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Neurofibromatosis 1 (NF1) is a rare genetic syndrome that leads to the development of neurofibromas and increases the risk of malignancy, including malignant peripheral nerve sheath tumors. Patients with NF1 often have other orthopaedic manifestations, including short stature, osteopenia, and dysplasia. A 47-year-old patient with a history of NF1 and multiple neurofibromas of the right lower extremity presented with a severe valgus deformity, instability, and osteoarthritis of the right knee that was debilitating to daily life. Over time, the patient lost proprioception and potentially some sensation to the right knee with neurofibroma formation, leading to the development of Charcot arthropathy of the right knee with secondary osteoarthritis. The preoperative workup consisted of a magnetic resonance imaging of the knee to confirm no malignancy was present and templating to ensure the standard implant size was amenable for the patient. A primary total knee arthroplasty was performed with a cemented-stemmed hinged knee implant. At 6 months post-surgery, the patient had a dramatic improvement in her pain and quality of life.

In a solid breeding blanket, ceramic breeder pebbles are in contact with reduced activation ferritic martensitic (RAFM) steel at high temperatures for years and accordingly form a corrosion layer on the blanket structural steel. Present study focuses on corrosion characteristics of EUROFER97 RAFM steel by an advanced breeder material of Li2TiO3 with excess Li (initial ratio of Li/Ti = 2.2) at 623, 823, and 1073 K under sweep gas (He + 0.1% H2) flow. Formation of a thick oxide double layer was found on the surface of the EUROFER plates heated at 823 and 1073 K, while the corrosion layer formed at 673 K was

Functional near-infrared spectroscopy (fNIRS) is increasingly used to study brain function in infants, but the development and standardization of analysis techniques for use with infant fNIRS data have not paced other technical advances. Here we quantify and compare the effects of different methods of analysis of infant fNIRS data on two independent fNIRS datasets involving 6–9-month-old infants and a third simulated infant fNIRS dataset. With each, we contrast results from a traditional, fixed-array analysis with several functional channel of interest (fCOI) analysis approaches. In addition, we tested the effects of varying the number and anatomical location of potential data channels to be included in the fCOI definition. Over three studies we find that fCOI approaches are more sensitive than fixed-array analyses, especially when channels of interests were defined within-subjects. Applying anatomical restriction and/or including multiple channels in the fCOI definition does not decrease and in some cases increases sensitivity of fCOI methods. Based on these results, we recommend that researchers consider employing fCOI approaches to the analysis of infant fNIRS data and provide some guidelines for choosing between particular fCOI approaches and settings for the study of infant brain function and development.

The mechanical behaviour of prismatic bars extracted from a high purity alumina tube was studied comparatively in the as-received condition and after being irradiated with high-energy protons. For this study, ten samples were irradiated with 8 MeV H+ ion beams up to a fluence of 1.63 × 1016 ions/cm2. Values of compressive strength, elastic modulus, hardness, and fracture toughness were determined from compression and micro-indentation tests. After the mechanical tests, the relationship of the mechanical behaviour shown with the microstructure was considered by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). A clear trend was observed, compressive strength and elastic modulus were considerably reduced, while hardness and fracture toughness increased. This change is attributed to radiation-induced cavities and dislocation loops after high-energy ion-irradiation.

