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This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

RESUMEN El objetivo de este manuscrito es realizar una revisión y actualización de la literatura de la insuficiencia ovárica primaria (IOP) en población adolescente, a partir del diagnóstico, manejo y seguimiento de un caso clínico. La insuficiencia ovárica primaria se define como la menopausia en una mujer antes de los 40 años, acompañada de amenorrea, hipogonadismo hipergonadotrópico e infertilidad. Su prevalencia varía entre 1 a 2%, y en mujeres menores de 20 años su prevalencia es un caso de cada 10,000. Aunque se sabe que muchas afecciones pueden llevar a una IOP, la más común es la causa idiopática. La presentación clínica es diversa, y varios trastornos diferentes pueden también, llevar a esta condición. Caso clínico: Se presenta el caso de una adolescente de 17 años, previamente sana, con historia de amenorrea secundaria, no embarazada, con examen físico general y ginecológico normal. Se solicita estudio analítico complementario resultando con niveles de hormona folículo estimulante (FHS), estradiol (E2) y hormona antimülleriana (AMH) compatibles con una insuficiencia ovárica como la observada en la posmenopausia. Se inicia terapia hormonal (TH) clásica con estradiol y progesterona, siendo posteriormente reemplazada por anticoncepción hormonal combinada (AHC) oral, coincidente con el inicio de vida sexual, con respuesta favorable y sangrados regulares. La IOP tiene graves consecuencias para la salud incluyendo trastornos psicológicos como angustia, síntomas depresivos o depresión, infertilidad, osteoporosis, trastornos autoinmunes, cardiopatía isquémica, y un mayor riesgo de mortalidad. La enfermedad de Hashimoto es el trastorno autoinmune más frecuente asociado a la IOP. Su tratamiento y diagnóstico deben establecerse de forma precoz para evitar consecuencias a largo plazo. La terapia con estrógenos es la base del tratamiento para eliminar los síntomas de la deficiencia de estrógenos, además de evitar las consecuencias futuras del hipogonadismo no tratado. También el manejo debe incluir los siguientes dominios: fertilidad y anticoncepción, salud ósea, problemas cardiovasculares, función psicosexual, psicológica y neurológica, informando a los familiares y a la paciente sobre la dimensión real de la IOP y la necesidad de tratamiento multidisciplinario en muchos casos. Conclusión: El caso presentado, pese a ser infrecuente, permite abordar de manera sistematizada el diagnostico de IOP y evaluar alternativas de manejo plausibles para evitar graves consecuencias en la salud, así como conocer respuesta clínica y de satisfacción de la adolescente.

Combined vaginal rings (ethinylestradiol (EE)/desogestrel), indicated for contraception, are highly effective, comparable to other combined hormonal contraceptives, such as pills. In addition to this benefit, vaginal rings are easy to use, with a probable lower risk of forgetting, due to their non-daily, monthly schedule. Besides, for users with poor gastric tolerance to oral formulations, they represent a method with safety and comparable extraconceptive benefits. The latest generation rings have a novel polymeric structure, do not need special storage methods and do not generate accelerated initial release of EE, reducing the early increased systemic exposure to the synthetic steroids they contain. This review describes main aspects related to its use, efficacy, and safety for contraceptive purposes.

Sin resumen.

Today health professionals are not only required to know medicine, but scientific reading, interpretation, and communication of new data. The new information about contraception and hormonal therapies must be analyzed by gynecologists to determine whether or not the new data are applicable to their patients and if it has an impact on their health. Recently a new study of hormonal contraceptives and the risk of breast cancer was published. In this study, the investigators found an elevation of the relative risk of breast cancers on the users versus the nonusers of hormonal contraception. After analyzing the publication and other data available, it is our opinion that it is a very low increase of the risk and its impact should be evaluated case by case, not forgetting to take into account the numerous beneficial effects that hormonal contraception have.

