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L’interactionnisme symbolique interpelle la réflexivité et la prise de conscience de « Soi » qui favorisent la rencontre des perspectives du patient avec celles du médecin. Le travail sur la « conscience de Soi » facilite la maîtrise du contre-transfert et les processus de changement. Il permet une métacommunication entre patient et médecin dans le cadre du « terrain commun ». L’interactionnisme symbolique donne du sens à ce « terrain commun » dans le cadre des compétences « approche centrée sur le patient » et « professionnalisme ».

Introduction. L’approche centrée sur le patient (ACP) nécessite de créer un « terrain commun » favorable à une relation thérapeutique. Cette relation peut s’exprimer sur la forme d’un interactionnisme symbolique (IS), dans lequel chacun propose à l’autre une « façade » symbolique pour élaborer son « personnage » sur la scène d’une « dramaturgie sociale ». Ceci s’exprime particulièrement lors de la prise en charge de patients ayant une maladie chronique comme le diabète de type 2. Objectif. Décrire les interactions entre les patients vivant avec un diabète de type 2 et leur médecin généraliste (MG). Méthode. Étude phénoménologique interprétative. Entretiens semidirigés auprès de patients vivant avec un diabète de type 2 et auprès de leurs MG. Une analyse comparée et croisée des discours a été conduite. L’analyse s’intéressait aux interactions médecin-patient pour en dégager les « représentations-personnages », le « terrain commun » et son impact sur la relation. Résultats. Dix patients présentant un diabète de type 2 et leurs cinq MG ont été interrogés. Dans trois interactions, le « terrain commun » semblait concordant entre médecin et patient dans un contexte relationnel de confiance et une bonne alliance thérapeutique entre les « personnages ». Dans quatre interactions, le « terrain commun » n’était pas concordant, avec une relation thérapeutique problématique. Dans deux autres interactions, le « terrain commun » semblait moins concordant, mais avec une relation thérapeutique satisfaisante. La dernière interaction mettait en évidence un terrain commun concordant, mais une relation thérapeutique très distanciée. Conclusion. S’intéresser aux « personnages-façades symboliques » que les médecins et les patients « jouent » dans leur interaction interpelle le « terrain commun » et la relation thérapeutique, composantes essentielles de l’approche centrée patient.

Background Intestinal ultrasonography (IUS) is a non-invasive, easily accessible and low-cost procedure to visualize the colon and determine disease activity, extent and treatment response in IBD. Our aim was to investigate whether ultrasonographic parameters predict short-term clinical remission in ulcerative colitis (UC). Methods Consecutive patients (pts) with moderate-to-severe UC (total Mayo score>6) starting biological therapies or small molecules were included. Patients were evaluated at baseline by clinical, biochemical, endoscopic (endoscopic Mayo score), and IUS assessments. IUS, doppler and elastographic parameters assessed at baseline before starting therapy were: bowel wall thickening (BWT), echopattern, blood flow (adapted Limberg’ score), Milan Ultrasound criteria (MUC) and shear wave elastography values. The most affected colonic segment was used for all imaging assessments. Clinical remission at 3 months was defined as partial Mayo Score=0-1. Predictive factors of clinical remission at 3 months were analyzed by logistic regression. ROC curve analysis was used to identify the best cut-off of BWT in predicting clinical remission. Results Thirty-one UC pts were enrolled (12 males [39%]; median age: 45 years, range 18-72; median disease duration: 108 months, range 3-312). Sixteen per cent of pts had left colitis and 84% had extensive UC according to the Montreal criteria. Forty-eight per cent of pts were treated with Anti-TNFs, 39% with vedolizumab, 10% with ustekinumab and 3% with tofacitinib. At baseline, 84% of patients had moderate disease and 16% severe disease according to the total Mayo score. A lower total Mayo score and partial mayo score at baseline were predictive of clinical remission at 3 months after starting biological therapy or small molecules than endoscopic Mayo score (OR 0.58, 95% CI 0.33-0.99, p=0.03; OR 0.55, 95% CI 0.29-0.99, p=0.037; OR 0.57, 95% CI 0.16-1.93, p=0.36, respectively; Figure 1, panels A-C). A lower BWT, Limberg’ score and MUC at baseline were predictive of clinical remission at 3 months (OR 0.19, 95% CI 0.05-0.72, p=0.0023; OR 0.22, 95% CI 0.06-0.77, p=0.004; OR 0.48, 95% CI 0.21-0.83, p=0.001, respectively; Figure 1, panels D-F). The most accurate cut-off value of BWT for predicting clinical remission was Conclusion IUS easily predicts early clinical remission in patients with moderate-to-severe UC after therapy.

