Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: Value of current severity classification schemes.

BACKGROUND AND AIMS: The current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC. PATIENTS: This retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC. RESULTS: A total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings. CONCLUSIONS: US should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making.

Categorización de la diverticulitis aguda de colon izquierdo mediante ecografía y tomografía computarizada. Valor de las clasificaciones de gravedad disponibles / Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: value of current severity classification schemes

Antecedentes y objetivoEl manejo actual de la diverticulitis aguda de colon izquierdo requiere pruebas con alto valor pronóstico. Los objetivos del estudio son analizar la utilidad de la ecografía como método diagnóstico inicial y evaluar la validez de las clasificaciones actuales de gravedad de dicha enfermedad.PacientesEstudio observacional retrospectivo de pacientes con diverticulitis aguda de colon izquierdo. Se solicitó ecografía o tomografía computarizada (TC) siguiendo un algoritmo clínico. Tras los hallazgos de imagen, se clasificó la enfermedad como leve, localmente complicada y complicada. Se evaluaron la eficacia de la ecografía como herramienta diagnóstica inicial y las razones por las que se realizó una TC como técnica inicial. Se compararon los hallazgos con las clasificaciones de diverticulitis publicadas.ResultadosDe 311 pacientes con diverticulitis aguda, se seleccionaron 183 con diverticulitis aguda de colon izquierdo, que fueron clasificadas por imagen como leves (104), localmente complicadas (60) y complicadas (19). En 98 pacientes, el diagnóstico se realizó por ecografía, en 77 por TC y en 8 mediante ambas. Las principales razones de utilización inicial de TC fueron falta de experiencia del radiólogo en ecografía abdominal y falta de disponibilidad de un radiólogo de guardia. A 6 pacientes diagnosticados por ecografía se les realizó una nueva evaluación por TC, pero solo en 3 cambió la clasificación. Ninguna de las clasificaciones publicadas recoge todos los hallazgos en imagen.ConclusionesLa ecografía debería ser la primera técnica a utilizar para el diagnóstico de diverticulitis aguda de colon izquierdo. Para establecer el pronóstico de la enfermedad, son útiles diversos parámetros analíticos y hallazgos de imagen. Para una apropiada toma de decisión terapéutica se necesitarían nuevas clasificaciones de gravedad. (AU)

Background and aimsThe current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC.PatientsThis retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC.ResultsA total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings.ConclusionsUS should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making. (AU)

Cell adhesion molecules E-cadherin and CADM1 are differently expressed in canine inflammatory mammary cancer.

Human inflammatory breast cancer (IBC) and canine inflammatory mammary cancer (IMC) are the most aggressive and lethal types of mammary tumors with specific characteristics such as exacerbated angiogenesis, lymphangiogenesis and lymphangiotropism. E-cadherin expression is another specific feature of IBC not previously studied in canine IMC. In this study, the expression of E-cadherin and CADM1 (Cell Adhesion molecule 1) and their possible role as key molecules involved in the pathogenesis of IMC were immunohistochemically analyzed in 19 canine IMC and 15 grade III non-IMC cases. E-cadherin and CADM1 expression was higher in IMC cases (p = 0.002, p = 0.008, respectively). In the IMC group, E-cadherin cytoplasmic immunolabeling was more frequent (p = 0.035) and it was associated to the expression of the angiogenic and lymphangiogenic factors COX-2 (p = 0.009), VEGF-A (p = 0.031) and VEGF-D (p = 0.008). The differential mRNA expression between IMC and non-IMC was studied by microarray analysis in 6 cases. E-cadherin gene (CDH1) was not up-regulated in IMC cases at a transcriptional level; interestingly CADM1 was 7-fold upregulated. The differential expression of E-cadherin protein in IMC suggests a possible role of E-cadherin in the characteristic exacerbated angiogenesis and lymphangiogenesis and further support IMC as a natural model for the study of human IBC. Future studies in IBC and IMC including a broad panel of adhesion molecules are necessary to elucidate their role in the metastatic process and angiogenesis.

Electroactive functional microenvironments from bioactive polymers: A new strategy to address cancer.

