exploración física y la determinación de la fracción N-terminal del propéptido natriurético cerebral pueden predecir un peor pronóstico en pacientes ambulatorios con insuficiencia cardíaca. Pacientes y métodos Estudio retrospectivo llevado a cabo entre 2010 y 2018, en 238 pacientes diagnosticados de insuficiencia cardíaca. Al inicio, se evaluó la presencia de crepitantes pulmonares y edema de miembros inferiores (congestión clínica) junto con la fracción N-terminal del propéptido natriurético cerebral≥1500pg/mL (congestión hemodinámica). Los pacientes se clasificaron en 4 grupos en función del patrón congestivo: sin congestión (G1) (n=50); con congestión clínica (G2) (n=43); con congestión hemodinámica (G3) (n=73) y con congestión clínica y hemodinámica (G4) (n=72). El objetivo primario fue la muerte por cualquier causa al año de seguimiento. Resultados Se analizaron un total de 238 pacientes, edad media 82 años, 61,8% mujeres, y 20,7% con fracción de eyección del ventrículo izquierdo reducida. Treinta pacientes (12,6%) fallecieron en el primer año de seguimiento. Después de ajustar por variables de confusión (sexo, alta hospitalaria reciente por insuficiencia cardíaca, filtrado glomerular estimado, y fracción de eyección del ventrículo izquierdo), el riesgo de muerte en cada grupo,al compararlos con el grupo de referencia G1, fue: G2, HR 4,121 (IC95% 1,131–15,019); G3, HR 2,511 (IC95% 1,007-6,263), y; G4, HR 7,418 (IC95% 1,630-33,763). Conclusión La congestión en pacientes ambulatorios con insuficiencia cardíaca se correlaciona con el pronóstico. Los pacientes con congestión clínica y hemodinámica tuvieron el mayor riesgo de muerte global al año (AU)

Introduction This work aims to evaluate whether a clinical examination and measurement of N-terminal pro-brain natriuretic peptide can predict poor prognosis in outpatients with heart failure. Patients and methods We carried out a retrospective study from 2010 to 2018 in 238 patients diagnosed with heart failure. At baseline, we evaluated the presence of pulmonary rales and bilateral leg edema (clinical congestion) together with N-terminal pro-brain natriuretic peptide≥1500 pg/mL (hemodynamic congestion). Patients were classified into 4 groups depending on their congestion pattern: no congestion (G1) (n=50); clinical congestion (G2) (n=43); hemodynamic congestion (G3) (n=73); and clinical and hemodynamic congestion (G4) (n=72). The primary outcome was all-cause mortality at one year of follow-up. Results A total of 238 patients were included. The mean age was 82 years, 61.8% were women, and 20.7% had reduced left ventricular ejection fraction. Thirty patients died in the first year of follow-up (12.6%). After controlling for confounding variables (sex, recent discharge for heart failure, estimated glomerular filtration rate, and left ventricular ejection fraction), the independent risk of death in each group compared to G1 as the reference group was: G2: HR 4.121 (95%CI 1.131-15.019); G3: HR 2.511 (95%CI 1.007-6.263); and G4: HR 7.418 (95%CI 1.630-33.763). Conclusion Congestion in outpatients with heart failure correlates with prognosis. Patients with both clinical and hemodynamic congestion had the highest risk of all-cause death at one year (AU)

Assessment of clinical and hemodynamic congestion as predictors of mortality in elderly outpatients with heart failure.

INTRODUCTION: This work aims to evaluate whether a clinical examination and measurement of N-terminal pro-brain natriuretic peptide can predict poor prognosis in outpatients with heart failure. PATIENTS AND METHODS: We carried out a retrospective study from 2010 to 2018 in 238 patients diagnosed with heart failure. At baseline, we evaluated the presence of pulmonary rales and bilateral leg edema (clinical congestion) together with N-terminal pro-brain natriuretic peptide ≥ 1500 pg/mL (hemodynamic congestion). Patients were classified into 4 groups depending on their congestion pattern: no congestion (G1) (n = 50); clinical congestion (G2) (n = 43); hemodynamic congestion (G3) (n = 73); and clinical and hemodynamic congestion (G4) (n = 72). The primary outcome was all-cause mortality at one year of follow-up. RESULTS: A total of 238 patients were included. The mean age was 82 years, 61.8% were women, and 20.7% had reduced left ventricular ejection fraction. Thirty patients died in the first year of follow-up (12.6%). After controlling for confounding variables (sex, recent discharge for heart failure, estimated glomerular filtration rate, and left ventricular ejection fraction), the independent risk of death in each group compared to G1 as the reference group was: G2: HR 4.121 (95%CI 1.131-15.019); G3: HR 2.511 (95%CI 1.007-6.263); and G4: HR 7.418 (95%CI 1.630-33.763). CONCLUSION: Congestion in outpatients with heart failure correlates with prognosis. Patients with both clinical and hemodynamic congestion had the highest risk of all-cause death at one year.

