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The Coronavirus pandemic outbreak in 2019 and the saturation of healthcare system led to an increased use of digital tools for surveillance. In this study we described our experience using telemedicine to follow-up on patients with intraductal papillary mucinous neoplasms during the COVID-19 era and analyze those factors associated to patients' satisfaction.This 1-year retrospective observational study enrolled patients with intraductal papillary mucinous neoplasms followed-up by telemedicine during COVID-19 outbreak. Patients with high-risk features needing on-site physical examination or declining remote follow-up were excluded. A 13-question survey was conducted; demographic, geographic, and employment information was collected. Univariate and multivariate analyses were performed to evaluate those factors associated to patients' satisfaction.Out of 287, a total of 177 patients with intraductal papillary mucinous neoplasms were included: the mean age was 69 (44-87) years and the male/female ratio was 0.78. A total of 80 (45.2%) patients had previously experienced abdominal pain. Most patients (85.3%) were satisfied with telemedicine: at univariate analysis, age ≥70 years (P = .007), retirement (P = .001), and absence of previous abdominal pain (P = .05) were significantly associated with patient satisfaction. At multivariate analysis, the absence of previous abdominal pain was the only factor independently associated with patient satisfaction (odds ratio 5.964, 95% confidence interval 2.21-16.11, P.001).Telemedicine allows a new follow-up strategy that can be used in selected patients with intraductal papillary mucinous neoplasms. The absence of previous abdominal pain is associated with patient satisfaction during follow-up. Further studies are needed to evaluate safety of remote follow-up in patients with intraductal papillary mucinous neoplasms.

Resumen Introduccion El lipedema es el deposito de tejido graso doloroso fundamentalmente en miembros inferiores. Afecta casi siempre a mujeres, y esta infradiagnosticado e infratratado. El objetivo del estudio es describir las caracteristicas del diagnostico y los tipos de tratamientos realizados por los pacientes con lipedema en Espana. Material y metodos Estudio descriptivo transversal mediante encuesta online anonima realizada entre noviembre-diciembre 2019. Se calculo el tamano muestral minimo para un nivel de confianza del 95% y margen de error del 5%. Se recogieron las variables sociodemograficas (edad, sexo y comunidad de residencia), aspectos diagnosticos y la mejoria percibida con diferentes opciones de tratamiento. Resultados Se obtuvieron 463 respuestas validas. La edad media de inicio de la sintomatologia fue de 18,2 anos (DE: 9,0). El 69% de los pacientes comenzaron con clinica entre los 10-19 anos. Transcurrieron 19,9 anos (DE: 10,1) desde el inicio de la clinica, y se necesitaron 4,9 visitas medicas (DE: 3,3) para obtener un diagnostico. El diagnostico se realizo con mas frecuencia en la medicina privada por cirujanos. El 78,4% de los pacientes probaron, al menos, 3 tipos diferentes de tratamientos. La perdida de peso fue el tratamiento mas utilizado y las prendas de compresion la opcion percibida como mas efectiva. Un 34% de los pacientes tienen acceso a la prescripcion de prendas de compresion. Conclusiones Actualmente el lipedema carece de un tratamiento estandarizado, y las diferentes terapias realizadas no son percibidas como satisfactorias por los pacientes. Es necesario mejorar su conocimiento para obtener un diagnostico temprano y proporcionar a los pacientes tratamientos adecuados.

Lipedema is a chronic and progressive disease. Most studies agree that it is underdiagnosed and undertreated. The aim of this study was to identify the diagnostic characteristics and types of treatment for lipedema in the Spanish population.A cross-sectional descriptive study was carried out through an anonymous 10-item online survey in November- December 2019. The minimum sample size was calculated for a 95% confidence level and 5% margin of error. Information was collected on sociodemographic variables (age, sex, place of residence), diagnostic characteristics and perceived improvement with distinct treatment options.A total of 463 valid responses were obtained. The mean age at first manifestation was 18.2 (SD: 9.0) years. Onset occurred between the ages of 10 and 19 years in 69% of the patients. It took an average of 19.9 (SD: 10.1) years to receive a diagnosis and 4.9 medical visits. Diagnosis was most frequently made in private clinics by surgeons. Most patients (78.4%) had tried at least three different types of treatment. Weight loss was the most frequent treatment (92%) and compression garments were perceived to be the most effective. Only 34% of respondents had access to financing for compression garments.Currently, there is no standard treatment for lipedema and patients perceive current treatments to be unsatisfactory. Better knowledge of this entity is needed to allow early diagnosis and provide adequate treatment.

