A Narrative Review: Opportunities and Challenges in Artificial Intelligence Skin Image Analyses Using Total Body Photography.

Artificial intelligence (AI) algorithms for skin lesion classification have reported accuracy at par with and even outperformance of expert dermatologists in experimental settings. However, the majority of algorithms do not represent real-world clinical approach where skin phenotype and clinical background information are considered. We review the current state of AI for skin lesion classification and present opportunities and challenges when applied to total body photography (TBP). AI in TBP analysis presents opportunities for intrapatient assessment of skin phenotype and holistic risk assessment by incorporating patient-level metadata, although challenges exist for protecting patient privacy in algorithm development and improving explainable AI methods.

Characterization of Rice Yield Based on Biomass and SPAD-Based Leaf Nitrogen for Large Genotype Plots.

The use of Unmanned Aerial Vehicle (UAV) images for biomass and nitrogen estimation offers multiple opportunities for improving rice yields. UAV images provide detailed, high-resolution visual information about vegetation properties, enabling the identification of phenotypic characteristics for selecting the best varieties, improving yield predictions, and supporting ecosystem monitoring and conservation efforts. In this study, an analysis of biomass and nitrogen is conducted on 59 rice plots selected at random from a more extensive trial comprising 400 rice genotypes. A UAV acquires multispectral reflectance channels across a rice field of subplots containing different genotypes. Based on the ground-truth data, yields are characterized for the 59 plots and correlated with the Vegetation Indices (VIs) calculated from the photogrammetric mapping. The VIs are weighted by the segmentation of the plants from the soil and used as a feature matrix to estimate, via machine learning models, the biomass and nitrogen of the selected rice genotypes. The genotype IR 93346 presented the highest yield with a biomass gain of 10,252.78 kg/ha and an average daily biomass gain above 49.92 g/day. The VIs with the highest correlations with the ground-truth variables were NDVI and SAVI for wet biomass, GNDVI and NDVI for dry biomass, GNDVI and SAVI for height, and NDVI and ARVI for nitrogen. The machine learning model that performed best in estimating the variables of the 59 plots was the Gaussian Process Regression (GPR) model with a correlation factor of 0.98 for wet biomass, 0.99 for dry biomass, and 1 for nitrogen. The results presented demonstrate that it is possible to characterize the yields of rice plots containing different genotypes through ground-truth data and VIs.

Development and validation of a nomogram to predict kidney survival at baseline in patients with C3 glomerulopathy.

Background: C3 glomerulopathy is a rare and heterogeneous complement-driven disease. It is often challenging to accurately predict in clinical practice the individual kidney prognosis at baseline. We herein sought to develop and validate a prognostic nomogram to predict long-term kidney survival. Methods: We conducted a retrospective, multicenter observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. The dataset was randomly divided into a training group (n = 87) and a validation group (n = 28). The least absolute shrinkage and selection operator (LASSO) regression was used to screen the main predictors of kidney outcome and to build the nomogram. The accuracy of the nomogram was assessed by discrimination and risk calibration in the training and validation sets. Results: The study group comprised 115 patients, of whom 46 (40%) reached kidney failure in a median follow-up of 49 months (range 24-112). No significant differences were observed in baseline estimated glomerular filtration rate (eGFR), proteinuria or total chronicity score of kidney biopsies, between patients in the training versus those in the validation set. The selected variables by LASSO were eGFR, proteinuria and total chronicity score. Based on a Cox model, a nomogram was developed for the prediction of kidney survival at 1, 2, 5 and 10 years from diagnosis. The C-index of the nomogram was 0.860 (95% confidence interval 0.834-0.887) and calibration plots showed optimal agreement between predicted and observed outcomes. Conclusions: We constructed and validated a practical nomogram with good discrimination and calibration to predict the risk of kidney failure in C3 glomerulopathy patients at 1, 2, 5 and 10 years.

Longitudinal change in proteinuria and kidney outcomes in C3 glomerulopathy.

INTRODUCTION: The association between a change in proteinuria over time and its impact on kidney prognosis has not been analysed in complement component 3 (C3) glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure. METHODS: This was a retrospective, multicentre observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modelling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure. RESULTS: The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13-41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (hazard ratio 0.79; 95% confidence interval 0.56-0.97; P < 0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up. CONCLUSIONS: The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.

