Differences in radiological patterns, tumour characteristics and diagnostic precision between digital mammography and screen-film mammography in four breast cancer screening programmes in Spain.

OBJECTIVES: To compare tumour characteristics between cancers detected with screen-film mammography (SFM) and digital mammography (DM) and to evaluate changes in positive predictive values (PPVs) for further assessments, for invasive procedures and for distinct radiological patterns in recalled women. METHODS: 242,838 screening mammograms (171,191 SFM and 71,647 DM) from 103,613 women aged 45-69 years, performed in four population-based breast cancer screening programmes in Spain, were included. The tumour characteristics and PPVs of each group were compared. Radiological patterns (masses, calcifications, distortions and asymmetries) among recalled women were described and PPVs were evaluated. RESULTS: The percentages of ductal carcinoma in situ (DCIS) were higher in DM than in SFM both in the first [18.5% vs. 15.8%(p = 0.580)] and in successive screenings [23.2% vs. 15.7%(p = 0.115)]. PPVs for masses, asymmetries and calcifications were higher in DM, being statistically significant in masses (5.3% vs. 3.9%; proportion ratio: 1.37 95%CI: 1.08-1.72). Among cancers detected by calcifications, the percentage of DCIS was higher in DM (60.3% vs. 46.4%, p = 0.060). CONCLUSIONS: PPVs were higher when DM was used, both for further assessments and for invasive procedures, with similar cancer detection rates and no statistically significant differences in tumour characteristics. The greatest improvements in PPVs were found for masses.

Corrigendum: ACE Gene Variants Rise the Risk of Severe COVID-19 in Patients With Hypertension, Dyslipidemia or Diabetes: A Spanish Pilot Study.

[This corrects the article DOI: 10.3389/fendo.2021.688071.].

ACE Gene Variants Rise the Risk of Severe COVID-19 in Patients With Hypertension, Dyslipidemia or Diabetes: A Spanish Pilot Study.

Coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to scale and threaten human health and public safety. It is essential to identify those risk factors that lead to a poor prognosis of the disease. A predisposing host genetic background could be one of these factors that explain the interindividual variability to COVID-19 severity. Thus, we have studied whether the rs4341 and rs4343 polymorphisms of the angiotensin converting enzyme (ACE) gene, key regulator of the renin-aldosterone-angiotensin system (RAAS), could explain the different outcomes of 128 COVID-19 patients with diverse degree of severity (33 asymptomatic or mildly symptomatic, 66 hospitalized in the general ward, and 29 admitted to the ICU). We found that G allele of rs4341 and rs4343 was associated with severe COVID-19 in hypertensive patients, independently of gender (p<0.05). G-carrier genotypes of both polymorphisms were also associated with higher mortality (p< 0.05) and higher severity of COVID-19 in dyslipidemic (p<0.05) and type 2 diabetic patients (p< 0.01). The association of G alleles with disease severity was adjusted for age, sex, BMI and number of comorbidities, suggesting that both the metabolic comorbidities and the G allele act synergistically on COVID-19 outcome. Although we did not find a direct association between serum ACE levels and COVID-19 severity, we found higher levels of ACE in the serum of patients with the GG genotype of rs4341 and rs4343 (p<0.05), what could explain the higher susceptibility to develop severe forms of the disease in patients with the GG genotype, in addition to hypertension and dyslipidemia. In conclusion, our preliminary study suggests that the G-containing genotypes of rs4341 and rs4343 confer an additional risk of adverse COVID-19 prognosis. Thus, rs4341 and rs4343 polymorphisms of ACE could be predictive markers of severity of COVID-19 in those patients with hypertension, dyslipidemia or diabetes. The knowledge of these genetic data could contribute to precision management of SARS-CoV-2 infected patients when admitted to hospital.

A first evaluation of the usefulness of Kudzu starch in cultural heritage restoration.