En esta monografía se dan las características morfológicas de dos nuevos cultivares de triticale forrajero (Don Frank INTA y Don Norman INTA) cuya difusión ha iniciado la Estación Experimental Agropecuaria de Anguil y la Facultad de Agronomía de la Universidad Nacional de La Pampa, a fin de poder diferenciarlos entre sí y de otros triticales cultivados en la región semiárida. Una clave dicotómica facilita tal diferenciación. Director Ing. Agr. Guillermo Covas

PurposeThe medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life.MethodsDesign and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50years old admitted in 48 hospitals in Spain.Outcomes: daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture.Statistics: Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range).ResultsA total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to -0.01 (-0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (-0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively.ConclusionsHip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture., This work has been sponsored by an unrestricted grant of AMGEN to the Hospital del Mar Institute of Medical Investigation (IMIM).

We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. Purpose To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. Methods Design: prospective cohort study. Consecutive sample of patients >= 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. Results A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. Conclusions Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis., Funded in part by CIBER on Frailty and Healthy Aging (CIBERFES), Instituto Carlos III, Spanish Ministry of Economy and Competitiveness, FEDER funds. Unrestricted research grant from Amgen S.A. Amgen did not have any role in study design, collection, analysis and interpretation of data, writing the report, and the decision to submit the report for publication.

a Grupo de Estudio e Investigacion de la Osteoporosis y la Fractura Osteoporotica de la Sociedad Espanola de Cirugia Ortopedica y Traumatologia (GEIOS-SECOT), Espana b Servicio de Cirugia Ortopedica y Traumatologia, Hospital Alto Deba, Arrasate-Mondragon, Gipuzkoa, Espana c Servicio de Cirugia Ortopedica y Traumatologia, Complexo Hospitalario Universitario Santiago Compostela, Santiago de Compostela, A Coruna, Espana d Servicio de Cirugia Ortopedica y Traumatologia, Hospital Universitario Infanta Leonor, Madrid, Espana e Servicio de Cirugia Ortopedica y Traumatologia, Complexo Hospitalario Pontevedra, Pontevedra, Espana f Servicio de Cirugia Ortopedica y Traumatologia, Hospital Universitario Virgen Macarena, Sevilla, Espana g Unidad de Gestion Clinica del Aparato Locomotor, Area Sanitaria Norte de Cordoba, Pozoblanco, Cordoba, Espana h Servicio de Cirugia Ortopedica y Traumatologia, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Espana i Catedra de Cirugia Ortopedica y Traumatologia, Facultad de Medicina, Cordoba, Espana j Servicio de Cirugia Ortopedica y Traumatologia, Complejo Hospitalario de Ourense, Ourense, Espana k Servicio de Cirugia Ortopedica y Traumatologia, Hospital Universitario La Paz, Madrid, Espana

Background and Aims: Grapevine bunch compactness is an important trait with impact on fruit quality, mainly affecting the susceptibility to bunch rot. Many and different variables have been reported to have a significant influence on the variation of bunch compactness in particular cultivars, but little is known about the role of such variables in a wider framework. The aim of this work was to identify and weight the features responsible for the natural variation in bunch compactness in a large and diverse grapevine collection. Methods and Results: Different statistical tests were sequentially applied to select the determining variables most influencing bunch compactness. Significant and low correlation was obtained for most of the variables studied for three consecutive seasons, confirming the multifactorial nature of this trait. Multivariate analyses indicated that there are three groups of variables with a significant influence on bunch compactness. Two groups, represented by the total number of berries per bunch and by the length of the first ramification of the bunch, are major factors responsible for the trait variation, whereas berry dimensions have a secondary role. Conclusions: Bunch compactness is defined by the difference between its morphological (apparent) volume and its actual (solid) volume. The results showed that the actual volume is mainly determined by the total number of berries, whereas the morphological volume also depends on its spatial arrangement, determined by the architecture of the rachis. Significance of the Study: This is the first multiyear study of bunch compactness at a multicultivar level, and it has allowed the selection and weighting of the main variables affecting the trait. These variables are suitable targets to study the underlying genetics of the trait.

Objective To evaluate the characteristics of the uterine junctional zone (JZ) by three-dimensional (3D) transvaginal sonography (TVS) in women with recurrent miscarriage (RM) as compared to normal fertile controls. Study design The thickness and the morphology of the JZ were evaluated in 75 women with a history of RM due to different causes and in 20 fertile women without a history of miscarriages or pelvic disease. All patients included in the study were selected among those who attended the outpatient clinic of “Tor Vergata” University. The JZ characteristics were evaluated in the midluteal phase of the cycle on the uterine coronal section obtained by 3D TVS. Results Patients with RM showed a JZ maximum thickness significantly increased when compared to that observed in control group (5.8 ± 0.7 vs. 5.0 ± 1.1 mm). When grouped according to the different causes of RM, all groups of patients with RM showed an increased JZ thickness when compared to fertile women, with the exception of those with anti-phospholipid antibody syndrome, probably due to the small number of cases with this pathology. Conclusions A thickened JZ could be an independent indicator of the risk of miscarriage and may represent an important contributing factor to some causes of RM. These observations may offer new perspectives for the screening and treatment of patients with RM. Although further studies are needed to ascertain if the reduction of the JZ thickness can determine a better pregnancy outcome, 3D TVS evaluation of the JZ could provide the opportunity to identify women in which appropriate therapeutic protocols can improve the possibility of successful pregnancy.

