Combining graph neural networks and computer vision methods for cell nuclei classification in lung tissue.

The detection of tumoural cells from whole slide images is an essential task in medical diagnosis and research. In this article, we propose and analyse a novel approach that combines computer vision-based models with graph neural networks to improve the accuracy of automated tumoural cell detection in lung tissue. Our proposal leverages the inherent structure and relationships between cells in the tissue. Experimental results on our own curated dataset show that modelling the problem with graphs gives the model a clear advantage over just working at pixel level. This change in perspective provides extra information that makes it possible to improve the performance. The reduction of dimensionality that comes from working with the graph also allows us to increase the field of view with low computational requirements. Code is available at https://github.com/Jerry-Master/lung-tumour-study, models are uploaded to https://huggingface.co/Jerry-Master/Hovernet-plus-Graphs, and the dataset is published on Zenodo https://zenodo.org/doi/10.5281/zenodo.8368122.

Glyoxal acid-free (GAF) histological fixative is a suitable alternative to formalin: results from an open-label comparative non-inferiority study.

Formalin, an aqueous solution of formaldehyde, has been the gold standard for fixation of histological samples for over a century. Despite its considerable advantages, growing evidence points to objective toxicity, particularly highlighting its carcinogenicity and mutagenic effects. In 2016, the European Union proposed a ban, but a temporary permission was granted in consideration of its fundamental role in the medical-diagnostic field. In the present study, we tested an innovative fixative, glyoxal acid-free (GAF) (a glyoxal solution deprived of acids), which allows optimal tissue fixation at structural and molecular level combined with the absence of toxicity and carcinogenic activity. An open-label, non-inferiority, multicentric trial was performed comparing fixation of histological specimens with GAF fixative vs standard phosphate-buffered formalin (PBF), evaluating the morphological preservation and the diagnostic value with four binary score questions answered by both the central pathology reviewer and local center reviewers. The mean of total score in the GAF vs PBF fixative groups was 3.7 ± 0.5 vs 3.9 ± 0.3 for the central reviewer and 3.8 ± 0.5 vs 4.0 ± 0.1 for the local pathologist reviewers, respectively. In terms of median value, similar results were observed between the two fixative groups, with a median value of 4.0. Data collected indicate the non-inferiority of GAF as compared to PBF for all organs tested. The present clinical performance study, performed following the international standard for performance evaluation of in vitro diagnostic medical devices, highlights the capability of GAF to ensure both structural preservation and diagnostic value of the preparations.

Transvaginal ultrasonography predictive model for the detection of pelvic congestion syndrome.

Background: The diagnosis of pelvic congestion syndrome (PCS) remains a challenge given the lack of universally accepted criteria. Although venography (VG) is the current gold standard for the diagnosis of PCS, non-invasive techniques like transvaginal ultrasonography (TVU) appear to be a valid alternative. The aim of this study was to design a predictive model for the venographic diagnostic of PCS using the parameters identified by TVU in patients with clinical suspicion of PCS, in order to individually assess the need to perform an invasive diagnostic and therapeutic technique such as VG. Methods: An observational and cross-sectional prospective study was conducted including 61 consecutively recruited patients with clinical suspicion of PCS, who were referred by the Pelvic Floor, Gynecology and Vascular Surgery Units, who were distributed in two groups: 18 belonging to the normal group and 43 to the PCS's group. We implemented and compared 19 binary logistic regression models, including the parameters that showed statistical significance in the prior univariate analysis. We evaluated individual predictive values with a receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results: The selected model, based on the presence of pelvic veins or venous plexus of 8 mm or larger, observed by transvaginal ultrasound, had an AUC of 0.79 (95% CI: 0.63-0.96; P<0.001), with a sensitivity of 0.90 and specificity of 0.69, while the VG had a sensitivity of 86.05%, a specificity of 66.67%, and a positive predictive value of 86.05%. Conclusions: This assessment presents a feasible alternative that could potentially be added to our usual gynecological practice.

Can Intrapartum Ultrasonography Improve the Placement of the Vacuum Cup in Operative Vaginal Deliveries?

