Risk factors for lymphedema after breast surgery: A prospective cohort study in the era of sentinel lymph node biopsy.

INTRODUCTION: The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS: Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1-54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS: Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92-18.16) and 3.9 (1.60-9.49) respectively. CONCLUSIONS: The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment.

Characteristics of dental arches and occlusion in children born prematurely. A case-control study.

AIM: To determine if there are differences between the dental arch dimensions and occlusal characteristics of children born prematurely and admitted into a Neonatal Intensive Care Unit (NICU) (study group) and children born at term (control group). The study group was analysed at the same time in order to find out if the parameters of the dental arches are related to specific perinatal variables. MATERIALS: Study design: Out of a total of 504 children born between 2011 and 2014 in high-risk conditions at the clinic of the University Hospital "San Cecilio" in Granada (Spain), 78 children were selected. Of these 42 had been born prematurely and admitted to the NICU (study group) and 36 had been born at term (control group). The age of the sample was 5 to 8 years. The parameters of the dental arches, together with the occlusal characteristics, were examined using dental casts. Both the upper and lower arches were measured for a total of 156 dental casts with a FINO digital caliper. CONCLUSION: The data confirm the smaller size of the dental arch dimensions of children born prematurely and admitted to a NICU compared with children born at term. This fact should be taken into consideration with regard to future orthodontic and paediatric dentistry treatments.

Masas renales infrecuentes: hematopoyesis perirrenal extramedular y linfangioma perirrenal / Uncommon renal masses: Perirenal extramedullary hematopoiesis and multiple lymphangiomatosis with a perirenal lymphangioma

OBJETIVO: Presentar dos casos de masas renales infrecuentes, intentando llegar a su diagnóstico preoperatoriamente. MÉTODOS: Describimos un caso remitido por Hematología por hallazgos en TAC de masas perirrenales bilaterales, que al biopsiar refieren hematopoyesis extramedular. El otro caso se estudió por disnea, apreciando en el TAC pulmones con múltiples quistes y en abdomen, masa quístico sólida perirrenal izquierda. La biopsia pulmonar nos informó de Linfangiomatosis pulmonar, con lo que obviamos la biopsia renal. RESULTADOS: La mayoría de las masas renales sólidas son hipernefromas (85%). El resto de las masas son sarcomas, linfomas, tumores de vías infiltrantes y tumores benignos. Para su diagnóstico disponemos de la clínica y las pruebas radiológicas (ecografía, TAC, RNM y PET-TAC); pero ante hallazgos inespecíficos el diagnóstico se basará en el estudio histológico. CONCLUSIONES: La hematopoyesis renal extramedular y el Linfangioma perirrenal son tumores raros y su diagnóstico preoperatorio es difícil

OBJETIVE: To present two cases of infrequent renal masses, trying to achieve the diagnosis before surgery. METHODS: We describe a case referred from the Department of Hematology in which bilateral perirrenal masses were described in the CT scan; after biopsy they where classified as extramedullary hematopoietic tissue. The other case was a patient presenting to the emergency room with dyspnea. CT Scan showed lungs with multiple cysts, chylothorax and a cystic-solid mass in the left perirenal space. In the lung biopsy they reported lung lymphangiomatosis, so we didn't perform renal biopsy. RESULTS: Most renal masses are renal carcinomas (85%). The less common diagnosis are sarcomas, lymphomas, upper urinary tract transitional cell carcinomas, metastases of other primary tumors, the Erdheim-Chester disease, the Castleman disease and benign tumors. All these diseases might show similar images in the CT scan and MRI, being the biopsy and histological study necessary for the diagnosis CONCLUSION: Perirenal extramedullary hematopoiesis and perirenal lymphangioma are rare diseases that need a pathologic study for their diagnosis

Uncommon renal masses: Perirenal extramedullary hematopoiesis and multiple lymphangiomatosis with a perirenal lymphangioma.

OBJECTIVE: To present two cases of infrequent renal masses, trying to achieve the diagnosis before surgery. METHODS: We describe a case referred from the Department of Hematology in which bilateral perirrenal masses were described in the CT scan; after biopsy they where classified as extramedullary hematopoietic tissue. The other case was a patient presenting to the emergency room with dyspnea. CT Scan showed lungs with multiple cysts, chylothorax and a cystic-solid mass in the left perirenal space. In the lung biopsy they reported lung lymphangiomatosis, so we didn't perform renal biopsy. RESULTS: Most renal masses are renal carcinomas (856%). The less common diagnosis are sarcomas, lymphomas, upper urinary tract transitional cell carcinomas, metastases of other primary tumors, the Erdheim-Chester disease, the Castleman disease and benign tumors. All these diseases might show similar images in the CT scan and MRI, being the biopsy and histological study necessary for the diagnosis CONCLUSIONS: Perirenal extramedullary hematopoiesis and perirenal lymphangioma are rare diseases that need a pathologic study for their diagnosis.