Las luxaciones puras de las articulaciones digitales durante el período de maduración esquelética son de presentación excepcional, dado que habitualmente las lesiones traumáticas a este nivel se presentan en forma de fracturas-luxaciones con afectación de la epífisis, debido a que su resistencia mecánica ante el traumatismo es menor que la de los propios ligamentos. Revisamos en este artículo nuestros casos de luxaciones digitales puras en niños y adolescentes y la literatura más relevante sobre las mismas.

Hoy en dia se considera que la resistencia osea, entendiendo como tal la fuerza necesaria para desencadenar el fracaso biomecanico de un hueso, es el resultado de la integracion de dos variables, la cantidad y la calidad osea, factores dependientes a su vez del remodelado oseo. Mientras la cantidad de hueso depende directamente de su densidad mineral, la calidad del mismo depende de variables tales como la estructuracion jerarquica y la composicion quimica del material que lo forma. Cada uno de estos determinantes primarios de la resistencia osea comprende a su vez una serie de determinantes secundarios, responsables directos de alguna de las propiedades biomecanicas oseas especificas. En conjunto, determinantes primarios y secundarios ayudan a establecer un hueso sano, resistente y biomecanicamente competente, mientras que sus alteraciones son responsables del desarrollo de osteopatias fragilizantes, procesos fisiopatologicos que incrementan el riesgo de fractura.

Resumen: Introducción: El ibuprofeno, antiinflamatorio no esteroideo bastante utilizado en pediatría como analgésico y antitérmico, se ha considerado un fármaco muy seguro que no se asocia a gastrolesividad en niños cuando se usa a dosis bajas durante periodos cortos. Pacientes y métodos: El objetivo de nuestro estudio fue revisar los casos de hemorragia digestiva y valorar si existen casos de gastropatía hemorrágica tras dosis habituales de ibuprofeno. Resultados: Se encontraron 9 casos de sangrado digestivo secundario a gastropatía en niños sanos, sin factores de riesgo, que habían ingerido varias dosis de ibuprofeno para el tratamiento de la fiebre. Abstract: Introduction: Ibuprofen is a non-steroidal anti-inflammatory drug frequently used in children for fever and pain. It is usually considered to be safe and of low risk at low doses and short-term use. Patients and methods: The aim of our study was to review the cases of gastrointestinal bleeding and assessment of gastrointestinal bleeding after recommended doses of ibuprofen. Results: We describe 9 previously healthy patients with upper gastrointestinal bleeding after receiving weight-related doses of ibuprofen for fever.

Study Objective To compare the reproductive outcome in women with recurrent spontaneous abortion (RSA) associated with septate uterus after hysteroscopic metroplasty compared with patients who did not undergo surgery. Design Longitudinal evaluation (Canadian Task Force classification II-2). Setting University of Rome, Tor Vergata-affiliated endoscopic unit. Patients Forty-eight consecutive women with septate uterus and RSA were enrolled in the study. Interventions Hysteroscopic metroplasty. Measurements and Main Results Reproductive outcome in terms of term pregnancy was significantly improved after hysteroscopic metroplasty compared with controls (76% vs. 20%). No differences were found in the prevalence of preterm delivery between groups (4% vs. 5%). Conclusion Our data suggest that hysteroscopic septum incision can improve pregnancy outcome in patients with RSA associated with septate uterus.

The presence of algal toxins in the aquatic environment represents an important socioeconomic concern in many places worldwide, due to the toxicity that these compounds can induce in seafood or freshwater organisms at very low levels. Several analytical alternatives have been proposed over the last years for the control of these contaminants, which acute or chronic toxicity requires low detection levels and demands for the search of sensitive methods for their detection and determination. HPLC has been widely used for this purpose, although several alternatives such as CE or capillary electrochromatography (CEC) are being lately developed with this aim. In this work we report on the application of improved HPLC, as well as CE and CEC, for the analysis of diarrhetic shellfish poisoning toxins, amnesic shellfish poisoning (ASP) toxins and microcystins (MCs) present in different matrices such as water, shellfish or algae. Improvements in sample preparation for increasing sensitivity and selectivity are also shown. While UV and fluorimetric detection are the detection methods generally used, mass spectrometric detection was also applied for ASP toxins and MCs, especially for confirmatory purposes. From the results obtained it can be concluded that both HPLC and CE offer a good potential for a sensitive and selective determination of these algal toxins in such complex matrices. The results obtained for CEC allow also to conclude that this technique can result in a promising technique for such application.