Although the fetal head position has traditionally been evaluated by digital examination (DE), it has a failure rate ranging between 20 and 70%; hence, intrapartum transabdominal ultrasonography (TUS) has become relevant. We aimed to evaluate the utility of the TUS to identify the fetal head positions in vacuum-assisted deliveries. We performed a prospective observational study including 101 pregnant patients in active labor who required a vacuum-assisted delivery. The fetal head position was assessed by a DE and a TUS prior to vacuum cup placement. After delivery, the optimal vacuum cup placement was evaluated as the distance between the chignon and the flexion point ≤2 cm. The general concordance rate between the DE and TUS was 72.2%, with the poorest concordance rate for occiput posterior positions at 46.1%. In five cases (4.9%), it was not possible to determine the fetal head position through the DE. The correlation was higher in low and medium planes, with 77% and 68.1% concordance rates, respectively, while it was lower in high planes (60%). In 90.1% of cases, the vacuum cup placement was optimal. Our findings show that intrapartum transabdominal ultrasonography is a useful technique to identify the fetal head position allowing optimal placement of the vacuum cup necessary for correct vacuum-assisted delivery.

Angiomixoma agresivo vulvar en mujer joven. Reporte de un caso / Aggressive vulvar angiomyxoma in a young woman. A case report

Resumen ANTECEDENTES: El angiomixoma agresivo profundo perineal es un tumor mesenquimatoso de muy limitada aparición que se origina debido a un crecimiento tumoral del tejido conjuntivo que se expande a pesar de su naturaleza benigna; se caracteriza por un comportamiento agresivo. CASO CLÍNICO: Paciente de 38 años, con un nódulo genital de 3 cm en el labio mayor izquierdo, con sospecha clínica de quiste de la glándula de Bartolino. Durante la intervención para su drenaje se objetivó una tumoración blanda, de aspecto mesenquimal, pediculado. El análisis histológico confirmó que se trataba de un angiomixoma agresivo profundo perineal. Posterior al estudio de extensión negativo, se completó la vulvectomía simple izquierda, con un posoperatorio favorable. CONCLUSIONES: La obtención de una biopsia inicial es decisiva, sobre todo en casos de tumores mesenquimales agresivos, como el angiomixoma agresivo perineal profundo. De esta manera puede establecerse un plan de tratamiento individual en función del diagnóstico histológico definitivo.

Abstract BACKGROUND: Aggressive deep perineal angiomyxoma is a mesenchymal tumor of very limited occurrence that originates due to a tumorous growth of connective tissue that expands despite its benign nature; it is characterized by an aggressive behavior. CLINICAL CASE: 38-year-old patient with a 3 cm genital nodule on the left labium majus, with clinical suspicion of Bartholin's gland cyst. During the intervention for its drainage, a soft, mesenchymal, pedunculated tumor was observed. Histological analysis confirmed that it was an aggressive deep perineal angiomyxoma. Following a negative extension study, a simple left vulvectomy was completed, with a favorable postoperative course. CONCLUSIONS: Obtaining an initial biopsy is critical, especially in cases of aggressive mesenchymal tumors, such as deep perineal aggressive angiomyxoma. In this way an individual treatment plan can be established based on the definitive histologic diagnosis.

Malformación arteriovenosa uterina como causa de hemorragia puerperal tardía / Uterine arteriovenous malformation as a cause of late puerperal hemorrhage

