Development and validation of a minimally invasive and image-guided tape stripping method to sample atopic skin in children.

BACKGROUND: Molecular skin profiling techniques, typically performed on skin samples taken by punch biopsy, have enhanced the understanding of the pathophysiology of atopic dermatitis (AD), thereby enabling the development of novel targeted therapeutics. However, punch biopsies are not always feasible or desirable, and novel minimally invasive methods such as skin tape stripping have been developed. AIM: To develop, optimize and validate a novel tape stripping method guided by noninvasive in vivo skin imaging to sample atopic skin in children. METHODS: Skin tape stripping-based procedures were compared and optimized using data from 30 healthy controls (HCs: 5 adults, 25 children) and 39 atopic children. Evaluations were guided by high-resolution photography, reflectance confocal microscopy, optical coherence tomography and transepidermal water loss measurements. We assessed and compared adverse events (AEs), the time needed to perform the sampling and the cDNA levels obtained from the tapes. RESULTS: Tape stripping methods based on previously described protocols resulted in erosions in all participants and required a median time of 65 min to perform (range 60-70 min), but provided good cDNA yield. Shorter durations appeared less invasive but provided lower cDNA yield. The final optimized tape stripping protocol, using 11 tapes of 22 mm in diameter, each applied twice for 5 s with 90° rotation, did not produce significant AEs, was completed within a median time of 7 min (range 5-15 min) and provided good cDNA yield both in HCs and atopic children. CONCLUSION: Our minimally invasive method is safe and reliable, and provides reproducible acquisition of cDNA in atopic children. In addition, it enables rapid sample collection, a crucial factor in clinical practice.

A spatial pattern analysis of the halophytic species distribution in an arid coastal environment.

Obtaining information about the spatial distribution of desert plants is considered as a serious challenge for ecologists and environmental modeling due to the required intensive field work and infrastructures in harsh and remote arid environments. A new method was applied for assessing the spatial distribution of the halophytic species (HS) in an arid coastal environment. This method was based on the object-based image analysis for a high-resolution Google Earth satellite image. The integration of the image processing techniques and field work provided accurate information about the spatial distribution of HS. The extracted objects were based on assumptions that explained the plant-pixel relationship. Three different types of digital image processing techniques were implemented and validated to obtain an accurate HS spatial distribution. A total of 2703 individuals of the HS community were found in the case study, and approximately 82% were located above an elevation of 2 m. The micro-topography exhibited a significant negative relationship with pH and EC (r = -0.79 and -0.81, respectively, p < 0.001). The spatial structure was modeled using stochastic point processes, in particular a hybrid family of Gibbs processes. A new model is proposed that uses a hard-core structure at very short distances, together with a cluster structure in short-to-medium distances and a Poisson structure for larger distances. This model was found to fit the data perfectly well.

Analysis of spurious peaks at series resonance in solidly mounted resonators by combined BVD-Mason modelling.

Solidly Mounted Resonators (SMRs) for high frequency RF filters and sensing applications often display spurious resonances that distort their frequency response. In this work, we try to identify the origin of spurious resonances accompanying the main series resonances in AlN-based SMRs with the help of modified Butterworth Van Dyke (BVD) and Mason's models. By manufacturing SMRs of different sizes and shapes and studying the influence of the position of the electrical probing spot, we have demonstrated both theoretically and experimentally that devices with larger areas are more likely to display these additional peaks. Our updated models accurately simulate the frequency response of the SMRs, revealing that spurious peaks are mostly related to the resistance of the electrodes. Our study clarifies the origin of the spurious resonances and offers solutions for both, the optimal design and measurement method of SMRs.

State of refractive surgery with Visian ICL posterior chamber phakic lens in Spain.

