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In this Letter, we show 3D steady-state trapping and manipulation of vapor bubbles in liquids employing a low-power continuous-wave laser using the Marangoni effect. Light absorption from photodeposited silver nanoparticles on the distal end of a multi-mode optical fiber is used to produce bubbles of different diameters. The thermal effects produced by either the nanoparticles on the fiber tip or the light bulk absorption modulate the surface tension of the bubble wall and creates both longitudinal and transversal forces just like optical forces, effectively creating a 3D potential well. Using numerical simulations, we obtain expressions for the temperature profiles and present analytical expressions for the Marangoni force. In addition, using an array of three fibers with photodeposited nanoparticles is used to demonstrate the transfer of bubbles from one fiber to another by sequentially switching on and off the lasers.

The most common approach to optically generate and manipulate bubbles in liquids involves temperature gradients induced by CW lasers. In this work, we present a method to accomplish both the generation of microbubbles and their 3D manipulation in ethanol through optothermal forces. These forces are triggered by light absorption from a nanosecond pulsed laser (λ = 532 nm) at silver nanoparticles photodeposited at the distal end of a multimode optical fiber. Light absorbed from each laser pulse quickly heats up the silver-ethanol interface beyond the ethanol critical-point (∼ 243 °C) before the heat diffuses through the liquid. Therefore, the liquid achieves a metastable state and owing to spontaneous nucleation converted to a vapor bubble attached to the optical fiber. The bubble grows with semi-spherical shape producing a counterjet in the final stage of the collapse. This jet reaches the hot nanoparticles vaporizing almost immediately and ejecting a microbubble. This microbubble-generation mechanism takes place with every laser pulse (10 kHz repetition rate) leading to the generation of a microbubbles stream. The microbubbles' velocities decrease as they move away from the optical fiber and eventually coalesce forming a larger bubble. The larger bubble is attracted to the optical fiber by the Marangoni force once it reaches a critical size while being continuously fed with each bubble of the microbubbles stream. The balance of the optothermal forces owing to the laser-pulse drives the 3D manipulation of the main bubble. A complete characterization of the trapping conditions is provided in this paper.

AIM: To determine the incidence of Type 1 diabetes in Caceres in children less than 14 years of age. We tested for differences in incidence by age, sex and season at diagnosis. METHODS: All Type 1 diabetes cases with onset <14 years of age between 1988 and 1999 were recorded retrospectively. Pediatric Unit registries provided the primary source of ascertainment. The secondary independent data source was based on the registries of local Diabetic Associations, diabetes camp records and guarantee cards of blood-glucose meters. We used the capture-recapture method for ascertainment. RESULTS: During the 12-year period, 137 new cases of Type 1 diabetes were identified. Completeness of ascertainment was 99.2%. Average annual observed incidence was 16.8/100,000/year (95% C.I. 14.1-19.8). Age-standardised incidence (world population): 16.5/100,000/year (95% C.I. 13.9-19.6). Average annual incidence for 0-4, 5-9 and 10-13-year-old groups: 12.7/100,000 (95% C.I. 8.8-17.9), 18.2/100,000 (95% C.I. 13.7-23.8) and 19.1/100,000 (95% C.I. 14.2-25.1). The highest age-specific annual incidence rate was found in the 10-13-year age group. There was a seasonal onset pattern, with the highest incidence in autumn and winter. November was the month with the highest number of cases (22/137). CONCLUSION: Caceres has a moderately high incidence of Type 1 diabetes in children less than 14 years of age, similar to that found in other more developed and densely populated regions of Spain, and in the range of other countries of northern Europe. These data do not support the hypothesis of a decrease in the incidence of the disease from north to south over Europe. [ABSTRACT FROM AUTHOR]

