Capi-score: a quantitative algorithm for identifying disease patterns in nailfold videocapillaroscopy.

OBJECTIVES: The European Alliance of Associations for Rheumatology (EULAR) supports the use of nailfold videocapillaroscopy (NVC) to identify disease patterns (DPs) associated with systemic sclerosis (SSc) and Raynaud's phenomenon (RP). Recently, EULAR proposed an easy-to-manage procedure, a so-called Fast Track algorithm, to differentiate SSc from non-SSc patterns in NVC specimens. However, subjectivity among capillaroscopists remains a limitation. Our aim was to perform a software-based analysis of NVC peculiarities in a cohort of samples from SSc and RP patients and, subsequently, build a Fast Track-inspired algorithm to identify DPs without the constraint of interobserver variability. METHODS: NVCs were examined by 9 capillaroscopists. Those NVCs whose DPs were consensually agreed (≥2 out of 3 interobservers) were subsequently analysed with an in-house developed software. Each variable's results were grouped according to the consensually agreed DPs in order to identify useful hallmarks to categorise them. RESULTS: Eight-hundred and fifty-one NVCs (21 957 images) whose DPs had been consensually agreed were software-analysed. Appropriate cut-offs set in capillary density and percentage of abnormal and giant capillaries, tortuosities and hemorrhages allowed DP categorization and the development of the CAPI-Score algorithm. This consisted of 4 rules: Rule 1, SSc vs non-SSc, accuracy 0.88; Rules 2 and 3, SSc-early vs SSc-active vs SSc-late, accuracy 0.82; Rule 4, non-SSc normal vs non-SSc non-specific, accuracy 0.73. Accuracy improved when the analysis was limited to NVCs whose DPs had achieved full consensus among interobservers. CONCLUSIONS: The CAPI-Score algorithm may become a useful tool to assign DPs by overcoming the limitations of subjectivity.

Resultados preclínicos de cannabinoides y dolor (algunos) / Some preclinical results of cannabinoids and pain

El papel del sistema endocannabinoide en la modulación de la nocicepción y en la interpretación de estas señales se conoce desde mediados del siglo pasado. Los trabajos desarrollados desde entonces han permitido profundizar en los mecanismos de acción implicados y así poder sintetizar diversos fármacos capaces de modular estas señales. Estos fármacos pueden ser agonistas, dirigidos a activar directamente receptores cannabinoides, pero pueden igualmente ser sustancias que modulen las enzimas encargadas de las síntesis y degradación de los endocannabinoides. Farmacológicamente se están estudiando, además, otras sustancias presentes en la planta Cannabis sativa, así como derivados sintéticos obtenidos a partir de estas, que pueden unirse, además de a los receptores antes mencionados, a otros tipos de receptores implicados en la fisiología de la nocicepción. Los resultados obtenidos hasta el momento demuestran eficacia en múltiples modelos animales de dolor, tanto agudo como crónico, tanto nociceptivo como neuropático, y abren vías de investigación para el tratamiento farmacológico del dolor crónico.(AU)

The role of the endocannabinoid system in the modulation of nociception and in the interpretation of those signals in known since the middle of the last century. The work carried out since then has made possible to better understand mechanisms of action involved and to synthesize different drugs able to modulate these signals. These drugs can be agonists, aimed at directly activating cannabinoid receptors, or substances that modulate the enzymes responsible for the synthesis and degradation of endocannabinoids. Pharmacologically, other substances present in the Cannabis sativa plant are also being studied, as well as synthetic derivatives obtained from these, which can bind, in addition to the aforementioned receptors, to other types of receptors involved in the physiology of the nociception. Results obtained to date demonstrate efficacy in multiple animal models of pain, both acute and chronic, both nociceptive and neuropathic, and offer new of research lines for the pharmacological treatment of chronic pain.(AU)

Behavior and electrophysiology studies of the peripheral neuropathy induced by individual and co-administration of paclitaxel and oxaliplatin in rat.

