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Morgagni Larray hernia (MLH) is a very rare disease, which accounts for less than 5% of all congenital diaphragmatic hernias. Laparoscopic repair has been widely used and accepted as a treatment option for patients with this disease. The purpose of our study is to analyze the outcomes of patients with MLH who underwent laparoscopic repair, and to evaluate their postoperative course for outcome, morbidity, and mortality.A retrospective chart review was performed of patients who were diagnosed with MLH and treated laparoscopically by 10 board-certified pediatric surgeons.Fourteen patients were included in the study. One patient died 1 month postoperatively due to respiratory complications unrelated to the surgery. Thirteen patients were followed for a median of 1.75 years (interquartile 0.3-6.95). There was a single recurrence, which resulted in a partial resection of the hernia sac and repaired without a mesh. We had a success rate of 92.86%.MLH is a rare congenital diaphragmatic hernia that is usually diagnosed incidentally. Laparoscopic repair has high success rates and is a viable option for patients with this pathology.

Kidney transplant patients treated with belatacept without depletional induction experience higher rates of acute rejection compared to patients treated with conventional immunosuppression. Costimulation blockade-resistant rejection (CoBRR) is associated with terminally differentiated T cells. Alemtuzumab induction and belatacept/sirolimus immunotherapy effectively prevents CoBRR. We hypothesized that cells in late phases of differentiation would be selectively less capable of repopulating post-depletion than more naïve phenotypes, providing a potential mechanism by which lymphocyte depletion and repopulation could reduce the risk of CoBRR. Lymphocytes from 20 recipients undergoing alemtuzumab-induced depletion and belatacept/sirolimus immunosuppression were studied longitudinally for markers of maturation (CCR7, CD45RA, CD57, PD1), recent thymic emigration (CD31), and the interleukin-7 receptor-α (IL-7Rα). Serum was analyzed for IL-7. Alemtuzumab induction produced profound lymphopenia followed by repopulation, during which naïve IL-7Rα(+)CD57(−)PD1(−) cells progressively became the predominant subset. This did not occur in a comparator group of 10 patients treated with conventional immunosuppression. Serum from depleted patients showed markedly elevated IL-7 levels posttransplantation. Sorted CD57(−)PD1(−) cells demonstrated robust proliferation in response to IL-7, while more differentiated cells proliferated poorly. These data suggest that differences in IL-7-dependent proliferation is one exploitable mechanism distinguishing CoB-sensitive and CoB-resistant T cell populations to reduce the risk of CoBRR. ClinicalTrials.gov - NCT00565773

This article deals with the social, cultural, and economic contributions of universities to the life of small cities in which they are located. Using a questionnaire, we estimated the direct and indirect contributions of students from two universities of the Public Universities System in the state of Oaxaca (Mexico)—SUNEO (Sistema de Universidades Estatales de Oaxaca): the Technological University of the Mixteca (UTM—La Universidad Tecnologica de la Mixteca) and the University of the Costa Region (UNCOS—la Universidad de la Costa) in the life of two cities, Huajuapan de Leon and Pinotepa Nacional, in which these universities are located. The results obtained make it possible to recommend the use of methodologies for developing a strategy for creating a system of universities in monofunctional cities in Russia. The cases of the establishment of universities in small and medium-sized cities of Russia, as well as the factors that contribute to and impede such diversification of the economy of monofunctional cities in the current conditions of applying digital technologies in education are considered.

Background Patients with spinal cord injury (SCI) who carry indwelling urinary catheters have an increased risk of urinary tract infection (UTI). Antiseptic silver alloy-coated (SAC) silicone urinary catheters prove to be a promising intervention to reduce UTIs; however, current evidence cannot be extrapolated to patients with SCI. Purpose This study aimed to assess the efficacy of SAC urinary catheters for preventing catheter-associated urinary tract infections. Design/Setting This is an open-label, multicenter (developed in Spain, Portugal, Chile, Turkey, and Italy), randomized clinical trial conducted in 14 hospitals from November 2012 to December 2015. Patient Sample Eligible patients were men or women with traumatic or medical SCI, aged ≥18 years, requiring an indwelling urinary catheter for at least 7 days. Outcome Measures The primary outcome was the incidence of symptomatic UTIs. The secondary outcome included bacteremia in the urinary tract and adverse events. Materials and Methods Patients were randomized to receive a SAC urinary catheter (experimental group) or a standard catheter (control group) for at least 7 days. Data were compared using chi-squared test and also calculating the absolute risk difference with a 95% confidence interval. An adjusted analysis including different risk factors of UTI was performed. This study was mainly funded by La Marato de TV3 Foundation (grant number # 112210) and the European Clinical Research Infrastructures Network organization. The funders had no role in the interpretation or reporting of results. Results A total of 489 patients were included in the study, aged 55 years in the experimental group and aged 57 in the control group (p=.870); 72% were men; 43% were hospitalized patients, and 57% were outpatients (p=1.0). The most frequent cause of SCI was traumatic (73.75%), and the localization was mainly the cervical spine (42.74%). Most of the patients had an A score (complete spinal injury and no motor and sensory is preserved) on the ASIA scale (62.37%). The median time of urethral catheterization was 27 days in the experimental group and 28 days in the control group (p=.202). Eighteen patients (7.41%) in the experimental group and 19 in the control (7.72%) group had a symptomatic UTI (odds ratio [OR] 0.96 [0.49–1.87]). The adjusted analysis revealed no change in the results. Only three patients in the experimental group had bacteremia within the urinary tract. The experimental group presented more adverse events related to the use of a catheter than the control group (OR 0.03 [0.00–0.06]). Conclusions The results of this study do not support the routine use of indwelling antiseptic SAC silicone urinary catheters in patients with SCI. However, UTIs associated to long-term urinary catheter use remain a challenge and further investigations are still needed.

Angiotensin II type 1 receptor agonist antibodies (AT1R-AAs) have been associated with hypertension, atherosclerosis and vascular inflammation in human diseases. The aim of the study was to evaluate the prevalence of AT1R-AAs in active lupus nephritis (LN) patients and their association with vascular damage. One hundred and seven active LN patients underwent a complete clinical examination, measurement of AT1R-AAs, ambulatory blood pressure monitoring, carotid intima-media thickness measurement and morphometric analysis of subintimal fibrosis and medial hyperplasia of the vessels in the kidney tissue. Plasma AT1R-AAs were positive in 58 (54.2%) patients. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, complement C3 and C4 levels and titers of anti-dsDNA antibodies were higher in the group with positive AT1R-AAs compared with those with negative AT1R-AAs. The AT1R-AA titers correlated with anti-dsDNA antibody titers and with complement C3 and C4 serum levels. In the kidney biopsy, the percentage of subintimal fibrosis and the area of medial hyperplasia were greater in the AT1R-AA-positive patients. No differences in arterial pressure, carotid intima-media thickness and response to therapy were detected. In conclusion, AT1R-AAs are prevalent in active LN patients and are associated with histologic features of microvascular damage.

