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Background: Increased serum antibodies against carbonic anhydrase II (CA-II Ab) or IgG4 levels have been reported in cases of autoimmune chronic pancreatitis (ACP). Aim: To assess the relevance of serum CA-Il Ab and lgG4 levels for the diagnosis of ACP in idiopathic CP (ICP) versus alcoholic CP and Sjögren's syndrome (SS). Subjects: This was a multicentre study involving 227 subjects divided into four groups: ICP (n = 54), normal controls (n = 54, paired by age and sex with ICP patients), alcoholic CP (n = 86), and SS (n = 33). Methods: CA-II Ab was measured by ELISA and confirmed by western blotting. A score of easy clinical use with major clinical, morphological, and biochemical parameters for the diagnosis of ACP was applied. Results: The percentage of patients with increased serum CA-II Ab was higher in the ICP group (28%) than in controls (1.9%) and in patients with alcoholic CP (10.5%), but lower than in patients with SS (64%). The proportion with elevated IgG4 levels was higher in the ICP group (15%) compared with controls (1.9%) and SS (0%) but not significantly different from alcoholic CP (8%). Most ICP patients (7/8) with high lgG4 levels exhibited increased CA-II Ab and a compatible ACP score. A definitive diagnosis of ACP by histological analysis was associated with other autoimmune disorders, an increase in both serum lgG4 and CA-II Ab levels, and IgG4 positive plasma cells. Conclusions: The increase in serum 1gG4 levels was strongly associated with elevated CA-II Ab levels, manifestations compatible with ACP, and lymphoplasmacytic infiltration when surgical specimens were available. [ABSTRACT FROM AUTHOR]

La sustentabilidad ambiental urbana implica alcanzar cualitativamente un nivel medioambiental, socioeconómico, e institucional que permita el funcionamiento equilibrado de la ciudad a largo plazo. Es por ello, que su análisis es relevante en las ciudades, que concentran la mayoría de la población mundial y donde se desarrollan actividades económicas y sociales fundamentales, y que presentan, así mismo, problemáticas ambientales. La detección del patrón espacial y distribución de la sustentabilidad es de interés para investigadores y agentes políticos y sociales para la comprensión del fenómeno y para su posible solución al facilitar la delimitación y caracterización de aquellas áreas de la ciudad menos sustentables. Se elaboró el Índice de Sustentabilidad Ambiental Urbana con 35 indicadores que comprenden las tres dimensiones de sustentabilidad, aplicando técnicas de análisis espacial (autocorrelación espacial, análisis de cluster) en la Megalópolis de México. Se validó el índice, detectando una desigual distribución de los niveles de sustentabilidad , decreciente de municipios centrales a exteriores en cada zona metropolitana, una asociación espacial positiva significativa y existencia de clústeres, de elevada sustentabilidad en los centros metropolitanos conurbados y de baja sustentabilidad en zonas periféricas. Se plantea la aplicación de técnicas de análisis de correlación espacial de tipo bivariado para detección de posibles factores explicativos de sustentabilidad en posteriores estudios.

Developmental language disorder (DLD) is considered a neurodevelopmental disorder that compromises language comprehension and/or expression and constitutes a risk factor for learning to read. The aim of the present study was to analyse the reading strategies used by students with DLD to read sentences. There is evidence in the literature that, when linguistic resources are insufficient, the keyword strategy (identifying some of the words in the sentence with their own semantic content, with barely no processing of the function words) is used to read sentences. A total of 31 primary and secondary school students diagnosed with DLD were evaluated using the PEALE battery. The results reveal that students with DLD present heterogeneous profiles that are below the established reading level for their age. In addition, children with DLD and better reading skills use the keyword strategy to read sentences. In conclusion, clinical and educational implications for reading intervention in individuals with DLD are discussed.