Influence of germline genetic variants on dermoscopic features of melanoma.

Nevus count is highly determined by inherited variants and has been associated with the origin of melanoma. De novo melanomas (DNMMs) are more prevalent in patients with a low nevus count and have distinctive dermoscopic features than nevus-associated melanomas. We evaluated the impact of nine single nucleotide polymorphisms (SNPs) of MTAP (rs10811629, rs2218220, rs7023329 and rs751173), PLA2G6 (rs132985 and rs2284063), IRF4 (rs12203592), and PAX3 (rs10180903 and rs7600206) genes associated with nevus count and melanoma susceptibility, and the MC1R variants on dermoscopic features of 371 melanomas from 310 patients. All MTAP variants associated with a low nevus count were associated with regression structures (peppering and mixed regression), blue-whitish veil, shiny white structures, and pigment network. SNPs of PLA2G6 (rs132985), PAX3 (rs7600206), and IRF4 (rs12203592) genes were also associated with either shiny white structures or mixed regression (all corrected p-values ≤ .06). Melanomas from red hair color MC1R variants carriers showed lower total dermoscopy score (p-value = .015) and less blotches than melanomas from non-carriers (p-value = .048). Our results provide evidence that germline variants protective for melanoma risk and/or associated with a low nevus count are associated with certain dermoscopic features, more characteristic of de novo and worse prognosis melanomas.

The Relevance of the MCP Risk Polymorphism to the Outcome of aHUS Associated With C3 Mutations. A Case Report.

Thrombotic microangiopathy (TMA) has different etiological causes, and not all of them are well understood. In atypical hemolytic uremic syndrome (aHUS), the TMA is caused by the complement dysregulation associated with pathogenic mutations in complement components and its regulators. Here, we describe a pediatric patient with aHUS in whom the relatively benign course of the disease confused the initial diagnosis. A previously healthy 8-year-old boy developed jaundice, hematuria, hemolytic anemia, thrombopenia, and mild acute kidney injury (AKI) in the context of a diarrhea without hypertension nor oliguria. Spontaneous and complete recovery was observed from the third day of admission. Persistent low C3 plasma levels after recovery raised the suspicion for aHUS, which prompted clinicians to discard the initial diagnosis of Shigatoxin-associated HUS (STEC-HUS). A thorough genetic and molecular study of the complement revealed the presence of an isolated novel pathogenic C3 mutation. The relatively benign clinical course of the disease as well as the finding of a de novo pathogenic C3 mutation are remarkable aspects of this case. The data are discussed to illustrate the benefits of identifying the TMA etiological factor and the relevant contribution of the MCP aHUS risk polymorphism to the disease severity.

Efecto de la suplementación nutricional sobre el balance energético en vacas lecheras en trópico bajo / Effect of nutritional supplementation over negative balance in dairy cows under tropical conditions / Efeito da suplementação nutricional no balanço energético em vacas leiteiras nos baixos trópicos

Resumen Introducción. La producción lechera intensiva o semi intensiva demanda alta oferta de alimentos para cumplir con los requerimientos nutricionales de la misma, éstos no logran ser proporcionados a la vaca recién parida en pastoreo, por la depresión del consumo, los cambios metabólicos y endocrinos ocurridos durante el periodo de transición. El menor consumo de alimento y el aumento en las exigencias para producción de leche, llevan al animal a un Balance Energético Negativo (BEN), el cual debe ser superado rápidamente para garantizar una mejor tasa reproductiva y una mayor producción de leche. Objetivo. Estudiar opciones de suplementación nutricional durante el periodo de transición, para reducir el Balance Energético Negativo. Materiales y métodos. Se emplearon 28 vacas adultas, en un sistema semi intensivo de producción de leche, ubicado en trópico bajo. Se formularon cuatro tratamientos: TT1, grupo control; TT2, grasa sobrepasante; TT3, nitrógeno no proteico encapsulado, y TT4, monensina sódica. Se analizaron hormonas y metabolitos relacionados con energía, proteína y minerales. Mediante ultrasonografía, se determinó la dinámica folicular y la presencia de cuerpo lúteo, igualmente se evaluaron indicadores reproductivos y producción de leche. El periodo de muestreo hasta los 105 días posparto permitió el análisis de la primera fase de lactancia e incluir el periodo fisiológico en el cual se espera que la vaca lechera reanude su actividad reproductiva. Resultado. Se presentaron variaciones en los periodos correspondientes al periodo de transición para los principales indicadores del metabolismo energético. La reactivación ovárica mostró que no fue rápida, sin embargo, hubo efecto sobre los días abiertos y la eficiencia reproductiva. Conclusión. Las concentraciones de hormonas y metabolitos analizados no presentaron variaciones significativas. Se evidenció efecto de al menos un tratamiento frente al control; igualmente, se presentaron variaciones en algunos periodos analizados. El comportamiento reproductivo fue deficiente.