Background Intestinal ultrasound (IUS) is an effective and easy-to-use tool in monitoring Crohn’s disease (CD) lesions during different biological therapies. Aim of our study was to evaluate whether lesion improvement during biological therapy could predict transmural healing. Methods We performed a prospective study enrolling CD patients (pts) with indication to biological therapies. IUS and doppler US parameters at baseline, at 3 and 12 months were: bowel wall thickening (BWT), lesion length, echopattern, complications, blood flow according to Limberg’ score. Transmural healing (TH) was defined as normalization of all parameters; IUS responders were defined as pts with improvement of BWT associated with decreased lesion length, Limberg’ score improvement, and no worsening of the other parameters. Delta (Δ) signified the difference between IUS parameters at baseline and at 3 months. Changes in parameters and in Δ values at baseline and after 3 months were analyzed using Mann Whitney test; the area under (a ROC) curve was calculated. Differences between combination of parameters were tested by Chi-square test. Results One hundred and fifteen CD pts were enrolled (63.5% males; median age 37 years; median disease duration 96 months). Forty-nine per cent of pts had L1, 9% had L2, 42% had L3 according to the Montreal criteria. TH rate at 12 months was 20% and IUS responder rate was 43%. At baseline, no statistical differences in terms of BWT were observed between pts achieving TH vs no TH. Similarly, no differences were observed in pts defined as IUS responders vs non responders. Patients achieving TH at 12 months had a higher ΔBWT than patient without TH (p=0.0004). On ROC curve, ΔBWT improvement of 1.25 mm showed sensitivity and specificity of 73% and 61%, respectively, in predicting pts who achieved TH. Similarly, IUS responder group at 12 months had a higher ΔBWT than patients IUS non-responder group (p Conclusion An early ΔBWT, and a combination of a ΔBWT and Limberg’ score improvement showed high diagnostic accuracy in predicting pts who achieved TH and IUS responder at 12 months. This information may help clinical decision making in terms of prompt optimization or switching/swapping therapies in CD.

Contexte. Un tiers des internes de médecine générale réalisent une enquête qualitative pour leur thèse d’exercice. Un programme d’apprentissage méthodologique pour les internes doit compléter le travail des directeurs de thèse (DT). L’objectif de ce travail était de développer un dispositif d’auto-apprentissage de la conduite d’entretien semi-directif, fondé sur une vidéo modèle/contre-modèle. Méthode. Une enquête qualitative auprès de DT expérimentés et une enquête quantitative auprès d’anciens internes ont été réalisées pour déterminer les principales difficultés expérimentées lors de l’apprentissage de la conduite d’entretien semi-directif. Un script modèle et contre-modèle a été rédigé à partir de cette évaluation des besoins. Une vidéo modèle/contre modèle a été tournée. Un modèle logique pédagogique a été développé.Une enquête quantitative auprès d’internes ayant testé le dispositif, et une enquête quantitative auprès de DT expérimentés ont permis d’évaluer le dispositif pédagogique. Résultats. Quatre difficultés principales ont été identifiées : i) l’usage de questions fermées, ii) enchaîner, iii) couper la parole, iv) induire des réponses, représentatives d’un interviewer novice centré sur son canevas d’entretien. Ces difficultés et leur miroir positif ont permis de réaliser une vidéo illustrant une attitude novice et une attitude expérimentée. Deux objectifs d’apprentissage ont été identifiés : un centré sur la connaissance, l’autre sur l’habileté. Quatre activités d’apprentissage ont été décrites répondant aux objectifs. Pour développer l’habileté de conduite d’entretien, la simulation d’entretien par jeu de rôle avec auto- et hétéro-évaluation (par le DT) a été retenue. La satisfaction du dispositif était élevée, les internes et DT recommandaient l’usage du kit. Conclusion. Le kit développé permet aux DT de dédier leur temps à l’enseignement de l’habileté plutôt qu’à l’apport de connaissances. L’impact sur la qualité des thèses reste à évaluer.