Resumen ANTECEDENTES: Las malformaciones arteriovenosas uterinas constituyen una causa infrecuente de hemorragia puerperal, en la bibliografía solo se encontraron 150 casos. Su conocimiento es importante porque son potencialmente mortales y porque se ha registrado un aumento en los últimos años. Suelen estar relacionadas con intervenciones en el útero: legrados, cesáreas o miomectomías o asociadas con neoplasias (enfermedad trofoblástica gestacional o adenocarcinoma endometrial), aunque otras son congénitas. CASO CLÍNICO: Paciente de 32 años, con una conización cervical y ablación de un mioma uterino mediante radiofrecuencia como únicos antecedentes de interés. A los 15 días posteriores a un parto eutócico, que fue el primero en su historial, tuvo un episodio de abundante metrorragia. En el puerperio inmediato tuvo una hemorragia abundante que requirió la transfusión de dos concentrados de hematíes. En la ecografía transvaginal el útero se observó de 22 x 44 mm, que podría corresponder a un cotiledón retenido. Ante la persistencia del sangrado se colocó un taponamiento intracavitario con una sonda de Foley con lo que se consiguió el cese del sangrado. Luego de descartar la embolización de las arterias uterinas debido al gran tamaño de la malformación arteriovenosa, se procedió a la histerectomía total simple por vía laparotómica. CONCLUSIÓN: Las malformaciones arteriovenosas uterinas, aunque son una causa infrecuente de hemorragia puerperal, deben ser sospechadas en virtud de ser potencialmente mortales.

Abstract BACKGROUND: Uterine arteriovenous malformations are a rare cause of puerperal hemorrhage, with only 150 cases reported in the literature. Their knowledge is important because they are life-threatening and because there has been an increase in recent years. They are usually related to interventions in the uterus: curettage, caesarean section or myomectomy or associated with neoplasms (gestational trophoblastic disease or endometrial adenocarcinoma), although others are congenital. CLINICAL CASE: A 32-year-old patient with a cervical conization and ablation of a uterine myoma by radiofrequency as the only history of interest. Fifteen days after a euthecological delivery, which was the first in her history, she had an episode of abundant metrorrhagia. In the immediate postpartum period, she had a heavy hemorrhage that required the transfusion of two red blood cell concentrates. Transvaginal ultrasound showed a uterus measuring 22 x 44 mm, which could correspond to a retained cotyledon. In view of the persistent bleeding, intracavitary tamponade was placed with a Foley catheter, which led to cessation of bleeding. After ruling out embolization of the uterine arteries due to the large size of the arteriovenous malformation, a simple total hysterectomy by laparotomy was performed. CONCLUSION: Uterine arteriovenous malformations, although an infrequent cause of puerperal hemorrhage, should be suspected because they are potentially fatal.

Attempted vaginal birth after cesarean: assessment of morbidity and predictors of success / Parto tras cesárea anterior: análisis de la morbimortalidad materno-fetal

Objective: Determining the appropriate approach for delivery after previous cesarean is a very controversial issue. Our objective was to establish whether pregnant women with a previous cesarean have an increased maternal and fetal morbidity and mortality after attempting vaginal delivery as well as to determine which factors may influence the achievement of a vaginal birth after cesarean. Materials and methods: A retrospective observational cohort study including 390 patients (196 cesarean group and 194 nulliparous group) was carried out. We compared neonatal and maternal outcomes between groups. Afterward, a multivariate logistic regression was applied for our second objective. Results: There were higher rates of uterine rupture (2% vs. 0%, p: 0.045) and puerperal hemorrhage (9.7% vs. 3.1%, p: 0.008) in the cesarean group and lower vaginal delivery rate (58.2% vs. 77.8%, p < 0.0005). We found that the induced onset of labor (OR = 2.9) and new born weight (OR = 1.0001) were associated with an increased risk of cesarean section. Conclusions: Our findings stress the need for further investigations in this field, which might provide a basis for a better management of patients with a previous cesarean.

Objetivo: Determinar el abordaje adecuado del tipo de parto tras una cesárea previa es un tema muy controvertido. Nuestro objetivo fue establecer si las gestantes con cesárea previa presentan mayor morbimortalidad materna y fetal tras intentar parto vaginal, así como determinar qué factores pueden influir en conseguir un parto vaginal posterior a la cesárea. Material y métodos: Estudio observacional de cohortes retrospectivo incluyendo 390 pacientes (196 con cesárea previa, 194 nulíparas). Comparamos los datos sobre los resultados neonatales y maternos. Posteriormente se aplicó un modelo de regresión logística multivariante. Resultados: Hubo mayores tasas de ruptura uterina (2% vs. 0%; p = 0.045) y hemorragia puerperal (9.7% vs. 3.1%, p: 0.008) en el grupo de cesárea anterior, así como una tasa de parto vaginal mas baja (58.2% vs. 77.8%, p < 0.0005). La inducción del parto (OR = 2,9) y el peso del recién nacido (OR = 1.0001) se asociaron a un mayor riesgo de cesárea. Conclusión: La probabilidad de parto vaginal en estas pacientes disminuye cuanto mayor sea el peso del recién nacido y con partos inducidos.