In this work, we present two new multifocal intraocular lens (MIOL) designs, both based on the silver mean kinoform diffractive lens. We demonstrate that a single aperiodic diffractive profile can be used to create two different MIOLs: one with a kinoform structure and the other with a stepwise profile. Quantitative assessment of the designs was carried out using the through focus modulation transfer function and the area under the modulation transfer function for the prediction of their visual performance. Our results show that both designs exhibit nearly identical optical performance at the design wavelength (λ = 550 nm), though their intrinsic longitudinal chromatic aberration differs significantly. Given that diffractive extended depth of focus (EDoF) intraocular lenses are prone to image degradation due to dysphotopic phenomena, we also compared the halos generated by these two designs and found notable differences in their behavior. Furthermore, under photopic conditions, the proposed lens designs demonstrated the potential to achieve visual acuity values of 0.2 logMAR or better across a vergence range from approximately 0 to 2 D. Finally, to qualitatively assess the behavior of the MIOLs, an objective experimental evaluation was conducted using an adaptive optics visual simulator in a model eye. Experimental results align with the quantitative assessment of the proposed designs., Competing Interests: The authors declare that there are no conflicts of interest related to this article., (© 2024 Optica Publishing Group.)

In this work, we design and implement a new bifocal diffractive spiral lens within an optical tweezers system. The proposed diffractive optical element coined Kolokaski Kinoform Spiral Lens (KKSL), generates twin optical vortices along the propagation direction. The axial positions, as well as the diameters of the generated vortex beams, are correlated with the Kolakoski aperiodic sequence introduced in the design of the diffractive lens. The unique properties of KKSLs make it ideal for optical trapping applications, allowing independent multiple trapping and particle displacement within each optical vortex beam. We present both the focusing properties of KKSL and the experimental results of its integration into the optical tweezer setup., (© 2024. The Author(s).)

In this work, we present a new family of Zone Plates (ZPs) designed using the self-generating Kolakoski sequence. The focusing and imaging properties of these aperiodic diffractive lenses coined Kolakoski Zone Plates (KZPs) are extensively studied. It is shown that under monochromatic plane-wave illumination, a KZP produces two main foci of the same intensity along the axial axis. Moreover, one of the corresponding focal lengths is double the other, property correlated with the involved aperiodic sequence. This distinctive optical characteristic is experimentally confirmed. We have also obtained the first images provided by these bifocal new diffractive lenses., (© 2024. The Author(s).)

Bacterial endospores, or simply spores, are formed by a diverse group of members within the phylum Bacillota and include notable genera such as Bacillus , Paenibacillus , and Clostridium . Spores are distributed ubiquitously in natural environments, with soil being an important primary reservoir for these microbes. As such, spores are present throughout the dairy farm environment, and transmission into raw milk occurs through several pathways that coalesce at the point of milk harvest. Despite the very low spore concentrations typically found in bulk tank raw milk, the impact of spores on dairy product quality, safety, and product conformance is widely documented. Processed dairy products affected by the presence of sporeforming bacteria include milk, cheese, dairy powders, ice cream mix, and more. Although raw milk is a major source of spores leading to quality, safety, and conformance issues in dairy products, the impact of other sources should not be discounted and may include ingredients (e.g., cocoa powder), contamination originating from biofilms in processing equipment, and even cross-contamination from the processing environment itself. Addressing spore contamination in the dairy system is complicated by this widespread distribution and by the diversity of these organisms, and successful source tracking often requires discriminatory molecular subtyping tools. Here, we review the key sources of sporeforming bacteria in the dairy system, the factors leading to the transmission of this diverse group of microbes into processed dairy products, and methods employed to enumerate and track spore contaminants., (© 2024, .)

The design and implementation of a multiplexed spiral phase mask in an experimental optical tweezers setup are presented. This diffractive optical element allows the generation of multiple concentric vortex beams with independent topological charges and without amplitude modulation. The generalization of the phase mask for multiple concentric vortices is also shown. The design for a phase mask of two multiplexed vortices with different topological charges is developed. We experimentally show the transfer of angular momentum to the optically trapped microparticles by enabling nearly independent orbiting dynamics around the optical axis within each vortex. The angular velocity of the confined particles versus the optical power in the focal region is also discussed for different combinations of topological charges., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

