Real-world healthcare costs and resource utilization in patients with von Willebrand disease and angiodysplasia.

OBJECTIVE: To describe the economic burden among VWD patients with angiodysplasia compared to VWD patients without angiodysplasia and the general population. METHODS: This was a retrospective analysis using the Merative MarketScan Commercial and Medicare Databases® (January 2011-September 2020). Selected patients had ≥1 medical claim for VWD or low VWF, ≥1 medical claim for AGD, and ≥3 GI-related bleeding episodes within a year. HCRU and all-cause costs were compared with the VWD (only) and the general cohorts. RESULTS: The mean total all-cause costs were $150,101 among patients with VWD and angiodysplasia (n = 34), higher compared to $48,249 among matched VWD patients without angiodysplasia (n = 136) and $31,029 among matched individuals of the general population [n = 136; p-value < 0.0001]. The differences in costs between groups were primarily due to inpatient care. During the 12-month follow-up, VWD patients with symptomatic (n = 35), asymptomatic (n = 81), and suspected (n = 378) angiodysplasia had an average of 4.1, 0.6, and 3.8 gastrointestinal (GI) bleeds, respectively. Desmopressin, VWF concentrates, and aminocaproic acid were the most frequent treatments used. The most frequent procedures to treat GI-related bleeding and underlying lesions were blood transfusion and laser therapy. CONCLUSIONS: Despite recent therapeutic advances, there is room for considerable reduction of the disease burden in patients with VWD and angiodysplasia.

Experiences of Mental Distress during COVID-19: Thematic Analysis of Discussion Forum Posts for Anxiety, Depression, and Obsessive-Compulsive Disorder.

The psychological impact of the COVID-19 pandemic on coronavirus patients, health care workers, and the general population is clear. Relatively few studies have, however, considered the impact of the pandemic on those with pre-existing mental health conditions. Therefore, the present study investigates the personal experiences of those with anxiety, depression, and obsessive-compulsive disorder during COVID-19. We conducted a qualitative study utilising Reddit discussion forum posts. We conducted three separate thematic analyses from 130 posts in subreddit forums aimed for people identifying with anxiety, depression, and obsessive-compulsive disorder. We identified a number of similar discussion forum themes (e.g., COVID-19 intensifying symptoms and a lack of social support), as well as themes that were unique to each forum type (e.g., hyperawareness and positive experiences during the pandemic). Findings should guide future practice and the support provided to those living with mental distress.

Experiencia en el manejo de intoxicaciones por Betabloqueadores y Calcioantagonistas: serie de casos y revisión de la literatura / Experience in the management of intoxications by Beta-blockers and Calcium-antagonists: case series and review

La intoxicación por betabloqueantes y calcio antagonistas suele generar una gran morbilidad y mortalidad secundaria a sus efectos tóxicos cardiovasculares, como son los trastornos de la conducción cardíaca y la caída en la resistencia vascular periférica. En sobredosis, los beta bloqueantes y calcio antagonistas tienen similar presentación clínica y su tratamiento suele ser común entre ellos, en varios puntos del manejo. Estas intoxicaciones, a menudo, son refractarias al manejo médico estándar, por lo que las intervenciones a realizar deben ser ordenadas y estandarizadas con conocimiento profundo de la farmacología. Las emulsiones lipídicas no son el tratamiento de primera línea para las intoxicaciones por calcio antagoistas y betabloqueantes y se usan solamente cuando se han agotado las otras opciones terapeúticas descritas, siendo una alternativa eficaz para el manejo de este tipo de intoxicaciones. En este trabajo se pretende, con una serie de casos y revisión de la literatura, analizar la evidencia disponible en el paso a paso del abordaje y tratamiento de los pacientes intoxicados por calcio antagonistas y betabloqueantes planteando un algoritmo de manejo

The poisoning by beta blockers and calcium antagonists usually generates great morbidity and mortality secondary to its cardiovascular toxic effects such as cardiac conduction disorders and the decrease in peripheral vascular resistance. In overdose beta blockers and calcium antagonists have a similar clinical presentation and their treatment usually overcomes, these poisonings are often refractory to standard medical management so the interventions to be performed must be ordered and standardized with deep knowledge of pharmacology. Lipid emulsions are not the first-line treatment for antagonistic calcium blockers and beta blockers, they are used only when the other therapeutic options described have been exhausted but they are an effective alternative for the management of this type of poisoning. It is intended with this series of cases and review of the literature to analyze the evidence available in the step-by-step approach and treatment of calcium-poisoning patients antagonists and beta blockers posing a management algorithm

