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International audience; Octreotide, a somatostatin analogue, has been used for more than 20 years in children with gastrointestinal bleeding, chylothorax or chylous ascites, intestinal lymphangiectasia, pancreatitis, intestinal dysmotility, and severe diarrhoea; however, until now, there is a lack of randomised clinical trials evaluating the efficacy of this compound in childhood. Hence, we aimed to review the literature in order to determine the evidence of its use and safety in children, using PubMed from 2000 to 2021 with the search terms "octreotide" and "children" and "bleeding or chylous ascites or chylothorax or acute pancreatitis or lymphangiectasia or diarrhoea or intestinal dysmotility".

The aim of this work is to fine-tuned a numerical procedure to predict the external aerodynamics flow around a real car. The hybrid RANS/LES method, called DDES, has been selected based on previous work and comparison between many turbulence approaches. First, the numerical procedure has been developed on the \(25^{\circ }\)Ahmed body. Based on this simplified geometry, we were able to define the numerical setup and grid in order to reproduce very accurately the flow around this shape. The second part of the work was to transpose this methodology on a more realistic vehicle, with some geometrical simplifications. At this preliminary stage of the study, the results are encouraging.

The aim of this work is to explore the efficiency of different improved Reynolds-Averaged Navier-Stokes (RANS) and hybrid LES/RANS approaches to study the external aerodynamics related to ground vehicles. These computational techniques should be able to build a bridge between accuracy and robustness in order to compute complex high Reynolds number bluff-body flows like ground vehicle flows. Bluff body flows are characterized by separated regions, containing wide spectra of turbulent scales. These regions, especially in the wake behind the body, are responsible for the main part of the drag forces. An accurate computation of these areas is a difficult task.

Resumen: Introducción: El retraso diagnóstico (RD) de la enfermedad inflamatoria intestinal pediátrica (EII-P) puede conllevar la aparición de complicaciones y una menor respuesta al tratamiento. Estudiar el RD y los factores que lo condicionan ayudaría a implementar medidas correctoras y mejorar la evolución de la enfermedad. Pacientes y métodos: Un total de 53 casos (31 de enfermedad de Crohn [EC], 19 de colitis ulcerosa [CU] y 3 EII-P no clasificadas) entre 2000 y 2012 se evaluaron de forma retrospectiva a través de la información recogida en las historias clínicas de atención primaria y las de un Servicio de Gastroenterología infantil de un hospital terciario. La variable respuesta principal fue el tiempo entre el primer contacto médico-paciente y el diagnóstico. Resultados: El tiempo mediano de RD fue de 12 semanas (rango intercuartílico 5-24). Sin embargo, un 26,3% de las CU y un 25,8% de las EC presentaron un RD superior a un año. Ninguno de los factores de riesgo estudiados se asoció significativamente a un RD relevante pero los niños de menor edad presentaron una tendencia a un mayor RD. Conclusiones: Aunque el RD mediano de la EII-P parece aceptable, existe una proporción importante de niños con unas características clínicas heterogéneas y unos tiempos diagnósticos considerables. Se debería profundizar en el análisis de las oportunidades perdidas de diagnóstico. Abstract: Introduction: Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease. Patients and methods: A retrospective study of the information collected from primary care medical records and that from the pediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out on 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified pediatric inflammatory bowel disease. The main response variable was the interval from the first physician-patient contact to diagnosis. Results: The median time to diagnosis was 12 weeks (interquartile range 5-24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors was associated with a relevant diagnostic delay, although it tended to be longer in younger children. Conclusions: Whereas the median delay for pediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out.

Introduction: Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease. Patients and methods: A retrospective study of the information collected from primary care medical records and that from the paediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out in 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified paediatric inflammatory bowel disease. The main response variable was the interval from the first physician–patient contact to diagnosis. Results: The median time to diagnosis was 12 weeks (interquartile range 5–24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors were associated with a relevant diagnostic delay, although it tended to be longer in younger children. Conclusions: Whereas the median delay for paediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out. Resumen: Introducción: El retraso diagnóstico (RD) de la enfermedad inflamatoria intestinal pediátrica (EII-P) puede conllevar la aparición de complicaciones y una menor respuesta al tratamiento. Estudiar el RD y los factores que lo condicionan ayudaría a implementar medidas correctoras y mejorar la evolución de la enfermedad. Pacientes y métodos: Un total de 53 casos (31 de enfermedad de Crohn [EC], 19 de colitis ulcerosa [CU] y 3 EII-P no clasificadas) entre 2000 y 2012 se evaluaron de forma retrospectiva a través de la información recogida en las historias clínicas de atención primaria y las de un Servicio de Gastroenterología infantil de un hospital terciario. La variable respuesta principal fue el tiempo entre el primer contacto médico-paciente y el diagnóstico. Resultados: El tiempo mediano de RD fue de 12 semanas (rango intercuartílico 5-24). Sin embargo, un 26,3% de las CU y un 25,8% de las EC presentaron un RD superior a un año. Ninguno de los factores de riesgo estudiados se asoció significativamente a un RD relevante pero los niños de menor edad presentaron una tendencia a un mayor RD. Conclusiones: Aunque el RD mediano de la EII-P parece aceptable, existe una proporción importante de niños con unas características clínicas heterogéneas y unos tiempos diagnósticos considerables. Se debería profundizar en el análisis de las oportunidades perdidas de diagnóstico.