In recent times, the use of natural and harmless products for the environment and restorer is taking place in the field of Cultural Heritage restoration. In this sense, wheat, rice and corn starches as adhesives, have suitable characteristics without toxicity risks. A new starch in this field, is the Kudzu, an almost pure compound (99.5% starch) that is processed by a natural way from a plant called Pueraria lobata. This is a preliminary study of the potential use of Kudzu starch for the restoration of Cultural Heritage, focusing, firstly, in its capacity as adhesive through a comparative evaluation with common starches. The accelerated aging process carried out proved that Kudzu ensures optimal chromatic behaviour. On the other hand, the main problem in starch paste is the biological colonization. The daidzein, a natural antimicrobial compound implicit in Kudzu starch, confirmed the resistance to microorganism in this preliminary approach. The evaluation of the adhesive capacity, and the reversibility of the starches, suggest that Kudzu starch is a valid adhesive in the field of paper restoration. Thus, the potential of this starch in the conservation of Cultural Heritage is evidenced and its use as cleaner, resistance to biological colonization and consolidant is promising.

Pelvic fracture in the patient with multiple injuries: factors and lesions associated with mortality. / Paciente politraumático con fractura de pelvis: factores y lesiones asociados a la mortalidad.

OBJECTIVES: The main objective of this study was to identify demographic, clinical, analytical factors or injuries associated with 30-day mortality in patients with pelvic fractures. MATERIAL AND METHODS: Prospective observational study of patients with multiple injuries including pelvic fractures between January 2009 and January 2017. We recorded demographic, clinical, and laboratory data on arrival at the emergency department; type of pelvic fracture; treatments; associated lesions; and 30-day mortality. Univariable and multivariable models were used to analyze the data. RESULTS: A total of 2061 multiple-injury patients were attended; 118 had pelvic fractures. Fifteen of the patients with pelvic fractures (12.7%) died within 30 days. Arterial blood pressure on admission was less than 90 mm Hg in 23.7%, heart rate was over 100 beats per minute in 41.52%, lactic acid level was 20 mg/dL or higher in 67.6%, and base excess of -6 or less was recorded for 26.3%. The mean Injury Severity Score was 20 points. Angiographic embolization was required in 80.6% and preperitoneal packing in 3.4%. The main associated lesions were rib fractures (35.6%), hemo-pneumothorax (31.3%), spinal injuries (35.6%), and head injuries (30%). CONCLUSION: The 6 independent variables associated with risk of death in multiple-injury patients with pelvic fractures are age, female sex, complex fractures (Tile type C), lactic acid level of 20 mg/dL or more, base excess of -6 or less, and bowel perforation.

OBJETIVO: El principal objetivo de este estudio es identificar aquellos factores demográficos, clínicos, analíticos o lesiones asociadas relacionados con la mortalidad a 30 días. METODO: Estudio observacional con recogida prospectiva de datos de pacientes politraumáticos (PPT) con fractura de pelvis (FP) asociada entre enero de 2009 y enero de 2017. Se recogieron variables demográficas, clínicas y analíticas a la llegada al servicio de urgencias, tipo de fractura pélvica, procedimientos terapéuticos, lesiones asociadas y mortalidad a los 30 días. Se realizó un análisis de asociación uni y multivariable. RESULTADOS: Se atendieron 2.061 PPT, de ellos 118 presentaban FP. La mortalidad a los 30 días fue del 12,7% (15 PPT). El 23,7% ingresaron con una presión arterial sistólica < 90 mmHg, el 41,52% con frecuencia cardiaca > 100 lpm, 67,6% con lactacidemia >= 20 mg/dl y el 26,3% con un exceso de base (EB) <= ­6. El Injury Severity Score medio fue de 20 puntos. Requirieron angiembolización el 80,6% y packing preperitoneal el 3,4%. Las principales lesiones asociadas fueron: fracturas costales (35,6%), hemo-neumotórax (31,3%), lesiones de raquis (35,6%) y traumatismo craneoencefálico (30%). Los factores independientes asociados a la mortalidad fueron: la edad, el sexo femenino, las fracturas complejas (Tile C), un lactato >= 20 mg/dL, un EB <= ­6 y la asociación a perforación intestinal. CONCLUSIONES: Se identifican 6 factores independientes relacionados con la mortalidad a 30 días de los PPT con FP.