Among the reasons for traffic accidents, distractions are the most common. Although there are many traffic signs on the road that contribute to safety, variable message signs (VMSs) require special attention, which is transformed into distraction. ADAS (advanced driver assistance system) devices are advanced systems that perceive the environment and provide assistance to the driver for his comfort or safety. This project aims to develop a prototype of a VMS (variable message sign) reading system using machine learning techniques, which are still not used, especially in this aspect. The assistant consists of two parts: a first one that recognizes the signal on the street and another one that extracts its text and transforms it into speech. For the first one, a set of images were labeled in PASCAL VOC format by manual annotations, scraping and data augmentation. With this dataset, the VMS recognition model was trained, a RetinaNet based off of ResNet50 pretrained on the dataset COCO. Firstly, in the reading process, the images were preprocessed and binarized to achieve the best possible quality. Finally, the extraction was done by the Tesseract OCR model in its 4.0 version, and the speech was done by the cloud service of IBM Watson Text to Speech.

We have performed a comparative ultrasequencing study of multiple colorectal lesions obtained simultaneously from four patients. Our data show that benign lesions (adenomatous or hyperplastic polyps) contain a high mutational load. Additionally multiple synchronous colorectal lesions show non overlapping mutational signatures highlighting the degree of heterogeneity between multiple specimens in the same patient. Observations in these cases imply that considering not only the number of mutations but an effective oncogenic combination of mutations can determine the malignant progression of colorectal lesions.

Chronic pancreatitis (CP) is a complex disease with a wide spectrum of clinical manifestations ranging from asymptomatic disease to disabling forms or serious complications. The management of CP frequently differs among geographical areas and even among centers. These differences are due to the scarcity of high-quality studies and clinical practice guidelines that focus on the diagnosis and treatment of this disease. The aim of the Spanish Pancreatic Club was to create evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. These experts were selected on the basis of their clinical and research experience in CP. A list of questions was drawn up and each question was then reviewed by two panelists. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. Levels of evidence were based on the classification of the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus process, recommendations were established for the management of pain, pseudocysts, biliary and duodenal stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP., (Copyright © 2012 Elsevier España, S.L. y AEEH y AEG. All rights reserved.)

Chronic pancreatitis (CP) is a relatively uncommon, complex and highly heterogeneous disease. There is no clear pattern applicable to the initial stages of CP, which hampers its early diagnosis. Some of the complications of CP, especially chronic pain, can be difficult to manage. There is wide variation in the diagnosis and treatment of CP and its complications among centers and health professionals. The Spanish Pancreatic Club has developed a consensus document on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. A list of questions was drawn up. Each question was reviewed by two experts. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. The first part of the consensus document focusses on the diagnosis of CP and its complications., (Copyright © 2012 Elsevier España, S.L. y AEEH y AEG. All rights reserved.)

Antibodies (Abs) to carbonic anhydrase (isoforms CA-I and CA-II) have been considered pathogenic factors in the development of autoimmune pancreatitis. Besides, such autoAbs might accelerate the pancreatic damage in alcoholic chronic pancreatitis (CP). The aim of the present study was to evaluate the presence of serum Abs to CA-I and CA-II in CP and the relative affinity of these Abs. Serum anti-CA-I and -CA-II Abs were measured in 89 patients with CP (48 alcoholic and 41 nonalcoholic) by an ELISA technique. The prevalence of those autoAbs in CP was compared with other autoimmune diseases where they have also been found. The presence of other serological manifestations of autoimmunity, such as hypergammaglobulinemia or antinuclear Abs, was determined in CP patients as well. Elevated serum levels of both anti-CA-I (24%) and -CA-II (18%) Abs were observed in CP, although their prevalence was lower than in autoimmune diseases like rheumatoid arthritis (44 and 25%, respectively) or systemic lupus erythematosus (39% for anti-CA-I Abs). Furthermore, these Abs were of low average avidity. On the other hand, a significantly higher proportion of nonalcoholic CP had anti-CA-II Abs with respect to alcoholic CP (15.2 vs. 2.4%, p < 0.05). Anti-CA-I and -CA-II Abs might be helpful in the diagnosis of autoimmune CP, and the detection of the latter Abs seems to discard alcoholic etiology. Although it does not discard any pathogenic role in autoimmune CP, the low-avidity of anti-CA Abs argues against such idea.