Does a High-Risk (>1/50) Result for First-Trimester Combined Screening Always Entail Invasive Testing? Which Patients from This Group Might Benefit from cfDNA Testing?

Currently, cell-free DNA (cfDNA) is offered as part of a contingent screening for patients with a first-trimester combined test (FCT) risk between 1/50 and 1/250. However, most aneuploidies are within the group of patients with a risk above 1/10. An observational, retrospective, and multi-centric study was carried out, to evaluate the theorical performance of lowering the cut-off point for the high-risk group from 1/50 to 1/10. Out of the 25,920 patients included, 25,374 (97.9%) consented to the cfDNA contingent screening for aneuploidies. With the proposed strategy, knowing that the detection rate (DR) of cfDNA testing for trisomy 21 is 99.7%, the DR for trisomy 21 would have stayed in a 93.2%, just as it was with the current strategy. In this instance, 267 (1.1%) invasive tests would have been performed, while the current strategy had a total of 307 (1.2%). The false positive rate (FPR) rate would have stayed at 5.2% in both scenarios. In conclusion, the contingent screening of aneuploidies based in the result of the FCT, offering the analysis of cfDNA to patients with an intermediate risk after lowering the cut-off point from 1/50 to 1/10, is a valid alternative that might maintain the current detection rates and avoid the complications associated with invasive testing.

Combination of mifepristone and misoprostol vs misoprostol monotherapy for treatment of second-trimester pregnancy loss.

OBJECTIVE: Our main goal was to evaluate whether a treatment protocol based on the combination of mifepristone and misoprostol for second-trimester foetal loss was more effective than misoprostol monotherapy. METHODS: This was an observational, retrospective, cross-sectional two-centre study of women receiving treatment for second-trimester pregnancy loss. Patients were recruited in two centres that used different treatment protocols: combined mifepristone-misoprostol treatment or misoprostol monotherapy. RESULTS: A total of 99 patients were included in the study: 41 in the mifepristone-misoprostol combined treatment group and 58 in the misoprostol monotherapy group. The combined treatment group had shorter times to expulsion and shorter hospitalisations, as well as higher rates of hospital discharge within 24 h and complete abortion within the first 6 h and 12 h. There were no differences regarding secondary effects and complication rates. CONCLUSION: A combination of mifepristone and misoprostol appears to be a feasible option for the treatment of second-trimester pregnancy loss.

Identification of Pelvic Congestion Syndrome Using Transvaginal Ultrasonography. A Useful Tool.

The gold standard for the diagnosis of pelvic congestion syndrome (PCS) is venography (VG), although transvaginal ultrasound (TVU) might be a noninvasive, nonionizing alternative. Our aim is to determine whether TVU is an accurate and comparable diagnostic tool for PCS. An observational prospective study including 67 patients was carried out. A TVU was performed on patients, measuring pelvic venous vessels parameters. Subsequentially, a VG was performed, and results were compared for the test calibration of TVU. Out of the 67 patients included, only 51 completed the study and were distributed in two groups according to VG results: 39 patients belonging to the PCS group and 12 to the normal group. PCS patients had a larger venous plexus diameter (15.1 mm vs. 12 mm; p = 0.009) and higher rates of crossing veins in the myometrium (74.35% vs. 33.3%; p = 0.009), reverse or altered flow during Valsalva (58.9% vs. 25%; p = 0.04), and largest pelvic vein ≥ 8 mm (92.3% vs. 25%). The sensitivity and specificity of TVU were 92.3% (95% CI: 78.03-97.99%) and 75% (95% CI: 42.84-93.31%), respectively. In conclusion, transvaginal ultrasonography, with the described methodology, appears to be a promising tool for the diagnosis of PCS, with acceptable sensitivity and specificity.