Pro-crossover factors regulate damage-dependent apoptosis in the Caenorhabditis elegans germ line.

During meiosis, DNA double-strand breaks (DSBs) are physiologically induced to start the recombination process and promote the formation of interhomologue crossovers (COs), which are required to ensure faithful chromosome segregation into the gametes. The timely repair of DSBs is an essential part of the meiotic programme, as accumulation of unprocessed DSBs during the pachytene stage of meiotic prophase triggers a DNA damage checkpoint response that induces apoptosis of damaged cells. We show that CO-promoting factors MSH-4, MSH-5, and ZHP-3, but not COSA-1, are required for the apoptotic response of the meiotic DNA damage checkpoint. Lack of MSH-4 or MSH-5 suppresses the apoptotic response observed in some DNA repair-defective mutants such as fcd-2 and brc-1 (orthologues of FANCD2 and BRCA1), irrespectively of the amount of DSBs present in pachytene nuclei. Although ionizing radiation fails to induce apoptosis in msh-4/5-mutant backgrounds, it induces transcriptional activation of the apoptosis-activator egl-1, which is controlled by the Caenorhabditis elegans p53 orthologue CEP-1. This finding suggests that MSH-4/5 involvement in the apoptotic response occurs downstream or independently of damage sensing and checkpoint activation. This study establishes a role for pro-CO factors MSH-4/5 and ZHP-3 in the execution of apoptosis at late meiotic prophase following the accumulation of exogenous or endogenous DNA damage.

Oral health status of a population with multiple sclerosis.

OBJECTIVE: To determine the oral treatment needs of a sample of patients diagnosed with multiple sclerosis in the Community of Madrid (Spain). PATIENTS AND METHODS: A cross-sectional epidemiological study was carried out with a sample of 64 patients who were aged 25 to 77 years. They were distributed into homogeneous age groups: < 46 years, 46-54 years and > 54 years. In order to evaluate the oral health status and treatment requirements, the parameters and guidelines of the WHO were used. RESULTS: The prevalence of caries was 100%, or very close in all three groups. As age increased, the morbidity rate decreased, but the mortality rate increased considerably. On analyzing gingival health, 65% of patients had calculus, 5% bleeding and 30% were healthy. CONCLUSIONS: The DMFT index found provided data that was, in general, very similar to that of the general population in Spain. However, the gingival health status found demonstrated that the population of multiple sclerosis patients requires specific assistance.

Meiosis in cereal crops: the grasses are back.

A major goal of breeding programs is to increase and manipulate the genetic diversity of crops. The incorporation of beneficial genes from wild relatives into crops is achieved by producing hybrid plants in which meiotic recombination events occur between the two genomes. Furthering our understanding of meiosis in the cereals could enable the manipulation of homolog pairing and recombination, significantly enhancing the efficiency of breeding programs. The main obstacle to the genetic analysis of meiosis in cereal crops has been the complex organization of most cereal genomes, many of which are polyploid. However, the recent sequencing of the rice genome, the use of insertional mutagenesis and reverse genetics approaches has opened the door for the genetic and genomic analysis of cereal meiosis. The goal of this review is to show how these new resources, as well as the use of three-dimensional microscopy, are rapidly providing insights into the mechanisms that control pairing, recombination and segregation of homologous chromosomes during meiosis in four major cereal crops: wheat, rice, maize and rye.

[Cough-inducing capsaicin challenge test in a healthy population]. / Test de provocación tusígena con capsaicina: resultados en una población sana.