Pancreatic cancer (PC) is a disease with bad prognosis. It is usually diagnosed at advanced stages and its treatment is complex. The aim of this consensus document was to provide recommendations by experts that would ameliorate PC diagnosis, reduce the time to treatment, and optimize PC management by interdisciplinary teams. As a consensus method, we followed the modified Delphi methodology. A scientific committee of experts provided 40 statements that were submitted in two rounds to a panel of 87 specialists of 12 scientific societies. Agreement was reached for 39 of the 40 proposed statements (97.5%). Although a screening of the asymptomatic population is not a feasible option, special attention to potential symptoms during primary care could ameliorate early diagnostic. It is especially important to decrease the period until diagnostic tests are performed. This consensus could improve survival in PC patients by decreasing the time to diagnose and time to treatment and by the implementation of multidisciplinary teams.

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.

PROBLEM: To compare the use of intravenous immunoglobulins (IVIG) with prednisone plus low-dose aspirin (LDA) in treating pregnant women with a history of recurrent fetal loss having the antiphospholipid antibody (aPL), in terms of live-birth rate and maternal and perinatal morbidity. METHOD: A prospective, two-centers trial study included 82 recurrent aborters with aPL syndrome. Twenty-nine were treated with prednisone and LDA in one center, 53 received IVIG in the other center. Maternal and fetal outcomes and pregnancy complications were compared between groups. RESULTS: Live-birth rates were equivalent between groups (78 vs 76%). Mean birth weight was higher in the IVIG group than in the prednisone plus LDA group. In the prednisone- plus LDA-treated patients, gestational hypertension and gestational diabetes were found significantly more often than in the IVIG-treated group (14 vs 5% and 14 vs 5%, respectively). CONCLUSION: In patients with aPL syndrome, IVIG treatment improved pregnancy outcome, with significantly lower pregnancy complication rates, when compared with prednisone plus LDA therapy.

Several complement modulating effects of high-dose intravenous immunoglobulins (IVIG) have been proposed from in vitro studies and experimental animal models. However, the in vivo effects of IVIG on plasma complement in humans are yet not known. We have investigated the in vivo effects of IVIG on complement in seven women with unexplained recurrent spontaneous abortion who were without evidence of autoimmune disease. Samples were obtained before and after the very first infusion of IVIG. There was a marked increase in immunoglobulin G (IgG) from (median and range) 12.4 (9.4-15.9) to 26.8 (22.4-30.0) g/l but no change in immunoglobulin A (IgA) or immunoglobulin M (IgM). A significantly increased complement activation was demonstrated using neoepitope-specific enzyme immunoassays to the activation products C3bc (median increased from 9.8 to 31.2 AU/ml), Bb (0.66-1.66 g/ml), C5a (10.5-12.7 ng/ml), and TCC (0.81-2.19 AU/ml) (P = 0.015 for all). There were no changes in antigenic concentrations of individual complement components or regulators (C1q, C4, C3, C1-inhibitor, C4b-binding protein) and no decrease in complement haemolytic activity (classical and alternative CH50), which were all within the normal range. The classical pathway activation products C1rs/C1-inhibitor complexes, C4bc and C4d were elevated in all patients before IVIG treatment and did not change significantly during treatment. In conclusion, IVIG induced a significant activation of complement in vivo.

Objective To explore the role of the GSTO1 gene in the pathogenesis of recurrent miscarriage (RM). Design Genetic association study. Setting Rome, Italy. Patient(s) 123 women with RM and 130 women without pregnancy complications. Intervention(s) None. Main Outcome Measure(s) Genotyping of two single nucleotide polymorphisms (A140D and E208K) and a 3-bp deletion (E155del) of the GSTO1 gene. Result(s) We found a statistically significant association between GSTO1*E208K variants and RM risk. Specifically, we identified this uncommon genetic variant only in women with RM. None of the women with physiologic pregnancies were carriers of K208 allele. Conclusion(s) GSTO1 has a role in detoxification metabolism, and we hypothesize that a functional variation of GSTO1 is a RM risk factor that interacts with environmental conditions.

Objective To investigate the role of glutathione S-transferases (GSTs) in the pathogenesis of recurrent miscarriage (RM). Design Genetic association study. Setting University of Rome, Tor Vergata and San Giovanni Calibita, Fatebenefratelli Hospital. Patient(s) One hundred twenty-one women with RM and 113 women without pregnancy complications. Intervention(s) Genomic DNA extracted from buccal cells and screening of positive/null genotypes of GSTM1 and GSTT1 genes and single nucleotide polymorphisms of GSTA1, GSTO2, and GSTP1 genes. Main Outcome Measure(s) Occurrence of GST polymorphisms. Result(s) Women with at least one GSTA1*-69T allele are more frequent in the RM group than in the control group: 67% vs. 48%, respectively. Significant outcomes were obtained considering different genetic models: codominant, dominant, and log-additive. In addition, the combined analysis suggests that GSTA1 and GSTM1 variants have a significant interaction in RM risk. Conclusion(s) Our study highlighted a significant association between the GSTA1 gene and an increased risk of RM. In particular, the -69T allele in the GSTA1 gene may be considered as a predisposing factor of RM.