Introduction There are 14 forms of lipofuscinosis, among them type 6 in its late childhood form is found, it starts between three and eight years with epilepsy, motor disorders, myoclonus, dysarthria, ataxia and neurological regression associated with vision loss and motor skills, and early death. It occurs from mutations in the CLN6 gene, most patients have homozygote variants associated with consanguinity, and rarely, with compound heterozygote variants. Case report Siblings, started at 4 and 5 years each, with unstable gear, frequent falls and difficult running. Subsequently, loss of gait, myoclonus, dysphagia, and hallucinations. On physical examination, present optic nerve atrophy, Babinski and trunk ataxia. Electroencephalogram with widespread slow wave bursts during non-REM sleep, non photoparoxystic response, MRI with periventricular white substance hyperintensity, cerebellar atrophy and cortical. Panel of lipofuscinosis report two mutations, c.552del and c.244G>C, not described previously, in both patients. The mother was the carrier of the 552 deletion and the father and paternal grandmother of the G>C substitution (Gly82Arg). Conclusions Differential diagnosis in neuroregression disorders is difficult because clinical signs are nonspecific, like many other neurodegenerative disorders with progressive myoclonic epilepsy. We report the clinical findings in two Mexican siblings with the late childhood variant of CLN6 with two new heterozygote mutations that contribute to the knowledge of mutations in the Mexican population and point out the relevance of performing next-generation genetic sequencing studies which will allow a better genetic counseling practice.

[Abstract] Objective: To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data. Methods: We sought evidence for 60 unique interventions. A systematic search of all relevant databases was conducted from inception through July 2018. After abstract and full-text screening by two independent reviewers, eligible studies were matched to PICO questions. Data were extracted and meta-analyses were conducted using RevMan software. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence Profiles were compiled using the GRADEpro web application. Voting for Core Treatments took place first. Four subsequent voting sessions took place via anonymous online survey, during which Panel members were tasked with voting to produce recommendations for all joint locations and comorbidity classes. We designated non-Core treatments to Level 1A, 1B, 2, 3, 4A, 4B, or 5, based on the percentage of votes in favor, in addition to the strength of the recommendation. Results: Core Treatments for Knee OA included arthritis education and structured land-based exercise programs with or without dietary weight management. Core Treatments for Hip and Polyarticular OA included arthritis education and structured land-based exercise programs. Topical non-steroidal anti-inflammatory drugs (NSAIDs) were strongly recommended for individuals with Knee OA (Level 1A). For individuals with gastrointestinal comorbidities, COX-2 inhibitors were Level 1B and NSAIDs with proton pump inhibitors Level 2. For individuals with cardiovascular comorbidities or frailty, use of any oral NSAID was not recommended. Intra-articular (IA) corticosteroids, IA hyaluronic acid, and aquatic exercise were Level 1B/Level 2 treatments for Knee OA, dependent upon comorbidity status, but were not recommended for individuals with Hip or Polyarticular OA. The use of Acetaminophen/Paracetamol (APAP) was conditionally not recommended (Level 4A and 4B), and the use of oral and transdermal opioids was strongly not recommended (Level 5). A treatment algorithm was constructed in order to guide clinical decision-making for a variety of patient profiles, using recommended treatments as input for each decision node. Conclusion: These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA.

Purpose To explore the relation between tumor kinetic assessed by 18F-FDG PET and final neoadjuvant chemotherapy (NC) response within a molecular phenotype perspective.

Backgorund and objectives Melanoma is steadily increasing over the past decade. Recent studies confirmed a link between tanning bed use and melanoma. We sought to determine the prevalence and frequency of tanning bed among young patients with melanoma. Methods We retrospectively analyzed tanning bed use among young melanoma patients compared to controls selected from the hospital medical records. A telephone survey investigated family history of melanoma or skin cancer, hair color, eye color, skin type, tanning bed use, and patient awareness of dangers of tanning bed use. Results A total of 601 melanoma cases were identified; 265 (44%) completed the telephone survey as did 195 (31%) controls. Of these 460 subjects, 260 were female. Females were 3.0 times more likely to have used a tanning bed. Melanoma patients had natural light color hair, blue–green eyes, and 2.0 times more likely to use a tanning bed than controls. Among the tanning bed users, 90% were aware of danger of tanning bed. Conclusions Our study found that tanning beds were more likely to be used by young women, the majority of whom are aware of the associated risks. Eliminating the use of tanning beds should be considered to decrease the incidence of melanoma. J. Surg. Oncol. 2015 111:183–187. © 2015 Wiley Periodicals, Inc.

Extensive pre-clinical and clinical studies have searched for therapeutic efficacy of cell-based therapeutics in diseases of the Central Nervous System (CNS) with no other viable options. Allogeneic cells represent the primary source of these therapies and immunosuppressive regimens have been empirically employed based on experience with solid organ transplantation, attempting to avoid immune mediated graft rejection. In this study, we aimed to 1) characterize the host immune response to stem cells transplanted into the CNS and 2) develop a non-invasive method for detecting immune response to transplanted cell grafts. Human neural progenitor cells were transplanted into the spinal cord of 10 Gottingen minipigs, of which 5 received no immunosuppression and 5 received Tacrolimus. Peripheral blood samples were collected longitudinally for flow cytometry cross match studies. Necropsy was performed at day 21 and spinal cord tissue analysis. We observed a transient increase in xeno-reactive antibodies was detected on post-operative day 7 and 14 in pigs that did not receive immunosuppression. This response was not detected in pigs that received Tacrolimus immunosuppression. No difference in graft survival was observed between the groups. Infiltration of numerous immune mediators including granulocytes, T lymphocytes, and activated microglia, and complement deposition were detected. In summary, a systemic immunologic response to stem cell grafts was detected for two weeks after transplantation using peripheral blood. This could be used as a non-invasive biomarker by investigators for detection of immunologic rejection. However, the absence of a detectable response in peripheral blood does not rule out a parenchymal immune response.