Source for production of ion of deuterium extracted from rf plasma (SPIDER) is the 100 keV negative ion source prototype of the ITER neutral beam injector. The cooling plant is one of the SPIDER auxiliary systems where ultrapure water (UPW) is used as the cooling media, thanks to its advantageous properties such as good cooling performance and high resistivity. Water resistivity needs to be maintained above certain values during SPIDER operation to enable the electrical insulation of in-vessel components that operate at different voltages. Nonetheless, degradation of water resistivity was observed in some circuits during operation. Water resistivity degradation had a negative impact on the SPIDER experimental campaign since it limits cooling plant availability. To understand the cause for the observed water degradation, sampling points were installed to sample water during operation. Ad hoc experiments have been performed on the worst affected circuit, and water samples were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Circulation experiments were conducted at constant temperature, pressure, and flow rate to assess water degradation by monitoring water conductivity increase. ICP-MS analyses on water from the worst affected circuit revealed the presence of Cu in relevant quantities and Zn. Corrosion induced by the presence of a non-compatible component with SPIDER requirements was found. The identified component was made of a galvanized steel plate, carbon steel, and brass. This was found responsible for the contamination of the cooling loop and its water properties' degradation.

Introduction : Afin de former des médecins généralistes compétents en soins primaires, le Collège national des généralistes enseignants a choisi d’utiliser une approche par compétences adaptée à l’exercice de la médecine générale. Au début du troisième cycle des études médicales de médecine générale, l’apprentissage par compétences s’accompagne d’un changement de paradigme, l’étudiant de médecine générale devient acteur de sa formation. Objectifs : Explorer les représentations et les pratiques de l’autoformation chez les étudiants de méde-cine générale lyonnais et identifier dans un second temps les pistes d’amélioration de l’autoformation. Matériels et méthodes : Méthode de recherche mixte associant d’une part une recherche qualitative combinant des entretiens individuels semi-dirigés et des entretiens de groupe, d’autre part une re-cherche quantitative à travers une étude descriptive observationnelle monocentrique. Résultats : Sur 909 internes, 212 ont répondus au questionnaire soit un taux de participation de 23 %. L’autoformation était considérée comme une nécessité par 99 % des participants mais seulement 17 % déclaraient se former au quotidien. Parmi les facteurs favorisant l’autoformation, 89 % des participants citaient le stage ambulatoire, 34 % désignaient le tutorat et 14 % mentionnaient le portfolio. Le manque de temps était rapporté comme un frein à l’autoformation par 90 % des participants. Conclusion : Cette étude a permis d’identifier les pistes d’amélioration de l’autoformation des étudiants de médecine générale : définir de manière claire et précise l’autoformation à tous les étudiants de mé-decine générale lors de la journée d’accueil en début d’année universitaire, respecter le temps de travail en stage hospitalier et en stage ambulatoire afin d’y consacrer davantage de temps et valoriser l’autofor-mation à travers la mise en place d’une évaluation certifiante.

We performed a systematic review of phase I trials specifically designed for lymphoma patients. PubMed and Cochrane Library databases were searched using (lymphoma*) AND (phase 1) and publication date 2015-2020 to identify phase I dose-finding trials including a majority of lymphoma patients. Eighty-two trials (n = 3289 lymphoma patients) were included: 46 (55%) enrolled only lymphoma patients, 34 (41%) included also other hematologic malignancies, 2 (2%) solid tumors. Forty-six trials (56%) evaluated a combination (in 25 addition of experimental drug to standard therapy). Seven trials (9%) enrolled untreated patients. Among trials reporting activity in lymphoma patients, 74% (n = 57) reported an overall response rate ≥ 30%. All trials reported grade ≥ 3 adverse events; however, rates were not comparable across trials. Thirty-one treatment-related deaths in lymphoma patients were reported (overall treatment-related grade 5 adverse events rate 0.94%). Phase I trials designed for lymphoma patients were generally safe and the majority reported overall response rate ≥ 30%.