Background: Integration of transcriptomic testing into EUS-FNA samples is a growing need for precision oncology in pancreatic ductal adenocarcinoma (PDAC). The NanoString platform is suitable for transcriptome profiling in low yield RNA samples. Methods: Inclusion of patients that underwent EUS-FNA cytological diagnosis of pancreatic ductal adenocarcinoma using 19G and/or 22G needles and subsequent surgical resection. Formalin-fixed, paraffin-embedded (FFPE) cytological and surgical samples underwent RNA extraction and transcriptomic analysis using a custom 52-gene NanoString panel of stromal PDAC features. Cell type abundance was quantified in FFPE specimens and correlated. Results: 18 PDAC patients were included. Mean EUS-FNA passes was 2 + 0.7. All FFPE passed the RNA quality control for genomic analysis. Hierarchical clustering on the global gene expression data showed that genes were differentially expressed between EUS and surgical samples. A more enriched cancer-associated fibroblasts and epithelial-mesenchymal transition transcriptomic profile was observed across surgical specimens whereas immunological biomarkers were more represented in EUS-FNA samples. Cytological examination confirmed a scanty representation of CAF and more immunological cell abundance in cytological samples in comparison to surgical specimens. Conclusion: Targeted transcriptomic NanoString profiling of PDAC samples obtained by EUS-FNA is a feasible approach for pre-surgical molecular analysis although stromal CAF/EMT mRNA biomarkers are underrepresented., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Pedrosa, Araujo, Cuatrecasas, Soy, López, Maurel, Sánchez-Montes, Montironi, Saurí, Sendino, Pérez, Ausania, Fernández-Esparrach, Espósito, Vaquero and Ginès.)

p53 immunohistochemistry (IHC) has been proposed as a surrogate for TP53 mutations in penile squamous cell carcinomas (PSCC). We aimed to evaluate the performance of a pattern-based evaluation of p53 IHC in PSCC. Human papilloma virus (HPV) DNA testing, p16 and p53 IHC, and whole exome sequencing were performed in a series of 40 PSCC. p53 IHC was evaluated following a pattern-based framework and conventional p53 IHC evaluation. Out of 40 PSCC, 12 (30.0%) were HPV-associated, and 28 (70.0%) were HPV-independent. The agreement between the p53 IHC pattern-based evaluation and TP53 mutational status was almost perfect (k = 0.85). The sensitivity and accuracy of the pattern-based framework for identifying TP53 mutations were 95.5% and 92.5%, respectively, which were higher than the values of conventional p53 IHC interpretation (54.5% and 70.0%, respectively), whereas the specificity was the same (88.9%). In conclusions, the pattern-based framework improves the accuracy of detecting TP53 mutations in PSCC compared to the classical p53 IHC evaluation.

Two pathways have been described for vulvar squamous cell carcinomas (VSCC), one associated with human papillomavirus (HPV), and the other HPV-independent. We compared the etiopathogenic features of a series of VSCC from Mozambique, a sub-Saharan country with high prevalence of HPV and HIV, with those of Spain, a European country with low prevalence of HPV and HIV. All VSCC diagnosed at the two institutions from January 2018 to December 2020 were included (n = 35 and n = 41, respectively). HPV DNA detection and genotyping, and immunohistochemistry for p16 and p53 were performed. Tumors showing p16 positive staining and/or HPV DNA positivity were considered HPV-associated. 34/35 tumors (97%) from Mozambique and 8/41 (19%) from Spain were HPV-associated (P < .001). Mean age of the patients from Mozambique and Spain was 45 ± 12 and 72 ± 14, respectively (P < .001). No differences were found in terms of HPV genotypes or multiple HPV infection rates. 1/35 tumors (3%) from Mozambique and 29/41 (70%) from Spain showed abnormal p53 immunostaining (P < .001). In contrast with the predominance of HPV-independent VSCC affecting old women in Europe, most VSCC in sub-Saharan Africa are HPV-associated and arise in young women. This data may have important consequences for primary prevention of VSCC worldwide., (© 2022 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Optical manipulation is interfacing disciplines in the micro and nanoscale, from molecular biology to quantum computation. Versatile solutions for increasingly more sophisticated technological applications require multiple traps with which to maneuver dynamically several particles in three dimensions. The axial direction is usually overlooked due to difficulties in observing particles away from an objective-lens focal plane, a normal element in optical tweezers, and in managing interparticle distances along the trapping beam propagating direction, where strong radiation pressure and shadowing effects compromise the simultaneous and stable confinement of the particles. Here, aperiodic kinoform diffractive lens based on the m-Bonacci sequence are proposed as a new trapping strategy. This lens provides split first-order diffractive foci whose separation depends on the generalized m-golden ratio. We show the extended manipulation capabilities of a laser tweezers system generated by these lens, in which concomitant trapping of particles in different focal planes takes place. Positioning particles in the axial direction with computer-controlled distances allows dynamic three-dimensional all-optical lattices, useful in a variety of microscale and nanoscale applications.