Background Ultrasound (US) is an important tool to support the clinician in the diagnosis and treatment monitoring of rheumatoid arthritis (RA). The EULAR recommended it for the follow up of RA patients. In spite of the evidence supporting the value of US, the real impact in treatment decisions is not clearly defined. Objectives To investigate the impact of US findings in the treatment decisions of rheumatologists in patients with RA in a real-life setting. Additionally, to verify the US findings that play a role in change of treatment, types of changes and their distribution. Methods RA patients were included. As a first step, the rheumatologist performed a clinical examination (including DAS28) and recorded the treatment approach suggested according his clinical evaluation (i.e. starting, changing or stopping pharmacological medication as well as local injection). In the same day, after the clinical assessment, the patients were sent for an US examination using the 7-joint score, which was performed by an independent rheumatologist sonographer who reported the US findings to the same rheumatologist that previously evaluated clinically the patient. This last decided, according to the US findings to maintain or change the previous suggested therapy. Additionally, the clinical rheumatologist reported the reasons which induced to change or not the treatment after the US examination Results A total of 128 RA patients were included [female 117 (91.4%), male 11 (8.59%)], with mean ± SD disease duration of 9.88±8.22 years. Ninety-four patients (73.4%) had active disease according the DAS 28, whereas 34 (26.5%) were considered in remission. US findings influenced a change in the treatment in 56 cases (43.7%) (47 with clinical active disease and 9 in remission). Among the main reasons that induced a change in the treatment based on the US examinations were: grade of synovitis (25%), higher number of synovitis than clinical examination (16.6%) and presence of power Doppler (PD) (16.7%). The most frequent treatment changes were increasing dose or start a new combination of DMARDs [39 patients (69.5%)]. The multiple logistic regression analysis showed that synovitis of 2nd metacarpophalangeal joint (MCPj) was the US finding with more influence in the decision to change treatment (p=0.016). With respect to distribution, 122 patients (95.3%) had al least one joint with US synovitis and 76 patients (59.3%) had at least one joint with PD. The wrist, 2nd MCPj and 2nd metatarsophalangeal joint (MTPj) were the most affected in terms of synovitis whereas the 5th MTPj showed more erosions (37.7%) and the extensor fingers tendons showed more tenosynovitis (23.02%). Conclusions US demonstrated to play an important role in the treatment decision of RA patients. The impact was more frequent in patients with active disease but also affected the decision in patients considered in clinical remission. Disclosure of Interest None declared

Background Accelerated atherosclerosis is known in gout. Hyperuricemia is considered an independent risk factor for cardiovascular (CV) disease. Evidence supporting both proatherogenic and prothrombotic states in HU is also published Ultrasound (US) measurement of the carotid intima-media thickness (cIMT) is a recognized measure of premature subclinical atherosclerosis with a predictive value respect to vascular events. Objectives To determine the prevalence of increased cIMT, as sign of subclinical atherosclerosis, by an automated US method, and the associated risk factors in patients with gout and asymptomatic hyperuricemia (aHU) Methods 138 patients with gout, 105 with aHU and 99 age and sex matched healthy controls were enrrolled. For all patients were recorded: clinical history, disease duration, smoking, ischemic heart disease, comorbidities (diabetes mellitus, high blood pressure, dyslipidemia, renal insufficiency, obesity), and current therapy. ESR and serum CRP, total and HDL cholesterol, triglycerides, glucose, creatinine and uric acid were recorded. Patients with history of CV and cerebrovascular events or autoimmune diseases were excluded. US examinations of both common carotids were performed by an experienced sonographer trained in cIMT examination, with a Esaote My Lab 70XVG, equipped with a linear probe (4–13 MHz) and an automatic IMT measure software. The definitions of Mannheim cIMT Consensus were adopted Results A total of 684 common carotids were assessed. The prevalence of increased cIMT was 47.1%, 47.6% and 1% in patients with gout, aHU, and control group, respectively. The final adjusted logistic regression for patients with gout showed that time of disease progression (OR =0.79, 95% CI 0.66–0.95) and previous smoking (OR =0.32, 95% CI, 0.10–0.97) were associated with cIMT increase (p Conclusions Our results demonstrate that patients with gout and aHU without clinically evident cardiovascular disease have a high prevalence of subclinical atherosclerosis. Disease duration and levels of uric acid are independent factors related with increased cIMT in gout and aHU respectively. These results support the importance of screening for CV risk and to include carotid ultrasound in CV prevention strategies in these patients. Disclosure of Interest None declared

Aim To assess dual time point 2-deoxy-2-[ 18 F]fluoro- d -glucose 18 F FDG PET-CT accuracy in nodal staging and in detection of extra-axillary involvement. Material and methods Dual time point [ 18 F] FDG PET/CT scan was performed in 75 patients. Visual and semiquantitative assessment of lymph nodes was performed. Semiquantitative measurement of SUV and ROC-analysis were carried out to calculate SUVmax cut-off value with the best diagnostic performance. Axillary and extra-axillary lymph node chains were evaluated. Results Sensitivity and specificity of visual assessment was 87.3% and 75%, respectively. SUVmax values with the best sensitivity were 0.90 and 0.95 for early and delayed PET, respectively. SUVmax values with the best specificity were 1.95 and 2.75, respectively. Extra-axillary lymph node involvement was detected in 26.7%. Conclusion FDG PET/CT detected extra-axillary lymph node involvement in one-fourth of the patients. Semiquantitative lymph node analysis did not show any advantage over the visual evaluation.

The Mexican territory has a large potential for renewable energy development, such as geothermal, hydro, biofuels, wind and solar. Thus, a 2.5 kW hybrid power system (solar, wind and hydrogen) was designed and installed to meet the power demand for a stand-alone application at the University of Zacatecas. The hybrid unit integrates three power energy sources –a photovoltaic system (PV), a micro-wind turbine (WT), a prototype of a unitized regenerative fuel cell (URFC) and energy storage devices (batteries)– in addition to their interaction methodology. The main contribution of this work is the URFC integration to a hybrid power system for the production of H2 (water electrolyzer mode) and energy (fuel cell mode). These three energy technologies were connected in parallel, synchronized to the energy storage system and finally coupled to a power conversion module. To achieve the best performance and energy management, an energy management and control strategy was developed to the properly operation of the power plant. A meteorological station that has wireless sensors for the temperature, the humidity, the solar radiation and the wind speed provides the necessary information (in real time) to the monitor and control software, which computes and executes the short and mid–term decisions about the energy management and the data storage for future analysis.

In this paper, the modifications made to a robot Bioloid type A to participate in weightlifting competition HuroCup of the International Federation of the Association of Robot Soccer, FIRA, is presented. The changes are based on a static analysis in critical positions that the robot should take during weightlifting competition. Furthermore, the designed elements will be simulated before construction using finite element software.

