Intratubular penetration capacity of HiFlow bioceramic sealer used with warm obturation techniques and single cone: A confocal laser scanning microscopic study.

Objective: The aim of this paper was to evaluate the intratubular penetration area of a bioceramic sealer, using continuous wave (CW), vertical condensation (VC) with two different types of gutta-percha (conventional (NG) and bioceramic-coated (BG)) and single cone (SC) technique with BG gutta-percha, in different root thirds. Methods: A total of 150 mature single-root human teeth (including incisors, canines and premolars) were prepared and randomly divided into five groups (n = 30). Teeth were filled using a bioceramic sealer (TotalFill BC Sealer HiFlow ®) and two different types of gutta-percha, with CW and VC techniques, the teeth in the control group were filled with SC technique and BG gutta-percha. The teeth were sectioned and evaluated as one-third portions in each case under a confocal laser microscope. The penetration area measurements were carried out with the Autocad ® programme. Data was analyzed using the one-factor ANOVA test (p < 0.05) and Post Hoc Test (p < 0.05). Results: The ANOVA Test showed significant differences in the penetration areas of the five obturation techniques (P < 0.05). The Post Hoc Test exhibited significant differences in multiple comparisons (P < 0.05). There was more dentinal tubule penetration in the coronal third than in the apical third in all techniques. Conclusions: The intratubular penetration of the bioceramic sealer was influenced by the obturation techniques tested, but not by the different gutta-percha tested. There was more penetration of sealer in the warm obturation techniques than the SC, regardless of the type of gutta-percha used.

Intratubular penetration ability in the canal perimeter using HiFlow bioceramic sealer with warm obturation techniques and single cone.

Background: The aim of this paper was to evaluate the intratubular penetration percentage in the perimeter of the canals of the calcium silicate-based sealer HiFlow, using three warm obturation techniques, continuous wave (CW) and vertical condensation (VC) with two different types of gutta-percha (conventional (NG) and bioceramic-coated (BG), GuttaCore (GC) and single cone (SC) with BG in different root thirds. Material and Methods: 180 human teeth with a single root were selected including incisors, canines and premolars were prepared and randomly divided into six groups (n=30). Teeth were filled using a bioceramic sealer TotalFill BC Sealer HiFlow (HiFlow) and two different types of gutta-percha, with CW, VC and GC techniques, the teeth in the control group were filled with SC technique and BG gutta-percha. The teeth were sectioned and evaluated as one-third portions in each case under a confocal laser microscope. The penetration ability in the canal's perimeter was carried out with the Autocad® programme. Data was analyzed using Levene's test (p<0,05), ANOVA test (p<0,05), Welch's comparison test (p<0,05), Games-Howell multiple comparison test (p<0,05), Bonferroni test (p<0,05). Results: The percentages relative to penetration was higher in the warm obturation techniques than the SC in all thirds evaluated. Games-Howell test (p<0,05) showed up significant differences in multiple comparisons. There was greater penetration in the perimeter of the canals in the coronal third than in the apical third in all of the techniques. Conclusions: The warm obturation techniques (CW, VC and GC) generated a greater intratubular penetration percentage in the canal perimeter of the sealer than the single cone in all thirds. Key words:HiFlow, calcium silicate-based sealer, confocal laser microscope, dentinal tubules.

Mapping the Cerebellar Cognitive Affective Syndrome in Patients with Chronic Cerebellar Strokes.

The cerebellar cognitive affective syndrome (CCAS) has been consistently described in patients with acute/subacute cerebellar injuries. However, studies with chronic patients have had controversial findings that have not been explored with new cerebellar-target tests, such as the CCAS scale (CCAS-S). The objective of this research is to prove and contrast the usefulness of the CCAS-S and the Montreal Cognitive Assessment (MoCA) test to evaluate cognitive/affective impairments in patients with chronic acquired cerebellar lesions, and to map the cerebellar areas whose lesions correlated with dysfunctions in these tests. CCAS-S and MoCA were administrated to 22 patients with isolated chronic cerebellar strokes and a matched comparison group. The neural bases underpinning both tests were explored with multivariate lesion-symptom mapping (LSM) methods. MoCA and CCAS-S had an adequate test performance with efficient discrimination between patients and healthy volunteers. However, only impairments determined by the CCAS-S resulted in significant regional localization within the cerebellum. Specifically, patients with chronic cerebellar lesions in right-lateralized posterolateral regions manifested cognitive impairments inherent to CCAS. These findings concurred with the anterior-sensorimotor/posterior-cognitive dichotomy in the human cerebellum and revealed clinically intra- and cross-lobular significant regions (portions of right lobule VI, VII, Crus I-II) for verbal tasks that overlap with the "language" functional boundaries in the cerebellum. Our findings prove the usefulness of MoCA and CCAS-S to reveal cognitive impairments in patients with chronic acquired cerebellar lesions. This study extends the understanding of long-term CCAS and introduces multivariate LSM methods to identify clinically intra- and cross-lobular significant regions underpinning chronic CCAS.