Caracterización de la expresión de galectina-3 mediante inmunohistoquímica enlesiones intraepiteliales de glándula mamaria de perras sin evidencia de tumor / Characterization of galectin-3 expression by immunohistochemistry in mammary intraepithelial lesions in bitches without evidence of tumor

RESUMEN Las lesiones intraepiteliales (LIEs) son anormalidades morfológicas locales de los ductos y los lobulillos de la glándula mamaria que incrementan el riesgo de cáncer. Los programas de detección temprana de cáncer de seno han incrementado la identificación de LIEs. En este sentido, en perras se ha propuesto las LIEs como modelo comparativo con humanos. La galectina-3 está involucrada con la progresión del cáncer en mujeres y hembras caninas pero su papel en el comportamiento biológico de las neoplasias es contradictorio según la célula de origen. El objetivo de este trabajo fue caracterizar la expresión de la galectina-3 por medio de inmunohistoquímica en 19 glándulas mamarias (GM) de seis perras sin evidencia de tumor que contenían 50 tipos de LIEs y 7 carcinomas invasivos, teniendo en cuenta el porcentaje de células positivas y la intensidad del color de la inmunoreacción. No hubo inmunomarcación para galectina-3 en las adenosis, las hiperplasias ductales usuales, la hiperplasia lobular atípica, las lesiones de células columnares, los carcinomas complejos o las hiperplasias complejas. Un papiloma/ adenoma con hiperplasia de acinos tuvo inmunomarcación multifocal en 11-50% de las células con moderada intensidad. Dos carcinomas in situ del subtipo lobular (uno de grado histológico nuclear intermedio y el otro de alto grado) tuvieron marcación en 10% de las células, pero uno tuvo intensidad baja y el otro, intensidad moderada. Los hallazgos sugieren que el papel de la galectina-3 es poco importante en la iniciación de las LIEs, pero sugieren que es una proteína de interés en la progresión de estas lesiones que posiblemente interactua en el comportamiento biológico de esta enfermedad.

ABSTRACT Intraepithelial lesions (IELs) are local morphological abnormalities of the ducts and lobules of the mammary gland that increase the risk of cancer. Programs of early detection of breast cancer have improved the identification of IELs. In canines they have been proposed as a comparative model with human IELs. Galectin-3 is involved with cancer progression in women and bitches but its role in the biological behavior of neoplasias is contradictory depending on the source cell. The aim of this study was to characterize by immunohistochemistry the expression of galectin-3 in 19 mammary glands (MG) from 6 canines without clinical signs of tumor, containing 50 types of IELs and seven invasive carcinomas, taking into account the percentage of positive cells and the intensity of color immunoreaction. There wasn't any immunostaining for galectin-3 in the adenosis, in the usual ductal hyperplasias, in the atypical lobular hyperplasia, in the columnar cell lesions, in the complex carcinomas or in the complex hyperplasias. A papilloma/adenoma with acinar hyperplasia had multifocal staining in 11-50% of the cells with moderate intensity. Two in situ lobular carcinomas (ISLC) (one of nuclear intermediate grade and the other of high nuclear grade) had 10% staining cells, but the intensity was moderate in one of them and low in the other. Findings suggest that the role of galectin-3 is unimportant in the initiation of IELs, but also that it is a protein of interest in the progression of the lesions and that it possibly acts in the biological behavior of the disease.

Trauma vascular en extremidades: enfoque diagnóstico y terapéutico en urgencias / Extremity vascular trauma: Diagnostic and therapeutic approach in emergencies / Trauma vascular em extremidades: enfoque diagnóstico e terapêutico em urgências

El trauma vascular en las extremidades es una causa importante de mortalidad y morbilidad. Por su fisiopatología se conoce que esta lesión puede tener efectos sistémicos ocasionados por el choque hemorrágico, y efectos locales debido a la isquemia tisular. El manejo se inicia desde el primer contacto con el paciente, bien sea por personal médico o de atención prehospitalaria. El escenario puede variar desde un área de conflicto armado, la vía pública hasta un hospital y la prioridad inicial será el control del sangrado. En este artículo se exponen elementos para el diagnóstico y el manejo no quirúrgico del trauma vascular incluyendo el uso temprano de torniquete, el diagnóstico clínico, la identificación y el tratamiento de pacientes con trauma vascular, lo que permitirá salvar vidas y extremidades.