Introduction and Objective: The penile metastasis is a rare clinical entity. The objective is to present the first documented case report of penile metastasis from right colon., Clinical Case: A case of a 78-year-old man who was diagnosed with penile metastasis from right colon. The patient came to our consultation complaining of colic pain in the kidney and swelling of the penile which finally result in a malignant priapism. The diagnosis was histopathologic and was treated with chemotherapy and died few months later., Conclusion: Metastatic lesions in the penile are extremely rare; only 300 cases have been reported in the literature. It is a sign of bad prognosis. The mechanism of metastatic spread to the penis is not well established. Even there are several treatment options, is usually paliative.

Introduction and Objectives: Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope., Material and Methods: Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated., Results: Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8 mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (p = 0.001) of more than 11 mm (p = 0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; p = 0.004] in multivariate analysis., Conclusions: Endourological treatment obtained a high success rate in our sample. Size greater than 11 mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS., (Copyright © 2021 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty., Material and Methods: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23., Results: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone., Discussion: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone., Conclusion: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients., (© 2020 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

Clinical guidelines promote the identification of several targetable biomarkers to drive treatment decisions in advanced non-small cell lung cancer (NSCLC), but half of all patients do not have a viable biopsy. Specimens from endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) are an alternative source of material for the initial diagnosis of NSCLC, however their usefulness for a complete molecular characterization remains controversial. EBUS-TBNA samples were prospectively tested for several biomarkers by next-generation sequencing (NGS), nCounter, and immunohistochemistry (PD-L1). The primary objectives were to assess the sensitivity of EBUS-TBNA samples for a comprehensive molecular characterization and to compare its performance to the reference standard of biopsy samples. Seventy-two EBUS-TBNA procedures were performed, and 42 NSCLC patients were diagnosed. Among all cytological samples, 92.9% were successfully genotyped by NGS, 95.2% by nCounter, and 100% by immunohistochemistry. There were 29 paired biopsy samples; 79.3% samples had enough tumor material for genomic genotyping, and 96.6% for PD-L1 immunohistochemistry. A good concordance was found between both sources of material: 88.9% for PD-L1, 100% for NGS and nCounter. EBUS-TBNA is a feasible alternative source of material for NSCLC genotyping and allows the identification of patient candidates for personalized therapies with high concordance when compared with biopsy.

This paper considers the most suitable market segment(s) from an environmental and local economic development perspective in the specific context of visits to natural environments. More specifically, the paper explores the distinctions and differences between tourists (non-residents) and residents with regard to visit behavior at natural attractions. By using the CHAID algorithm, a decision tree is constructed for means of transportation which serves as a key factor in the segmentation process. However, such a tree for visitors' resident or non-resident status cannot be built as a first explicative variable, unless it is statistically forced. Once it is forced, the tree opens in several sub-segments, for non-residents and residents alike. Finally, it allows understanding of the means of transportation used by visitors according to their geographical origin as well as a set of added independent variables: accommodation establishment, length of stay, season, and other demographic variables (educational level, gender, and age). Also, more importantly, we have obtained segments with no overlap configured according to all the aforementioned variables. This is a very strong result from a methodological point of view and for policy makers in destination settings., (© 2020 The Authors.)

Introduction: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%., Objective: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS., Material and Methods: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out., Results: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805., Conclusions: There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.