The flow around the \(25^{\circ }\) Ahmed body has been studied computationally by applying different methods including an improved URANS formulation, the SAS model and two popular hybrid RANS/LES formulations: DDES and SBES models. All of the turbulence models employ the underlying SST RANS formulation. These hybrid models show a good prediction for the drag coefficient, with an error between 0–4% compared to experiments, whereas the discrepancy is slightly more important for the lift coefficient. The DDES model shows the best representation of the flow features between all the models studied.

From a computing standpoint, flash X-ray radiography is much more time-consuming than traditional X-ray applications, and despite the constant increase of computing resources, methods to reduce the calculation time while preserving accuracy are highly needed. At the Commissariat a l'Energie Atomique, DIANE is the code devoted to flash X-ray calculations. After a brief description of the general features of DIANE, two selected methods implemented in DIANE to provide fast calculations are described. One concerns bremsstrahlung X-ray creation without electron transport electrons: the SSB model. The quality of this model is assessed within the framework of flash X-ray applications on two test problems with a fully photon-electron transport performed with MCNP5. The other focuses on particle tracking and Woodcock tracking. The performance of tracking within large meshes is evaluated.

In this paper we propose a review of the model called MVHR (Multi-Vibrational Hydrogen Release) dealing with Si-H bond physics and allowing explaining the complex physics of gate oxide breakdown. A large amount of effect as polarization, gate bias, temperature, and oxide thickness impacts are well explained by this physical model. In addition the model predicts some process related effects such as poly doping and oxide nitridation impact. The application of this model to high-K metal gate stack is discussed and a complete description of physical degradation in high-K stack is provided. A large amount of gate stack is studied as gate material (TiN, TaC, Poly), gate oxide (SiON, HfSiON, HfO2, HfZrO2). Hence the reliability limit of the SiON gate oxide will be predicted and guideline will be provided for metal gate dielectrics lifetime extrapolation.

Objective Selective granulocyte-monocyte adsorption (GMA) apheresis is a safe technique that has shown efficacy in inflammatory bowel disease (IBD), especially in adult steroid-dependent and steroid-refractory ulcerative colitis. GMA apheresis is performed with Adacolumn, a direct blood perfusion system that selectively adsorbs circulating granulocytes and monocytes. Studies on efficacy of GMA apheresis in paediatric IBD are scarce. Our aim was to evaluate efficacy, safety, and tolerability of GMA apheresis in paediatric IBD patients followed for 1 year. Patients and methods Nine patients with a mild to moderate flare-up (6 boys, 3 girls; 5 ulcerative colitis [UC], 4 Crohn disease [CD]) were included. Mean age at inclusion was 13 years and 9 months, and mean disease duration before inclusion was 28 months. All of our patients with UC were steroid-dependent; patients with CD had been unsuccessfully treated with other therapies. GMA apheresis consisted of 5 consecutive weekly sessions lasting 60 minutes each. Results After the 5 sessions, 4 of 5 patients with UC and 1 of 4 patients with CD achieved remission. This remission was maintained in 2 of 4 patients with UC and in the single patients with CD. Patients taking steroids could begin to taper their daily doses after the second apheresis, and 3 of 5 of these patients reached the end of the study steroid-free. GMA apheresis was well tolerated and no severe side effects related to the technique were observed. Conclusions GMA apheresis is a safe, well-tolerated technique in paediatric IBD. As previously reported, we have observed a better efficacy in promoting and maintaining remission, and reducing conventional drugs in patients with UC than in patients with CD.

