Prediction of Degraded Infrastructure Conditions for Railway Operation.

In the railway sector, rolling stock and infrastructure must be maintained in perfect condition to ensure reliable and safe operation for passengers. Climate change is affecting the urban and regional infrastructure through sea level rise, water accumulations, river flooding, and other increased-frequency extreme natural situations (heavy rains or snows) which pose a challenge to maintenance. In this paper, the use of artificial intelligence based on predictive maintenance implementation is proposed for the early detection of degraded conditions of a bridge due to extreme climatic conditions. For this prediction, continuous monitoring is proposed, with the aim of establishing alarm thresholds to detect dangerous situations, so restrictions could be determined to mitigate the risk. However, one of the main challenges for railway infrastructure managers nowadays is the high cost of monitoring large infrastructures. In this work, a methodology for monitoring railway infrastructures to define the optimal number of transductors that are economically viable and the thresholds according to which infrastructure managers can make decisions concerning traffic safety is proposed. The methodology consists of three phases that use the application of machine learning (Random Forest) and artificial cognitive systems (LSTM recurrent neural networks).

A comparative analysis of Spanish Clinical encoder-based models on NER and classification tasks.

OBJECTIVES: This comparative analysis aims to assess the efficacy of encoder Language Models for clinical tasks in the Spanish language. The primary goal is to identify the most effective resources within this context. IMPORTANCE: This study highlights a critical gap in NLP resources for the Spanish language, particularly in the clinical sector. Given the vast number of Spanish speakers globally and the increasing reliance on electronic health records, developing effective Spanish language models is crucial for both clinical research and healthcare delivery. Our work underscores the urgent need for specialized encoder models in Spanish that can handle clinical data with high accuracy, thus paving the way for advancements in healthcare services and biomedical research for Spanish-speaking populations. MATERIALS AND METHODS: We examined 17 distinct corpora with a focus on clinical tasks. Our evaluation centered on Spanish Language Models and Spanish Clinical Language models (both encoder-based). To ascertain performance, we meticulously benchmarked these models across a curated subset of the corpora. This extensive study involved fine-tuning over 3000 models. RESULTS: Our analysis revealed that the best models are not clinical models, but general-purpose models. Also, the biggest models are not always the best ones. The best-performing model, RigoBERTa 2, obtained an average F1 score of 0.880 across all tasks. DISCUSSION: Our study demonstrates the advantages of dedicated encoder-based Spanish Clinical Language models over generative models. However, the scarcity of diverse corpora, mostly focused on NER tasks, underscores the need for further research. The limited availability of high-performing models emphasizes the urgency for development in this area. CONCLUSION: Through systematic evaluation, we identified the current landscape of encoder Language Models for clinical tasks in the Spanish language. While challenges remain, the availability of curated corpora and models offers a foundation for advancing Spanish Clinical Language models. Future efforts in refining these models are essential to elevate their effectiveness in clinical NLP.

Elevated levels of cell-free NKG2D-ligands modulate NKG2D surface expression and compromise NK cell function in severe COVID-19 disease.

Introduction: It is now clear that coronavirus disease 19 (COVID-19) severity is associated with a dysregulated immune response, but the relative contributions of different immune cells is still not fully understood. SARS CoV-2 infection triggers marked changes in NK cell populations, but there are contradictory reports as to whether these effector lymphocytes play a protective or pathogenic role in immunity to SARS-CoV-2. Methods: To address this question we have analysed differences in the phenotype and function of NK cells in SARS-CoV-2 infected individuals who developed either very mild, or life-threatening COVID-19 disease. Results: Although NK cells from patients with severe disease appeared more activated and the frequency of adaptive NK cells was increased, they were less potent mediators of ADCC than NK cells from patients with mild disease. Further analysis of peripheral blood NK cells in these patients revealed that a population of NK cells that had lost expression of the activating receptor NKG2D were a feature of patients with severe disease and this correlated with elevated levels of cell free NKG2D ligands, especially ULBP2 and ULBP3 in the plasma of critically ill patients. In vitro, culture in NKG2DL containing patient sera reduced the ADCC function of healthy donor NK cells and this could be blocked by NKG2DL-specific antibodies. Discussion: These observations of reduced NK function in severe disease are consistent with the hypothesis that defects in immune surveillance by NK cells permit higher levels of viral replication, rather than that aberrant NK cell function contributes to immune system dysregulation and immunopathogenicity.

