Ozone and peroxone disinfection of Toxocara canis eggs in water.

Water pollution in developing countries continues to be a major health problem due to various anthropological activities that contribute to the spread of many parasitic diseases, including those caused by helminths. The aim of this study is to explore the ability of ozone and peroxone to disinfect drinking water contaminated samples with Toxocara canis eggs. The oxidants used were ozone and ozone-hydrogen peroxide combination. The treatment of Toxocara canis eggs was carried out in a 50 ml reactor with an operating volume of 10 ml. The pH conditions (5, 7 and 10) were varied for each treatment. The treatment effect was calculated by counting eggs and examining the condition of the larvae larval condition (whole, broken and hatched larvae) using an optical microscope. The experiment was carried out by exposing the eggs for 60 and 120 minutes to ozone and peroxone. The best results were obtained for helminths treated with the ozone/hydrogen peroxide combination at pH 10, with an inactivation of 79.2%. The synergistic effect of ozone combined with hydrogen peroxide allows higher helminth egg inactivation rates, demonstrating that advanced oxidation processes are a real alternative to apply in the inactivation of Toxocara canis eggs. The results obtained in this study show that the ozone and peroxone treatment could be a useful disinfection process to destroy or inactivate Toxocara canis eggs in processes commonly applied in water treatment.

Cambios en el manejo ambulatorio de pacientes con cáncer de próstata durante la pandemia por SARS-CoV-2. Revisión bibliográfica y aporte de nuestro grupo en atención telemática / Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care

Introducción y objetivo: La pandemia por COVID-19ha supuesto un cambio en la atención a pacientes en el ámbito urológico, especialmente con cáncer de próstata.El objetivo de este trabajo es mostrar los cambios en el manejo a nivel ambulatorio individualizando para cada perfil de paciente la atención telemática.Materiales y métodosSe han revisado artículos publicados desde marzo del 2020 hasta enero del 2021. Se han seleccionado aquellos que aportaban los mayores niveles de evidencia en cuanto al riesgo en distintos aspectos: cribado, diagnóstico, tratamiento y seguimiento del cáncer de próstata.ResultadosDesarrollamos una clasificación según prioridades, en diferentes etapas de la enfermedad (cribado, diagnóstico, tratamiento y seguimiento) adaptando a esta el tipo de control: presencial o telefónico. Establecemos 4 opciones: prioridad A o baja, en la que la atención será telefónica en todos los casos; prioridad B o intermedia, en la que si el paciente valorado telefónicamente se considera subsidiario de visita presencial, esta se citará dentro de los 3 meses posteriores; prioridad C o alta, el paciente será visto presencial con un margen para la visita de 1 a 3 meses, y prioridad D o muy alta, la visita deberá ser siempre presencial con un margen de hasta 48 h y considerada muy preferente.ConclusionesLa atención telemática en cáncer de próstata representa una oportunidad para desarrollar nuevos protocolos de actuación y seguimiento que deberán ser analizados exhaustivamente en futuros trabajos con el fin de conformar un entorno seguro y garantizar resultados oncológicos para los pacientes. (AU)

Introduction and objective: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer.The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile.Materials and methodsArticles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer.ResultsWe developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48hours and considered very preferential.ConclusionsTelematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients. (AU)

Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer. The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS: Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS: We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 h and considered very preferential. CONCLUSIONS: Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.

Swine as reservoirs of zoonotic borderline oxacillin-resistant Staphylococcus aureus ST398.

