Autofluorescent Cancer Stem Cells: Potential Biomarker to Predict Recurrence in Resected Colorectal Tumor.

Cancer stem cells (CSCs) in colorectal cancer (CRC) drive intratumoral heterogeneity and distant metastases. Previous research from our group showed that CSCs can be easily detected by autofluorescence (AF). The aim of the present study was to evaluate the potential role of AF CSCs as a prognostic biomarker for CRC relapse. Seventy-five freshly-resected tumors were analyzed, by flow cytometry. AF was categorized as high (H-AF) or low (L-AF), and results were correlated with histological features (grade of differentiation, presence of metastases in lymph nodes (LN), perivascular and lymphovascular invasion) and clinical variables (time to relapse and overall survival). Nineteen out of 75 (25.3%) patients experienced relapse (local or distant), 13 out of these 19 patients showed positive LNs and 6 patients had H-AF. Of note, 4 of them died before 5 years. While patients with H-AF CSCs percentages in the global population experienced 1.5 times increased relapse -HR 1.47, CI 95% (0.60 - 3.63), patients with H-AF CSC percentages and LN metastases had the highest risk of relapse; HR 7.92, p< 0.004, CI 95% (1.97 - 31.82). These data support AF as an accurate and feasible marker to identify CSCs in resected CRC. A strong statistical association between H-AF CSCs and the risk of relapse was observed, particularly in patients with positive LNs, suggesting that H-AF patients might benefit from adjuvant chemotherapy regimens and intensive surveillance due to their high propensity to experience disease recurrence.

[Transanal resection using a single port trocar: a new approach to NOTES]. / Resección transanal a través de un trocar monopuerto. Una nueva aproximación al NOTES.

INTRODUCTION: The morbidity and mortality, along with the functional changes that arise from radical surgery of rectal cancer, has led to an increasing interest in local treatment in the early stages of cancer of the rectum. Conventional transanal surgery has a high recurrence rate, for this reason transanal endoscopic microsurgery (TEM) is considered the treatment of choice in the last few years in large rectal adenomas and in early rectal cancer (low risk T1). PATIENTS AND METHOD: We have intervened five patients, four with a diagnosis of villous adenoma of the rectum, and one in situ rectal carcinoma, using this new transanal approach, with a single port device. RESULTS: The locations of the lesions were in the mid-rectum, at a mean distance of 9 cm (range 6-10) from the anal margin. All of them were situated in the posterior side. The resection margins were negative in all cases. The mean size of the adenomas was 4 cm, three being sessile shaped, and one with a short, thick pedicle (>1cm); the size of the carcinoma was 3 cm. The mean surgical time was 55 minutes. All the patients were discharged 48 hours after the surgical procedure. CONCLUSION: We believe that the transanal endoscopic approach with a single port device is a simple, easily reproducible and cost-effective procedure when compared to TEM.

Feasible Use of Recycled Concrete Aggregates with Alumina Waste in Road Construction.

The management of different industrial by-products, such as recycled aggregates from construction and demolition waste and alumina by-products, as well as the reduction of landfill deposits by incorporating these products in a second life cycle, were the focus of this work. The aim of this study was to demonstrate the technical viability of using these waste and by-product as a material for road pavement base layers. For this purpose, a real-scale application was carried out, and the behavior of three types of materials, applied on a section of an experimental road under real vehicle traffic conditions, was studied and compared. Three materials were used in these sections applied in the road sub-bases. First, a control material composed of a type of artificial gravel was used to be compared with the rest of materials; the second material was composed of recycled aggregates, and the third was composed of a mix of recycled aggregates and alumina waste. The results concluded that the effectiveness of the sections built using recycled aggregates and alumina waste was very positive and similar those constructed using natural aggregates.

Improvement of Bearing Capacity in Recycled Aggregates Suitable for Use as Unbound Road Sub-Base.

Recycled concrete aggregates and mixed recycled aggregates are specified as types of aggregates with lower densities, higher water absorption capacities, and lower mechanical strength than natural aggregates. In this paper, the mechanical behaviour and microstructural properties of natural aggregates, recycled concrete aggregates and mixed recycled aggregates were compared. Different specimens of unbound recycled mixtures demonstrated increased resistance properties. The formation of new cement hydrated particles was observed, and pozzolanic reactions were discovered by electronon microscopy in these novel materials. The properties of recycled concrete aggregates and mixed recycled aggregates suggest that these recycled materials can be used in unbound road layers to improve their mechanical behaviour in the long term.

