Herlyn–Werner–Wünderlich syndrome: A case series / Síndrome de Herlyn-Werner-Wünderlich: una serie de casos

Introduction: Herlyn–Werner–Wünderlich syndrome is a uterine malformation characterized by uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. Clinical findings: The manifestation of the disease is widely diverse; it is usually diagnosed after menarche, with dysmenorrhea and abnormal uterine bleeding; it is also associated with infertility. Main diagnosis: Four clinical cases, their diagnosis are reported here. Therapeutic interventions and results: The treatment and results of these four patients are described here. Conclusion: When studying uterine malformation it is important to consider this rare disease to avoid possible complications and giving the patient a correct diagnose and treatment. The hysteroscopy resection of the longitudinal vaginal septum in those symptomatic patients with hematocolpos should be considered as a good option for treatment.(AU)

Introducción: El síndrome de Herlyn-Werner-Wünderlich es una malformación uterina que asocia útero didelfo, hemivagina obstruida total o parcialmente y agenesia renal ipsilateral. Hallazgos clínicos: La clínica que presenta este síndrome es muy diversa; se suele diagnosticar después de la menarquia cursando con dismenorrea y sangrado uterino anómalo; así mismo se asocia a infertilidad. Diagnósticos principales: Se presentan a continuación 4 casos clínicos, su diagnóstico y tratamiento mediante diversas técnicas. Intervenciones terapéuticas y resultados: Se describen en este manuscrito los tratamientos aplicados a estas pacientes y sus resultados. Conclusión: Ante el hallazgo de una malformación uterina es importante tener en cuenta esta entidad infrecuente, para evitar posibles complicaciones y proporcionar a la paciente un diagnóstico y tratamiento correctos. La resección histeroscópica del tabique vaginal longitudinal en aquellas pacientes sintomáticas con hematocolpos debe ser considerada como una buena opción de tratamiento.(AU)

Response to azacitidine in patients with chronic myelomonocytic leukemia according to overlap myelodysplastic/myeloproliferative neoplasms criteria.

BACKGROUND: Azacitidine (AZA) is approved for the treatment of high-risk chronic myelomonocytic leukemia (CMML) of myelodysplastic (MD) subtype. Data of response rates using the specific response criteria for this disease are scarce. The aim of this study was to evaluate the response to AZA in patients diagnosed with CMML from the Spanish Registry of Myelodysplastic Syndromes (MDS) applying the overlap myelodysplastic/myeloproliferative neoplasms (MDS/MPN) response criteria. METHODS: We retrospectively studied 91 patients with CMML treated with at least one cycle of AZA from the Spanish Registry of MDS. As it was a real-world study, the response rate was evaluated between cycle 4 and 6, applying the MDS/MPN response criteria FINDINGS: The overall response rate at cycle 4-6 was 58%. Almost half of the patients achieved transfusion independence and one quarter showed clinical benefit, regardless of the CMML French-American-British (FAB) and World Health Organization (WHO) subtypes and CMML Specific Prognosis Scoring (CPSS) risk groups. Toxicity was higher in the MD-CMML subtype. INTERPRETATION: In our series, most CMML patients achieved an overall response rate with AZA according to the overlap-MDS/MPN response criteria regardless of the CMML FAB and WHO subtypes and CPSS risk groups. Thus, AZA may also be a treatment option for patients with the myeloproliferative CMML subtype and those with a lower-risk CPSS, but symptomatic.

Valoración del estado Nutricional en enfermos mentales institucionalizados / Assessing nutritional status in institutionalized mental patients