Determination of De Novo Suberin-Lignin Ferulate Deposition in Xylem Tissue Upon Vascular Pathogen Attack.

Plant vascular pathogens use different ways to reach the xylem vessels and cause devastating diseases in plants. Resistant and tolerant plants have evolved various defense mechanisms against vascular pathogens. Inducible physico-chemical structures, such as the formation of tyloses and wall reinforcements with phenolic polymers, are very effective barriers that confine the pathogen and prevent colonization. Here, we use a combination of classical histochemistry along with bright-field and fluorescence microscopy and two-dimensional nuclear magnetic resonance (2D-NMR) spectroscopy to visualize and characterize wall reinforcements containing phenolic wall polymers, namely, lignin, ferulates, and suberin, which occur in different xylem vasculature in response to pathogen attack.

BCG priming followed by a novel interleukin combination activates Natural Killer cells to selectively proliferate and become anti-tumour long-lived effectors.

The short-lived nature and heterogeneity of Natural Killer (NK) cells limit the development of NK cell-based therapies, despite their proven safety and efficacy against cancer. Here, we describe the biological basis, detailed phenotype and function of long-lived anti-tumour human NK cells (CD56highCD16+), obtained without cell sorting or feeder cells, after priming of peripheral blood cells with Bacillus Calmette-Guérin (BCG). Further, we demonstrate that survival doses of a cytokine combination, excluding IL18, administered just weekly to BCG-primed NK cells avoids innate lymphocyte exhaustion and leads to specific long-term proliferation of innate cells that exert potent cytotoxic function against a broad range of solid tumours, mainly through NKG2D. Strikingly, a NKG2C+CD57-FcεRIγ+ NK cell population expands after BCG and cytokine stimulation, independently of HCMV serology. This strategy was exploited to rescue anti-tumour NK cells even from the suppressor environment of cancer patients' bone marrow, demonstrating that BCG confers durable anti-tumour features to NK cells.

Renal Transplant Artery Stenosis and Kinking: An Unusual Association.

Renal artery stenosis of the kidney allograft associated with kinking is not a frequent finding. As a correctable cause of graft dysfunction, it is important to diagnose it as soon as possible to avoid further graft damage and improve graft and patient survival. As pulsed wave Doppler ultrasound mapping of the graft's renal arteries is essential to diagnose possible alterations, point of care ultrasound (POCUS) is a highly useful tool for early diagnosis. We present a case in which nephrologists performed this examination promptly allowing a timely diagnosis and treatment plan.

Ciencia, pseudociencia y la Revista de la AEN / Science, pseudoscience and the AEN Journal

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Rethinking medicalization: discursive positions of children and their caregivers on the diagnosis and treatment of ADHD in Chile / Repensando la medicalización: posiciones discursivas de niños y de sus cuidadores sobre el diagnóstico y tratamiento del TDAH en Chile

Abstract The debates around the diagnosis and pharmacological treatment of Attention Deficit and Hyperactivity Disorder (ADHD) have traditionally been approached from the perspective of the "medicalization processes" of children's behaviour. However, this perspective tends to overlook the meanings of diagnosis and treatment of ADHD for children and their caregivers. The purpose of this article is to describe the discursive positions of children and their caregivers on the diagnosis and treatment of ADHD. In-depth interviews were conducted with seven Chilean children and their caregivers. The material was analysed following the procedures of the discourse structure analysis. A discursive structure was identified that configures four emerging realities: the myth of origin of the child's behaviour and learning problems; the ambivalences in/of medicalization; the process of identity (dis)stabilization under diagnosis and treatment; and the subversion of medicalization. It is observed that the subjective experience of the diagnosis and treatment of ADHD is not homogeneous, since different discursive positions, family and institutional understandings that enter into conflict cross it. The experiences of ADHD are shaped by discursive structures that condition the meanings of this experience. The medicalization process is not univocal, but can take different forms and have consequences on children's experiences and social trajectories.

