Assessment of the likelihood of hypothyroidism in dogs diagnosed with and treated for hypothyroidism at primary care practices: 102 cases (2016-2021).

BACKGROUND: There is a possibility that an incorrect diagnosis of hypothyroidism could be made in euthyroid dogs, and the prevalence of hypothyroidism in the dog population remains unknown. OBJECTIVES: To retrospectively assess the percentage of dogs diagnosed with, and treated for, hypothyroidism at first opinion practice which are likely to be hypothyroid and require levothyroxine supplementation. ANIMALS: One hundred two client-owned dogs were included in this study. MATERIALS AND METHODS: The computerized databases of 7 first opinion practices were searched to identify dogs treated with levothyroxine supplementation. Three European College of Veterinary Internal Medicine-Companian Animals (ECVIM-CA) diplomates independently assigned 1 of 4 clinical assessments to each case as follows: confirmed or likely hypothyroid, hypothyroidism suspected but not confirmed, hypothyroidism considered unlikely, and no reason to suspect hypothyroidism. They commented as to whether or not they thought levothyroxine supplementation was appropriate. RESULTS: The clinical assessments of "confirmed or likely hypothyroid"; "Hypothyroidism suspected but not confirmed"; "Hypothyroidism considered unlikely"; and "No reason to suspect hypothyroidism" was assigned respectively by Clinician 1 to 38.2%, 5.9%, 3.9%, and 52% of cases, by Clinician 2 to 48%, 22.6%, 22.6%, 6.9% of cases, and by Clinician 3 to 55.9%, 11.8%, 13.7% and 18.6%. Clinician 1, Clinician 2, and Clinician 3 considered levothyroxine supplementation not indicated in 58.8%, 52.9%, and 45.1% of cases, respectively. CONCLUSION: These results support the concern that hypothyroidism might be overly and incorrectly diagnosed in first opinion practice, and that thyroid function testing should be performed only in those dogs with a high pretest probability of the disease.

Successful treatment of sebaceous adenitis with oclacitinib and low-dose prednisolone in a dog.

Finding an effective and well-tolerated treatment for canine idiopathic sebaceous adenitis (ISA) can be challenging. This case report describes an 8-year-old male Rottweiler with ISA successfully treated with a combination of oclacitinib and low doses of prednisolone.

Encontrar um tratamento eficaz e bem tolerado para a adenite sebácea idiopática (ISA) pode ser desafiador. Este relato descreve o caso de um cão Rottweiler macho de oito anos de idade tratado satisfatoriamente com uma associação de oclacitinib e baixas doses de prednisolona.

Encontrar un tratamiento efectivo y bien tolerado frente a la adenitis sebácea idiopática (ISA) puede ser un reto difícil. Este artículo describe el caso de un perro Rottweiler de ocho años tratado con eficacia con una combinación de oclacitinib y dosis bajas de prednisolona.

Trouver un traitement efficace et bien toléré pour l'adénite sébacée idiopathique canine (ASI) peut s'avérer difficile. Ce rapport clinique décrit le cas d'un Rottweiler mâle de 8 ans atteint d'ASI et traité avec succès par une combinaison d'oclacitinib et de faibles doses de prednisolone.

Propiedades psicométricas de la escala de tácticas de conflictos modificada. Aplicación en el contexto de los adolescentes ecuatorianos / Psychometric properties of the modified conflict tactics scale. Application in the Ecuadorian adolescent context

El estudio de la violencia en el noviazgo adolescente tiene relevancia para la Salud Pública, dado su carácter predictivo y el impacto social de esta variable en la convivencia de la población adulta. Las escalas de valoración de violencia en el noviazgo requieren ser validadas para asegurar la fiabilidad y la certeza de sus resultados. Objetivo: Analizar las propiedades psicométricas de la escala de tácticas de conflicto modificada M-CTS en el contexto de la violencia en el noviazgo de adolescentes ecuatorianos. Materiales y métodos: Se trata de un estudio de validación mediante análisis factorial confirmatorio y análisis de variables lingüísticas y culturales, con muestreo al probabilístico (n=1249) con edades comprendidas entre 13 y 19 años, que cumplieron los requisitos de tener o haber tenido una relación de noviazgo. Resultados: Fueron modificadas culturalmente 6 preguntas y fue verificada la estructura de 4 factores del cuestionario (argumentación, violencia psicológica, física leve y física severa). Se encontró una baja fiabilidad para el ítem argumentación perpetrador (0,26) y victimización (0,26) y buena fiabilidad para violencia física grave para los dos perfiles (0,80 y 0,76). Conclusiones principales: La adaptación cultural del M-CTS ofreció una validez adecuada para los diferentes tipos de violencia en población adolescente ecuatoriana permitiendo comparar las prevalencias encontradas con otros países que usaron este instrumento basado en las mismas perspectivas teóricas y metodológicas. (AU)