Popularidad de Neurología en España: análisis de la elección de la especialidad / The popularity of neurology in Spain: An analysis of specialty selection

INTRODUCCIÓN: Neurología es una de las especialidades ofertadas a los opositores que acceden a la formación sanitaria especializada cada año. Este proyecto analiza los datos de elección de Neurología en los últimos años. MATERIAL Y MÉTODOS: Los datos de la elección se han obtenido de la publicación oficial del Ministerio de Sanidad, Servicios Sociales e Igualdad. Se ha recabado información de los distintos centros docentes con relación a la disponibilidad de unidad de ictus, intervencionismo endovascular, consultas de referencia nacional relacionadas con Neurología, guardias específicas para residentes y vinculación con facultades de medicina o redes de investigación nacional. RESULTADOS: La mediana de elección de número de orden para Neurología ha descendido anualmente, situando la especialidad en la convocatoria 2016 entre las cuatro más populares. Los electores son mayoritariamente mujeres de nacionalidad española y baremo académico alto. La mediana de los hospitales con mayor número de camas, intervencionismo vascular, unidad de ictus o consultas de referencia nacional es significativamente menor. Lo mismo sucede al analizar los centros según guardias específicas de Neurología para residentes o vinculación con facultades de medicina o redes de investigación nacionales. Los centros con menor mediana de número de orden para el periodo 2012-2016 fueron los hospitales universitarios Clínico San Carlos, 12 de Octubre y Vall d'Hebron. CONCLUSIONES: Neurología ha ido mejorando de manera progresiva en la elección de plazas de especialización, situándose entre las cuatro más populares. Los electores se decantan por centros grandes, de mayor complejidad asistencial y con intensa actividad investigadora

INTRODUCTION: Neurology is one of the medical specialties offered each year to residency training candidates. This project analyses the data associated with candidates choosing neurology residency programmes in recent years. METHODS: Data related to specialty selection were obtained from official reports by the Spanish Ministry of Health, Social Services, and Equality. Information was collected on several characteristics of teaching centres: availability of stroke units, endovascular intervention, national reference clinics for neurology, specific on-call shifts for neurology residents, and links with medical schools or national research networks. RESULTS: The median selection list position of candidates selecting neurology training has been higher year on year; neurology was among the 4 most popular residency programmes in 2016. Potential residents were mainly female, Spanish, and had good academic results. The median number of hospitals with higher numbers of beds, endovascular intervention, stroke units, and national reference clinics for neurology is significantly lower. This is also true when centers are analysed by presence of specific on-call shifts for neurology residents and association with medical schools or national research networks. The centres selected by candidates with the highest median selection list position in 2012-2016 were the Clínico San Carlos, 12 de Octubre, and Vall d'Hebron university hospitals. CONCLUSIONS: Neurology has gradually improved in residency selection choices and is now one of the 4 most popular options. Potential residents prefer larger centres which are more demanding in terms of patient care and which perform more research activity

The popularity of neurology in Spain: An analysis of specialty selection. / Popularidad de Neurología en España: análisis de la elección de la especialidad.

INTRODUCTION: Neurology is one of the medical specialties offered each year to residency training candidates. This project analyses the data associated with candidates choosing neurology residency programmes in recent years. METHODS: Data related to specialty selection were obtained from official reports by the Spanish Ministry of Health, Social Services, and Equality. Information was collected on several characteristics of teaching centres: availability of stroke units, endovascular intervention, national reference clinics for neurology, specific on-call shifts for neurology residents, and links with medical schools or national research networks. RESULTS: The median selection list position of candidates selecting neurology training has been higher year on year; neurology was among the 4 most popular residency programmes in 2016. Potential residents were mainly female, Spanish, and had good academic results. The median number of hospitals with higher numbers of beds, endovascular intervention, stroke units, and national reference clinics for neurology is significantly lower. This is also true when centers are analysed by presence of specific on-call shifts for neurology residents and association with medical schools or national research networks. The centres selected by candidates with the highest median selection list position in 2012-2016 were the Clínico San Carlos, 12 de Octubre, and Vall d'Hebron university hospitals. CONCLUSIONS: Neurology has gradually improved in residency selection choices and is now one of the 4 most popular options. Potential residents prefer larger centres which are more demanding in terms of patient care and which perform more research activity.

La elección de la especialidad medicina intensiva: análisis de los últimos 10 años / Choice of critical care medicine: Analysis of the last 10 years

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Association of serum testosterone levels and testicular volume in adult patients.