Mini-resectoscope vs morcellator for in-office hysteroscopic myomectomy: Evaluation of results and patient satisfaction.

INTRODUCTION: The development of hysteroscopic techniques has led to an advance in submucous myoma treatment, offering a safe and effective minimally invasive alternative. Our objective was to compare the results of hysteroscopic myomectomy when using whether the mini-resectoscope or the MyoSure morcellator, as well as patient satisfaction after the procedure. MATERIAL AND METHODS: A prospective, cross-sectional, observational study including 80 patients distributed into two groups: Mini-Resectoscope group (MRG) or MyoSure group (MSG), depending on the instrument used for the in-office hysteroscopic myomectomy. Resection time, pain during entry, pain during resection, number of resections required, complete resection, and total satisfaction were recorded. RESULTS: MSG had statistically significant shorter time of entrance. There were no other statistically significant differences between groups. CONCLUSIONS: In-office hysteroscopic myomectomy is associated with high levels of patient satisfaction, without differences between the mini-resectoscope or the MyoSure, allowing high rates of complete resection using both instruments. Thus, it is a feasible technique which could be performed with both instruments, depending on the operator's expertise.

Influence of home/school environments on children's obesity, diet, and physical activity: the SUECO study protocol / Impacto del entorno residencial/escolar en la obesidad, la dieta y la actividad física en población infantil: protocolo del estudio SUECO

Objective: The SUECO study examines the relationship between urban obesogenic environments and health outcomes among school-age children in the city of Madrid, Spain. We will study how features of the urban environment (related to the food- and the physical activity environment) associate with children's anthropometrics, eating habits, and physical activity levels. Method: We describe the study protocol of this multilevel study in a representative sample of school-age children in the city of Madrid (2017; n=5,961 children ages 3-12). Main outcome variables include anthropometrics (body mass index, waist circumference, and body fat), healthy and unhealthy consumption measures, and physical activity measures. The primary explanatory variables are grouped into food environment (e.g., unhealthy food retailers' density) and physical activity environment (e.g., walkability, physical activity opportunities) variable categories. Multilevel models will be used to calculate the associations between each indicator and obesity and physical inactivity. (AU)

Objetivo: El estudio SUECO evaluará la relación entre el entorno urbano obesogénico y los resultados en salud en la población infantil escolarizada en Madrid. El estudio explorará cómo influyen las características del entorno urbano (relacionadas con la alimentación y con la actividad física) en las variables antropométricas, los hábitos alimentarios y la actividad física. Método: Se presenta el protocolo de este estudio multinivel, realizado con una muestra representativa de población infantil escolarizada en la ciudad de Madrid (2017; n=5961 escolares de 3 a 12 años). Las principales variables de resultado incluyen antropometría (índice de masa corporal, circunferencia de cintura y porcentaje de grasa corporal), hábitos alimentarios (saludables y no saludables) y actividad física. Las principales variables independientes son contextuales (del entorno alimentario y del entorno de actividad física). Se utilizarán modelos de regresión multinivel para evaluar las asociaciones entre cada indicador contextual, la obesidad y la inactividad física. (AU)

Influence of home/school environments on children's obesity, diet, and physical activity: the SUECO study protocol.

OBJECTIVE: The SUECO study examines the relationship between urban obesogenic environments and health outcomes among school-age children in the city of Madrid, Spain. We will study how features of the urban environment (related to the food- and the physical activity environment) associate with children's anthropometrics, eating habits, and physical activity levels. METHOD: We describe the study protocol of this multilevel study in a representative sample of school-age children in the city of Madrid (2017; n=5,961 children ages 3-12). Main outcome variables include anthropometrics (body mass index, waist circumference, and body fat), healthy and unhealthy consumption measures, and physical activity measures. The primary explanatory variables are grouped into food environment (e.g., unhealthy food retailers' density) and physical activity environment (e.g., walkability, physical activity opportunities) variable categories. Multilevel models will be used to calculate the associations between each indicator and obesity and physical inactivity.