Introducción y objetivos: la malnutrición continúa siendo un problema no reconocido en los centros psiquiátricos. El objetivo del presente estudio fue conocer la prevalencia de la malnutrición y reconocer la importancia de la dieta en la alimentación de los enfermos mentales. Métodos: se evaluó el estado Nutricional de 65 pacientes mediante medidas antropométricas (peso, talla, índice de masa corporal, pliegue cutáneo tricipital, pliegue cutáneo bicipital, pliegue cutáneo subescapular, pliegue cutáneo suprailíaco, pliegue cutáneo tibial, pliegue cutáneo abdominal, índice cintura-cadera, circunferencia de la cadera y circunferencia de la cintura), analíticas (ferritina, triglicéridos, albúmina, colesterol, glucosa), otras variables (presión arterial), el cuestionario MNA-2009 y el menú de una semana. De cada paciente, además, se registraron datos personales, sexo, hábito tabáquico, edad, tipo de enfermedad, actividad física, visitas familiares y las variables enmarcadas en el cuestionario MNA-2009. Resultados: la muestra estuvo formada por 13 mujeres y 52 hombres, todos ellos enfermos mentales de una institución psiquiátrica. El 43,1 % presentaban sobrepeso y el 21,5 % obesidad, siendo estos índices superiores en las mujeres que en los hombres. Respecto a los valores bioquímicos, se observó que los niveles de triglicéridos y colesterol eran superiores a los valores recomendados. Además, los sujetos presentaron un gran desequilibrio en macronutrientes y micronutrientes en la valoración Nutricional diaria. Conclusión: en este estudio se ha demostrado la gran prevalencia de la malnutrición en los pacientes psiquiátricos, en concreto de la obesidad por el gran exceso que presentan cada uno de los macronutrientes y micronutrientes repartidos en el menú durante el día de los pacientes psiquiátricos (AU)

Introduction and objectives: malnutrition remains an unrecognised problem in psychiatric centers. The aim of the present study was to find out the prevalence of malnutrition and to recognize the importance of diet in the nutrition of the mentally ill. Methods: the nutritional status of 65 patients was assessed by anthropometric measurements (weight, height, body mass index, tricipital skin fold, bicipital skin fold, subscapular skin fold, suprailiac skin fold, tibial skin fold, abdominal skin fold, waist-hip index, hip circumference and waist circumference), blood tests (ferritin, triglycerides, albumin, cholesterol, glucose), other variables (blood pressure), the MNA-2009 questionnaire, and the one-week menu. Personal data, sex, smoking habits, age, type of disease, physical activity, family visits and the variables included in the MNA-2009 questionnaire were also recorded for each patient. Results: the sample consisted of 13 women and 52 men, all of whom were mentally ill patients in a psychiatric institution. A total of 43.1 % were overweight and 21.5 % obese, with more women than men in each category. Regarding biochemical values, it was observed that triglyceride and cholesterol levels were higher than recommended values. In addition, they presented a great imbalance in macronutrients and micronutrients in the daily nutritional assessment. Conclusion: this study has demonstrated the high prevalence of malnutrition in psychiatric patients, in particular obesity, due to the large excess of each of the macronutrients and micronutrients in the daily menu of psychiatric patients (AU)

Different methylation signatures at diagnosis in patients with high-risk myelodysplastic syndromes and secondary acute myeloid leukemia predict azacitidine response and longer survival.

BACKGROUND: Epigenetic therapy, using hypomethylating agents (HMA), is known to be effective in the treatment of high-risk myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) patients who are not suitable for intensive chemotherapy and/or allogeneic stem cell transplantation. However, response rates to HMA are low and there is an unmet need in finding prognostic and predictive biomarkers of treatment response and overall survival. We performed global methylation analysis of 75 patients with high-risk MDS and secondary AML who were included in CETLAM SMD-09 protocol, in which patients received HMA or intensive treatment according to age, comorbidities and cytogenetic. RESULTS: Unsupervised analysis of global methylation pattern at diagnosis did not allow patients to be differentiated according to the cytological subtype, cytogenetic groups, treatment response or patient outcome. However, after a supervised analysis we found a methylation signature defined by 200 probes, which allowed differentiating between patients responding and non-responding to azacitidine (AZA) treatment and a different methylation pattern also defined by 200 probes that allowed to differentiate patients according to their survival. On studying follow-up samples, we confirmed that AZA decreases global DNA methylation, but in our cohort the degree of methylation decrease did not correlate with the type of response. The methylation signature detected at diagnosis was not useful in treated samples to distinguish patients who were going to relapse or progress. CONCLUSIONS: Our findings suggest that in a subset of specific CpGs, altered DNA methylation patterns at diagnosis may be useful as a biomarker for predicting AZA response and survival.

miR-146a rs2431697 identifies myeloproliferative neoplasm patients with higher secondary myelofibrosis progression risk.