Contacto y emociones en la enseñanza de deportes sociomotores de colaboración-oposición a futuros docentes de educación física / Contacto e emoções no ensino de desportos sóciomotores de colaboração-oposição a futuros docentesde educaçãofísica / Contact and emotions in teaching sociomotor sports of collaborationopposition to future physical education teachers

Partiendo de la conceptualización de los problemas afectivos derivados del contacto (PADC) estudiamos su influencia en el aprendizaje de Rugby, Balonmano y Voleibol. El trabajo, desarrollado en el contexto universitario (n=16), se aborda dentro del paradigma cualitativo, mediante el análisis de contenido y con el apoyo de estrategias cuantitativas, siguiendo los Métodos Mixtos. El estudio prospectivo de los datos permitió describir la realidad a estudiar y el refinamiento de la metodología, centrada en el método de análisis de diarios con entrevista sobre los diarios, con el apoyo de herramientas informáticas de análisis cualitativo (Nvivo). Los resultados muestran la existencia de PADC y su influencia negativa en el aprendizaje de tareas motrices de los deportes estudiados. Las emociones que suscitan la aparición de estos problemas están fundamentalmente relacionadas con el miedo, aunque también con la ansiedad y/o la vergüenza. Además, se describen cuáles son los tipos de contactos que generan esos problemas. Igualmente, se concretan 29 factores que podrían ser valorados para disminuir la aparición de los PADC en procesos de enseñanza-aprendizaje de tareas motrices que impliquen contacto. La importancia de cada uno de estos factores varía en función del tipo de contacto que requiera la tarea motriz. (AU)

From the conceptualization of emotional problems related to contact (EPRC), we study its influence in the learning of Rugby, Handball and Volleyball. This research, developed at the university sphere (n=16), is framed within qualitative framework through the analysis of content assisted with quantitative strategies (Mixed Methods). The prospective study of the data allowed the description of the reality in study and the refinement in methodology. So, the method focused on the analysis of diaries with interviews about them with the support of computer tools of qualitative analysis (NVivo). The results show the existence of EPRC and its negative influence in the learning of motor tasks of the aforementioned sports. The emotions that facilitate the appearance of these problems are fundamentally related to fear, but also to anxiety or shame. In addition, the types of contacts that generate these problems are described. Furthermore, there were specified 29 factors that could be considerated to decrease the appearance of EPRCs in contact motor tasks teaching-learning processes. The importance of each of these factors varies depending on the type of contact that the motor task requires. (AU)

Partindo da conceituação de problemas afetivos derivados do contacto (PADC), estudamos sua influência na aprendizagem de Rugby, Handebol e Voleibol. O trabalho, desenvolvido no contexto universitário (n=16), é abordado dentro do paradigma qualitativo, através do método de análise de conteúdo e com o apoio de estratégias quantitativas, seguindo os Métodos Mistos. O estudo prospetivo dos dados permitiu descrever a realidadea ser estudada e o aprimoramento da metodologia, centrada no método de análise de diários com entrevista sobre os diários, com o apoio duma ferramenta computacional de análise qualitativa (Nvivo). Os resultados mostram a existência do PADC e sua influência negativa naaprendizagem de tarefas motoras dos desportos observados. As emoções produtoras desses problemas estão fundamentalmente relacionadas ao medo, mas também à ansiedade ou vergonha. Além disso, são descritos os tipos de contactos que geram esses problemas. Da mesma forma, foram especificados 29 fatores que poderiam ser avaliados para diminuir a aparência dos PADCs nos processos de ensino-aprendizagem de tarefas motoras que envolvem contacto. A importância de cada um desses fatores varia de acordo com o tipo de contacto que a tarefa motora exige. (AU)

High PD-1/PD-L1 Checkpoint Interaction Infers Tumor Selection and Therapeutic Sensitivity to Anti-PD-1/PD-L1 Treatment.