Abstract Introduction. The intensive dairy production demand high food offers to fill the nutritional requirements of the lactation, these cannot be provided to the peripartum cow, by the depression of the consumption and metabolic and endocrine changes occurring during of the transition period. The lower consumption of dry matter and the energy demands for high milk production, take the animal to the Negative Energy Balance (NEBAL), which must be overcome quickly to ensure a better reproductive rate and a higher milk production. Objective. To explore different nutritional options during the transition period, in order to reduce negative energy balance. Materials and methods. 28 cows were used, in a semi-intensive dairy cows system, located in the tropics. Four treatments were used: TT1, control group; TT2, high energy density; TT3, non-protein nitrogen encapsulated, and TT4, monensin sodium. We analyzed hormones and metabolites related to energy, protein and minerals. By ultrasonography, it was determined the follicular dynamics and the presence of corpus luteum; likewise, we evaluated the reproductive indicators values and milk production. The sampling period up to 105 days postpartum allowed for the analysis of the first phase of lactation and covers the period in which it is expected that the dairy cow is in gestation. Results. Some variations were observed in the periods corresponding to the transition period for the main indicators of energy metabolism. Ovarian reactivation showed that it was not rapid, however, there was an effect on open days and reproductive efficiency. Conclusion. The concentrations of hormones and metabolites analyzed did not show significant variations. The effect of at least one treatment against the control was evident; likewise, there were variations in some analyzed periods. Reproductive behavior was poor.

Resumo Introdução. A produção leiteira intensiva requer alta oferta de alimentos com os quais preencher os requerimentos nutricionais da vaca em lactação e sob pastejo, mesmo estes não consigam ser entregues na vaca recém-parida, pela depressão do consumo e as mudanças metabólicas e as endócrinas acontecidas durante o período de transição. O menor consumo de alimento e as grandes exigências para a produção do leite geram no animal o Balance Energético Negativo (BEN), o qual tem que ser superado com rapidez para garantir um melhor desempenho reprodutivo e uma maior produção leiteira. Objetivo. Estudar diferentes opções nutricionais durante o período de transição para reduzir o balanço energético negativo. Materiais e métodos. Foram empregadas 28 vacas num sistema não intensivo de produção de leite no tropico baixo. Foram analisados quatro tratamentos: TT1, grupo controle; TT2, energia de alta densidade; TT3, nitrogênio não proteico protegido, e TT4, monensina sódica. Analisaram- se hormônios e metabolitos relacionados com energia, proteína e minerais. Foi avaliada a dinâmica produtiva e através de ultrassom foi determinada a atividade folicular e a presença de corpo lúteo. O período de amostragem até os 105 dias pós-parto, permitiu as análises na primeira fase da lactação e o período fisiológico no qual esperasse que a vaca fique prenha. Resultados. Foram apresentadas variações nos períodos correspondentes ao período de transição para os principais indicadores do metabolismo energético. A reativação ovariana mostrou que ela não era rápida, empero melhorou os dias em aberto, afetando a eficiência reprodutiva. Conclusão. As concentrações de hormônios e metabolitos analisados não apresentaram diferenças significativas. Foi achado efeito de quanto menos um tratamento frente ao controle; igualmente, presentaram-se variações em alguns dos períodos analisados. O comportamento reprodutivo foi deficiente.

Analysis of urine composition from split 24-h samples: use of 12-h overnight samples to evaluate risk factors for calcium stones in healthy and stone-forming children.