The study of adolescent dating violence is relevant for Public Health, given its predictive nature and the social impact of this variable on the coexistence of the adult population. Dating violence rating scales need to be validated to ensure the reliability and certainty of their results. Objective: To analyze the psychometric properties of the modified M-CTS conflict tactics scale in the context of dating violence among Ecuadorian adolescents. Materials and methods: This is a validation study through confirmatory factor analysis and analysis of linguistic and cultural variables, with probabilistic sampling (n = 1249) with ages between 12-20 years, who met the requirements of having or having had a dating relationship. Results: 6 questions were culturally modified, and the 4-factor structure of the questionnaire was verified (argumentation, psychological violence, mild physical and severe physical). Low reliability was found for the perpetrator argument (0.26) and victimization (026) items and good reliability for severe physical violence for both profiles (0.80 and 0.76). Main conclusions: The cultural adaptation of the M-CTS offered adequate validity for the diverse types of violence in the Ecuadorian adolescent population, allowing to compare the prevalence found in other countries that used this instrument based on the same theoretical and methodological perspectives. (AU)

Skeletal pathologies track body plan evolution in ichthyosaurs.

Changing predator-prey interactions during the Mesozoic Marine Revolution (MMR) profoundly altered the trajectory of marine tetrapod evolution. Here, we assess potential signatures of this landmark transition through the fossil record of skeletal pathologies in ichthyosaurs - iconic marine reptiles that developed increasingly 'fish-like' body plans over time. We surveyed a stratigraphically constrained sample of 200 Middle Triassic ichthyosaur specimens and compared the type, distribution and prevalence of pathologies with an approximately equivalent assemblage of Early Jurassic age. Overall, skeletal pathologies were equally prevalent in these groups, and most often manifested in species >4 m long. However, pathological bones were found to be concentrated in the hind limbs and tail of Triassic ichthyosaurs, whereas the jaws, forelimbs, and ribcage were preferentially affected in Jurassic taxa. We posit that the occurrence of ankylosed zygapophyses in the caudal peak of Triassic ichthyosaurs could represent a functional by-product of their primitive 'eel-like' swimming. Conversely, increased instances of broken ribs in Jurassic ichthyosaurs may infer ramming or tail strike behaviours that characterise morphologically 'fish-like' marine tetrapods, such as modern toothed whales. Different categories of skeletal pathologies thus evidently reflect structural modifications in the ichthyosaur body plan, and indirectly coincide with ecological turnover during the MMR.

Palaeoepidemiology in extinct vertebrate populations: factors influencing skeletal health in Jurassic marine reptiles.

Palaeoepidemiological studies related to palaeoecology are rare, but have the potential to provide information regarding ecosystem-level characteristics by measuring individual health. In order to assess factors underlying the prevalence of pathologies in large marine vertebrates, we surveyed ichthyosaurs (Mesozoic marine reptiles) from the Posidonienschiefer Formation (Early Jurassic: Toarcian) of southwestern Germany. This Formation provides a relatively large sample from a geologically and geographically restricted interval, making it ideal for generating baseline data for a palaeoepidemiological survey. We examined the influence of taxon, anatomical region, body size, ontogeny and environmental change, as represented by the early Toarcian Oceanic Anoxic Event, on the prevalence of pathologies, based on a priori ideas of factors influencing population skeletal health. Our results show that the incidence of pathologies is dependent on taxon, with the small-bodied genus Stenopterygius exhibiting fewer skeletal pathologies than other genera. Within Stenopterygius, we detected more pathologies in large adults than in smaller size classes. Stratigraphic horizon, a proxy for palaeoenvironmental change, did not influence the incidence of pathologies in Stenopterygius. The quantification of the occurrence of pathologies within taxa and across guilds is critical to constructing more detailed hypotheses regarding changes in the prevalence of skeletal injury and disease through Earth history.