Ibuprofen is a non-steroidal anti-inflammatory drug frequently used in children for fever and pain. It is usually considered to be safe and of low risk at low doses and short-term use.The aim of our study was to review the cases of gastrointestinal bleeding and assessment of gastrointestinal bleeding after recommended doses of ibuprofen.We describe 9 previously healthy patients with upper gastrointestinal bleeding after receiving weight-related doses of ibuprofen for fever.

It has been twenty years since the first paper reporting the association between thyroid antibodies (TAIs) and spontaneous miscarriage was published. Following this observation, several studies have clearly demonstrated an increased prevalence of TAI in patients with recurrent miscarriage (RM). However, the exact mechanism underlying this association remains a matter of debate. The aim of the present study was to evaluate the thyroid function, throughout a specific test, in patient with RM and TAI focusing on the hypothesis that TAI should be an indirect sign of a mild thyroid dysfunction. 46 patients with RM and TAI were included in the study. All patients underwent short TRH stimulation test showing an abnormal response in the vast majority of cases (65%). Normal FT4 and FT3 mean values were found whereas TSH values were in the upper normal range (2.64±1.3 mUI/L). Our data support the hypothesis that in patients with RM the presence of TAI is an indirect sign of a subtle thyroid dysfunction detectable by a specific test. This test give the possibility to identify women with RM in which specific therapeutic approaches could effectively improve the possibility for a successful pregnancy.

background: Proper maternal thyroid function is necessary for a successful pregnancy. In order to identify women who may experience miscarriage due to transient impairment of the pituitary– thyroid axis in early pregnancy, we aimed to investigate the ratio between basal and peak thyroid stimulating hormone (TSH) [following stimulus with thyrotrophin-releasing hormone (TRH)] in euthyroid women with unexplained recurrent miscarriage (RM). methods: We have established a ‘iTSHa index’ (TSH increase after TRH adjusted for the levels of basal TSH), determining TSH serum levels at time 0 and 20 min after TRH stimulus in 463 consecutive women attending two antenatal care units for two or more miscarriages occurring within the first 10 weeks of pregnancy. results: The mean basal TSH serum levels were higher (P , 0.001) in RM women [2.1 mIU/ml; 95% confidence interval (CI): 2.0 –2.2] compared with the controls (1.3 mIU/ml; 95% CI: 1.2– 1.4). Establishing serum TSH at an individual level, a large overlap was observed and the receiver operating characteristic curves did not allow us to find an optimal cut-off point with an adequate sensitivity/specificity ratio. Therefore, we suggest a novel statistical model, the ‘iTSHa index’ (available on www.afar.it/tsh-trh-miscarriage), that is capable of identifying women with RM due to transient thyroid function impairment of the early pregnancy, in particular when baseline serum TSH is less than 1.5 mIU/ml, i.e. well below the conventional upper cut-off indicated as ‘safe’ in those who want to conceive. conclusions: A transient impairment of thyroid function in early pregnancy may cause an inadequate adaptation to the increased thyroid requirement and may be implicated in RM. The evaluation of the proposed iTSHa index, if validated in a larger cohort of patients, may provide information useful to identifying a subset of healthy women, without evidence of thyroid dysfunction or autoimmunity and a TSH in the low-normal reference range, who may be at risk of RM.

Blood-stream catheter related infection is the most severe complication in patients carrying a central venous catheter. Parenteral nutrition (PN) use seems to be a risk factor for developing a catheter-related infection (CRI).In order to know the incidence of CRI in children to further implement policies to reduce nosocomial infection, we review all charts of children (1 month to 17 years) who received parenteral nutrition while in hospital. All episodes of fever + positive blood culture were recorded. Infection rate was defined as number of episodes/1000 Parenteral nutrition days.48 positive blood cultures was obtained from 120 patients. Infection rate was 37.8/1000 days. Incidence was significantly higher in infants and toddlers (52% vs 29.8%, p = 0.016). Most frequent organisms were coagulase negative Staph. (56.8%), Gram negative bacilli (20.8%), Staph aureus (12.5%) and fungus (12.5%). No difference in incidence were found according to the underlying disease or the length of PN use.Infection rate in our PN inpatient patients was significantly higher. PN may represent a risk factor for developing a CRI. Specific measurements and policies need to be implemented to overcome present situation.