The present work reports on a new approach based on electroactive microenvironments to mitigate skeletal muscle cancer. For that, piezoelectric films based on poly(vinylidene fluoride) have been applied to evaluate the influence of mechano- and/or electrical stimuli on rhabdomyosarcoma (RMS) proliferation. Human embryonal rhabdomyosarcoma (RD) cells were cultured on PVDF pristine films with different surface charge (non-poled, poled+ and poled-) and magnetic composites (10% and 20% Fe3O4, and 20% CFO filler content) to allow magneto-mechanical and magnetoelectrical stimulation films. Electrospun PVDF pristine (oriented and randomly) and magnetic (10% Fe3O4) fiber mats were also evaluated to take into consideration the morphology effect on cell response. It was found that the mechanical stimuli enhance RMS proliferation whereas the mechano-electrical decreases it. It was also verified that the RD cells proliferate better on randomly oriented fibers, whereas myoblast cells do it better in oriented ones. The obtained results confirm that electroactive microenvironments can be used to develop novel and effective approaches to deal with RMS cancer, that can be extrapolated to others cancer types.

Ionic liquid-based electroactive materials: a novel approach for cardiac tissue engineering strategies.

Cardiac tissue regeneration strategies are increasingly taking advantage of electroactive scaffolds to actively recreate the tissue microenvironment. In this context, this work reports on advanced materials based on two different ionic liquids (ILs), 2-hydroxyethyl-trimethylammonium dihydrogen phosphate ([Ch][DHP]) and choline bis(trifluoromethylsulfonyl)imide ([Ch][TFSI]), combined with poly(vinylidene fluoride-co-trifluoroethylene) (P(VDF-TrFE)) for the development of ionic electroactive IL/polymer hybrid materials for cardiac tissue engineering (TE). The morphological, physico-chemical, thermal and electrical properties of the hybrid materials, as well as their potential use as scaffolds for cardiac TE applications, were evaluated. Besides inducing changes in surface topography, roughness and wettability of the composites, the incorporation of [Ch][DHP] and [Ch][TFSI] leads to the increase in surface (σsurface) and volume (σvolume) electrical conductivities. Furthermore, washing the hybrid samples with phosphate-buffered saline solution strongly decreases the σsurface, whereas σsurface and σvolume of the composites remain almost unaltered after exposure to ultraviolet sterilization treatment. Additionally, it is verified that the incorporation of IL influences the P(VDF-TrFE) microstructure and crystallization process, acting as a defect during its crystallization. Cytotoxicity assays revealed that hybrid films based on [Ch][DHP] alone are not cytotoxic. These films also support H9c2 myoblast cell adhesion and proliferation, demonstrating their suitability for cardiac TE strategies based on electroactive microenvironments.

Strain and temperature measurement discrimination with forward Brillouin scattering in optical fibers.

A novel method that enables simultaneous and discriminative measurement of strain and temperature using one single optical fiber is presented. The method is based on the properties of transverse acoustic mode resonances (TAMRs) of the optical fiber. In particular, it is based on the different sensitivity to temperature and strain that exhibit the radial modes R0,m and a family of torsional-radial modes denoted as T R2,m(1). We show that the resonance frequencies of both types of resonances shift linearly with temperature and strain, but at different rates. By the combined use of the different sensitivities of the two families of TAMRs, we experimentally demonstrate discriminative measurements of strain and temperature. A detection limit of strain and temperature better than 25 µÎµ and 0.2 °C is achieved.

Initial risk perception and feeling of preparedness of primary care physicians regarding the COVID-19 pandemic in Belgium, France and Spain in February 2020.