In this study pure molybdenum was produced by laser powder bed fusion on an AISI 304 building-plate. Adhesion issues were found at the interface between the two materials since the very beginning of the production process. Interface analysis was performed in order to investigate possible origins of the failure. The investigation showed that large cracks could propagate and led to separation of the printed part from substrate when the dilution of Mo on AISI 304 platform was approximately in the range 40 ÷ 50. The brittle intermetallic sigma phase was extracted and analysed by XRD on Mo-AISI 304 interface specimens. It is assumed that the sigma phase impaired the interface strength, providing a preferential route for brittle crack propagation.

The aim of this study was to evaluate the pathophysiological role and the prognostic significance of pulmonary artery compliance (C PA ), a measure of right ventricular pulsatile afterload, in cardiogenic shock. We retrospectively included 91 consecutive patients with cardiogenic shock due to primary left ventricular failure, monitored with a pulmonary artery catheter within the first 24 h. C PA was calculated as the ratio of stroke volume to pulmonary artery pulse pressure, and we determined whether C PA predicted mortality and whether it performed better than other pulmonary hemodynamic variables. The overall in-hospital mortality in our cohort was 27%. Survivors and nonsurvivors had comparable left ventricular ejection fraction, systolic, diastolic and mean pulmonary artery pressure, transpulmonary gradient, diastolic pressure gradient, and pulmonary vascular resistance at 24 h. In contrast, C PA was the only pulmonary artery variable significantly associated with mortality in univariate and multivariate analyses. Mortality increased from 4.5% at the highest quartile of C PA (3.6-6.5 mL/mmHg) to 43.5% at the lowest quartile (0.7-1.7 mL/mmHg). In 64 patients with a PAC inserted immediately upon admission, we calculated the trend of C PA between admission and 24 h. This trend was positive in survivors (+0.8 ± 1.3 ml/mmHg) but negative in nonsurvivors (-0.1 ± 1.0 mL/mmHg). The lower C PA in nonsurvivors was associated with more severe right ventricular systolic dysfunction. In conclusion, a reduced compliance of the pulmonary artery promotes right ventricular dysfunction and is independently associated with mortality in cardiogenic shock. Future studies should evaluate the impact on pulmonary arterial compliance and right ventricular afterload of therapies used in cardiogenic shock.

Capo S. Marco is the southernmost termination of the Sinis Peninsula in the northwestern border of the Oristano Gulf (western Sardinia, Italy). In the area, there are some of the most controversial and debated Quaternary deposits of Sardinia, consisting of beach, aeolian and slope sediments, whose chronological attribution changed according to different authors and, in different times, by the same authors. These discrepancies have not been solved by new radiometric dates, as radiocarbon and Optically Stimulated Luminescence (OSL) methods provided ages that are significantly different. During recent investigations at Capo S. Marco, beach notches filled with bioclastic sands, gravels, and boulders were discovered up to an elevation of similar to 4.5 m, which is the highest elevation of the known beach notches. These sediments rest on aeolian deposits and form a marine terrace in two sites. In some places, these sediments also include small colonies of the coral Cladocora caespitosa in living position that have been recently dated by U/Th at 70 +/- 4 ka and attributed to the end of MIS 5. Here, we report new U-series analyses of two samples of C. caespitosa collected on the uppermost part of the sequence. The U/Th ages of 153 +/- 0.8 and 149 +/- 0.6 ka would correspond to MIS 6, but the high values for the initial delta U-234 (177 and 179) compared to the modern seawater value (147) point to an open-system addition of U-234 and/or Th-230. The corrected ages using the open-system model of Thomson et al. are 141.6 +/- 2 and 132 +/- 2 ka. However, these deposits and the beach notches are not buried under aeolian or colluvial sediments, as are almost all the Tyrrhenian marine deposits found in Sardinia. They also rest on aeolian sediments, which, at San Giovanni di Sinis, were dated to MIS4 or Late MIS2 by OSL and radiocarbon dating of buried organic palaeosols, respectively. Accordingly, the stratigraphic evidence would suggest their attribution to the Holocene, although this contrasts with the Holocene sea level models available and the U/Th dating results. (C) 2014 Elsevier Ltd and INQUA. All rights reserved.