INTRODUCTION: The analysis of 24-h urine is the gold standard to diagnose metabolic abnormalities in the stone-forming patient. However, urinary composition changes throughout the day and analyzing the whole 24-h urine may mask peaks of increased risk of crystallization. OBJECTIVE: To examine variations of stone-promoting and stone-inhibiting factors in urine using split 24-h samples from healthy and stone-forming children. STUDY DESIGN: Urine was collected from 87 healthy and 26 stone-forming children using a split collection procedure (12-h daytime urine and 12-h overnight urine). Urine volume, pH, calcium (Ca), magnesium (Mg), phosphate (P), citrate (Cit), uric acid (Ur), and oxalate (Ox) were determined, and the Ca/Cit ratio was calculated. RESULTS: The overnight urine samples in both groups had higher levels of P and Mg, lower volume, lower pH, and less citrate and uric acid. As can be seen in the table, higher percentages of healthy and stone-forming children had altered 12-h night urine than 24-h urine with regards to Ca/Cr, Cit/Cr and Ca/Cit ratios. All healthy subjects and all stone-forming children (except one) with altered Cit/Cr ratios or Ca/Cit ratios in the 24-h sample also had altered ratios in the 12-h overnight sample. DISCUSSION: This study indicates that urine composition changes throughout the day, and that there is daily variability in most of the parameters related to kidney stone formation. Furthermore, 12-h overnight samples seem to be more sensitive than 24-h samples in detecting the most common urinary abnormalities. The main limitation of this study is the relative low sample size of stone-forming children, owing to the low prevalence of nephrolithiasis in childhood. CONCLUSIONS: We observed a higher excretion of stone-promoting substances and a lower citrate in urine at night. However, the study results do not provide enough evidence to conclude that the use of a 12-h overnight sample collection can replace 24 h urine analysis in the metabolic evaluation of children with lithiasis.

Role of community pharmacists in skin cancer screening: A descriptive study of skin cancer risk factors prevalence and photoprotection habits in Barcelona, Catalonia, Spain.

BACKGROUND: Skin cancer incidence is increasing alarmingly, despite current efforts trying to improve its early detection. Community pharmacists have proven success in implementing screening protocols for a number of diseases because of their skills and easy access. OBJECTIVE: To evaluate the prevalence of skin cancer risk factors and the photoprotection habits with a questionnaire in community pharmacy users. METHODS: A research group consisting of pharmacists and dermatologists conducted a descriptive cross-sectional study to assess photoprotection habits and skin cancer risk factors by using a validated questionnaire in 218 community pharmacies in Barcelona from May 23rd to June 13th 2016. All participants received health education on photoprotection and skin cancer prevention. Patients with ≥1 skin cancer risk factor were referred to their physician, as they needed further screening of skin cancer. RESULTS: A total of 5,530 participants were evaluated. Of those, only 20.2% participants had received a total body skin examination for skin cancer screening in the past by a physician and 57.1% reported using a SPF 50+ sunscreen. 53.9% participants presented ≥1 skin cancer risk factor: 11.8% participants reported having skin cancer familial history and 6.2% reported skin cancer personal history; pharmacists found ≥10 melanocytic nevi in 43.8% participants and chronically sun-damaged skin in 21.4%. Lesions suspicious for melanoma were reported in 10.9% of the participants and urgent dermatological evaluation was recommended. CONCLUSIONS: Pharmacists can detect people with skin cancer risk factors amongst their users. This intervention can be considered in multidisciplinary strategies of skin cancer screening.

Role of community pharmacists in skin cancer screening: A descriptive study of skin cancer risk factors prevalence and photoprotection habits in Barcelona, Catalonia, Spain

Background: Skin cancer incidence is increasing alarmingly, despite current efforts trying to improve its early detection. Community pharmacists have proven success in implementing screening protocols for a number of diseases because of their skills and easy access. Objective: To evaluate the prevalence of skin cancer risk factors and the photoprotection habits with a questionnaire in community pharmacy users. Methods: A research group consisting of pharmacists and dermatologists conducted a descriptive cross-sectional study to assess photoprotection habits and skin cancer risk factors by using a validated questionnaire in 218 community pharmacies in Barcelona from May 23rd to June 13th 2016. All participants received health education on photoprotection and skin cancer prevention. Patients with ≥1 skin cancer risk factor were referred to their physician, as they needed further screening of skin cancer. Results: A total of 5,530 participants were evaluated. Of those, only 20.2% participants had received a total body skin examination for skin cancer screening in the past by a physician and 57.1% reported using a SPF 50+ sunscreen. 53.9% participants presented ≥1 skin cancer risk factor: 11.8% participants reported having skin cancer familial history and 6.2% reported skin cancer personal history; pharmacists found ≥10 melanocytic nevi in 43.8% participants and chronically sun-damaged skin in 21.4%. Lesions suspicious for melanoma were reported in 10.9% of the participants and urgent dermatological evaluation was recommended. Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their users. This intervention can be considered in multidisciplinary strategies of skin cancer screening

