Intestinal perforation after pediatric liver transplantation: risk factors and management. / Perforación intestinal tras trasplante hepático pediátrico: factores de riesgo y manejo.

BACKGROUND: Intestinal perforation (IP) after pediatric liver transplant (PLT) is an uncommon complication with high mortality reported. The aim of this study is to identify the risk factors and management of this complication. MATERIALS AND METHODS: Retrospective study of IP after PLT from January 2014 to October 2020. RESULTS: Four intestinal perforations were indentificated in 102 PLT (3,9%). Three patients with BA and one neonate with hemochromatosis (HC) presented this complication. The mean weight of patients with IP was 6.3± 2.5kg (3.1-9) and 19.9 ± 15.4kg for the rest (p< 0.05). All IP with BA had a previous laparotomy. Two living donors and two left lateral reduced liver were implanted. The diagnosis of intestinal perforation was done on day 11 ± 3.3 (8-15 days). Diagnosis was suspected with clinical and biological signs of perforation, CT scan confirmed the diagnosis in patiens with BA and by direct visualization through the mesh for temporary closure in the patient with hemocromatosis. Urgent laparotomy was performed. We identified three colonic perforations, all of them in BA patients and all repaired with direct suture. The patient with HC presented multiple perforations secondary to necrotizing enterocolitis requiring an ileostomy and finally died due to multiorgan failure. CONCLUSION: Intestinal perforation after PLT is an infrequent complication. Age, weight, previous laparotomy and BA could be risk factors for IP in PLT. Urgent laparotomy after diagnosis should be performed in order to reduce mortality. Isolated IP with adequate treatment might not affect long term outcomes after pediatric liver transplantation.

INTRODUCCION: La perforación intestinal (PI) tras trasplante hepático pediátrico (THP) es una complicación poco frecuente, pero con una elevada mortalidad. El objetivo de este estudio es identificar los factores de riesgo y el manejo de esta complicación. MATERIAL Y METODOS: Estudio retrospectivo de la PI tras THP entre enero de 2014 y octubre de 2020. RESULTADOS: Se hallaron 4 perforaciones intestinales en 102 THP (3,9%). Presentaron esta complicación 3 pacientes con atresia biliar (AB) y un neonato con hemocromatosis (HC). El peso medio de los pacientes con PI era de 6,3 ± 2,5 kg (3.1-9) y de 19,9 ± 15,4 kg en el caso del resto (p<0,05). Todos los pacientes con PI y AB habían sido sometidos previamente a laparotomía. Se implantaron 2 hígados de donantes vivos y 2 hígados laterales reducidos izquierdos. El diagnóstico de perforación intestinal se efectúo en el día 11 ± 3,3 (8-15 días), sospechándose con signos clínicos y biológicos de perforación, y confirmándose mediante escáner en los pacientes con AB y mediante visualización directa a través de la malla para el cierre temporal en el paciente con hemocromatosis. Se llevó a cabo laparotomía de urgencia. Se identificaron 3 perforaciones de colon, todas ellas en pacientes con AB y reparadas con sutura directa. El paciente con HC presentaba múltiples perforaciones secundarias a enterocolitis necrotizante que precisaron ileostomía, falleciendo finalmente como consecuencia de un fallo multiorgánico. CONCLUSIONES: La perforación intestinal tras THP es una complicación poco frecuente. La edad, el peso, las laparotomías previas y la AB podrían ser factores de riesgo de PI en el THP. Para reducir la mortalidad, es conveniente practicar una laparotomía de urgencia tras el diagnóstico. Una PI aislada con un adecuado tratamiento puede no influir en los resultados a largo plazo tras un trasplante hepático pediátrico.

Perforación intestinal tras trasplante hepático pediátrico: factores de riesgo y manejo / Intestinal perforation after pediatric liver transplantation: risk factors and management