Although most prostate carcinomas belong to the conventional acinar type, unusual variants have been reported. The adenoid cystic/basal cell carcinoma of the prostate is a rare tumor with distinctive histopathologic features. There are quite few publications in the literature concerning the diagnosis, treatment, and prognosis of this neoplasm. Methods. A 71-year-old man had an increased PSA value (5.11 ng/dL); the prostatic biopsy examination was positive for adenoid cystic/basal cell carcinoma. For this reason we proceeded with radical prostatectomy. The histology examination showed an acinar conventional carcinoma and adenoid cystic/basal cell carcinoma. At eight months the patient did not show any recurrence. Conclusions. Various histologic and immunohistochemical features are helpful in recognizing the adenoid cystic/basal cell carcinoma of the prostate. Clinically, the only difference from a conventional adenocarcinoma is that the PSA value is usually normal or only slightly increased. This tumor has a biological potential that can result in metastases in some cases; the current treatment consists primarily in the surgical resection. A close, long-term follow-up is strongly recommended.

To investigate differences in the frictional behavior between initially bare rock surfaces of serpentinite and powdered serpentinite (“gouge”) at subseismic to seismic slip rates, we conducted single-velocity step and multiple-velocity step friction experiments on an antigorite-rich and lizardite-rich serpentinite at slip rates (V) from 0.003 m/s to 6.5 m/s, sliding displacements up to 1.6 m, and normal stresses (σn) up to 22 MPa for gouge and 97 MPa for bare surfaces. Nominal steady state friction values (μnss) in gouge at V = 1 m/s are larger than in bare surfaces for all σn tested and demonstrate a strong σn dependence; μnss decreased from 0.51 at 4.0 MPa to 0.39 at 22.4 MPa. Conversely, μnss values for bare surfaces remained ∼0.1 with increasing σn and V. Additionally, the velocity at the onset of frictional weakening and the amount of slip prior to weakening were orders of magnitude larger in gouge than in bare surfaces. Extrapolation of the normal stress dependence for μnss suggests that the behavior of antigorite gouge approaches that of bare surfaces at σn ≥ 60 MPa. X-ray diffraction revealed dehydration reaction products in samples that frictionally weakened. Microstructural analysis revealed highly localized slip zones with melt-like textures in some cases gouge experiments and in all bare surfaces experiments for V ≥ 1 m/s. One-dimensional thermal modeling indicates that flash heating causes frictional weakening in both bare surfaces and gouge. Friction values for gouge decrease at higher velocities and after longer displacements than bare surfaces because strain is more distributed. Key Points Gouge friction approaches that of bare surfaces at high normal stress Dehydration reactions and bulk melting in serpentinite in < 1 m of slip Flash heating causes dynamic frictional weakening in gouge and bare surfaces