Methicillin resistance mediated by the mecA gene in Staphylococcus aureus, also known as "true MRSA", is typically associated with high oxacillin MIC values (≥8 mg/L). Because non-mecA-mediated oxacillin resistant S. aureus phenotypes can also cause hard-to-treat diseases in humans, their misidentification as methicillin-susceptible S. aureus strains (MSSA) can compromise the efficiency of the antimicrobial therapy. These strains have been refereed as Borderline Oxacillin-Resistant S. aureus (BORSA) but their characterization and role in clinical microbiology have been neglected. Considering the increasing importance of livestock-associated methicillin-resistant S. aureus ST398 (LA-MRSA) as an emerging zoonotic pathogen worldwide, this study aimed to report the genomic context of oxacillin resistance in porcine S. aureus ST398 strains. S. aureus isolates were recovered from asymptomatic pigs from three herds. Oxacillin MIC values ranged from 4 to 32 mg/L. MALDI-TOF-confirmed isolates were screened for mecA and mecC by PCR and genotyped by means of PFGE and Rep-PCR. Seven isolates were whole genome sequenced. None of the isolates harbored the mecA gene or its variants. Although all seven sequenced isolates belonged to one sequence type (ST398), two different spa types (t571 and t1471) were identified. All isolates harbored conserved blaZ gene operon and no mutations on genes encoding for penicillin-binding-proteins were detected. Genes conferring resistance against other drugs such as aminoglycosides, chloramphenicol, macrolide, lincosamide and streptogramin (MLS), tetracycline and trimethoprim were also detected. Isolates also harbored virulence genes encoding for adhesins (icaA; icaB; icaC; icaD; icaR), toxins (hlgA; hlgB; hlgC; luk-PV) and protease (aur). Pigs can serve as reservoirs of non-mecA-mediated oxacillin-resistant ST398 strains potentially pathogenic to humans. Considering that mecA has been the main target to screen methicillin-resistant staphylococci, the occurrence of BORSA phenotypes is probably underestimated in livestock.

[Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care]. / Cambios en el manejo ambulatorio de pacientes con cáncer de próstata durante la pandemia por SARS-CoV-2. Revisión bibliográfica y aporte de nuestro grupo en atención telemática.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer.The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS: Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS: We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 hours and considered very preferential. CONCLUSIONS: Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.

Epidemiological behavior and current forecast of syphilis in Mexico: increase in male population.

OBJECTIVES: Even when new cases of syphilis are notifiable since 1944, the Mexican National Epidemiological Surveillance System lacks information on the changes of the rate of case reports considering the geographic and demographic variables. Therefore, it is necessary to have evidence, with particular attention to the study of the epidemiological behavior by the identification of risk factors and groups. The objective of this study was to analyze the epidemiology, geographical distribution, and forecast of syphilis in Mexico. STUDY DESIGN: The design of the study was a secondary research of epidemiological databases. METHODS: A retrospective analysis of the national surveillance data (2007-2017) of acquired and congenital syphilis (CS) issued by the General Directorate of Epidemiology was performed. RESULTS: Of all cases, 34,998 and 1030 cases were reported for acquired syphilis (AS) and CS , respectively, reflecting an increasing trend in the whole country for both diseases. Cases and incidence of AS per year showed that, male gender presented an increase in reproductive age. Distribution of the rate of case reports is mostly commanded by the states in the extreme north (Gulf of California and northern Gulf of Mexico) and south (Gulf of southern Mexico and the Caribbean Sea). Likewise, the Seasonal Autoregressive Integrated Moving Average model was selected as the best-fit model for the forecast analysis. This model was used to forecast AS cases during 2018-2019. AS may have a slight fluctuation (on the rise) during the following 24 months. CONCLUSIONS: These findings underscore the importance of intensifying, as well as expanding screening and treatment in adult population, including men, who are not routinely benefiting from maternal and reproductive service-based syphilis screening and treatment.

Constraints on Lorentz Invariance Violation from HAWC Observations of Gamma Rays above 100 TeV.

Because of the high energies and long distances to the sources, astrophysical observations provide a unique opportunity to test possible signatures of Lorentz invariance violation (LIV). Superluminal LIV enables the decay of photons at high energy. The high altitude water Cherenkov (HAWC) observatory is among the most sensitive gamma-ray instruments currently operating above 10 TeV. HAWC finds evidence of 100 TeV photon emission from at least four astrophysical sources. These observations exclude, for the strongest of the limits set, the LIV energy scale to 2.2×10^{31} eV, over 1800 times the Planck energy and an improvement of 1 to 2 orders of magnitude over previous limits.

Multiple Galactic Sources with Emission Above 56 TeV Detected by HAWC.