¿Quién cura y cómo cura? Tratamiento de la enfermedad en una comunidad rural de Ecuador / Who heals and how does it cure? Treatment of the disease in a rural community from Ecuador / Quem cura e como se cura? Tratamento da doença em uma comunidade rural do Equador

INTRODUCCIÓN: La medicina tradicional es una alternativa terapéutica que respeta los saberes ancestrales y la multiculturalidad. OBJETIVO: Explorar las prácticas utilizadas para la curación de enfermedades en la comunidad rural San Miguel de Chalata, Ecuador. MÉTODOS: Se realizó una investigación cualitativa, hermenéutica. Respondieron una entrevista semiestructurada, 22 adultos mayores residentes en la comunidad. Los discursos fueron grabados, transcritos y analizados. RESULTADOS: Se valora a la medicina tradicional para curar enfermedades somáticas por su accesibilidad, bajo costo y efectividad. Reconocen a la medicina convencional en la curación de enfermedades crónicas. Sin embargo, la asocian con prolongados tiempos de espera y trato discriminatorio con las personas de mayor edad. Usan rituales en enfermedades sobrenaturales, mezclando fe, religiosidad y asistencia del poder divino universal. CONCLUSIONES: La medicina tradicional y la convencional tienen atribuciones definidas en el pensamiento colectivo de esta comunidad. Aprueban el poder del sanador y respetan el conocimiento científico de los médicos profesionales. Las barreras del sistema convencional deberían estudiarse por su importancia en la utilización de los servicios sanitarios y la igualdad en salud

INTRODUCTION: Traditional medicine is a therapeutic alternative that respects ancestral knowledge and multiculturalism. OBJECTIVE: To explore the practices used for the cure of diseases in the rural community of San Miguel de Chalata, Ecuador. METHODS: A qualitative, hermeneutical research was carried out. A semi-structured interview was answered by 22 older adults living in the community. The discourses were recorded, transcribed and analyzed. RESULTS: Traditional medicine is valued to cure somatic diseases due to its accessibility, low cost and effectiveness. They recognize conventional medicine in the cure of chronic diseases, however, they associate it with prolonged waiting times and discriminatory treatment with the elderly. They use rituals in supernatural diseases, mixing faith, religiosity and assistance of the universal divine power. CONCLUSIONS: Traditional and conventional medicine have defined attributions in the collective thought of this community. They approve the power of the healer and respect the scientific knowledge of professional doctors. The barriers of the conventional system should be studied because of their importance in the use of health services and equality in health

INTRODUÇÃO: A medicina tradicional é uma alternativa terapêutica que respeita o conhecimento ancestral e o multiculturalismo. OBJETIVO: Explorar as práticas utilizadas para a cura de doenças na comunidade rural de San Miguel de Chalata, Equador. MÉTODOS: Uma pesquisa qualitativa e hermenêutica foi realizada. Responderam a uma entrevista semiestruturada 22 idosos vivendo na comunidade. Os discursos foram gravados, transcritos e analisados. RESULTADOS: A medicina tradicional é valorizada para curar doenças somáticas, devido à sua acessibilidade, baixo custo e eficácia. Eles reconhecem a medicina convencional na cura de doenças crônicas. No entanto, associam-na a prolongados tempos de espera e tratamento discriminatório com os idosos. Eles usam rituais em doenças sobrenaturais, misturando fé, religiosidade e assistência do poder divino universal. CONCLUSÕES: A medicina tradicional e convencional têm atribuições definidas no pensamento coletivo dessa comunidade. Eles aprovam o poder do curador e respeitam o conhecimento científico dos médicos profissionais. As barreiras do sistema convencional devem ser estudadas devido à sua importância no uso de serviços de saúde e igualdade na saúde

Medicina convencional frente a medicina tradicional: preferencias de uso en una comunidad rural del Ecuador / Conventional medicine versus traditional medicine: preferences for use in a rural community in Ecuador

Objetivo: Analizar las preferencias del tratamiento convencional, frente al tratamiento con plantas medicinales en una comunidad rural del Ecuador. Métodos: Se realizó una investigación cuantitativa, no experimental, descriptiva, transversal. Se aplicó un cuestionario de 22 preguntas a 49 informantes, uno por cada hogar de la comunidad. Se cumplieron todas las consideraciones éticas en la obtención y manejo de la información. Resultados: Estas personas tienen una concepción de causalidad para diferenciar las enfermedades físicas de otras de origen sobrenatural, cuya curación corresponde exclusivamente a la medicina tradicional. Reconocen la efectividad de la medicina convencional para tratar problemas agudos de tipo somático y traumático, así como también, para curar y prevenir complicaciones de enfermedades crónicas. Sin embargo, en dolores viscerales la población prefiere el tratamiento con plantas medicinales, por su mayor accesibilidad y rapidez de acción. Conclusiones: La medicina convencional es elegida en la mayoría de los problemas físicos de salud, no obstante, se valora a la medicina tradicional para tratar problemas de origen sobrenatural y se promueve el respeto por las cosmovisiones del proceso salud enfermedad.

