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In the past, laser propagation in a fluid with heat transfer has been modeled using simplistic conduction and convection conditions yielding inaccurate predictions. Here we present a detailed numerical study describing the thermal profile of the fluid and its interaction with the laser. Furthermore, we evaluate the diffraction field in the far field produced by a pump beam impinging in the fluid and the interferometric pattern obtained normal to the propagation direction to test our model. Direct comparison between experimental results and numerical simulation allows for a complete understanding of the energy transfer from the laser to the liquid and the subsequent effect on the laser propagation. Spatial self-phase modulation and propagation control from small-phase diffraction to aberration-controlled diffraction and up to diffraction oscillation are observed and explained with our modeling.

The treatment of choice for high-risk non-muscle invasive bladder cancer (NMIBC) is bacillus Calmette-Guérin (BCG). However, when this fails, the indicated treatment is radical cystectomy. In recent years, trials are being developed with various drugs to avoid this surgery in patients with BCG failure. The aim of this article is to update the treatments under study for bladder preservation in this patient population. Non-systematic review, searching PubMed with the terms "Bladder cancer", "Non-muscle invasive bladder cancer", "NMIBC", "BCG", "BCG-refractory", "Mitomycin C", "MMC", "Hyperthermia", "Electromotive Drug Administration", "EMDA". We used the search engines clinicaltrials.gov and clinicaltrialsregister.eu to find clinical trials. The only intravesical drug approved by the Food and Drug Administration (FDA) for carcinoma in situ (CIS) after failure to BCG is Valrubicin. Recently, the FDA has approved intravenous Pembrolizumab, following the publication of preliminary data from the KEYNOTE-057 study. Atezolizumab has demonstrated similar preliminary efficacy results. Only microwave-induced chemohyperthermia and EMDA-MMC (Electromotive Drug Administration) are recognized as alternatives in European guidelines. Other options under investigation are taxanes and gemcitabine, alone or in combination, recombinant viruses and device-assisted intravesical chemohyperthermia. The results of new drugs are promising, with a large number of trials underway. Knowing the mechanisms of resistance to BCG is essential to explore new therapeutic options.

The cable layout optimisation for floating offshore wind farms is a complex task due to the number of elements involved and their nature, such as dynamic cables with buoyant sections. The first step is defining a model of the suspended cables that connect wind turbines between them or to cables on the seabed (risers). A lumped mass model and the finite element method are used to find the static position and mechanical stresses of the cables, keeping a balance between computational time and the quality of the results. The model allows the inclusion of standard ancillary equipment such as bend stiffeners, buoyancy modules, clamps and tethers in order to simulate multiple configurations: double hanging, single hanging (catenary), lazy wave, steep wave and tethered wave. The external actions considered are marine growth and currents and the main cable properties are taken into account to calculate its weight, buoyancy, tensions, moments and drag forces. The information obtained after the simulation includes cable tensions, curvature, laid and suspended lengths and tether tension, when applicable. Next steps include the optimisation of the suspended cables and the full network in the farm.

To analyze the likelihood of undetectable PSA (0.01 ng/mL) after extended (ePLND) versus standard pelvic lymph-nodes dissection (sPLND) in pN+ patients.The institutional prospectively maintained Prostate Cancer Database was queried for patients who underwent radical prostatectomy with PLND and were found with 3or less lymph-nodal metastases between 2007 and 2017. The extension of the PLND was defined according to the number of lymph-nodes (LN) removed. Patients in the 75th or higher percentile of lymph-nodes removed were considered as the ePLND group; patients in the 25th or lower percentile in the sPLND group. Groups were compared in clinical and pathological variables. Student T-test was used for comparing continuous variables; chi-square test was used for categorical variables. Multivariable logistic regression assessed the probability of undetectable PSA at 31478 patients were treated within the time span considered. 95 with 1 to 3 lymph-nodal metastases were extracted. After accounting for inclusion criteria, 23 patients with a median of 11 LN removed were included in the sPLND group (25th percentile); 23 patients with27 LN were included in ePLND group (75th percentile). Surgical time was longer for ePLND. Sixteen patients (69.6%) who underwent ePLND had undetectable PSA postoperatively. At multivariable analysis, the probability of undetectable PSA at 3ePLND is more likely to predict undetectable PSA at third month after radical prostatectomy, irrespective of disease characteristics.