We present the first catalog of gamma-ray sources emitting above 56 and 100 TeV with data from the High Altitude Water Cherenkov Observatory, a wide field-of-view observatory capable of detecting gamma rays up to a few hundred TeV. Nine sources are observed above 56 TeV, all of which are likely galactic in origin. Three sources continue emitting past 100 TeV, making this the highest-energy gamma-ray source catalog to date. We report the integral flux of each of these objects. We also report spectra for three highest-energy sources and discuss the possibility that they are PeVatrons.

Estado actual de la labor de los fisioterapeutas en las unidades de cuidados intensivos de adultos del área metropolitana de Barcelona / Current physiotherapists' role in adult intensive care units in the metropolitan area of Barcelona

Antecedentes y objetivo: Los fisioterapeutas son un grupo de profesionales con importancia creciente dentro de las unidades de cuidados intensivos (UCI). Sin embargo, tanto sus prácticas terapéuticas como su disponibilidad en estas unidades son muy heterogéneas. El objetivo de este trabajo fue evaluar la variabilidad en cuanto a disponibilidad, actividades terapéuticas, formación y entorno de trabajo de los fisioterapeutas de las UCI de adultos en Barcelona. Materiales y métodos: Se realizó un estudio transversal y descriptivo a través de dos cuestionarios que se diseñaron para ser contestados por los jefes de servicio y por los fisioterapeutas de las UCI de adultos del área metropolitana de Barcelona durante marzo y abril de 2018. Resultados: Se contestaron 19/21 cuestionarios de jefes de servicio y 23/29 de fisioterapeutas. Todas las UCI disponían de servicio de fisioterapia en días laborables, con una ratio -mediana (rango intercuartílico, p25-p75)- de 13 (11,5, 5,5-17) camas UCI por fisioterapeuta, dedicando la mayoría (65%) un promedio de 16-30 min por paciente. La disponibilidad en festivos era del 47% de los casos, y no se ofrecía fisioterapia en horario nocturno. El trabajo de los fisioterapeutas fue considerado satisfactorio por la mayoría de los jefes de servicio, si bien se consideraban insuficientes en número y en tiempo de dedicación para cubrir las necesidades. Las actividades terapéuticas fueron variables entre los participantes. Conclusiones: La disponibilidad de los fisioterapeutas en las UCI de adultos de Barcelona es variable, siendo significativamente inferior a las recomendaciones europeas y nacionales vigentes. Existen también diferencias entre las actividades terapéuticas realizadas entre ellos

Background and objective: Physiotherapists are a group of professionals with increasing importance within the intensive care units (ICU). However, both their therapeutic practices and their availability for these units are very heterogeneous. The aim of this study was to evaluate the variability in terms of availability, therapeutic activities, training and work environment of the physiotherapists of adult ICU in Barcelona. Materials and methods: A cross-sectional and descriptive study was carried out through two questionnaires that were designed to be answered by department heads and physiotherapists of adult ICU in the metropolitan area of Barcelona, from March to April 2018. Results: Nineteen of 21 questionnaires for head physicians and 23/29 for physiotherapists were answered. All ICU had a physiotherapy service on weekdays, with a median (IQR, p25-p75) ratio of 1 physiotherapist for every 13 (11.5, 5.5-17) ICU beds. Most of the physiotherapists (65%) spent 16-30 minutes per patient. Availability on holidays was 47%, and there were no physiotherapists during the night-shifts. Physiotherapist assistance was considered satisfactory by most head physicians, although it was also considered insufficient both in number and time to meet patients' needs. Therapeutic activities were different among participants. Conclusions: Physiotherapist availability in adult ICU in Barcelona was variable and significantly below current European and national recommendations. There were also differences in therapeutic activities among them

Terapia en espejo para el dolor central posterior al accidente cerebrovascular: serie de casos / Mirror therapy in central post-stroke pain: Case series