A retrospective observational study was undertaken to gain new insight into the relationship between total testicular volume and levels of serum testosterone, luteinising hormone, follicle-stimulating hormone, prolactin and clinical variables. A total of 312 men with sexual dysfunction or infertility were divided into groups A and B (156 each) on the basis of basal plasma testosterone ≤5 nmol/L of ≥12 nmol/L respectively. Group A was subclassified in A1 (primary hypogonadism) and A2 (secondary hypogonadism). There were significant differences in total testicular volume between group A (15.33 ± 11.94 ml) and group B (36.74 ± 6.9; p < .001) and also between subgroup A1 (11.07 ± 8.49 ml) and subgroup A2 (23.62 ± 13.04 ml; p < .001). Only 13.5% of patients in group B had a total testicular volume <30 ml. Differences in all studied parameters were found between group A and group B. There were no variations when comparing age, body mass index and testosterone in groups A1 and A2 . The use of total testicular volume and body mass index together for predicting testosterone levels yields a sensitivity and specificity of 85.3% and 86.5% respectively. Logistic regression analysis, univariate and multivariate models, using the measurement of total testicular volume resulted in a high capacity to predict testosterone levels.

Bifurcations and dynamics in convection with temperature-dependent viscosity in the presence of the O(2) symmetry.

We focus on the study of a convection problem in a two-dimensional setup in the presence of the O(2) symmetry. The viscosity in the fluid depends on the temperature as it changes its value abruptly in an interval around a temperature of transition. The influence of the viscosity law on the morphology of the plumes is examined for several parameter settings, and a variety of shapes ranging from spout- to mushroom-shaped are found. We explore the impact of the symmetry on the time evolution of this type of fluid, and we find solutions which are greatly influenced by its presence: at a large aspect ratio and high Rayleigh numbers, traveling waves, heteroclinic connections, and chaotic regimes are found. These solutions, which are due to the presence of symmetry, have not been previously described in the context of temperature-dependent viscosities. However, similarities are found with solutions described in other contexts such as flame propagation problems or convection problems with constant viscosity also in the presence of the O(2) symmetry, thus confirming the determining role of the symmetry in the dynamics.

Horse species symposium: a novel approach to monitoring pathogen progression during uterine and placental infection in the mare using bioluminescence imaging technology and lux-modified bacteria.

Uterine and placental infections are the leading cause of abortion, stillbirth, and preterm delivery in the mare. Whereas uterine and placental infections in women have been studied extensively, a comprehensive examination of the pathogenic processes leading to this unsatisfactory pregnancy outcome in the mare has yet to be completed. Most information in the literature relating to late-term pregnancy loss in mares is based on retrospective studies of clinical cases submitted for necropsy. Here we report the development and application of a novel approach, whereby transgenically modified bacteria transformed with lux genes of Xenorhabdus luminescens or Photorhabdus luminescens origin and biophotonic imaging are utilized to better understand pathogen-induced preterm birth in late-term pregnant mares. This technology uses highly sensitive bioluminescence imaging camera systems to localize and monitor pathogen progression during tissue invasion by measuring the bioluminescent signatures emitted by the lux-modified pathogens. This method has an important advantage in that it allows for the potential tracking of pathogens in vivo in real time and over time, which was hitherto impossible. Although the application of this technology in domestic animals is in its infancy, investigators were successful in identifying the fetal lungs, sinuses, nares, urinary, and gastrointestinal systems as primary tissues for pathogen invasion after experimental infection of pregnant mares with lux-modified Escherichia coli. It is important that pathogens were not detected in other vital organs, such as the liver, brain, and cardiac system. Such precision in localizing sites of pathogen invasion provides potential application for this novel approach in the development of more targeted therapeutic interventions for pathogen-related diseases in the equine and other domestic species.

Photonic characteristics and ex vivo imaging of Escherichia coli-Xen14 within the bovine reproductive tract.

The objectives of this study were to (1) characterize the photonic properties of Escherichia coli-Xen14 and (2) conduct photonic imaging of E. coli-Xen14 within bovine reproductive tract segments (RTS) ex vivo (Bos indicus). E. coli-Xen14 was grown for 24h in Luria Bertani medium (LB), with or without kanamycin (KAN). Every 24h, for an 8-d interval, inoculums were imaged and photonic emissions (PE) collected. Inoculums were subcultured and plated daily to determine the colony forming units (CFU) and ratio of photon emitters to nonemitters. In the second objective, abattoir-derived bovine reproductive tracts (n=9) were separated into posterior and anterior vagina, cervix, uterine body, and uterine horns. Two concentrations (3.2x10(8) and 3.2x10(6) CFU/200microL for relative [High] and [Low], respectively) of E. coli-Xen14 were placed in translucent tubes for detection of PE through RTS. The CFU did not differ (P=0.31) over time with or without KAN presence; they remained stable with 99.93% and 99.98% photon emitters, respectively. However, PE were lower (P<0.0001) in cultures containing KAN than in those containing no KAN (629.8+/-117.7 vs. 3012.0+/-423.5 relative lights units per second [RLU/sec], respectively). On average, the percentage of PE between RTS, for both concentrations, was higher (P<0.05) in the uterine body. In summary, E. coli-Xen14 remained stable with respect to the proportions of photon emitters with or without KAN (used to selectively culture E. coli-Xen14). However, KAN presence suppressed photonic activity. The ability to detect PE through various segments of the reproductive tract demonstrated the feasibility of monitoring the presence of E. coli-Xen14 in the bovine reproductive tract ex vivo.