Aims: To study the response of clinical variables (HbA 1c , body weight, lipid profile and blood pressure) over 24 months of liraglutide treatment in a real-world clinical setting, and to describe the evolution of HbA 1c and body weight reduction in response to liraglutide treatment by employing generalized additive mixed models (GAMMs)., Methods: We included people aged ≥ 18 years with Type 2 diabetes mellitus that initiated liraglutide treatment between November 2011 and May 2015. Demographic and clinical data were retrieved retrospectively over 24 months from electronic medical records with a median duration of observation of 7.0 (IQR 3.0-12.0) months., Results: Individuals that initiated liraglutide therapy were obese (BMI 39.1 kg/m 2 ), with inadequate HbA 1c (68 mmol/mol [8.4%]), blood pressure and lipid levels. Upon liraglutide treatment, HbA 1c , body weight, mean systolic and diastolic blood pressure, and lipid levels decreased gradually. GAMMs demonstrated that longer treatment with liraglutide was a predictor of improved HbA 1c response, whereas higher baseline HbA 1c , longer Type 2 diabetes duration and treatment with insulin were predictors of worse HbA 1c response. Higher baseline weight, longer treatment with liraglutide and the interaction between metformin and time were predictors of improved weight response., Conclusions: In this real-world study, we showed the effectiveness of liraglutide in improving body weight, HbA 1c , mean systolic and diastolic blood pressure, and lipid levels. GAMMs indicated that baseline HbA 1c and weight, time of treatment with liraglutide, diabetes duration and the use of metformin or insulin are predictors of clinical response to liraglutide., (© 2018 Diabetes UK.)

This article presents the design of a field programmable gate array (FPGA)-based prototype of a system on chip (SoC) capable of behaving as one of the nerve centres comprising the neuroregulatory system in humans: the cortical-diencephalic nerve centre. The neuroregulatory system is a complex nerve system consisting of a heterogeneous group of nerve centres. These centres are distributed throughout the length of the spinal cord, are autonomous, communicate via interneurons, and govern and regulate the behaviour of multiple organs and systems in the human body. As a result of years of study of the functioning and composition of the neuroregulatory system of the lower urinary tract (LUT), the centres that regulate this system have been isolated. The objective of this study is to understand the individual functioning of each centre in order to create a general model of the neuroregulatory system that is capable of operating at the level of the actual nerve centre. This model represents an advancement of the current black box models that do not allow for isolated or independent treatment of system dysfunction. In this study, we re-visit our research into the viability of the hardware design of one of these centres-the cortical-diencephalic centre. We describe this hardware because functioning of the centre is completely configurable and programmable, which validates the design for other centres that comprise the neuroregulatory system. In this document, we succinctly present the formal model of the centre, propose a hardware design and an FPGA-based prototype, construct a testing and simulation environment to evaluate it and, lastly, analyse and contrast the results using data obtained from real patients, verifying that the functional behaviour fits that observed in humans., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Wilkie syndrome, also referred as superior mesenteric artery syndrome, is an unusual cause of a proximal small bowel obstruction. It is characterised by the compression of the duodenum in its third portion due to a narrowing of the space between the superior mesenteric artery and the aorta. Its presentation symptoms are consistent and include the obstruction of the proximal small bowel. However, the physical and laboratory findings are non-specific. Nevertheless, many imaging methods are useful for its diagnosis. The management of this condition varies between observation and surgery, depending on each particular case., Clinical Case: The case is presented of a 19 year-old male who began with acute, intense abdominal pain, nausea, vomiting, and diarrhoea. On examination, he had abdominal wall rigidity and hyperesthesia. Imaging studies were requested, revealing a decreased superior mesenteric artery angle, a shortening of the aortic mesenteric distance, and a decrease in the calibre of the third duodenal portion, all findings concomitant with Wilkie syndrome. Conservative treatment was applied and the patient was discharged without complications., Conclusions: Wilkie syndrome continues to be an unknown condition to the general practitioner, and the underdiagnosis of this condition may put a patient at risk of serious complications. A high index of suspicion is required to reach a diagnosis. Early treatment should give a good outcome most of the time., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.)