Pathological survey on Temnodontosaurus from the Early Jurassic of southern Germany.

Paleopathologies document skeletal damage in extinct organisms and can be used to infer the causes of injury, as well as aspects of related biology, ecology and behavior. To date, few studies have been undertaken on Jurassic marine reptiles, while ichthyosaur pathologies in particular have never been systematically evaluated. Here we survey 41 specimens of the apex predator ichthyosaur Temnodontosaurus from the Early Jurassic of southern Germany in order to document the range and absolute frequency of pathologies observed in this taxon as a function of the number of specimens examined. According to our analysis, most observed pathologies in Temnodontosaurus are force-induced traumas with signs of healing, possibly inflicted during aggressive interactions with conspecifics. When the material is preserved, broken ribs are correlated in most of the cases with traumas elsewhere in the skeleton such as cranial injuries. The range of cranial pathologies in Temnodontosaurus is similar to those reported for extinct cetaceans and mosasaurs, which were interpreted as traces of aggressive encounters. Nevertheless, Temnodontosaurus differs from these other marine amniotes in the absence of pathologies in the vertebral column, consistent with the pattern previously documented in ichthyosaurs. We did not detect any instances of avascular necrosis in Temnodontosaurus from southern Germany, which may reflect a shallow diving life style. This study is intended to provide baseline data for the various types of observed pathologies in large ichthyosaurs occupying the 'apex predator' niche, and potentially clarifies aspects of species-specific behavior relative to other ichthyosaurs and marine amniotes.

Studying Closed Hydrodynamic Models of "In Vivo" DNA Perfusion in Pig Liver for Gene Therapy Translation to Humans.

INTRODUCTION: Expressing exogenous genes after naked DNA delivery into hepatocytes might achieve sustained and high expression of human proteins. Tail vein DNA injection is an efficient procedure for gene transfer in murine liver. Hydrodynamic procedures in large animals require organ targeting, and improve with liver vascular exclusion. In the present study, two closed liver hydrofection models employing the human alpha-1-antitrypsin (hAAT) gene are compared to reference standards in order to evaluate their potential clinical interest. MATERIAL AND METHODS: A solution of naked DNA bearing the hAAT gene was retrogradely injected in 7 pig livers using two different closed perfusion procedures: an endovascular catheterization-mediated procedure (n = 3) with infrahepatic inferior vena cava and portal vein blockage; and a surgery-mediated procedure (n = 4) with completely sealed liver. Gene transfer was performed through the suprahepatic inferior cava vein in the endovascular procedure and through the infrahepatic inferior vena cava in the surgical procedure. The efficiency of the procedures was evaluated 14 days after hydrofection by quantifying the hAAT protein copies per cell in tissue and in plasma. For comparison, samples from mice (n = 7) successfully hydrofected with hAAT and healthy human liver segments (n = 4) were evaluated. RESULTS: Gene decoding occurs efficiently using both procedures, with liver vascular arrest improving its efficiency. The surgically closed procedure (sealed organ) reached higher tissue protein levels (4x10^5- copies/cell) than the endovascular procedure, though the levels were lower than in human liver (5x10^6- copies/cell) and hydrofected mouse liver (10^6- copies/cell). However, protein levels in plasma were lower (p<0.001) than the reference standards in all cases. CONCLUSION: Hydrofection of hAAT DNA to "in vivo" isolated pig liver mediates highly efficient gene delivery and protein expression in tissue. Both endovascular and surgically closed models mediate high tissue protein expression. Impairment of protein secretion to plasma is observed and might be species-related. This study reinforces the potential application of closed liver hydrofection for therapeutic purposes, provided protein secretion improves.