OBJECTIVE: Cough-inducing agents are used to study the cough reflex in both pharmacological and physiological research. Clinical use of cough challenge testing as a tool in diagnostic algorithms has been limited by the lack of either uniform methodology or reference values for healthy subjects. The objective of this study was to determine the cough threshold for capsaicin in a sample of healthy subjects, while also evaluating the influence of age, sex and smoking. We also assessed the reliability and repeatability of the test. MATERIAL AND METHODS: Ninety-two healthy subjects were enrolled and given a capsaicin challenge test using concentrations from 0.49 to 500mg. The concentrations of capsaicin that triggered two and five coughs, C2 and C5 respectively, were recorded. The test was repeated three days later in a sub-sample of 30 subjects. RESULTS: No subject showed clinical or functional signs of bronchoconstriction. The mean values obtained for the study population were log C2:1.5 +/- 0.69 mM. and log C5: 2.1 +/- 0.4 microM. The geometric means were 31.6 and 134.8 microM for C2 and C5, respectively. No significant differences were found for sex or smoking; however age was significantly related to log C5 (r: -0.27, p < 0.05). Repeatability of the capsaicin test was high, with intra-class correlation coefficients and 95% confidence intervals of 0.75 (0.53-0.87) and 0.88 (0.76-0.97)for C2 and C5, respectively. CONCLUSION: The capsaicin challenge test was safe and easy to administer,gave reproducible results and allowed us to obtain reference values for a healthy population in our community.

Test de provocación tusígena con capsaicina: resultados en una población sana / Cough-inducing capsaicin challenge test in a healthy population

OBJETIVOS: Es conocido el uso de agentes tusígenos en el estudio del reflejo de la tos, tanto en el campo de la investigación farmacológica como de la fisiología de dicho reflejo. Su aplicación clínica como una herramienta más en los algoritmos diagnósticos se ve limitada por la falta de uniformidad metodológica y de valores de referencia en sujetos sanos. El objetivo del presente estudio ha sido determinar el umbral tusígeno a la capsaicina en una muestra de sujetos sanos, evaluando la influencia de la edad, el sexo y el tabaquismo, así como analizando la fiabilidad y repetibilidad del test. MATERIAL Y MÉTODOS: Se incluyeron en el estudio 92 sujetos sanos a los que se les aplicó el test de provocación con capsaicina, cuyas concentraciones iban desde 0,49 a 500 µM. Se determinaron los valores de C2 y C5, siendo éstas las concentraciones de capsaicina que provocan al menos dos y 5 toses, respectivamente. La prueba se repitió a los 3 días en una submuestra de 30 sujetos. RESULTADOS: Ningún paciente presentó evidencia clínica ni funcional de broncoconstricción. Los valores medios obtenidos en la población de estudio fueron log C2: 1,5 ñ 0,69 µM y log C5: 2,1 ñ 0,4 µM. La media geométrica para ambos valores fue: C2: 31,6 y C5: 134,8 µM. No se hallaron diferencias significativas para el sexo ni el tabaquismo. Sin embargo, la edad guardó una asociación significativa con el log C5. La repetibilidad del test de la capsaicina fue alta, con un coeficiente de correlación intraclase y un intervalo de confianza del 95 por ciento de 0,75 (0,53-0,87) y 0,88 (0,76-0,94) para C2 y C5, respectivamente. CONCLUSIÓN: El test de provocación con capsaicina ha resultado seguro, fácil de aplicar, con unos resultados reproducibles y nos ha permitido obtener unos valores de referencia en una población sana de nuestra área (AU)

The Ph1 locus is needed to ensure specific somatic and meiotic centromere association.

The correct pairing and segregation of chromosomes during meiosis is essential for genetic stability and subsequent fertility. This is more difficult to achieve in polyploid species, such as wheat, because they possess more than one diploid set of similar chromosomes. In wheat, the Ph1 locus ensures correct homologue pairing and recombination. Although clustering of telomeres into a bouquet early in meiosis has been suggested to facilitate homologue pairing, centromeres associate in pairs in polyploid cereals early during floral development. We can now extend this observation to root development. Here we show that the Ph1 locus acts both meiotically and somatically by reducing non-homologous centromere associations. This has the effect of promoting true homologous association when centromeres are induced to associate. In fact, non-homologously associated centromeres separate at the beginning of meiosis in the presence, but not the absence, of Ph1. This permits the correction of homologue association during the telomere-bouquet stage in meiosis. We conclude that the Ph1 locus is not responsible for the induction of centromere association, but rather for its specificity.

[Tridimensional echography: a new urologic challenge]. / Ecografía tridimensional: nuevo reto urológico.