Many cancers are termed immunoevasive due to expression of immunomodulatory ligands. Programmed death ligand-1 (PD-L1) and cluster of differentiation 80/86 (CD80/86) interact with their receptors, programmed death receptor-1 (PD-1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4), respectively, on tumor-infiltrating leukocytes eliciting immunosuppression. Immunotherapies aimed at blocking these interactions are revolutionizing cancer treatments, albeit in an inadequately described patient subset. To address the issue of patient stratification for immune checkpoint intervention, we quantitatively imaged PD-1/PD-L1 interactions in tumor samples from patients, employing an assay that readily detects these intercellular protein-protein interactions in the less than or equal to 10 nm range. These analyses across multiple patient cohorts demonstrated the intercancer, interpatient, and intratumoral heterogeneity of interacting immune checkpoints. The PD-1/PD-L1 interaction was not correlated with clinical PD-L1 expression scores in malignant melanoma. Crucially, among anti-PD-1-treated patients with metastatic non-small cell lung cancer, those with lower PD-1/PD-L1 interaction had significantly worsened survival. It is surmised that within tumors selecting for an elevated level of PD-1/PD-L1 interaction, there is a greater dependence on this pathway for immune evasion and hence, they exhibit more impressive patient response to intervention. SIGNIFICANCE: Quantitation of immune checkpoint interaction by direct imaging demonstrates that immunotherapy-treated patients with metastatic NSCLC with a low extent of PD-1/PD-L1 interaction show significantly worse outcome.

The Urinary Transcriptome as a Source of Biomarkers for Prostate Cancer.

Prostate cancer (PCa) is the second most common cancer of men and is typically slow-growing and asymptomatic. The use of blood PSA as a screening method has greatly improved PCa diagnosis, but high levels of false positives has raised much interest in alternative biomarkers. We used next-generation sequencing (NGS) to elucidate the urinary transcriptome of whole urine collected from high-stage and low-stage PCa patients as well as from patients with the confounding diagnosis of benign hyperplasia (BPH). We identified and validated five differentially expressed protein-coding genes (FTH1 BRPF1, OSBP, PHC3, and UACA) in an independent validation cohort of small-volume (1 mL) centrifuged urine (n = 94) and non-centrifuged urine (n = 84) by droplet digital (dd)PCR. These biomarkers were able to discriminate between BPH and PCa patients and healthy controls using either centrifuged or non-centrifuged whole urine samples, suggesting that the urinary transcriptome is a valuable source of non-invasive biomarkers for PCa that warrants further investigation.

Pre-implantation kidney biopsy: value of the expertise in determining histological score and comparison with the whole organ on a series of discarded kidneys.

BACKGROUND: Evidence about the reliability of pre-implantation biopsy is still conflicting, depending on both biopsy type and pathologist's expertise. Aim of the study is to evaluate the agreement of general v specialist pathologists and to compare scores on biopsy and whole organs in a set of discarded kidneys. METHODS: 46 discarded kidneys were identified with their corresponding biopsies. The biopsies were reviewed by three general and two specialist pathologists, blinded to the original report, according to Remuzzi score. The intraclass correlation coefficient (ICC) was calculated for both groups. Discarded kidneys were scored according to Remuzzi score by a single specialist pathologist. Biopsies and organs were compared by Wilcoxon signed rank test. Weighted κ coefficients between biopsy and organ scores were also calculated. RESULTS: Specialist pathologists achieved higher values of ICC, reaching excellent or good agreement in most of the parameters, while general pathologists values were mainly fair or good. On whole organs, scores were consistently lower than biopsies, with a significant difference in most of the parameters. Weighted κ coefficient was slight or fair for most of the parameters. CONCLUSIONS: Our data suggests that the creation of a pool of specialist pathologists would improve organ utilization. Moreover, biopsies are not representative of the whole organ. As the Remuzzi score on biopsy is a major reasons for discard, a quota of transplantable kidneys may be erroneously discarded. Refinement in Remuzzi cut-offs based on expert reporting and recognition of sampling error of biopsies in correlation with clinical outcome data should be undertaken.