Evaluación de la efectividad y satisfacción de las pacientes tras miomectomía histeroscópica en consulta / Evaluation of effectiveness and patient satisfaction of hysteroscopic myomectomy in office

OBJETIVO: Analizar la efectividad de las miomectomías histeroscópicas en consulta realizadas con minirresector y conocer si hay factores relacionados con el grado de satisfacción de las pacientes. MÉTODO: Estudio observacional, transversal y prospectivo, de mujeres sometidas a miomectomía histeroscópica en consulta durante el año 2018. Las pacientes recibieron medicación para la preparación cervical, analgesia oral y anestesia paracervical. La miomectomía se realizó con un minirresector de 5.8 mm. Se registraron el tiempo y el dolor en una escala visual analógica (EVA) durante la entrada y la resección, así como la satisfacción de las pacientes a los 3 meses con el cuestionario validado CSQ-8. RESULTADOS: El estudio incluyó 59 pacientes. El tiempo medio de entrada fue menor de 1 minuto (47,93 segundos) y el de resección fue de 13,51 minutos. El dolor referido por las pacientes en la EVA durante la entrada y la resección puntuó en torno a 3 y 4, respectivamente. Se consiguió un 74.6% de resecciones completas de los miomas y la puntuación media de satisfacción de las pacientes fue de 27.17. La resección completa del mioma se asoció con una mayor satisfacción total de las pacientes. CONCLUSIONES: La miomectomía histeroscópica en consulta llevada a cabo con un minirresector de 5.8 mm con analgesia paracervical obtiene buenos resultados clínicos, con buena satisfacción de las pacientes. Esta última se relaciona con una resección completa del mioma, sin que influyan el tiempo necesario para su exéresis ni el dolor.

OBJECTIVE: To analyze the effectiveness of hysteroscopic myomectomy in office performed with mini-resectoscope, and to know if there is any variable related with patient satisfaction. METHOD: Observational and prospective transversal study, which included all women who underwent a hysteroscopic myomectomy in office in 2018. Patients received drugs for cervical preparation and pain management, as well as paracervical block. We used the 5.8 mm mini-resectoscope. We kept record of time and AVS pain during entrance and resection, as well as patient satisfaction 3 months after the procedure using the CSQ-8. RESULTS: The study included 59 patients. Mean entrance time was less than 1 minute (47.93 seconds), while mean resection time was 13.51 minutes. AVS pain during entrance and resection was around 3 and 4, respectively. We achieved 74.6% rate of complete resection. Mean patient satisfaction rate was 27.17 points. We found that a complete myoma resection is related to higher patient satisfaction. CONCLUSIONS: Hysteroscopic myomectomy in office performed with the 5.8 mm mini-resectoscope, using cervical block, achieves good clinical results and a good patient satisfaction. Patient satisfaction is associated with a complete resection of the myoma, without any influence of pain experienced or time required.

Association between sexual dysfunction and avulsion of the levator ani muscle after instrumental vaginal delivery.

INTRODUCTION: The effects of levator ani muscle (LAM) avulsion after instrumental delivery on the sexual function of patients are currently unknown. Therefore, the objective of our study was to use a validated questionnaire, namely, the Female Sexual Function Index (FSFI), to compare the sexual function in patients with and without LAM avulsion after instrumental vaginal delivery. MATERIAL AND METHODS: This was a prospective observational study of 112 primiparous women after instrumental (vacuum or forceps) vaginal delivery. The obstetric and general characteristics of the population were studied. At 6 months postpartum, the contraceptive method used and the occurrence of LAM avulsion (using four-dimensional transperineal ultrasound) were determined, and the FSFI was administered. RESULTS: A total of 100 patients (62 without avulsion and 38 with avulsion) completed the study. Thirty-eight (38%) were diagnosed with avulsion (42.1% after Kielland forceps delivery, 57.9% after Malmström vacuum delivery; P = .837). Women with LAM avulsion had significantly lower scores for desire (2.9 ± 1.2 vs 3.4 ± 1.1; P = .049), arousal (2.8 ± 1.7 vs 3.6 ± 1.4; P = .014), lubrication (2.3 ± 1.4 vs 3.0 ± 1.2; P = .011), orgasm (2.6 ± 1.6 vs 3.3 ± 1.2; P = .006) and satisfaction (3.1 ± 1.8 vs 3.9 ± 1.5; P = .051) than did women without LAM avulsion. The overall FSFI score was lower in patients with avulsion (16.7 ± 8.9 vs 20.7 ± 6.9, P = .033). These results were obtained after controlling for confounders (delivery mode, induced labor, birthweight, perineal tears, avulsion degree, contraceptive method and group assignment for the parent study) in the multivariate analysis (F = 4.974, P = .001). CONCLUSIONS: Patients with LAM avulsion present a higher degree of sexual dysfunction compared wiith patients without avulsion at 6 months after instrumental vaginal delivery.