Introducción: La perforación intestinal (PI) tras trasplante hepáticopediátrico (THP) es una complicación poco frecuente, pero con unaelevada mortalidad. El objetivo de este estudio es identificar los factoresde riesgo y el manejo de esta complicación. Material y métodos: Estudio retrospectivo de la PI tras THP entreenero de 2014 y octubre de 2020. Resultados: Se hallaron 4 perforaciones intestinales en 102 THP(3,9%). Presentaron esta complicación 3 pacientes con atresia biliar (AB)y un neonato con hemocromatosis (HC). El peso medio de los pacientescon PI era de 6,3 ± 2,5 kg (3.1-9) y de 19,9 ± 15,4 kg en el caso delresto (p<0,05). Todos los pacientes con PI y AB habían sido sometidospreviamente a laparotomía. Se implantaron 2 hígados de donantes vivosy 2 hígados laterales reducidos izquierdos. El diagnóstico de perforaciónintestinal se efectúo en el día 11 ± 3,3 (8-15 días), sospechándose consignos clínicos y biológicos de perforación, y confirmándose medianteescáner en los pacientes con AB y mediante visualización directa a travésde la malla para el cierre temporal en el paciente con hemocromatosis.Se llevó a cabo laparotomía de urgencia. Se identificaron 3 perforacionesde colon, todas ellas en pacientes con AB y reparadas con sutura directa. El paciente con HC presentaba múltiples perforaciones secundarias aenterocolitis necrotizante que precisaron ileostomía, falleciendo finalmente como consecuencia de un fallo multiorgánico.Conclusión: La perforación intestinal tras THP es una complicaciónpoco frecuente. La edad, el peso, las laparotomías previas y la AB podrían ser factores de riesgo de PI en el THP. Para reducir la mortalidad,es conveniente practicar una laparotomía de urgencia tras el diagnóstico.Una PI aislada con un adecuado tratamiento puede no influir en losresultados a largo plazo tras un trasplante hepático pediátrico.(AU)

Background: Intestinal perforation (IP) after pediatric liver trans-plant (PLT) is an uncommon complication with high mortality reported.The aim of this study is to identify the risk factors and management ofthis complication. Material and methods: Retrospective study of IP after PLT fromJanuary 2014 to October 2020. Results: Four intestinal perforations were indentificated in 102 PLT(3,9%). Three patients with BA and one neonate with hemochromatosis(HC) presented this complication. The mean weight of patients with IPwas 6.3 ± 2.5kg (3.1-9) and 19.9 ± 15.4kg for the rest (p< 0,05). AllIP with BA had a previous laparotomy. Two living donors and two leftlateral reduced liver were implanted. The diagnosis of intestinal perforation was done on day 11 ± 3.3 (8-15 days). Diagnosis was suspectedwith clinical and biological signs of perforation, CT scan confirmed thediagnosis in patiens with BA and by direct visualization through themesh for temporary closure in the patient with hemocromatosis. Urgentlaparotomy was performed. We identified three colonic perforations, allof them in BA patients and all repaired with direct suture. The patientwith HC presented multiple perforations secondary to necrotizing enterocolitis requiring an ileostomy and finally died due to multiorgan failure.Conclusion: Intestinal perforation after PLT is an infrequent complication. Age, weight, previous laparotomy and BA could be risk factorsfor IP in PLT. Urgent laparotomy after diagnosis should be performed inorder to reduce mortality. Isolated IP with adequate treatment might notaffect long term outcomes after pediatric liver transplantation.(AU)

Interplay between psychosocial and heart failure related factors may partially explain limitations in self-efficacy in patients with heart failure: Insights from a real-world cohort of 1,123 patients.

BACKGROUND AND AIMS: Worse self-care is associated with a higher risk of readmission and mortality in patients with heart failure (HF). Little is known about how the interplay between clinical and psycho-social factors may modulate self-care behaviours in these patients. The aim of our study was to identify clinical, and particularly psycho-social factors associated with worse self-care and assess their interaction inpatients with heart failure. METHODS AND RESULTS: We conducted an observational, prospective, cohort study of 1,123 consecutive patients with chronic heart failure. Self-care was assessed with the modified European Heart Failure Self-care Behavior Scale 9-item version (EHFSCBS-9), and both clinical and psycho-social profile of the patients included were also meticulously evaluated. A total of 484 patients (43%) were women, mean age was 72 years, and mean left ventricular ejection fraction was 44.5%. In multivariable analyses combining clinical and psycho-social factors, low social support (OR 3.53, 95% CI [2.13-5.86]; p-value <0.001), absence of caregiver support (OR 2.16, 95% CI [1.34 -3.48]; p-value 0.001) and depressive symptoms (OR 2.40, 95% CI [1.53-3.77]; p-value <0.001) were independent determinants of impaired global self-care. Advanced functional class was associated with better self-care (OR 0.43, 95%CI [0.26-0.70]; p-value 0.001). No other clinical factors remained significantly associated with self-care in these joint models. In discrimination analyses, models containing psycho-social determinants outperformed models only containing heart failure -related (clinical) variables (all p-values<0.001). CONCLUSION: Impairment in self-care behaviour is strongly determined by psycho-social factors. Specifically, low social support, the lack of caregiver support and the presence of depressive symptoms are the main drivers of the risk of impairment of self-care in heart failure patients. Evaluation of self-care and self-care interventions should be complemented by a comprehensive psycho-social assessment in patients with heart failure. ABBREVIATIONS: DAMOCLES, Definition of the neuro-hormonal Activation, Myocardial function, genOmic expressionand CLinical outcomes in hEart failure patients; NYHA, New York Heart Failure Association; GAM, Generalized Additive Model; BMI, Body Mass Index; GDS, GeriatricDepression Scale.