BACKGROUND: The knowledge of risk perceptions in primary care could help health authorities to manage epidemics. METHODS: A European multi-center cross-sectional study was conducted in France, Belgium and Spain to describe the perceptions, the level of anxiety and the feeling of preparedness of primary healthcare physicians towards the COVID-19 infection at the beginning of the pandemic. The factors associated with the feeling of preparedness were studied using multivariate logistic regressions. RESULTS: A total of 511 physicians participated to the study (response rate: 35.2%). Among them, only 16.3% (n=82) were highly anxious about the pandemic, 50.6% (n=254) had the feeling to have a high level of information, 80.5% (n=409) found the measures taken by the health authorities suitable to limit the spread of COVID-19, and 45.2% (n=229) felt prepared to face the epidemic. Factors associated with feeling prepared were: being a Spanish practitioner (adjusted OR=4.34; 95%CI [2.47; 7.80]), being a man (aOR=2.57, 95%CI [1.69; 3.96]), finding the measures taken by authorities appropriate (aOR=1.72, 95%CI [1.01; 3.00]) and being highly informed (aOR=4.82, 95%CI [2.62; 9.19]). CONCLUSIONS: Regarding the dramatic evolution of the pandemic in Europe in the weeks following the study, it appears that information available at this time and transmitted to the physicians could have given a wrong assessment of the spread and the severity of the disease. It seems essential to better integrate the primary care physicians into the information, training and protection channels. A comparison between countries could help to select the most effective measures in terms of information and communication.

High accuracy measurement of Poisson's ratio of optical fibers and its temperature dependence using forward-stimulated Brillouin scattering.

Transverse acoustic mode resonances enable a high accuracy determination of Poisson's ratio and elastic properties of optical fibers. An all-optical pump and probe technique is used for efficient excitation and accurate characterization of both, radial and torsional-radial acoustic resonances of optical fibers. Simple and precise algebraic expressions for the frequencies of high order acoustic resonances are derived, enabling a rigorous analysis of the experimental data using standard least squares fitting. Following this approach, the determination of Poisson's ratio does not require the measurement of any physical length, but only frequency measurements are required. An accuracy better than 1 ‰ is achieved. The dependence of the fiber Poisson's ratio with temperature is also determined experimentally.

Factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism.

OBJECTIVE: The objective was to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism (PHPT). METHODS: A retrospective observational study was designed in 195 patients (mean age: 59.2 ±â€¯13.0 years; 77% woman) with PHPT (calcium: 11,3 ±â€¯1,1 mg/dl and PTH: 218 ±â€¯295 pg/ml) studied in endocrinology setting between 2013 and 2020. An univariate and multivariate analysis was made to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning. RESULT: 50 patients (26%) with negative 99mTc-MIBI scanning had lower PTH levels (146 ±â€¯98 vs. 244 ±â€¯334; p < 0,001), adenomas with smaller sonographic dimensions (maximum diameter: 1,2 ±â€¯0,4 vs. 1,7 ±â€¯0,9 cm; p = 0,001 and volume: 0,36 ±â€¯0,43 vs. 1,7 ±â€¯4,1 cm3; p < 0,001), localized more frequently in upper parathyroid glands (37% vs 14%; p = 0,005) and associated more frequently to thyroid nodules (72% vs 57%; p = 0,045) than patients with positive scanning. 116 patients were operated and parathyroid adenomas were smaller (maximum diameter: 1,3 ±â€¯0,5 vs. 1,9 ±â€¯1,1 cm; p = 0,008 and volume: 0,30 ±â€¯0,20 vs. 1,2 ±â€¯1,1 cm3; p < 0,001), less heavy (567 ±â€¯282 vs. 1470 ±â€¯1374 mgr.; p = 0,030) and were localized more frequently in upper situation (65% vs 16%; p < 0,001) than patients with positive scanning. In the multivariate analysis an independent association between negative 99mTc-MIBI scanning and size of removed adenoma ≤1 cm (OR: 5,77; IC 95: 1,46-22,71) and upper adenoma localization were observed (OR: 8,05; IC 95%: 2,22-29,16). CONCLUSIONS: One in four patients studied for PHPT had a negative 99mTc-MIBI scanning and were independent associated with size of adenoma ≤1 cm and upper adenoma localization.

Measurement of phase and group refractive indices and dispersion of thermo-optic and strain-optic coeffients of optical fibers using weak fiber Bragg gratings.