Over the years, vascular injury in extremities has been an important cause of mortality and morbidity. Because of the physiopathology of these injuries, it is known that they produce systemic effects due to the hemorrhagic shock and local effects due to tissue ischemia. Treatment begins from the first contact, whether by physicians or pre-hospital attention personnel, and the setting can range anywhere from an area of armed conflict to a public area to a hospital. Regardless of these variables, the priority will always be hemorrhage control. This article exposes key elements for diagnosis and non-surgical treatment of vascular injury in extremities including early use of tourniquets, clinical diagnosis, images and damage control resuscitation. Thus, adequate identification and treatment of patients with vascular injury allows us to salvage lives and limbs.

O trauma vascular nas extremidades é uma causa importante de mortalidade e morbilidade. Por sua fisiopatologia se conhece que esta lesão pode ter efeitos sistémicos ocasionados pelo choque hemorrágico, e efeitos locais devido à isquemia tissular. O manejo se inicia desde o primeiro contato com o paciente, bem seja pelo pessoal médico ou de atenção pré-hospitalar. O cenário pode variar desde uma área de conflito armado, a via pública até um hospital e a prioridade inicial será o controle do sangrado. Neste artigo se expõe elementos para o diagnóstico e o manejo não cirúrgico do trauma vascular incluindo o uso precoce de torniquete, o diagnóstico clínico, a identificação e o tratamento de pacientes com trauma vascular, o que permitirá salvar vidas e extremidades.

Infarto agudo de miocardio manifestado como bloqueo de rama izquierda nuevo: revisión de la literatura / Acute myocardial infarction manifested as new left bundle branch block: A literature review / Infarto agudo de miocardio manifestado como bloqueio do ramo esquerdo novo: revisão da literatura

A través del tiempo se ha hablado del hallazgo de bloqueo de rama izquierda del Haz de His como un posible equivalente ST, en el paciente que se presenta a los servicios médicos con dolor torácico. Es claro que en condiciones puntuales como inestabilidad hemodinámica o choque cardiogénico se cumple dicha premisa y el paciente debe ser manejado de manera invasiva urgente, sin embargo, hay otras condiciones que ameritan trabajo de campo adicional para abordar estos pacientes.

Over time, there has been discussion regarding the finding of left bundle branch block in the bundle of His as a possible ST-segment equivalent, in patients seeking medical attention with chest pain. It is clear that, in particular conditions such as hemodynamic instability or cardiogenic shock, this premise is met and patients must undergo emergency invasive procedures. However, there are other conditions that warrant further field work to treat these patients.

A través do tempo se há falado da descoberta de bloqueio do ramo esquerdo de Feixe de His como um possível equivalente ST, no paciente que se apresenta aos serviços médicos com dor torácico. É claro que em condições pontuais como instabilidade hemodinâmica ou choque cardiogênico se cumpre dita premissa e o paciente deve ser manejado de maneira invasiva urgente, embora, há outras condições que merecem trabalho de campo adicional para abordar estes pacientes.

Prevalence of metabolic syndrome and its association with lower urinary tract symptoms and sexual function. / Prevalencia del síndrome metabólico y su asociación con síntomas del tracto urinario inferior y función sexual.

OBJECTIVES: To estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). MATERIAL AND METHODS: A retrospective study was conducted. Data from all male patients aged ≥40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors. RESULTS: A total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6-48.3). The bivariate model showed an association between MetS and LUTS (p<0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14-2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24-7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12-5.8). CONCLUSION: This study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it.

4-bromo-2, 5-dimetoxifeniletilamina (2CB) un riesgo en nuestro medio: serie de casos / The risk of 2, 5-dimethoxy-4-bromophenylethylamine (2C-B): Case series / 4-bromo-2, 5-dimetoxifeniletilamina (2CB) um risco em nosso meio: série de casos

En Medellín, la prevalencia de consumo de drogas en el último año es del 3.6% y es el grupo de edad más predominante entre los 19 y 29 años. Sin embargo, hay un subregistro relevante sobre el consumo de las nuevas drogas que son vendidas como alternativas legales a las drogas clásicas de abuso. El objetivo de este reporte es mostrar tres casos que muestran las complicaciones cardiovasculares, neurológicas y musculares asociadas con 4-bromo-2,5-dimetoxifeniletilamina (2CB), sustancia conocida en Colombia desde 2007. El consumo de 2CB está en aumento y es prioritario que los profesionales de la salud reconozcan sus riesgos.