Resumen Los debates en torno al diagnóstico y tratamiento farmacológico del Trastorno de Déficit Atencional e Hiperactividad (TDAH) han sido tradicionalmente abordados desde la perspectiva de los "procesos de medicalización" del comportamiento infantil. Sin embargo, esta perspectiva tiende a pasar por alto los sentidos y significaciones del diagnóstico y tratamiento del TDAH para los niños y sus cuidadores. El objetivo de este artículo es describir las posiciones discursivas de niños y de sus cuidadores sobre el diagnóstico y tratamiento farmacológico del TDAH. Se realizaron entrevistas en profundidad a siete niños chilenos y a sus cuidadores. El material fue analizado siguiendo los procedimientos del análisis estructural del discurso. Se identificó una estructura discursiva que configura cuatro realidades emergentes: el mito de origen de los problemas de comportamiento y de aprendizaje del niño; las ambivalencias en/de la medicalización; el proceso de (des)estabilización identitaria bajo el diagnóstico y tratamiento; y la subversión de la medicalización. Se observa que la experiencia subjetiva del diagnóstico y tratamiento del TDAH no es homogénea, dado que se encuentra atravesada por distintas posiciones discursivas, comprensiones familiares e institucionales que entran en conflicto. Las experiencias del diagnóstico y tratamiento del TDAH se encuentran modeladas por estructuras discursivas que condicionan las posibilidades de dar sentido a dicha experiencia. El proceso de medicalización no es unívoco, sino que puede asumir formas diferentes y tener consecuencias diversas sobre las experiencias y trayectorias sociales de niños y niñas.

Prolongación del asa biliopancreática para el control del reflujo enterobiliar tras coledocoduodenostomía en un cruce duodenal / Enlargement of the biliopancreatic channel to control the enterobiliary reflux after a choledochoduodenostomy in a duodenal switch

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Diversidad de Vanilla spp. (Orchidaceae) y sus perfiles bioclimáticos en México / Diversity and bioclimatic profiles of Vanilla spp. (Orchidaceae) in Mexico

Resumen: El género Vanilla comprende alrededor de 110 especies, distribuidas en las partes tropicales del mundo, y es el continente americano donde se encuentra la mayor cantidad de especies reportadas. En México, el cultivo de la vainilla está relacionado con diversas culturas como la totonaca, maya, chinanteca, mazateca, entre otras. En la actualidad, este cultivo presenta factores condicionantes tales como: técnicos, económicos, sociales, ecológicos y climáticos, que limitan su producción y la conservación de especies silvestres y cultivadas, por lo que es necesario, conocer su estado actual, en relación con su diversidad, así como algunos de los principales indicadores del perfil bioclimático de cada una de las especies, que ayuden en la toma de decisiones para su conservación y mejoramiento genético. Durante 2008, se realizaron consultas a herbarios de IPN, MEXU, XAL, base de datos de la Red Mundial de Información sobre la Biodiversidad de la CONABIO (REMIB), Global Biodiversity Information Facility (GBIF) y datos de accesiones vivas del banco de germoplasma de vainilla de la BUAP, formado del 2008 al 2014. Se realizaron mapas de distribución mediante un sistema de información geográfica. Se obtuvo el perfil bioclimático de cada especie considerando 19 variables de World Clim, y altitud a una resolución espacial de aproximadamente 1 Km2. Se calcularon las medias, desviaciones estándar y varianzas de las 19 variables en cada uno de los puntos registrados. Se obtuvieron los intervalos de las condiciones ambientales extremas (mínimo, promedio y máximo) para cada una de las especies de vainilla. Para determinar las variables de mayor importancia en la distribución de las especies se realizó un análisis de componentes principales, y a las variables que resultaron significativas se les realizó pruebas de Kruskal-Wallis y Dunn. Los resultados indicaron que en México se tienen registros de V. planifolia, V. pompona, V. insignis, V. inodora V. odorata, V. cribbiana y V. sprucei distribuidas en nueve estados. V. planifolia presentó intervalos amplios de temperatura y precipitación; V. pompona, V. odorata, V. insignis y V. inodora tuvieron intervalos intermedios. La amplitud de los datos extremos de cada especie puede considerarse para ubicar los sitios donde se puedan llevar a cabo estrategias regionales de conservación ex situ y el establecimiento de cultivos. El perfil bioclimático encontrado permite inferir de manera indirecta la condición genética de cada especie que podría ser utilizada en programas de mejoramiento genético como: la alta altitud y tolerancia a bajas temperaturas (V. odorata), la tolerancia a altas temperaturas (V. inodora) y tolerancia a baja precipitación (V. odorata, V. pompona y V. planifolia).