Características generales de los tumores de cabeza y cuello. Vías de extensión según las diferentes localizaciones

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The purified colicin S8 is a multimeric protein.

Bacteriocins have been isolated both as simple proteins and as proteins in association with carbohydrates, lipids, etc. Colicins are commonly inducible and extracellular. Their molecular masses range from 30 to 90 kDa. Pure colicin S8 was obtained in three steps from supernatant of induced cells: (i) Ammonium sulfate precipitation; (ii) anion exchange chromatography; and (iii) phenyl-Sepharose hydrophobic chromatography, either by preparative or fast performance liquid chromatography (FPLC) analytical purification procedure. In our hands, purified colicin S8 was an aggregation of extremely related polypeptides. Composition of those active fractions was the same: five polypeptides of molecular weight around 55 kDa. Behavior on molecular filtration indicated a molecular weight higher than 200 kDa. Similar results were obtained when purification was carried out through FPLC. Producing strains contain a single plasmid that encodes colicin S8; in minicells, this plasmid was shown to specify a 60 kDa polypeptide. We conclude that more than one form of colicin S8 exists. The forms are structurally related and can be recognized by antibodies raised against one of the polypeptides. Consistent with this conclusion, comparison of peptides produced after hydrolysis with chlorosuccinamide indicated that the active proteins contained both shared and unique components.

[Tonsillar angiofibroma]. / Angiofibroma amigdalar.

We report in this paper a case of a tonsillar angiofibroma, whose histopathological features did not differ from its nasopharyngeal counterpart. In an exhaustive review done we have only found another one reference, in the german literature of such location.

Chemotherapy as a part of each treatment fraction in a twice-a-day hyperfractionated schedule: a new chemoradiotherapy approach for advanced head and neck cancer.

BACKGROUND: Using chemotherapy as a part of each treatment fraction remains unexplored. This study integrates the concomitant administration of carboplatin with hyperfractionated irradiation by optimizing chemopotentiation through carboplatin administration with each irradiation fraction. METHODS: From February 1993 to August 1996, 52 patients with advanced head and neck cancer were treated on a twice-a-day chemoradiotherapy schedule. Each fraction consisted of 115 cGy preceded by 5 mg/m2 of carboplatin. Treatment was given 5 days a week up to total doses of 350 mg/m2 of carboplatin + 8050 cGy in 7 weeks. RESULTS: All (100%) of patients tolerated the treatment (83% as scheduled). Acute and late toxicities were moderate. Rates of 96% complete response (CR) and 4% partial response (PR) were achieved. At 52 months, local control and cause-specific survival rates are 72% and 59%, respectively. Nodal control rate is 95%. CONCLUSION: These results show potential for improvement upon hyperfractionated radiotherapy alone and compare favorably with those of most reported trials.

Effective management of marked lymphedema of the leg.

BACKGROUND: Several conservative and surgical treatment methods have been demonstrated to be useful in the management of lymphedema. METHODS: In a patient with an enormous lymphedema of the leg, we first used complex decongestive physiotherapy as proposed by Földi et al. in 1989, and then followed it with surgery. RESULTS: Satisfactory results were obtained in a short period of time and were maintained during the 2-year follow-up. CONCLUSIONS: We recommend a combined medical, surgical, and physiotherapeutic approach in patients with marked lymphedema.

[Late hereditary degenerative sensorineural hearing loss associated with IgA mesangial glomerulonephritis of probable autosomal dominant heredity]. / Hipoacusia neurosensorial heredodegenerativa tardía, asociada a glomerulonefritis mesangial IgA, de probable herencia autosómica dominante.

We studied four generations of a Canary Islands family presenting a tardive heredodegenerative hearing loss, associated with IgA mesangial glomerulonephritis, of probable autosomal dominant heredity. With respect to the family, we revised Alport's syndrome, for possible transmission associated with X chromosome, as well as heredodegenerative hearing loss associated with renal pathology of autosomic transmission currently described; we differentiate these hearing losses from our case study, and we discuss the pathogeny of the auditive affection in the said hereditary syndromes. Lastly, we stress the autoimmune hypothesis because of the IgA nephropathy association in the family case, and we list the characteristics of the syndrome described.