OBJECTIVES: To analyse the state of refractive surgery with Visian ICL phakic lens implantation in Spain, indicating the mean ranges of implanted powers, visual and refractive outcomes obtained and safety and efficacy indices. METHOD: This is a population-based, cross-sectional, descriptive, analytical, retrospective, multicentre study in which each co-author collected data from at least the last 10 patients (up to a maximum of 30) with Visian ICL phakic lens implantation. One eye from each subject was randomly selected for study inclusion, and the variables analysed were: age, gender, visual acuities with and without correction pre and post-surgery, preoperative and residualrefraction, keratometry, endothelial cellular density, anterior chamber depth from endothelium, central corneal pachymetry, intraocular pressure, white-white, implanted lens (power and size), expected and achieved spherical equivalent (SEQ) post-surgery at one month after surgery. RESULTS: A sample of 140 eyes was obtained from 140 patients with a mean age of 31.35 ± 7.28 years. Mean preoperative SEQ was -6.33 ± 3.69D, mean CDVA was 0.96 ± 0.16, ACD was 3.30 ± 0.29 mm, WTW 12.02 ± 0.40 mm, CCT 535.03 ± 37.68 µm, ECD 2684.37 ± 313.74 cels/mm2 and IOP 14.84 ± 2.59 mmHg. 66.4% of the implanted lenses were spherical ICLs and 33.6% toric, with a mean power of -7.81 ± 4.09D and a mean cylinder of 2.27 ± 1.23D. 5.7% of the implanted lenses were hypermetropic. The mean SEQ target selected was +0.04 ± 0.27D. 48.92% of the implanted lenses were of size 13.2 mm, with the remaining 36.69, 10.79 and 3.60% being of sizes 12.6, 12.1 and 13.7 mm, respectively. At one month after surgery a residual SEQ of -0.01 ± 0.31D was obtained. The efficacy and safety indices were 1.06 ± 0.18 and 1.10 ± 0.19, respectively. The mean central vault was 508.80 ± 201.04 µm. The accuracy between the calculated SEQ and the obtained SEQ was 99.3% for spherical lenses and 88.2% for Cyl correction. The mean ECD at 1 month after surgery was 2805.53±273.30céls/mm2, which was a difference from preoperative of 0.11% (p = 0.922), similarly, the mean IOP was 13.98 ± 2.57 mmHg, which was a difference of -0.92 ± 2.80 mmHg. CONCLUSIONS: ICL phakic lens surgery is an effective, safe and predictable procedure. There were no significant changes in endothelial cell count or intraocular pressure measurement one month after surgery.

Isolated cardiomyopathy caused by a DMD nonsense mutation in somatic mosaicism: genetic normalization in skeletal muscle.

X-linked dilated cardiomyopathy is a pure cardiac dystrophinopathy phenotype mainly caused by DMD mutations that present a specific transcription effect in cardiac tissue. We report a 26-year-old male who presented with severe dilated cardiomyopathy and high creatine kinase. The patient did not complain of skeletal muscle weakness. A muscle biopsy showed mild dystrophic changes and a low proportion of dystrophin-negative fibres. A molecular study identified a nonsense DMD mutation (p.Arg2098X) in somatic mosaicism. The ratio of mutant versus normal allele in blood and skeletal muscle suggests selective pressure against mutant muscle cells, a process known as genetic normalization. We hypothesize that this process may have mitigated skeletal muscle symptoms in this patient. This is the second report of a DMD somatic mosaic with evidence of genetic normalization in muscle. Somatic DMD mutations should be considered in patients presenting with idiopathic dilated cardiomyopathy.

[Difficult necks. Diagnosis and treatment. Retrospective study of 145 cases using the method of Feldman]. / Les cous difficiles. Diagnostic et traitement. Étude rétrospective de 145 cas utilisant la méthode de Feldman.

To identify a neck as difficult seems an easy thing. Nevertheless, we must admit that various clinical situations are represented under this single designation. A clinical and anatomical classification is proposed regarding the surgical strategy presented in this paper. Predominant tissue laxity and predominant fat accumulation are presented as progressive forms. Short platysma muscles and low hyoid bones are presented as constitutional. According to this classification, 145 patients among 438 facial rejuvenations were designated as difficult necks. The surgical strategy was intended, in each case, to address the underlying anatomical features, using a short incision system. A combination of wide skin undermining, fat removal under direct vision and corset platysmaplasty was performed in the 145 patients between November 2003 and May 2008. The average age was 59 years old and medium follow-up at 22 months. There was only 2% of secondary touch up for aesthetic reasons. Difficult necks, as described in this article, responded adequately to the present protocol. The postoperative results on the neck were consistent with the rest of the rejuvenated face and stood the test of time.