Utilización de la Medicina Natural y Tradicional, un reto en atención primaria de salud / Use of Natural and Traditional Medicine, a challenge in primary healthcare

Se realizó un estudio observacional descriptivo con características analítica de todos los pacientes atendidos con las distintas modalidades de Medicina Natural y Tradicional del Policlínico "Felipe Ismael Rodríguez Ramos" en San Antonio de los Baños, Artemisa, en el periodo comprendido desde enero del 2014 a diciembre del mismo año. El objetivo fue determinar la aplicación de la Medicina Natural y Tradicional en sus distintas modalidades, para la atención de las diferentes patologías, y con específicos para identificar las formulaciones más utilizadas en fitoterapia y las especialidades con mayor prescripción de Medicina Natural y Tradicional. El universo estuvo constituido por 40456 pacientes atendidos en las consultas del Policlínico (medicina interna, ginecología, pediatría, medicina natural y tradicional, fisioterapia, médicos de familia, ortopedia, dermatología, urología, psicología y psiquiatría); la muestra se seleccionó de forma intencional y estuvo constituida por 10296, se emplearon criterios de exclusión y exclusión. Las patologías donde más se hizo uso de la Medicina Natural y Tradicional fueron en las osteomioarticulares, aunque en menor porciento estuvieron la acupuntura, fitofármacos, apiterapia entre otras modalidades. En las especialidades que más se prescribió fue Medicina Natural y Tradicional, Medicina General e Integral y Medicina Interna, así como las formulaciones más empleadas fueron los jarabes y las decocción o cocimiento.

A descriptive observational studywas carried out,with analytic characteristics of all the patients treated with the different modalities of Natural and Traditional Medicine at the Policlinic "Felipe Ismael Rodriguez Fields", San Antonio de los Baños, Artemisa, from January to December 2014. The general objective was to determine the application of Natural and Traditional Medicine in its different modalities for the treatment ofvarious conditions, and specifically to identify the formulations mostly used in Phytotherapy and the medical the specialties with more prescriptions of Natural and Traditional Medicine. The universe was conformed by 40456 patients treated in the Policlinicby different speciaalties(Internal Medicine, Gynecology and Obstetrics, Pediatrics, Natural and Traditional Medicine, Physiotherapy, Family Medicine, Orthopedics, Dermatology, Urology, Psychology and Psychiatrics). The sample was selected in an intentional way and it was conformed by 10296. Exclusion and inclusion criteria were used. The diagnosis where Natural and Traditional Medicine was mostly usedwere related to Orthopedics, although Acupuncture, Phytotheapy and Apitherapy wereapplied by smaller percent, among other modalities. Natural and Traditional Medicine, Family Medicine and Internal Medicine were the specialties where Natural and Traditional Medicine was mostly applied. The most common formulations employees were the syrups and decoctions or "cocimientos".

Framingham score, renal dysfunction, and cardiovascular risk in liver transplant patients.

Cardiovascular (CV) events represent major impediments to the long-term survival of liver transplantation (LT) patients. The aim of this study was to assess whether the Framingham risk score (FRS) at transplantation can predict the development of post-LT cardiovascular events (CVEs). Patients transplanted between 2006 and 2008 were included. Baseline features, CV risk factors, and CVEs occurring after LT (ischemic heart disease, stroke, heart failure, de novo arrhythmias, and peripheral arterial disease) were recorded. In total, 250 patients (69.6% men) with a median age of 56 years (range, 18-68 years) were included. At transplantation, 34.4%, 34.4%, and 33.2% of patients, respectively, had a low, moderate, and high FRS with a median FRS of 14.9 (range, 0.09-30); 14.4% of LT recipients developed at least 1 CVE at a median of 2.619 years (range, 0.006-6.945 years). In the univariate analysis, factors associated with the development of CVEs were the continuous FRS at LT (P = 0.003), age (P = 0.007), creatinine clearance [estimated glomerular filtration rate (eGFR); P = 0.020], and mycophenolate mofetil use at discharge (P = 0.011). In the multivariate analysis, only the eGFR [hazard ratio (HR), 0.98; 95% confidence interval (CI), 0.97-1.00; P = 0.009] and FRS (HR, 1.06; 95% CI, 1.02-1.10; P = 0.002) remained in the model. Moreover, an association was also found between the FRS and overall survival (P = 0.004) with 5-year survival rates of 82.5%, 77.8%, and 61.4% for the low-, moderate-, and high-risk groups, respectively. Continuous FRS, eGFR, and hepatitis C virus infection were independent risk factors for overall mortality. In our series, the FRS and eGFR at LT were able to predict the development of post-LT CVEs and poor outcomes. Liver Transpl 21:812-822, 2015. © 2015 AASLD.