Transmantle Pressure Computed from MR Imaging Measurements of Aqueduct Flow and Dimensions.

BACKGROUND AND PURPOSE: Measuring transmantle pressure, the instantaneous pressure difference between the lateral ventricles and the cranial subarachnoid space, by intracranial pressure sensors has limitations. The aim of this study was to compute transmantle pressure noninvasively with a novel nondimensional fluid mechanics model in volunteers and to identify differences related to age and aqueductal dimensions. MATERIALS AND METHODS: Brain MR images including cardiac-gated 2D phase-contrast MR imaging and fast-spoiled gradient recalled imaging were obtained in 77 volunteers ranging in age from 25-92 years of age. Transmantle pressure was computed during the cardiac cycle with a fluid mechanics model from the measured aqueductal flow rate, stroke volume, aqueductal length and cross-sectional area, and heart rate. Peak pressures during caudal and rostral aqueductal flow were tabulated. The computed transmantle pressure, aqueductal dimensions, and stroke volume were estimated, and the differences due to sex and age were calculated and tested for significance. RESULTS: Peak transmantle pressure was calculated with the nondimensional averaged 14.4 (SD, 6.5) Pa during caudal flow and 6.9 (SD, 2.8) Pa during rostral flow. It did not differ significantly between men and women or correlate significantly with heart rate. Peak transmantle pressure increased with age and correlated with aqueductal dimensions and stroke volume. CONCLUSIONS: The nondimensional fluid mechanics model for computing transmantle pressure detected changes in pressure related to age and aqueductal dimensions. This novel methodology can be easily used to investigate the clinical relevance of the transmantle pressure in normal pressure hydrocephalus, pediatric communicating hydrocephalus, and other CSF disorders.

Muerte súbita en epilepsia: casuística de una unidad médica de epilepsia española / Sudden unexpected death in epilepsy: Incidence at a Spanish epilepsy unit

INTRODUCCIÓN: La muerte súbita en epilepsia (SUDEP) es la causa más frecuente de muerte atribuible a la propia enfermedad. Casi toda la información sobre esta entidad procede de estudios realizados en el centro/norte de Europa y Estados Unidos. Presentamos la casuística de SUDEP de la Unidad Médica de Epilepsia de nuestro hospital. MÉTODOS: Estudiamos una cohorte histórica hospitalaria española, sin selección de pacientes por su gravedad, con 2.309 pacientes, de edad ≥ 14 años, entre enero de 2000 y junio de 2013. La identificación de los fallecidos se realizó a través de los Registros Civiles. Las causas de muerte se establecieron mediante certificados de defunción, autopsias forenses, informes de mortalidad hospitalarios, de médicos de familia y de testigos de los fallecimientos. Calculamos la incidencia y la mortalidad proporcional. RESULTADOS: Identificamos 7 casos de SUDEP definitivas (2 SUDEP-plus), uno probable y uno posible. Considerando solo los casos con autopsia, la incidencia es de 0,44/1.000 persona-año; la mortalidad proporcional es del 4,6%. Son 4 varones y 3 mujeres. La edad media es de 38,14 años. Casi todos los fallecimientos ocurrieron sin testigos, en la cama. La etiología de la epilepsia es sintomática remota o criptogénica. Menos 2 pacientes, todos tenían crisis generalizadas. Ninguno estaba en remisión. CONCLUSIONES: Pensamos que la incidencia y la mortalidad proporcional de SUDEP de nuestro estudio se asemejan a las encontradas en estudios poblacionales por el carácter escasamente seleccionado de nuestra cohorte. Los factores de riesgo para SUDEP encontrados en nuestros pacientes son concordantes con los reconocidos en la bibliografía