Objetivo: Evaluar si un nuevo protocolo de terapia en espejo (MT, por sus siglas en inglés) es efectivo para provocar cambios analgésicos en pacientes afectados por dolor central posterior al accidente cerebrovascular (CPSP, por sus siglas en inglés). Materiales y métodos: Tres pacientes con CPSP fueron evaluados sobre la intensidad percibida de los síntomas del dolor neuropático, su interferencia con las actividades cotidianas, el nivel de ansiedad y en el desempeño del entrenamiento para la discriminación de lateralidad. Dentro de un intervalo de 3 semanas se realizaron 15 sesiones de MT progresivas, con mediciones pre-postratamiento, y a una semana de seguimiento. Resultados: En los 3 casos, el protocolo de intervención mejoró la sintomatología neuropática (reducción de dolor: 11,3 puntos; DE: 3,1), su interferencia con actividades cotidianas (reducción de: 10 puntos; DE: 2) y el desempeño en discriminación de lateralidad (aumento de aciertos: 13%; DE: 18,1) al postratamiento y manteniéndose estables al seguimiento. Sin embargo, la mejoría para ansiedad no fue relevante. Conclusiones: Este estudio piloto sugiere resultados prometedores con relación a la MT, así como buena tolerancia y seguridad. Futuros estudios podrían explorar la efectividad de este protocolo con un mayor número de pacientes y proponer estrategias sinérgicas para potenciar los efectos analgésicos

Objective: To determine whether a novel mirror therapy (MT) protocol effectively led to analgesic changes in patients suffering from Central Post-Stroke Pain (CPSP). Materials and methods: Three patients were identified with CPSP and assessed in perceived intensity of neuropathic pain symptoms, interference with activities of daily living, anxiety level, and laterality discrimination training performance. Each participant received 15 sessions of progressive MT within a three-week interval, and assessed at pre-post treatment, and at 1-week follow-up. Results: The intervention-protocol improved the neuropathic symptoms in all 3 cases (pain reduction: 11.3 points; SD: 3.1), interference with activities of daily living, (reduction of: 10 points; SD: 2), and an increase in laterality discrimination accuracy (13%; SD: 18.1) at post-treatment, which maintained stable at follow-up in the three cases. However, anxiety levels did not show any significant improvement. Conclusions: This pilot-study suggests promising results in the application of MT, including good tolerance and safety. Future studies should examine the effectiveness of the protocol with a larger sample size and propose synergic strategies to enhance analgesic effects

Importancia de la electrofisiología ocular en el diagnóstico de las distrofias retinianas / Importance of ocular electrophysiology in the diagnosis of retinal dystrophies

Antecedentes y objetivo: El diagnóstico de las distrofias retinianas es complejo y se basa en estudio oftalmológico completo, estudio genético y los estudios electrofisiológicos (EEF). En este estudio pretendemos evaluar el papel de las pruebas electrofisiológicas y del médico solicitante en el diagnóstico de las distrofias de retina. Materiales y métodos: Estudio observacional retrospectivo. Se seleccionaron 50 pacientes atendidos en el Servicio de Neurofisiología del Hospital Universitario Virgen Macarena. Se valoró el sexo, la edad, el hospital de origen, motivo por el que se solicitó los EEF, diagnóstico de presunción tras examen oftalmológico, EEF realizados, estudio genético y el diagnóstico definitivo tras realización de EEF. Se elaboró un sistema de clasificación que otorga a cada caso un valor comprendido entre 0 y 2, en función de la contribución de las pruebas electrofisiológicas al diagnóstico final. Resultados: La edad media fue 44,34 ± 18,03 años (60% mujeres). Retinosis pigmentaria, neuropatía óptica y enfermedad de Stargardt fueron los diagnósticos más frecuentes. Los EEF modificaron el diagnóstico de presunción en el 48% de los casos, confirmaron el diagnóstico en el 44% y no aportaron información en el 8%. La contribución de los EEF fue mayor en pacientes atendidos en el Hospital Universitario Virgen Macarena y cuando se solicitaban por hallazgos en la exploración (p = 0,001). Los falsos positivos para distrofia retiniana fueron del 60% en pacientes no valorados en dicho hospital. Conclusiones: Las pruebas electrofisiológicas y el manejo especializado de los pacientes con distrofias retinianas desempeñan un papel importante en el diagnóstico de estas patologías