Myelofibrosis (MF) occurs as part of the natural history of polycythemia vera (PV) and essential thrombocythemia (ET), and remarkably shortens survival. Although JAK2V617F and CALR allele burden are the main transformation risk factors, inflammation plays a critical role by driving clonal expansion toward end-stage disease. NF-κB is a key mediator of inflammation-induced carcinogenesis. Here, we explored the involvement of miR-146a, a brake in NF-κB signaling, in MPN susceptibility and progression. rs2910164 and rs2431697, that affect miR-146a expression, were analyzed in 967 MPN (320 PV/333 ET/314 MF) patients and 600 controls. We found that rs2431697 TT genotype was associated with MF, particularly with post-PV/ET MF (HR = 1.5; p < 0.05). Among 232 PV/ET patients (follow-up time=8.5 years), 18 (7.8%) progressed to MF, being MF-free-survival shorter for rs2431697 TT than CC + CT patients (p = 0.01). Multivariate analysis identified TT genotype as independent predictor of MF progression. In addition, TT (vs. CC + CT) patients showed increased plasma inflammatory cytokines. Finally, miR-146a-/- mice showed significantly higher Stat3 activity with aging, parallel to the development of the MF-like phenotype. In conclusion, we demonstrated that rs2431697 TT genotype is an early predictor of MF progression independent of the JAK2V617F allele burden. Low levels of miR-146a contribute to the MF phenotype by increasing Stat3 signaling.

Longitudinal associations of active renal disease with irreversible organ damage accrual in systemic lupus erythematosus.

OBJECTIVE: To examine longitudinal associations of active lupus nephritis with organ damage accrual in patients with systemic lupus erythematosus (SLE). METHODS: This study was performed using data from a large multinational prospective cohort. Active lupus nephritis at any visit was defined by the presence of urinary casts, proteinuria, haematuria or pyuria, as indicated by the cut-offs in the SLE Disease Activity Index (SLEDAI)-2K, collected at each visit. Organ damage accrual was defined as a change of SLICC-ACR Damage Index (SDI) score >0 units between baseline and final annual visits. Renal damage accrual was defined if there was new damage recorded in renal SDI domains (estimated glomerular filtration rate <50%/proteinuria >3.5 g per 24 h/end-stage kidney disease). Time-dependent hazard regression analyses were used to examine the associations between active lupus nephritis and damage accrual. RESULTS: Patients (N = 1735) were studied during 12,717 visits for a median (inter-quartile range) follow-up period of 795 (532, 1087) days. Forty per cent of patients had evidence of active lupus nephritis at least once during the study period, and active lupus nephritis was observed in 3030 (24%) visits. Forty-eight per cent of patients had organ damage at baseline and 14% accrued organ damage. Patients with active lupus nephritis were 52% more likely to accrue any organ damage compared with those without active lupus nephritis (adjusted hazard ratio = 1.52 (95% confidence interval (CI): 1.16, 1.97), p < 0.02). Active lupus nephritis was strongly associated with damage accrual in renal but not in non-renal organ domains (hazard ratios = 13.0 (95% CI: 6.58, 25.5) p < 0.001 and 0.96 (95% CI: 0.69, 1.32) p = 0.8, respectively). There was no effect of ethnicity on renal damage accrual, but Asian ethnicity was significantly associated with reduced non-renal damage accrual. CONCLUSION: Active lupus nephritis measured using the SLEDAI-2K domain cut-offs is associated with renal, but not non-renal, damage accrual in SLE.

Effect of the reaction medium on the characteristics of silanized titanium dioxide particles: Differences obtained in the Zeta potential data and infrared spectra.

In this document we present the differences in the Zeta potential and in the Infrared spectra data obtained from the characterization of silanized titanium dioxide particles, using two different solvents as reaction media: ethanol and toluene. Also, we provide micrographs of transmission electron microscopy in order to show morphological differences between the analyzed samples.

Frequency and clinical impact of CDKN2A/ARF/CDKN2B gene deletions as assessed by in-depth genetic analyses in adult T cell acute lymphoblastic leukemia.