[The immigrant in primary care consultations]. / El inmigrante en la consulta de atención primaria.

In consultations at health centres, the GP, the paediatrician and the nursing staff have faced, above all since the end of the XIX century and so far in the XXI century, the fact of having to attend to a numerous population formed of people uprooted from their community, without close relatives in the majority of cases, with different languages and cultures, and with a different way of understanding health and illness. This article analyses this phenomenon and aims to improve the understanding of health professionals and contribute to improving care for the immigrant patient.

Improvements in the wallpaper industry during the second half of the 19th century: micro-Raman spectroscopy analysis of pigmented wallpapers.

Scientific studies of the pigments used in the manufacturing process of some pigmented wallpapers are presented in this work. Non-destructive micro-Raman spectroscopy was selected for this purpose, and provides important information about how the 19th century wallpaper industry incorporated new materials in their works and designs. At the same time, analysis can help to date the samples of uncatalogued wallpapers. Chrome yellow, burnt Sienna, Prussian blue, ultramarine blue, red lead, carbon black, calcium carbonate, red iron oxide and a red organic pigment were identified. According to the palette used, as well as to the manufacturing process, the wallpapers in this study can be dated to the second half of the 19th century.

Raman fibre optic approach to artwork dating.

Raman micro-probe spectroscopy has been applied to the analysis of a non catalogued hand-crafted wallpaper during its restoration process. The analysis has been totally non-destructive without the necessity of taking any sample. The artwork showed a great chromatic palette having been detected the presence of calcium carbonate, Prussian blue, ultramarine blue, gypsum (CaSO4.2H2O), minium (Pb3O4), vermilion (HgS), chrome orange (CaCO3), chrome yellow (PbCrO4), barium sulphate and carbon black (C). From the spectroscopic analysis the date of its manufacturing has been set between 1828 and 1830, introduction of chrome yellow and orange, as well as artificial ultramarine blue, and 1840, when continuous industrial wallpapers were extensively manufactured in Europe.

[Transthoracic needle aspiration biopsy. The diagnostic accuracy of pulmonary lesions]. / Punción diagnóstica transtorácica. Precisión diagnóstica de la lesión pulmonar.

We performed 91 transthoracic functions, under fluoroscopy, sonographically or by computed tomography control, at Clinic Hospital in Valencia. The procedures was performed with Chiba needle 22 gauges while the cytopathologist was present. Maximum number of needle passes was four. Malignant diagnosis has been obtained in 64.8% of cases, in 12 patients a benign diagnosis was obtained and confirmed, 13 cases were false negative and the specimen was insufficient for diagnosis in 7 (5 of them lesions had a diameter less than 2 cm). The study showed 82% for sensitivity, 100% for specificity and 85% for accuracy. The punction was guided by fluoroscopy in 49 patients, by sonography in 6 and by computed tomography control in 36. The accuracy diagnosis for fluoroscopy guidance was 96%. The complications were 9 (9.9%): Two patients presented minor hemoptysis resolved spontaneously, 6 patients showed minor pneumothorax and one patient was treated a cause of a large pneumothorax. We concluded that transthoracic biopsy is a simple and save technique that can provide a high diagnosis accuracy in patients with pulmonary pathology.

[HCV and HBV prevalence in hemodialyzed pediatric patients. Multicenter study]. / Prevalencia de HCV y HBV en pacientes pediátricos hemodializados. Estudio multicéntrico.

Hemodialized pediatric patients are a risk population for the hepatitis B and C virus infection. The aim of this paper was to study the serum prevalence of HBV and HCV infection in hemodialized children. We study 61 pediatric patients at hemodialisis, 12 on renal transplant, range between 2 and 20 years old (mean: 12.9 years), 23 male and 38 female. The specific anti-HCV IgC were measured by enzyme immunoassay (ELISA Abbott) and confirmed by LIA-TEK (Organon). The anti-HBV were measured by ELISA Abbott and transaminases by cinetic method (ASAT: 29 UI/L and ALT: 33 UI/L). The 19.7% of studied children were HCV (+) and 29.5% were HBV (+), 38.9% of them were HbsAg (+) and 50% anti-HBs (+). The HCV and HBV infection was more elevated in relation to the transfusion number and the hemodilisis time. The elevation of ALT/ASAT activity isn't a right infection index for HCV and HBV in this children.