AIMS: Antitumor agents, as taxanes and platinum compounds, induce peripheral neuropathies which can hamper their use for cancer treatment. The study of chemotherapy-induced neuropathies in humans is difficult because of ethical reasons, differences among administration protocols and intrinsic characteristics of patients. The aim of the present study is to compare the neuropathic signs induced by individual or combined administration of paclitaxel and oxaliplatin. MAIN METHODS: Oxaliplatin and paclitaxel were administered individually and combined to induce peripheral neuropathy in rats, sensory neuropathic signs were assessed in the hind limbs and orofacial area. The in vitro skin-saphenous nerve preparation was used to record the axonal activity of Aδ sensory neurons. KEY FINDINGS: Animals treated with the combination developed mechanical allodynia in the paws and muscular hyperalgesia in the orofacial area, which was similar to that in animals treated with monotherapy, the latter also developed cold allodynia in the paws. Aδ-fibers of the rats treated with the combination were hyperexcited and presented hypersensitivity to pressure stimulation of the innervated skin, also similar to that recorded in the fibers of the animals treated with monotherapy. SIGNIFICANCE: Our work objectively demonstrates that the combination of a platinum compound with a taxane does not worsen the development of sensorial neuropathies in rats, which is an interesting data to take into account when the combination of antitumor drugs is necessary. Co-administration of antitumor drugs is more effective in cancer treatment without increasing the risk of the disabling neuropathic side effects.

Outcome of treatment of MDR-TB or drug-resistant patients treated with bedaquiline and delamanid: Results from a large global cohort.

The World Health Organization (WHO) recommends countries introduce new anti-TB drugs in the treatment of multidrug-resistant tuberculosis. The aim of the study is to prospectively evaluate the effectiveness of bedaquiline (and/or delamanid)- containing regimens in a large cohort of consecutive TB patients treated globally. This observational, prospective study is based on data collected and provided by Global Tuberculosis Network (GTN) centres and analysed twice a year. All consecutive patients (including children/adolescents) treated with bedaquiline and/or delamanid were enrolled, and managed according to WHO and national guidelines. Overall, 52 centres from 29 countries/regions in all continents reported 883 patients as of January 31st 2021, 24/29 countries/regions providing data on 100% of their consecutive patients (10-80% in the remaining 5 countries). The drug-resistance pattern of the patients was severe (>30% with extensively drug-resistant -TB; median number of resistant drugs 5 (3-7) in the overall cohort and 6 (4-8) among patients with a final outcome). For the patients with a final outcome (477/883, 54.0%) the median (IQR) number of months of anti-TB treatment was 18 (13-23) (in days 553 (385-678)). The proportion of patients achieving sputum smear and culture conversion ranged from 93.4% and 92.8% respectively (whole cohort) to 89.3% and 88.8% respectively (patients with a final outcome), a median (IQR) time to sputum smear and culture conversion of 58 (30-90) days for the whole cohort and 60 (30-100) for patients with a final outcome and, respectively, of 55 (30-90) and 60 (30-90) days for culture conversion. Of 383 patients treated with bedaquiline but not delamanid, 284 (74.2%) achieved treatment success, while 25 (6.5%) died, 11 (2.9%) failed and 63 (16.5%) were lost to follow-up.

[Results of arthroscopic treatment of rotator cuff rupture in patients over 60 years of age]. / Resultados del tratamiento artroscópico de la rotura del manguito rotador en pacientes mayores de 60 años.