Objetivo: Los tumores hepáticos malignos (THM) pediátricos son el resultado final de la combinación variable de los factores de riesgo (FR) constitucionales y ambientales. La presente revisión pretende divulgar los principales FR asociados a los THM pediátricos para fomentar su prevención primaria y el diagnóstico precoz en los síndromes constitucionales. Método: Revisión sistemática de la bibliografía de los últimos 25 años, obtenida del Medline, Embase, Cancerlit, Lilacs y SciElo. El perfil de búsqueda utilizado fue la combinación de “etiology/risk factor/epidemiology” and “malignant liver tumors/hepatic cancer” or “hepatoblastoma/hepatocarcionoma”. Resultados: Los THM en la época pediátrica constituyen el 1% del total de cánceres pediátricos. Los dos tipos principales, el hepatoblastoma (HB) y el hepatocarcinoma (HC), engloban el 98-99% de los THM. Diversos FR constitucionales y ambientales están asociados a un mayor riesgo de desarrollar dichas neoplasias. Los principales FR constitucionales son los siguientes: a) síndrome de Beckwith-Wiedemann (BW); b) síndrome de hemihiperplasia aislada (HA); c) poliposis adenomatosa familiar; d) hemocromatosis; e) tirosinemia hereditaria tipo 1; f) deficiencia de alfa-1 antitripsina; g) porfirias; h) cirrosis; i) esteatosis no alcohólica, y j) colangitis esclerosante primaria. Los principales FR ambientales son los siguientes: a) virus de las hepatitis B (VHB) y C (VHC); b) aflatoxina B1 (AFB1); c) radiación ionizante; d) alcohol; e) tratamientos hormonales; f) exposiciones laborales a solventes, pesticidas, cloruro de vinilo y metales; g) tabaquismo; h) arsénico; i) prematuridad y muy bajo peso al nacimiento, y j) tremátodos. Conclusiones: El cribado clínico, analítico y ecográfico de los principales síndromes genéticos comentados, especialmente el de BW y HA, durante los primeros años de vida, facilitan el diagnóstico precoz del HB. La vacunación universal de los recién nacidos con el VHB, constituye el pilar básico de la prevención primaria de los THM. El control del VHB y VBC en la sangre, hemoderivados, donaciones de órganos y en drogadictos también es de gran utilidad. Otras medidas efectivas en la prevención primaria de los THM son: la reducción/ eliminación de alimentos con AFB1, la abstención alcohólica pediátrica y la reducción de las exposiciones prenatales al tabaco, radiaciones ionizantes, solventes, pesticidas, cloruro de vinilo, metales y tratamientos hormonales. : Objective: Pediatric Hepatic Malignancies (PHMs) are the result of the interaction between constitutional and environmental risk factors (RFs). We review the evidence on the main RFs associated to PHMs. Method: Systematic review of the literature published in the last 25 years on Medline, Embase, Cancerlit, Lilacs and SciElo using the following key words: “etiology/risk factor/epidemiology” and “malignant liver tumors/hepatic cancer” or “hepatoblastoma/hepatocarcionoma”. Results: PHMs account for 1% of all pediatric malignancies. The main types, hepatoblastoma (HB) and hepatocarcionma (HCC) make up 98-99% of PHM. The main constitutional RFs are: a) Beckwith-Wiedemann (BW) syndrome; b) isolated hemihyperplasia syndrome (IHS); c) adenomatous polyps of the colon; d) hemochromatosis; e) Hereditary Tyrosinemia Type 1; f) α-1-antitrypsin deficiency; g) porphyrias; h) cirrhosis; i) nonalcoholic steatosis; and j) primary sclerosing cholangitis. The main environmental RFs are: a) hepatitis B virus (HBV) and C virus (HCV); b) B1 aflatoxin (B1AF); c) ionizing radiation; d) alcohol; e) hormonal treatments; f) occupational exposure to pesticides, solvents, vinyl chloride and metals; g) smoking; h) arsenic; i) prematury and very low birth weight; and j) trematodes. Conclusions: The clinical, analytical and ultrasound screening facilitate the early diagnosis of HB in the previously mentioned genetic syndromes, particularly BW and IHS during the first years of life. HBV universal vaccination of newborns provides the biggest opportunity to prevent a substantial proportion of PHMs. Also systematic monitoring of HBV and HCV in blood, hemoderivates, donated organs and drug addicts, are very useful. Other effective measures are: the reduction/elimination of B1AF in food, zero alcohol intake during childhood and adolescence as well decreasing prenatal exposure to the tobacco, solvents, pesticides, vinyl chloride, metals, ionizing radiation and hormonal treatments.

espanolUna analgesia inadecuada en cirugia toracica facilita las complicaciones respiratorias potencialmente graves y se asocia al sindrome de dolor cronico post-toracotomia. El cateter epidural y el cateter paravertebral son los tratamientos que resultan mas efectivos, dentro de una estrategia multimodal. El parche de lidocaina 5% esta indicado para el dolor en la neuropatia post-herpetica. Existe literatura sobre su utilidad en otros modelos de dolor. Presentamos tres pacientes con dolor postquirurgico en cirugia de torax, a pesar del tratamiento convencional, y su buena respuesta analgesica tras la aplicacion de parche de lidocaina 5%. EnglishSub-optimal management of acute post-thoracotomy pain is associated to pulmonary complications and has been identified as an independent factor for a post-thoracotomy pain syndrome. Epidural analgesia and paravertebral catheter are the most effective in a multimodal analgesia regime. Lidocaine patch 5% is for a treatment for post-herpetic neuralgia. Some literature suggests its use in other types of pain. We present three patients after different thoracic procedures with uncontrolled pain despite conventional treatment, and their good pain response to lidocaine patch 5%.

Resumen: En el momento actual existe una situación de indefinición con respecto a cuándo, cómo y de qué forma debe introducirse el gluten en la dieta del lactante. Durante años ha prevalecido la recomendación del Comité de Nutrición de la ESPGHAN de evitar tanto la introducción precoz, antes de los 4 meses, como la tardía, después de los 7 meses, y de introducir el gluten gradualmente mientras el lactante recibe leche materna; se pretendía con ello reducir el riesgo de enfermedad celiaca, diabetes y alergia al gluten. Sin embargo, 2 estudios independientes publicados en octubre de 2014 en The New England Journal of Medicine llegan a la conclusión de que la edad de introducción del gluten no modifica el riesgo de desarrollar la enfermedad celiaca y que la lactancia materna a cualquier edad tampoco confiere protección.Por otra parte, según la evidencia científica disponible, en general, se recomienda la introducción de otros alimentos en la dieta distintos de la leche materna o de fórmula alrededor de los 6 meses de edad, ya que la introducción antes de los 4 meses se asociaría a un riesgo aumentado de enfermedades autoinmunes y alergia alimentaria, y retrasarla más allá de los 7 meses no tendría efecto protector.En este contexto, un grupo de expertos ha considerado pertinente elaborar un documento de consenso basado en las evidencias científicas actuales y establecer unas recomendaciones generales para la introducción del gluten en la práctica clínica diaria. Abstract: At present there is a degree of uncertainty regarding when, how and in what form gluten should be introduced into the infant diet. For years the recommendations of the ESPGHAN Committee on Nutrition have prevailed, which include avoiding early introduction, before 4 months, and late, after 7 months, and gradually introducing gluten into the diet while the infant is being breastfed, with the aim of reducing the risk of celiac disease, diabetes and gluten allergy. However, 2 independent studies published in The New England Journal of Medicine in October 2014 reached the conclusion that the age of introduction of gluten does not modify the risk of developing celiac disease, and that breastfeeding at any age does not confer protection against celiac disease development.On the other hand, according to available scientific evidence, the introduction of foods other than breast milk or formula into the infants diet is generally recommended around 6 months of age, since the introduction before 4 months could be associated with an increased risk of food allergy and autoimmune diseases, and delaying it beyond 7 months would not have a protective effect.In this context, a group of experts has considered it appropriate to produce a consensus document based on the current scientific evidence and present general recommendations for daily clinical practice on the introduction of gluten into the diet.