In this work we report on the measurement, with record accuracy, of the absolute modal effective refraction index (phase index) of single-mode optical fibers by using Bragg gratings. We also demonstrate a new method to measure the group index of the fibers from the grating's Bragg wavelength. We present as well the characterization of the thermo-optic and strain-optic coefficients as a function of the wavelength; the values we have obtained are the closest to those of pristine fiber measured with gratings technology so far. The phase index is measured with a set of gratings in the wavelength ranges from 1509 to 1563 nm, and the group index is obtained from the wavelength dependence of the phase index. Very weak gratings with reflectivity down to 10-3 have been used in order to minimize the perturbation of the pristine fiber. Results are presented at a temperature of 22°C and zero strain after preliminary calibration of the thermo-optic and strain-optic coefficients as a function of the wavelength. Accuracies better than 3×10-5 and 7×10-4 have been achieved for the phase and group indices, respectively. It is also shown that the main source of error relates to the uncertainty in pitch of the phase masks used for grating inscription. The technique is useful for testing different kinds of fibers including telecommunication, amplifying, and polarization maintaining.

Efficient interrogation method of forward Brillouin scattering in optical fibers using a narrow bandwidth long-period grating.

A new technique, to the best of our knowledge, for the characterization of the effective refractive index modulation in optical fibers due to transverse acoustic mode resonances excited by electrostriction is reported. The resonances excited by an optical pulse are probed by a narrow bandwidth long-period grating (LPG) inscribed in the fiber, which is interrogated by a continuous wave (CW) beam. The LPG used in this experiment has a narrow bandwidth and high sensitivity to small mode index perturbations, allowing the measurement of index variations from below 10-9 to 10-6. Radial and torsional-radial acoustic modes were characterized up to 1.1 GHz. The linewidth of resonances was found to be much shorter than in previous reports in which long fiber lengths are typically required, obtaining Q factors as high as 5000.

Broadband tuning of polarization modulation instability in microstructured optical fibers.

The wideband tuning of strong bands generated through polarization modulation instability (PMI) in microstructured optical fibers (MOFs) is reported. Tunability is achieved by exploiting the dependence of the phase-matching condition on the fiber's chromatic dispersion and birefringence, which is particularly sensitive when the fiber is pumped near the zero-dispersion wavelength. MOFs designed to accomplish PMI phase-matching when they are infiltrated with ethanol and pumped at 1064 nm were designed and fabricated. Taking advantage of the large thermo-optic coefficient of ethanol, both chromatic dispersion and birefringence were varied through temperature. Wavelength shifts from 937 nm to 863 nm (anti-Stokes) and from 1231 nm to 1387 nm (Stokes) are demonstrated. Such a tuning range corresponds to a frequency shift between the pump and a PMI sideband ranging from 1274cm-1 to 2189cm-1.

Host immune genetic variations influence the risk of developing acute myeloid leukaemia: results from the NuCLEAR consortium.

The purpose of this study was to conduct a two-stage case control association study including 654 acute myeloid leukaemia (AML) patients and 3477 controls ascertained through the NuCLEAR consortium to evaluate the effect of 27 immune-related single nucleotide polymorphisms (SNPs) on AML risk. In a pooled analysis of cohort studies, we found that carriers of the IL13rs1295686A/A genotype had an increased risk of AML (PCorr = 0.0144) whereas carriers of the VEGFArs25648T allele had a decreased risk of developing the disease (PCorr = 0.00086). In addition, we found an association of the IL8rs2227307 SNP with a decreased risk of developing AML that remained marginally significant after multiple testing (PCorr = 0.072). Functional experiments suggested that the effect of the IL13rs1295686 SNP on AML risk might be explained by its role in regulating IL1Ra secretion that modulates AML blast proliferation. Likewise, the protective effect of the IL8rs2227307 SNP might be mediated by TLR2-mediated immune responses that affect AML blast viability, proliferation and chemorresistance. Despite the potential interest of these results, additional functional studies are still warranted to unravel the mechanisms by which these variants modulate the risk of AML. These findings suggested that IL13, VEGFA and IL8 SNPs play a role in modulating AML risk.

The use of microindentation for the study of bone properties in type 1 diabetes mellitus patients.