Recurrent deletions of the CDKN2A/ARF/CDKN2B genes encoded at chromosome 9p21 have been described in both pediatric and adult acute lymphoblastic leukemia (ALL), but their prognostic value remains controversial, with limited data on adult T-ALL. Here, we investigated the presence of homozygous and heterozygous deletions of the CDKN2A/ARF and CDKN2B genes in 64 adult T-ALL patients enrolled in two consecutive trials from the Spanish PETHEMA group. Alterations in CDKN2A/ARF/CDKN2B were detected in 35/64 patients (55%). Most of them consisted of 9p21 losses involving homozygous deletions of the CDKNA/ARF gene (26/64), as confirmed by single nucleotide polymorphism (SNP) arrays and interphase fluorescence in situ hybridization (iFISH). Deletions involving the CDKN2A/ARF/CDKN2B locus correlated with a higher frequency of cortical T cell phenotype and a better clearance of minimal residual disease (MRD) after induction therapy. Moreover, the combination of an altered copy-number-value (CNV) involving the CDKN2A/ARF/CDKN2B gene locus and undetectable MRD (≤ 0.01%) values allowed the identification of a subset of T-ALL with better overall survival in the absence of hematopoietic stem cell transplantation.

Computer vision-based analytical chemistry applied to determining iron in commercial pharmaceutical formulations.

Two different computer vision-based analytical chemistry (CVAC) methods were developed to quantify iron in the commercial pharmaceutical formulations Ferbisol® and Ferro sanol®. The methods involve using a digital camera or a desktop scanner to capture a digital image of a series of Fe2+ standard solutions and the unknown sample upon reaction with o-phenanthroline. The images are processed with appropriate software (e.g., the public domain programme ImageJ, from NIH) to obtain a numerical value (analytical signal) based on colour intensity. The fact that such a value is proportional to the analyte concentration allows one to construct a calibration graph from the standards and interpolate the value for the sample in order to determine its concentration. The results thus obtained were compared with those provided by a spectrophotometric method and the US Pharmacopoeia's recommended method. The differences never exceeded 2%. The two proposed methods are simple and inexpensive; also, they provide an effective instrumental alternative to spectrophotometric methods which can be especially beneficial in those cases where purchasing and maintaining a spectrophotometer is unaffordable.

Metabolomic analysis of heat-hardening in adult green-lipped mussel (Perna canaliculus): A key role for succinic acid and the GABAergic synapse pathway.

We evaluated the thermotolerance (LT50) of adult green-lipped mussels (Perna canaliculus) following an acute thermal challenge in the summer of 2012 and the winter of 2013. Mussels were grouped into two treatments, naïve (N, no prior heat treatment) and heat-hardened (HH = 1 h at 29 °C, 12 h recovery at ambient) before being immersed for 3 h in water of varying temperature, i.e. Ambient (Control), 25, 29, 31, 33, and 35 °C with subsequent mortality monitored for 30 days. As expected, naïve mussels were less thermotolerant than heat-hardened i.e. Summer LT50, N = 31.9, HH = 33.5 °C; Winter LT50, N = 31.4, HH = 33.8 °C. Moreover, at 33 °C no heat-hardened mussels died compared to 100% mortality in naïve specimens. At 35 °C all mussels died regardless of treatment. For the 'Summer' mussels, metabolite abundances in gill tissues of both naïve and heat-hardened mussels were quantified. For mussels at 33 °C, succinic acid was significantly higher in naïve mussels than heat-hardened mussels, indicating perturbations to mitochondrial pathways in these thermally stressed mussels. Additionally, analysis of biochemical pathway activity suggested a loss of neural control i.e. significantly reduced GABAergic synapse activity, in naïve vs. heat-hardened mussels at 33 °C. Taken together these findings suggest that heat-hardening improves mussel survival at higher temperatures by delaying the onset of cellular anaerobic metabolism, and by maintaining inhibition of neural pathways. Such results offer new perspectives on the complex suite of sub-cellular stress responses operating within thermally stressed organisms.

QSPR studies on the photoinduced-fluorescence behaviour of pharmaceuticals and pesticides.

Fluorimetric analysis is still a growing line of research in the determination of a wide range of organic compounds, including pharmaceuticals and pesticides, which makes necessary the development of new strategies aimed at improving the performance of fluorescence determinations as well as the sensitivity and, especially, the selectivity of the newly developed analytical methods. In this paper are presented applications of a useful and growing tool suitable for fostering and improving research in the analytical field. Experimental screening, molecular connectivity and discriminant analysis are applied to organic compounds to predict their fluorescent behaviour after their photodegradation by UV irradiation in a continuous flow manifold (multicommutation flow assembly). The screening was based on online fluorimetric measurement and comprised pre-selected compounds with different molecular structures (pharmaceuticals and some pesticides with known 'native' fluorescent behaviour) to study their changes in fluorescent behaviour after UV irradiation. Theoretical predictions agree with the results from the experimental screening and could be used to develop selective analytical methods, as well as helping to reduce the need for expensive, time-consuming and trial-and-error screening procedures.