INTRODUCTION: Increasing life expectancies in population increase the number of patients with rotator cuff tears. The purpose of this study was to evaluate clinical outcomes after arthroscopy rotator cuff repair in patients over 60 years old. We hypothesized that shoulder arthroscopy would allow significant improvements in clinical outcomes without serious complications. MATERIAL AND METHODS: We screened from our shoulder arthroscopy database patients older than 60 years old, with rotator cuff tear, and minimun 2-year follow-up. The patients were evaluated using Constant scores for clinical outcomes and Quick-DASH score for quality of life. RESULTS: In total, 42 patients were enrolled in the study with a mean age of 66.7 years old (range 60 to 83). A double-row repair was indicated in 25 patients (59.5%), and single-row repair in 17 patients (40.5%). As associated injuries we found proximal biceps pathology in 31 patients (48.4%), subscapularis tears in 24 patients (37.5%), and SLAP tears in 3 patients (7.1%). Mean follow-up was 32.4 months. Constant scores improved from 48.3 preoperatively to 87.2 at final follow-up. Quick-DASH decreased from 52.5 preoperatively to 11.0 at final follow-up. DISCUSSION: Arthroscopy cuff repair in patients older than 60 years old provides satisfactory clinical outcomes without morbidity at medium follow-up.

ANTECEDENTES: El aumento de la esperanza de vida de la población incrementa el número de pacientes con patología sintomática del manguito rotador. Nuestro objetivo fue determinar los resultados clínicos de una cohorte de pacientes mayores de 60 años con rotura del manguito rotador intervenidos mediante cirugía artroscópica de hombro (CAH). La hipótesis de trabajo fue que la CAH permitiría resultados clínicos satisfactorios. MATERIAL Y MÉTODOS: De nuestra base de datos prospectiva de CAH seleccionamos los pacientes con: edad mayor de 60 años, rotura de manguito rotador, seguimiento mínimo de dos años. La valoración clínica se determinó según el test de Constant y el cuestionario Quick-DASH de calidad de vida. RESULTADOS: 42 pacientes con una edad media de 66.7 años (rango de 60 a 83). La rotura del supraespinoso se reparó con sutura en doble fila en 25 pacientes (59.5%) y en fila única en 17 pacientes (40.5%). Lesiones asociadas: lesión de la porción larga del bíceps en 31 pacientes (48.4%), del subescapular en 24 pacientes (37.5%) y lesión tipo SLAP en tres pacientes (7.1%). El seguimiento medio fue de 32.4 meses. La puntuación media en la escala de Constant pasó de 48.3 puntos en el preoperatorio a 87.2 puntos al final del seguimiento. El cuestionario DASH síntomas/discapacidad disminuyó de 52.5 de media a 11.0 al final del seguimiento. DISCUSIÓN: El tratamiento artroscópico de las roturas de manguito rotador en mayores de 60 años permite obtener resultados satisfactorios en los cuestionarios de valoración funcional y calidad de vida a mediano plazo.

Pulse immunosuppressive therapy for multiple sclerosis during the SARS-CoV-2 lockdown de-escalation plan: Safety algorithm. / Tratamiento inmunosupresor en pulsos en esclerosis múltiple durante el desescalado de la epidemia por SARS-CoV-2. Algoritmo de seguridad.

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT.

Susceptibility of entomopathogenic nematodes to ivermectin and thiabendazole.

The objective of the present study was to determine the susceptibility of entomopathogenic nematodes to ivermectin and thiabendazole. Soil samples collected from the municipalities of Irapuato and León, Guanajuato, Mexico, were obtained, from which the entomopathogenic nematodes (EPNs) of the Steinernematidae and Heterorhabditidae families were isolated. The samples were classified from livestock and nonlivestock soils, and the susceptibility of EPNs to anthelmintics was determined with the larval motility assay (LMA, 24 h) and the larval migration inhibition assay (LMI assay, 48 h). Sterile distilled water (T1) and treatments with 1% ivermectin diluted in 5% DMSO (dimethyl sulfoxide) (T2) and 5% thiabendazole diluted in 5% DMSO (T3) were applied to infective juvenile larvae. Analysis of variance was performed with a factorial design and Tukey's test at 0.05 probability. In addition, different concentrations of ivermectin (0.1, 0.5, 1, 1.2, 1.5, and 2 µg) and thiabendazole (1, 5, 10, 12, 15, and 20 mg) were evaluated to perform a Probit analysis to determine their LC50. All strains of EPNs were susceptible to ivermectin in both the LMA and LMI assay. The results show that EPNs are susceptible to ivermectin and thiabendazole, and the degree depends on the type of test performed, the chemical product used, and the origin of the strain of EPN.