[Breast reconstruction with TRAM flap after selective embolization of the deep inferior epigastric artery (series of 69 patients)]. / Reconstruction mammaire par TRAM après embolisation sélective de l'artère épigastrique inférieure (série de 69 patientes).

Vascular complications of the unipedicled TRAM flap pointed out the need for solutions to decrease such occurrences. The flap surgical delay before transfer has been advocated to improve the blood supply but, at the same time, it increases the risk of wound infection at the donor site and imposes a general anesthesia. The DIEP and the free TRAM flap are more complex procedures and need heavy structural resources. Preferential use of the ipsilateral muscular pedicle suggests a lower partial flap necrosis rate. Selective embolization of the deep inferior epigastric arteries prior to surgery realizes an alternative delay and brings a decrease in the vascular complication rate as shown in a study of 40 patients by Scheufler in 2000. We present a series of 69 patients who were reconstructed by means of a delayed pedicled TRAM flap with selective embolization and a predominant use of the ispsilateral pedicle. Sonographic studies performed in 48 patients prior to surgery showed no significative difference in the diameter of the superior epigastic arteries, with or without previous radiotherapy. The mean interval between embolization and surgery was 30 days; the embolization was performed bilateraly in five patients (4 %), and unilaterally in 64 patients (96 %). The mean age of patients was 54 years, radiotherapy was applied in 43 patients (62 %), smoking patients: 11 (16 %), obesity: five (7 %). The ispsilateral pedicled was used in 67 patients (97 %), controlateral pedicle in two patients (3 %). Postoperative flap complications were comprised of partial flap necrosis in two cases (2,9 %), fat necrosis in six cases (8,7 %), impaired wound healing in three cases (4,3 %), abdominal wall weakness in two cases (2,9 %). We compared the present study of ispsilateral delayed pedicled flap to a study from the same authors concerning controlateral pedicled flaps without delay. It has been demonstrated that the complications rate of partial necrosis was divided by four in the first study compared to the second. The preoperative selective embolization of the deep inferior epigastric artery in association with the use of ipsilateral pedicule in TRAM flap decrease the complications rate significatively compared to the controlateral pedicled flap in TRAM flaps.

Use of the modified BCR three-step sequential extraction procedure for the study of trace element dynamics in contaminated soils.

The modified BCR three-step sequential extraction procedure was used to examine the temporal dynamics of trace elements in soils contaminated by an accidental spill from an opencast mine in south-west Spain. Soils were mainly contaminated with pyritic sludge and acidic wastewater, whereas some soils were affected only by acidic wastewater. The distributions obtained for both some major (Ca, Fe and Mn) and trace elements (As, Cd, Cu, Pb and Zn) in the sludge and soil samples taken at different times after the accident, 1-3 months and 21 months, were compared. Sequential extractions were useful in identifying different sources of contamination, and in obtaining additional information on the solubility of secondary minerals formed by pyrite oxidation. Thus, the effectiveness of the BCR procedure has proved to be a useful tool for predicting short- and long-term mobility of trace elements, even in complex environmental scenarios.

Keratitis secondary to Fusarium spp. in Spain 2012-2014. / Queratitis secundaria a Fusarium spp. en España 2012-2014.

OBJECTIVE: To describe the clinical-epidemiological characteristics of a case series of fungal keratitis associated with Fusarium spp.., in Spain during the years 2012 to 2014. METHODS: A retrospective study of a case series was conducted on a systematic random sample of 10% of patients identified in Health Centres of provincial capitals (n=250). The centres were asked whether they had been presented with cases of Fusarium spp. keratitis characterised by microbiological methods. Of the 23 centres that responded, 14 had detected cases, with 13 of them accepting to participate, and 11 of them completing the study. The latter being sent a previously validated questionnaire. The variables analysed were: age, gender, habitual residence, profession, disease and medical history (previous systemic and ocular diseases, previous eye surgeries), and their outcomes. RESULTS: The response rate was 92%, identifying 23 cases of Fusarium spp.. of which 21 (91.3%) of them lived in urban areas. The professions most affected by the disease included chefs, administrative, and technical, with 13 cases (56.5%). The treatment guidelines established to confirm the infection showed the combined use of topical antibiotics associated with antiviral and/or antifungal agents. The use of contact lenses (86.9%) was the main risk factor. DISCUSSION: This study showed that this is a rare disease in Spain, but that a large percentage of people who present with the disease are resident in urban areas, and they work in closed environments, focusing attention on microtraumas caused by use of contact lenses.