The objective of evidence-based medicine is to employ the best scientific information available to apply to clinical practice. Understanding and interpreting the scientific evidence involves understanding the available levels of evidence, where systematic reviews and meta-analyses of clinical trials are at the top of the levels-of-evidence pyramid.The review process should be well developed and planned to reduce biases and eliminate irrelevant and low-quality studies. The steps for implementing a systematic review include (i) correctly formulating the clinical question to answer (PICO), (ii) developing a protocol (inclusion and exclusion criteria), (iii) performing a detailed and broad literature search and (iv) screening the abstracts of the studies identified in the search and subsequently of the selected complete texts (PRISMA).Once the studies have been selected, we need to (v) extract the necessary data into a form designed in the protocol to summarise the included studies, (vi) assess the biases of each study, identifying the quality of the available evidence, and (vii) develop tables and text that synthesise the evidence.A systematic review involves a critical and reproducible summary of the results of the available publications on a particular topic or clinical question. To improve scientific writing, the methodology is shown in a structured manner to implement a systematic review.

Objective: To assess the effect of androgen deprivation therapy (ADT) on cognitive performance (CP) in patients with prostate cancer (PCa) after 6 months of treatment with luteinizing hormone-releasing hormone (LHRH) analogues. Material and methods: Prospective, observational, multicentre, open-label study of patients diagnosed with nonmetastatic or asymptomatic metastatic PCa scheduled to receive LHRH analogues for >= 6 months. We assessed four CP domains at baseline and after 6 months of ADT: 1) Working memory: Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Subtest (WAIS ill-Digit); 2) Visual memory: ad hoc visual memory test; 3) Visuospatial ability: Judgement of Line Orientation (JLO) and Mental Rotation of Three-Dimensional Objects (3D-Rotation); and 4) Nonverbal analytical reasoning: WAIS III Matrix Reasoning Test (WAIS III-MRT). Changes outside the baseline 95% confidence intervals were considered significant. Results: A total of 308 patients completed the study. Of these, 245 (79.6%) experienced no statistically significant changes on any test and 63 patients (20.4%) experienced significant changes in >= 1 test. Of these, most presented a change in only one test, distributed evenly between improvements (58 patients; 18.8%) and worsening (56 patients; 18.2%). For individual tests, most patients (87.8% to 91.8%) had no change from baseline; however, the significant changes (improvement vs. deterioration, respectively) were as follows: WAIS III-Digit (6.3% vs. 5.9%); visual memory (5.3% vs. 5.7%); JLO (5.3% vs. 4.5%); 3D-Rotation (4.1%vs. 4.1%); and WAIS III-MRT (4.8% vs. 5.8%). Conclusions: CP in patients with PCa does not appear to be adversely affected by 6 months of LHRH analogue administration. (C) 2017 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