Typical and atypical carcinoid tumors of the lung: a clinicopathological correlation of 783 cases with emphasis on histological features.

We present 783 surgical resections of typical and atypical carcinoid tumors of the lung identified in the pathology files of 20 different pathology departments. All cases were critically reviewed for clinical and pathological features and further correlated with clinical outcomes. Long-term follow-up was obtained in all the patients and statistically analyzed to determine significance of the different parameters evaluated. Of the histopathological features analyzed, the presence of mitotic activity of 4 mitoses or more per 2 mm2, necrosis, lymphatic invasion, and lymph node metastasis were identified as statistically significant. Tumors measuring 3 cm or more were also identified as statistically significant and correlated with clinical outcomes. Based on our analysis, we consider that the separation of low- and intermediate-grade neuroendocrine neoplasms of the lung needs to be readjusted in terms of mitotic count as the risk of overgrading these neoplasms exceeds 10% under the current criteria. We also consider that tumor size is an important feature to be considered in the assessment of these neoplasms and together with the histological grade of the tumor offers important features that can be correlated with clinical outcomes.

Pulmonary Adenofibromas: A Clinicopathologic Correlation of 13 Cases.

Thirteen cases of primary pulmonary adenofibromas are presented. The patients are 8 women and 5 men between the ages of 41 and 73 years (average: 57 y). The patients presented with nonspecific symptomatology or their tumor was identified during routine chest films. A wedge resection was performed in all cases with lymph node sampling. Grossly, the tumors varied in size from 1 to 2.5 cm in greatest dimension. The entire tumor was histologically evaluated in all cases. All the tumors shared similar histologic features namely leaf-like/phyllodes-like growth patterns with varying areas of sclerosis, focal inflammation, and entrapped epithelium. A wide panel of immunohistochemical studies was performed including epithelial, neural, muscle, and vascular markers, all of which showed negative staining. The tumors were positive only for vimentin in the stroma and keratin in the entrapped epithelium. Further evaluation in 6 cases using in situ hybridization for the solitary fibrous tumor was performed and was negative. Clinical follow-up in all the patients showed no evidence of recurrence or metastatic disease, during a period of 12 to 36 months. The current cases highlight the unusual occurrence of pulmonary adenofibromas and the importance of separating these tumors from other tumors that may have the potential to recur or metastasize. The use of proper immunohistochemical stains/molecular analysis aids in the proper classification of these tumors.

Building bridges between cellular and molecular structural biology.

The integration of cellular and molecular structural data is key to understanding the function of macromolecular assemblies and complexes in their in vivo context. Here we report on the outcomes of a workshop that discussed how to integrate structural data from a range of public archives. The workshop identified two main priorities: the development of tools and file formats to support segmentation (that is, the decomposition of a three-dimensional volume into regions that can be associated with defined objects), and the development of tools to support the annotation of biological structures.