Objective: This study aims to determine time differences (differences in restricted mean survival times [RMSTs]) in the onset of invasive breast cancer, coronary heart disease, stroke, pulmonary embolism, colorectal cancer, and hip fracture between the placebo group and the conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg group of the Women_s Health Initiative (WHI) trial based on survival curves of the original report and to provide adequate interpretation of the clinical effects of a given intervention. Methods: Distribution of survival function was obtained from cumulative hazard plots of the WHI report; Monte Carlo simulation was performed to obtain censored observations for each outcome, in which assumptions of the Cox model were evaluated once corresponding hazard ratios had been estimated. Using estimation methods such as numerical integration, pseudovalues, and flexible parametric modeling, we determined differences in RMSTs for each outcome. Results: Obtained cumulative hazard plots, hazard ratios, and outcome rates from the simulated model did not show differences in relation to the original WHI report. The differences in RMST between placebo and conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg (in flexible parametric modeling) were 1.17 days (95% CI, j2.25 to 4.59) for invasive breast cancer, 7.50 days (95% CI, 2.90 to 12.11) for coronary heart disease, 2.75 days (95% CI, j0.84 to 6.34) for stroke, 4.23 days (95% CI, 1.82 to 6.64) for pulmonary embolism, j2.73 days (95% CI, j5.32 to j0.13) for colorectal cancer, and j2.77 days (95% CI, j5.44 to j0.1) for hip fracture. Conclusions: The differences in RMST for the outcomes of the WHI study are too small to establish clinical risks related to hormone therapy use.

Objective In this article, we describe the planning phase and clinical procedure where a CAD CAM 3D printed master model was utilized to create a prefabricated-titanium reinforced-fixed provisional prosthesis for a full-arch immediate loading after computer-guided implant placement. Clinical considerations The clinical procedure should be performed based on digital planning through an advanced surgical planning software and following the guidelines of full-arch immediate loading protocol. The fact that the master model is fabricated under a computer-assisted design and computer-assisted manufacturing approach before implant placement makes the whole process considerably easier, faster, more precise and cheaper. Conclusions The use of a prefabricated-metal framework-provisional prosthesis for full-arch immediate loading created from a 3D printed master model seems to be a predictable treatment option when computer-guided implant surgery is performed. Clinical significance The presented article described an interesting and innovative technique to optimize implant treatment based on digital technologies and 3D printing. The presented technique will help to diminish treatment costs and times especially for immediate loading procedures in fully edentulous patients because it allows to fabricate a prosthetic structure prior implant placement based on a 3D printing process.

Chlormadinone acetate (CMA) is a progesterone derivative (17α-acetoxy-6-chloro-4,6-pregnadiene-3,20-dione), first synthesized in 1961. It was used as progestin-based hormone replacement therapy; since 1999 it was first used for oral contraception combined with ethinyl estradiol (EE). CMA exerts a potent progestagenic effect, about one third higher than that observed with endogenous progesterone. CMA is also an anti-estrogen, showing no androgenic effects (at birth control dose). Unlike progesterone, it has a mild glucosteroidal effect with no anti-mineralocorticoid effect at all. These biological actions have allowed CMA to have a role for therapeutic use in dysmenorrhea, hyperandrogenism, and as a contraceptive agent. In addition, CMA has exhibited beneficial neuroendocrine effects on women's mood. CMA-EE combination has shown excellent contraceptive efficacy, high tolerability, and compliance due to its risk-benefit profile, having additional benefits on skin and hair, such as reduction of seborrhea and acne. Metabolic tolerance of CMA has been demonstrated in several clinical studies. Currently, CMA is formulated to be taken as oral caplets in a 21 caplets package containing 0.03 mg/EE and 2 mg CMA per pill with/without seven placebo additional pills. Another presentation has 24 caplets containing 0.02 mg/EE and 2 mg CMA plus four placebo pills.

The relative yielding efficiency of sweet corn cultivars (Jubilee, Dulce UACH and Dulce Team) associated to common bean cultivars (Vista Florida, Fleetwood and Orfeo Negro) as compared to monoculturas was evaluated at Santa Rosa Experimental Station, belonging to Universidad Austral de Chile, in Valdivia, under dryland conditions. Efficiency indexes (land equivalent ratio (LER), area time equivalent ratio (ATER) and LER + ATER average) and competition indexes (relative crowding coefficient (CCR) and aggressivity) were calculated. LER and LER + ATER average, indicated that associations presenting advantages in relation to monoculture were Dulce Team with Orfeo Negro, Jubilee with Fleetwood and Jubilee with Vista Florida. The superiority for these three associations was also determined by the most rigorous ATER index, in agreement with the CCR competition index. Corn was pointed out as dominant species in all associations by the aggressiveness index.