End-of-life treatment and attention to the needs of relatives are not adequate for several reasons: Society denies or hides the death; it is very difficult to predict it accurately; treatment is frequently fragmented between different specialists, and there is insufficient palliative medicine training, including communication skills. There are frequent conflicts with decisions made at the end of life, particularly the suitability of therapeutic effort. The attitude of professionals on the adequacy of therapeutic effort is not homogenous, and varies depending on the specialty, experience, and beliefs. Many doctors are still afraid of inconveniencing patients. Primary care is in a privileged position to approach the life and values of our patients and their families, and not just the disease, which makes it the right place to guide and advise the patient on the preparation and registration of living wills., (Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

We present the case of a 56-yr-old woman with vague abdominal pain of approximately 5 months duration. An ultrasound study showed moderate dilation of the common bile duct. Magnetic resonance cholangiopancreatography confirmed a cystic dilatation of the right hepatic duct with intra and extra hepatic component. The patient underwent right hepatectomy and complete excision of the cyst. Microscopically, the cyst wall was formed by fibrous tissue with mild acute and chronic inflammatory infiltrate, the inner surface showed a single layer of columnar epithelium and extensive squamous metaplasia without atypia, wich expressed p63 and high molecular weight cytoqueratin (34BE12).

The Takotsubo syndrome, also called transient apical dyskinesia syndrome, was first described in Japan in the 1990s. It is a rare entity found in almost 1% of all patients with suspicion of acute coronary syndrome. It usually affects postmenopausal women with a few cardiovascular risk factors. It is characterized by angina-type chest pain, electrocardiographic changes, elevation of the enzymes of myocardial injury, absence of coronary obstruction on angiography, and a characteristic left ventricular anteroapical dyskinesia, which returns to normal within a few days. Severe emotional stress is the most common trigger for this syndrome. The aetiopathogenesis of this syndrome remains to be defined. This syndrome has been considered a clinical condition since 2001, when a series of 88 cases was published. It is a disease with a partially known mechanism, characterised by the morphology adopted by the left ventricle secondary to hypokinesis or dyskinesia of the apical segments, and hypercontractility of basal segments. Unlike acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. In addition, the alterations described are reversible. Some clinical diagnostic criteria have been proposed, although they are still controversial, as well as in the complementary examinations required for diagnosis., (Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.)

The usefulness of the community pharmacy blood pressure (CPBP) method in the diagnosis or treatment of hypertension has not been adequately addressed in controlled studies. The authors' aim was to assess the agreement between awake ambulatory blood pressure (ABP), home blood pressure (HBP), and CPBP in treated hypertensive patients. This was a cross-sectional study carried out in 169 patients in which blood pressure (BP) was measured at the pharmacy (4 visits), at home (4 days), and by 24-hour ABP monitoring. Lin correlation-concordance coefficient (CCC) and Bland-Altman plots were used to evaluate quantitative agreement. The qualitative agreement to establish the degree of BP control was evaluated using κ coefficient. The agreement was acceptable between HBP and CPBP (CCC=0.80 for systolic BP [SBP] and 0.80 for diastolic BP [DBP]; κ=0.62) and moderate between awake ABP and CPBP (CCC=0.74/0.67, respectively; κ=0.56). The Bland-Altman plots also showed lowest mean differences (0.5/0.3 for SBP and DBP, respectively) for the comparison between CPBP and HBP. The CPBP has a better agreement with HBP than with awake ABP. Thus, the CPBP measurement method could be a good alternative to HBP monitoring, whereas it cannot be used as a screening test to assess the degree of BP control by awake ABP., (© 2012 Wiley Periodicals, Inc.)

Background: The presentation of heart tumors is very uncommon. Eighty percent of primary heart neoplasias are benign, and myxomas represent the first cause in frequency among adult populations. Due to the frequency of presentation of these tumors, it is common to make the clinical/surgical diagnosis without obtaining histopathologic confirmation. Our objective was to determine the frequency of presentation of heart tumors and its correlation between the surgical/clinical and histopathologic diagnosis in our Institute., Methods: This is a case series with 16 patients with cardiac tumors treated surgically at the Department of Cardiothoracic Surgery during a 4-year period. We used descriptive statistics, and quantitative variables are expressed as mean, range and standard deviation whereas qualitative variables were described as proportions., Results: We included 3 men (19%) and 13 women (81%) with a mean age of 41.4 +/- 16.2 years. Clinical presentation was predominantly of congestive heart failure. Clinical diagnosis was determined in 15 patients (94%) and just one case of intracardiac thrombus (6%), whereas the histopathologic diagnosis reported myxoma in only 11 cases (68.8%), three patients with intra-cardiac thrombus (18.7%) and two patients with sarcomas (12.5%), leiomiosarcoma and angiosarcoma, respectively. We found a positive correlation between the clinical diagnosis and the histopathology results. There was no mortality., Conclusions: Even though myxomas represent the most frequent proportion of presentation in heart tumors, histopathological confirmation is necessary for diagnosis. Clinical and histopathologic correlation represents the basis for the choice of adequate management strategies and prognosis for the patient.