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Diagnostic accuracy of imaging studies for initial staging of T2b to T4b melanoma patients: A cross-sectional study.

BACKGROUND: There is no consensus on the imaging tests that should be performed at the initial staging of melanoma patients. OBJECTIVE: To evaluate the diagnostic accuracy of 4 imaging studies for the initial staging of melanoma patients. METHODS: Cross-sectional study with prospectively collected data, from January 2011 to April 2017, including patients with clinical stage T2b to T4b according to 2009 American Joint Committee on Cancer, without evidence of metastasis. RESULTS: Initial staging of 308 patients detected 16.6% of metastases and 5.8% false-positive results, overall. Regional lymph node ultrasonography showed a metastasis detection rate (MDR) of 12.8%, false-positive rate of 0.8%, and accuracy of 96.0%. Computed tomography (CT) and positron emission tomography-CT had the highest detection rates at stage T4b: MDR, 13.3%; false-positive rate, 8.9%; accuracy, 91.1%; and MDR, 6.9%; false-positive rate, 0%; and accuracy, 93.1%, respectively. Brain magnetic resonance imaging showed a MDR of 2.0% in T4b. LIMITATIONS: Single-center study. CONCLUSION: Performing ultrasound scans for assessing lymph node metastasis in patients with American Joint Committee on Cancer T2b stage and above is advisable. In patients with stage T4b, CT or positron emission tomography-CT are suitable for the detection of metastasis. Brain magnetic resonance imaging at T4b deserves further discussion, considering the ultimate clinical benefit in management and therapeutic options for asymptomatic patients.

Nuestra experiencia en el tratamiento urgente de la hemorragia renal / Our experience in emergency treatment of renal haemorrhage

INTRODUCCIÓN: Los casos de hemorragia renal que provocan un compromiso para la vida del paciente requieren de una cirugía urgente. Actualmente la cirugía endovascular es el tratamiento de primera elección. OBJETIVO: Revisar los pacientes con una hemorragia renal que fueron intervenidos de urgencia mediante una técnica endovascular en nuestro centro. Evaluar las causas de sangrado renal, el tratamiento realizado así como los resultados obtenidos. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de pacientes consecutivos con sangrado renal y que fueron tratados con una técnica endovascular entre junio del 2012 y junio del 2017 en el Hospital Universitari Joan XXIII (Tarragona). Se recogieron los datos demográficos (edad, sexo, comorbilidad) y otras variables relacionadas (mecanismo de la lesión, la estabilidad hemodinámica y si estaba en tratamiento anticoagulante). También se analizaron los hallazgos encontrados en la angio-TAC, el tiempo transcurrido entre el diagnóstico y la realización de la cirugía, la técnica endovascular y el material utilizado, la extensión de parénquima embolizado y los resultados obtenidos. RESULTADOS: Incluimos a 22 pacientes con una edad media de 63 años (19-85). Las causas de lesión fueron relacionadas con punción de una biopsia renal (n=7,31; 8%), sangrado de tumoraciones malignas renales (n=5; 22,7%), traumatismos (n=4; 18,2%), angiomiolipomas (n=2; 9,1%), sangrado espontáneo (n=2; 9,1%) y complicaciones quirúrgicas (n=2; 9,1%). En todos los casos la técnica endovascular realizada fue la embolización. El material utilizado fue: esferas (9,1%), coils (63,6%), esferas + coils (18,2%), esferas+oclusor (9,1%). En 17 de los casos (77,3%) se llevó a cabo una embolización selectiva y en 5 casos (22,7%) una embolización de todo el riñón. El éxito clínico y técnico fue del 100%. La mortalidad a los 30 días fue del 9,1%. CONCLUSIÓN: Creemos que el tratamiento endovascular es una técnica efectiva para el control del sangrado renal y permite, en la mayoría de casos, la preservación de gran parte de parénquima renal