Background and objective; The diagnosis of retinal dystrophies is complex and is based on complete ophthalmological study, genetic study and electrophysiological studies (EPS). In this study, we intend to evaluate the role of electrophysiological and medical tests in the diagnosis of retinal dystrophies. Material and methods: A retrospective observational study was conducted on 50 selected patients that attended the Neurophysiology Department of the University Hospital Virgen Macarena. An analysis was made of the variables that included, gender, age, referral hospital, reason for which the EPS was requested, applied EPS, genetic study, presumed diagnosis, and definitive diagnosis after EPS. A classification system was subsequently developed, which gives each case a value between 0 and 2, depending on the contribution of the electrophysiological tests to the final diagnosis. Results: The mean age was 44.34 ± 18.03 years (60% women). Retinitis pigmentosa (24%), optic neuropathy (12%), and Stargardt's disease (8%) were the most frequent diagnoses. The EPS modified the presumed diagnosis in 48% of the cases, confirmed the diagnosis in 44%, and did not provide any useful information in 8%. The contribution of the EPS was greater in patients seen in the HUVM and when requested by findings in the examination (P = .001). The false positives in the diagnosis of retinal dystrophy were 60% in patients not evaluated by the University Hospital Virgen Macarena. Conclusions: Electrophysiological test and specialised management of patients with retinal dystrophies play an important role in the diagnosis of these conditions

Importance of ocular electrophysiology in the diagnosis of retinal dystrophies. / Importancia de la electrofisiología ocular en el diagnóstico de las distrofias retinianas.

BACKGROUND AND OBJECTIVE: The diagnosis of retinal dystrophies is complex and is based on complete ophthalmological study, genetic study and electrophysiological studies (EPS). In this study, we intend to evaluate the role of electrophysiological and medical tests in the diagnosis of retinal dystrophies. MATERIAL AND METHODS: A retrospective observational study was conducted on 50 selected patients that attended the Neurophysiology Department of the University Hospital Virgen Macarena. An analysis was made of the variables that included, gender, age, referral hospital, reason for which the EPS was requested, applied EPS, genetic study, presumed diagnosis, and definitive diagnosis after EPS. A classification system was subsequently developed, which gives each case a value between 0 and 2, depending on the contribution of the electrophysiological tests to the final diagnosis. RESULTS: The mean age was 44.34 ±18.03 years (60% women). Retinitis pigmentosa (24%), optic neuropathy (12%), and Stargardt's disease (8%) were the most frequent diagnoses. The EPS modified the presumed diagnosis in 48% of the cases, confirmed the diagnosis in 44%, and did not provide any useful information in 8%. The contribution of the EPS was greater in patients seen in the HUVM and when requested by findings in the examination (P=.001). The false positives in the diagnosis of retinal dystrophy were 60% in patients not evaluated by the University Hospital Virgen Macarena. CONCLUSIONS: Electrophysiological test and specialised management of patients with retinal dystrophies play an important role in the diagnosis of these conditions.

Utilidad de la PET/TC 18-FDG en diagnóstico y seguimiento de tumores urológicos uroteliales y renales / Usefulness of PET/CT 18-FDG for the diagnosis and follow-up of urological, urothelial and kidney tumours