OBJECTIVE: To describe the urological applications of three-dimensional ultrasonography, a new method that basically transforms the two-dimensional into three-dimensional images through complex data processing for enhanced imaging. METHODS: Since the technology for three-dimensional studies was incorporated into our US equipment a few months ago, we have performed three-dimensional US after the conventional two-dimensional study in 30 renal units, 15 bladders and 15 prostates, using the same well-established procedures for ultrasound assessment. The images obtained by both methods were compared to determine the diagnostic enhancements, if any, afforded by this new technology. RESULTS: Three-dimensional US offers more possibilities for renal cortical volume measurement and determination of the extent of the tumor. It also appears to be promising in regard to its capacity to determine the degree of tumor infiltration in the bladder and permits even more precise measurements of residual volume or bladder content. Transrectal ultrasound of the prostate may benefit more since three-dimensional US permits analysis of focal changes from different perspectives and planes without difficulty. CONCLUSIONS: Three-dimensional US was developed recently. It has been utilized in gynecology and cardiology, but there is limited experience in urology. We have started a clinical study to determine its possibilities and main applications in our field. Its impact on other diagnostic parameters or biopsy selection criteria are other interesting areas of research.

Ehrlichiosis humanas: infecciones zoonósicas emergentes

Objetivos.- Destacar la importancia en patología humana de las zoonosis emergentes y el posible riesgo al que pueden estar expuestos los miembros de las Fuerzas Armadas (FAS). Fuentes de datos.-Medline, Intemet, Revistas nacionales y extranjeras. Selección de estudios.- Basados en los que se refieren a la descripción de casos, distribución mundial, etiología, epidemiología, clínica, métodos diagnósticos, tratamiento y prevención. Síntesis de datos.- Se analizan los factores de riesgo que condicionan la morbilidad y letalidad del proceso. Conclusiones.- Teniendo en cuenta los estudios multivariados se destaca la importancia actual de las ehrlichiosis humanas como enfermedades emergentes de reciente aparición. Consideradas en principio como procesos poco frecuentes y localizados en ciertos territorios con diferencias geográficas y regionales concretas actualmente se describen cada vez más mayor número de casos e infecciones subclínicas en diversas naciones, incluidas las del mundo desarrollado. Su aparición en las FAS puede constituir una amenaza que debe ser tenida en cuenta por los servicios sanitarios. Se trata de enfermedades cuyo cuadro clínico es poco específico razón por lo que cuando no son diagnosticadas precozmente y tratadas adecuadamente pueden evolucionar de forma desfavorable (AU)

Polyploidy induces centromere association.

Many species exhibit polyploidy. The presence of more than one diploid set of similar chromosomes in polyploids can affect the assortment of homologous chromosomes, resulting in unbalanced gametes. Therefore, a mechanism is required to ensure the correct assortment and segregation of chromosomes for gamete formation. Ploidy has been shown to affect gene expression. We present in this study an example of a major effect on a phenotype induced by ploidy within the Triticeae. We demonstrate that centromeres associate early during anther development in polyploid species. In contrast, centromeres in diploid species only associate at the onset of meiotic prophase. We propose that this mechanism provides a potential route by which chromosomes can start to be sorted before meiosis in polyploids. This explains previous reports indicating that meiotic prophase is shorter in polyploids than in their diploid progenitors. Even artificial polyploids exhibit this phenotype, suggesting that the mechanism must be present in diploids, but only expressed in the presence of more than one diploid set of chromosomes.

Homologous chromosome pairing in wheat.

Bread wheat is a hexaploid (AABBDD, 2n=6x=42) containing three related ancestral genomes, each having 7 chromosomes, giving 42 chromosomes in diploid cells. During meiosis true homologues are correctly associated in wild-type wheat, but a degree of association of related chromosomes (homoeologues) occurs in a mutant (ph1b). We show that the centromeres are associated in non-homologous pairs in all floral tissues studied, both in wild-type wheat and the ph1b mutant. The non-homologous centromere associations then become homologous premeiotically in wild-type wheat in both meiocytes and the tapetal cells, but not in the mutant. In wild-type wheat, the homologues are colocalised along their length at this stage, but the telomeres remain distinct. A single telomere cluster (bouquet) is formed in the meiocytes only by the onset of leptotene. The sub-telomeric regions of the homologues associate as the telomere cluster forms. The homologous associations at the telomeres and centromeres are maintained through meiotic prophase, although, during leptotene, the two homologues and also the sister chromatids within each homologue are separate along the rest of their length. As meiosis progresses, first the sister chromatids and then the homologues associate intimately. In wild-type wheat, first the centromere grouping, then the bouquet disperse by the end of zygotene.

[Natural history of cancer of the kidney: iconographic follow-up]. / Historia natural del cáncer de riñón: seguimiento iconográfico.