INTRODUCTION: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with epilepsy. Most studies concerning this issue have been conducted in central and northern European countries and the United States. We conducted an epidemiologic study of SUDEP at our hospital's epilepsy unit. METHODS: This retrospective cohort study included all epileptic patients aged ≥14 years, regardless of epilepsy severity, who were treated at the outpatient epilepsy unit of our hospital between 2000 and 2013. The study included 2,309 patients. Deceased patients were identified using civil records. The cause of death was obtained from death certificates, autopsy reports, hospital reports, general practitioner records, and witnesses of the event. We calculated the incidence and proportional mortality of SUDEP based on our data. RESULTS: We identified 7 cases of definite SUDEP (2 patients with SUDEP plus), one case of probable SUDEP, and one case of possible SUDEP. Considering only cases of definite SUDEP, incidence was estimated at 0.44 cases per 1,000 patient-years and proportional mortality at 4.6%. Mean age of patients with definite SUDEP was 38.14 years; 4 were men and 3 were women. Most deaths occurred while patients were in bed and were therefore unwitnessed. Epilepsy in these patients was either remote symptomatic or cryptogenic. All patients but 2 had generalised seizures. None of the patients was in remission. CONCLUSIONS: SUDEP incidence and proportional mortality rates in our study are similar to those reported by population studies. This may be due to the fact that we did not select patients by severity. Risk factors for SUDEP in our sample are therefore consistent with those reported in the literature

Sudden unexpected death in epilepsy: Incidence at a Spanish epilepsy unit. / Muerte súbita en epilepsia: casuística de una unidad médica de epilepsia española.

INTRODUCTION: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with epilepsy. Most studies concerning this issue have been conducted in central and northern European countries and the United States. We conducted an epidemiologic study of SUDEP at our hospital's epilepsy unit. METHODS: This retrospective cohort study included all epileptic patients aged ≥14 years, regardless of epilepsy severity, who were treated at the outpatient epilepsy unit of our hospital between 2000 and 2013. The study included 2,309 patients. Deceased patients were identified using civil records. The cause of death was obtained from death certificates, autopsy reports, hospital reports, general practitioner records, and witnesses of the event. We calculated the incidence and proportional mortality of SUDEP based on our data. RESULTS: We identified 7 cases of definite SUDEP (2 patients with SUDEP plus), one case of probable SUDEP, and one case of possible SUDEP. Considering only cases of definite SUDEP, incidence was estimated at 0.44 cases per 1,000 patient-years and proportional mortality at 4.6%. Mean age of patients with definite SUDEP was 38.14 years; 4 were men and 3 were women. Most deaths occurred while patients were in bed and were therefore unwitnessed. Epilepsy in these patients was either remote symptomatic or cryptogenic. All patients but 2 had generalised seizures. None of the patients was in remission. CONCLUSIONS: SUDEP incidence and proportional mortality rates in our study are similar to those reported by population studies. This may be due to the fact that we did not select patients by severity. Risk factors for SUDEP in our sample are therefore consistent with those reported in the literature.

Intrareservoir Administration of Alteplase to Treat a Distal Ventriculoatrial Shunt Obstruction.

BACKGROUND: Ventriculoatrial shunts can be afflicted with distal malfunctions due to thrombus formation at the distal tip. Distal tip thrombus formation may occur more commonly in oncologic patients who are predisposed to hypercoagulability. CASE DESCRIPTION: A patient who had a ventriculoatrial shunt placed for leptomeningeal carcinomatosis presented with headaches and confusion and was found to have a partial distal shunt obstruction. Intrareservoir administration of alteplase resulted in resolution of her symptoms. Nuclear medicine shunt patency test demonstrated restoration of distal flow. CONCLUSIONS: Intrareservoir administration of alteplase can be a useful nonoperative treatment strategy for ventriculoatrial shunt malfunction. This strategy may be particularly useful in cases with higher perioperative risk, such as patients with advanced metastatic cancer.

Subject-Specific Studies of CSF Bulk Flow Patterns in the Spinal Canal: Implications for the Dispersion of Solute Particles in Intrathecal Drug Delivery.