Abstract: The genus Vanilla comprises around 110 species distributed throughout Earth's tropical regions, with the largest number of reported species growing in the American continent. Vanilla farming is associated with many Mexican cultures such as the Totonac, Mayan, Chinantec, and Mazatec, among others. Currently, this crop is threatened by technical, social, ecological, and climatic conditioning factors, limiting its production and the preservation of wild and cultivated species. It is therefore necessary to ascertain the current diversity status of each of these species, as well as some of their main bioclimatic profile indicators, in order to help decision-making, aimed at preserving and genetically improve these species. During 2008, we gathered data from IPN, MEXU, and XAL herbaria, as well as from CONABIO's World Information Network on Biodiversity (REMIB), the Global Biodiversity and Information Facility (GBIF), and we also used data from live access to BUAP's vanilla germplasm bank, obtained between 2008 and 2014. Distribution maps were generated using a geographical information system. Bioclimatic profiles for each species were obtained considering 19 WorldClim variables and altitude at a spatial resolution of approximately 1 Km2. Variance, Mean, and standard deviation for each of the 19 variables were calculated at each of the registered points. Extreme environmental condition intervals (minimum, average, and maximum) were also obtained. In order to determine the most important distribution variables of the species, we performed a principal component analysis and carried out Kruskal-Wallis and Dunn's tests on the variables identified as significant. Results indicated records for V. planifolia, V. pompona, V. insignis, V. inodora V. odorata, V. cribbiana, and V. sprucei in Mexico, distributed throughout nine states in the country. V. planifolia presented wide intervals of temperature and rain precipitation, while V. pompona, V. odorata, V. insignis and V. inodora presented intermediate intervals. The amplitudes of extreme data for each species can be considered in locating areas where ex situ regional preservation strategies could be put in place, as well as in establishing areas for cultivation. The bioclimatic profile we found, allows for an indirect inference of each species' genetic condition, which could be used in genetic improvement programs; for instance, V. odorata grows at high altitudes and tolerates low temperatures, while V. inodora tolerates high temperatures, and V. odorata, V. pompona and V. planifolia tolerate low rain precipitation. Rev. Biol. Trop. 65 (3): 975-987. Epub 2017 September 01.

Las perturbaciones del objeto psiquiátrico y sus determinantes: el caso de la desaparición de la esquizofrenia / The disturbances of the psychiatric object and their determinants: the case of the disappearance of schizophrenia

Desde hace años existe un volumen creciente de literatura dedicada al análisis de las insuficiencias del concepto de esquizofrenia y a las propuestas de su sustitución. En el presente trabajo se realiza una exposición de las principales características de esta postura y se analiza desde el punto de vista conceptual. Se concluye que este proyecto es una continuación de la visión neopositivista y biológica dominante en la psiquiatría a la que contribuye también la influencia de la industria farmacéutica. Se apunta la necesidad de desarrollar una teoría psicopatológica que pueda dar cuenta del proceso de formación de los conceptos y abordar de manera crítica los cambios nosológicos que están por venir (AU)