Clinical and radiological features of breast tumors according to history of false-positive results in mammography screening.

BACKGROUND: Women with a false-positive result after a screening mammogram have an increased risk of cancer detection in subsequent participations, especially after assessments involving cytology or biopsy. We aimed to compare women's personal characteristics, tumoral features and the radiological appearance of cancers with and without a previous false-positive result generated by additional imaging or invasive procedures. METHODS: From 1996 to 2007, 111,098 women aged 45-69 years participated in four population-based breast cancer screening programs in Spain, and 1281 cancers were detected. We included all cancers detected in subsequent screenings (n=703) and explored the occurrence of previous false-positive results. We identified false-positives requiring additional imaging or invasive procedures. Differences on tumoral features (invasiveness, tumor size, and lymph node status) and radiological appearance were assessed by Chi-square test, and agreement between the location of cancer and prior suspicious by Cohen's kappa coefficient. A multivariate analysis was preformed to evaluate the effect of previous screening results and age on the odds of presenting an in situ carcinoma. RESULTS: Among the 703 cancers detected in subsequent screenings, 148 women (21.1%) had a previous false-positive result. Of these, 105 were by additional imaging and 43 by invasive procedures. Women with prior false-positive result requiring invasive assessment, compared to women with negative tests, and women with prior false-positive requiring additional imaging, had a higher proportion of in situ carcinomas (31.7%, 15.3%, 12.9%, respectively; p=0.014) and microcalcifications (37.2%, 20.2%, 9.5%, respectively; p=0.003). The proportion of in situ carcinomas was even higher in women over 60 years (39.2%, 12.5%, 13.0%, respectively; p=0.001). Ipsilateral cancer was observed in 65.7% of cases with prior cytology or biopsy (k=0.479; 95%CI: 0.330-0.794). CONCLUSION: A large number of in situ malignancies and calcification patterns were found among women with prior false-positive result in mammography screening requiring cytology or biopsies, suggesting progression from a previously benign lesion.

Determination of rotary diffusivity of poly(n-propyl isocyanate) by molecular dynamics.

The rotational dynamics of a nondilute solution of the rodlike polymer poly(n-propyl isocyanate) (PPIC) has been studied on an atomistic model by means of a large-scale classical molecular dynamics investigation. The rotary diffusivity of PPIC in toluene solution has been determined from the Einsteinian diffusion regime of the end-to-end vector on the surface of the unit sphere and has been found to be Dr=10.5x10(5)(+/-2.7) s-1, which falls in the range of the experimental data available. A comparison of molecular dynamics predictions with theoretical and perturbation expansion predictions has also been performed.

On-line FT-Raman and dispersive Raman spectra database of artists' materials (e-VISART database).

Raman spectroscopy has been widely applied in the analysis of different types of artwork. This technique is sensitive, reliable, non-destructive and can be used in situ. However, there are few references in the literature regarding specific Raman spectra libraries for the field of artwork analysis. In this paper, the development of two on-line databases with Fourier transform Raman (FT-Raman; 1064 nm) and dispersive Raman (785 nm) spectra of materials used in fine art is presented; both are implemented in the e-vibrational spectroscopic databases of artists' materials database (e-VISART). The database provides not only spectra, but also information about each pigment. It must be highlighted that for each pigment or material several spectra are available from different dealers. Some of the FT-Raman spectra available in the e-VISART database have not been published until now. Some examples in which the e-VISART database has been successfully used are presented.

[Self-care and education for the asthmatic patient]. / Autocontrol y educación del paciente asmático.