BACKGROUND AND PURPOSE: Recent flow dynamics studies have shown that the eccentricity of the spinal cord affects the magnitude and characteristics of the slow bulk motion of CSF in the spinal subarachnoid space, which is an important variable in solute transport along the spinal canal. The goal of this study was to investigate how anatomic differences among subjects affect this bulk flow. MATERIALS AND METHODS: T2-weighted spinal images were obtained in 4 subjects and repeated in 1 subject after repositioning. CSF velocity was calculated from phase-contrast MR images for 7 equally spaced levels along the length of the spine. This information was input into a 2-time-scale asymptotic analysis of the Navier-Stokes and concentration equations to calculate the short- and long-term CSF flow in the spinal subarachnoid space. Bulk flow streamlines were shown for each subject and position and inspected for differences in patterns. RESULTS: The 4 subjects had variable degrees of lordosis and kyphosis. Repositioning in 1 subject changed the degree of cervical lordosis and thoracic kyphosis. The streamlines of bulk flow show the existence of distinct regions where the fluid particles flow in circular patterns. The location and interconnectivity of these recirculating regions varied among individuals and different positions. CONCLUSIONS: Lordosis, kyphosis, and spinal cord eccentricity in the healthy human spine result in subject-specific patterns of bulk flow recirculating regions. The extent of the interconnectivity of the streamlines among these recirculating regions is fundamental in determining the long-term transport of solute particles along the spinal canal.

Sumisión química. Guía informativa para adolescentes y jóvenes / Chemical submission. Informative guide for teenagers and young people

La sumisión química consiste en la administración de sustancias químicas a una persona, sin su consentimiento y sin su conocimiento, con fines delictivos. En las últimas décadas este fenómeno se ha incrementado notablemente, adquiriendo una gran relevancia social. Los delitos contra la libertad sexual son los más frecuentes. En su mayoría, las víctimas son mujeres, y las más vulnerables son las más jóvenes. Por ello se justifica la necesidad de informar de una manera clara y veraz a la población más joven, para que sepan en qué consiste este fenómeno, qué sustancias pueden estar implicadas, cuáles son los síntomas principales, qué pueden hacer para evitarlo y qué deben hacer en los casos de conocer o ser víctimas de un delito de esta índole

Chemical submission consists on giving chemical substances to a person, without him/her consenting or being aware of it, and with a criminal purpose. In the last decades, this phenomenon has significantly increased, becoming a considerable social concern. Sexual assaults are the most frequent crimes, the victims are mainly women and the youngest are the most vulnerable ones. For this reason, it is necessary to instruct young people in a clear and truthful way. They need to know what this phenomenon is, what substances can be involved, what the main symptoms are, how to avoid this situation and what to do in case of being a victim of this kind of crime or knowing someone who is

Delayed referral to specialist centre increases morbidity in patients with bile duct injury (BDI) after laparoscopic cholecystectomy (LC).

BACKGROUND: There is still a debate regarding the optimal management of bile duct injury following cholecystectomy. Our aim was to ascertain if delayed referral influenced clinical outcomes for patients with BDI treated in our institution. MATERIALS AND METHODS: We interrogated a prospectively maintained database, including all patients with BDI (Bismuth and Strasberg classifications) post LC managed in our unit from 2000-2014. Referrals were arbitrarily defined as early (<96 h from the injury) and delayed (>96 h). RESULTS: 68 patients with BDI were managed. Patient demographics, referral time, level of injury and morbidity data was collected. 50 patients (77%) required a surgical bile duct reconstruction. The Early referral Group included 33 patients (52.4%) and Delayed referral group 30 (47.6%). The patients referred late had a significantly high incidence of right hepatic artery injury (23% vs. 3%) and the overall number of complications (0.0001). The average number of surgical interventions (2.5 vs 1.8, p < 0.05) and invasive procedures (4 vs. 2.5, p < 0.05) per patient was high in the late referral group. There was significant difference in the interval between BDI-to-reconstruction (median 3 vs. median 88 days, p < 0.05) and referral-to-hospital discharge (median 9 vs. median days 59, p < 0.05). On multivariate analysis only delayed referral (OR 7.58, 95% CI 2.1-26.6) and Strasberg-E injuries (OR 4.86, 95% CI 1.1-20.9) were significant. CONCLUSION: A late referral was associated with a higher incidence of post-treatment complications, greater need for invasive procedures and a longer recovery period. These observations support the need for early patient transfer to a tertiary institution following BDI.

Use-patterns of personal care and household cleaning products in Switzerland.