At present there is a degree of uncertainty regarding when, how and in what form gluten should be introduced into the infant diet. For years the recommendations of the ESPGHAN Committee on Nutrition have prevailed, which include avoiding early introduction, before 4 months, and late, after 7 months, and gradually introducing gluten into the diet while the infant is being breastfed, with the aim of reducing the risk of celiac disease, diabetes and gluten allergy. However, 2 independent studies published in The New England Journal of Medicine in October 2014 reached the conclusion that the age of introduction of gluten does not modify the risk of developing celiac disease, and that breastfeeding at any age does not confer protection against celiac disease development.On the other hand, according to available scientific evidence, the introduction of foods other than breast milk or formula into the infant diet is generally recommended around 6 months of age, since the introduction before 4 months could be associated with an increased risk of food allergy and autoimmune diseases, and delaying it beyond 7 months would not have a protective effect.In this context, a group of experts has considered it appropriate to produce a consensus document based on the current scientific evidence and present general recommendations for daily clinical practice on the introduction of gluten into the diet. Resumen: En el momento actual existe una situación de indefinición con respecto a cuándo, cómo y de qué forma debe introducirse el gluten en la dieta del lactante. Durante años ha prevalecido la recomendación del Comité de Nutrición de la ESPGHAN de evitar tanto la introducción precoz, antes de los 4 meses, como la tardía, después de los 7 meses, y de introducir el gluten gradualmente mientras el lactante recibe leche materna; se pretendía con ello reducir el riesgo de enfermedad celiaca, diabetes y alergia al gluten. Sin embargo, 2 estudios independientes publicados en octubre de 2014 en The New England Journal of Medicine llegan a la conclusión de que la edad de introducción del gluten no modifica el riesgo de desarrollar la enfermedad celiaca y que la lactancia materna a cualquier edad tampoco confiere protección.Por otra parte, según la evidencia científica disponible, en general, se recomienda la introducción de otros alimentos en la dieta distintos de la leche materna o de fórmula alrededor de los 6 meses de edad, ya que la introducción antes de los 4 meses se asociaría a un riesgo aumentado de enfermedades autoinmunes y alergia alimentaria, y retrasarla más allá de los 7 meses no tendría efecto protector.En este contexto, un grupo de expertos ha considerado pertinente elaborar un documento de consenso basado en las evidencias científicas actuales y establecer unas recomendaciones generales para la introducción del gluten en la práctica clínica diaria.

At present there is a degree of uncertainty regarding when, how and in what form gluten should be introduced into the infant diet. For years the recommendations of the ESPGHAN Committee on Nutrition have prevailed, which include avoiding early introduction, before 4 months, and late, after 7 months, and gradually introducing gluten into the diet while the infant is being breastfed, with the aim of reducing the risk of celiac disease, diabetes and gluten allergy. However, 2 independent studies published in The New England Journal of Medicine in October 2014 reached the conclusion that the age of introduction of gluten does not modify the risk of developing celiac disease, and that breastfeeding at any age does not confer protection against celiac disease development. On the other hand, according to available scientific evidence, the introduction of foods other than breast milk or formula into the infants diet is generally recommended around 6 months of age, since the introduction before 4 months could be associated with an increased risk of food allergy and autoimmune diseases, and delaying it beyond 7 months would not have a protective effect. In this context, a group of experts has considered it appropriate to produce a consensus document based on the current scientific evidence and present general recommendations for daily clinical practice on the introduction of gluten into the diet.

An inexpensive, high optical-quality relay lens made up of two eyepieces arranged in an afocal assembly for use in confocal scanning laser imaging is described. In the past we have used relays, within our confocal microscopes, made up of achromats with long focal lengths (> or = 10 cm), which take up large optical tracks and suffer from significant amounts of astigmatism and curvature of field. We quantify aberrations associated with achromat and eyepiece relays using CODE V optical design and analysis software. The eyepiece relay is found to be more compact, better corrected, and not significantly more expensive than its achromat counterpart. In addition to being used to interconnect two scanning mirrors optically as well as scanning mirrors with microscope objectives, it can form part of the optics in a confocal scanning laser MACROscope-Microscope system (Biomedical Photometrics, Inc., Waterloo, Ontario, Canada). Due to design constraints, the MACROscope-Microscope system cannot incorporate a conventional wide-field microscope into its structure such as is done in most commercial confocal microscopes. The eyepiece relay is used as a stand-alone, compact optical link between the scanning mirrors and the microscope objective. This consequently makes the MACROscope-Microscope system more compact and easier to commercialize.