The prevalence of drug consumption in Medellin over the last year was 3.6%, where the principal age group was between 19 and 29 years. The phenomenon of the consumption of new drugs being sold as legal alternatives to the classic drugs of abuse has been greatly underreported. The objective of this report is to show three cases with muscular, neurological, and cardiovascular complications associated with 2,5-dimethoxy-4-bromophenylethylamine (2C-B), a substance known in Colombia since 2007. The consumption of 2C-B is on the rise and must become a priority for health professionals due to the risks involved.

Em Medellín, a prevalência de consumo de drogas no último ano é de 3.6% e é o grupo de idade mais predominante entre os 19 e 29 anos. Porém, há um sub-registro relevante sobre o consumo das novas drogas que sao vendidas como alternativas legais às drogas clássicas de abuso. O objetivo deste relatório é mostrar três casos que mostram as complicações cardiovasculares, neurológicas e musculares associadas com 4-bromo-2,5-dimetoxifeniletilamina (2CB), substância conhecida na Colômbia desde 2007. O consumo de 2CB está em aumento e é prioritário que os profissionais da saúde reconheçam seus riscos.

Extended pelvic lymphadenectomy in patients with clinically localised prostate cancer: A prospective observational study. / Linfadenectomía pélvica extendida en pacientes con cáncer de próstata clínicamente localizado: estudio observacional prospectivo.

OBJECTIVE: To determine the frequency of lymph node involvement in patients with clinically localised prostate adenocarcinoma who had radical prostatectomy and extended pelvic lymphadenectomy. MATERIAL AND METHODS: A prospective observational study was conducted on 137 patients with clinically localised prostate cancer of low, intermediate or high risk according to the D'Amico classification. All participants underwent radical prostatectomy plus extended pelvic lymphadenectomy in 3 reference centres in Bogota, Colombia, between 2013 and 2014. The following variables were assessed: age, prostate specific antigen levels, Gleason score of the biopsy, probability of lymph node involvement calculated with Partin tables and the histopathology result of the surgical specimen, with the definitive Gleason pattern and the total number of resected and involved lymph nodes per tumour, according to the territory of the dissection. RESULTS: A total of 2,876 lymph nodes were extracted (an average of 20.99 lymph nodes per patient). There was lymph node involvement in 14 (10.22%) patients. The high-risk and intermediate-risk group presented lymph node metastases in 28.57% and 5.25%, respectively. There was no lymph node involvement in the low-risk group. Of the patients at risk of lymph node involvement (≥2% according to the Partin tables), 19.40% had lymph node metastases. CONCLUSION: Lymph node involvement in our population is similar to that reported in the worldwide literature. Extended pelvic lymphadenectomy increased the probability of detecting lymph node metastases in our community.

Polymorphisms of the FTO and MTHFR genes and vascular, inflammatory and metabolic marker levels in postmenopausal women.

OBJECTIVE: To determine the prevalence of three single nucleotide polymorphisms (SNPs) in postmenopausal women with and without the metabolic syndrome (METS) and to explore levels of circulating biomarkers of inflammation, vascular and metabolic dysfunction according to SNP genotypes. METHODS: DNA was extracted from the whole blood of 192 natural postmenopausal women (40 to 65 years) screened for the METS and tested for three gene SNPs related to obesity: the fat mass obesity (FTO: rs9939609) and the methylenetetrahydrofolate reductase (MTHFR: C677T and A1298C). Blood levels of angiopoietin, IL-8, sFASL, IL-6, TNF-α, sCD40L, PAI-1, u-PA, leptin, adiponectin, resistin, ghrelin, visfatin, adipsin and insulin were measured in a subgroup, with and without the METS, using multiplex technology (n = 100) and compared according to SNP genotypes. RESULTS: Genotype frequency of the three studied SNPs did not differ in relation to the presence of the METS. However, genotypes CT+TT (C677T) and AT (rs9939609) were more prevalent in women with high triglyceride levels. Pooled sub-analysis (n = 100) found that median sCD40L and visfatin levels were higher in women with genotypes AT+TT (rs9939609) as compared to AA (1178 vs. 937.0 pg/mL and 0.93 vs. 0.43 ng/mL, respectively, p < 0.05). CONCLUSION: Two SNP genotypes related to obesity were more prevalent in women with abnormal triglyceride levels and two vascular and inflammatory serum markers were higher in relation to the rs9939609 SNP.