Possible involvement of orphan receptors GPR88 and GPR124 in the development of hypertension in spontaneously hypertensive rat.

Hypertension (HBP) is a chronic disease characterized by increased blood pressure, which despite several treatments maintains a high morbi-mortality, which suggests that there are other mechanisms involved in this pathology, within which the orphan receptors could be candidates for the treatment of the HBP; these receptors are called orphan receptors because their ligand is unknown. These receptors have been suggested to participate in some pathologies because they are associated with various systems such as GPR88, which has been linked to the dopaminergic system, and GPR124 with angiogenesis, suggesting that these receptors could take part in HBP. Hence, the aim of this work was to study the expression of orphan receptors GPR88 and GPR124 in various tissues of normotensive and hypertensive rats. We used Wistar Kyoto (WKY) and spontaneously hypertensive rat (SHR) of 6-8 and 10-12 weeks of age and we determined systolic blood pressure (SBP), heart rate, as well as mRNA of GPR88 and GPR124 receptors by reverse transcription polymerase chain reaction (RT-PCR) in the aorta, heart, kidney, and brain. Our results showed that GPR88 and GPR124 were expressed in all analyzed tissues, but their expression is dependent on the age and development of HBP because their expression tends to be modified as HBP is established. Therefore, we conclude that GPR88 and GPR124 receptors may be involved in the development or maintenance of high blood pressure.

An insight into the antibiofilm properties of Costa Rican stingless bee honeys.

OBJECTIVE: There is an increasing search for antibiofilm agents that either have specific activity against biofilms or may act in synergy with antimicrobials. Our objective is to examine the the antibiofilm properties of stingless bee honeys. METHOD: Meliponini honeys from Costa Rica were examined along with Medihoney as a reference. All honeys were submitted to a screening composed of minimum inhibitory concentration, inhibition of biofilm formation and biofilm destruction microplate-based assays against a Staphylococcus aureus biofilm forming strain. Dialysis led to the isolation of an antibiofilm fraction in Tetragonisca angustula honeys. The honey antibiofilm fraction was evaluated for protease activity and for any synergistic effect with antibiotics on a Staphylococcus aureus biofilm. The active fraction was then separated through activity guided isolation techniques involving SDS-PAGEs, anion exchange and size exclusion fast protein liquid chromatographies. The fractions obtained and the isolated antibiofilm constituents were tested for amylase and DNase activity. RESULTS: A total of 57 Meliponini honeys from Costa Rica were studied in this research. The honeys studied belonged to the Tetragonisca angustula (n=36) and Melipona beecheii (n=21) species. Costa Rican Tetragonisca angustula honeys can inhibit the planktonic growth, biofilm formation, and are capable of destroying a Staphylococcus aureus biofilm. The antibiofilm effect was observed in the protein fraction of Tetragonisca angustula honeys. The biofilm destruction proteins allowed ampicillin and vancomycin to recover their antimicrobial activity over a Staphylococcus aureus biofilm. The antibiofilm proteins are of bee origin, and their activity was not due to serine, cysteine or metalloproteases. There were 2 proteins causing the antibiofilm action; these were named the Tetragonisca angustula biofilm destruction factors (TABDFs). TABDF-1 is a monomeric protein of approximately 50kDa that is responsible of the amylase activity of Tetragonisca angustula honeys. TABDF-2 is a protein monomer of approximately 75kDa. CONCLUSION: Tetragonisca angustula honeys from Costa Rica are a promising candidate for research and development of novel wound dressings focused on the treatment of acute and chronic Staphylococcus aureus biofilm wound infections.

Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or HIV/Hepatitis C Virus Coinfection.