Fever in the elderly as compared with young adults has a clinical expression, prevalence, and diagnosis that require a specific type of evaluation. The significance of fever in the elderly gains importance with the increase of the population's age and it must be considered an alarm signal in these patients. Etiologically, the primary cause of prolonged fever with unspecific origin in this population, is arteritis of giant cells, followed by (according to epidemiological environment) tuberculosis and hematological neoplasias. There is no consensus on diagnostic approaches, but it is essential to take great care in the process due to risk associated with invasive tests and low tolerance to them.

Background Benznidazole is effective for treating acute and chronic (recently acquired) Trypanosoma cruzi infection (Chagas' disease). Recent data indicate that parasite persistence plays a pivotal role in the pathogenesis of chronic Chagas' cardiomyopathy. However, the efficacy of trypanocidal therapy in preventing clinical complications in patients with preexisting cardiac disease is unknown. Study Design BENEFIT is a multicenter, randomized, double-blind, placebo-controlled clinical trial of 3,000 patients with Chagas' cardiomyopathy in Latin America. Patients are randomized to receive benznidazole (5 mg/kg per day) or matched placebo, for 60 days. The primary outcome is the composite of death; resuscitated cardiac arrest; sustained ventricular tachycardia; insertion of pacemaker or cardiac defibrillator; cardiac transplantation; and development of new heart failure, stroke, or systemic or pulmonary thromboembolic events. The average follow-up time will be 5 years, and the trial has a 90% power to detect a 25% relative risk reduction. The BENEFIT program also comprises a substudy evaluating the effects of benznidazole on parasite clearance and an echo substudy exploring the impact of etiologic treatment on left ventricular function. Recruitment started in November 2004, and >1,000 patients have been enrolled in 35 centers from Argentina, Brazil, and Colombia to date. Conclusion This is the largest trial yet conducted in Chagas' disease. BENEFIT will clarify the role of trypanocidal therapy in preventing cardiac disease progression and death.

Antigen-experienced T cells, also known as memory T cells, are functionally and phenotypically distinct from naive T cells. Their enhanced expression of adhesion molecules and reduced requirement for co-stimulation enables them to mount potent and rapid recall responses to subsequent antigen encounters. Memory T cells generated in response to prior antigen exposures can cross-react with other nonidentical, but similar, antigens. This heterologous cross-reactivity not only enhances protective immune responses, but also engenders de novo alloimmunity. This latter characteristic is increasingly recognized as a potential barrier to allograft acceptance that is worthy of immunotherapeutic intervention, and several approaches have been investigated. Calcineurin inhibition effectively controls memory T-cell responses to allografts, but this benefit comes at the expense of increased infectious morbidity. Lymphocyte depletion eliminates allospecific T cells but spares memory T cells to some extent, such that patients do not completely lose protective immunity. Co-stimulation blockade is associated with reduced adverse-effect profiles and improved graft function relative to calcineurin inhibition, but lacks efficacy in controlling memory T-cell responses. Targeting the adhesion molecules that are upregulated on memory T cells might offer additional means to control co-stimulation-blockade-resistant memory T-cell responses.

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.

Belatacept is a B7-specific fusion protein used to prevent allograft rejection by blocking T cell costimulation. Generally efficacious, it fails to prevent acute rejection in a sizable minority of patients. In experimental models, memory T cells mediate costimulation blockade-resistant rejection (CoBRR), but this remains undefined in humans. To explore relationships between individual patients' immune cell phenotypes and CoBRR, we studied patients receiving belatacept or conventional calcineurin inhibitor-based immunosuppression. We identified a population of CD57(+) PD1(-) CD4 T cells present prior to transplantation that correlated with CoBRR. Contrary to data recognizing CD57 as a marker of senescence on CD8 T cells, we discovered a nonsenescent, cytolytic phenotype associated with CD57 on CD4 T cells. Moreover, CD57(+) CD4 T cells expressed high levels of adhesion molecules implicated in experimental CoBRR, were CD28(-) , expressed a transcriptional phenotype broadly defining allograft rejection and were shown to be present in rejecting human kidney allografts. These data implicate CD57(+) CD4 T cells in clinical CoBRR. If prospectively validated, this characteristic could identify patients at higher risk for acute rejection on belatacept-based therapy.

Purpose To explore the relation between tumor kinetic assessed by 18 F-FDG PET and final neoadjuvant chemotherapy (NC) response within a molecular phenotype perspective. Material and Methods Prospective study included 144 women with breast cancer. All patients underwent a dual-time point 18 F-FDG PET/CT previous to NC. The retention index (RI), between SUV-1 and SUV-2 was calculated. Molecular subtypes were re-grouped in low, intermediate and high-risk biological phenotypes. After NC, all residual primary tumor specimens were histopathologically classified in tumor regression grades (TRG) and response groups. The relation between SUV-1, SUV-2 and RI with the TRG and response groups was evaluated in all molecular subtypes and in accordance with the risk categories. Results Responder's lesions showed significant greater SUVmax compared to non-responders. The RI value did not show any significant relation with response. Attending to molecular phenotypes, statistical differences were observed with greater SUV for responders having high-risk molecular subtypes. Conclusion Glycolytic tumor characteristics showed a significant correlation with NC response and dependence of risk phenotype.

Aim To explore the relationship between basal 18 F-FDG uptake in breast tumors and survival in patients with breast cancer (BC) using a molecular phenotype approach. Material and Methods This prospective and multicentre study included 193 women diagnosed with BC. All patients underwent an 18 F-FDG PET/CT prior to treatment. Maximum standardized uptake value (SUVmax) in tumor (T), lymph nodes (N), and the N/T index was obtained in all the cases. Metabolic stage was established. As regards biological prognostic parameters, tumors were classified into molecular sub-types and risk categories. Overall survival (OS) and disease free survival (DFS) were obtained. An analysis was performed on the relationship between semi-quantitative metabolic parameters with molecular phenotypes and risk categories. The effect of molecular sub-type and risk categories in prognosis was analyzed using Kaplan–Meier and univariate and multivariate tests. Results Statistical differences were found in both SUVT and SUVN, according to the molecular sub-types and risk classifications, with higher semi-quantitative values in more biologically aggressive tumors. No statistical differences were observed with respect to the N/T index. Kaplan–Meier analysis revealed that risk categories were significantly related to DFS and OS. In the multivariate analysis, metabolic stage and risk phenotype showed a significant association with DFS. Conclusion High-risk phenotype category showed a worst prognosis with respect to the other categories with higher SUVmax in primary tumor and lymph nodes.