HEPATIC LESIONS IN CATTLE GRAZING ON Brachiaria decumbens IN MESETAS, META (COLOMBIA) / LESIONES HEPÁTICAS EN BOVINOS MANTENIDOS EN PASTURAS DE Brachiaria decumbens EN MESETAS, META (COLOMBIA)

Brachiaria spp. is the predominate pasture grass for cattle grazing in the Orinoco watershed in Colombia. However, it has been recognized that this grass can cause liver damage, leading to photosensitization in ruminants; such injury is caused by the steroidal saponins found in this plant. Liver samples taken from five clinically-healthy bulls' left and right liver lobes and portal vein entrance were processed by routine histological techniques to evaluate liver lesions caused by Brachiaria decumbens in cattle grazing on Colombia's Eastern plains. The main lesions observed in these tissues were mononuclear cell cholangiohepatitis, foamy macrophages, moderate bile pigment accumulation, hepatocyte death, binucleated hepatocytes, moderate bile duct hyperplasia and multiple foci of mild fibrosis in portal areas; these were corroborated by Masson's trichrome staining. Such lesions were predominantly distributed at the portal vein entrance, frequently being located in the periportal region. This type of lesion has usually been attributed to Brachiaria decumbens consumption, and was present in clinically healthy animals exclusively feeding on this type of grass. Thus we conclude that the tissue alterations found herein were caused by Brachiaria decumbens. This research should be expanded to involve a larger selection of cattle populations, throughout a broader geographical region.

En la Orinoquía colombiana hay una considerable cantidad de ganado bovino que se alimenta predominantemente de Brachiaria spp. Sin embargo, se ha reconocido que esta pastura puede ocasionar daño hepático y posterior fotosensibilización en rumiantes, por las saponinas esteroidales que contiene. Con el propósito de evaluar las lesiones hepáticas en ganado bovino procedente de los Llanos Orientales colombianos, se tomaron y procesaron, mediante técnicas histológicas de rutina, muestras de hígado de los lóbulos derecho e izquierdo, así como de la entrada de la vena porta de cinco toros clínicamente sanos. Las principales lesiones observadas en estos tejidos fueron colangiohepatitis mononuclear, macrófagos espumosos, acumulación moderada de pigmentos biliares, muerte de hepatocitos, hepatocitos binucleados, moderada hiperplasia de ductos biliares y múltiples focos de fibrosis leve en áreas periportales, que fueron corroborados por tinción tricrómica de Masson. Estas lesiones se distribuyeron predominantemente en la entrada de la vena porta y se localizaron con frecuencia en la entrada de la región periportal. Dado que estas lesiones se atribuyen comúnmente al consumo de Brachiaria decumbens, y estaban presentes en animales clínicamente sanos exclusivamente alimentados con esta pastura, se concluye que las lesiones aquí encontradas fueron causadas por la Brachiaria decumbens. Se sugiere ampliar este estudio involucrando más bovinos, granjas y municipios.

Magneto-optical enhancement by plasmon excitations in nanoparticle/metal structures.

Coupling magnetic materials to plasmonic structures provides a pathway to dramatically increase the magneto-optical response of the resulting composite architecture. Although such optical enhancement has been demonstrated in a variety of systems, some basic aspects are scarcely known. In particular, reflectance/transmission modulations and electromagnetic field intensification, both triggered by plasmon excitations, can contribute to the magneto-optical enhancement. However, a quantitative evaluation of the impact of both factors on the magneto-optical response is lacking. To address this issue, we have measured magneto-optical Kerr spectra on corrugated gold/dielectric interfaces with magnetic (nickel and iron oxide) nanoparticles. We find that the magneto-optical activity is enhanced by up to an order of magnitude for wavelengths that are correlated to the excitation of propagating or localized surface plasmons. Our work sheds light on the fundamental principles for the observed optical response and demonstrates that the outstanding magneto-optical performance is originated by the increase of the polarization conversion efficiency, whereas the contribution of reflectance modulations is negligible.