INTRODUCTION: Renal haemorrhage is a potentially life-threatening event requiring emergency surgery. Endovascular therapy is currently the first-line treatment option. OBJECTIVS: Review patients with renal haemorrhage who required emergency endovascular therapy at our center. Evaluate the causes of the bleeding, the treatment performed and the clinical outcomes. MATERIAL AND METHODS: We performed a retrospective analysis of consecutive patients with renal bleeding who underwent endovascular therapy from June 2012 to June 2017 at Hospital Universitari Joan XXIII (Tarragona, Spain). Demographic data (age, gender and comorbidity) and other related variables were collected (mechanism of injury, haemodynamic stability and anticoagulant therapy). We also studied the CT angiography findings, time from diagnosis to surgery, endovascular technique and materials used, extent of tissue embolised and outcomes. RESULTS: Twenty-two (22) patients were included with a mean age of 63 (range 19-85). The aetiology of injuries included: renal biopsy (n=7, 31.8%), bleeding from malignant kidney tumour (n=5, 22.7%), trauma (n=4, 18.2%), angiomyolipoma (n=2, 9.1%), spontaneous bleeding (n=2, 9.1%) and surgical complications (n=2, 9.1%). The endovascular therapy technique was embolisation in all cases. The following materials were used: spheres (9.1%); coils (63.6%); spheres + coils (18.2%); and spheres + plug (9.1%). In 17 cases (77.3%), selective embolisation was performed and in five cases (22.7%), embolisation of the whole kidney. Clinical and technical success rates of 100% were recorded. The 30-day mortality rate was 9.1%. CONCLUSION: We believe that endovascular therapy is an effective modality for the management of renal bleeding which, in many cases, enables a large part of the renal tissue to be preserved

Our experience in emergency treatment of renal haemorrhage. / Nuestra experiencia en el tratamiento urgente de la hemorragia renal.

INTRODUCTION: Renal haemorrhage is a potentially life-threatening event requiring emergency surgery. Endovascular therapy is currently the first-line treatment option. OBJECTIVES: Review patients with renal haemorrhage who required emergency endovascular therapy at our center. Evaluate the causes of the bleeding, the treatment performed and the clinical outcomes. MATERIAL AND METHODS: We performed a retrospective analysis of consecutive patients with renal bleeding who underwent endovascular therapy from June 2012 to June 2017 at Hospital Universitari Joan XXIII (Tarragona, Spain). Demographic data (age, gender and comorbidity) and other related variables were collected (mechanism of injury, haemodynamic stability and anticoagulant therapy). We also studied the CT angiography findings, time from diagnosis to surgery, endovascular technique and materials used, extent of tissue embolised and outcomes. RESULTS: Twenty-two (22) patients were included with a mean age of 63 (range 19-85). The aetiology of injuries included: renal biopsy (n=7, 31.8%), bleeding from malignant kidney tumour (n=5, 22.7%), trauma (n=4, 18.2%), angiomyolipoma (n=2, 9.1%), spontaneous bleeding (n=2, 9.1%) and surgical complications (n=2, 9.1%). The endovascular therapy technique was embolisation in all cases. The following materials were used: spheres (9.1%); coils (63.6%); spheres + coils (18.2%); and spheres + plug (9.1%). In 17 cases (77.3%), selective embolisation was performed and in five cases (22.7%), embolisation of the whole kidney. Clinical and technical success rates of 100% were recorded. The 30-day mortality rate was 9.1%. CONCLUSION: We believe that endovascular therapy is an effective modality for the management of renal bleeding which, in many cases, enables a large part of the renal tissue to be preserved.

The pursuit of healthier communities through a community health medical education program.