Manejo de pacientes con hipoparatiroidismo: Guías clínicas del Servicio de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes

El hipoparatiroidismo es una enfermedad endocrina poco común que se caracteriza por niveles bajos de calcio sérico, niveles altos de fosfato sérico y niveles inapropiadamente bajos o ausentes de hormona paratiroidea (PTH) en la circulación. La enfermedad puede aparecer como una patología aislada o en asociación con otra patología. Usualmente la enfermedad es de tipo hereditaria, aunque la causa más común en el adulto es el hipoparatiroidismo adquirido postquirúrgico. La mayoría de los pacientes se presentan con síntomas como parestesias, calambres o tetania, pero eventualmente también podría manifestarse como convulsiones, broncoespasmo, laringoespasmo o arritmias cardiacas. Es importante identificar si la hipocalcemia está asociada o no con un nivel sérico ausente o inapropiadamente bajo de PTH (hipoparatiroidismo) o si la hipocalcemia está asociada con el correspondiente aumento compensatorio de dicha hormona. La anamnesis, las características fenotípicas, la evaluación radiológica y el apropiado perfil bioquímico son determinantes para realizar un diagnóstico correcto. La hipocalcemia sintomática puede ser una emergencia médica que requiera la administración aguda vía endovenosa de calcio. La meta terapéutica principal del manejo crónico incluye mantener en un rango aceptable los niveles de calcio sérico, fosforo sérico y la excreción urinaria de calcio en 24 horas.

Hypoparathyroidism is an uncommon endocrine deficiency disease characterized by low serum calcium levels, elevated serum phosphorus levels, and absent or inappropriately low levels of parathyroid hormone (PTH) in the circulation. The disease may appear as an isolated disorder or in association with other organ defects. Usually the disease is identifiable as hereditary, although the most common acquired cause of hypoparathyroidism in adults is postsurgical. Patients with hypoparathyroidism most often present with paresthesia, cramps, or tetany, but the disorder may also manifest acutely with seizures, bronchospasm, laryngospasm, or cardiac rhythm disturbances. The major general distinction to be made is whether the hypocalcemia is associated with an absent or inappropriately low serum PTH concentration (hypoparathyroidism) or whether the hypocalcemia is associated with an appropriate compensatory increase in PTH. The anamnesis, phenotypical features, radiology evaluation and some biochemical profiles are determinant in an appropriate diagnosis. Symptomatic hypocalcemia can be a medical emergency requiring acute intravenous administration of calcium. The primary goals of chronic management include maintaining within an acceptable range the following indexes: serum total calcium, serum phosphorus and 24-h urine calcium excretion.

Recomendaciones para el estudio patológico de las metástasis hepáticas de cáncer colorrectal tras neoadyuvancia. Consenso Nacional de la Sociedad Española de Anatomía Patológica / Recommendations for the study of liver metastases of colorectal cancer after neoadjuvant therapy. National Consensus of the Spanish Society of Pathology (SEAP)

Las resecciones hepáticas por metástasis de cáncer colorrectal (CCR) son una pieza quirúrgica frecuente en muchos servicios de anatomía patológica. Si al aumento de la incidencia de CCR añadimos otros factores como la frecuencia de metástasis hepáticas sincrónicas o metacrónicas, la ampliación en los criterios quirúrgicos de resecabilidad y el tratamiento neoadyuvante que facilita la resecabilidad, nos encontramos con una patología en aumento. El estudio anatomopatológico de estas piezas quirúrgicas se ha modificado y ha aumentado su complejidad debido a que se deben valorar nuevos datos histológicos como son los cambios potenciales producidos por el tratamiento neoadyuvante quimioterápico en el hígado no tumoral, y en el tumor el grado de regresión tumoral patológico, por su valor pronóstico. Teniendo en cuenta estos antecedentes, un grupo de patólogos se propuso revisar su papel en el diagnóstico y pronóstico de los pacientes con metástasis hepáticas de CCR con el objetivo de elaborar unas recomendaciones prácticas de procedimiento. De esta revisión se han obtenido unas directrices que podrían ser adaptadas por los distintos departamentos de patología con el fin de unificar procedimientos y obtener diagnósticos comparables. En este trabajo se exponen los resultados de este consenso (AU)