Summary In this study the effect of collagen-polyvinylpyrrolidone (collagen-PVP) vs. triamcinolone acetonide (Triam) in scleroderma (SSc) skin lesions was evaluated. Ten SSc patients were treated weekly with subcutaneous injections of 0.2 mL Triam (8 mg/mL) or 0.2 mL collagen-PVP (1.66 mg collagen). Skin biopsies were obtained from lesions before and after treatment. Tissue sections were evaluated by histology and immunohistochemistry (ELAM-1, VCAM-1, IL-1β, TNF-α, TGF-β1 and PDGF). The corticoid-treated group showed abnormal tissue architecture while the biodrug-treatment restored cutaneous appendages and type I/III collagen proportion. Cytokine and adhesion molecule expression was almost inhibited with Triam, while collagen-PVP down-regulated it. Collagen-PVP improved the tissue architecture of SSc lesions and down-regulated some proinflammatory parameters, without the side effects induced by corticoids.

A photoelectrode structure is proposed in which a dense and thin TiO2 film is grown on the conducting support using microwave activated chemical bath deposition (MW-CBD) before depositing the thicker and porous TiO2 layer. IPCE and open-circuit photovoltage spectra of the two-layer TiO2 nanostructured photoelectrode are presented. Better characteristics for the two-layer structure were found when compared to those of a single layer without the MW-CBD TiO2 film. Possible factors leading to parameter improvements are discussed. Use of MW-CBD underlying films can contribute to the development of liquid- and solid-dye-sensitized solar cells, as well as facilitate the use of other redox couples.

We reviewed a series of consecutive total hip replacements with cemented femoral components. Modern cementing techniques were followed in all cases, but two different medullary plugs were used—one was polyethylene and the other bioabsorbable gelatin. Cement mantle quality and plug migration were assessed by three different observers (X, Y, and Z); their findings did not agree. This was particularly evident when the cement mantles were assessed. There was a better cement mantle grading and less distal migration with polyethylene plugs, although there was no significant statistical difference between the two groups.

9 páginas Abstract Objective Human leucocyte antigen (HLA) B27 and HLA-B15 are associated with spondyloarthritis (SpA). Recent Assessment of SpondyloArthritis international Society (ASAS) criteria emphasise a distinction between SpA with axial and peripheral patterns. We analysed whether HLA-A, HLA-B and HLA-DRB1 alleles could associate with these patterns. Methods We studied 100 healthy individuals and 178 patients with SpA according to European Spondyloarthropathy Study Group (ESSG) criteria. Patients were then classified according to ASAS criteria, the axial spondyloarthritis pattern (axSpA) being defined by ascertained sacroiliitis and the peripheral pattern (pSpA) by enthesitis and/or arthritis in extremities. A combined ax/p pattern was also considered. Results Only HLA-B27 and HLA-B15 alleles were associated with SpA. ASAS criteria for axSpA were met in 152 patients (12 with isolated axSpA and 140 with a combined ax/p patterns). When the ASAS peripheral criteria were applied, 161 patients met these criteria (13 with isolated pSpA and 148 with a combined ax/p pattern). HLA-B27 was found in 83% of patients with axSpA and 43% of ax/pSpA patients according to axASAS. HLA-B27 occurred in 7% controls but not in any patient with isolated pSpA. HLA-B15 was encountered in 31% of patients with isolated pSpA and 20% of ax/pSpA patients according to pASAS criteria. Moreover, 2 healthy controls, but none of our patients with isolated axSpA were positive for HLA-B15. Conclusions Our data suggest that the presence of HLA-B15 favours the development of isolated/combined peripheral rather than isolated axSpA, while HLA-B27 promotes an isolated/combined axial disease and excludes a peripheral pattern. HLA-B15 should be considered in addition to HLA-B27 when diagnosing patients with SpA according to ASAS criteria.

Nanostructured TiO2 is used in novel dye sensitized solar cells. Because of their interaction with light, thin TiO2 films are also used as coatings for self-cleaning glasses and tiles. Microwave activated chemical bath deposition represents a simple and cost-effective way to obtain nanostructured TiO2 films. It is important to study, in this technique, the role of the conducting layer used as the substrate. The influence of microwave–substrate interactions on TiO2 deposition is analysed using different substrate positions, employing substrates with different conductivities, and also using different microwave radiation powers for film deposition. We prove that a common domestic microwave oven with a large cavity and inhomogeneous radiation field can be used with equally satisfactory results. The transmittance spectra of the obtained films were studied and used to analyse film thickness and to obtain gap energy values. The results, regarding different indium–tin oxide resistivities and different substrate positions in the oven cavity, show that the interaction of the microwave field with the conducting layer is determinant in layer deposition. It has also been found that film thickness increases with the power of the applied radiation while the gap energies of the TiO2 films decrease approaching the 3.2 eV value reported for bulk anatase. This indicates that these films are not crystalline and it agrees with x-ray spectra that do not reveal any peak.

The present study was conducted in order to analyze the relationship existing between leptin, insulin and neuropeptide Y (NPY) levels in massive weight loss and weight recovery. Twenty-three patients with severe obesity, 23 patients with anorexia nervosa and 28 healthy control subjects were studied. Patients with severe obesity underwent a vertical banded gastroplasty followed by an 800 kcal/day diet during 16 weeks, with evaluation taking place before (Body mass index, BMI, 52,1 8 Kg/m2) and after the drastic weight loss (BMI 39,2 6,2 Kg/m2). Patients with anorexia nervosa were treated with nutritional therapy exclusively during 16 weeks, and they were evaluated in the low weight situation (BMI 15,3 1,7 Kg/m2) and after weight recovery (BMI 18,9 2,8 Kg/m2). Normal subjects had a normal BMI from 20 to 27 (average 21,8 2 Kg/m2). BMI, percentage of body fat, and serum levels of leptin, insulin, and NPY, were determined in each patient and normal subjects. In severe obese patients serum leptin and insulin decreased significantly after drastic weight reduction (leptin: from 48,8 19,2 to 24,3 9,8 ng/ml; insulin: from 26,2 10,8 to 18 6 U/ml). In patients with anorexia nervosa serum leptin mean levels were significantly higher after weight recovery (3,7 1,9 vs 9,2 5,1 ng/ml). In subjects with morbid obesity NPY levels decreased after weight loss below those of control group (43,5 16,1 vs 57,3 12,8 pmol/l). On the other hand, patients with anorexia nervosa had NPY levels superior to those of control group. In subjects with anorexia, NPY levels decreased after weight recovery (69,1 16,7 a 59,1 20,3 pmol/l). In the whole population, Leptin and NPY plasma levels were correlated with body fat percentage. Leptin was positively correlated with BMI and body fat percentage in obese and anorectic subjects after weight loss or recovery, respectively. NPY was inversely correlated with body fat percentage in controls and obese subjects before treatment. These data reveal that the concentration of serum leptin and NPY correlates significantly with the total adiposity in subjects with a wide weight range and caloric intake. Leptin plasma levels are proportional to fat stores in patients with severe obesity and anorexia nervosa after drastic weight loss or recovery, respectively. NPY serum levels are negatively correlated with de total body fat in normal weight subjects and obese patients in their initial weight.