Transplant center provision of education and culturally and linguistically competent care: a national study.

Although transplant centers are required to educate patients about kidney transplantation (KT) and living donation (LD), little is known about the educational format, and cultural and linguistic competence necessary for patients to make informed treatment decisions. This study surveyed US transplant administrators about education provided concerning KT and LD and culturally and linguistically competent care. Transplant administrators were invited to participate in an anonymous Internet-based survey about education format, education providers, promoting LD, culturally and linguistically competent care and center characteristics. Most (61%) transplant administrators contacted (N = 280/461) completed the survey. Most administrators (91%) reported that their center provides any type of formal education in their pre-KT evaluation. Education was mostly provided by: nurses (97%), social workers (72%) and surgeons (55%), and predominantly as one-on-one (80%) versus group discussions (60%). Education was primarily delivered through written materials (93%). Written educational materials in Spanish (86%) and the provision of interpreters (82%) were emphasized over educational sessions in Spanish (39%), or employing bilingual (51%) and bicultural staff (39%). Half (55%) promoted LD as the best option. Transplant centers need to take greater efforts to consistently provide appropriate education, promote LD, and provide culturally and linguistically competent care to ensure effective communication with all patients.

A kernel-based uulti-feature image representation for histopathology image classification / Una representación multi-características de imágenes basada en kernels para clasificación de imágenes de histopatología

This paper presents a novel strategy for building a high-dimensional feature space to represent histopathology image contents. Histogram features, related to colors, textures and edges, are combined together in a unique image representation space using kernel functions. This feature space is further enhanced by the application of Latent Semantic Analysis, to model hidden relationships among visual patterns. All that information is included in the new image representation space. Then, Support Vector Machine classifiers are used to assign semantic labels to images. Processing and classification algorithms operate on top of kernel functions, so that, the structure of the feature space is completely controlled using similarity measures and a dual representation. The proposed approach has shown a successful performance in a classification task using a dataset with 1,502 real histopathology images in 18 different classes. The results show that our approach for histological image classification obtains an improved average performance of 20.6% when compared to a conventional classification approach based on SVM directly applied to the original kernel.

Este trabajo presenta una estrategia nueva para la construcción de un espacio de características de gran dimensionalidad para la representación del contenido de imágenes de histopatología. Histogramas de características, relacionados con colores, texturas y bordes, son combinados para obtener una única representación de la imagen utilizando funciones de kernels. Este espacio de características es mejorado mediante la aplicación de Análisis de Semántica Latente, para modelar relaciones ocultas entre los patrones visuales. Esta información es incluida en la representación de la imagen en el nuevo espacio. Luego, un clasificador de Máquinas de Vectores de Soporte es utilizado para asignar etiquetas semánticas a las imágenes. Algoritmos de procesamiento y de clasificación son utilizados en las funciones del kernel, por lo que la estructura del espacio de características es completamente controlada mediante medidas de similitud y la representación dual. El enfoque propuesto mostró un desempeño exitoso en la tarea de clasificación con un conjunto de datos de 1.502 imágenes reales de histopatología en 18 clases diferentes. Los resultados muestran que nuestro enfoque para la clasificación de imágenes histológicas obtiene una mejora promedio en el rendimiento del 20,6% en comparación con un método de clasificación convencional, basado en la aplicación de una Máquina de Vectores de Soporte sobre la función de kernel original.

Expanded infectious diseases screening program for Hispanic transplant candidates.

Most guidelines for pre-transplant screening recommend enhanced screening among patients with potential exposure to such pathogens as Strongyloides stercoralis and Trypanosoma cruzi, the cause of Chagas disease. The incidence of these diseases in the Hispanic immigrant population has not been extensively studied. Transplant candidates who were evaluated by our program's Hispanic Transplant Program were referred for expanded infectious disease screening including Mycobacterium tuberculosis, S. stercoralis, Leishmania, and T. cruzi. Between December 2006 and December 2008, 83 patients were screened. Most were from Mexico but we also screened patients from Ecuador, Puerto Rico, and Peru. Most patients lived in urban locations before moving to the United States. Latent tuberculosis infection (LTBI) was found in 20%, and 6.7% had serologic evidence of S. stercoralis infection. These patients underwent treatment of latent infection without difficulty. To date, 14 patients have undergone living-donor kidney transplantation. Two of these patients had positive Leishmania titers and are being followed clinically, 1 was treated for S. stercoralis, and 2 were treated for LTBI pre-transplant. All have done well without evidence of screened pathogens an average of 348 days (range 65-766 days) post transplant. Expanded screening identifies endemic infections in the Hispanic immigrant population that can be treated before transplant, thereby minimizing post-transplant infectious complications.