Asthma constitutes one of the most frequent chronic illnesses during infant ages and although is represents a minor illness in the majority of cases, its chronic course, the limitation of activities that it implies and the possibility that serious exacerbations appear, make it a pathology that has great impact on a social-health level. Over the last few years it appears that there is an increase in both the occurrence as well as the morbidity and the mortality of asthma. On the other hand, it is know that the most serious consequences of asthma can, to a large extent, be prevent and we can compare prevention experiences that have been going on for a long time, that have demonstrated their efficiency in other countries. Numerous health control and promotion programmes for asthma have shown that the patients education and their inclusion in programmes on self care improves the therapeutic performance, allowing patients to have a better quality of live and they influence favourably on the course of the illness. The guides and the consensus on the treatment of asthma insist that the education of the patient should start at the moment the illness is diagnosed and that he should be integrated into a continual assistance programme that includes all the people related to the patients treatment, the specialist, the doctors and nurses. The clinic should instruct the patient on the nature of asthma, on the treatment options, and should indicate a treatment plan that is simple, but compatible, with optimum care and encourage an active participation. A personalised education can be carried out but additional education resources will also be involved, in groups, and supported by established programmes. In order to achieve this objetctives, the health programme should be adapted to the epidemiological and cultural characteristics of the population it is aimed at, choosing groups of patients that are as homogeneous as possible, taking into account the seriousness of the illness, the patients age and the demographic characteristics. It is necessary to use strict criteria when knowing which patients can obtain the greatest benefits from the self care programmes, aiming at making the resources as beneficial as possible.

Delayed hypersensitivity reaction to paracetamol (acetaminophen).

We are reporting three patients who experienced delayed cutaneous reactions after treatment with paracetamol (acetaminophen). These reactions were confirmed in controlled challenge tests. Patch tests with paracetamol were positive in all patients. A biopsy performed of the case 1 patch test confirmed that the lesion was compatible with delayed hypersensitivity reaction-type allergic contact dermatitis.

[Comparative study of 3 types of lancets for performing prick tests]. / Estudio comparativo de tres tipos de lancetas para la realización de prick test.

Skin Prick Test is considered the cutaneous test of choice in rutinary clinical practice as well as in research. In the last 15 years a large number of lancets for puncture test have been developed looking for a higher level of standardisation and reproducibility. We have compared three lancets, two of them, NeoAbelló (NA) and Dome/Hollister Stier (DHS), used in puncture test and a third one, Blood Lancet (BL), in the modified prick test. Twenty-two patients sensitised to Phleum pratense were tested with the three lancets at three extract concentrations and histamine 10 mg/mL in duplicate. We compared their wheal sizes by means of parallel line assay, their reproducibility, frequency of bleeding wheals, the disturbance for the patient and the correlation between specific IgE and skin response. Wheal size was similar for puncture tests (DHS and NA lancets) and significatively lower than BL, being necessary to increase 1.9 times the extract concentration when using DHS and NA lancets to achieve the same wheal size than when using BL lancets (p < 0.01). Reproducibility with histamine was similar with the three lancets while with the extract was somehow better with puncture tests but without statistical significance. Bleeding was significantly more frequent with BL although this did not influence the results. Less pain was obtained with BL. Finally, correlation with specific IgE was slightly significant for NA and very similar for the other two. With these results in mind we think that any of the three lancets is valid for the diagnostic of the allergic patient. Nevertheless, puncture tests are probably the most suitable at a research level.

Baker's asthma in a child.

BACKGROUND: baker's asthma is a well-known occupational lung disease which usually develops in adults. We report the case of a two years old boy who suffered from asthma, urticaria and atopic dermatitis for twelve months, whose symptoms were associated to visits to his grandfather's bakery. METHODS AND RESULTS: skin prick tests (SPT) were made to dust mites, moulds, flours, alfa-amylase and egg. It was also determined total IgE and specific IgE antibodies to alfa-amylase and flours. Subsequently, a challenge test was carried out with wheat flour. The SPTs were positive to flours, alfa-amylase and egg. The determination of specific IgE antibodies showed 2.64 kU/L to wheat, 0.79 kU/L to glyadin and 2.98 kU/L to alfa-amylase. The patient developed asthma and rhinitis after manipulating wheat flour for 10 min. CONCLUSIONS: we demonstrated a type I hypersensitivity to wheat flour and alfa-amylase in a two years old child by SPT, specific IgE antibodies and challenge test. This case in the childhood equivalent of occupational baker's asthma.

