Evaluation of the Feasibility, Safety and Efficacy of the Use of Intravenous Infusions of Adenosine Triphosphate (ATP) in People Affected by Moderate to Severe Alzheimer's Disease: A Double-Blind Masked Clinical Trial for Dose Finding.

BACKGROUND: There are currently no drug therapies modifying the natural history of patients suffering Alzheimer's disease (AD). Most recent clinical trials in the field include only subjects in early stage of the disease, while patients with advanced AD are usually not represented. OBJECTIVES: To evaluate the feasibility, safety and efficacy of systemic infusions of adenosine triphosphate (ATP) in patients with moderate to severe AD, and to select the minimum effective dose of infusion. DESIGN: A phase IIb, randomized, double-blind, placebo-controlled clinical trial investigates. PARTICIPANTS: A total of 20 subjects with moderate or severe AD were included, 16 in the treatment group and 4 in the placebo group (4:1 randomization) at two dosage regimens, 6-hour or 24-hour infusions. RESULTS: The proof-of-concept study was successfully conducted, with no significant deviations from the study protocol and no serious adverse events reported. Regarding efficacy, only marginal differences were observed between ATP and placebo arms for H-MRS and MMSE variables. CONCLUSIONS: Our study demonstrates that the use of ATP infusion as therapy is feasible and safe. Larger studies are however needed to assess the efficacy of ATP in moderate to severe AD.

Variables acceptance reliability sampling plan for items subject to inverse Gaussian degradation process.

Until now, in the literature, a variety of acceptance reliability sampling plans have been developed based on different life test plans. In most of the reliability sampling plans, the decision procedures to accept or reject the corresponding lot are developed based on the lifetimes of the items observed on tests, or the number of failures observed during a pre-specified testing time. However, frequently, the items are subject to degradation phenomena and, in these cases, the observed degradation level of the item can be used as a decision statistic. In this paper, we develop a variables acceptance sampling plan based on the information on the degradation process of the items, assuming that the degradation process follows the inverse Gaussian process. It is shown that the developed sampling plan improves the reliability performance of the items conditional on the acceptance in the test and that the lifetimes of items after the reliability sampling test are stochastically larger than those before the test. A study comparing the proposed degradation-based sampling plan with the conventional sampling plan which is based on a life test is also performed.

Implicación en Cataluña de los Servicios de Anestesiología y Reanimación en la pandemia por SARS-CoV-2. Una solución real coste-efectiva para una crisis sanitaria sin precedentes / Involvement in Catalonia of the Anaesthesiology and Resuscitation Services in the SARS-CoV-2 pandemic. A real, cost-effective solution to an unprecedented health crisis

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Lesión ungueal en un escolar, ¿qué sospechar? / Nail injury in a seven-year-old girl, what to suspect?

Las alteraciones ungueales en los niños representan un motivo de consulta frecuente en Atención Primaria. El adecuado desarrollo de las uñas depende de varios procesos fisiológicos, tanto locales como sistémicos, por lo que un gran número de afecciones pueden generar alteraciones ungueales. Durante la infancia existen diferencias fisiológicas del aparato ungueal con los adultos. Conocer estas variaciones fisiológicas es imprescindible para un correcto manejo. Se presenta el caso clínico de una niña de siete años con lesiones ungueales con piqueteado ungueal y estriación (AU)

The nail changes in children are a common reason for consultation in primary care. The proper development of nails depends on various physiological processes, both local and systemic, so a large number of conditions can cause nail changes. During infancy, there are physiological differences on nails with adults. Knowing these physiological variations is essential for proper management. The case of a seven-year-old girl with nail lesions with nail pitting and striations is presented (AU)

Bloqueo interescalénico ecoguiado: análisis coste-eficiencia, ropivacaína frente a levobupivacaína / Ultrasound-guided interscalene block: cost-efficiency analysis, ropivacaine versus levobupivacaine

El bloqueo interescalénico del plexo braquial proporciona anestesia y/o analgesia a nivel del hombro, brazo y antebrazo. Es una técnica anestésica y/o analgésica muy habitual en la práctica clínica diaria, bastante sencilla y segura. Desde su descripción se han desarrollado varios métodos para su realización por referencias anatómicas, neuroestimulación y ecografía, así como diferentes abordajes. Revisamos de forma exhaustiva la anatomía y el abordaje ecoguiado del plexo braquial a nivel interescalénico. Esta técnica permite una localización sencilla, reproducible y mínimamente invasiva, con las ventajas que ello implica en el campo de acción de la anestesia regional. Asimismo, se realiza un análisis coste-eficiencia del uso de ropivacaína frente a levobupivacaína en dicho bloqueo, observándose con el uso de ropivacaína un ahorro económico considerable. El uso de dosis equipotentes de ropivacaína frente a levobupivacaína en dicho bloqueo representa un ahorro de un 50 % en el caso de la administración de una dosis única y de hasta un 66 % en el caso de los preparados para perfusiones continuas (AU)