Objetivo: Obtener un mejor conocimiento del comportamiento deuna población de pacientes con diagnóstico de atresia de vías biliares en las distintas fases de la enfermedad Pacientes y métodos: Estudio retrospectivo, transversal y descriptivo, tipo serie de casos clínicos. Pacientes con diagnóstico de atresia de vías biliares atendidos en la Unidad de Gastroenterología del Hospital Infantil La Fe de Valencia desde enero de 1990 a diciembre del 2000 Resultados: De los 16 niños controlados, en el momento actual permanecen estables ocho, han precisado trasplante hepático seis y han fallecido dos. La edad media al diagnóstico es de 47,5 días de vida. La manifestación clínica más frecuente es la ictericia (87,5 %), y el hallazgo analítico más importante el aumento de la gammaglutamiltranspeptidasa (GGT) (3–4 veces su valor de referencia) en el 100 % de los casosLas imágenes ecográficas son diagnósticas en el 85,7 %. El Hepato-Hida ofrece una sensibilidad del 100 %. El tratamiento quirúrgico mediante portoenterostomía se realizó en todos los pacientes, con biopsia hepática en el mismo acto. La precocidad en la intervención se refleja en un mejor pronóstico a largo plazo, siendo mejor si ésta se realiza antes de los 65 días de vida Conclusiones: Un alto índice de sospecha permite el tratamiento quirúrgico precoz, única medida terapéutica que puede condicionar un pronóstico menos desfavorable : Objective: To gain further insight into the natural history of patients with biliary atresia Patients and methods: We performed a retrospective, cross-sectional, descriptive, case series study. All patients with biliary atresia attended at the Pediatric Gastrointestinal and Hepatology Unit of La Fe Children's Hospital in Valencia (Spain) from January 1990 to December 2000 were included Results: Of 16 children followed-up, eight are currently stable, six have undergone liver transplantation and two died. The mean age at diagnosis was 47.5 days. The most frequent clinical manifestation was jaundice (87.5 %) and the most common biochemical finding was raised γ-glutamyltransferase (3–4 times its standard value), which appeared in 100 % of the patientsAbdominal ultrasonography was diagnostic in 85.7 % of the patients. Nuclear scintiscan (DISIDA) showed a sensitivity of 100 %. Portoenterostomy with intraoperative liver biopsy was performed in all patients. Patient age at surgery was a predictor of long-term outcome, with more favorable results in patients aged less than 65 days of life Conclusions: Biliary atresia should be suspected as soon as possible, since early surgical treatment is the only therapeutic measure that can improve outcome

Objetivo: Estudiar la incidencia de infección perinatal por citomegalovirus en los recién nacidos ingresados en nuestro hospital en los últimos 3 años, las posibles fuentes de contagio, los datos serológicos y microbiológicos y la evolución clínica de los niños. Métodos: Estudio retrospectivo. Revisión de historias clínicas de los neonatos con diagnóstico de infección por citomegalovirus. Resultados: Se encontraron 24 niños con este diagnóstico. El 85% de los niños eran prematuros, con peso menor de 1.500 g, los cuales representan el 6% de los niños con ese peso ingresados en este período. El porcentaje de transfusión y lactancia materna fue elevado (87 y 91 %, respectivamente), por lo que la fuente de contagio no pudo establecerse. Nueve (34 %) de los niños presentaron afectación hepática y 3 (12 %) tuvieron un cuadro clínico grave que precisó tratamiento antiviral. Conclusiones: La infección perinatal por citomegalovirus es una enfermedad frecuente en el grupo de niños prematuros, que puede llegar a ser grave. Es importante pensar en su diagnóstico e insistir en la prevención. Objective: To study the incidence of perinatal cytomegalovirus infection in neonates admitted to our hospital in the last three years, as well as the mode of transmission, serologic and microbiologic data, and the clinical outcome of these infants. Methods: :We performed a retrospective study by reviewing the medical records of neonates with a diagnosis of cytomegalovirus infection. Results: Twenty-four neonates received this diagnosis. Of these, 21 (85%) were premature infants with a birthweight of less than 1500 gr, representing 6% of all neonates with this birthweight hospitalized during the study period. The percentage of transfusion and breastfeeding was high (87% and 91 %, respectively) and consequently the route of transmission could not be identified. Nine neonates (34%) presented associated hepatic dysfunction and three (12%) developed severe disease requiring antiviral treatment. Conclusions: Perinatal cytomegalovirus infection is frequent in preterm infants and may be serious. It is important to detect cytomegalovirus infections and to develop preventive methods.