Re-irradiation to prevent ectopic bone formation after major hip surgery.

Ectopic bone formation may occur after total hip arthroplasty, but fortunately most patients are asymptomatic. Both pre-operative and post-operative radiotherapy are effective in prevention of ectopic bone formation. In the few patients who needed re-operation, we found that re-irradiation is possible and safe. This case report presents our experience with single dose reirradiation of the hip in an attempt to prevent post-operative ectopic bone formation.

Intracranial germ cell tumor mimicking anorexia nervosa.

We report on a case of a 23 year-old female diagnosed as having a germ-cell tumour located in the sellar region. The patient referred anorexia, psychic disorders, weight loss of 15 kilograms and secondary amenorrhea during the previous three years. This is the reason why the patient was diagnosed as having anorexia nervosa. Subsequently, the patient presented some endocrine dysfunction. MRI revealed the existence of a lesion located in suprasellar and hypothalamic regions. This case shows that the presence of intracranial tumours next to the hypothalamus must be borne in mind as a rare but real possibility in cases of anorexia nervosa, specially in those non-typical cases.

[The role of radiotherapy in the management of bucopharyngeal epidemic Kaposi's sarcoma]. / Radioterapia en el tratamiento del sarcoma de Kaposi epidémico bucofaríngeo.

PURPOSE: This study is presented to help define the role of radiotherapy in the management of buccopharyngeal epidemic Kaposi's sarcoma. MATERIAL AND METHODS: Between January 1999 and December 2004, we treated 17 patients who had acquired inmunodeficiency syndrome related to mucous Kaposi's sarcoma. Kaposi's sarcoma lesions were in the oral cavity in 12 patients (70%), oropharynx in 3 patients (18%) and larynx in 2 patients (12%). All the patients were treated by radiotherapy using a Cobalt Unit beam energy, the treatment doses ranged from 15 to 30 Gy. RESULTS: Tolerance was generally satisfactory, with an effective palliation of symptoms (88,4% overall rate of objective responses). Nevertheless an enhanced mucosal reaction was noted in patients receiving doses close to 30 Gy (mucositis grade 3). CONCLUSIONS: We conclude that radiotherapy is an efficient treatment for mucous epidemic Kaposi's sarcoma; a dose of 15 Gy may be enough to shrink the tumour and obtain a good palliation of symptoms. Prophylactic measures with antifungal treatment should be systematically associated with oropharyngeal irradiation in order to improve tolerance to the treatment.

Chest wall reconstruction after full thickness resection: an experience with 22 patients.

The authors present their experience of chest wall reconstruction after full thickness resection in 22 patients. The patients are from a series of 80 patients treated by chest wall resection from 1967 to 1989. Whether performed on breasts still in place, for recurrent disease, or for radiation-induced lesions (which are often associated), the defect created by complete resection of the chest wall layers causes difficulties. Large cutaneous flaps, often including the opposite breast were used at the beginning of the series. Then came omentum associated to Mersilene mesh and myocutaneous flaps. The results, in terms of comfort and local control are acceptable, even though surgery is only palliative for cancer patients. We feel that full thickness chest wall resection is the only effective treatment for some primary and recurrent malignant tumors and for extensive thoracic radionecroses. Such procedures are designed to improve the patient's quality of life even if they do not actually prolong survival. The goals guiding the reconstruction programme are: (1) the restoration of a stable parietal rigidity; and (2) the reconstruction of long lasting superficial layers.

Particle size distribution of major inorganic species in atmospheric aerosols from Majorca (Spain).

Atmospheric aerosols collected by means of a cascade impaction system at the campus of the University of the Balearic Islands (Majorca, Spain) from November 1993 to February 1994 were analysed for chloride, nitrate, sulphate, ammonium, calcium, magnesium, sodium and potassium. Based on particle size distribution, the species studied were classified into three groups: (a) concentration decrease with particle size (sulphate and ammonium), (b) concentration increase with particle size (chloride, calcium, magnesium and sodium), and ( c) independent of particle size (nitrate and potassium). A principal component analysis (PCA) revealed a clear relationship between particle size and analyte origin. Also, the origin of sulphate and potassium fine and coarse particles was found to be different.