The homeostatic chemokine CXCL13 is preferentially produced in B-follicles and is crucial in the lymphoid organ development by attracting B-lymphocytes that express its selective receptor CXCR5. Follicular dendritic cells (FDCs) have been identified as the main cellular source of this chemokine in lymphoid organs. Recently, genome-wide approaches have Suggested follicular CD4 T-helper cells (THF) as additional CXCL13 producers in the germinal centre and the neoplastic counterpart of TIIF (CD4+ turnour T-cells in angioimmunoblastic T-cell lymphoma) retains the capability of producing this chemokine. In contrast, no data are available on CXCL13 expression on FDC sarcoma (FDC-S) cells. By using multiple approaches, we investigated the expression of CXCL13 at mRNA and protein level in reactive and neoplastic FDCs. In reactive lymph nodes and tonsils, CXCL13 protein is mainly expressed by a subset of FDCs in B-cell follicles. CXCL13 is maintained during FDC transformation, since both dysplastic FDCs from 13 cases of Castleman's disease and neoplastic FDCs from tell cases of FDC-S strongly and diffusely express this chemokine. This observation was confirmed at nRNA level by using RT-PCR and in situ hybridization. Of note, no CXCL13 reactivity was observed in a cohort of epithelial and mesenchymal neoplasms potentially mimicking FDC-S. FDC-S are commonly associated with a dense intratumoural inflammatory infiltrate and immunohistochemistry showed that these lymphocytes express the CXCL13 receptor CXCR5 and are mainly of mantle zone B-cell derivation (IgI)+ and TCLI+). In conclusion, this study demonstrates that CXCL13 is produced by dysplastic and neoplastic FDCs and call be instrumental in recruiting intratumoural CXCR5+ lymphocytes. In addition to the potential biological relevance of this expression, the use of reagents directed against CXCL13 call be useful to properly identify the origin of spindle cell and epithelioid neoplasms. Copyright (C) 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. The homeostatic chemokine CXCL13 is preferentially produced in B-follicles and is crucial in the lymphoid organ development by attracting B-lymphocytes that express its selective receptor CXCR5. Follicular dendritic cells (FDCs) have been identified as the main cellular source of this chemokine in lymphoid organs. Recently, genome-wide approaches have Suggested follicular CD4 T-helper cells (THF) as additional CXCL13 producers in the germinal centre and the neoplastic counterpart of TIIF (CD4+ turnour T-cells in angioimmunoblastic T-cell lymphoma) retains the capability of producing this chemokine. In contrast, no data are available on CXCL13 expression on FDC sarcoma (FDC-S) cells. By using multiple approaches, we investigated the expression of CXCL13 at mRNA and protein level in reactive and neoplastic FDCs. In reactive lymph nodes and tonsils, CXCL13 protein is mainly expressed by a subset of FDCs in B-cell follicles. CXCL13 is maintained during FDC transformation, since both dysplastic FDCs from 13 cases of Castleman's disease and neoplastic FDCs from tell cases of FDC-S strongly and diffusely express this chemokine. This observation was confirmed at nRNA level by using RT-PCR and in situ hybridization. Of note, no CXCL13 reactivity was observed in a cohort of epithelial and mesenchymal neoplasms potentially mimicking FDC-S. FDC-S are commonly associated with a dense intratumoural inflammatory infiltrate and immunohistochemistry showed that these lymphocytes express the CXCL13 receptor CXCR5 and are mainly of mantle zone B-cell derivation (IgI)+ and TCLI+). In conclusion, this study demonstrates that CXCL13 is produced by dysplastic and neoplastic FDCs and call be instrumental in recruiting intratumoural CXCR5+ lymphocytes. In addition to the potential biological relevance of this expression, the use of reagents directed against CXCL13 call be useful to properly identify the origin of spindle cell and epithelioid neoplasms. Copyright (C) 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

The inflammatory pseudotumour of the lung is a rare and non-malignant neoplasm, which can be asymptomatic or characterized by variable clinical expressions. This report refers to a case occurring in a young woman and presenting as a persistent airway obstructive syndrome. With regard to histopathologic characterization, the present case can be classified as a fibrous histiocytic subtype.

This paper presents didactic strategies in a ludic tone to explore the methodology of Monte Carlo and analizes the implementations that have been performed in several educational scenarios. These proposals allow us to put into action concepts of probability and statistics in an amusing and attractive way by conducting cooperative “experiments-games” that are based on the use of real and virtual objects. Each strategy is aimed to teachers of high school and teacher training institutes, and also for early stages at University level, in order to be modified, recreated, and enhanced according to the specific areas of application. En este artículo se presentan estrategias didácticas en tono lúdico para explorar la metodología de Monte Carlo y se analizan las puestas en práctica realizadas en diversos escenarios educativos. Las propuestas elaboradas permiten poner en acción conceptos de probabilidad y estadística de un modo divertido y atrayente mediante la realización de “experimentos-juegos” cooperativos con objetos reales y virtuales. Cada estrategia está dirigida a profesores de escuelas secundarias y de institutos de formación docente, y también al ciclo básico de la Universidad, para que sea modificada, recreada y profundizada de acuerdo a las áreas específicas de aplicación.