It has recently been proposed to introduce a new terminology to identify patients with axial spondyloarthritis earlier: nonradiographic axial spondyloarthritis [1]. This new concept, which does not define a new nosological entity, is the last act, for now, of a long and interesting journey that began in the 1960s and still continues nowadays, fascinating many rheumatologists. Until the second half of last century, rheumatologists regarded the ankylosing spondylitis or “Morbus Bechterew” as a spinal variant of the rheumatoid arthritis [2]. However, the attentive and careful clinical observation allowed by some rheumatologists among which highlight JM Moll and V Wright intuits that a heterogeneous group of patients with apparently very different diseases shared a lot of clinical aspects and familial aggregation. So, in this way, the concept of the spondyloarthropathies (SpA) was introduced by Moll et al. in 1974 as a family of interrelated disorders sharing clinical and genetic characteristics distinct from rheumatoid arthritis (RA) [3]. At the base of the concept stood the clinical observation of the aggregation of some common diseases (psoriasis, spondylitis, peripheral arthritis, enthesitis, acute anterior uveitis, chronic inflammatory bowel disease) in the same patient or in different members of the same family. One finding that has helped to strengthen the concept of SpA has been, without doubt, its association with HLA-B27, observation made independently but at same time by Brewerton et al. [4] and Schlosstein et al. [5], confirming pathophysiologically the clinical suspicion. Twenty years later, the evidence that a rat transgenic for HLA-B27, spontaneously developed some characteristics of these diseases, provided a definite support for the suspicion long intuited by the pioneers of spondyloarthritis [6]. Presently, it is accepted that the spondyloarthropathies or spondyloarthritis are a heterogeneous group of interrelated rheumatic inflammatory diseases that share common etiopathogenesis, clinical, genetic, and radiological features. SpA encompasses ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, inflammatory bowel, and diseaserelated arthritis, whose estimated prevalence ranges 0.3–0.5% for AS and 1–2 % of SpA, which is higher than rheumatoid arthritis [7]. These groups of diseases frequently show familial aggregation and are strongly associated with HLA-B27; however, the strength of this association varies markedly between the various types of SpA of which AS remains as the paradigm. Identification of patients with these diseases has also been a long and interesting road, marked by progress in the deepest knowledge of the clinical expression with new technologies. Initially the patient was identified by appearance: “Complains of back being “set” for 3 years; cannot turn her head to the side or bend it backwards; is stiff when walking, but is better by day than by night; has pain at lower end of spine and in the hips” [8]. Radiological findings have been the cornerstone in which the diagnosis has been based, as stated in an early (perhaps the first) serious review by Buckley [9]. Radiographic sacroiliitis has been considered a hallmark of AS and is present in all patients with an established disease, and it is also a requirement for the fulfillment of the modified New York criteria for AS established in 1984, which are widely used as classification and diagnostic criteria in clinical E. Collantes-Estevez (*) Rheumatology Department, “Reina Sofia” Hospital/IMIBIC/ University of Cordoba, Cordoba, Spain e-mail: educollantes@yahoo.es

Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by severe proximal myalgias associated with an elevated erythrocyte sedimentation rate (ESR). In this report 10 otherwise typical PMR patients with an ESR35 mm/hr, and 10 PMR patients with an ESR35 mm/hr were examined and prospectively followed. We report the initial laboratory response to steroids in both groups as well as follow-up (average32.6 months in the low ESR group). The average follow-up for this study is the longest reported for low ESR PMR. The most significant difference noted was a longer duration before diagnosis and therapy for the low ESR group. Both groups showed similar clinical and laboratory response to therapy and similar post-treatment disease duration.The absence of an elevated ESR does not exclude the diagnosis of PMR. Clinical response to steroids and a drop in the ESR after therapy are proposed as useful to confirm the diagnosis.

Aim: To explore the usefulness of metabolic variables of breast tumours obtained in 18F-FDG PET/CT in the prediction of response to neoadjuvant chemotherapy (NC) and prognosis in locally advanced breast cancer (LABC). Material and methods: Prospective multicenter study including 60 patients with LABC and NC indication and a baseline 18F-FDG PET/CT. After breast tumor segmentation, SUV variables (SUVmax, SUVmean and SUVpeak) and volume-based variables as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were obtained. Univariate analysis was performed with the use of Kaplan-Meier and Cox proportional hazards models to study the potential of metabolic variables, molecular phenotypes of breast cancer specimens and histologic response to predict: disease-free status (DFs), disease-free survival (DFS) and overall survival (OS). Results: Sixty patients underwent NC. 14 were classified as pCR. 56 patients where free of recurrence during the follow-up. Median ± SD of DFS and OS was 43±15 and 46±13 months respectively. SUV and volume-based variables showed significant relations (p MTV and TLG showed significant association with DFs (p=0.015 and p=0.038 respectively). Median, mean and SD of MTV and TLG for patients with DFs were: 8.90, 13.72 and 15.12 and 33.78. 90.54 and 144.64 respectively. Median, mean and SD of MTV and TLG for patients with a non-DFs were: 16.72, 29.70 and 31.09 and 90.89, 210.98 and 382.80 respectively. No significant relations were observed with SUV variables and DFs. No significant relations were obtained for none metabolic variable with DFS and OS. Conclusion: In patients with locally advanced breast cancer, volume-based metabolic variables obtained with 18F-FDG PET/CT, differently to SUV based variables, were good predictors of neoadjuvant chemotherapy response and disease free status. Citation Format: Muñoz-Sánchez MdM, Soriano MdC, Garcia-Vicente AM, Molina-Garrido MJ, Pérez-Beteta J, Olaverri-Herández A, Molina-García D, Santiago Crespo JA, Pérez García VM, Val-Pérez E, Martín-Ordóñez F, Chacón-Muñiz JI, Álvarez-Cabellos R, Espinosa-Aunión R, Ortega-Ruipérez C, Cantero MJ, Castro A, Vaquero E, Catalá E, Torrecillas F, Soriano-Castrejón A. Assessing response in locally advanced breast cancer treated with neaodjuvant chemotherapy: Predictive and prognostic potential of volume-based metabolic variables with 18F-FDG PET/CT [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-01-04.