P. Pyreneplax basaensis nou gènere, nova espècie (Decapoda, Brachyura, Vultocinidae) del Priabonià (Eocè Superior) del Pirineu d’Osca (Aragó, Espanya), i observacions sobre el gènere Lobonotus A. Milne-Edwards, 1863. Els nous braquiürs fòssils trobats a la Formació Margas de Arguís (Priabonià, Eocè superior) dels Pirineus Centrals (Aragó), permeten la descripció d’un nou gènere y una nova espècie ( Pyreneplax basaensis), així com la revisió d’alguns tàxons previament assignats al gènere Lobonotus A. Milne-Edwards, 1863 (Carpilioidea: Tumidocarcinidae). Tenint en compte la gran similitud existent entre Pyreneplax n. gen. i les espècies Lobonotus sandersi(Blow i Manning, 1997), L. granosus(Beschin, Busulini, De Angeli i Tessier, 2002) i L. sommarugai Beschin, Busulini i Tessier, 2009, aquestes són també assignades al nou gènere. A més, un conjunt de caràcters tant dorsals com ventrals, compartits amb la espècie actual Vultocinus anfractusNg i Manuel-Santos, 2007, suggereixen la inclusió del nou gènere dins la família Vultocinidae Ng i Manuel-Santos, 2007 (Goneplacoidea). Al mateix temps es discuteixen alguns aspectes de la posició sistemàtica del gènere Lobonotus A. Milne-Edwards, 1863., New fossil brachyuran finds in the Margas de Arguís Formation (Priabonian, Late Eocene) in the Central Pyrenees of Aragon (Spain), allow the description of a new genus and a new species ( Pyreneplax basaensis), and the revision of some taxa previously assigned to the genus Lobonotus A. Milne-Edwards, 1863 (Carpilioidea: Tumidocarcinidae). According to the close similarity between Pyreneplax n. gen. and Lobonotus sandersi (Blow and Manning, 1997), L. granosus (Beschin, Busulini, De Angeli and Tessier, 2002) and L. sommarugai Beschin, Busulini and Tessier, 2009, these species are here assigned to the new genus. In addition, an important set of dorsal and ventral characters shared with the extant species Vultocinus anfractus Ng and Manuel-Santos, 2007, suggests the inclusion of the new genus in the family Vultocinidae Ng and Manuel-Santos, 2007 (Goneplacoidea). Remarks on the genus Lobonotusare also discussed herein., P. Pyreneplax basaensisnuevo género, nueva especie (Decapoda, Brachyura, Vultocinidae) del Priaboniense (Eoceno Superior) del Pirineo de Huesca (Aragón, España), y observaciones sobre el género Lobonotus A. Milne-Edwards, 1863. Nuevos braquiuros fósiles encontrados en la Formación Margas de Arguís (Priaboniense, Eoceno superior), en los Pirineos Centrales (Aragón), permiten la descripción de un nuevo género y una nueva especie ( Pyreneplax basaensis), así como la revisión de algunos taxones previamente asignados al género Lobonotus A. Milne-Edwards, 1863 (Carpilioidea: Tumidocarcinidae). De acuerdo con la notable similitud entre Pyreneplax n. gen., y las especies Lobonotus sandersi (Blow y Manning, 1997), L. granosus(Beschin, Busulini, De Angeli y Tessier, 2002) y L. sommarugaiBeschin, Busulini y Tessier, 2009, éstas se asignan al nuevo género. Asimismo, un destacado conjunto de caracteres dorsales y ventrales compartidos con la especie actual Vultocinus anfractus Ng y Manuel-Santos, 2007, sugiere la inclusión del nuevo género en la familia Vultocinidae Ng y Manuel-Santos, 2007 (Goneplacoidea). También se efectúan algunas observaciones sobre el género LobonotusA. Milne-Edwards, 1863.

Background Abdominal perineal excision (APE) was originally described with levator ani removal for rectal cancer. An even wider, more aggressive extralevator resection for APE has been proposed. Although some surgeons are performing a very wide ‘extralevator APE (ELAPE)’, there are few data to recommend it routinely. This multicentre study aimed to compare outcomes of APE and ELAPE. Methods A multicentre propensity case-matched analysis comparing two surgical approaches (APE and ELAPE) was performed. All patients who underwent abdominoperineal resection of a rectal tumour were considered for the analysis. Tumour height was defined by magnetic resonance imaging measurement and patients with stage II–III tumours had neoadjuvant radiochemotherapy. Involvement of the circumferential resection margin (CRM) and intraoperative tumour perforation were the main outcome measures. A logistic regression model was used to study the relationship between the surgical approaches and outcomes. Results From January 2008 to March 2013 a total of 1909 consecutive patients underwent APE or ELAPE, of whom 914 matched patients (457 in each group) formed the cohort for analysis. Intraoperative tumour perforation occurred in 7·9 and 7·7 per cent of patients during APE and ELAPE respectively (P = 0·902), and there was CRM involvement in 13·1 and 13·6 per cent (P = 0·846). There were no differences between APE and ELAPE in terms of postoperative complication rates (52·3 versus 48·1 per cent; P = 0·209), need for reoperation (7·7 versus 7·0 per cent; P = 0·703), perineal wound problems (26·0 versus 21·9 per cent; P = 0·141), mortality rate (2·0 versus 2·0 per cent; P = 1·000) and local recurrence rate at 2 years (2·7 versus 5·6 per cent; P = 0·664). Conclusion ELAPE does not improve rates of CRM involvement, intraoperative tumour perforation, local recurrence or mortality.