Effect of theophylline on airway responsiveness to methacholine and on exercise-induced bronchoconstriction.

The aim of this study was to compare the relative effect of (1) a single dose of a rapid release theophylline, (2) treatment for 1 week with a sustained release theophylline, and (3) placebo after a washout period of at least 2 weeks on bronchial hyperresponsiveness to methacholine and on exercise-induced bronchoconstriction in 14 mildly asthmatic children. A dose of rapid release theophylline increased geometric mean (GM) PC20 (mg/mL) for methacholine from 0.25 to 0.85 (P < .001) at a mean (+/- SD) serum theophylline concentration of 9.5 +/- 2.5 mg/L (52.3 +/- 14.24 mumol/L). After 1 week on a slow release theophylline, GM PC20 increased to 0.41 (P < .01) at a mean serum theophylline concentration of 13.63 +/- 4.7 mg/L (74.9 +/- 25.8 mumol/L), (P < .01) compared with rapid release theophylline. The difference in PC20 between both theophylline treatments was statistically significant (P < .05). No significant changes in PC20 were noted after placebo compared with baseline values. During baseline and after placebo mean maximum FEV1 fall (MMFF) after exercise was 40 +/- 19.9% and 31.7 +/- 15.5%, respectively (n.s.). After a dose of rapid release theophylline, MMFF on exercise test was 8.7 +/- 8.2% (mean serum theophylline concentration 10 +/- 3.2 mg/L (55.4 +/- 17.82 mumol/L)), P < .001 compared with baseline and placebo. After 1 week of treatment with slow release theophylline, MMFF was 26.2% +/- 18.3 (mean serum theophylline concentration 12.2 +/- 3.9 mg/L (67.43 +/- 21.5 mumol/L)) (P = .01 and P = .30 compared with baseline and placebo, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Allergy to cockroaches in patients with asthma and rhinitis in an urban area (Madrid).

Previous studies have established that cockroach allergens are important sensitizing agents in the induction of rhinitis and asthma principally in urban areas. This study was undertaken to assess skin test reactivity and specific IgE antibody reactivity to extracts of Periplaneta americana (P.a.), Blattella germanica (B.g.), B. orientalis (B.o.), and a fecal extract of B. germanica (FEB.g.) in a group of patients with rhinitis and asthma living in an urban area in Europe. We examined clinical characteristics and aerollergen sensitivities of 171 consecutive Madrid urban patients with rhinitis and asthma who met the criteria for the study. A comprehensive clinical evaluation was followed by skin prick test with common allergens and saline extracts of P.a., B.g., B.o., and FEB.g. and measurement of serum specific IgE antibody to cockroach extracts. The age of patients ranged from 7 to 68 years (mean 20.4 +/- 16). A total of 153 (90.5%) subjects were atopic and 19 (10%) were considered nonallergic. Pollen sensitivity (66.5%) was most prevalent, distantly followed by sensitivity to cockroach (25.7%), mite (20%), cat (15.5%), Alternaria alternata (14.5%), dog (14%), and food (2%). Skin test reactivity to cockroach extracts was 37 (21.6%) to B.o., 20 (11.6%) to P.a., 19 (11.1%) to B.g. and five (2.9%) to FEB.g. Twenty-one of these patients had rhinitis, 19 rhinitis and asthma, and one only asthma; 26 had perennial symptoms, while 16 had seasonal (spring) symptoms; three (1.7%) patients had only positive prick test to cockroach; all had perennial rhinitis and/or asthma. Eighteen (10.5%) patients had specific serum IgE (RAST 1 or 2) to B.o., 13 (7.6%) to P.a., and six (3.5%) to B.g. Eighty (46.7%) patients had visual evidence of cockroach infestation in their home, mostly B.o.; 31 had positive prick test to cockroach (P < 0.0003). The results indicate that sensitivity to outdoor allergens (pollen) is more prevalent than to indoor allergens. Cockroach sensitization is the most important indoor allergen in our area, and B.o. accounts for most cockroach sensitization.