BACKGROUND: It has been suggested that routine CD4 cell count monitoring in human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads and CD4 cell counts >300 cell/µL could be reduced to annual. HIV/hepatitis C virus (HCV) coinfection is frequent, but evidence supporting similar reductions in CD4 cell count monitoring is lacking for this population. We determined whether CD4 cell count monitoring could be reduced in monoinfected and coinfected patients by estimating the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression. METHODS: The PISCIS Cohort study included data from 14 539 patients aged ≥16 years from 10 hospitals in Catalonia and 2 in the Balearic Islands (Spain) since January 1998. All patients who had at least one period of 6 months of continuous HIV suppression were included in this analysis. Cumulative probabilities with 95% confidence intervals were calculated using the Kaplan-Meier estimator stratified by the initial CD4 cell count at the period of continuous suppression initiation. RESULTS: A total of 8695 patients were included. CD4 cell counts fell to <200 cells/µL in 7.4% patients, and the proportion was lower in patients with an initial count >350 cells/µL (1.8%) and higher in those with an initial count of 200-249 cells/µL (23.1%). CD4 cell counts fell to <200 cells/µL in 5.7% of monoinfected and 11.1% of coinfected patients. Of monoinfected patients with an initial CD4 cell count of 300-349 cells/µL, 95.6% maintained counts ≥200 cells/µL. In the coinfected group with the same initial count, this rate was lower, but 97.6% of coinfected patients with initial counts >350 cells/µL maintained counts ≥200 cells/µL. CONCLUSIONS: From our data, it can be inferred that CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts >300 cells/µL and HIV/HCV-coinfected patients with counts >350 cells/µL.

[The two faces of veno-arteriolar reflex: cutaneous vasodilatation and vasoconstriction to raise and to lower the arm]. / Las dos caras del reflejo venoarteriolar: vasoconstriccion y vasodilatacion cutanea al bajar y subir el brazo.

INTRODUCTION: The veno-arteriolar reflex (VAR) is triggered by an increase in the transmural venous pressure on placing a part of the body in the same direction as the gravitational acceleration below the heart. AIM: To assess the VAR in healthy subjects on raising a part of the body above the level of the heart. SUBJECTS AND METHODS: VAR was studied in 16 healthy subjects (20-65 years old) by means of changes in the blood flow in the skin detected using a digital infrared photoplethysmograph attached to the fingertip under the following conditions: right arm at the height of the heart, right arm below the heart and right arm below the level of the heart. The variables measured were: amplitude of the blood flow in the skin with the arm raised to the height of the heart (baseline amplitude), percentage decrease of the blood flow in the skin with the arm below the heart and percentage increase in blood flow with the arm above the heart. RESULTS: The percentage of vasoconstriction with the right arm below the heart was 35%, and that of vasodilation, 50%. CONCLUSIONS: Evaluation of the VAR with the arm below the heart causes vasoconstriction, and elevation of the arm causes an important degree of vasodilation. Vasoconstriction and vasodilation are maintained while the limb is kept above or below the heart. This is an economical and potentially very useful way of studying the innervation of the microcirculation in a number of different peripheral neuropathies of thin and mixed fibres.

TITLE: Las dos caras del reflejo venoarteriolar: vasoconstriccion y vasodilatacion cutanea al bajar y subir el brazo.Introduccion. El reflejo venoarteriolar (RVA) lo provoca un incremento en la presion venosa transmural al colocar una parte del cuerpo en el sentido de la aceleracion gravitatoria por debajo del corazon. Objetivo. Evaluar el RVA en sujetos sanos al levantar una parte del cuerpo por encima del corazon. Sujetos y metodos. En 16 sujetos sanos (20-65 años) se estudio el RVA mediante cambios en el flujo sanguineo de la piel con un fotopletismografo digital infrarrojo colocado en el pulpejo en sujetos sanos durante las siguientes condiciones: brazo derecho a la altura del corazon, brazo derecho 40 cm por debajo del corazon y brazo derecho 40 cm por encima del corazon. Las variables medidas fueron: amplitud del flujo sanguineo de la piel con el brazo a la altura del corazon (amplitud basal), porcentaje de disminucion del flujo sanguineo de la piel con el brazo por debajo del corazon y porcentaje de aumento del flujo sanguineo de la piel con el brazo por encima del corazon. Resultados. El porcentaje de vasoconstriccion con el brazo derecho por debajo del corazon fue del 35%, y el de vasodilatacion, del 50%. Conclusiones. La evaluacion del RVA con el brazo por debajo del corazon provoca vasoconstriccion, y la elevacion del brazo produce una importante vasodilatacion. La vasoconstriccion y la vasodilatacion se mantienen mientras la extremidad se mantenga por encima o por debajo del corazon. Este es un estudio potencialmente muy util y economico para estudiar la inervacion de la microcirculacion en diversas neuropatias perifericas de fibras delgadas y mixtas.