Perception versus reality?: Virtual crossmatch--how to overcome some of the technical and logistic limitations.

The goal of this work was to evaluate concordance between (a) actual flow cytometric crossmatch (FCXM) that is performed by the OPO laboratory servicing our transplant center and (b) virtual XM (vXM) prediction based on antibody identification by solid-phase methods performed in our laboratory. A total of 1586 FCXM, performed between June 2007 and September 2008, between all potential deceased donors in our region and sera from patients awaiting kidney or kidney-pancreas transplant, listed at Northwestern Memorial Hospital were evaluated. A key finding of this analysis was the understanding that a thorough vXM cannot be performed in some donor/recipient pairs due to the lack of certain antibody profile data specific to the donor in question. Obtaining more in depth and stringent information regarding antibody specificities, we demonstrate an excellent sensitivity and specificity of the vXM assays- 86.1% and 96.8%, respectively, with a positive likelihood ratio and negative likelihood ratios of 26.9 and 0.14, respectively. The vXM can serve as an outstanding tool to predict HLA compatibility between donor and recipient, with the caveat that the presence/absence of all antibodies against the potential donor and their strength have been thoroughly investigated.

An open randomised trial of second-line endocrine therapy in advanced breast cancer. comparison of the aromatase inhibitors letrozole and anastrozole.

It was previously shown that letrozole (Femara) was significantly more potent than anastrozole (Arimidex) in inhibiting aromatase activity in vitro and in inhibiting total body aromatisation in patients with breast cancer. The objective of this study was to compare letrozole (2.5 mg per day) and anastrozole (1 mg per day) as endocrine therapy in postmenopausal women with advanced breast cancer previously treated with an anti-oestrogen. This randomised, multicentre and multinational open-label phase IIIb/IV study enrolled 713 patients. Treatment was for advanced breast cancer that had progressed either during anti-oestrogen therapy or within 12 months of completing that therapy. Patients had tumours that were either positive for oestrogen and/or progesterone receptors (48%) or of unknown receptor status (52%). The primary efficacy endpoint was time to progression (TTP). Secondary endpoints included objective response, duration of response, rate and duration of overall clinical benefit (responses and long-term stable disease), time to treatment failure, and overall survival, as well as general safety. There was no difference between the treatment arms in TTP; median times were the same for both treatments. Letrozole was significantly superior to anastrozole in the overall response rate (ORR) (19.1% versus 12.3%, P=0.013), including in predefined subgroups (receptor status-unknown, and soft-tissue- and viscera-dominant site of disease). There were no significant differences between the treatment arms in the rate of clinical benefit, median duration of response, duration of clinical benefit, time to treatment failure or overall survival. Both agents were well tolerated and there were no significant differences in safety. These results support previous data documenting the greater aromatase-inhibiting activity of letrozole and indicate that advanced breast cancer is more responsive to letrozole than to anastrozole as second-line endocrine therapy.

[Examination of the hypothesis 'the factors and mechanisms of superiority']. / Exploración de la hipótesis 'Los factores y mecanismos de la superioridad'.