Retos e implicaciones clínicas de la heterogeneidad intratumoral / Clinical challenges and implications of intratumor heterogeneity

Las neoplasias muestran un elevado, aunque variable, grado de heterogeneidad intratumoral (HIT) desde el punto de vista clínico y morfológico. Además, las técnicas de análisis molecular masivo están mostrando en los últimos tiempos hasta qué punto los tumores pueden ser heterogéneos también desde el punto de vista molecular. Este hecho tiene una importancia capital para los pacientes, ya que incide de forma decisiva en el éxito de las llamadas terapias de precisión y justifica una parte muy importante de los fracasos terapéuticos de la oncología moderna. Esta revisión pretende ser una puesta al día de los últimos hallazgos en este campo en un grupo de neoplasias con alto impacto social con las que los patólogos nos enfrentamos muy frecuentemente

Tumors display a high, albeit variable, grade of intratumor heterogeneity, both from a clinical and a morphological viewpoint. Furthermore, recent methods of large-scale molecular analysis demonstrate to what extent tumors can also be heterogeneous from a molecular perspective. This is of paramount importance for patients as it has a great impact on the success of so-called precision therapies and explains the reason for a significant number of therapeutic failures in modern oncology. We present an up-to-date review of the latest findings in a group of tumors with a high social impact, commonly seen in the daily routine of the pathology laboratory

Types of Cerebral Herniation and Their Imaging Features.

Cerebral herniation, defined as a shift of cerebral tissue from its normal location into an adjacent space, is a life-threatening condition that requires prompt diagnosis. The imaging spectrum can range from subtle changes to clear displacement of brain structures. For radiologists, it is fundamental to be familiar with the different imaging findings of the various subtypes of brain herniation. Brain herniation syndromes are commonly classified on the basis of their location as intracranial and extracranial hernias. Intracranial hernias can be further divided into three types: (a) subfalcine hernia; (b) transtentorial hernia, which can be ascending or descending (lateral and central); and (c) tonsillar hernia. Brain herniation may produce brain damage, compress cranial nerves and vessels causing hemorrhage or ischemia, or obstruct the normal circulation of cerebrospinal fluid, producing hydrocephalus. Owing to its location, each type of hernia may be associated with a specific neurologic syndrome. Knowledge of the clinical manifestations ensures a focused imaging analysis. To make an accurate diagnosis, the authors suggest a six-key-point approach: comprehensive analysis of a detailed history of the patient and results of clinical examination, knowledge of anatomic landmarks, direction of mass effect, recognition of displaced structures, presence of indirect radiologic findings, and possible complications. CT and MRI are the imaging modalities of choice used for establishing a correct diagnosis and guiding therapeutic decisions. They also have important prognostic implications. The preferred imaging modality is CT: the acquisition time is shorter and it is less expensive and more widely available. Patients with brain herniation are generally in critical clinical condition. Making a prompt diagnosis is fundamental for the patient's safety.©RSNA, 2019.

[Clinical challenges and implications of intratumor heterogeneity]. / Retos e implicaciones clínicas de la heterogeneidad intratumoral.

Tumors display a high, albeit variable, grade of intratumor heterogeneity, both from a clinical and a morphological viewpoint. Furthermore, recent methods of large-scale molecular analysis demonstrate to what extent tumors can also be heterogeneous from a molecular perspective. This is of paramount importance for patients as it has a great impact on the success of so-called precision therapies and explains the reason for a significant number of therapeutic failures in modern oncology. We present an up-to-date review of the latest findings in a group of tumors with a high social impact, commonly seen in the daily routine of the pathology laboratory.

Solitary fibrous tumor of the kidney: a report of two cases / Tumor fibroso solitário do rim: relato de dois casos

ABSTRACT Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm, composed of monotonous spindle cells, intermingled with collagen fibers. Kidney location is sporadic, with few reports in literature. We present two cases of 40- and 48-year-old males, one with incidental detection of a peripheral mass; another with hilar lesion perceived following investigation of hematuria. Both revealed a spindle-cell proliferation, without mitosis and necrosis. Immunohistochemical studies: positivity for CD34, CD99 and B-cell lymphoma 2 (Bcl-2). No sign of disease were evident nine and five months after surgery, respectively. SFT is mostly benign, but can show malignant behavior. Morphologic and immunohistochemical characteristics are essential for diagnosis.