Anastomosis between both hypoglossal nerves in a 30 mm human embryo.

In this paper we present the first description of an anastomosis between both hypoglossal nerves during the embryonic period, a very uncommon anatomical variation. This was observed in a 30 mm crown-rump (C-R) length human embryo (Carnegie stage 23) from the Bellaterra Collection (Prof. Doménech Mateu), stained for nerve fibers. The anastomosis consisted of a large diameter trunk (36.7 microns) situated in front of and slightly below the hyoid cartilage, and clearly distinguishable from the anastomosis found in adults, which has a very fine diameter and is located in the suprahyoid region.

Estimating respiratory pattern variability by symbolic dynamics.

OBJECTIVES: The traditional techniques of data analysis are often not sufficient to characterize the complex dynamics of respiration. In this study the respiratory pattern variability was analyzed using symbolic dynamics. METHODS: A group of 20 patients on weaning trials from mechanical ventilation were studied at two different pressure support ventilation levels. Breath duration (T(TOT)) time series and the relation T(I)/T(TOT), that contains the influence of inspiratory time (T(I)), were considered. Length-3 words and 3 different symbols were proposed. The incidence of the overlapping tau and the parameter alpha were analyzed. RESULTS: From the breath duration time series, the distribution of words with probability of occurrence higher than 6% was concentrated on one word for low respiratory variability, whereas high variability was characterized by 4 words, presenting a statistically significant difference (p

Uncommon number and distribution of the Pacinian corpuscles in a human hand.

We describe some rare findings seen when dissecting the hands of a 65-year-old male cadaver. Very many lamellated (Pacinian) corpuscles were distributed all over the palms of both hands. They were normal in structure, but their size was greater (8 mms. in length and 5 mms. across) than the normal (2 mms. in length and 100-500 microns. across). Each lamellated corpuscle had only one nervous pedicle.

Development of the pelvic plexus in human embryos and fetuses and its relationship with the pelvic viscera.

Development of the pelvic plexus is studied in 15 human embryos and 2 fetuses ranging in size from 4 to 132 mm. C.R. length. A tridimensional reconstruction of the entire pelvic block was made in two specimens (30 and 132 mm. C.R. length) 80 X. The first ganglionic elements appear in Carnegie's stage 16, but the real definition of what in the final anatomy of the plexus is described as the hypogastric ganglion (Lee-Frankenhäuser) is formed in stage 18. Complete development of the plexus occurs in stage 23. Other relevant facts are: the appearance in stage 18 of the pelvic splanchnic nerves, which are formed from S2, S3 and S4, the involvement of S1 and S5 were not observed in any case. In all specimens studied, a close proximity was seen between the pelvic plexus and genitourinary organs. Starting in stage 18, the terminal ureter consistently crosses the posterosuperior part of the pelvic plexus.

Prenatal development of the rat sinuatrial node.

In order to study the origin and mode of differentiation of the cells which make up the sinuatrial node, samples of the sinuatrial junction of rat embryos of different ages were studied by transmission electron microscopy. From a seemingly morphologically homogeneous cell population at 11 days, an ultrastructural differentiation occurs from day 12. So, one could see: a) irregular-shaped cells with dark nucleus and medium-sized contractile apparatus which we have identified as ordinary ("working") atrial myocardiocytes and, b) pale cells with a clear spheroidal nucleus and cytoplasm containing few organelles and fine myofibrils which we have classified as nodal cells. Numerous undifferentiated cells of intermediate morphology appear intermingled with nodal and ordinary cells. Throughout development, nodal and ordinary cells progressively enhanced their mutual differences. Ordinary myocardiocytes become increasingly rich in myofibrils and mitochondria, and nodal cells contain scanty organelles and fine myofibrils, whereas undifferentiated cells are few at every stage. At the end of prenatal life, the sinuatrial node shows numerous unmyelinated axons of immature aspect but direct contacts between nodal cells and nerve fibers are not seen. The images we obtained suggest that the sinuatrial node must not be taken as an embryological remnant. Nodal cells are recognized from the 12th day of embryonic life as a particular form of differentiation of the cells which make up the sinuatrial region at the preceeding stages.