Diabetes mellitus is associated with a higher risk of fracture. In this study, we analysed the bone quality of premenopausal women with type 1 diabetes mellitus by microindentation. No differences in bone quality were identified between patients and healthy controls, suggesting that intensive insulin therapy can preserve bone health. PURPOSE: To compare the bone quality of women with type 1 diabetes mellitus (T1DM) and healthy controls, and to determine the relationship with bone mineral density (BMD). METHODS: This was a cross-sectional study of 45 premenopausal women with T1DM and 21 healthy controls, matched according to age and BMI. Clinical parameters, BMD and bone tissue mechanical properties (assessed using the bone material strength index [BMSi]) were evaluated in each group using microindentation. In T1DM patients, glycosylated haemoglobin (HbA1c), the number of hypoglycaemic events and the status of chronic complications were also analysed. RESULTS: No differences in BMSi or BMD between T1DM patients and healthy controls were identified. In the T1DM patients, the mean HbA1c was 7.52% ± 1.00% and the mean time elapsed since diagnosis was 22.6 ± 12.2 years. Eight patients (17.7%) met the criteria for metabolic syndrome (MetS), and microvascular complications were present in 12 patients (26.7%). Neither the number of features of MetS present nor the presence of microangiopathy was found to be associated with BMSi. CONCLUSIONS: T1DM premenopausal patients showed bone tissue properties comparable to those shown by controls. Further larger-scale studies should be conducted to confirm these results.

Validación del índice SCORE y el SCORE para personas mayores en la cohorte de riesgo de enfermedad cardiovascular en Castilla y León / Validation of the SCORE index and SCORE for old people in the Castilla y Léon cardiovascular disease risk cohort

Introducción y objetivos: El Systematic Coronary Risk Evaluation (SCORE) es el índice más extendido en Europa para la valoración del riesgo cardiovascular global. El presente trabajo tiene como objetivo validar el riesgo calculado en 2004 con la mortalidad cardiovascular observada en 10 años de seguimiento de una cohorte de población de 40 a 75 años. Métodos: En 2004 se calculó el SCORE y el SCORE OP para personas mayores en la población de 40 a 64 y de 65 a 74 años, respectivamente. En 2014 se estimó la mortalidad a 10 años con el modelo de supervivencia y el estimador de Kaplan-Meier. Se calcularon la sensibilidad, la especificidad, los valores predictivos, el riesgo relativo con valores SCORE≥5% y el área bajo la curva (estadístico C). Resultados: La mortalidad cardiovascular estimada por el SCORE fue 3 veces superior a la observada. La sensibilidad de un SCORE≥5% fue del 20% en mujeres y del 28,6% por debajo de los 65 años. Los valores predictivos positivos fueron también bajos, sobre todo en las mujeres, con un escaso 0,6%. El estadístico C no fue significativo ni para las mujeres ni para los menores de 65 años. Conclusiones: El índice de riesgo de mortalidad SCORE no refleja adecuadamente al patrón epidemiológico de las enfermedades cardiovasculares en Castilla y León. Se hace necesaria una revisión periódica de los modelos de predicción de enfermedad y de mortalidad para adaptar y corregir los protocolos de prevención y tratamiento. El SCORE OP presenta mejores parámetros de validez que el SCORE tradicional

Introduction and objectives: The Systematic Coronary Risk Evaluation (SCORE) is the most extended index in Europe for overall cardiovascular risk assessment. This study aims to validate the calculated risk with the observed 10-year cardiovascular mortality in a population cohort aged 40 to 75 years. Methods: In 2014 the SCORE and the SCORE OP (for older people) were calculated in a population aged 40 to 64 years-old and 65 to 75 years-old, respectively. In 2014 the 10-year mortality was estimated with the Kaplan-Meier estimator and survival model. Sensitivity, specificity, predictive values, risk ratio of a SCORE value≥5%, and the area under the curve (C statistic) were calculated. Results: Cardiovascular mortality estimated by SCORE was 3 times higher than the observed mortality. The sensitivity of a SCORE≥5% was 20% in women and 28.6% in those less than 65 years old. Predictive positive values were also low, particularly in women with 0.6%. Neither women nor those aged less than 65 years had a significant C statistic. Conclusions: The SCORE index does not suitably reflect the cardiovascular mortality pattern in Castilla y León. The prediction models for morbidity and mortality need to be periodically updated in order to adjust the prevention and treatment protocols. The SCORE OP has better validity parameters than the SCORE calculated below that age