An epidemiological study of urinary stone disease has been carried out in the districts of La Sierra and Hellín (Albacete, Spain). Between January 1992 and December 1999 a total of 887 patients with urinary lithiasis have been studied, analysing the number of patients discharged from hospital with the primary diagnosis of lithiasis, the distribution of lithiasis by area, age, gender, family history of lithiasis, diet, occupation and concurrent pathology. The geographical, geological, and climatic conditions, the composition of the water supply and the clinical characteristics are described. The incidence of urinary lithiasis in the whole area in 2.66 per thousand inhabitants/year, showing a male predominance with a male:female ratio of 1.26:1. The mean age was 51.34 years (bimodal distribution with peaks in the 4th and 7th decades). 20.41% of the patients had a family history, with the father being the most frequently affected relation. Those occupations associated with a sedentary life style or with a hot, dry workplace show a higher incidence of lithiasis. A hot, dry climate favours the formation of urinary lithiasis and the highest incidence of lithiasis is in the summer, during the months of July and August. No statistically significant influence was shown between at the hardness of the water and the incidence of urinary lithiasis in the study population.

Hemoglobin I (HbI) from Lucina pectinata reacts with hydrogen sulfide to form the ferric sulfide complex needed to transport H2S to the bacterial endosymbiont. To further study HbI, expression studies of this protein were performed in Escherichia coli. This is the first time that the recombinant HbI was produced using a recombinant DNA expression system. Hemoglobin I cDNA was amplified and cloned into the TOPO-PBAD expression vector, which contains a fusion tag of six histidine residues (6XHis tag). Plasmid clone sequence analysis was carried out in order to ensure that the insert was in the correct reading frame for proper protein expression in E. coli. The expression of recombinant HbI was optimal when induced for 5 hr with 0.002% of L-arabinose as detected by Western blot analysis. The proto-porphyrin group was inserted into the recombinant HbI. Purification of the heme-bound recombinant protein was performed under native conditions by affinity chromatography using Ni-NTA and Probond resins. The sodium dithionite-reduced recombinant protein presented a shift from the Soret band at 413-435 nm, indicating the presence of the heme group in the adequate amino acid environment of HbI. These results indicate that recombinant HbI from Lucina pectinata can be successfully expressed in a prokaryotic system retaining its activity toward reduction, oxidation, and ligand binding.

The tropical clam Lucina pectinata contains a unique hemoglobin (HbI) which serves to transport H2S to autotrophic bacteria. The cDNA-derived amino acid sequence was obtained from overlapping clones containing the cDNA that codes for HbI. The reverse transcriptase-polymerase chain reaction (RT-PCR) and rapid amplification of cDNA ends (RACE) methods were employed to synthesize the cDNA fragments. An initial 354-bp cDNA clone encoding 118 amino acid residues of HbI was amplified from total RNA by RT-PCR using degenerate oligonucleotides. Gene-specific primers derived from the HbI-partial cDNA sequence were used for obtaining the 5' and 3' ends of the cDNA by RACE. The length of the HbI cDNA, estimated from sequence analysis of overlapping clones, was 1322 bp for the full-length cDNA. The coding region of the full-length cDNA codes for 143 amino acid residues. The most conserved amino acid residues in HbI from Lucina pectinata were identified by a multiple alignment with nonvertebrate globin sequences.

Objectives: The present work will give a general view of the epididymis adenomatoid tumour, an unusual pathology reviewing its differential diagnosis and therapeutical choices., Methods/results: We present the case of a 32-year-old patient with an adenomatoid tumour located in the tail of the left epididymis. The diagnosis was achieved by echography, and was confirmed by surgical excision and histological analysis., Conclusions: Due to its low incidence in intrascrotal pathology, we believe it is important to know about this illness in order to make a differential diagnosis from other inflammatory processes and to adopt a surgical approach more frequently, due to its high diagnostic-therapeutical rentability and low morbidity.