Se cruzaron seis genotipos de cebada de ciclo de desarrollo primaveral en un arreglo dialelo, con el fin de estudiar sus capacidades combinatorias para rendimiento de grano y doce caracteres de calidad maltera. El comportamiento de los híbridos F1 fue analizado utilizando el Modelo I, método 2 de Griffing. El análisis de capacidad combinatoria general (CCG), de capacidad combinatoria específica (CCE) y la relación CCG/CCE, demostraron que ocho de los trece caracteres estudiados mostraron expresión asociada a efectos génicos de tipo aditivo, que fueron: peso de grano, extracto de malta, viscosidad, friabilidad, proteína de la malta, proteína soluble, índice de Kolbach y amino nitrógeno libre (FAN: free amino nitrogen). Por otra parte en la expresión de los caracteres calibre de grano, diferencia del extracto, e índice de Hartong fueron importantes tanto los efectos aditivos como los no aditivos, siendo los primeros de mayor magnitud. Solo el rendimiento de grano y el poder diastásico mostraron predominio de acción génica de tipo no aditivo (dominancia y sobredominancia), aunque los efectos aditivos también estuvieron presentes. Six spring barley (Hordeum vulgare L.) genotypes were crossed in a diallel system to study combining ability for grain yield and twelve malting quality traits. The F1 hybrids behavior was analyzed using Griffing’s Model I, method 2. The analysis for general combining ability (CCG), specific combining ability (CCE) and the relationship CCG/CCE showed that expression of eight out of the thirteen traits were associated with genes which were additive in their effects: grain weight, malt extract, viscosity, friability, malt protein, soluble protein, Kolbach index and free amino nitrogen (FAN). On the other hand, the expression of grain plumpness, extract difference and the Hartong index showed both additive and non-additive genetic control, the former being of greater magnitude. Only grain yield and diastatic power had mainly non-additive control, even though additive effects were also present.

Genetic variability in phosphorus efficiency was examined in spring wheat genotypes under field conditions at deficient and non -limiting levels of P fertilization in a P-deficient soil. Phosphorus efficiency was measured by three parameters: phosphorus efficiency ratio (PE), root efficiency ratio (RE) and phosphorus uptake efficiency (PUE). Grain yield was correlated with P content at maturity; genotypes with high grain yield had high P content of tops. At the low P application rate, large variation existed between genotypes in relation to phosphorus effciency ratio (PE), which was not correlated with grain yield. The genotypes were more root efficient (RE) at tillering initiation. In relation to the ability of wheat plants to obtain P from the soil (PUE), the genotypes differed in their P uptake strategy and were more efficient between tillering and anthesis; phosphorus application rate had no effect on PUE. The data presented in this paper suggests that the ability of plants to remove soil P would depend upon the PUE of plants, that is to say, from their ability to locate and acquire soil P, as well as the temporal uptake of soil P by the genotype. Selection for phosphorus uptake efficiency (PUE) may be of some benefit., Se evaluó la variabilidad genética de la eficiencia de absorción y utilización de fósforo en genotipos de trigo primaverales en condiciones de campo con dos niveles de fertilización fosforada, uno deficiente y otro no limitado. La eficiencia de fósforo se estimó por los parámetros relación de eficiencia de fósforo (PE), relación de eficiencia radical (RE) y eficiencia de absorción de fósforo (PUE). Los genotipos de mayor rendimiento fueron aquellos que presentaron el mayor contenido de P en sus tejidos a la madurez de cosecha. Existieron marcadas diferencias genotípicas en cuanto a la utilización del P por las plantas (PE) en niveles de baja fertilización fosforada; además esta relación de eficiencia no se correlacionó con el rendimiento de grano. Por otra parte, los genotipos fueron más eficientes al inicio de macolla que a la antesis y a la madurez de cosecha estimada a través de la relación de eficiencia radical (RE). En cuanto a la capacidad de las plantas de obtener el P del suelo (PUE), los genotipos difirieron en su estrategia y presentaron una mayor eficiencia ente macolla y antesis; la fertilización fosforada no afectó este parámetro. Los resultados sugieren que la habilidad de las plantas para remover el fósforo del suelo dependería del PUE de ellas, es decir, de su habilidad para localizar y obtener el P del suelo como también por la absorción temporal del P del suelo por el genotipo. Selección para eficiencia de absorción de fósforo (PUE) podría tener algún beneficio.