Reliable consumer use data are needed to determine health risks posed by chemicals contained in household cleaning and personal care products. Essential information includes the amount of product applied, the frequency of use, and the site of application. To obtain such data, a survey was conducted in Switzerland to assess consumer usage patterns. The use-patterns of 12 household care products, 5 laundry products, and 22 personal care products were collected among the Swiss population (N = 759; ages 0-91) by postal questionnaire, providing for the first time in Europe comprehensive information regarding use of household cleaning and personal care products for the same study population. Apart from the investigation of use frequency, quantity, duration, and habits, also co-use analysis was performed separately for household and personal care products. Use-patterns are presented for both genders and all age groups, including children below the age of 12, who may be more vulnerable to adverse effects attributed to certain chemicals. Also, the currently missing use factors for cosmetic/baby wet wipes were assessed. Stratification of the data by gender, age and other socio-demographic factors, such as region affiliation, allowed us to identify differences between population sub-groups, emphasizing the need for region-specific exposure factors.

Risk factors of urethral diverticula in male patients with spinal cord injury.

STUDY DESIGN: A case-control study in a series of 55 males with urethral diverticula (UD) and their correspondent control, matched by age and time of radiological assessments. OBJECTIVES: To evaluate the risk factors to develop UD in males with spinal cord injury (SCI) and the place in the urethra where they are, most commonly, allocated. SETTING: Toledo, Spain. METHODS: Clinical histories and urodynamic studies, of all patients, were reviewed. The study was completed with a telephone survey according to an established protocol. RESULTS: The univariate analysis study showed the following risk factors: the age of onset of the spinal injury, the sphincterotomy procedure, personal history of lower urinary tract infections (LUTIs) and the chronic need of either indwelling catheter (IC) or the external condom drainage (ECD). Regarding the location of the UD, we have found the stress urinary incontinence as the only risk factor to develop UD in the prostatic urethra.On the other hand, we can conclude that the sphincterotomy, the ECD, the personal history of LUTIs and the detrusor external sphincter dyssynergia seem to be risk factors to develop diverticula in the bulbo-membranous urethra. Finally, we could point out the IC as the only risk factor for penile UD. Multivariate analysis showed that all of these risk factors were independent among them except the age of the onset of the injury and the ECD for UD in the bulbo-membranous urethra. CONCLUSION: According to our study, there is evidence of some specific risk factors for the development of UD in male patients with SCI, and therefore we should adopt the appropriate preventive measures to prevent them.

Gel-free proteomic methodologies to study reversible cysteine oxidation and irreversible protein carbonyl formation.

Oxidative modifications in proteins have been traditionally considered as hallmarks of damage by oxidative stress and aging. However, oxidants can generate a huge variety of reversible and irreversible modifications in amino acid side chains as well as in the protein backbones, and these post-translational modifications can contribute to the activation of signal transduction pathways, and also mediate the toxicity of oxidants. Among the reversible modifications, the most relevant ones are those arising from cysteine oxidation. Thus, formation of sulfenic acid or disulfide bonds is known to occur in many enzymes as part of their catalytic cycles, and it also participates in the activation of signaling cascades. Furthermore, these reversible modifications have been usually attributed with a protective role, since they may prevent the formation of irreversible damage by scavenging reactive oxygen species. Among irreversible modifications, protein carbonyl formation has been linked to damage and death, since it cannot be repaired and can lead to protein loss-of-function and to the formation of protein aggregates. This review is aimed at researchers interested on the biological consequences of oxidative stress, both at the level of signaling and toxicity. Here we are providing a concise overview on current mass-spectrometry-based methodologies to detect reversible cysteine oxidation and irreversible protein carbonyl formation in proteomes. We do not pretend to impose any of the different methodologies, but rather to provide an objective catwalk on published gel-free approaches to detect those two types of modifications, from a biologist's point of view.

Outcome after liver resection in patients presenting with simultaneous hepatopulmonary colorectal metastases.