Beta-blocker use is associated with fragility fractures in postmenopausal women with coronary heart disease.

BACKGROUND AND AIMS: An association between cardiovascular disease and osteoporosis is described. A number of drugs often used by patients with coronary heart disease, such as thiazides, statins and beta-blockers, have shown controversial effects on bone. 1) To study the possible association between coronary heart disease (CHD) and bone mass density (BMD), quantitative ultrasound measurements (QUS) and the prevalence of fragility and vertebral fractures. 2) To study the possible influence of a number of drugs, statins, thiazides and beta-blockers, on BMD and fractures. METHODS: Case-control study performed on 74 postmenopausal women who had recently suffered from CHD, and 111 age-matched controls. BMD was measured by Dual X-Ray Absorptiometry (DXA) at the lumbar spine and proximal femur. Quantitative Ultrasound (QUS) was also measured at the heel. Vertebral fractures were diagnosed by lateral, thoracic and lumbar X-rays. The occurrence of non-vertebral fractures was determined by examination of medical records. RESULTS: Patients with CHD had higher values of BMI. They had a higher prevalence of arterial hypertension and hyperlipidemia, and consequently higher consumption of beta-blockers and statins, but not of thiazides, and had lower alcohol consumption. Patients with CHD had higher BMD values, measured by DXA at the proximal femur, than controls, but there were no differences in DXA values at the lumbar spine or QUS at the heel between the two groups. The prevalence of all fragility factures was slightly higher in patients with CHD, but not to a significant extent. The prevalence of vertebral fractures was similar in the two groups. In a logistic analysis to identify factors associated with all fractures, beta-blockers were positively associated with fragility fractures, and DXA at the femoral neck was inversely associated with fragility fractures. CONCLUSIONS: Postmenopausal women with CHD have higher values of BMD at the proximal femur but, despite this, show a slight but non-significant increase in the prevalence of fragility fractures. Beta-blockers are independently associated with fragility fractures, but thiazides and statins are not.

Características del neumoperitoneo por neumatosis quística intestinal / Characteristics of pneumoperitoneum due to intestinal cystic pneumatosis

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Bone mineral density and risk of fractures in aging, obese post-menopausal women with type 2 diabetes. The GIUMO Study.

BACKGROUND AND AIMS: Type 2 diabetes mellitus (DM) has a high prevalence in aging obese postmenopausal women. It is not clear whether or not diabetes produces an increase in bone mineral density or an increase in fracture rates. OBJECTIVE: The main objective of this study was to investigate whether type 2 DM produces a higher prevalence of vertebral, hip and non-vertebral fractures in obese postmenopausal Caucasian women. A secondary objective was to study the influence of DM in quantitative ultrasound measurements of the heel (QUS) and bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA), in both lumbar spine (L2-L4) and proximal femur. METHOD: This study was a prospective cohort of 111 patients with type 2 DM and 91 control individuals (CTR) over age 65 and obese, recruited from 16 centers in Spain. MAIN OUTCOME MEASURES: Lateral dorsal and lumbar X-rays were performed to assess vertebral fractures. Hip and non-vertebral fractures were noted from medical records, written reports or Xray studies. QUS measurements were made of the calcaneus and BMD measurements of the lumbar spine (L2-L4) and proximal femur. RESULTS: Patients had higher BMD in the lumbar spine (L2-L4) than controls (0.979 g/cm2 vs 0.927 g/cm2, p=0.035), but we found no statistically significant differences in the proximal femur. QUS measurements showed similar values in both groups: BUA (69.3 dB/Mhz vs 66.7 dB/Mhz, p=0.291), SOS (1537 m/sg vs 1532 m/sg, p=0.249) and QUI (87.5 vs 83.7, p=0.153). No statistically significant differences were found in any case. There was no association between vertebral, hip and non-vertebral fractures and DM. The crude odds ratio, without adjusting was 1.045 (CI 95% 0.531 ; 2.059), and the adjusted odds ratio was 0.927 (CI 95% 0.461 ; 1.863). CONCLUSIONS: In obese postmenopausal Caucasian women, type 2 DM produces an increase in BMD of the lumbar spine without changes in BMD of the proximal femur or in QUS measurements of the heel. The prevalence of vertebral, hip and non-vertebral fractures did not increase in type 2 DM.