The interscalene brachial plexus block provides anesthesia and/or analgesia at the shoulder, arm and forearm. The interscalene brachial plexus block is a fairly simple, safe and common anesthetic/ analgesic technique used in daily clinical practice Since its description, several methods have been developed to implement this block by means of anatomical landmarks, nerve stimulation and ultrasound-guidance, as well as the description of different technical approaches. This paper focuses on reviewing the anatomy and ultrasound-guided approach to brachial plexus at interscalene region. This technique allows a simple, reproducible and minimally invasive location, with the advantages that regional anesthesia imply. Moreover, a cost-efficiency comparison of the use of local anesthetics (ropivacaine versus levobupivacaine) in this block technique results in considerable economic savings from the use of ropivacaine. Use of equipotent doses of ropivacaine versus levobupivacaine in this technique represents a saving of 50 % in the case of administering a single dose and up to 66 % in the case of preparations for continuous infusions (AU)

Bloqueos periféricos en cirugía ambulatoria; aportaciones de la ecografía / Peripheral blocks in one-day surgery; contribution of ultrasound

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Nevus lentiginoso atípico. Estudio clínico-patológico de 14 casos / Atypical Lentiginous Nevus: A Clinical and Histopathologic Study of 14 Cases

Introducción: El nevus lentiginoso atípico (NLA) del anciano es una forma peculiar de nevus displásico, que clínicamente puede simular un melanoma maligno, y que histológicamente presenta un patrón lentiginoso con grados variables de atipia en ausencia de nidos dérmicos, que puede sugerir erróneamente el diagnóstico de lentigo melanoma o melanoma lentiginoso. Material y métodos: Hemos recogido 14 casos de nevus melanocítico lentiginoso atípico diagnosticados entre diciembre de 2007 y marzo de 2009 en el Servicio de Dermatología del Hospital General de Valencia. Hemos estudiado sus características clínicas e histopatológicas tras la tinción de las piezas con hematoxilina-eosina, melan-A y Ki67 y las hemos comparado con los datos publicados en la literatura. Resultados: Entre los datos clínicos, el 28% eran menores de 50 años, con una relación entre sexos de 1:1. La mayoría de las lesiones sugerían clínicamente un nevus atípico (8/14) y todas aparecieron en la espalda. Todos los casos presentaron hiperplasia epidérmica lentiginosa irregular, con proliferación de células melanocíticas individuales, limitadas a la membrana basal, en ausencia de nidos dérmicos; solo 4/14 tenían también ascenso epidérmico focal. Todos presentaron atipia citológica (en un 85% de los casos moderada). El índice de proliferación, valorado mediante la tinción con Ki67, fue bajo (<5%) en todos los casos estudiados. Conclusión: Los NLA son lesiones que pueden simular clínica e histológicamente un melanoma, y que se encuentran en el grupo de las lesiones pigmentadas atípicas con patrón lentiginoso: tanto en nuestra serie como en las series previamente publicadas, los hallazgos histológicos y evolución clínica de estos pacientes orientan hacia el diagnóstico de nevus displásico. Actualmente todos los pacientes estudiados están sanos y sin recidivas después de un seguimiento mínimo de 18 meses (AU)

Background: Atypical lentiginous nevus (of the elderly) is a peculiar form of dysplastic nevus. Clinically, this condition can resemble malignant melanoma and histologically, it has a lentiginous pattern with variable degrees of atypia and an absence of dermal nests. These features may lead to an erroneous diagnosis of lentigo maligna melanoma or lentiginous melanoma. Material and methods: We reviewed 14 cases of atypical lentiginous nevus diagnosed at the dermatology department of Hospital General de Valencia in Valencia, Spain between December 2007 and March 2009. We studied the clinical and histopathologic features of the lesions after hematoxylin-eosin, Melan-A, and Ki-67 staining and compared our results to data reported in the literature. Results: Four (28%) of the 14 patients (7 men, 7 women) were under 50 years of age. Clinically, most of the lesions (8/14) resembled atypical nevi and they were all located on the back. Histologically, they all had irregular lentiginous epidermal hyperplasia, with a proliferation of individual melanocytes only in the basal layer of the epidermis and an absence of dermal nests. Focal upward migration of melanocytes into the epidermis was present in just 4 cases. All the lesions had cellular atypia, which was moderate in 85% of cases. The Ki-67 proliferation index was low (<5%) in all the lesions analyzed. Conclusions: Atypical lentiginous nevi, which can be classified as atypical pigmented lesions with a lentiginous pattern, may clinically and histologically resemble melanoma. Our findings support earlier reports that both clinical and histologic findings may suggest a diagnosis of dysplastic nevus. All of the patients in our series are healthy and free of recurrence after 18 months or longer (AU)

[Atypical lentiginous nevus: a clinical and histopathologic study of 14 cases]. / Nevus lentiginoso atípico. Estudio clínico-patológico de 14 casos.