In recent years there is an increasing number of studies devoted to the analysis of the insufficiencies of the schizophrenia concept and the need of a terminological change. In the present paper I analyze the core features of this proposal from a conceptual point of view. It is concluded that this view is a prolongation of the neopositivist and biological approaches in psychiatry in addition to the influence of the pharmaceutical industry. The necessity of a psychopathological theory that can give answer to future nosological changes is pointed out (AU)

Complicaciones vasculares del trasplante renal. Diagnóstico y tratamiento / Vascular complications of kidney transplantation. Diagnosis and treatment

Existen diferentes técnicas quirúrgicaspara la reconstrucción del tracto urinario en el trasplanterenal. Sin embargo es frecuente la aparición de complicaciones urinarias en el postoperatorio, siendo el uréterla localización frecuente de las mismas. Esto implicaun alto gasto sanitario, aumentando la morbimortalidaddel paciente y pudiendo llegar a desencadenar la pérdida del injerto. Por ello es importante la prevención, elcorrecto diagnóstico y su tratamiento.El objetivo de esta revisión es describir las técnicas quirúrgicas más usadas en el trasplante renal para la ureteroneocistostomía. Analizar las ventajas y desventajas decada una de ellas y comparar sus complicaciones. Porotro lado se resume la literatura reciente sobre las cuatrocomplicaciones urinarias más frecuentes en el postoperatorio del trasplante. Se exponen las posibles causas ytratamiento de la fuga urinaria, la obstrucción ureteral,la hematuria y el reflujo ureterovesical.(AU)

There are different surgical techniques forreconstruction of the urinary tract in kidney transplant.However, urinary complications are frequent in the postoperative period, being the ureter the frequent locationof these complications. This results in high health carecosts, increasing patient morbimortality and sometimesgraft loss. For this reason, prevention, correct diagnosisand treatment are important.The aim of this review is to describe the surgical techniques most commonly used in kidney transplant forureteroneocystostomy. To analyze the advantages anddisadvantages of each of them and to compare theircomplications. On the other hand, we summarize therecent literature on the four most frequent urinary complications in the postoperative period after transplantation.The possible causes and treatment of urine leak, uretericobstruction, hematuria and vesicoureteral reflux are presented.(AU)

Ceftazidima-avibactam en el tratamiento de infecciones urinarias por Klebsiella productora de carbapenemasa en trasplante renal / Ceftazidime-avibactam in urinary tract infections due to carbapenemase-producing Klebsiella in kidney transplantation

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Resultados y pronóstico del trasplante renal en pacientes con lupus eritematoso sistémico / Kidney transplantation in systemic lupus erythematosus: Outcomes and prognosis

Introducción: Los resultados del lupus eritematoso sistémico (LES) en el trasplante renal (TR) a largo plazo son variables. El objetivo de este estudio fue analizar la supervivencia del injerto y del paciente comparándola con la relativa a las glomerulonefritis primarias (GNP). Materiales y métodos: Se compararon 43 pacientes a los que se les había realizado TR con diagnóstico de nefritis lúpica (NL) y 367 con GNP entre enero de 1980 y diciembre de 2014. Se analizó la supervivencia y las causas de pérdida y muerte del injerto y del paciente. Resultados: No hubo diferencias significativas entre las variables analizadas en ambos grupos. La supervivencia del injerto a los 5 años (80% LES vs. 70% GNP) y 10 años (63% LES vs. 55% GNP) y del paciente a los 5 años (90% LES vs. 90% GN) y 10 años (76% LES vs. 79% GN) fueron similares. Ningún injerto se perdió por recidiva de la NL. Conclusiones: Los enfermos con LES son unos candidatos a trasplante similares a los de otras enfermedades renales de etiología inmunológica. No se observó recidiva de la enfermedad en ningún paciente