Background: Bacterial translocation implies the transit of viable gastric microflora from the intestinal lumen through the intestinal wall to the mesenteric ganglia and seems to be the mechanism by which microflora reach necrotic tissue in acute pancreatitis (AP). This occurs in 40-70% of necrotizing hemorrhagic AP and plays a major role in up to 80% of deaths from this cause., Aims: To analyze the possible influence of bacterial decontamination in the gut on bacterial translocation in severe experimental AP., Methods: Severe AP was induced in 43 male Sprague-Dawley rats by administration of 0.2 ml of 2.5% taurodeoxycholate sodium in NaOH glycyl-glycine buffer after cannulizing the bilio-pancreatic duct through the duodenum and clamping the common bile duct in the hepatic junction. The rats were divided into two groups: a) control group: 24 rats in which only AP was induced; b) problem group: 19 rats that underwent bacterial decontamination through the administration of 4 mg/ml gentamicin, bacitracin and neomycin in the drinking water during the 5 days prior to AP induction. Twenty-four hours after AP induction, laparotomy was performed and a sample for the culture of mesenteric lymphatic ganglia, pancreas, liver, spleen, peritoneum and cecum was obtained., Results: Seven rats in the control group died. Of the 17 rats that survived 24 hours, positive cultures in the pancreas were obtained in nine. In the problem group, two rats died within 24 hours. Of the remaining 17 rats, positive pancreatic cultures were obtained in 2 while in 15 pancreatic cultures were negative. No microflora were cultured in the peritoneum. The microflora most frequently cultivated were Escherichia coli, enterococcus and proteus. No differences were found in the percentage of Gram-positive and Gram-negative bacteria between the two groups., Conclusions: a) The majority of the bacteria in AP tissue originate in the intestinal microflora, E. coli being the most prevalent. b) One of the main mechanisms in this process is bacterial translocation via the lymphatic pathway; transit directly through the transperitoneal pathway is not essential. c) Bacterial translocation already occurs in the earlier phases of AP. d) Bacterial decontamination prior to AP decreases the frequency of bacterial translocation and does not interfere in the Gram-positive/Gram negative balance, nor does it increase fungal infections.

Unlabelled: In recent years, variceal ligation has been introduced as an alternative treatment to endoscopic sclerotherapy., Aim: To evaluate the occurrence of excess gastroesophageal reflux in cirrhotic patients with esophageal varices eradicated by band ligation., Patients and Methods: Twenty-six cirrhotic patients with esophageal varices underwent band ligation until variceal eradication. pH monitoring was carried out in all patients before inclusion in the eradication program and again at the end. The results were evaluated according to De Meester's criteria., Results: Five patients presented excess gastroesophageal reflux before the beginning of treatment. A further six patients developed excess gastroesophageal reflux after endoscopic treatment. The only factor implicated in the development of excess gastroesophageal reflux was the use of sclerosant at the end of treatment to ensure complete eradication: five of the eight who needed sclerosant developed excess gastrophageal reflux, while only two of the 16 treated without sclerosant did so (p < 0.01)., Conclusion: Esophageal variceal band ligation does not significantly provoke excess gastroesophageal reflux if sclerosant is not used in the endoscopic technique.

Objective: The role of adrenomedullin in cirrhosis is at present unknown. The aim of this study was to investigate plasma levels of adrenomedullin in cirrhosis., Methods: We measured plasma adrenomedullin concentrations using radioimmunoassay in 43 patients with cirrhosis (17 in Child-Pugh's class A, 13 in Child-Pugh's class B, and 13 in Child-Pugh's class C) and compared these values with those in 24 age-matched healthy subjects. Renal function, plasma cyclic adenosine monophosphate (cAMP) concentration, plasma renin activity, and plasma aldosterone concentration were measured in each patient., Results: Plasma adrenomedullin levels were increased significantly in patients with cirrhosis compared with healthy subjects. In addition, plasma adrenomedullin values were higher in patients with cirrhosis and ascites than in those without ascites. Moreover, plasma adrenomedullin levels increased in relation to the severity of cirrhosis. Significant positive correlations also were found between adrenomedullin and cAMP concentrations and plasma renin activity or plasma aldosterone concentrations., Conclusions: Plasma adrenomedullin is increased in patients with cirrhosis compared with healthy subjects. The increase in plasma adrenomedullin levels is related at least in part to the severity of cirrhosis and may contribute to the arteriolar vasodilation in patients with cirrhosis. These effects are related in part to a cAMP-dependent pathway.