RESUMEN Tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente de células fusiformes monótonas, separadas por bandas de colágeno. Localización renal es poco habitual, con escasos casos descriptos. Reportamos dos casos de pacientes masculinos, de 40 e 48 anos, el uno con detección incidental de masaperiférica; el otro con lesión hiliar descubierta en la investigación de hematuria. Los dos revelaronproliferación fusocelular sin necrosis ni mitosis. Inmunohistoquímica: positividad para CD34, CD99 y linfoma de células B2 (Bcl-2). No hay evidencia de recidiva a los nueve y cinco meses de la cirugía, respectivamente. TFS es, por lo general, benigno, pero puede revelar comportamiento agresivo. Características morfológicas y inmunohistoquímicas son esencialespara el diagnóstico.

RESUMO Tumor fibroso solitário (TFS) é uma neoplasia mesenquimatosa rara composta por células fusiformes monótonas, intercaladas por fibras de colágeno. Localização renal é incomum, com escassos casos descritos. Relatamos dois casos do gênero masculino, com 40 e 48 anos, um com detecção incidental de massa periférica; outro com lesão hilar descoberta na sequência de investigação por hematúria. Ambos revelaram proliferação fusocelular sem mitoses nem necrose. Imuno-histoquímica: positividade para CD34, CD99 e linfoma de células B2 (Bcl-2). Não há evidência de recidiva nove e cinco meses após cirurgia, respetivamente. TFS é maioritariamente benigno, mas pode revelar comportamento agressivo. Características morfológicas e imuno-histoquímicas são essenciais para o diagnóstico.

Correction: Lymphangioleiomyomatosis Biomarkers Linked to Lung Metastatic Potential and Cell Stemness.

[This corrects the article DOI: 10.1371/journal.pone.0132546.].

"High-grade oncocytic renal tumor": morphologic, immunohistochemical, and molecular genetic study of 14 cases.

The spectrum of the renal oncocytic tumors has been expanded in recent years to include several novel and emerging entities. We describe a cohort of novel, hitherto unrecognized and morphologically distinct high-grade oncocytic tumors (HOT), currently diagnosed as "unclassified" in the WHO classification. We identified 14 HOT by searching multiple institutional archives. Morphologic, immunohistochemical (IHC), molecular genetic, and molecular karyotyping studies were performed to investigate these tumors. The patients included 3 men and 11 women, with age range from 25 to 73 years (median 50, mean 49 years). Tumor size ranged from 1.5 to 7.0 cm in the greatest dimension (median 3, mean 3.4 cm). The tumors were all pT1 stage. Microscopically, they showed nested to solid growth, and focal tubulocystic architecture. The neoplastic cells were uniform with voluminous oncocytic cytoplasm. Prominent intracytoplasmic vacuoles were frequently seen, but no irregular (raisinoid) nuclei or perinuclear halos were present. All tumors demonstrated prominent nucleoli (WHO/ISUP grade 3 equivalent). Nine of 14 cases were positive for CD117 and cytokeratin (CK) 7 was either negative or only focally positive in of 6/14 cases. All tumors were positive for AE1-AE3, CK18, PAX 8, antimitochondrial antigen, and SDHB. Cathepsin K was positive in 13/14 cases and CD10 was positive in 12/13 cases. All cases were negative for TFE3, HMB45, Melan-A. No TFEB and TFE3 genes rearrangement was found in analyzable cases. By array CGH, complete chromosomal losses or gains were not found in any of the cases, and 3/9 cases showed absence of any abnormalities. Chromosomal losses were detected on chromosome 19 (4/9), 3 with losses of the short arm (p) and 1 with losses of both arms (p and q). Loss of chromosome 1 was found in 3/9 cases; gain of 5q was found in 1/9 cases. On molecular karyotyping, 3/3 evaluated cases showed loss of heterozygosity (LOH) on 16p11.2-11.1 and 2/3 cases showed LOH at 7q31.31. Copy number (CN) losses were found at 7q11.21 (3/3), Xp11.21 (3/3), Xp11.22-11.21 (3/3), and Xq24-25 (2/3). CN gains were found at 13q34 (2/3). Ten patients with available follow up information were alive and without disease progression, after a mean follow-up of 28 months (1 to 112 months). HOT is a tumor with unique morphology and its IHC profile appears mostly consistent. HOT should be considered as an emerging renal entity because it does not meet the diagnostic criteria for other recognized eosinophilic renal tumors, such as oncocytoma, chromophobe renal cell carcinoma (RCC), TFE3 and TFEB RCC, SDH-deficient RCC, and eosinophilic solid and cystic RCC.