Introduction: The outcome and prognosis of systemic lupus erythematosus (SLE) in long-term kidney transplantation (KT) is variable. The objective of this study was to analyse the survival of the graft and the patient, comparing rates with a control group (primary glomerulonephritis [PGN]). Materials and methods: Forty-three patients receiving a KT with diagnosis of lupus nephritis (LN) and 367 patients with PGN were compared between January 1980 and December 2014. The survival causes of loss and death of the graft and the patient were analysed. Results: There were no significant differences between the variables analysed. The graft survival at five years (80% SLE vs. 70% PGN) and 10 years (63% SLE vs. 55% PGN) and the patient at 5 years (90% SLE vs. 90% PGN) and 10 years (76% LES vs. 79% PGN) were similar. Not recurrence of LN was observed in any patient. Conclusions: Patients with SLE are similar candidates to KT than that with other immunological kidney diseases. There was no recurrence of the disease in any patient

Configuración de la psicopatología y práctica psiquiátrica / The construction of psychopathology and psychiatric practice

La psiquiatría parece condenada a la perpetuidad de un abordaje teórico fragmentario. Las perspectivas histórica, social, psicológica o biológica dan cuenta de una realidad parcial e incompleta de esta disciplina que en ocasiones se intenta subsanar sin éxito amalgamándolas. Se plantea, por lo tanto, necesaria una reelaboración teórica que permita pensar la psiquiatría en su completud. El propósito de este trabajo es localizar en el análisis de la psicopatología la encrucijada en que se concentran las complejas relaciones del campo psiquiátrico. Se concluye que no hay posibilidad de intelección de la manera en la que la psicopatología y sus objetos se configuran si son separados de su vínculo con una praxis determinada políticamente. Se apunta, finalmente, el alcance que estas conclusiones tienen para una teoría de la individuación de los síntomas (AU)

Psychiatry seems condemned to a perpetual fragmentary theoretical approach. Historical, social, psychological and biological narratives or conventional pluralism -a blend of them all-, can only account for isolated and incomplete parts of a complex psychiatric reality. It is necessary to be able to analyze psychiatry in its entirety. To that end, in this paper psychopathology is investigated as a crossroad where these fragments are in an interwoven relationship. The main conclusion is that, in order to understand psychopathology and its objects properly, they must be considered connected with a practice determined by politics. Finally, some consequences for a theory of symptom individuation are drawn (AU)

A. y la radio escacharrada. La reducción causal en un caso de psicosis en ancianos / A. and the broken radio. Causal reduction in a case of psychosis in the elderly

En el presente trabajo se intenta dar cuenta de distintas aproximaciones al caso de una paciente a la que presuponemos una causa orgánica para el trastorno presentado. Para ello se utilizan las obras de Kurt Schneider y Karl Jaspers como marcos teóricos desde los que realizar tal ejercicio; intentando, finalmente, librarnos de un abordaje que sólo incluya las causas para encontrar otro que pueda hacerse cargo de la experiencia, en su integridad, de la paciente (AU)

In this work we try to explain different approaches to the case of a patient, whose illness is assumed to be caused by an organic impairment. To that end we use Kurt Schneider's and Karl Jasper's writings as theoretical backgrounds, in an attempt to avoid an approach that only considers causes, favouring, rather, another that accounts for the patient's experience (AU)

Causas de inicio no programado del tratamiento renal sustitutivo con hemodiálisis / Causes of unscheduled haemodialysis initiation

La mitad de los enfermos que comienzan tratamiento con hemodiálisis periódica lo hacen con un catéter venoso como acceso vascular (inicio no programado). Un objetivo del Grupo de Gestión de Calidad de la Sociedad Española de Nefrología es conseguir que el 80% de los enfermos comiencen la hemodiálisis a través de una fístula arteriovenosa. Hemos querido revisar las causas que condicionan en la actualidad el inicio no programado, para analizar cuáles pueden ser corregibles. En el año 2010, 43 enfermos comenzaron tratamiento con hemodiálisis periódica en el Hospital Ramón y Cajal de Madrid. La edad media fue de 61 años, el 79% eran hombres, la etiología más frecuente fue la diabetes mellitus (23%) y el índice de Charlson era de 6,3 ± 2,6. El inicio no programado de la hemodiálisis ocurrió en 20 enfermos (47%), sin objetivarse diferencias con los 23 enfermos que comenzaron (..) (AU)