Introduction L’infection de prothese articulaire de genou (IPG) est une complication severe de la chirurgie orthopedique. Le changement en 2 temps operatoires est considere comme le traitement de reference. Le changement en 1 temps est une alternative qui pourrait permettre un controle satisfaisant de l’infection ainsi qu’une amelioration des resultats fonctionnels. Materiels et methodes Etude retrospective monocentrique de patients traites pour IPG par changement de prothese et antibiotherapie ciblee entre le 1 er janvier 2009 et le 31 decembre 2014. Les objectifs de l’etude etaient de comparer l’evolution de l’infection et les resultats fonctionnels entre les changements de prothese en 1 et en 2 temps. Le choix du type d’intervention etait fait en RCP par l’equipe multidisciplinaire. Les resultats fonctionnels etaient evalues au-dela d’un an apres la chirurgie a l’aide du score International Knee Society (IKS), du score Knee injury and Osteoarthritis Outcome Score (KOOS) et du score de qualite de vie SF-12. Resultats Soixante-deux patients ont ete inclus. L’âge moyen etait de 71 ans (ecart-type = ± 9 ans) et la duree moyenne de suivi apres la chirurgie de 22 mois (ecart-type = ± 13 mois). Quarante et un patients ont eu un changement en 2 temps et 21 patients ont eu un changement en 1 temps. Une guerison de l’infection a ete obtenue chez 78 % des patients avec changement en 2 temps et 90 % des patients avec changement en 1 temps ( p = 0,3). Un Staphylococcus aureus , un staphylocoque a coagulase negative ou un streptocoque etait respectivement identifie dans 19 %, 33 % et 24 % des changements en 1 temps et dans 34 %, 36 % et 2 % des changements en 2 temps. Les amplitudes articulaires en flexion etaient significativement plus grandes pour les patients avec changement en 1 temps (102°) que pour les patients avec changement en 2 temps (86°) ( p p = 0,048), satisfaction ( p = 0,046) et score clinique objectif ( p = 10 −3 ). Les resultats du score KOOS etaient meilleurs chez les patients avec changement en 1 temps pour les sous-categories symptomes ( p = 0,042) et vie quotidienne ( p = 0,03). Il n’y avait pas de difference pour le score SF-12. Conclusion Les changements en 1 temps pour IPG sont associes a une frequence de guerison semblable a celle des changements en 2 temps et a une meilleure fonction du genou, lorsque realises par une equipe entrainee. La decision prise en RCP parait correcte mais des criteres plus precis du choix 1 temps vs 2 temps restent a definir.

Study Objective: To test venous endothelial function in long-term climateric therapy with tibolone. Design: Measurement of dorsal hand-vein diameter by venous occlusion plethysmography during infusion of norepinephrine (NE), bradykinin (BK), NG-monomethyl l -arginine ( l -NMMA) and sodium nitroprusside (SNP). Setting: Plethysmography and Menopause Units. University Hospital Valdecilla. Santander. Spain. Patients: Eleven postmenopausal women having continuous treatment with oral tibolone (2.5 mg/day) for 6 months. Interventions: Three plethysmography studies were made: at baseline, and at three and six months of treatment. Main outcome measures: Dorsal hand-vein diameter measured by venous occlusion plethysmography during infusion of NE, BK, l -NMMA and SNP. Results: (a) Baseline study: maximum dilation with BK was 54.2±10.2%. (b) Three-month study: BK dilation of 71.5±11.9%, with a significant increase of 17.3% ( P =0.019) compared with baseline. (c) Six-month study: BK dilation of 77.5±11.9%, with a significant increase 23.3% ( P =0.002) compared with baseline. Maximal vasodilation was reached with SNP in the three studies and l -NMMA infusion has a similar vasoconstrictor response in the three studies. Conclusions: Long-term climateric therapy with tibolone improves vein endothelium-dependent vasodilation suggesting a positive impact of this drug on endothelial function.

Micron level resolution is required to image tightly spaced annual bands in speleothems. These same bands must be viewed over several millimeters and sometimes centimeters in order to ensure continuity. We report luminescence imaging results from several speleothem specimens using a novel confocal scanning laser macroscope instrument. The macroscope can non-destructively image specimens as large as 7.5×7.5 cm using reflected light and photoluminescence with a 10 μm lateral resolution in under 10 s. A high-resolution version of the macroscope can image specimens up to 1–2 cm in size with lateral resolutions ranging from 1 to 2 μm depending upon the laser scan lens utilized. The combination of both these instruments allows for entire specimens to be imaged even beyond 7.5×7.5 cm fields of view via tiling. Confocal imaging improves overall resolution of the instrument by eliminating light originating from outside the focal plane which tends to blur the image. High-contrast, crisp images are achieved in this way. We show photoluminescence imaging results for speleothem specimens where emphasis is placed on resolving to the level of annual bands.

We report the fabrication of photovoltaic devices by the anodization of microcrystalline silicon films on single-crystal silicon substrates. The porosity of the films was varied from 20% to 60% by changing the anodization conditions. The influence of the porosity on the series resistance ( R s ), the reflectance, and the spectral response of the devices was studied. In order to determine R s , the current–voltage characteristics were analyzed, both in the dark and under illumination. We observed that the value of R s increased from 3 to 100 Ω and the value of the reflectance decreased from 24% to 7% when the porosity increased from 20% to 60%. The optimum device performance (fill factor of 0.53 and efficiency of 7.2%), which was achieved for a porosity of 40% and can be improved further, resulted from a trade-off between good electrical and optical properties. From optical beam-induced current images, the homogeneity of the devices was found to be excellent and no defects were detected. Our results indicate that the fabrication of commercial solar cells based on porous microcrystalline Si (PMSi) is possible.