Liver resections for colorectal cancer (CRC) metastasis are common in most pathology departments. In addition, the frequency of liver resections for CRC specimens has increased due to an increased incidence of CRC the frequency of synchronous or metachronous liver metastases, the use of neoadjuvant therapy, and the increased surgical criteria of resectability. The pathological study of the specimens should include new histological data, i.e.: changes caused by therapy, both in the tumour and in the liver parenchyma, such as the pathological tumour regression grade, and the histologic degree of liver damage by the therapy, because of its prognostic value. On this setting, a group of pathologists has elaborated a guideline proposal, in order to obtain a more uniform procedure and diagnosis of CRC liver metastasis specimens. The aim was to give useful recommendations in order to obtain homogeneous and comparable pathologic reports among different pathology departments. The results of this consensus are presented in this paper (AU)

New ophthalmosaurid ichthyosaurs from the European Lower Cretaceous demonstrate extensive ichthyosaur survival across the Jurassic-Cretaceous boundary.

BACKGROUND: Ichthyosauria is a diverse clade of marine amniotes that spanned most of the Mesozoic. Until recently, most authors interpreted the fossil record as showing that three major extinction events affected this group during its history: one during the latest Triassic, one at the Jurassic-Cretaceous boundary (JCB), and one (resulting in total extinction) at the Cenomanian-Turonian boundary. The JCB was believed to eradicate most of the peculiar morphotypes found in the Late Jurassic, in favor of apparently less specialized forms in the Cretaceous. However, the record of ichthyosaurs from the Berriasian-Barremian interval is extremely limited, and the effects of the end-Jurassic extinction event on ichthyosaurs remains poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: Based on new material from the Hauterivian of England and Germany and on abundant material from the Cambridge Greensand Formation, we name a new ophthalmosaurid, Acamptonectes densus gen. et sp. nov. This taxon shares numerous features with Ophthalmosaurus, a genus now restricted to the Callovian-Berriasian interval. Our phylogenetic analysis indicates that Ophthalmosauridae diverged early in its history into two markedly distinct clades, Ophthalmosaurinae and Platypterygiinae, both of which cross the JCB and persist to the late Albian at least. To evaluate the effect of the JCB extinction event on ichthyosaurs, we calculated cladogenesis, extinction, and survival rates for each stage of the Oxfordian-Barremian interval, under different scenarios. The extinction rate during the JCB never surpasses the background extinction rate for the Oxfordian-Barremian interval and the JCB records one of the highest survival rates of the interval. CONCLUSIONS/SIGNIFICANCE: There is currently no evidence that ichthyosaurs were affected by the JCB extinction event, in contrast to many other marine groups. Ophthalmosaurid ichthyosaurs remained diverse from their rapid radiation in the Middle Jurassic to their total extinction at the beginning of the Late Cretaceous.

Impaired social behavior in children with benign childhood epilepsy with centrotemporal spikes.

The aim of the present study was to assess the emotional and cognitive aspects of social cognition among patients with rolandic epilepsy. A computerized neuropsychological battery was used for cognitive evaluation. Affective and cognitive social cognition were evaluated using two computerized Theory of Mind tasks. Cognitive abilities and social behavior of 15 children, diagnosed with rolandic epilepsy, ages 7 to 13 years were assessed and compared with 15 age- and education-matched healthy controls. Compared with controls, the epileptic patients had lower scores on verbal and visual learning rate parameters and on verbal processing and were significantly impaired on "affective Theory of Mind" tasks but not on "cognitive Theory of Mind" conditions. Our findings raise the possibility that rolandic epilepsy may affect neural networks affecting cognition and mediating social cognition essential for social behavior, thus challenging the benign nature of the condition.

Tau and 14-3-3 of genetic and sporadic Creutzfeldt-Jakob disease patients in Israel.

One of the largest clusters of genetic Creutzfeldt-Jakob disease (gCJD) is found among Jews of Libyan origin in Israel and is linked to the E200K mutation in PRNP (gCJDE200K). The aim of this study was to compare the levels of cerebrospinal fluid (CSF) biomarkers, Tau and 14-3-3 proteins, between gCJDE200K patients, sporadic CJD (sCJD) patients and non-CJD controls in Israel between the years 1996-2006. The levels of Tau and 14-3-3 proteins in CSF were measured by ELISA and immunoblotting, respectively. CSF Tau levels were similar in gCJDE200K and sCJD, both were significantly higher than in controls [1,107 ± 470 pg/ml [33/46 (72%)] of the cases >1,000 pg/ml, 1,280 ± 580 pg/ml [25/30 (83.3%)], and 354 ± 338 pg/ml [17/243 (6.9%)], respectively, p < 0.001]. 14-3-3 was detected in CSF of 41/53 (77%) of each gCJDE200K and sCJD patients tested, but only in 70/417 (16.8%) of controls (p < 0.001). An inverse correlation was found between disease duration and Tau levels in both gCJDE200K and sCJD (r = -0.464 and r = -0.284). No difference was found in Tau or 14-3-3 between the various codon 129 genotypes. We conclude that CSF biomarkers, Tau and 14-3-3, may be used in the diagnosis in both patients' populations, presenting a similar sensitivity yet Tau assay having higher specificity.