Half of patients starting chronic hemodialysis used a transient vascular catheter as a vascular access (unplanned initiation). An objective of the Quality Management Group of the Spanish Society of Nephrology is to achieve that 80% of the patients starting hemodialysis do it with an arteriovenous fistula. We want to review the causes of non-planned hemodialysis nowadays. In 2010, 43 patients had started chronic hemodialysis in the Hospital Ramón y Cajal in Madrid (Spain). Mean age was 61 years, 79% were men, the most frequent cause of chronic renal disease was the diabetes (23%) and Charlson Comorbidity Index was 6.3 ± 2.6. The unplanned hemodialysis (..) (AU)

Valoración del ganglio centinela en el cáncer papilar de tiroides T1-T2. Estudio preliminar / Evaluation of the sentinel lymph node in T1-T2 papillary thyroid cancer: a preliminary study

Objetivo: La biopsia del ganglio centinela en el cáncer diferenciado de tiroides puede beneficiar a los pacientes sin ganglios clínicamente afectados y evitar la linfadenectomía profiláctica o de estadificación. Metodos Estudio prospectivo de 23 pacientes consecutivos con carcinoma papilar de tiroides sin sospecha de afectación ganglionar clínica o radiológica. Tras inyección peritumoral de azul de metileno y biopsia intraoperatoria del ganglio centinela identificado, se realizó la tiroidectomía total y linfadenectomía ipsilateral vi a-b para estudio diferido con citoqueratina. Si el ganglio centinela era positivo se realizaba linfadenectomía radical modificada ipsilateral (grupos ii a v ). Resultados En 21 de los 23 pacientes (91,3%) se identificó claramente el ganglio centinela. Siete de los 21 ganglios identificados (33,3%) fueron positivos en el estudio intraoperatorio, de los cuales 3 (42,8%) mostraron afectación del compartimento lateral. En conjunto, 9 pacientes (39,1%) mostraron afectación ganglionar en el grupo vi al identificarse 2 pacientes más con micrometástasis en el estudio diferido. La biopsia del ganglio centinela aporta una sensibilidad del 87,5%, una especificidad del 100%, un valor predictivo positivo del 100% y un valor predictivo negativo del 93,7%, con 7,1% de falsos negativos. Cinco pacientes presentaron hipocalcemia transitoria (21,7%).Conclusiones La identificación del ganglio centinela en pacientes con tumores T1-T2 sin sospecha de afectación ganglionar permite la selección de pacientes que deberían ser tratados con linfadenectomías selectivas (AU)

Objective: Sentinel lymph node biopsy in differentiated thyroid cancer may benefit patients with no clinically affected lymph nodes and can avoid a prophylactic or staging lymphadenectomy. Methods: A prospective study was conducted on 23 consecutive patients with papillary thyroid carcinoma with no clinical or radiological suspicion of lymph involvement. After injecting methylene blue around the tumour during the biopsy of the identified sentinellymph node, a total thyroidectomy and a VIa-b ipsilateral lymphadenectomy was performed for the later study with cytokeratin. If the sentinel lymph node was positive, a modified ipsilateral radical lymphadenectomy was perfumed (groups II to V).Results: The sentinel lymph node was clearly identified in 21 of the 23 patients (91.3%). Seven(33%) of the 21 lymph nodes identified were positive in the intra-operative study, of which 3(42.8%) demonstrated involvement with the lateral compartment. All together, 9 patients(39.1%) showed lymph node involvement group VI, with two more patients being identified with micrometastases in the later study. Biopsy of the sentinel lymph node had a sensitivity of 87.5%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 93.7%, with 7.1% false negatives. Five patients (21.7%) had transient hypocalcaemia. Conclusions: The identification of the sentinel lymph node in patients with T1-T2 tumours with no suspicion of lymph node involvement helps in the selection of patients who should be treated with selective lymphadenectomies (AU)

Fístula esófago-espondilorraquídea en paciente tratado con radioterapia y quimioterapia / Spinal-esophageal fistula in a patient treated with concurrent chemotherapy and radiotherapy