OBJECTIVE: To describe the natural history of renal cancer based on the images obtained in a case with more than 11 years' follow-up, from the initial stages of the disease to its outcome. METHODS/RESULTS: The history of a female patient in whom a renal mass had been detected at age 25 years is described. The patient died 11 years later due to metastasis. The images obtained throughout follow-up clearly illustrate the natural course of the disease, which could not be changed because the patient had refused surgery. CONCLUSIONS: The observation of a small renal mass in young patients is an indication for early surgery. The natural course of this disease is predictably fatal, its benign behaviour being highly questionable. Because pregnancy does not appear to accelerate the course of the disease, patient assessment can be completed and treatment can be instituted after delivery.

[Impact of Spanish-language urological publications in periodicals in the English language]. / Impacto de las publicaciones urológicas en lengua española en revistas en lengua inglesa.

OBJECTIVE: A study was conducted to analyze the impact of the articles published by Spanish authors in the English language urological journals and those published in Spanish journals in the bibliography referenced in the English language urological literature. METHODS: We randomly analyzed volumes 147, 39 and 69 of the Journal of Urology, Urology and the British Journal of Urology, respectively. All articles in the foregoing volumes were reviewed and analyzed as follows: sections, country, no of references, no of Spanish publications referenced, no of references of Spanish publications and the number of Spanish references cited in these. RESULTS: 356 articles were published in the Journal of Urology: of these, 59% were by American and only 6 (1.68%) were by Spanish authors, which ranked 8th according to number. These 6 articles by Spanish authors cited 84 references; of these, only 3 were Spanish publications. Overall, there were 6,708 references (mean 18.8); 6 (0.11%) were articles published by Spanish authors. In Urology, 140 articles were published: of these, 75% were by American and only one (0.71%) by Spanish authors, which ranked 6th according to number. This article by Spanish authors cited 38 references; of these, only 3 were Spanish publications. Overall, there were 2,055 references (mean 14.6); only 8 (0.38%) were articles published by Spanish authors. In the British Journal of Urology, 177 articles were published: of these, 96 (54.2%) were by British authors and only one (0.56%) by Spanis authors, which ranked 9th according to number. This article by Spanish authors cited 11 references; none of them were Spanish publications. Overall, there were 1,988 references (mean 11.2); 14 (0.7%) were articles published by Spanish authors. CONCLUSION: Spanish authors are not worse off than those of other neighbouring countries in regard to the number of articles published (1.18%) in the three journals analyzed, where most of the articles were chiefly by American or British authors. Spanish publications have no impact in the English-speaking countries, although the number of Spanish publications has been slowly but steadily growing and currently account for 1.21% of the publications worldwide: 41.5% of these are referenced in the Science Citation Index and the Uro-Andrological publications rank 6th (4.2%). Moreover, when Spanish authors are able to publish articles in the English-language journals, they rarely reference Spanish publications. However, in proportion, these have more impact than the Spanish publications. The current trend in the prevalence of the English language in the scientific field is probably the cause of the nonexistent impact outside Spain, where they are hardly-read by the Spanish-speaking communities. The foregoing situation is further assisted by the fact that indexing is also done in the English language. Spanish authors are encouraged to increase the number of Spanish publications referenced, particularly those publishing articles in the foreign journals.

[Fracture of the penis: two new cases. Review of the literature. Usefulness of echography]. / Fractura de pene: dos nuevos casos. Revisión de la literatura. Utilidad de la ecografía.

OBJECTIVE: To analyze the diagnostic and therapeutic difficulties in rupture of the albuginea penis and review the literature. METHODS/RESULTS: Two additional cases of penile rupture are described. Penile ultrasound evaluation disclosed a hematoma in the corpus cavernosum in one case and hematoma and a probable rupture of the albuginea penis in the other case. Treatment was by immediate surgery which achieved good cosmetic and functional results. CONCLUSIONS: Penile fracture is an uncommon condition which occurs when the penis is in erection. Ultrasound is useful in its diagnosis, but MRI is more precise. Treatment is by immediate surgery to avoid sequelae, which are common in cases treated conservatively.

[Diagnosis of leukemic infiltration of the prostate p6ompted by PSA elevation]. / Diagnóstico de infiltración leucémica de la próstata motivado por elevación del P.S.A.

Presentation of one case-report of leukaemic infiltration of the prostate. Interestingly, the biopsy was only performed after finding distinctly elevated PSA levels and not because of the clinical findings, whether exploratory or echographic.