Small bowel polyp resection using device-assisted enteroscopy in Peutz-Jeghers Syndrome: Results of a specialised tertiary care centre.

INTRODUCTION: Enteroscopy resection of small bowel polyps in Peutz-Jeghers syndrome has only been described in small case series. Herein, we aimed to assess the efficacy of enteroscopy resection of small bowel polyps within a specialised tertiary care centre and the impact on intraoperative enteroscopy. METHODS: This was an observational single-centre study. All adult Peutz-Jeghers syndrome patients followed in the Predisposition Digestive Ile-de-France network who underwent an endoscopic resection of at least one small bowel polyp ≥ 1 cm by enteroscopy between 2002-2015 were included. Small bowel polyps were detected under a dedicated screening programme by previous capsule endoscopy and/or magnetic resonance enterography, performed every 2-3 years. Complete treatment was defined as the absence of polyps ≥ 1 cm after conventional endoscopic resection. Intraoperative enteroscopy or surgical resection were indicated in incomplete treatments. The overall complete treatment rate including conventional enteroscopy and intraoperative enteroscopy was also considered. RESULTS: Endoscopic resection of 216 small bowel polyps (median: 8.6 per patient, size: 6-60 mm) was performed by 50 enteroscopies in 25 patients (mean age: 36 years, range: 18-71, 56% male) with small bowel polyp ≥ 1 cm. Twenty-three patients (92%) underwent 42 screening capsule endoscopies and 14 (57%) had 23 magnetic resonance enterographies during a median follow-up of 60 months. Complete treatment was achieved in 76%. Intraoperative enteroscopy and surgical resection were performed in four (16%) and two (8%) patients. Intraoperative enteroscopy improved by 16% the complete treatment rate and the overall rate was 92%. The complication rate was 6%. CONCLUSION: This long-term study confirmed the efficacy and safety of endoscopic resection of small bowel polyps in Peutz-Jeghers syndrome. Intraoperative enteroscopy can be a complementary approach in selected cases.

Resultados del tratamiento artroscópico de la rotura del manguito rotador en pacientes mayores de 60 años / Results of arthroscopic treatment of rotator cuff rupture in patients over 60 years of age

Resumen: Antecedentes: El aumento de la esperanza de vida de la población incrementa el número de pacientes con patología sintomática del manguito rotador. Nuestro objetivo fue determinar los resultados clínicos de una cohorte de pacientes mayores de 60 años con rotura del manguito rotador intervenidos mediante cirugía artroscópica de hombro (CAH). La hipótesis de trabajo fue que la CAH permitiría resultados clínicos satisfactorios. Material y métodos: De nuestra base de datos prospectiva de CAH seleccionamos los pacientes con: edad mayor de 60 años, rotura de manguito rotador, seguimiento mínimo de dos años. La valoración clínica se determinó según el test de Constant y el cuestionario Quick-DASH de calidad de vida. Resultados: 42 pacientes con una edad media de 66.7 años (rango de 60 a 83). La rotura del supraespinoso se reparó con sutura en doble fila en 25 pacientes (59.5%) y en fila única en 17 pacientes (40.5%). Lesiones asociadas: lesión de la porción larga del bíceps en 31 pacientes (48.4%), del subescapular en 24 pacientes (37.5%) y lesión tipo SLAP en tres pacientes (7.1%). El seguimiento medio fue de 32.4 meses. La puntuación media en la escala de Constant pasó de 48.3 puntos en el preoperatorio a 87.2 puntos al final del seguimiento. El cuestionario DASH síntomas/discapacidad disminuyó de 52.5 de media a 11.0 al final del seguimiento. Discusión: El tratamiento artroscópico de las roturas de manguito rotador en mayores de 60 años permite obtener resultados satisfactorios en los cuestionarios de valoración funcional y calidad de vida a mediano plazo.