Varón de 56 años con antecedente de carcinoma glótico tratado con quimioterapia y radioterapia concomitante en remisión completa. Acude a urgencias por cervicalgia intensa, paresia de miembro superior derecho y disfagia. La exploración física muestra además rigidez cervical. Se realiza resonancia magnética donde se objetiva espondilitis a nivel vertebral C6-C7 con formación de un absceso extradural que comprime la médula. Un tránsito baritado muestra una úlcera esofágica con trayecto fistuloso posterior. Se realiza tratamiento conservador con gastrostomía percutánea y antibioticoterapia. El paciente mejora ostensiblemente de sus síntomas y en los estudios de imagen de control se objetiva la desaparición de la fístula (AU)

We present the case of a 56-year-old male patient with a history of glottic carcinoma treated with concurrent chemotherapy and radiotherapy in complete remission, who went to hospital with severe neck pain, upper right limb weakness and dysphagia. Physical examination showed neck stiffness as well. Spondylitis at C6-C7 spinal level with extradural abscess formation was diagnosed by MRI. Barium radiography revealed an esophageal ulcer with a posterior sinus path. Conservative treatment was given with percutaneous gastrostomy and antibiotics. The patient's symptoms improved and the fistula and the abscess had disappeared in the later MRI control studies (AU)

Odontomas complejos / Complex Odontomas

Introducción: Los odontomas son uno de los tumores odontogénicos más frecuentes. Su etiología es desconocida, aunque se han implicado numerosos factores como traumatismos, infecciones y mutaciones genéticas entre otros. El diagnóstico diferencial debe establecerse con el fibroma amelobástico, el fibroodontoma ameloblástico y el odontoameloblastoma, siendo el tratamiento de elección de estos tumores la enucleación quirúrgica. El objetivo de este artículo es presentar el caso clínico de un paciente con un odontoma complejo mandibular, así como los resultados de la revisión bibliográfica hecha al respecto. Caso clínico: Se expone el caso de un paciente varón, que es remitido a nuestras consultas por el hallazgo casual de una lesión ósea mandibular derecha, radiopaca, amorfa, de 2 cm de diámetro, en relación con el cordal 48 incluido y sugerente de odontoma complejo, sin sintomatología dolorosa niinflamatoria acompañante. Tras un adecuado estudio radiológico y ante el diagnóstico de presunción de odontoma complejo, se procede a su extirpación quirúrgica y posterior análisis anatomopatológico para su diagnóstico de confirmación. Conclusiones: Los odontomas se clasifican en compuestos y complejos, siendo los primeros los más frecuentes. Su sintomatología es escasa o nula, por lo que su hallazgo es casual en la mayoría de las ocasiones. El tratamiento de elección es quirúrgico, con un pronóstico favorable y escasas recidivas (AU)

Introduction: The odontomas are one of the most frequent odontogenic tumours. Their etiology is unknown, although numerous factors have been implicated, such as traumatisms, infections and genetic mutations, among others. The differential diagnosis must be established with ameloblastic fibroma, ameloblastic fibroodontoma and odontoameloblastoma, with surgical enucleation being the treatment of choice of these tumours. The objective of this article is to present the clinical case of a patient with a complex mandibular odontoma, as well as the results of the bibliographical review made in this regards. Clinical case: The case is described of a male patient, referred to our offices because of the casual finding of a right mandibular bone lesion ,radiopaque, amorphous, of 2 cm in diameter, in relation to the included wisdom tooth 48 and suggesting complex odontoma, without painful symptoms or accompanying inflammation. After the appropriate radiological analysis and in view of the presumption diagnosis of complex odontoma, it was surgically removed and subsequent anatomopathological analysis was conducted for the confirmation of the diagnosis Conclusions: Odontomas are classified as compound or complex, with the former being the most frequent. Their symptoms are scarce or nil, for which their finding is casual in the majority of the occasions. The treatment of choice is surgery, with a favourable prognosis and few recurrences (AU)