Case Report: Multifocal biphasic squamoid alveolar renal cell carcinoma.

A multifocal biphasic squamoid alveolar renal cell carcinoma in a 68-year-old man is reported. Four different peripheral tumor nodules were identified on gross examination. A fifth central tumor corresponded to a conventional clear cell renal cell carcinoma. Biphasic squamoid alveolar renal cell carcinoma is a rare tumor that has been very recently characterized as a distinct histotype within the spectrum of papillary renal cell carcinoma. Immunostaining with cyclin D1 seems to be specific of this tumor subtype. This is the first reported case with multifocal presentation.

Study of breast cancer incidence in patients of lymphangioleiomyomatosis.

Molecular evidence has linked the pathophysiology of lymphangioleiomyomatosis (LAM) to that of metastatic breast cancer. Following on this observation, we assessed the association between LAM and subsequent breast cancer. An epidemiological study was carried out using three LAM country cohorts, from Japan, Spain, and the United Kingdom. The number of incident breast cancer cases observed in these cohorts was compared with the number expected on the basis of the country-specific incidence rates for the period 2000-2014. Immunohistochemical studies and exome sequence analysis were performed in two and one tumors, respectively. All cohorts revealed breast cancer standardized incidence ratios (SIRs) ≥ 2.25. The combined analysis of all cases or restricted to pre-menopausal age groups revealed significantly higher incidence of breast cancer: SIR = 2.81, 95 % confidence interval (CI) = 1.32-5.57, P = 0.009; and SIR = 4.88, 95 % CI = 2.29-9.99, P = 0.0007, respectively. Immunohistochemical analyses showed positivity for known markers of lung metastatic potential. This study suggests the existence of increased breast cancer risk among LAM patients. Prospective studies may be warranted to corroborate this result, which may be particularly relevant for pre-menopausal women with LAM.

Lymphangioleiomyomatosis Biomarkers Linked to Lung Metastatic Potential and Cell Stemness.

Lymphangioleiomyomatosis (LAM) is a rare lung-metastasizing neoplasm caused by the proliferation of smooth muscle-like cells that commonly carry loss-of-function mutations in either the tuberous sclerosis complex 1 or 2 (TSC1 or TSC2) genes. While allosteric inhibition of the mechanistic target of rapamycin (mTOR) has shown substantial clinical benefit, complementary therapies are required to improve response and/or to treat specific patients. However, there is a lack of LAM biomarkers that could potentially be used to monitor the disease and to develop other targeted therapies. We hypothesized that the mediators of cancer metastasis to lung, particularly in breast cancer, also play a relevant role in LAM. Analyses across independent breast cancer datasets revealed associations between low TSC1/2 expression, altered mTOR complex 1 (mTORC1) pathway signaling, and metastasis to lung. Subsequently, immunohistochemical analyses of 23 LAM lesions revealed positivity in all cases for the lung metastasis mediators fascin 1 (FSCN1) and inhibitor of DNA binding 1 (ID1). Moreover, assessment of breast cancer stem or luminal progenitor cell biomarkers showed positivity in most LAM tissue for the aldehyde dehydrogenase 1 (ALDH1), integrin-ß3 (ITGB3/CD61), and/or the sex-determining region Y-box 9 (SOX9) proteins. The immunohistochemical analyses also provided evidence of heterogeneity between and within LAM cases. The analysis of Tsc2-deficient cells revealed relative over-expression of FSCN1 and ID1; however, Tsc2-deficient cells did not show higher sensitivity to ID1-based cancer inhibitors. Collectively, the results of this study reveal novel LAM biomarkers linked to breast cancer metastasis to lung and to cell stemness, which in turn might guide the assessment of additional or complementary therapeutic opportunities for LAM.