The assessment of the cognitive impairment in the multiple sclerosis disease is one of the most relevant challenges nowadays. An essential objective is to obtain diverse approaches that allow valuing objectively this impairment and its correlation with physiological variables.To analyze the possible modulations in physiological components of the information processing (ERPs) related with an attentional deficit in diverse classes of patients with multiple sclerosis.17 patients with remitting-relapsing multiple sclerosis, 9 patients with benign multiple sclerosis and 19 healthy subjects participated in the study. Behavioral performance in a visuo-spatial task (Posner paradigm) and later, an auditory oddball test was carried out where electroencephalography signal was registered to obtain ERPs. Correlation analyses were calculated between patient variables (EDSS or disease duration) and psychophysiological variables.A delay in the reaction time during the development of the Posner task and a delay in the latency of the component P3 during the realization of the oddball task were found in both groups of patient with multiple sclerosis.The data obtained in this experiment confirm the presence of attentional impairment in patients with diverse forms of multiple sclerosis. The exclusive modulation of the P3 latency component suggests that the impairment in these patients, at the beginning of the disease, is localized at a central level of cognitive processing and is product of the demyelinating process.

Objective To determine the effect of different therapeutic approaches on uterine artery blood flow in women with recurrent miscarriage (RM) and impaired uterine perfusion. Design Prospective, randomized study. Setting Department of Obstetrics and Gynecology, University of Rome "Tor Vergata," Italy. Patient(s) Sixty women with unexplained RM and impaired uterine perfusion. Intervention(s) Patients were randomly assigned to three different therapeutic regimens: 20 patients received a daily dose of 100 mg of aspirin (LDA); 20 patients were treated with omega-3 fatty acids (Ω 3 ), 4 g daily; and 20 patients received LDA plus Ω 3 . Main Outcome Measure(s) Doppler measurement of uterine artery pulsatility index (PI) was performed, in the midluteal phase of the cycle, before and after 2 months of therapy. Result(s) All therapeutic regimens induced an improvement in uterine perfusion with a significant reduction of uterine artery PI values. LDA alone or in combination with Ω 3 was found to achieve the highest improvement of uterine blood flow. Omega-3 supplementation was less effective, as reflected by the lower PI values. Conclusion(s) LDA and Ω 3 are effective in improving uterine artery blood flow velocity in women with RM due to abnormal uterine perfusion. Further studies are needed to determine whether the improvement of uterine perfusion may lead to a better pregnancy outcome.

Un aborto e tradizionalmente definito “ricorrente” quando si manifesta in tre o piu episodi clinicamente accertati, con o senza una precedente gravidanza con parto vitale, prima della 20a–22a settimana [1]. Si parla di aborto spontaneo ricorrente (ASR) primario in presenza di aborti ed assenza di una gravidanza con un figlio vivo e di ASR secondario qualora vi sia almeno una precedente gravidanza con figlio vivo a prescindere dal numero di aborti subiti. Tale patologia colpisce circa il 5% delle coppie in eta fertile. In presenza di tale condizione si e concordi sulla necessita d’intraprendere un iter diagnostico per individuare le possibili cause che essa sottende.

Objective To compare the impedance to uterine artery blood flow, during the midluteal phase, in women with recurrent spontaneous abortion (RSA) as compared to normal fertile controls. Design A prospective study involving women with a history of RSA and fertile controls. Setting University of Rome "Tor Vergata." Patient(s) Two hundred thirty women with RSA and 50 fertile controls referred for routine examination. Intervention(s) Transvaginal Doppler examination of uterine arteries during the midluteal phase of untreated cycles. Main Outcome Measure(s) The mean pulsatility index (PI) of uterine arteries. Result(s) Uterine arteries PI values in RSA patients (2.42 ± 0.79) were significantly higher with respect to those found in the control group (2.08 ± 0.47). When patients were grouped according to the different RSA causes, the highest PI values were found among patients with uterine abnormalities (2.82 ± 1.0), antiphospholipid antibodies syndrome (2.70 ± 1.1), and unexplained RSA (2.60 ± 0.7). These values were significantly higher with respect to that found in the control group. No differences were observed in PI values between fertile patients and those with RSA due to thyroid abnormalities (2.10 ± 0.55), inherited thrombophilia (2.03 ± 0.45), autoimmune pathology (2.34 ± 1.18), and genetic anomalies (2.47 ± 0.54). Similar results were observed when patients were grouped according to primary and secondary RSA. Conclusion(s) Increased resistance to uterine blood flow may be an important contributing factor to some causes of RSA and may represent an independent indication of the risk of pregnancy loss.