Introducción: En los últimos años han surgido nuevos estudios de imagen en diagnóstico y seguimiento de tumores urológicos metastásicos. Material y métodos: Se revisa a 41 pacientes con sospecha de recidiva de tumor urotelial o renal, analizando el rendimiento diagnóstico de las PET-TC realizadas entre 2013 y 2016. Resultados: Recopilamos 17 tumores uroteliales y 24 renales, con una mediana de seguimiento de 30 meses. Un 29,3% de los uroteliales corresponden a alto grado y un 29,3% de los renales a carcinoma de célula clara Furhman II. En conjunto, los estudios de imagen detectaron recidivas en 34 pacientes. La TC fue positiva en el 83% de los pacientes, mientas la PET lo fue en el 75,6%. La coincidencia TC/PET fue del 50%. La PET detectó más enfermedad en un 41% de los casos frente a un 5% con TC. Esto supuso un cambio en la estrategia terapéutica en el 40% de los pacientes. La sensibilidad, especificidad, valor predictivo positivo y negativo para la TC y la PET fueron de 92 y 92%; 57 y 100%; 92 y 100% y 57 y 70%, respectivamente. Conclusión: En tumores urológicos, la PET presenta una sensibilidad similar a las técnicas de imagen estándar, pero con una mayor especificidad, valor predictivo positivo y valor predictivo negativo. Esto supuso un cambio en la estrategia de tratamiento en el 40% de los pacientes de nuestra serie. La PET probablemente se convierta en la prueba de referencia en los estudios de extensión y seguimiento de la mayor parte de los tumores urológicos

Introduction: New imaging studies have appeared in recent years for the diagnosis and follow-up of metastatic urological tumours. Material and methods: A total of 41 patients were reviewed with suspected recurrence of a urothelial or kidney tumour, analysing the diagnostic performance of PET-CT scans undertaken between 2013 and 2016. Results: We collected 17 urothelial tumours and 24 renal tumours, with a median follow-up of 30 months. A total of 39.3% of the urothelial tumours were high grade and 29.3% of the kidney tumours were clear cell Fuhrman II. As a whole, the imaging studies detected recurrences in 34 patients. CT was positive in 83% of the patients, while the PET scan was positive in 75.6%, CT/PET coincidence was 50%. The PET scan detected further disease in 41% of the cases compared to 5% by CT. This resulted in a change of therapeutic strategy in 40% of the patients. Sensitivity, specificity, positive predictive value and negative predictive value for the CT and the PET scans were 92% and 92%, 57% and 100%, 92% and 100%, and 57% and 70% respectively. Conclusion: The PET scan showed similar sensitivity for urological tumours to the standard imaging techniques but with higher specificity, positive predictive value and negative predictive value. This led to a change in treatment strategy for 40% of the patients in our series. The PET scan will probably become the standard test in the extension and follow-up studies of most urological tumours

Usefulness of PET/CT 18-FDG for the diagnosis and follow-up of urological, urothelial and kidney tumours. / Utilidad de la PET/TC 18-FDG en diagnóstico y seguimiento de tumores urológicos uroteliales y renales.

INTRODUCTION: New imaging studies have appeared in recent years for the diagnosis and follow-up of metastatic urological tumours. MATERIAL AND METHODS: A total of 41 patients were reviewed with suspected recurrence of a urothelial or kidney tumour, analysing the diagnostic performance of PET-CT scans undertaken between 2013 and 2016. RESULTS: We collected 17 urothelial tumours and 24 renal tumours, with a median follow-up of 30 months. A total of 39.3% of the urothelial tumours were high grade and 29.3% of the kidney tumours were clear cell Fuhrman II. As a whole, the imaging studies detected recurrences in 34 patients. CT was positive in 83% of the patients, while the PET scan was positive in 75.6%, CT/PET coincidence was 50%. The PET scan detected further disease in 41% of the cases compared to 5% by CT. This resulted in a change of therapeutic strategy in 40% of the patients. Sensitivity, specificity, positive predictive value and negative predictive value for the CT and the PET scans were 92% and 92%, 57% and 100%, 92% and 100%, and 57% and 70% respectively. CONCLUSION: The PET scan showed similar sensitivity for urological tumours to the standard imaging techniques but with higher specificity, positive predictive value and negative predictive value. This led to a change in treatment strategy for 40% of the patients in our series. The PET scan will probably become the standard test in the extension and follow-up studies of most urological tumours.

Publisher Correction: Very-high-energy particle acceleration powered by the jets of the microquasar SS 433.

In this Letter, owing to a production error, the penultimate version of the PDF was published. The HTML version was always correct. The PDF has been corrected online.

Very-high-energy particle acceleration powered by the jets of the microquasar SS 433.