BACKGROUND: Atypical lentiginous nevus (of the elderly) is a peculiar form of dysplastic nevus. Clinically, this condition can resemble malignant melanoma and histologically, it has a lentiginous pattern with variable degrees of atypia and an absence of dermal nests. These features may lead to an erroneous diagnosis of lentigo maligna melanoma or lentiginous melanoma. MATERIAL AND METHODS: We reviewed 14 cases of atypical lentiginous nevus diagnosed at the dermatology department of Hospital General de Valencia in Valencia, Spain between December 2007 and March 2009. We studied the clinical and histopathologic features of the lesions after hematoxylin-eosin, Melan-A, and Ki-67 staining and compared our results to data reported in the literature. RESULTS: Four (28%) of the 14 patients (7 men, 7 women) were under 50 years of age. Clinically, most of the lesions (8/14) resembled atypical nevi and they were all located on the back. Histologically, they all had irregular lentiginous epidermal hyperplasia, with a proliferation of individual melanocytes only in the basal layer of the epidermis and an absence of dermal nests. Focal upward migration of melanocytes into the epidermis was present in just 4 cases. All the lesions had cellular atypia, which was moderate in 85% of cases. The Ki-67 proliferation index was low (<5%) in all the lesions analyzed. CONCLUSIONS: Atypical lentiginous nevi, which can be classified as atypical pigmented lesions with a lentiginous pattern, may clinically and histologically resemble melanoma. Our findings support earlier reports that both clinical and histologic findings may suggest a diagnosis of dysplastic nevus. All of the patients in our series are healthy and free of recurrence after 18 months or longer.

¿Melanoma lentiginoso acral: metastásico,simultáneo, persistente? / Persistent, simultaneous, metastasic, acral lentiginous melanoma?

El melanoma lentiginoso acral (MLA) supone un 5% de todos los melanomas malignos, y presenta una frecuencia de metástasis loco-regionales mayoral resto de subtipos de melanoma. En la práctica clínica habitual observamos que existe un porcentaje significativo de casos de MLA que presentan recurrencias locales en zonas de piel aparentemente sanas, incluso después de haber realizado una extirpación con márgenes de seguridad adecuados, como en el caso clínico que presentamos. Esto podría estar generado por la presencia del denominado “campo de células de melanoma”, definido recientemente por Bastian (AU)

Acral lentiginous melanoma (MLA) represents 5% of all malignant melanomas, and has a frequency of loco-regional metastases greater than other subtypes of melanoma. In clinical practice we observed that a significant percentage of cases of MLA that recurrences in apparently healthy areas of skin, even after making excision with adequate safety margins, as in a case that we present. This could be generated by the presence of so-called“ melanoma field cells” recently defined by Bastian (AU)

Alitretinoína oral: tratamiento específicio del eczema crónico de manos grave refractario a corticoides / Oral alitretinoin: specific therapy for severe chronic eczema of the hands refractory to corticosteroids

El eczema de manos (ECM) es la dermatosis más frecuente de la manos, y se trata de un importante (..) (AU)

Eczema of the hands (EOH) is the most prevalent hand dermatosis and represents and important healthcare, social (..) (AU)

Anatomic study of the lymph nodes of the mesorectum.

PURPOSE: Lymph node involvement is the most important prognostic factor when staging patients with colorectal cancer. The probability of detecting metastasis grows with the number of nodes examined. However, the number of nodes found in surgical specimens varies substantially. We have therefore determined the number and distribution of lymph nodes in the mesorectum by cadaveric dissection. METHODS: Twenty formalin-fixed cadaveric pelvises were dissected (13 males). The search for lymph nodes was performed in a systematic way, from the division of the superior rectal artery following the smallest visible branches to the level of the anorectal ring. RESULTS: A total of 168 lymph nodes were found in 20 mesorectal blocks, with a mean (standard deviation) number per specimen of 8.4 (4.45). Lymph node size ranged from 2 to 10 mm. Distribution of lymph nodes in mesorectum was as follows: 120 nodes (71.4 percent) were found around the branches of the superior rectal artery proximal to the peritoneal reflection, and 48 nodes (28.6 percent) were found distal to the peritoneal reflection. Fourteen specimens (70 percent) had lymph nodes at the division of the superior rectal artery. CONCLUSIONS: The mean number of lymph nodes found in the mesorectum distal to the superior rectal artery division was 8.4. Most of these lymph nodes were proximal to the peritoneal reflection. The range found in the number of lymph nodes per case should be considered for use in the formulation of guidelines in anatomicopathologic studies of surgical specimens obtained after mesorectal excision.

[Squamous carcinoma of the prostate]. / Carcinoma escamoso de próstata.

A primary squamous cell carcinoma occurring in the prostate of 84 year-old man is described. The patient died of local progression six months after diagnosis. Review of the literature suggests that such a cancer of the prostate is rare, highly aggressive, and responds poorly to any mode of therapy.