Abstract: Introduction: Increasing life expectancies in population increase the number of patients with rotator cuff tears. The purpose of this study was to evaluate clinical outcomes after arthroscopy rotator cuff repair in patients over 60 years old. We hypothesized that shoulder arthroscopy would allow significant improvements in clinical outcomes without serious complications. Material and methods: We screened from our shoulder arthroscopy database patients older than 60 years old, with rotator cuff tear, and minimun 2-year follow-up. The patients were evaluated using Constant scores for clinical outcomes and Quick-DASH score for quality of life. Results: In total, 42 patients were enrolled in the study with a mean age of 66.7 years old (range 60 to 83). A double-row repair was indicated in 25 patients (59.5%), and single-row repair in 17 patients (40.5%). As associated injuries we found proximal biceps pathology in 31 patients (48.4%), subscapularis tears in 24 patients (37.5%), and SLAP tears in 3 patients (7.1%). Mean follow-up was 32.4 months. Constant scores improved from 48.3 preoperatively to 87.2 at final follow-up. Quick-DASH decreased from 52.5 preoperatively to 11.0 at final follow-up. Discussion: Arthroscopy cuff repair in patients older than 60 years old provides satisfactory clinical outcomes without morbidity at medium follow-up.

Draft Genome Sequence of Brevundimonas sp. Strain T2.26MG-97, Isolated from a Rock Core Sample from 492.6 Meters Deep on the Subsurface of the Iberian Pyrite Belt.

The draft genome of Brevundimonas sp. strain T2.26MG-97, isolated at a depth of 492.6 m in the subsurface of the Iberian Pyrite Belt, is reported here. It consists of 262 scaffolds with a total genome length of 3.68 Mbp, where 3,549 coding DNA sequences have been annotated.

Efectos de la imaginería motora aplicada durante el periodo de inmovilización o posquirúrgico en miembro superior: una revisión sistemática / Effects of motor imagery applied during upper limb immobilisation and / or after surgery: A systematic review

Objetivo: El objetivo de esta revisión sistemática fue resumir toda la evidencia relativa a los efectos de la imaginería motora realizada durante el periodo de inmovilización después de una lesión o en el inmediato posquirúrgico y los efectos sobre el dolor, la fuerza, la función y el rango articular. Métodos: Se hicieron búsquedas sistemáticas en todos los idiomas y en 4 bases de datos: PubMed, OtSeeker, Cinhal, WOS y PEDro. Se seleccionaron los estudios elegibles publicados hasta noviembre de 2018. Se incluyeron ensayos clínicos aleatorizados que investigaron los efectos de la intervención de imaginería motora durante el periodo de inmovilización después de una lesión o en el inmediato posquirúrgico de miembro superior. Se utilizó la escala PEDro de calidad metodológica. Resultados: Se seleccionaron 4 ensayos clínicos aleatorizados, 2 con calidad metodológica buena y 2 con calidad metodológica insuficiente. El rango articular se evaluó en los 4ensayos, el dolor en 2, la fuerza en 3 y en uno la función. Se observaron cambios positivos en el grupo de imaginería motora en el rango articular en 3 estudios: 2 de calidad metodológica buena (n = 40 y n = 18) y uno de calidad insuficiente (n = 18); en el dolor, en un estudio de calidad buena (n = 40); en la fuerza en 2 estudios: uno de calidad buena (n = 40) y uno de insuficiente (n = 18) y en la función, en uno de calidad buena (n = 40). Conclusiones: Los resultados muestran beneficios positivos en el uso de imaginería motora aplicándola inmediatamente después del periodo posquirúrgico o en personas sanas simulando una inmovilización