SS 433 is a binary system containing a supergiant star that is overflowing its Roche lobe with matter accreting onto a compact object (either a black hole or neutron star)1-3. Two jets of ionized matter with a bulk velocity of approximately 0.26c (where c is the speed of light in vacuum) extend from the binary, perpendicular to the line of sight, and terminate inside W50, a supernova remnant that is being distorted by the jets2,4-8. SS 433 differs from other microquasars (small-scale versions of quasars that are present within our own Galaxy) in that the accretion is believed to be super-Eddington9-11, and the luminosity of the system is about 1040 ergs per second2,9,12,13. The lobes of W50 in which the jets terminate, about 40 parsecs from the central source, are expected to accelerate charged particles, and indeed radio and X-ray emission consistent with electron synchrotron emission in a magnetic field have been observed14-16. At higher energies (greater than 100 gigaelectronvolts), the particle fluxes of γ-rays from X-ray hotspots around SS 433 have been reported as flux upper limits6,17-20. In this energy regime, it has been unclear whether the emission is dominated by electrons that are interacting with photons from the cosmic microwave background through inverse-Compton scattering or by protons that are interacting with the ambient gas. Here we report teraelectronvolt γ-ray observations of the SS 433/W50 system that spatially resolve the lobes. The teraelectronvolt emission is localized to structures in the lobes, far from the centre of the system where the jets are formed. We have measured photon energies of at least 25 teraelectronvolts, and these are certainly not Doppler-boosted, because of the viewing geometry. We conclude that the emission-from radio to teraelectronvolt energies-is consistent with a single population of electrons with energies extending to at least hundreds of teraelectronvolts in a magnetic field of about 16 microgauss.

Eficacia y seguridad de distintas cepas de BCG en el tratamiento del tumor vesical en práctica clínica habitual / Safety and efficacy of various strains of bacille Calmette-Guérin in the treatment of bladder tumours in standard clinical practice

Introducción: La evolución natural del tumor vesical no músculo infiltrante (TVNMI) es la recidiva con elevado porcentaje de progresión. La BCG se ha demostrado eficaz para disminuir estos porcentajes, pero hay pocos estudios comparativos entre cepas. Material y métodos: Registro observacional, prospectivo y multicéntrico, estudiándose 433 pacientes con visita de seguimiento a 12 meses de 961 registrados y evaluado supervivencia libre de enfermedad (SLE), de progresión (SLP) cáncer-específica (SE) y efectos adversos. Se estudiaron las cepas Tice, Russian, Tokyo, Connaught y RIVM. Resultados: Los datos sociodemográficos, antecedentes de TVNMI, comorbilidades, tamaño, número, estadio, grado, CIS asociado y Re-RTU, están bien balanceados. SLE: 85 recidivas (19,6%). La mediana del tiempo de SLE fue 20 meses. Al comparar las diferentes cepas, no se detectaron diferencias estadísticamente significativas (Log-rank test, p = 0,93). SLP: 33 progresiones (7,62%). Al comparar las diferentes cepas, no se detectaron diferencias estadísticamente significativas (Log-rank test, p = 0,69). SE: fallecieron 7 pacientes (1,68%). Al comparar la SE entre las diferentes cepas, no se detectaron diferencias (Log-rank test, p = 0,93). En seguridad, el 33,3% habían presentado algún tipo de efecto adverso, mayoritariamente clínica urinaria baja no ITU < 48h, > 48h y hematuria. Según los Common Toxicity Criteria de la European Organisation for Research and Treatment of Cancer, el 92,7% eran grado 1. No se obtuvieron diferencias estadísticamente significativas relevantes entre cepas. Conclusiones: En este análisis intermedio, el riesgo de recidiva, progresión, muerte específica y seguridad es independiente de la cepa de BCG utilizada