Segundos molares mandibulares: estudio de su variabilidad anatómica mediante tomografía computarizada de haz cónico (CBCT) / Mandibular second molars: anatomical variability study through cone beam computed tomography (CBCT)

Objetivo: Evaluar la morfología de las raíces y sistema de conductos de los segundos molares mandibulares permanentes en un grupo de pacientes a los que se les ha realizado una CBCT. Material y métodos: Se analizaron 169 segundos molares mandibulares mediante el aparato CBCT Galileos Sirona. Los criterios de exclusión son: molar endodonciado, diente joven con ápice abierto, imagen borrosa y gran calcificación de conductos. Los aspectos evaluados son: edad, sexo, morfología y número de raíces; morfología y número de conductos; presencia y clasificación de conductos tipo C. Se han utilizado medidas estadísticas test de Kappa, test chi-cuadrado, test t de Student, prueba de tendencia lineal y coeficiente de correlación de Spearman. Resultados: La anatomía más frecuente es de dos raíces paralelas o convergentes con tres conductos: dos en mesial redondos , y uno en distal redondo. El conducto en C aparece en un 8,8%, de los cuales los más frecuentes son los tipos I y III y con la convexidad hacia lingual en un 71,4%. La variabilidad anatómica es del 23,7%, mayor en mujeres, y existe un alto grado de concordancia entre ambos molares contralaterales. La prevalencia del conducto de forma redondeada aumenta con la edad. Conclusiones: La morfología más común de segundos molares mandibulares es de dos raíces con tres conductos, pero existe una gran variabilidad Anatómica

Objective: Evaluate the root and canal morphology of the mandibular second molars in a group of patients who have been subjected to a CBCT. Material and methods: In this study,169 samples were examined by Sirona Galileos CBCT. Exclusion criteria were: molar endodontic, young tooth with open apex, blur and large calcification root canals. The details evaluated are: age, sex, morphology and number of roots; morphology and number of root canals; presence and classification of C-shaped canal Statistical analysis: Kappa test, chi-square test, Student’s t test, linear trend test and Spearman correlation coefficient. Results: The most common anatomy is two parallel or converging roots with three canals: two rounds in mesial and one round in distal. The C-shaped canal was observed in 8.8%.The most common are Type I and III and the grooves were directed lingual in 71.4%. The anatomical variability is 23.7% higher in women, and appears in both contralateral molars in 85.9%. The prevalence of rounded root canal increases with age. Conclusions: The most common morphology of mandibular second

Hemiparesia izquierda en un paciente diabético: encefalitis granulomatosa crónica por Acanthamoeba / Left-sided hemiparesis in a diabetic patient: chronic granulomatous encephalitis due to Acanthamoeba

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Metaplasia escamosa descamativa queratinizante (colesteatoma) del uréter / Keratinizing desquamative squamous metaplasia (cholesteatoma) of the ureter

La metaplasia escamosa descamativa queratinizante del tracto urinario es una enfermedad poco frecuente que puede simular un proceso neoplásico. Se presenta un ejemplo típico de esta entidad en una paciente de 71 años de edad con una larga historia de cólicos de repetición. El estudio radiológico mostró una lesión sospechosa, ocupante de espacio, en el muñón ureteral de una nefrectomía previa, y el examen histológico mostró metaplasia escamosa del urotelio y abundante descamación córnea en la luz formando masas irregulares(AU)

Keratinizing desquamative squamous metaplasia of the urinary tract is a rare condition that may mimic neoplasia. We report a characteristic case occurring in a 71-year old woman with a long previous history of recurrent nephritic colic. Imaging studies showed a suspicious mass in the ureteral stump of a previous nephrectomy. Histology revealed squamous metaplasia of the urothelium with abundant keratinizing material in the lumen forming irregular masses(AU)

[Surgical pathology of epilepsy]. / Patología quirúrgica de la epilepsia.

INTRODUCTION: The surgical treatment of refractory epilepsy represents a large step forward in the quality of life and survival of many patients, particularly for those whose pathology is located in the temporal lobe. AIM: To concentrate the basic histological aspects of an extremely varied, although generally little known, genuinely neural pathology into one single review work. DEVELOPMENT: The causes of refractory epilepsy with a genuinely neurohistological foundation can be either malformative or neoplastic. The former include cortical dysplasias and hippocampal sclerosis, while the latter involve the so-called glioneuronal tumours (dysembryoplastic neuroepithelial tumour, ganglioglioma) and some glial cell-related tumours. CONCLUSIONS: There is a group of disorders that are intrinsic to cerebral development and primary brain tumours which are closely related to epilepsy. Surgery applied to these processes cures epilepsy in a high percentage of cases that are resistant to pharmacological treatment.