Resumen: Introducción: La tos crónica (TC) asociada a reflujo es muy frecuente en la práctica clínica, pero su diagnóstico no siempre es sencillo. La determinación de pepsina en saliva es un método novedoso, sencillo y no invasivo para el estudio de reflujo. Objetivo: Analizar rentabilidad diagnóstica de la determinación de pepsina en saliva en paciente con TC. Método: Estudio prospectivo sobre una cohorte consecutiva de pacientes con TC. Los pacientes se diagnostican de tos asociada a reflujo según 3 criterios: 1) presencia de síntomas típicos de reflujo gastroesofágico; 2) Reflux Symptom Index > 13, Reflux Findings Score ≥ 5, y 3) tránsito gastroesofágico, endoscopia digestiva o pHmetría-impedanciometría positiva. A todos los pacientes se les realizaron 2 determinaciones de pepsina en saliva, mediante la aplicación del Peptest®. Resultados: Se incluyó a 99 pacientes, de los cuales 64 (64,6%) fueron diagnosticados de TC asociada a reflujo, 9 (14,1%) como única causa y 55 (85,9%) asociada a otros diagnósticos. Cincuenta y seis tenían un Peptest® positivo, con una sensibilidad de la prueba del 87,5%, una especificidad del 65,7% y los valores predictivo positivo (VPP) y negativo (VPN) del 82 y el 74%, respectivamente. En pacientes sin síntomas digestivos, el VPP de la pepsina fue del 64% y el VPN del 88%. Conclusiones: El reflujo es una causa importante de TC y generalmente forma parte de una etiología multifactorial. La determinación de pepsina en saliva tiene una alta sensibilidad para reflujo, aunque con baja especificidad que a día de hoy limita su uso sistemático. Abstract: Introduction: Chronic cough (CC) associated with reflux is very common in clinical practice, but it is not always easy to diagnose. The determination of pepsin in saliva is a novel, simple and non-invasive method for the study of reflux. Objective: To analyze the diagnostic yield of the determination of pepsin in saliva in a patient with CC. Method: This was a prospective study conducted in a consecutive cohort of patients with CC. Patients were diagnosed with cough associated with reflux according to 3 criteria: 1) Presence of typical symptoms of gastroesophageal reflux disease (GERD), 2) Reflux Symptom Index > 13, Reflux Findings Score ≥ 5 and 3) gastroesophageal transit, gastrointestinal endoscopy, and/or positive impedance pH monitoring. All patients underwent 2 determinations of pepsin in saliva, using the Peptest®. Results: We included 99 patients, of which 64 (64.6%) were diagnosed with CC associated with reflux, 9 (14.1%) as the sole cause and 85.9% (55) associated with other diagnoses. Fifty-six had a positive Peptest®, with a sensitivity of 87.5%, specificity of 65.7%, and positive (PPV) and negative (NPV) predictive values of 82% and 74%, respectively. In patients without digestive symptoms, the PPV of pepsin was 64% and the NPV was 88%. Conclusions: Reflux is an important cause of chronic cough and usually forms part of a multifactorial etiology. The determination of pepsin in saliva has a high sensitivity for reflux, but a low specificity that currently limits its routine use.

Objective: To assess socio-sanitary expenditure after the addition of omalizumab to standard treatment in the control of severe asthma and to analyse its effectiveness under standard clinical practice. Method: Observational retrospective multicentre study conducted in 12 pneumology services in the Valencian Community, Spain. Data from 186 patients were analysed. Results of the year before and after the addition of omalizumab were compared. Effectiveness was calculated based on a 3-point increase in the Asthma Control Test and a reduction in the number of annual exacerbations. Utility was calculated by the number of quality adjusted life years. The economic assessment included both direct and indirect costs and results were expressed in terms of incremental cost- effectiveness and incremental cost-utility ratio. Results: Significant improvements were found in lung function, asthma control, quality of life, and quality adjusted life years between the year before and after the introduction of omalizumab. Taking into account direct and indirect costs, the incremental cost-effectiveness for each avoided exacerbation was € 1,789.28 (95% CI: € 1,019.13-3,038.12) and € 4,569.38 (95% CI: 3,442.86-6,075.05) per 3-point increase in the Asthma Control Test score. The incremental cost-utility ratio per quality adjusted life years gained was € 50,239.98 (95% CI: 37,209.88-68,923.84). Conclusions: The addition of omalizumab to the treatment regime of patients with severe asthma is effective under standard clinical practice, decreases direct and indirect costs, and provides significant improvements in the health status of patients.