In last years, advances in endocrinological and neuroradiological research have lead to an earlier recognition and more effective management of pituitary tumours. At the same time, pharmacological investigation has allowed the development of useful drugs in the treatment of pituitary adenomas, either as an exclusive therapy or as an aid to surgery and radiotherapy. In this article we review indications and dosage of recently developed drugs for different types of hormone-secreting pituitary adenomas.

Presentation of one case of cystic lymphangioma of the suprarenal gland in a 34-year-old female patient with a background of lower urinary tract infections, presenting with continuous and aggravating pain in left lumbar area and with no other associated symptomatology, diagnosed with ultrasound, IVU and CAT. A review of the literature is made. The present study pretends to give an overall view of a rare and benign disease, commenting upon the difficulties found in its diagnosis and the different therapeutical options.

Objective: The present study reviews bladder leiomyoma, an uncommon pathology. The problems of differential diagnosis and the therapeutic options are discussed and the literature reviewed., Methods/results: A 33-year-old female with anterolateral intramural leiomyoma of the bladder is described. Patient evaluation included US, cystography, CT, cystoscopy and ultrasound-guided suprapubic puncture., Conclusions: Leiomyoma is an uncommon benign tumor of the bladder. To our knowledge, only 235 cases have been reported in the literature. We advocate the use of ultrasound-guided suprapubic puncture, a simple procedure that is frequently diagnostic, in the evaluation of this tumor type.

We report on 23 patients with acquired vesicoenteric fistula treated during the past 12 years: 48% of these were of inflammatory etiology (11 cases), 35% were caused by neoplasms (8 cases) and 17% were iatrogenic (4 cases). The most frequent symptoms were pneumaturia and fecaluria (78% of cases). Cystoscopy was the most useful diagnostic procedure in detecting fistula (13 of 18 cases). Other imaging techniques, though less effective for diagnosis, were useful in assessing the status of the GI tract and, at times, in determining the etiology of the fistulae. Treatment depends on the etiology, localization and patient general condition. The technique most frequently applied in our series was resection of the fistulous tract, together with the compromised intestinal segment, and bladder suture.

The reconstruction of extensive defects of the trachea ist best accomplished by the use of the patient's own tissue. Unfortunately, this is not always feasible and several prosthetic devices for replacement of the trachea have been described. In an experimental study staged tracheal replacements were performed in five dogs using a ringed polyethylene terephthalate (PET) tubular prosthesis previously cultured in the major omentum of the subjects. A set of stainless-steel arches embodied in silicone compound was designed to prevent collapse of the prosthesis. One of the subjects died on the 10th post-operative day of an unidentified cause and the remaining four eventually developed signs of respiratory distress. The cause of the respiratory insufficiency was anastomotic stenosis in every case. Infection, erosion, collapse or displacement were not observed. The rings designed to avoid collapse of the prosthesis represent a suitable alternative for use as external reinforcement in the tracheal situation. The PET grafts implanted as tracheal prosthesis according to the guidelines of this protocol consistently developed anastomotic stenosis and failed to support a functional respiratory epithelium. A further conclusion is that the use of absorbable sutures encourages anastomotic dehiscence and thus must be avoided.

We have carried out a research into the clinicopathological characteristics of the cancer of larynx between 1972 and 1984 in the area of Cartagena, with a populations that oscillated between 210,944 and 250,233 inhabitants, and over a number of 207 cases. We observe that the symptom to which the patients attach most importance and the reason why they most often consult is dysphonia or voice-alteration, and that its clinical development average time until diagnosis is of 6.08 months. It is to be pointed out the proportion of supraglottic carcinomas which at the moment of diagnosis usually show a T3 or a T4 stage and palpable adenopathies in a third of the patients. On the contrary, glottic carcinomas are usually T1 lesions and without satellite adenopathies. With regard to the histologic type, the great majority of cases belong to epidermoid carcinomas, followed at a great distance by warty carcinomas and finally by pseudosarcomas.