One way to create models of elliptical galaxies is to start from a system of particles with a suitable distribution and to follow its evolution with an N-body code until it reaches equilibrium. In previous works we used the code of L.A. Aguilar to generate non-cuspy and cuspy models, the latter giving a better representation of elliptical galaxies. However, the method proposed by Hernquist and Ostriker is more suitable for the cases with central cusps, because it uses an expansion of the potential in radial functions that already reflects the cuspy character. Here we consider two models, one non-cuspy and another cuspy, obtained with the method of Aguilar and whose potentials we now fit with the Hernquist and Ostriker expansion. We obtained the corresponding variational equations and we used them to determine the Lyapunov exponents of orbits already investigated with the method of Aguilar and to separate the chaotic ones. We classified the regular orbits through the analysis of their orbital frequencies. Here we present a comparison of the results obtained with the two methods for both types of orbits. Un método para generar modelos de galaxias elípticas consiste en partir de un sistema de partículas con una configuración adecuada y seguir su evolución con un código de N-cuerpos hasta que alcanza el equilibrio. En trabajos anteriores hemos utilizado el código de L.A. Aguilar para generar modelos tanto no cuspidales como cuspidales, ofreciendo los segundos una mejor representación de las galaxias elípticas. Sin embargo, el método propuesto por Hernquist & Ostriker es más adecuado para los casos con cúspides centrales, puesto que utiliza una expansión del potencial en funciones radiales que ya tiene caracter cuspidal. Aquí consideramos dos modelos, uno no cuspidal y otro cuspidal, obtenidos con el método de Aguilar y cuyos potenciales ajustamos ahora con la expansión de Hernquist & Ostriker. Obtuvimos las ecuaciones variacionales correspondientes y las empleamos para determinar los exponentes de Lyapunov de órbitas ya estudiadas con el método de Aguilar y separar las caóticas. Las ́orbitas regulares las clasificamos mediante el análisis de sus frecuencias orbitales. Presentamos una comparación de los resultados obtenidos con los dos métodos para ambos tipos de órbitas.

Although most prostate carcinomas belong to the conventional acinar type, unusual variants have been reported. The adenoid cystic/basal cell carcinoma of the prostate is a rare tumor with distinctive histopathologic features. There are quite few publications in the literature concerning the diagnosis, treatment, and prognosis of this neoplasm. METHODS. A 71-year-old man had an increased PSA value (5.11 ng/dL); the prostatic biopsy examination was positive for adenoid cystic/basal cell carcinoma. For this reason we proceeded with radical prostatectomy. The histology examination showed an acinar conventional carcinoma and adenoid cystic/basal cell carcinoma. At eight months the patient did not show any recurrence. CONCLUSIONS. Various histologic and immunohistochemical features are helpful in recognizing the adenoid cystic/basal cell carcinoma of the prostate. Clinically, the only difference from a conventional adenocarcinoma is that the PSA value is usually normal or only slightly increased. This tumor has a biological potential that can result in metastases in some cases; the current treatment consists primarily in the surgical resection. A close, long-term follow-up is strongly recommended.

Personal experience in the diagnosis and management of two patients, one adult and one child, with pathologically proven bronchogenic cysts is described. Both patients presented with a solitary neck mass that proved to be bronchogenic cysts on histological examination. Aim of the review is to define the cytology, histopathological and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts. Definitive treatment requires surgical excision.

In this paper, we consider a wireless sensor network (WSN) where packets are forwarded to a central collector node (the sink). As all network traffic converges to this point, congestion builds up. We deal with this problem by assuming that the nodes around the sink are allowed to use a different, more efficient protocol for advancing data, namely a method designed to yield more throughput and reduce collisions, at the expense of some coordination efforts. We carry out extensive simulations, and compare our solution (which is composed of two protocols, one for the sink and its neighbors and one for the rest of the network) to a simpler collision avoidance approach used throughout the whole network. This allows to highlight the tradeoff between coordinating and interfacing two protocols (which requires better design, but achieves higher effectiveness) and using just one protocol (simpler, but more prone to congestion and losses). We show how our two-protocol solution outperforms the simpler one.