Bergeyella porcorum sp. nov., isolated from pigs.

Four Gram-stain-negative, catalase- and oxidase-positive, bacillus-shaped bacterial isolates were recovered from the lungs and tonsils of four pigs. Based on cellular morphology and biochemical criteria the isolates were tentatively assigned to the genus Bergeyella, although the organisms did not appear to correspond with Bergeyella zoohelcum, the only validly named species of this genus. 16S rRNA gene sequencing demonstrated that isolates represented a distinct subline within the genus Bergeyella with <97%. 16S rRNA gene sequence similarity with B. zoohelcum ATCC 43767(T). The predominant cellular fatty acids of strain 1350-03(T) were iso-C15:0 and iso-C17:0 3-OH and the major quinone was MK-6. The DNA G+C content of strain 1350-03(T) was 37.7mol%. The novel isolates can be phenotypically distinguished from B. zoohelcum based on physiological traits. On the basis of both phenotypic and phylogenetic findings, we describe a new species of the genus Bergeyella for which we propose the name of Bergeyella porcorum sp. nov. (1350-03(T)=CCUG 67887(T)=CECT 9006(T)).

A Case Report: Pseudoangiomatous Stromal Hyperplasia Tumor Presenting as a Palpable Mass.

We report a case of woman with a palpable lump on her left breast. On mammography, a huge mass located between the inner and the outer inferior breast quadrants of the left breast was found. The ultrasound examination realized later revealed a heterogeneous mass with smooth and lobulated borders. An MRI was also performed, showing an oval mass with heterogeneous areas of enhancement. Finally, a core biopsy under sonographic guidance revealed a pseudoangiomatous stromal hyperplasia of the breast.

Impacto de los subtipos intrínsecos del cáncer de mama en la predicción de metástasis en los ganglios axilares / Impact of intrinsic subtypes of breast cancer in predicting axillary node metastases

Resumen: Introducción: Observamos que el compromiso axilar es uno de los factores de pronóstico más importantes. Aunque la asociación entre el compromiso axilar y el tamaño tumoral ha sido estudiada en varias series, la relación del subtipo según la inmunohistoquímica (IHQ) para predecir compromiso axilar, no es muy conocida. El objetivo de este estudio es correlacionar los subtipos intrínsecos según la IHQ con la afectación axilar. Como objetivos secundarios evaluamos la sobrevida global y libre de enfermedad. Material y métodos: Se incluyeron en este estudio 1.413 pacientes operadas en forma consecutiva en el Hospital Italiano de Buenos Aires con diagnóstico de cáncer de mama primario (se excluyeron los estadios IV) entre los años 2007 y 2012. Fueron analizados los datos clínicos y patológicos de las pacientes que realizaron la biopsia del ganglio centinela o la linfadenectomía axilar. Los subtipos se clasificaron en cuatro grupos según la IHQ: luminal A (RE+, RP+, HER–, Ki67 <15%); luminal B (RE+, RP+, HER+, Ki67 >14%); HER2 (RE–, RP–, HER+); y triple negativo (RE–, RP–, HER–). Resultados: Evaluamos 1.413 pacientes de las cuales se analizaron 1.248 casos, donde 386 casos (31%) mostraron metástasis en los ganglios axilares. Tomando como referencia al grupo luminal A encontramos que la presencia de compromiso axilar es significativo en aquellos subtipos luminal B y HER (p<0,0001), no así en el subtipo TN (p=0,4468). Mediante un modelo de regresión logística múltiple se evaluó la probabilidad de compromiso axilar ajustado por cada uno de los diferentes subtipos tumorales, tamaño tumoral. En aquellos tumores menores de 2 cm observamos que los tumores luminal B y los TN aumentan el riesgo de compromiso axilar con un OR=2,73 (95% IC: 1,73-4,31; p>0,000), y un OR=2,05 (95% IC: 1,13-3,70; p=0,017), respectivamente, y los tumores HER2 aumentan el riesgo con un OR=6,62 (95% IC: 3,02-14,50; p>0,000).