Objective The aim of the study was to propose a set of tests to clarify the diagnosis of repeated implantation failure in patients undergoing in vitro fertilization (IVF). Study design Fifty-nine patients with at least two unsuccessful IVF attempts were included in the study. Blood samples were evaluated for the presence of underlying thyroid abnormalities, antiphospholipid antibodies (aPL), increased levels of natural killer cells (NK), inherited thrombophilia and mouse embryo assay factor (MEA-f). The same tests were performed on 20 normal fertile control patients. Results Seventy-six percent of IVF patients showed at least one abnormal result. This incidence was higher with respect to that found among control patients (45%). The prevalence of thyroid abnormalities, aPL and increased NK level was higher in IVF patients whereas no differences were observed in terms of prevalence of inherited thrombophilias and MEA-f. Conclusions A better understanding of reproductive failure mechanisms should allow an effective diagnostic flow chart and a focused therapeutic option for patients experiencing repeated IVF failure. With this objective in mind, our data provide two important results: thyroid abnormalities, aPL and increased NK levels are more prevalent in women experiencing IVF failure. No evidence was found for an association between inherited thrombophilia and MEA-f and failure to achieve pregnancy after IVF.

1695-4033/$ – see front matter © 2012 Asociacion Espanola de Pediatria. doi:10.1016/j.anpedi.2012.03.012 pigastrio y bajo el reborde costal derecho, sin detectar asas ni visceromegalias. Mediante ecografia abdominal se bserva una dilatacion de la via biliar intrahepatica central y ormacion quistica de 7 cm de diametro en region de cabeza ancreatica. Ante sospecha de quiste de coledoco se amplia l estudio con colangio-RM (figs. 1--3), observandose hallazos compatibles con quiste tipo I de Todani y drenaje biliar berrante. El quiste del coledoco es una dilatacion congenita de

Previous studies of the spontaneous activity of the EEG indicate that women present bigger absolute spectral power in the alpha band than men, but few studies have been done during cognitive activity.To check possible gender differences in the EEG frequency domain during a visuo-spatial attentional task to understand better the temporary dynamics of alpha.A classic oddball paradigm was used whose stimuli (90% standard-10% objectives) were complex. In each block (10 with 100 trials) it was requested to the subjects (20, 10 of each gender) to attend to one of the visual fields (left and right, with random stimuli and identical probability). Power spectral density values were calculated applying the fast Fourier transform in the alpha band (9-11 Hz) in two overlapped windows (sliding windows): of 0-512 ms and of 412-924 ms.The normalized data were analyzed by means of ANOVAs, with the following factors: gender, attention, hemisphere, visual field and electrodes.Different modulations were obtained attending to the gender variable: men showed smaller alpha or bigger suppression of the rhythm in posterior electrodes and women exhibited smaller power in anterior electrodes.

The relationship between developmental and mental deficits due to genetic or acquired causes is well established. However the possible relationship between neurological signs and intellectual development has not been sufficiently studied.We have conducted a transversal study to test the possible association between neurological signs and psychometric measures in children and young adolescents.123 patients were neurologically explored (ages between 54-185 months), 36 girls and 87 boys. These subjects were neurologically and psychometrically tested during a period of 3 years. Contingency tables, chi squared tests, discriminant analysis and ROC curves were used for statistical analysis. This statistic allowed to establish the contingencies between neurological signs (presence or absence) and intelligence quotient (IQ) groups (low and normal scores).The results showed a statistically significant relationship between IQ and the presence of 7 neurological signs (chi2=6.213; p=0.013). The discriminant analysis classified correctly 77.2% of subjects. The ROC curves indicated a high sensitivity and specificity if subjects presented more than 3 neurological signs. The frequency analysis established the more discriminant neurological signs.The obtained results in children with learning and behavioural disabilities suggest comorbidity between low IQ and neurological signs. This association is more marked in the group of children than in the pre- and adolescent group.

The event related potentials (ERPs) allow to study the evolution of the cerebral electric activity related with the diverse sensorial, motors and cognitive processes. However, the ERPs and the spectral analyses based in Fast Fourier Transform, are not able to show the variations along the time of the spectral content of the electroencephalogram (EEG).The present work will show the necessary methodology to obtain the temporal dynamics of the frequency (TSE) in the EEG, a technique described by Salmelin and Hari (1994) that allows the analysis of the modulations of any spectral band along the time.The presented data correspond to the electroencephalographic registration of 20 human subjects during an experiment of visual spatial attention.The modulations of the ERPs differ of the observed by the spectral techniques in latency and topography. Likewise, comparing different spectral techniques is proven that the TSE allows to define with more temporal precision the variations on the spectral content.The application of the TSE technique to the same EEG signal that is used for obtaining the ERPs, allows the inclusion of the variable time in the spectral analysis of the EEG, what can be crucial to understand the physiological bases of some neuropathologies.