Aim: To investigate the use of 18F-FDG PET/CT at diagnosis and after end-of-treatment in the prediction of response to neoadjuvant chemotherapy (NAC) and its role in the prognosis of patients with locally advanced breast cancer (LABC). Materials and Methods: One hundred thirty-two patients underwent a baseline FDG PET/ CT (PET-1) after the second course of chemotherapy (PET-2) and after the last course (PET-3). Breast tumors were classified into molecular phenotypes and grouped into risk categories according to the biological prognostic factors obtained by immunohistochemistry. PET/CT scans were semiquantitatively evaluated, obtaining the Δ% SUV1-2 and SUV1-3 in primary tumor and axillary lymph nodes to establish response groups attending to EORTC criteria. Moreover, a binary assessment was obtained classifying the studies as positive or negative. Pathological response was determined both in breast and axillary lymph node specimens. Overall survival (OS) and disease-free survival (DFS) were obtained during the follow-up. ROC analysis was performed to determine a cutoff value of Δ% SUV1-2 and SUV1-3 for the prediction of response and prognosis. Relations between molecular phenotypes, metabolic behavior, final pathological response, OS, and DFS were evaluated. This prospective and multicenter study was approved by the local ethics committee of our institution and included 7 hospitals of our region. Results: In binary analysis, only PET-3 was able to predict pathological response in lymph nodes. The cutoff values of %Δ SUV1-2 and %Δ SUV1-3 with the best sensitivity and specificity in the prediction of response in breast tumor were 62% (Se: 70% and Sp: 69%) and 84% (Se: 70%and Sp: 88%). A%ΔSUV1-3 of 74% in breast tumor was a predictor of DFS (AUC = 0.647; P = 0.037, Se: 52% and Sp: 66%). Kaplan- Meier analysis revealed significant relations between the binary lymph node assessment of PET-3 with OS (P = 0.016, χ2 = 5.78) and DFS (P = 0.003, χ2 = 9.10). Conclusions: Among the multiple metabolic response variables in breast tumor and lymph nodes, end-of-treatment 18F-FDG PET/CT was a significant predictor of breast and lymph node response and patient prognosis. The molecular phenotypes and pathological lymph node response rate were independent predictors of OS and DFS. This stresses the potential of the biological influence over metabolic variables in the prognosis of patients. Metabolic response variables work better in their predictive and prognostic value in high-risk tumors. Citation Format: Muñoz-Sánchez MdM, Molina-Garrido MJ, García Vicente AM, Soriano Rodríguez MdC, Amo Salas M, Olaverri Hernández A, Chacón Muñiz JI, Álvarez Cabellos R, Espinosa Aunión R, Ortega Ruipérez C, Martín Ordóñez F, Pena Pardo FJ, Jiménez Londoño GA, Val Pérez E, Santiago Crespo JA, Soriano Castrejón A. Determining the prognostic role of early and end-of-neoadjuvant chemotherapy 18F-FDG PET/CT in patients with locally advanced breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD3-03.

Basados en el efecto fotoacústico pulsado, se desarrolló un dispositivo experimental para generar imágenesbidimensionales de muestras ópticamente opacas ocultas en un medio turbio. El medio turbio se hizo de agar ynanopartículas monodispersas, con estos materiales indujimos una absorción y esparcimiento óptico semejante al delos tejidos humanos. La señal PA se genera por la absorción óptica del la muestra; una vez producida viaja a travésdel medio esparsor. Las propiedades de ópticas de la muestra así como la forma de éste definen la amplitud y formade la señal PA. En el sistema fotoacústico se utilizaron pulsos láser de Nd: YAG de 10 ns, con frecuencia derepetición de 10Hz, y longitud de onda de 1064 nm. Las señales generadas fueron registradas por un transductorultrasónico con frecuencia de corte de 10 MHz. Tanto la muestra como el medio esparsor se rotaron para obtener 36proyecciones, las cuales fueron utilizadas para alimentar un algoritmo de reconstrucción de imágenes basado en latransformada de Radon. Como resultado se obtuvieron imágenes tomográficas 2D de tres muestras distintas.

A preliminary step in the decision to install flotation columns in an existing separation circuit is the so-called amenability testing. This testing consists of comparing metallurgical results from laboratory columns with, for example the performance of the existing circuit or with laboratory mechanical cells. The following step is to select the size and number of columns required for the duty. One way this is achieved is by using a computer simulator based on a scale-up model. This model requires, among other parameters, the flotation rate constants and the solids removal froth capacity, which have to be experimentally determined. This paper describes the apparatus and methodology used to conduct flotation column amenability and scale-up tests and discusses problems encountered during experience at a number of different concentrators. Amenability tests and scale-up procedure are illustrated using examples from two particular case studies: Mount Isa Mines and Falcombridge Ltd.

Background Osteoarthritis (OA) is a chronic, inflammatory and multifactorial disease. The metabolic syndrome (MS) has been described as a risk factor in this disease; adipokines levels have been associated in the pathogenesis of OA, some studies have described this association in patients with late OA, however few information is available about the adipokines behavior in patients with early OA. Objectives To assess the levels of adipokines and inflammatory cytokines in patients with early OA, with and without MS, compared with a group of healthy people. Methods We conducted a cross-sectional and observational study. Patients must full-fill ACR Knee primary OA criteria, both genders and the patients should have clinical and radiographic criteria of early knee OA; these patients were divided into two groups: patients with and without MS according with the criteria of the ATP-III and were compared with a group of healthy people as a control group. Through an interview, we collected epidemiological and demographic data. Blood sample was collected in order to evaluate serum adipokines and inflammatory cytokines by ELISA (R & D Systems®). Descriptive and bivariate statistics was used. The analyses was done with 12® STATA software. Results 100 patients with OA and 41 healthy controls were studied. The mean age was 49.5 in the osteoarthritis group with metabolic syndrome (OAMS), 45 and 47 for groups of osteoarthritis without metabolic syndrome (OAnMS) and healthy controls respectively. There were 82% women in the OA group vs 95% control. The mean BMI was 31.4 OAMS group, 29.3 OAnMS and 26.0 for the control group. In Table 1, we summarize the values of the cytokines tested. The levels of NGF (nerve growth factor) obtained had no significant value in the study groups. Significant results were obtained in patients in the OAMS group, in which the serum adipokines levels were increased: IL-6, IL-8, HGF (hepatocyte growth factor), MCP-1 (macrophage chemoattractant protein-1), TNF-α (tumor necrosis factor-α) and PAI-1 (plasminogen activator inhibitor-1); adiponectin was found higher in patients with OAnMS, and others adipokines as resisitina, IL-1β and leptin were also increased. Conclusions We found a significant difference between levels of cytokines and adipokines, these finding supports that in the early stages of OA, the serum adipokines and pro-inflammatory cytokines play an important pathogenic role. It is likely that in the future, we can use these findings in order to classify the OA in phenotypes according to the serum levels of adipokines. It is noteworthy that our entire population was overweight, including the control group. It could be a possible confounding factor. References Abella V, Scotece M, Conde J, Lόpez V, Lazzaro V, Pino J, Gualillo O (2014). Adipokines, metabolic syndrome and rheumatic diseases. Journal of Immunology Research, 2014, 343746. doi:10.1155/2014/343746 Haseeb A, Haqqi TM (2013). Immunopathogenesis of osteoarthritis. Clinical Immunology. Kadowaki T, Yamauchi T (2005). Adiponectin and adiponectin receptors. Endocrine Reviews. doi:10.1210/er.2005-0005 Kaur J (2014). A comprehensive review on metabolic syndrome. Cardiology Research and Practice, 2014, 943162. doi:10.1155/2014/943162 Disclosure of Interest None declared