We explored the role of lymphatic mapping and sentinel lymphadenectomy (originally described for melanoma and breast cancer) in colon cancer. Pathologic techniques can successfully identify micrometastatic disease in lymph nodes, but they are not suitable for clinical routine use. We evaluated the role of sentinel node (SN) mapping in refining the staging of colorectal cancer.A total of 56 open colorectal resections were performed, and Patent Blue V dye was injected under the serosa surrounding the tumor immediately after opening the abdomen. SNs were analysed by immunohistochemistry to find micrometastatic disease. A literature search for the role of SNs in colorectal cancer was also performed.We identified the SN in 100% of patients, with a mean of 2.02 SNs/patient (range 1-5). After immunohistochemical staining, we could upstage 21 out of 56 patients (37.5%), and we observed 10.7% false negative SNs (6/56 patients). Fewer than half of the articles described false negative rates of15%, and most articles showed an upstaging rate of5% of patients. These differences are probably the result of different sensitivities of the methods used in identifying the lymph node micrometastases.SN mapping is an easy and cost-effective technique that holds promise and warrants further investigations.

This study describes the occurrence of sarcoidosis with lung and skin involvements in a 56-yr-old woman who suffered from 5q-myelodysplastic syndrome since the age of 50. The 5q-myelodysplastic syndrome is marked by deletion of the long arm of chromosome 5, which carries the genes coding for T-helper cell 2 cytokines, such as interleukins-3, -4 and -5, and granulocyte-macrophage colony-stimulating factor. Although the aetiology of sarcoidosis remains unclear, sarcoid granulomatous inflammation is marked by predominant expression of T-helper cell 1 cytokines, with reduced expression of T-helper cell 2 cytokines. The authors suggest that 5q-abnormality may have predisposed to sarcoidosis through an imbalance in the cytokine network, caused by the deletion of genes coding for T-helper cell 2 cytokines.

The stereotactic approach to intracranial expansive lesions is to be considered complementary to the traditional “free hand” surgery. With both techniques it is possible to explore or remove any kind of lesion sited everywhere into the cranial space. When an intraparenchimatous lesion is to be approached the only help to the surgeon is the possibility to distinguish normal from pathological tissue. This is not always possible. A surgical approach with the stereotactic frame not only helps to guide exactely the position of the surgical instrument into the tumor, but also to recognize the volume of the lesion when removal is acheavable (open-stereotaxis). 362 (26%) out of 1385 patients with intracranial expansive lesions were approached with stereotactic guide from May 1983 to May 1990. In 96% of these patients serial stereotactic samples were sufficient to reach an histopathological diagnosis. The most important result is that about 20% of all patients had not neoplasms, 35% had slow growing tumors and 45% had fast growing or malignant tumors. Stereoguided histopathology helps in making decision for a more adequate further treatment.

Isolated thrombocytopenia (platelets less than 100,000 mmc) may be the first clinical symptom in HIV positive patients or occur in all the evolutive phases up to overt AIDS. In this paper bone marrow lesions are evaluated at light and electron microscopy in 32 HIV positive patients with isolated thrombocytopenia (group II and III CDC 1986). At light microscopy an increase in megakaryocytes with small dysplastic changes, plasmacytosis and hypereosinophilia were the bone marrow lesions detected. Electron microscoy revealed megakaryocytes with focal nuclear alterations (hypolobation and dilatation of the perinuclear cisternae) and abnormalities in the maturation of platelets associated with cytoplasmic micro-macrovacuolation, absence of viral particles or of virus correlated structures. About 9% of HIV positive patients presented with isolated thrombocytopenia as a first clinical symptom: thrombocytopenia is not believed to have unfavourable prognostic significance in the evolution to overt AIDS.