BACKGROUND: The most common sites of metastasis from colorectal cancer (CRC) are hepatic and pulmonary; they can present simultaneously (hepatic and pulmonary metastases) or sequentially (hepatic then pulmonary metastases, or vice versa). Simultaneous disease may be aggressive, and thus may be approached with caution by the clinician. The aim of this study was to determine the outcomes following hepatic and pulmonary resection for simultaneously presenting metastatic CRC. METHODS: A retrospective review was undertaken of a prospectively maintained database to identify patients presenting with simultaneous hepatopulmonary disease who underwent hepatic resection. Patients' electronic records were used to identify clinicopathological variables. The log rank test was used to determine survival, and χ(2) analysis to determine predictors of failure of intended treatment. RESULTS: Fifty-nine patients were identified and underwent hepatic resection; median survival was 45·4 months and the 5-year survival rate 38 per cent. Twenty-two patients (37 per cent) did not have the intended pulmonary intervention owing to progression or recurrence of disease. Thirty-seven patients who progressed to hepatopulmonary resection had a median survival of 54·2 months (5-year survival rate 43 per cent). Those who had hepatic resection alone had a median survival of 24·0 months (5-year survival rate 30 per cent). Failure to progress to pulmonary resection was predicted by heavy nodal burden of primary colorectal disease and bilobar hepatic metastases. Redo pulmonary surgery following pulmonary recurrence did not confer a survival benefit. CONCLUSION: Selected patients with simultaneous hepatopulmonary CRC metastases should be considered for attempted curative resection, but some patients may not receive the intended treatment owing to progression of pulmonary disease after hepatic resection.

Performance of prognostic scores in predicting long-term outcome following resection of colorectal liver metastases.

BACKGROUND: Ten-year survival appears to define cure following resection of colorectal liver metastases (CRLMs). Various scores exist to predict outcome at 5 years. This study applied several scores to a patient cohort with 10 years of actual follow-up to assess their performance beyond 5 years. METHODS: The study included consecutive patients who underwent liver resection at a single institution between 1992 and 2001. The ability of eight prognostic scoring systems to predict disease-free (DFS) and disease-specific (DSS) survival was analysed using the C-statistic. RESULTS: Among 286 patients, the 1-, 3-, 5- and 10-year actual DSS rates were 86.6, 58.3, 39.5 and 24.5 per cent respectively. Seventy patients underwent 105 further resections for recurrent disease, of which 84.8 per cent were within 5 years of follow-up. Analysis of C-statistics showed only one score--the Rees postoperative index--to be a significant predictor of DFS and DSS at all time points. The remaining scores performed less well, and regularly showed no significant improvement in predictive accuracy over what would be expected by chance alone. No score yielded a C-statistic in excess of 0.8 at any time point. CONCLUSION: Although available risk scores can predict DFS and DSS, none does so with sufficient discriminatory accuracy to identify all episodes of recurrent disease. A non-negligible proportion of patients develop recurrent disease beyond 5 years of follow-up and so surveillance beyond this point may be advantageous.

Mejoría de la calidad de vida en mujeres con incontinencia tras el tratamiento rehabilitador. ¿Existe relación entre el ICIQ-SF y el pad test? / improvement of quality of life in females suffering from urinary incontinence with rehabilitation treatment. The relationship between ICIQ-SF and pad-test?

Introducción. Los objetivos de este trabajo son: 1) Conocer las características en las pacientes con incontinencia urinaria (IU) derivadas a una Unidad de Suelo Pélvico; 2) Analizar si existe relación entre los datos objetivos y subjetivos de IU medidos con el pad test y el cuestionario International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) respectivamente, y 3) Valorar si existe mejoría en la calidad de vida con el tratamiento rehabilitador. Material y métodos. Se realiza un estudio retrospectivo de junio de 2008 a diciembre de 2010, recogiendo diferentes variables (demográficas, tipo de IU, antecedentes quirúrgicos y obstétricos, índice de masa corporal, objetividad de la IU (pad test), tipo de tratamiento rehabilitador pautado y calidad de vida (cuestionario ICIQ-SF) valorada en la primera consulta y al alta de tratamiento. Resultados. Se obtiene una muestra de 145 mujeres con una edad media de 51 años, de las cuales el 51% presentan IU de esfuerzo y 38,6% de IU mixta. El 86,2% tienen antecedentes de dos o más partos. El 70,3% presentan sobrepeso u obesidad. Las pacientes con mayores pérdidas de orina según el pad test, obtienen mayor puntuación en el ICIQ-SF. La puntuación global del ICIQ mejoraba tras tratamiento rehabilitador. Conclusiones. El perfil de paciente es el de una mujer de 50 años con sobrepeso, que ha tenido dos o más partos y presenta una IU de esfuerzo. Existe una relación positiva entre los datos objetivos de IU (pad test) y los subjetivos (ICIQ-SF). La calidad de vida de las pacientes mejora con el tratamiento rehabilitador (AU)