Immunoglobulin E-dependent regulation of the CCR3 chemokine receptor by interferon-gamma in atopic asthmatics.

BACKGROUND: The chemokine receptor CCR3 mediates the migration of cells that play an important role in the pathogenesis of asthma to inflammatory foci. Interferon (IFN)-gamma is known to downregulate the expression of some chemokine receptors. Therefore, we decided to analyze the regulation of CCR3 by IFN-gamma in asthmatics and to characterize the dependence of this process on immunoglobulin E (IgE) levels. METHODS: Atopic asthmatics were treated with IFN-gamma or placebo, and the IgE concentration in the blood was measured using an ultra-micro-ELISA for total IgE. Mononuclear cells from patients and controls were isolated by Ficoll-Hypaque gradient and incubated in the absence or presence of IFN-gamma for different periods of time. After incubation, the cells were washed and lysed for RT-PCR analysis, which was performed using a Perkin-Elmer kit. RESULTS: IFN-gamma treatment apparently improved the evaluated clinical variables; however, the differences were not significant compared to the placebo group. We found that IFN-gamma downregulated CCR3 mRNA expression ex vivo and in vivo in those patients with IgE levels higher than 500 IU/ml, whereas IFN-gamma upregulated CCR3 mRNA expression in patients with IgE levels lower than 500 IU/ml. Correspondence between ex vivo and in vivo results was observed using this approach. There was found to be a direct correlation between total serum IgE and CCR3 mRNA expression. CONCLUSIONS: In those asthmatic patients with high levels of IgE, who are thus susceptible to downregulation of CCR3 by IFN-gamma, a significant therapeutic effect with systemic IFN-gamma might be expected.

Immunopathologic study of erythema dyschromicum perstans (ashy dermatosis).

Erythema dyschromicum perstans (EDP) is a pigmentary disease of unknown etiology in which damage to basal cells is thought to be mediated by adhesion molecules. The aim of this study was to characterize the histopathology and immunopathology of EDP. Forty-three patients from Medellín, Colombia, with the diagnosis of EDP were evaluated. Skin biopsy specimens were obtained for histopathology and immunohistochemistry, using monoclonal antibodies directed against the following markers: CD4, CD8, CD56, CD1a, CD68, CLA, HLA-DR, ICAM-1 and LFA-1alpha. A dermal lymphocytic infiltrate was observed in all cases, with a perivascular location in 86%. Other histologic features included melanophages in all specimens, vacuolization of the basement membrane zone (BMZ) 58% and exocytosis of lymphocytes (53.5%). The mean number of total leukocytes was 1510 cells mm-2 of tissue. There was a predominance of CD8+ T lymphocytes in the dermis and HLA-DR+, ICAM-1+ keratinocytes in the epidermis. Exocytosis of cutaneous lymphocyte antigen (CLA)+cells was observed in areas of BMZ damage, suggesting that response to antigenic stimulation may play a role in the development of EDP.

Determination of the diagnostic accuracy of saline infusion sonography in the evaluation of postmenopausal bleeding: a preliminary study

Objective: To determine the diagnostic accuracy of transvaginal ultrasound and saline infusion sonography in the evaluation of postmenopausal bleeding. Setting: Philippine General Hospital Design: Cross-sectional study. Transvaginal sonography and saline infusion sonography were performed and findings correlated with histopathologic results obtained by hysteroscopy or endometrial biopsy. Results: At a 95 percent confidence interval, the sensitivity of TVS was higher than SIS (92.9 percent), the specificity of SIS was greater than TVS (50 percent vs 0). The positive predictive value and negative predictive of SIS (91.7 percent, 50 percent) were both greater than that obtained by TVS (86.7 percent, 0). Comparing these two proportions, there was no sufficient evidence to say that there exists a significant difference. Conclusion: Transvaginal sonography and saline infusion sonography are invaluable tools in the evaluation of postmenopausal bleeding.