To propose uterine myoma embolization as an alternative to myomectomy or hysterectomy in the treatment of symptomatic myomas; to evaluate the efficacy of the procedure in terms of clinical outcome, adopting all procedural and technical precautions to ensure minimal X-ray exposure and preserve reproductive potential.Between April 1998 and February 2000, 26 patients, age range 32-54 years (mean 41 years), underwent uterine arterial embolization for menorrhagia, pelvic pain, and sensation of mass and pressure. Inclusion criteria were: single myomas, intramural localization and rich vascolarization of the lesion. Dose to patient was obtained by placing a thermoluminescent dosimeter (Harshaw, Solon, Ohio) both placed in posterior fornix of the vagina and on the skin at the beam entrance site. The procedure was performed under peridural anesthesia; polyvinil alcohol particles 355-500 mu (Contour) (Target Therapeutics, Boston Scientific Corporation, Fremont CA, USA) were employed as embolic agent. The uterine arteries were incannulated with a 5F (Glidecath, Terumo, Europe NV, Belgium) and successively 3F coaxial microcatheter (Target, Boston Scientific Corporation, Fremont CA, USA); the embolic material was injected as distally as possible. Color Power Doppler Ultrasound follow-up before and after i.v. contrast media administration (Levovist SHU 508 A, Shering, Berlin, Germany) was carried out at 15 days, at 1, at 3, at 6 months, and at 1 year from embolization. Pre-procedural evaluation and follow-up at 1 year was performed by MRI using T1 and T2 weighted images before and after Gadolinium (GdDTPA Shering, Berlin, Germany) administration.The technical success of the interventional procedure was 100% (26/26 cases). The mean fluoroscopy time was 20 minutes, and the mean number of angiographic exposures was 10. The mean estimated ovarian dose was 18.75 cGy and the mean adsorbed skin dose was 126.71 cGy. The imaging follow-up showed a 55% reduction of myoma volume at 6 months and a 75% reduction at 1 year. All patients reported a marked decrease in symptoms. No major complications were observed. The appearance of pelvic pain in the 24-48 hours after the procedure required sedation by analgesic pump; transitorial amenorrhea was observed in 3 patients. As for term complications, 2 patients have eliminated necrotic material through the vagina four weeks after procedure. The patients reported great satisfaction with the procedure.Many treatment options are currently available for symptomatic uterine myomas. One is surgical myomectomy which is associated with increased blood loss, pain and post operative morbidity and requires an additional surgical procedure for fibroma recurrence in 20-25% of patients. Another alternative treatment is hormonal therapy, which drammatically improves symptoms and reduces fibroid size although leiomyomas regrow to their original size within a few months of discontinuing treatment. Uterine embolization is a relatively new treatment for uterine fibroids that can be considered as an alternative to surgical and medical procedures. The radiation exposure adsorbed by the patient is reduced by using pulsed fluoroscopy and taking all the precautionary measures required to minimize the dose.The technical success, the patient' satisfation, the short hospitalization time and preservation of fertility confer to uterine artery embolization the role of a new alternative therapy for the treatment of symptomatic uterine myomas.

The present report studied the contingent negative variation during Gap and Non-Gap conditions using visual stimulation and manual responses. The reaction times during the Gap condition were facilitated compared with those of the Non-Gap condition. The contingent negative variation component was obtained during the preparatory period from electrodes placed at 58 scalp sites for both Gap and Non-Gap conditions. The comparison between both conditions: Gap and non-gap did not show statistically significant differences during the preparatory period. The topography of the voltage and current source density maps showed three different foci: (i) an early negativity centred in electrodes overlying the supplementary motor area and cingulate motor areas, (ii) an activation over the primary motor cortex contralateral to the finger movement, and (iii) a bilateral activation on posterior sites. All these results suggest that the facilitation induced by the warning stimuli occurs in neural circuits that would be recruited for the subsequent processing of the imperative stimulus. The facilitation of the reaction times during the gap condition with respect to non-gap condition must be justified by neural events occurring during the gap period.

To evaluate the prevalence of different anatomic factors in women with recurrent spontaneous abortion (RSA).Retrospective analysis over 9 years (Canadian Task Force classification II-2).University hospital-affiliated endoscopic unit.Three hundred forty-four consecutive patients with RSA and 922 controls referred for abnormal uterine bleeding.Diagnostic hysteroscopy.Major and minor uterine mullerian abnormalities (septate, unicornuate uteri) were found significantly more often in women with RSA than in controls (32% vs 6%, p0.001). The frequency of acquired uterine anomalies (submucous myomas, polyps) was significantly higher in controls (32% vs 9%, p0.001). No significant differences were observed between groups in frequency of adhesions (4% vs 2%).Major mullerian uterine abnormalities are associated with RSA, and minor uterine anomalies may be correlated with an increased risk of recurrent miscarriage.