Objective: The objective of this systematic review was to make a detailed examination of all the evidence concerning the effects of motor imagery (MI) performed during the immobilisation period after an injury, or in the immediate postoperative period, and the effects on pain, strength, function, and joint range. Methods: Systematic searches were conducted in all languages and in 4 electronic databases: PubMed, OTseeker, Cinahl, WOS and PEDro. Eligible studies published up to November 2018 were selected. Randomised controlled trials that investigated the effects of a motor imagery intervention performed during the period of immobilisation after an injury, or in the immediate postoperative upper limb were included. methodological quality was assessed using the PEDro scale. Results: Four randomised clinical trials were selected, 2 with good methodological quality and 2 with insufficient methodological quality. The joint range was evaluated in the 4 trials, pain in 2, strength in 3, and function in one. Positive changes were observed in the group of motor imagery in the joint mobility in 3 studies: 2 of good methodological quality (n = 40 and n = 18) and one insufficient (n= 18), in pain in one study of good quality (n = 40), in strength in 2 studies: one good quality (n = 40) and 1 insufficient (n = 18) and in function in 1 of good quality (n = 40). Conclusions: The results show positive benefits in the use of motor imagery applied immediately after the postoperative period or in healthy people simulating an immobilisation

Perspectives on cervical cancer screening and prevention: challenges faced by providers and patients along the Texas-Mexico border.

BACKGROUND: The Rio Grande Valley (RGV) and Laredo regions located along the Texas-Mexico border consist of seven counties with a population of approximately 1.5 million people and a high uninsured rate (33.5%). Cervical cancer mortality in these border counties is approximately 30% higher than the rest of Texas. The RGV and Laredo areas were studied to better understand the state of access to cervical cancer prevention services along the Texas-Mexico border. METHODS: Data on the population served and the services provided were analyzed to determine the gap between cervical cancer screenings recommended versus those received. Through interviews, we gathered the perspectives of 16 local stakeholders regarding cervical cancer screening for underserved individuals in the region. FINDINGS: It is estimated that 69,139 uninsured women aged 21-64 years in the RGV/Laredo per year are recommended to undergo cervical cancer screening with Papanicolaou (Pap) and/or human papillomavirus (HPV) testing, but only 8941 (12.9%) Pap tests are being performed by the Federally Qualified Health Center (FQHC) serving uninsured women in these regions. Systemic barriers identified include insufficient provider clinical capacity, the high cost of healthcare, and uncertainty about government funding sources. Patient barriers identified include inadequate knowledge on navigating the local healthcare system, low health literacy, lack of money and childcare, an inability to miss work, limited transportation, and fear of deportation. CONCLUSION: Decreasing the disparity between cervical cancer screening services provided and those recommended requires addressing the barriers, identified by local experts, which prevent uninsured women from accessing care. These challenges are being addressed through ongoing programs and collaborations.

Chronic pain and cannabinoids. Great expectations or a christmas carol.

The discovery of the endocannabinoid system nearly three decades ago generated great interest among pain scientists. Moreover, its analogy with the opioid system in terms of evolutionary preservation, tissue localization and analgesic activity enabled a vast new field for the development of medicines addressed to those types of pain that still nowadays are difficult to manage. However, the main disadvantage that hampers the use of cannabinergic drugs as analgesics is their identification with recreational use, besides their psychotomimetic actions. Pain has traditionally been classified attending to the ailment duration (acute or chronic) and drugs are used according to the intensity of the pain to treat, but it is also important to target the mechanism involved despite the intensity or duration of pain. The present chapter reviews the study and use of cannabinoids attending separately to four classic types of pain: nociceptive, inflammatory, neuropathic and oncological, considering basic research (pain animal models) as well as clinical practice.

Microfluidic solvent extraction of poly(vinyl alcohol) droplets: effect of polymer structure on particle and capsule formation.