BACKGROUND: Distinct periods in the community health undergraduate medical program at the University of La Sabana (Colombia) were identified in its evolution from 1999 to 2013. We describe each period and explain the succesion of changes toward improvement. METHODS: An ordered review of the community health program was constructed based on the retrospective recollection, classification, and analysis of information from document archives and interviews with participants. The review of the experience reconstructs periods of the program, organizing the evolution of its learned lessons and identified changes across the development of community health projects (CHPs) and the phases followed in their implementation. RESULTS: Two principal stages were identified, the first when students' CHPs involved only schools, and the second when students worked in a broader array of community settings. Identified phases of the community health cycle leading to identifying changes across the program timeline were focus of the community-campus partnership; development of relationships among participants; health and health determinants' assessment; defining project goals and objectives; devising a project activity plan; implementing and gathering results; disseminating project achievements; and building sustainability of program activities. Periods were bounded by important new characteristics introduced in the pursuit of healthier communities. DISCUSSION: Understanding the evolution of the program revealed the key concepts and practices in setting community health apprenticeship scenarios for the various participants. Overall, trust and commitment from stakeholders requires competent facilitators able to build meaningful and sustainable collaborations that can translate the purpose of community health practice into an effective teaching-learning experience. Institutional capacity building and collaborative practice contribute to improvements in the community health program and its ability to be flexible to adapt to different contexts. Periods reflecting improvement in this school's programs over time can help others identify key elements that need to be integrated into a community health medical education program.

Aneurismas poplíteos. Evolución y factores pronósticos en la trombosis del saco / Popliteal aneurysms. Their course and prognostic factors in thrombosis of the sac

Objetivos. Conocer la evolución de aneurismas poplíteos tratados quirúrgicamente y evaluar factores pronósticos en la trombosis del saco. Pacientes y métodos. Desde mayo de 1993 hasta junio del año 2005, 43 pacientes presentaron 64 aneurismas poplíteos (diámetro medio: 2,8 cm; intervalo: 1,2-8 cm); de ellos, 19 (29%) han recibido tratamiento médico (compensación tras trombosis), dos (3%) aneurismectomía más injerto terminoterminal vía posterior, 22 (34%) exclusión por ligadura más bypass poplíteo-poplíteo y, por último, 21 (32%) exclusión y bypass femoropoplíteo. Hemos realizado un estudio descriptivo transversal en los 43 aneurismas tratados mediante exclusión y bypass (67%). Mediante eco-Doppler de control se evaluó: diámetro, presencia de flujo o trombosis del aneurisma y permeabilidad del bypass. Se analizó, mediante regresión de Cox, si existía asociación estadísticamente significativa entre la trombosis postoperatoria del saco aneurismático y los siguientes factores: diámetro preoperatorio del aneurisma, edad, factores de riesgo cardiovascular, comorbilidad, tipo de tratamiento, run-off, permeabilidad del bypass y presencia de aneurisma contralateral o de aorta. Resultados. De 43 aneurismas intervenidos, se pudieron evaluar 25 (56%). Se detectó flujo Doppler intraaneurismático en cuatro casos (16%); de éstos, hubo crecimiento del saco en tres (12%), y en uno (4%) disminuyó. De los 21 casos (84%) con trombosis completa del saco, se detectó su crecimiento en dos (8%), y en los 19 restantes (76%) disminuyó. El control clínico medio fue de 65 meses (intervalo: 1-128 meses). No se detectaron roturas ni síntomas compresivos. El tipo de cirugía resultó ser el único factor estadísticamente significativo (p = 0,04). Conclusiones. La reparación quirúrgica no garantiza la trombosis del aneurisma. El bypass poplíteo-poplíteo muestra mayores garantías en la trombosis del saco aneurismático

Aims. To determine how surgically treated popliteal aneurysms progressed and to evaluate the prognostic factors for thrombosis of the aneurysmal sac. Patients and methods. Between May 1993 and June 2005, 43 patients presented with 64 popliteal aneurysms (mean diameter: 2.8 cm; interval: 1.2-8 cm), of which 19 (29%) received medical treatment (compensation following thrombosis), two (3%) underwent an aneurysmectomy plus an end-to-end graft inserted using a posterior approach, 22 (34%) were treated with exclusion by ligation plus popliteal-popliteal bypass and, lastly, 21 (32%) underwent exclusion and femoral-popliteal bypass. We conducted a cross-sectional descriptive study in the 43 aneurysms treated by means of exclusion and bypass (67%). A control Doppler ultrasound recording was used to evaluate diameter, presence of flow or thrombosis of the aneurysm and patency of the bypass. Cox regression was used to analyse whether there was a statistically significant association between post-operative thrombosis of the aneurysmal sac and the following factors: pre-operative diameter of the aneurysm, age, cardiovascular risk factors, comorbidity, type of treatment, run-off, patency of the bypass and the presence of a contralateral or aortic aneurysm. Results. Of the 43 aneurysms that were treated with surgery, we were able to evaluate 25 (56%). Intra-aneurysmal Doppler flow was detected in four cases (16%); of these, the sac was seen to have grown in three (12%) and it had diminished in one (4%). Of the 21 cases (84%) with complete thrombosis of the sac, growth was detected in two of them (8%) and it had diminished in the remaining 19 (76%). Mean clinical monitoring time was 65 months (interval: 1-128 months). No ruptures or symptoms of compression were detected. Findings showed that type of surgery is the only statistically significant factor (p = 0.04). Conclusions. Surgical repair does not guarantee thrombosis of the aneurysm. A popliteal-popliteal bypass offers a higher degree of safety in thrombosis of the aneurysmal sac