The increase of the diagnosis of low risk prostate cancer translates into a new clinical entity, for which active surveillance may not be always enough and conventional therapies are clearly overtreatment. Faced with the necessity of giving a therapeutic answer to these patients, and facilitated by the technological advances in the imaging field and new energy sources, the interest is centered in the clinical development of focal therapies as an alternative with minimal morbidity and oncologically safe. As a part of the review carried out in this monographic issue, this article focus on the features relative to the preclinical and clinical development of laser ablative therapy and the innovative photodynamic vascular therapy with soluble TOOKAD®. With this aim we performed an exhaustive bibliographic search, updated to February 2016, in the greater databases, including original articles and reviews in reference to the object of this review, without restrictions for year of publication. This article reviews the preclinical and clinical development of these innovative ablative techniques in the field of focal therapy for low risk prostate cancer.

Aim The study aimed to assess the diagnostic yield of a colonoscopy screening programme in first-degree relatives of colorectal cancer (CRC) patients and to identify factors associated with advanced neoplasia. Method We conducted a cross-sectional study. Individual characteristics, family trees and colonoscopy findings of asymptomatic first-degree relatives of CRC patients were collected. The findings were classified into cancer (invasive carcinoma and/or non-invasive high-grade neoplasia), high-risk adenomas (≥ 10 mm and/or a villous component) and low-risk adenomas (tubular

Lactose malabsorption (LM) is a very common problem with high prevalence in Southern Europe. The lactose tolerance test (LTT) is a basic probe, which is widespread in local hospitals, because it requires non-complex and inexpensive infrastructure. The aims of our study are to determine that a reduction in the duration of LTT does not affect its diagnostic accuracy to detect LM and to calculate the savings that this reduction may represent. A prospective study of consecutive patients who underwent LTT for suspected LM was conducted. We analyzed and compared the clinical results and costs (extraction, analytical measurement, time spent by nursing staff, technicians and patients) of suppressing LTT points at 30 and 120 min. The study included 201 patients. Pathological LTT was found in 119 cases. Eliminating the measurement of glucose at 120 min did not alter the LTT interpretation in any patient; however, up to 18.4% of patients had a LTT misinterpretation when the 30 min point was suppressed. If the LTT 120 min measurement would have been suppressed, 41 334 euros could have been saved. Suppressing the 120 min LTT point does not imply any changes in clinical results and reduces patient’s waiting time; it also benefits the health system by saving time, manpower and materials.

SUMMARY Mature-green and commercial harvest stage guava fruits were picked in a commercial orchard in Zitacuaro, Michoacan, Mexico. They were wrapped in polyethylene plastic film bags (PF), that had pores of 10 mm diameter pores, and stored at 5 and 10 °C during 6, 12 and 18 days. The results were compared with a control stored at temperate room (20 °C and 70% relative humidity). CO 2 , O 2 , and ethylene were determined in the internal atmosphere generated by the PF; the characteristics evaluated were weight loss, firmness, total soluble solids, titratable acidity and fruit color at the above mentioned storage days and 6 days after the removal of fruits from the cold storage. The PF modified the internal atmosphere in function of both temperature and stage of ripeness stage of the fruit. Fruit stored at 5 and 10 °C in PF had good physiological and biochemical characteristics, and good quality up to 18 days of storage. The best results were found with guavas harvested at the mature-green stage followed by 6 days after removal from storage at 5 °C for 6 days, chilling injury was not observed. The fruit stored at room temperature showed color and weight loss, and attack of Colletotrichum gloeosporioides Penz. after 18 days of storage.

The increasingly common incidental diagnosis of small renal masses (SRMs) (measuring under 4 cm in size) has led to the consideration of applying minimally invasive techniques to deal with them--particularly in view of the high percentage of non-malignant conditions of this size that are radiologically indistinguishable from tumor lesions. Accordingly, laparoscopic access has gained great importance in the management of these masses, in an attempt to lessen the morbidity associated with lumbotomy. Laparoscopic partial nephrectomy (LPN) is an evolving technique in most centers; on one hand it competes with open partial nephrectomy as the technique of choice, and on the other it will compete in the future with the non-excisional management techniques. These latter procedures in turn have become more precise thanks to laparoscopy. Based on a standardized review of the abundant literature on the treatment of SRMs, the present study examines the technical innovations and improvements afforded by the laparoscopic approach, not only for excision purposes but also a vehicle for minimally invasive treatments. Likewise, the requirements of Services of Urology and the improvements that could be introduced in health systems for advancing the application of LPN in the management of SRMs are commented. Progressive fine-tuning of the technique, with improvement of the laparoscopic repertoire and availability of hemostatic agents, will contribute to increase the indications for LPN in the future. The limited frequency of the disorder and the need to optimize the technique will require health care supervisors to centralize this type of pathology in centers with experience in laparoscopy and open partial nephrectomy.