Harvest index values were studied in eight cultivars and two lines of spring wheat, and the determination of plant components most strongly iníluencing it. The mean harvest index value of 43.2% was found with a range from 39.7 to 49.3%. Differences at the 1% level of probability were observed. Stems contributed with the greatest amount of dry weight to the straw yield, 28%. The leaves contributed nearly as much as the chaff, 14 and 15% respetcively. Reduction in plant height lowered the stem dry weight which resulted in an increased harvest index. Harvest index was negatively correlated with plant height and stem dry weight. There was not significative correlation between harvest index and grain yield., Se evaluaron para índice de cosecha ocho cultivares y dos líneas experimentales de trigo de primavera y los componentes de la planta que en él influyen. Los resultados mostraron un índice de cosecha promedio de 43,2%, con un rango desde 39,7 a 49,3%, observándose diferencias significativas al 1% de probabilidad. Los tallos contribuyeron en mayor cantidad de peso seco al rendimiento de paja, 28%; las hojas contribuyeron tanto como el capotillo, 14 y 15% respectivamente. Reducción en la altura de la planta disminuyó el peso seco de los tallos incrementando el índice de cosecha. El índice de cosecha fue correlacionado negativamente con la altura de la planta y el peso seco de los tallos. No hubo correlación significativa entre índice de cosecha y rendimiento.

The essential feature of the MIrizzi syndrome is partial common hepatic duct obstruction due to an impacted cystic duct stone. This entity has rarely been reported but is apparently more common than previously thought. Our review of the world literature shows 42 proven cases in 18 publications from 7 different countries. We are adding 11 further cases with surgical proof. The preoperative x-ray diagnosis of the Mirizzi syndrome was established in 10 of the 42 previously reported cases. This diagnostic problem was probably due to limitations of plain film and intravenous cholangiography techniques. The preoperative diagnosis was possible in 8 of our 11 cases, primarily with the use of transhepatic cholangiography. The preoperative diagnosis is important and can lead to a decrease in surgical complications, particularly if stone penetration, fistula formation, and adjacent inflammatory masses are demonstrated.

The main objetive of this study was demostrated the interrelationships between yield and its component on spring wheat by mean the path-coefficient analysis. The following characters were measured: grain yield per plant, number of grains per spike, 1000-grain weights, heading date and plant height.The results indicated that only number of spikes and heading date were shown to be positively correlated, r = 0.861** and r = 0.684**, respectively, with grain , yield.Through the path-coefficient analysis it was demostrated that the direct effects on yield were positive and hight in the following characters, considered as the primary yield components: number of spikes (P = 1.0344), grains per spike (P = 0.7104) and grain weight (P = 0.7110). In the case of heading date and plant height, considered as secondary components, the effects on yield were low (P = - 0,1013 and P = 0.1513, respectively).The effects of yield components on yield were disturbed by the use of simple correlation coefficients as a. mean to analise the degree of association between characters., Se investigó las interrelaciones y su efecto sobre el rendimiento de los factores considerados como componentes del rendimiento en trigo de primavera. Los caracteres evaluados fueron rendimiento de grano por planta, número de espigas por planta, número de granos por espiga, peso de 1000 granos, precocidad (días de siembra a espigadura) y altura de planta adulta.Los resultados mostraron que el rendimiento sólo estuvo correlacionado en forma positiva y significativa al nivel de 0,01, con número de espigas (r = 0,861) y precocidad (r = 0,684).A través del análisis de causa y efecto se demostró que los efectos directos sobre el rendimiento fueron positivos y altos de los siguientes caracteres, considerados como componentes principales: número de espigas (P = 1,0344), granos por espiga (P = 0,7104) y peso de los granos (P = 0,7110). En el caso de la precosidad y altura de planta, considerados como componentes secundarios, fueron bajos, P = - 0,1013 y P = 0,1513, respectivamente.El uso de las correlaciones simples, como un medio de analizar el grado de asociación entre los caracteres, alteró los efectos de los componentes sobre el rendimiento.