DIANE is the general Monte Carlo code developed at CEA-DAM. DIANE is a 3D multiparticle multigroup code. DIANE includes automated biasing techniques and is optimized for massive parallel calculations.

Resumen: El trasplante hepático (TH) es el único tratamiento efectivo existente para las enfermedades hepáticas en fase terminal. La desproporción entre demanda y oferta de órganos constituye su principal limitación, planteando la necesidad de buscar alternativas de tratamiento.El trasplante de hepatocitos humanos o trasplante celular hepático (TCH) constituye, en el momento actual, la mejor opción terapéutica puente al restablecimiento de la función hepática o al trasplante hepático. Consiste en trasplantar hepatocitos humanos totalmente diferenciados a un órgano receptor, en cantidad suficiente para que estos sobrevivan y restauren la función hepática normal, basándose en la capacidad de regeneración hepática.El TCH consta básicamente de 4 pasos: el aislamiento de los hepatocitos a partir de injertos hepáticos descartados para TH, la preparación de las suspensiones celulares, la criopreservación de los hepatocitos aislados y, finalmente, su implante en el receptor.Esta terapia se ha llevado a cabo en pacientes con insuficiencia hepática aguda de distintas etiologías con intención de sustituir o servir de puente al TH y en el tratamiento de pacientes pediátricos con errores congénitos del metabolismo con objetivo de reemplazar el déficit enzimático causante de la enfermedad.En el Hospital La Fe de Valencia hemos puesto en marcha una Unidad de Terapia Celular Hepática y llevado a cabo el primer TCH en España, abriendo una nueva línea de trabajo dentro del Programa de Trasplante Hepático. Abstract: Liver transplantation has been remarkably effective in the treatment of patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the main limitation, resulting in longer waiting times and an increase in the mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation. Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients, a bridge to restore liver function or liver transplant.The procedure consists in transplanting individual cells in a recipient organ in enough quantity to survive and restore the function. The capacity of hepatic regeneration constitutes the biological basis of hepatocyte transplantation. Liver cell transplantation is carried out by means of the isolation of hepatocytes from donor liver rejected for orthotopic transplantation, to prepare a cell suspension for infusion, cryopreservation and, finally, hepatocytes are implanted into the recipient.This may be an optional therapeutic procedure in some patients with inborn errors of metabolism, fulminant hepatic failure, and acute and chronic liver failure, as a bridge to orthotopic liver transplantation.The first hepatocyte transplantation in Spain was performed in the Cell Therapy Unit of the Hospital La Fe of Valencia, creating a new research line in the transplant program.

Liver transplantation has been remarkably effective in the treatment of patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the main limitation, resulting in longer waiting times and an increase in the mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation. Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients, a bridge to restore liver function or liver transplant. The procedure consists in transplanting individual cells in a recipient organ in enough quantity to survive and restore the function. The capacity of hepatic regeneration constitutes the biological basis of hepatocyte transplantation. Liver cell transplantation is carried out by means of the isolation of hepatocytes from donor liver rejected for orthotopic transplantation, to prepare a cell suspension for infusion, cryopreservation and, finally, hepatocytes are implanted into the recipient. This may be an optional therapeutic procedure in some patients with inborn errors of metabolism, fulminant hepatic failure, and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. The first hepatocyte transplantation in Spain was performed in the Cell Therapy Unit of the Hospital La Fe of Valencia, creating a new research line in the transplant program.

This paper describes a confocal scanning beam MACROscope/Microscope which can image specimens up to 7 × 7 cm in size using reflected light, photoluminescence and optical beam induced current. The MACROscope provides a 10 μm spot size at various wavelengths and generates 512 × 512 pixel images in less than 5 s. When used in combination with a conventional confocal scanning laser microscope sub-micron spot sizes become possible providing resolutions as high as 0.25 μm laterally and 0.5 μm axially in reflected light. The main function of this imaging system is to spatially resolve any defects within solar cells and similar devices. Several reflected-light, photoluminescence and OBIC images of CdS CuInSe 2 and CdZnS CuInSe 2 thin film solar cells are presented.

High resolution, large area photoluminescence mapping with scanning stage microscopes has proven to be a useful, but slow, quality control technique for compound semiconductor wafers. This paper describes a confocal scanning beam MACROscope-Microscope which can image specimens up to 7.5×7.5 cm in size, in less than 10s, using reflected light, photoluminescence, and optical beam induced current. MACROscope mode provides 5 μm lateral resolution and 300 μm axial resolution. Microscope mode provides 0.25 μm lateral and 0.5 μm axial resolution, with a minimum field of view of 25×25 μm. This instrument can be used to evaluate preparation parameters involved in the manufacture of porous silicon as well as to provide quality control at a macroscopic and microscopic level for the fabrication of porous silicon specimens, wafers, detectors, and similar devices. A brief introduction to confocal microscopy and porous silicon is given. Several confocal and non-confocal photoluminescence and reflected-light images of a porous silicon wafer are shown at macroscopic and microscopic levels. A 3D profile of porous silicon structures reconstructed from confocal slices is also shown.