A 77-year-old asymptomatic male was referred by his family doctor with this liver test: total bilirubin (TB) 1.84 mg/dl, WBC 3,700/μL, platelets 109,000/μL, and GGT 71 U/L. Past medical history: no allergies to medication. Hypertension treated with captopril 25 mg/day. No abdominal surgery or trauma or liver biopsies. Drinker of 40 g alcohol daily. No known liver disease. No family history of interest. Physical examination showed no stigmata for chronic liver disease, and the abdomen was soft. CBC: leukocytes 2,990/μL, neutrophils 860/μL, lymphocytes 1,570/μL, platelets 112,000/μL, hemoglobin 138 g/L, hematocrit 0.396 L/L, MCV 90.4 fl, prothrombin activity 75.6%, cephalin time 33.6 seg, TB 1.73 mg/dl, GGT 72 U/L, with glucose, urea, creatinine, AST, ALT, ALP, Ca, serum ferritin, amylase, Na, K, TSH, AFP, and autoantibodies (ANA, AMA, SMA) within normal values. Hepatitis B and C were negative. Doppler ultrasounds and computed tomography (CT) + abdominal reconstruction with volume-rendering phase (Figs. 1 and 2) showed a dilated right suprahepatic vein, in its distal end an expansion in the two converging aneurysmatic segmental right portal branches. At this stage no portal flow is seen in the other branches. The main portal branch and the left branch had a normal caliber. The spleen was normal in size. The gallbladder and pancreas had no changes. No free fluid. An inferior vena cava to the left, with retroaortic iliac bifurcation and iliac veins being prominent. There is some increased density in the mesenteric fat due to diffuse, likely venous engorgement.

Hydatidosis is a zoonosis with a continuing high prevalence in our environment. The most commonly affected organs are the lungs and the liver, with the musculoskeletal location being considered an unusual one. We comment the case of a patient who presented a series of lesions in his left iliac crest and middle left buttock with spontaneous fistulization to the skin surface. In this case a combined treatment was given; prior to the surgical operation we administered a cycle of albendazol. Following removal of the lesion, the patient was given two further cycles of albendazol in order to minimize the risk of a recurrence of the illness. This patient is currently free of any symptoms relating to this illness.

Spontaneous intramural dissection of the esophagus (SIDE) is an unusual clinical entity. It is a benign disease that, despite its alarming endoscopic appearance, usually responds well to conservative management and has an excellent prognosis. Nevertheless, some situations require emergency surgical treatment. These situations include esophageal perforation with mediastinitis, massive bleeding, and abscess, among others. Upper gastrointestinal endoscopy is a useful diagnostic test when radiological examinations (hydrosoluble contrast esophagogram, computed tomography, or magnetic resonance imaging) have excluded perforation. We present the case of a 42-year-old woman who was admitted to our hospital complaining of acute chest pain, dysphagia, and odynophagia. Because of the persistence of symptoms and diagnostic uncertainty (SIDE versus complicated esophageal duplication cyst) surgery was performed. The definitive diagnosis was SIDE.

La hidatidosis es una zoonosis con una elevada prevalencia aún en nuestro medio. Generalmente afecta a hígado y pulmón, debiendo considerarse la afectación músculo-esquelética una localización atípica de la enfermedad. Presentamos el caso de un paciente con lesiones en cresta iliaca y glúteo medio izquierdos, con fistulización espontánea a través de la piel. Se realizó tratamiento combinado con un ciclo de albendazol previo a la intervención y exéresis quirúrgica de la lesión. En el postoperatorio se completaron dos ciclos más de tratamiento con albendazol en un intento de disminuir el riesgo de recurrencia de la enfermedad. El paciente se encuentra asintomático y no ha presentado ninguna complicación hasta la fecha.