INTRODUCTION. The hypothesis of Geschwind and Galaburda suggests that specific cognitive superiority arises as a result of an alteration in development of the nervous system. In this article we review the co existence of superiority and inferiority . PATIENTS AND METHODS. A study was made of six children aged between 6 and 8 years old at the Instituto de Belles Artes Antonio Maria Valencia in Cali,Columbia with an educational level between second and third grade at a primary school and of medium low socio economic status. The children were considered to have superior musical ability by music experts, which is the way in which the concept of superiority was to be tested. The concept of inferiority was tested by neuropsychological tests = 1.5 DE below normal for the same age. We estimated the perinatal neurological risk in each case. Subsequently the children s general intelligence and specific cognitive abilities were evaluated. In the first case the WISC R and MSCA were used. The neuropsychological profiles were obtained by broad evaluation using a verbal fluency test, a test using counters, Boston vocabulary test, the Wechster memory scale, sequential verbal memory test, super imposed figures test, Piaget Head battery, Rey Osterrieth complex figure and the Wisconsin card classification test. The RESULTS showed slight/moderate deficits in practical construction ability and mild defects of memory and concept abilities. In general the results supported the hypothesis tested. The mechanisms of superiority proposed in the classical hypothesis mainly involve the contralateral hemisphere: in this study the ipsilateral mechanism was more important.

Exploración de la hipótesis `Los factores y mecanismos de la superioridad' / Examination of the hypothesis `the factors and mechanisms of superiority'

Introducción. La hipótesis de Geschwind y Galaburda supone el surgimiento de `superioridad' cognitiva específica como consecuencia de trastorno del neurodesarrollo. En este artículo revisamos la coexistencia de `superioridad' e `inferioridad'. Pacientes y métodos. El estudio se realizó con seis sujetos de edades comprendidas entre los 6 y 8 años de edad del Instituto de Bellas Artes Antonio María Valencia, en Cali (Colombia), con un nivel de escolaridad entre el segundo y tercer grado de educación primaria y de nivel socioeconómico medio-bajo. Los sujetos fueron caracterizados con habilidades musicales superiores por expertos en el campo, manera en que se operacionalizó el concepto `superioridad'. El concepto `inferioridad' se operacionalizó como ejecución en pruebas neuropsicológicas = 1,5 DE por debajo de la norma para la misma edad. Se estimó el riesgo neurológico perinatal de cada sujeto. Posteriormente, los sujetos fueron evaluados en inteligencia general y habilidades cognitivas específicas. En el primer caso, se utilizaron el WISC-R y el MSCA. Los perfiles neuropsicológicos se obtuvieron mediante evaluación amplia compuesta por la prueba de fluidez verbal, la prueba de fichas, la prueba de vocabulario de Boston, la escala de memoria de Wechsler, la prueba de memoria verbal secuencial, la prueba de figuras superpuestas, la batería Piaget-Head, la figura compleja de Rey-Osterrieth y la prueba de clasificación de cartas de Wisconsin. Resultados y conclusiones. Los resultados revelaron déficit leves/moderados en habilidades practicoconstructivas y leves en habilidades mnésicas y de conceptualización. En general, los resultados soportan la hipótesis evaluada. Los mecanismos de la superioridad propuestos en la hipótesis clásica implican, principalmente, al hemisferio contralateral; en este estudio prevaleció el mecanismo ipsilateral (AU)

Effect of anaerobic pretreatment on environmental and physicochemical characteristics of duckweed based stabilization ponds.

Duckweed based stabilization ponds, an alternative for wastewater treatment, are attracting a growing interest from researchers because they are basically a low cost technology, easy to built and operate, and produce tertiary quality effluents. Besides, this technology offers the possibility of resource recovery by producing high quality duckweed protein, which can be of further use. Since the technology is rather new, there are many aspects to be studied before its full-scale implementation. It is necessary to gain sound knowledge of the basic principles of the complex processes occurring in the system, as well as of the practical aspects of design and operation. The presence of a layer of duckweed on the surface is expected to produce different environmental and physicochemical conditions in the water from those found in conventional stabilization ponds. These environmental and physicochemical conditions affect both plant growth and biological treatment processes in the system, therefore it is important to determine their behavior in a duckweed system and how they can be affected by an anaerobic pretreatment. Continuous flow pilot plants composed of seven ponds in series were operated with artificial substrate under two different conditions: with anaerobic pretreatment and without anaerobic pretreatment. The flow was kept constant during the operation. Conditions such as pH, temperature, dissolved oxygen, alkalinity, conductivity, chemical oxygen demand, biochemical oxygen demand, total and ammonium nitrogen, nitrites and nitrates, and phosphorus were evaluated in the system under steady state conditions. The main conclusions from the study include the following: pH, temperature and oxygen profiles are more stable in duckweed ponds than in conventional stabilization ponds; anaerobic pretreatment has a significant effect on the oxygen concentration in the system and on the organic matter removal but not on the nutrient removal.