SUMMARY A new confocal scanning beam system (MACROscope) that images very large-area specimens is described. The MACROscope uses a telecentric, f-theta laser scan lens as an objective lens to image specimens as large as 7·5 cm × 7·5 cm in 5 s. The lateral resolution of the MACROscope is 5 μm and the axial resolution is 200 μm. When combined with a confocal microscope, a new hybrid imaging system is produced that uses the advantages of small-area, high-speed, high-resolution microscopy (0·2 μm lateral and 0·4 μm axial resolution) with the large-area, high-speed, good-resolution imaging of the MACROscope. The advantages of the microscope/MACROscope are illustrated in applications which include reflected-light confocal images of biological specimens, DNA sequencing gels, latent fingerprints and photoluminescence imaging of porous silicon.

En los ultimos 10 anos, una serie de estudios previos sobre la enfermedad celiaca (EC), y en particular los de Ivarsson et al. sobre la llamada epidemia sueca de celiaquia de mediados de los ochenta, han dado origen a la hipotesis de que la introduccion de pequenas cantidades de gluten, preferiblemente durante un periodo de lactancia materna, podria contribuir a reducir el riesgo de EC. Pero ademas de esos estudios, otro de Norris et al. mostraba que la introduccion del gluten en lactantes con riesgo genetico en una edad igual o inferior a los 3 meses, o igual o superior a los 7, se asociaba a un mayor riesgo de autoinmunidad celiaca y desarrollo de EC. Todo ello llevo a la comunidad cientifica a aceptar mayoritariamente la existencia de una «ventana de oportunidad» para la introduccion del gluten entre los 4 y 6 meses de edad. En consecuencia, el Comite de Nutricion de la ESPGHAN recomendo evitar la introduccion del gluten antes de los 4 meses o despues de los 6 meses de edad. Para investigar el potencial concreto de la intervencion dietetica en la prevencion de la EC se llevo a cabo un estudio multicentrico prospectivo europeo, el Prevent Coeliac Disease (PreventCD, www.preventcd.com, FP6-2005-FOOD4B-36383-PREVENTCD), en el que, desde el Centro Medico de la Universidad de Leiden, en los Paises Bajos, se coordino la colaboracion entre hospitales, universidades, laboratorios e industria de 7 paises europeos e Israel. Los resultados de

Organic–inorganic hybrid materials can be defined as materials combining organic and inorganic domains in a nanometric scale. The development of these organic–inorganic hybrids has achieved properties from both organic and inorganic materials. In this research we have studied the scratch behaviour of coatings of organic–inorganic hybrid materials prepared by sol–gel processing, using as precursors, trialkoxysilanes with organic functionalities that react via free radical polymerization. We have also evaluated the influence of pure inorganic precursor as tetralkoxysilanes or pure organic precursors on the scratch behaviour. The main goal of this research was to evaluate how the chemical structure of the organic–inorganic hybrid influences the scratch behaviour of the coatings.

Coeliac disease (CD) development involves genetic (HLA-DQ2/DQ8) and environmental factors. Herein, the influence of the HLA-DQ genotype on the gut colonization process of breast-fed children was determined. A cohort of 20 newborns, with at least one first-degree relative with CD, were classified according to their HLA-DQ genotype into high, intermediate and low genetic risk groups, showing 24-28%, 7-8% and less than 1% probability to develop CD, respectively. Faecal microbiota was analysed at 7 days, 1 and 4 months of children's age by fluorescence in situ hybridization. When considering all data, Gram-negative bacteria and Bacteroides-Prevotella group proportions were higher (P0.05) in the high than in the intermediate and low genetic risk groups. E. coli, Streptococcus-Lactococcus, E. rectale-C. coccoides, sulphate-reducing bacteria, C. lituseburense and C. histolyticum group proportions were also significantly higher (P0.05) in the high than in the low genetic risk group. Correlations between these bacterial groups and the genetic risk were also detected (P0.05). In addition, the number and type of CD relative seemed to influence (P0.050) these bacterial proportions in children at CD risk. At 4 months of age, similar relationships were established between the high genetic risk to develop CD and the proportions of Streptococcus-Lactococcus (P0.05), E. rectale-C. coccoides (P0.05), C. lituseburense (P0.05), C. histolyticum (P0.05), Bacteroides-Prevotella (P0.10) groups and total Gram-negative bacteria (P0.05). The results suggest a relationship between HLA-DQ genes and the gut microbial colonization process that could lead to a change in the way this disorder is investigated.

The association between human leukocyte antigen (HLA) class II antigens and celiac disease (CD) was analyzed in a Spanish population. No association with DRB1*04 and DQB1*0302 was noted. The main associated haplotype (70.8%) was DRB1*03-DQB1*0201-DQA1*0501(DR3-DQ2), followed by DRB1*07-DQB1*0202-DQA1*0201 (DR7-DQ2) haplotype, which is associated with DRB1*11-DQB1*0301-DQA1*0505 (DR11-DQ7). The combinations of DR3-DQ2 with DR7-DQ2, and DR7-DQ2 with DR11-DQ7, present a twofold risk compared with each haplotype in homozygosis. An independence test in DR3-DQ2 haplotype found that association with CD was attributable to the whole haplotype, but for DR7-DQ2 was secondary to DQB1/DQA1. There is no need of a double gene dosage to increase the risk. CD-associated alleles typing demonstrates a very high negative predictive value to exclude CD in risk groups.