We investigate the formation of poly(vinyl alcohol) microparticles by the selective extraction of aqueous polymer solution droplets, templated by microfluidics and subsequently immersed in a non-solvent bath. The role of polymer molecular mass (18-105 kg mol-1), degree of hydrolysis (88-99%) and thus solubility, and initial solution concentration (0.01-10% w/w) are quantified. Monodisperse droplets with radii ranging from 50 to 500 µm were produced at a flow-focusing junction with carrier phase hexadecane and extracted into ethyl acetate. Solvent exchange and extraction result in droplet shrinkage, demixing, coarsening and phase-inversion, yielding polymer microparticles with well-defined dimensions and internal microstructure. Polymer concentration, varied from below the overlap concentration c* to above the concentrated crossover c**, as estimated by viscosity measurements, was found to have the largest impact on the final particle size and extraction timescale, while polymer mass and hydrolysis played a secondary role. These results are consistent with the observation that the average polymer concentration upon solidification greatly exceeds c**, and that the internal microparticle porosity is largely unchanged. However, reducing the initial polymer concentration to well below c* (approximately 100×) and increasing droplet size yields thin-walled (100's of nm) capsules which controllably crumple upon extraction. The symmetry of the process can be readily broken by imposing extraction conditions at an impermeable surface, yielding large, buckled, cavity morphologies. Based on these results, we establish robust design criteria for polymer capsules and particles, demonstrated here for poly(vinyl alcohol), with well-defined shape, dimensions and internal microstructure.

Indications for and diagnostic yield of capsule endoscopy in the elderly. / Indicaciones y rendimiento diagnóstico de la cápsula endoscópica en el anciano.

INTRODUCTION AND AIMS: The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients. MATERIALS AND METHODS: All consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed. RESULTS: Of 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001). CONCLUSIONS: Capsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield.

Prevalence of functional gastrointestinal disorders in adults with systemic lupus erythematosus.

Objective (a) to assess the prevalence of functional gastrointestinal disorders (FGIDs) in female Mexican systemic lupus erythematosus (SLE) patients using the Rome III criteria and (b) to examine the effect of disease duration on FGID prevalence. Methods Female SLE outpatients aged ≥18 years with no organic gastrointestinal disorder were included. Participants were invited to upper gastrointestinal endoscopy screening and a faecal immunochemical test. FGID symptoms were evaluated using the Rome III questionnaire. Results Eighty-six SLE patients with median age of 45 (interquartile range 34-54) years were included. At least one FGID was found in 76.7% (66/88) of patients with SLE. The most prevalent domains of FGID diagnosed were functional oesophageal, gastroduodenal disorders and bowel disorders, of which functional dyspepsia (72.7%), functional heartburn (68.1%) and bloating (63.8%) were the most frequent. Fifty-nine per cent of patients had overlapping FGIDs. The most prevalent overlap was the combination of functional dyspepsia and functional heartburn. Patients with longer disease duration had a higher prevalence of FGID than those with shorter disease duration. Conclusions There was a high prevalence of FGIDs in Mexican SLE women with low disease activity. Overlapping FGIDs were frequent. Longer disease duration may be associated with FGIDs in SLE patients.

Encefalitis de Bickerstaff / Bickerstaff encephalitis

La encefalitis de tallo cerebral es un síndrome que se presenta con alteración del estado de conciencia, oftalmoplejia, ataxia y signos piramidales. Esta condición neurológica rara que fue descrita en 1950 por primera vez, presenta similares características clínicas a Síndrome de Guillain-Barré, por lo que representa un reto diagnóstico para el clínico. En este artículo se presenta el caso clínico de una paciente de 51 años de edad que se presenta con alteración del estado de conciencia, es llevada a unidad de cuidado intensivo de adulto donde se considera el diagnóstico de encefalitis de Bickerstaff, tras un exhaustivo abordaje diagnostico; el cual se describe, al igual que sumanejo y evolución...(AU)

Brain stem encephalitis is a syndrome that presents with altered state of consciousness, ophthalmoplegia, ataxia and pyramidal signs. This rare neurological condition that was described in1950 by The first time, it presents similar clinical characteristics to Guillain-Barré syndrome, which represents a diagnostic challenge for the clinician. This article presents the clinical case of a 51-year-old patient who presents with altered state of consciousness, is taken to the adult intensive care unit where the diagnosis of Bickerstaff encephalitis is considered, after an exhaustive diagnostic approach ; which is described, as well as its management and evolution ... (AU)