The new mutation, E46K, of alpha-synuclein causes Parkinson and Lewy body dementia.

Familial parkinsonism and dementia with cortical and subcortical Lewy bodies is uncommon, and no genetic defect has been reported in the previously described sibships. We present a Spanish family with autosomal dominant parkinsonism, dementia, and visual hallucinations of variable severity. The postmortem examination showed atrophy of the substantia nigra, lack of Alzheimer pathology, and numerous Lewy bodies which were immunoreactive to alpha-synuclein and ubiquitin in cortical and subcortical areas. Sequencing of the alpha-synuclein gene showed a novel, nonconservative E46K mutation in heterozygosis. The E46K mutation was present in all affected family members and in three young asymptomatic subjects, but it was absent in healthy and pathological controls. The novel mutation, that substitutes a dicarboxylic amino acid, glutamic acid, with a basic amino acid such as lysine in a much conserved area of the protein, is likely to produce severe disturbance of protein function. Our data show that, in addition to the previously described hereditary alpha-synucleinopathies, dementia with Lewy bodies is related to mutation of alpha-synuclein.

Resección transanal a través de un trocar monopuerto. Una nueva aproximación al NOTES / Transanal resection using a single port trocar: a new approach to NOTES

Introducción La morbilidad y la mortalidad, así como las alteraciones funcionales que conllevan la cirugía radical del cáncer de recto, han hecho que se produzca un incremento en el interés por el tratamiento local del cáncer de recto en estadios precoces. La cirugía transanal convencional ofrece una tasa de recurrencia elevada por lo que en los últimos años la TEM se considera el tratamiento de elección en los adenomas rectales de gran tamaño y en el cáncer de recto precoz (T1 de bajo riesgo).Pacientes y método Hemos intervenido cinco pacientes, con diagnóstico de adenoma velloso de recto (4) y carcinoma in situ de recto (1), mediante este nuevo abordaje transanal, utilizando un dispositivo monopuerto. Resultados La localización de las lesiones fue en recto medio, a una distancia media del margen anal de 9cm (r: 6-10). Todas las lesiones estaban situadas en cara posterior. Los márgenes de resección en todos los casos fueron negativos. El tamaño medio de los adenomas fue de 4cm, siendo tres de forma sésil y uno con pedículo corto y grueso (> 1cm); el carcinoma tenía un tamaño de 3cm. El tiempo medio quirúrgico fue de 55 minutos. Todos los pacientes fueron dados de alta a las 48 horas del procedimiento quirúrgico. Conclusión Pensamos que el abordaje transanal endoscópico a través de un dispositivo monopuerto es un procedimiento sencillo, fácilmente reproductible y coste-efectivo comparado con la TEM (AU)

Introduction The morbidity and mortality, along with the functional changes that arise from radical surgery of rectal cancer, has led to an increasing interest in local treatment in the early stages of cancer of the rectum. Conventional transanal surgery has a high recurrence rate, for this reason transanal endoscopic microsurgery (TEM) is considered the treatment of choice in the last few years in large rectal adenomas and in early rectal cancer (low risk T1).Patients and method We have intervened five patients, four with a diagnosis of villous adenoma of the rectum, and one in situ rectal carcinoma, using this new transanal approach, with a single port device. Results The locations of the lesions were in the mid-rectum, at a mean distance of 9cm (range 6-10) from the anal margin. All of them were situated in the posterior side. The resection margins were negative in all cases. The mean size of the adenomas was 4cm, three being sessile shaped, and one with a short, thick pedicle (>1cm); the size of the carcinoma was 3cm. The mean surgical time was 55minutes. All the patients were discharged 48hours after the surgical procedure. Conclusion We believe that the transanal endoscopic approach with a single port device is a simple, easily reproducible and cost-effective procedure when compared to TEM (AU)

Prurito refractario al tratamiento / Pruritus resistant to treatment

El prurito es un síntoma que puede esconder tras de sí múltiples patologías cutáneas y/o sistémicas,siendo por tanto cardinal la búsqueda y eliminación de la causa que lo provoca.Presentamos el caso de un varón de 24 años de edad, que consulta por prurito generalizado

The pruritus is a symptom that could hide behind many skin and/or systemic diseases; this reasonmakes it very important to search for the origin of it.We show the case of a 24 years old male, who consulted with generalized itching (AU)