Background: The natural progression of bladder tumours (nonmuscle-invasive bladder cancer [NMIBC]) is recurrence with a high rate of progression. Bacille Calmette-Guérin (BCG) has been shown effective in reducing these rates, but there are few comparative studies between strains. Material and methods: An observational, prospective and multicentre registry studied 433 patients with a 12-month follow-up visit from 961 registered patients, assessing disease-free survival (DFS), progression-free survival (PFS) cancer-specific survival (CSS) and adverse effects. We studied the Tice, Russian, Tokyo, Connaught and RIVM strains. Results: The sociodemographic data, NMIBC history, comorbidities, size, number, stage, grade, associated carcinoma in situ and transurethral resection were well balanced. DFS: There were 85 relapses (19.6%). The median DFS time was 20months. When comparing the various strains, we detected no statistically significant differences (log-rank test; P =.93). LPS: There were 33 cases of progression (7.62%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P = .69). CSS: Seven patients died (1.68%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P = .93). In terms of safety, 33.3% of the patients presented some type of adverse effect, mostly lower urinary symptoms (no urinary tract infections) < 48 h, > 48 h and haematuria. According to the Common Toxicity Criteria of the European Organisation for Research and Treatment of Cancer, 92.7% of the patients were grade 1. There were no statistically significant differences between the strains. Conclusions: In this intermediate analysis, the risk of recurrence, progression, specific death and safety were independent of the BCG strain employed

Safety and efficacy of various strains of bacille Calmette-Guérin in the treatment of bladder tumours in standard clinical practice. / Eficacia y seguridad de distintas cepas de BCG en el tratamiento del tumor vesical en práctica clínica habitual.

BACKGROUND: The natural progression of bladder tumours (nonmuscle-invasive bladder cancer [NMIBC]) is recurrence with a high rate of progression. Bacille Calmette-Guérin (BCG) has been shown effective in reducing these rates, but there are few comparative studies between strains. MATERIAL AND METHODS: An observational, prospective and multicentre registry studied 433 patients with a 12-month follow-up visit from 961 registered patients, assessing disease-free survival (DFS), progression-free survival (PFS) cancer-specific survival (CSS) and adverse effects. We studied the Tice, Russian, Tokyo, Connaught and RIVM strains. RESULTS: The sociodemographic data, NMIBC history, comorbidities, size, number, stage, grade, associated carcinoma in situ and transurethral resection were well balanced. DFS: There were 85 relapses (19.6%). The median DFS time was 20months. When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). LPS: There were 33 cases of progression (7.62%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.69). CSS: Seven patients died (1.68%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). In terms of safety, 33.3% of the patients presented some type of adverse effect, mostly lower urinary symptoms (no urinary tract infections) <48h, >48h and haematuria. According to the Common Toxicity Criteria of the European Organisation for Research and Treatment of Cancer, 92.7% of the patients were grade1. There were no statistically significant differences between the strains. CONCLUSIONS: In this intermediate analysis, the risk of recurrence, progression, specific death and safety were independent of the BCG strain employed.

[Intraarticular lesions associated with tibial fixation during anterior cruciate ligament reconstruction]. / Lesiones intraarticulares asociadas a la fijación tibial en la reconstrucción del ligamento cruzado anterior.

Anterior cruciate ligament reconstruction is a demanding procedure; complications may arise at any of its stages. This is the report of three cases in which the tibial fixation devices (IntraFix and Bio-IntraFix) led to intraarticular lesions. The complications were detected in one of the cases while the patient was still in the operating room and in the remaining two during the follow-up. All the patients had a stable knee, but all of them sustained chondral lesions resulting from the inadequate placement of the implants used for tibial fixation. Several suggestions to avoid the complications stemming from these devices are provided.

La reconstrucción del ligamento cruzado anterior es un procedimiento exigente; las complicaciones pueden presentarse en cualquiera de sus etapas. Presentamos tres casos en los cuales los dispositivos para la fijación tibial (IntraFix y Bio-IntraFix) condicionaron lesiones intraarticulares. Las complicaciones fueron detectadas, en uno de los casos, mientras el paciente se encontraba aún en la sala de operaciones, y en los otros dos, durante el seguimiento. Todos los pacientes contaban con una rodilla estable, pero tuvieron lesiones condrales causadas por la inadecuada colocación de los implantes para la fijación tibial. Se exponen algunas sugerencias para evitar complicaciones con estos dispositivos.