The influence of four dates of planting spring wheat (september 5th, 21st, october 7th and 23rd) was measured with varieties Pumafen, Panguifen, Intermedio and Flecha, in Valdivia, Chile. The different varieties were, similar although, as an average, the total yield was affected by the date of planting from 3,14 to 2,34 grams per plant. Pumafen, Panguifen and Flecha which averaged over 12 percent protein, were significantly superior to Intermedio with 10,8 percent. This percentage of protein appeared since september 5 until oct. 23 to increase from 11,2 to 12,6 percent. An opposite relationship between yield and protein, non significant, was observed. Only 55 percent of variation of the protein values could be assigned to variation in yield. The significant values, indicating lowering yields in later states of planting, did not make wise to delay the sowing date as a mean of improving the protein content without economical losses., Se investigó la influencia de cuatro épocas de siembra, 5 sept, 21 sept, 7 oct. y 23 oct., sobre el rendimiento y contenido de proteína, de las variedades de trigo de primavera Pumafen, Panguifen, Intermedio y Flecha, bajo las condiciones ambientales de Valdivia. Las variedades mostraron, en promedio un rendimiento similar siendo éste afectado por la fecha de siembra, variando de 3,14 a 2,34 g/planta. Pumafen, Panguifen y Flecha con más de 12% de proteína media, fueron significativamente superiores a Intermedio con sólo 10,8%. Este porcentaje de proteína mostró una tendencia al aumento al variar la época de siembra desde el 5 de septiembre al 23 de octubre, de 11,2 a 12,6%. Una relación inversa entre proteína y rendimiento, aún cuando no significativa fue observada, pudiendo ser explicada solamente el 55% de la variación del porcentaje de proteína por variaciones en el rendimiento. La disminución significativa del rendimiento en fechas posteriores al 21 de septiembre, nos impiden recomendar un atraso en la época de siembra, como un medio de aumentar el porcentaje de proteína, sin afectar el resultado económico del cultivo.

In four patients, intra-abdominal abscesses were identified by ultrasonic technique: a right lower quadrant abscess in Crohn disease, a pyogenic liver abscess, a pelvic abscess following rejection and removal of a transplanted kidney, and a perinephric abscess. In all four the establishment by ultrasound that the mass was filled with fluid was critical in guiding drainage. Diagnostic ultrasound is a safe and effective means for the detection, localization, and characterization of retroperitoneal, intraperitoneal, or intraparenchymal inflammatory masses.

Three genus ofMaydeae (Tripsaceae)are found in America:Zea, EuchlaenaandTripsacum. These groups have been extensively studied in regards to the problem of maize origin.Tripsacumdoes not cross in nature with corn and the artificial hybrids obtained show low fertility. Nevertheless there are evidences which indicate that hight yielding hybrids can be obtained by means of introgressive hybri-dization with Tripsacum.Corn teosinte hybrids are completely fertile. Teosinte could be used as a source of germplasm for the improvement of corn inbreds. The success of this improvement would depend upon (a) the corn inbred to be used for breeding, (b) the variety of teosinte selected as a source of new germplasm, and (c) the proportion of teosinte genotype to be introduced in the corn inbred., La tribuMaydeae (Tripsaceae), está representada en América por tres géneros:Zea, EuchlaenayTripsacum. Estos tres géneros han sido estudiados por mucho tiempo en relación al problema del origen del maíz.Tripsacumno se cruza naturalmente con el maíz y los híbridos artificiales obtenidos presentan un grado muy bajo de fertilidad. No obstante existen antecedentes que indican la posibilidad de sintetizar híbridos superiores de maíz por medio de la introgesión de germoplasma deTrpsacum.Los híbridos de maíz-teosinte son completamente fértiles. El teosinte puede servir como fuente de germoplasma para el mejoramiento de líneas puras de maíz. El éxito de este mejoramiento va a depender (a) de la línea pura de maíz a ser mejorada, (b) la elección de la variedad de teosinte a ser usada como nueva fuente de germoplasma, y (c) la proporción de germoplasma a ser incorporado a la línea pura de maíz.