Endothelin-1 is a vasoconstrictor peptide released by the vascular endothelium by various chemical and mechanical factors. Cellular rejection is one of the most common complications following orthotopic liver transplantation, endotheliitis being its most specific and consistent histological feature. To assess the role of endothelin in cellular hepatic rejection, we studied 21 cirrhotic patients undergoing elective liver transplantation. These patients were divided in two groups: Group I comprised 10 patients without cellular rejection, and Group II comprised 11 patients with cellular rejection. Endothelin was measured on day 7 after transplantation, on the day of liver biopsy, and after treatment for rejection. We found a significant increase in the plasma endothelin levels in the early postoperative period in the patients with moderate or severe cellular rejection compared with the non-rejection group. It remained significantly elevated until the clinical diagnosis of rejection was made. This value returned to baseline with successful treatment. So, the monitorization of this peptide may be of help in the diagnosis of rejection, its severity, and the evaluation of its resolution.

Unlabelled: The purpose of this study was to assess the role of duodenal diverticula as an etiologic factor in acute pancreatitis., Methods and Patients: We have reviewed the records of patients with diverticulum of the second portion of the duodenum diagnosed by gastroduodenal radiology or endoscopy during the period 1991-1992 in our hospital. As a control group we studied patients without duodenal diverticulum. All subjects underwent biliary-pancreatic ultrasonography. Thirty-eight patients had a duodenal diverticulum and gallstones 36 had a duodenal diverticulum but no gallstones; 21 had gallstones alone; and, finally, 42 patients were free of duodenal diverticulum and gallstones., Results: Patients with duodenal diverticula had a greater prevalence of gallstones than those without (51.3% VS 33.3%, p < 0.005). Of the thirty-eight patients with duodenal diverticula and gallstones 23.7% had acute pancreatitis. None of the 21 patients without duodenal diverticulum and with gallstones had acute pancreatitis, p < 0.05. The median age of patients with duodenal diverticulum without gallstones was 64.25 years, range 34-85, and the age of those with duodenal diverticulum and gallstones was 70.4 years, range 37-87, p < 0.05., Conclusions: 1) Gallstones may cause acute pancreatitis in patients with D2 duodenal diverticula. 2) Patients with a D2 duodenal diverticulum frequently have gallstones. 3) The fact that the age of patients with duodenal diverticulum was lower than that of patients with both duodenal diverticulum and gallstones suggests that duodenal diverticula may play a role in the pathogenesis of gallstones.

Early recognition of severity of acute pancreatitis is very uncertain. For this reason it is necessary to have objective criteria to predict with accuracy the course of the disease. The aim of this study was to examine the value of the determination of the acute phase reactants: C reactive protein (CRP), alpha 1-antitrypsin (alpha-AT) and alpha 1-glycoprotein acid (alpha-GA) as prognostic indicators of acute pancreatitis on admission and on the third day. We have studied 40 patients with acute pancreatitis and serum concentrations of CRP, alpha-AT and alpha-GP were related to the Ranson Index. On admission the median levels of CRP: 74 mg/L, alpha-AT: 208 mg% and alpha-GA: 303 mg% were significantly higher (p less than 0.001) in patients with Ranson Index greater than or equal to 3 than in those with Ranson Index less than or equal to 2 (CRP: 166 mg/L, alpha-AT: 303 mg% and alpha-GA: 121 mg%). The values which differentiated patients with better and worse prognosis were: CRP 100 mg/L (sensitivity 100% and specificity 86%); alpha--AT 275 mg% (sensitivity 71% and specificity 85%); and alpha-GA 90 mg% (sensitivity 87.5% and specificity 57.9%). CRP, and to a lesser degree the alpha-AT and alpha-GA, were related to the duration of the ileus, and to the severe complications of the acute pancreatitis.