Introduction. Objectives are: 1) To determine the characteristics of women suffering from UI who have been referred to the Pelvic Floor Unit; 2) Analysis of whether a relationship exists between objective UI results measured with the pad test and subjective UI results measured with International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) test; and 3) To assess whether there is an improvement in quality of life with rehab treatment. Materials and methods. A retrospective study was conducted between june 2008 and december 2010, collecting the following variables: demography, type of UI, previous surgical and obstetrics history, body fat percentage, objectivity of the UI, type of treatment arranged and quality of life before and after treatment. Results. A total of 145 female patients, with a mean age 51 years, of whom 51% had UI due to stress, 38.6% with a mixed UI. The large majority (86.2%) had given birth on 2 or more occasions. Obesity or overweight was observed in 70.3%. Patients with more loss of urine had a higher score on ICIQ-SF, according to the pad test. The overall ICIQ-SF score improved after rehab treatment. Conclusion. The profile is an overweight 50-year-old woman, who has given birth on 2 or more occasions, presenting with a stress UI. There is a positive relationship between the objective results of UI (pad test) and the subjective results (ICIQ-SF). The patient quality of life improved after rehab treatment (AU)

The Atlantic-Mediterranean watershed, river basins and glacial history shape the genetic structure of Iberian poplars.

Recent phylogeographic studies have elucidated the effects of Pleistocene glaciations and of Pre-Pleistocene events on populations from glacial refuge areas. This study investigates those effects in riparian trees (Populus spp.), whose particular features may convey enhanced resistance to climate fluctuations. We analysed the phylogeographic structure of 44 white (Populus alba), 13 black (Populus nigra) and two grey (Populus x canescens) poplar populations in the Iberian Peninsula using plastid DNA microsatellites and sequences. We also assessed fine-scale spatial genetic structure and the extent of clonality in four white and one grey poplar populations using nuclear microsatellites and we determined quantitative genetic differentiation (Q(ST) ) for growth traits in white poplar. Black poplar displayed higher regional diversity and lower differentiation than white poplar, reflecting its higher cold-tolerance. The dependence of white poplar on phreatic water was evidenced by strong differentiation between the Atlantic and Mediterranean drainage basins and among river basins, and by weaker isolation by distance within than among river basins. Our results suggest confinement to the lower river courses during glacial periods and moderate interglacial gene exchange along coastlines. In northern Iberian river basins, white poplar had lower diversity, fewer private haplotypes and larger clonal assemblies than in southern basins, indicating a stronger effect of glaciations in the north. Despite strong genetic structure and frequent asexual propagation in white poplar, some growth traits displayed adaptive divergence between drainage and river basins (Q(ST) >F(ST)), highlighting the remarkable capacity of riparian tree populations to adapt to regional environmental conditions.

Valoración de riesgo de los hallazgos clínico-quirúrgicos y de anatomía patológica en neonatos con enterocolitis necrotizante que han recibido tratamiento quirúrgico / Evaluation of the risk of the clinical-surgical and pathology study findings in newborns with necrotizing enterocolitis who have received surgical treatment

Introducción. A pesar de los avances en cuidados neonatales entre el 20 y 63% de los niños con enterocolitis necrotizante (ECN) necesitan cirugía. El objeto fue buscar una correlación y factores de riesgo de los neonatos con ECN “IIB/IIIA/IIIB” de Bell y los hallazgos clínicos, quirúrgicos y de anatomía patológica. Material y métodos. Se analizaron neonatos con diagnóstico de ECN que recibieron cirugía y se analizó las variables: clínico- quirúrgicas y de anatomía patológica. Estudiamos dos grupos: control (n= 5)y grupo ECN (n= 12). Se realizaron comparaciones entre los grupos mediante la U-Mann-Whitney y el coeficiente de Sperman (r). Para valorar el riesgo de morbilidad/mortalidad asociada a la extensión de (..) (AU)

Introduction. Despite advances in neonatal care between 20% and63% of children with necrotizing enterocolitis (NEC) require surgery. The aim was correlation the risk factors of infants with NEC “IIB / IIIA/ IIIB” Bell and the clinical, surgical and pathological findings. Method. In the children with diagnosis of NEC surgically treated, were analyzed of variables: clinical, surgical and pathological findings. We studied two groups: control (n= 5) and NEC group (n= 12). Comparisons were made between groups using the Mann-Whitney U- and the Spearman coefficient (r). To assess the risk of morbidity / mortality associated with the extent of intestinal resection we applied the Cox (..) (AU)