A 52-year-old man was evaluated in our outpatient facility because of a thoracic mass for one month. A needle biopsy of the chest mass was performed and microbiological culture showed growth of Aggregatibacter actinomycetemcomitans. Three months after starting antimicrobial therapy, acute phase reactants normalized, and chest CT showed a progressive reduction in the size of the phlegmon. To our knowledge, we report the first case of A. actinomycetemcomitans diaphragmatic and chest wall infection without pulmonary involvement. This supports the theory of hematogenous spread of the germ from oral mucosa to produce thoracic lesions.

Objetivo: Describir la incidencia de nuevos diagnósticos de infección por el virus de la inmunodeficiencia humana (VIH) y su tendencia. Métodos: Se incluyeron los nuevos diagnósticos de VIH notificados en 2009 en las 15 comunidades autónomas con sistemas de información (64% de la población española). Para analizar las tendencias durante 2004-2009 se incluyeron las nueve comunidades con datos en ese periodo. Se obtuvo información clínico-epidemiológica de las hojas de notificación de casos y se realizaron distribuciones de nuevos diagnósticos y diagnóstico tardío según distintas variables. Para evaluar las tendencias se ajustó un modelo de Poisson. Resultados: En 2009 se notificaron 2.264 nuevos diagnósticos de VIH, la mayoría en hombres (80%). La mediana de edad al diagnóstico fue de 36 años (rango intercuartílico 29-43) y el 37,6% de los casos eran inmigrantes, destacando los latinoamericanos y los subsaharianos. La categoría de transmisión más común (42,5%) fue la de hombres que tienen sexo con hombres, seguida de la heterosexual (34,5%) y la parenteral (8,1%). Al diagnóstico, la mediana de CD4/µl era de 347 (rango intercuartílico: 152-555) y un 50,2% tenían Objective: To describe the incidence of new HIV diagnoses and its trend in Spain. Methods: All new HIV diagnoses notified to the case-registries of 15 autonomous regions (64% of the total Spanish population) in 2009 were analyzed. To evaluate trends from 2004 to 2009, data from only nine regions were available. Clinical-epidemiological data were obtained from the notification forms. Distributions of new HIV diagnoses and late diagnoses according to several variables were performed. The Poisson distribution was used to evaluate trends. Results: In 2009, 2264 new HIV diagnoses were notified, mostly in men (80%). The median age at diagnosis was 36 years (interquartile range 29-43) and 37.6% of affected individuals were immigrants, mostly from Latin-America and sub-Saharan Africa. The most common transmission category (42.5%) was men who have sex with men (MSM) followed by the heterosexual and parenteral modes of transmission (34.5% and 8.1%, respectively). The median CD4 count at diagnosis was 347 (interquartile range: 152-555), and CD4 count was

El derrame pericárdico es una entidad clínica de manejo multidisciplinar. Dependiendo de la urgencia del cuadro, la etiología, el pronóstico vital del paciente y la necesidad de toma de muestras histológicas han sido descritos diversos abordajes terapéuticos. En el presente estudio aportamos nuestra experiencia en la utilización de la cirugía videotoracoscópica (CVT) en los derrames de etiología no neoplásica. Material y métodos: Hemos practicado pericardiectomías parciales mediante CVT en la sospecha clínica de enfermedad no neoplásica. Fue practicada a pacientes con ecocardiografía demostrativa de derrame pericárdico y estabilidad clínica. La existencia de signos radiológicos o ecocardiográficos de pericarditis constrictiva o la inestabilidad clínica nos hicieron desestimar la aplicación de la pericardiectomía empleando esta técnica. Resultados: Se trataron 12 pacientes con una edad media de 67,7 años. Cuatro habían sido tratados quirúrgicamente de enfermedad cardíaca en los días previos. En seis se evacuó el derrame pleural concomitante, tomando biopsias pleurales. Tras un periodo de seguimiento medio de 23 meses un paciente reingresó con derrame pleural. Ninguno ha fallecido al cierre del estudio. Conclusiones: La pericardiectomía parcial practicada por CVT es un procedimiento de utilidad en los derrames pericárdicos no malignos donde el estado general del paciente, la expectativa de vida, la posibilidad de respuesta a un tratamiento específico y la ausencia de un diagnóstico histológico apoyan la elección de la técnica.