Derivación iliofemoral frente a femorofemoral. ¿Cuál es la mejor opción? Seguimiento a largo plazo / Ileofemoral or femorofemoral by-pass. Which is the best option? A long-term follow-up study

Objetivo. Comparar la permeabilidad primaria y el salvamento de la extremidad a los cinco años entre la derivación iliofemoral y la femorofemoral y determinar los factores que influyen en la permeabilidad de estas derivaciones. Pacientes y métodos. Desde enero de 1992 a diciembre de 2000, se intervinieron 72 pacientes con enfermedad ilíaca unilateral e isquemia crítica de la extremidad (21 iliofemorales, con una edad media de 66,3 años y 51 femorofemorales, con una edad media de 70 años). Se realizaron tablas de contingencia (c2, t de Student) para comparar los grupos entre sí, según los factores de riesgo cardiovascular, el sexo, la edad y la salida distal; test de log-rank para comparar la permeabilidad primaria y el salvamento de la extremidad entre grupos (representación gráfica por Kaplan-Meier), y se realizó un análisis multivariante por regresión de Cox para determinar los factores predictivos de oclusión a los cinco años. Resultados. La permeabilidad primaria del grupo femorofemoral fue del 63 por ciento a los cinco años; en el grupo iliofemoral fue del 76 por ciento, sin que existieran diferencias entre ellos (p = 0,831). El salvamento de la extremidad del grupo femorofemoral fue del 87 por ciento a los cinco años; la del grupo iliofemoral fue del 85 por ciento. No hubo diferencias significativas entre los grupos (p = 0,449). Por regresión de Cox, el único factor que influye en la permeabilidad de estas derivaciones a largo plazo es la salida distal. Conclusiones. A los cinco años, no hay diferencias entre los dos grupos en cuanto a permeabilidad primaria y salvamento de la extremidad. La única variable predictiva de oclusión de estas derivaciones a los cinco años es la salida distal (AU)

Adaptación funcional y psicosocial después de cirugía de articulación temporomandibular / Functional and psychological adaptation after temporomandibular surgery

El propósito de este estudio fue describir los cambios funcionales y psicosociales experimentados por los pacientes que se sometieron a tratamiento quirúrgico temporomandibular ATM. En 10 pacientes en los cuales se hizo reposicionamiento discal de la ATM se evaluó el grado de adaptación funcional y psicosocial mediante un cuestionario aplicado antes y tres meses después de la cirugía. El cuestionario constaba de 77 preguntas: 48 pertenecientes al índice OHIP (Oral Healt Impact Profile) agrupadas en los siguientes ítems: limitación funcional, afección social, alteración física y malestar psicológico; 9 preguntas con respecto a la apariencia de la cara y 20 preguntas del test de ansiedad y depresión de Zung. Los resultados mostraron que antes de la cirugía los pacientes encuestados, en general no presentaban un componente psicosocial y depresivo importante y que si en algunos casos había compromiso leve, este mejoraba después del procedimiento quirúrgico. De los aspectos investigados el más comprometido antes de la cirugía fue la limitación funcional. Todos los aspectos presentaron mejoría clínica después de la cirugía. La limitación funcional mostró una mejoría del 44.9 por ciento, la afección social del 61.6 por ciento, la alteración física mejoró un 30.9 por ciento y en el malestar psicológico la mejoría fue del 39.5 por ciento…