Heridas en consultas de enfermería: ¿qué lesión genera más carga de trabajo? Estudio observacional urbano / Wounds in nursing consultations: what injury creates more work load? Urban observational study

Introducción: El deterioro de la integridad cutánea representa una parte importante de la carga de trabajo en las consultas de enfermería de atención primaria. Objetivo: Cuantificar el tipo de heridas que se tratan en la consulta a demanda. Determinar qué grupo genera mayor demanda asistencial. Cuantificar el tiempo empleado por enfermería en el cuidado de las heridas, en las consultas a demanda. Metodología: estudio observacional multicéntrico urbano y transversal, realizado en el ámbito de la atención primaria en la ciudad de Castellón de la Plana durante enero/febrero de 2015. Resultados: La población incluida en los cinco centros de salud participantes fue de 95 040 habitantes mayores de15 años. La participación de los profesionales de enfermería en la recogida de datos fue del 80,40%. Las heridas quirúrgicas representaron el 40,33%. Las heridas en extremidades inferiores, el 29%; las úlceras por presión, el 14,38%, y otras lesiones el 16,28%, siendo el número total de curas de 2420. La carga de trabajo representa el 39,22% de la consulta de enfermería. Discusión: La ausencia de bibliografía sobre el tema nos impide realizar comparaciones entre estudios. Lo publicado se centra en consultas de nueva creación o atención a heridas agudas en urgencias. Conclusiones: Las heridas quirúrgicas generan mayor demanda de atención, seguidas de las lesiones de las extremidades inferiores y de las heridas no englobadas en otras franjas de estudio. Las úlceras por presión generan menor demanda. Pero el tiempo real de atención es superior en las heridas de las extremidades inferiores, lo que genera una carga de trabajo efectiva superior a las heridas quirúrgicas

Introduction: The deterioration of the skin integrity represents an important part of the workload in the consultations in primary care nursing. Objective: to quantify the type of lesions of the skin integrity are retreated in consultation and determine which group generates higher welfare demand. Quantize the time spent by nurses in wound care, in consultations on demand Methodology: observational multicenter study urban and cross in the field of primary health care in the city of Castellón de la Plana during January/February 2015. Results: The population included in the 5 participating health centres was 95,040 population > 15 years. The participation of nurses in the collection of data was 80,40%. QX wounds they represented (40,33%) injuries in EE.II. (29 %), for pressure ulcers (14.38 %) and other injuries (16.28 %), being the total number of cures of 2,420.The workload represents the 39.22% of the nursing consultation. Discussion: The absence of references on the subject prevents us from comparisons between studies, as published focuses on queries of new creation or acute wounds in emergency care. Conclusions: Are surgical wounds which generate increased demand for care, followed by lesions of the BSII and wounds not included in otherstrips of study, being by pressure ulcers who generate lower demand

Association between sleep disordered breathing and aggressiveness markers of malignant cutaneous melanoma.

Some recent studies have shown an association between sleep disordered breathing (SDB) and cancer mortality and incidence but no study has focused on a specific type of cancer. The objective of this study was to analyse the relationship between the severity of SDB and factors related to cutaneous malignant melanoma (CMM) aggressiveness. We performed a multicentre observational study in 82 consecutive patients diagnosed with CMM. 56 patients in whom melanoma measurements were available were finally included in the study. Melanoma measurements of aggressiveness included: tumour mitotic rate, Breslow index, presence of ulceration, stage of disease and growth rate of melanoma. A sleep study was performed in all the included patients. Multivariate analyses were used to examine the independent relationship between SDB severity (apnoea-hypopnea index (AHI) and nocturnal oxygen desaturation indexes (ODI3% and ODI4%)) and measures of CMM aggressiveness. 60.7% of patients had SDB (AHI ≥ 5) and 14.3% severe obstructive sleep apnoea (AHI ≥ 30). In fully adjusted multivariate analyses, AHI (OR 1.08, 95% CI 1.02-1.14), ODI3% (OR 1.08, 95% CI 1.02-1.11) and ODI4% (OR 1.1, 95% CI 1.02-1.2) were independently associated with an increased melanoma growth rate. Furthermore, AHI, ODI4% and ODI3% were significantly correlated with other aggressiveness factors of CMM, such as Breslow index, presence of ulceration and mitotic index. SDB severity markers are associated with some aggressiveness markers of CMM.