The design of new medical drugs is a very complex process in which combinatorial chemistry techniques are used. For this reason, it is very useful to have tools to predict and to discriminate the pharmacological activity of a given molecular compound so that the laboratory experiments can be directed to those molecule groups in which there is a high probability of finding new compounds with the desired properties. This work presents an application of Artificial Neural Networks to the problem of discriminating and predicting pharmacological characteristics of a molecular compound from its topological properties. A large amount of different configurations are tested, yielding very good performances.

To describe two cases of malakoplakia of the bladder with an unusual form of presentation and review the cases previously reported in the literature.Two patients, a 61-year-old female and a 71-year-old male, are described. Both patients had a history of recurrent infection caused by coliform pathogens. Treatment consisted of trimethoprim sulfamethoxazole, ascorbic acid and bethanecol chloride, together with extended TUR of the bladder lesion.Although malacoplakia of the bladder is considered to be a benign disease, close follow-up is warranted due to frequent recurrence of symptoms and the difficulty in achieving long-lasting effects since it is frequently associated with immunosuppression.

Thrombolytic therapy (TT) modifies the natural history of acute myocardial infarction (AMI) diminishing morbi-mortality rate. In recent studies, modification of infusion velocity, decreased the mortality 10 percentage points.Test if rt PA administration over an hour is safe and practical.A prospective, cooperative trial during 3 years, included patients with AMI with less than 6 hours of the onset of symptoms that received rt-PA therapy. Initially 10 mg bolus and then 90 mg over 60 minutes period. Together with the administration of rt-PA, 5000 units of heparin was given, followed by 1000 units per hour adjusted to keep PTT at 1.5 to 2 times normal. All patients received aspirin and according of the evolution adjuvant therapy. We defined bleeding complications and/or cerebrovascular accident related to thrombolytic therapy.We included 225 patients who received rt-PA. Average age was 57.1 +/- 22.2 years, 78.7% males and 21.3% females. Arrival time at hospital was 2.93 +/- 1.7 hours. 82.2% were in class I-II by NYHA. 59.2% had anterior wall location and 32.4% posterior-inferior wall 80% had reperfusion criteria. Only 7.1% required transfusion and 0.4% presented CNS bleeding. The survival rate was 95.2%. The mortality had no relation with bleeding.Fast infusion is an effective and safe method. Transfusion requirements are no greater, and CNS bleeding was noted in 0.4% of the cases.

We report a case of cutaneous metastasis originating from prostate adenocarcinoma. We underscore this rare site of metastasis and the poor outcome.

To discover how patients in a provincial general hospital, diagnosed as having pulmonary tuberculosis had first clinically and radiologically presented.This was a retrospective observational study. SITE. The San Jorge de Huesca General Hospital. The period of study was between January, 1986, and December, 1989.Those studied were the 59 patients diagnosed as having active pulmonary tuberculosis during the study period.The average age of the patients was 45.6 +/- 19.25 SD. There was greater occurrence in males. The most common form in which the disease first appeared was thoracic symptomatology (59%), followed by constitutional syndrome (45.7%). 8 patients were addicted to drugs taken parenterally (ADVP), of whom 4 were HIV-positive (6.8%). The most common radiological pattern was ulcero-caseous.We underline the importance of diagnostical awareness at the Primary Care level in order to rapidly begin the correct treatment; and thus fight the adverse epidemiological situation caused by tuberculosis today.

As of August 1988, 1,628 cases of AIDS had been reported in Mexico, of which 12% were ascribed to transmission through blood. Of the 201 subjects infected by blood, 159 (79%) were infected through transfusions. The relatively high number of such cases was found to be associated with a prevalence of HIV infection of 7% among paid donors as compared with a prevalence of 0.1% among volunteer donors. A National AIDS Prevention Committee has been established in Mexico, and amendments to the country's General Health Law mandate compulsory screening to detect HIV infection among all donors and prohibit the sale of blood. A national network of screening laboratories was established and an educational campaign initiated among health personnel. Evaluation of this program shows that the current frequency of HIV infection in donors is 0.04%.