Background Total body fat mass is related to development of knee OA (KOA), strength and lean body mass of quadriceps in the setting of neutral articular alignment is a risk factor for loss of articular space in KOA and further incapacity. Higher percentage of body fat mass has been established as a risk factor for postoperative complications as transfusion requirement and longer in-hospital stay; progressive loss of lean mass precludes poor funtional and mortality outcomes in elderly (sarcopenia), however its relationship with functional outcomes in younger patients with E/L-OA remains unknown. Objectives To describe differences in body composition phenotypes measured as total and appendicular lean/fat body mass between early vs late KOA cohort patients and its relationship with quality of life and functional outcomes. Methods We conducted a cross-sectional, observational study. Patients must full-fill ACR Knee primary OA criteria, autoimmune and secondary OA were excluded. Kellgren & Lawrence score less than or equal to II where classified as EOA, and patients full filling criteria for knee arthroplasty were classified as LOA. A protocolized interview collected epidemiological data, joint function with WOMAC and other knee index; Patients were analyzed with multifrequency BIA (InBody 720®) to determine FM and LM. Analysis: Appropriate descriptive and bivariate test compared data between EOA vs. LOA. Results 110 patients were evaluated, 56 with EOA and 54 LOA. The EAO group was younger: 48.5 vs. 65.5 y.o (p=0.001). Proportion of women was superior in both groups: 71.8% women. The OA evolution was 20.3 months in EOA vs 60 months in LOA (p=0.001). Main comparisons are shown in table 1. Conclusions We found remarkable differences in total and appendicular LM and BM in EOA vs LOA, Sarcopenic Obesity (predominant higher fat mass than lean mass) body composition phenotype is probably the most prevalent in both groups but with more functional impairment in LOA, even when BMI where not significantly different between groups. As a limitantion we lack of reference body composition normal population values to compare with. However we propose that good/poor outcomes after total knee arthroplasty might be related to proportion of total and appendicular preoperative lean mass/fat mass relationship; it could be a target of treatment in EOA and LOA patients, further research is needed in this field. References Sowers, M. F. et al. BMI vs body composition and radiographically defined osteoarthritis of the knee in women: a 4-year follow-up study. Osteoarthritis Cartilage 16, 367–372 (2008). Sharma, L., Dunlop, D. D., Cahue, S., Song, J. & Hayes, K. W. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Ann. Intern. Med. 138, 613–619 (2003). Lee, S., Kim, T.-N. and Kim, S.-H. (2012), Sarcopenic obesity is more closely associated with knee osteoarthritis than is nonsarcopenic obesity: A cross-sectional study. Arthritis & Rheumatism, 64: 3947–3954. doi: 10.1002/art.37696. Ledford, Cameron K. et al. Percent Body Fat More Associated with Perioperative Risks After Total Joint Arthroplasty Than Body Mass Index. The Journal of Arthroplasty, 29(9):150 - 154. Disclosure of Interest None declared

Las metástasis intestinales por cáncer de pulmón, son entidades clínicas muy raras, que excepcionalmente, se manifiestan antes que el tumor primario. El diagnóstico se basa en la expresión inmunohistoquímica de diversos tipos de queratinas y marcadores específicos pulmonares como TTF-1. El tratamiento se enfocará en el contexto de un cáncer de pulmón metastásico, aunque puede requerirse una resección quirúrgica intestinal en caso de perforación, hemorragia u obstrucción intestinal, como el presente caso. La supervivencia, en los pocos casos publicados es escasa, no superando las 20 semanas, a pesar del tratamiento realizado. Presentamos un caso de una invaginación intestinal por metástasis de un carcinoma anaplásico de pulmón.

This study was designed to determine the efficacy and safety of the paclitaxel and carboplatin combination in second-line chemotherapy treatment of patients with non-small-cell lung cancer. Treatment consisted of 175 mg/m 2 paclitaxel infused in 1 hour and carboplatin AUC 5 infused in 30 minutes, administered each 3 weeks for a maximum of 6 cycles. The following patient groups were included in the study: those who were stage IV at diagnosis; with progression during or after the administration of previous first-line chemotherapy; PS ≤ 2 and with normal hepatic, renal and bone marrow function. Twenty-two patients were included between January 2000 and December 2002. Their clinical characteristics were: male 81% / female 19%; adenocarcinoma histology in 12 patients (55%) / squamous carcinoma in 6 patients (27%) / large cell carcinoma in 2 patients (9%), and other-types in 2 patients (9%). The Performance Status (ECOG Scale) was 0 in 5 patients (22%), 1 in 5 patients (22%) and 2 in 12 patients (55%). Previously administered treatments were: combinations with cisplatin in 11 patients (50%) and combinations without cisplatin (ifosfamide, gemcitabine, vinorelbine) in 11 patients (50%). The mean number of first-line chemotherapies received was 1 to 4 cycles in 50% patients. The mean number of second-line treatments was 1 to 3 cycles in 50% and 3 to 6 cycles in the others. The doses administered were 100% of that planned in 20 patients, with 2 patients requiring dose reductions due to neutropenia and grade 3 neurotoxicity. The treatment was well tolerated with presentation of the following grade 3-4 toxicities: neutropenia in 2 patients (9%), peripheral neuropathy in 2 patients (9%). The overall response rate was 23% (CI 95%, 8-45): 5 patients (23%) with partial response, 9 (36%) with stable disease and 8 (31%) with progression. The median time to progression with second-line treatment was 16 weeks, reaching a median overall survival of 79 weeks. From the initiation of second-line treatment median survival was 24.1 weeks (CI 95%, 13.7-34.5). In this study it was observed that the combination of paclitaxel with carboplatin as second-line chemotherapy in patients with non-small-cell lung cancer presented moderate/restrained activity without severe toxicity.