Desórdenes venosos pélvicos en la mujer debidos a varices pélvicas. Tratamiento mediante embolización. Breve revisión

El síndrome de congestión pélvica (SCP), actualmente englobado en los “desordenes venosos pélvicos en la mujer (DVPm) debidos a varices pélvicas”1 es una condición patológica que sufre un importante porcentaje de mujeres, y generalmente, se caracteriza por dolor abdominal que dura al menos 6 meses. Existen diferentes tipos de tratamientos, pero el más extendido es la embolización de las venas varicosas pélvicas. Presentamos una pequeña revisión del tema y aportamos nuestra experiencia de casi 20 años con más de 500 pacientes. La embolización de las varices pélvicas parece ser un tratamiento seguro y relativamente efectivo en la gran mayoría de las mujeres

The first cyclotron harmonic of 4U 1538–52

Context. Cyclotron resonant scattering features are an essential tool for studying the magnetic field of neutron stars. The fundamental line provides a measure of the field strength, while the harmonic lines provide information about the structure and configuration of the magnetic field. Until now only a handful of sources are known to display more than one cyclotron line and only two of them have shown a series of harmonics. Aims. The aim of this work is to see the first harmonic cyclotron line, confirming the fundamental line at ~22 keV, thus increasing the number of sources with detected harmonic cyclotron lines. Methods. To investigate the presence of absorption or emission lines in the spectra, we have combined RXTE and INTEGRAL spectra. We modeled the 3–100 keV continuum emission with a power law with an exponential cut off and look for the second absorption feature. Results. We show evidence of an unknown cyclotron line at ~47 keV (the first harmonic) in the phase-averaged X-ray spectra of 4U 1538–52. This line is detected by several telescopes at different epochs, even though the S/N of each individual spectrum is low. Conclusions. We conclude that the line-like absorption is a real feature, and the most straightforward interpretation is that it is the first harmonic, thus making 4U 1538–52 the fifth X-ray pulsar with more than one cyclotron line.Part of this work was supported by the Spanish Ministry of Education and Science Primera ciencia con el GTC: La astronomía española en vanguardia de la astronomía europea CSD200670 and Multiplicidad y evolución de estrellas masivas project number AYA200806166C0303. J.M.T. acknowledges the support by the Spanish Ministerio de Educación y Ciencia (MEC) under grant PR2007-0176. J.J.R.R. acknowledges the support by the Spanish Ministerio de Educación y Ciencia (MEC) under grant PR2009-0455

Genesis and evolution of the San Manuel iron skarn deposit (Betic Cordillera, SW Spain)

The San Manuel magnesian skarn is an iron deposit hosted in dolomitic marbles from a tectonic slice imbricated within the Ronda peridotites, in the westernmost part of the Betic Cordillera, Spain. According to the dominant mineral assemblage, the skarn is subdivided into three different zones, (1) forsterite +/- calcite skarn, (2) calcite +/- chlorite +/- serpentine skarn, and (3) Ca-amphibole skarn. The main ore in the skarn is a similar to 2.5 m thick, massive ore body situated in the middle of the sequence. In this paper, we firstly report a comprehensive major to trace element composition, texture, microstructure, and mineralogy characterization for zoned magnesioferritemagnetite grains of the San Manuel deposit using a combination of (1) laser ablation inductively coupled plasma mass spectrometer, (2) focused ion beam combined with transmission electron microscopy, and (3) electron back-scattered diffraction. We have defined four different magnesioferrite-magnetite generations. A complete sequence of zoning includes cores of magnesioferrite (Mag-1; MgO up to 10.6 wt%) overprinted by three successive generations of magnetite, namely Mag-2, Mag-3, Mag-4. Mag-2 (MgO < 4 wt%), hosts composite forsterite +/- calcite +/- chlorite inclusions, consistently with high Si, Ca, and Sr (average: 8204 ppm, 8980 ppm, and 49 ppm respectively) contents detected by in situ laser ablation inductively coupled plasma (LA-ICP-MS). Mag-3 replacing former Mag-1 and Mag-2 includes nanometric spinel and gahnite exsolutions detected by focused ion beam combined with a transmission electron microscope (FIB-TEM), which is consistent with its high Al, Ti, V, and Ga (average: 5073 ppm, 368 ppm, and 20 ppm, respectively) trace element concentration. Mag-4 is the Fe-richest magnetite (up to 94.16 wt% FeOtotal) forming the outermost rims in magnetite grains, and exhibiting the lowest total trace element contents. Approaches in temperature estimations employing magnetitespinel exsolutions in Mag-3 suggest that the minimum temperature of the prograde stage reached temperatures below 700 degrees C, whereas Mag-4 should be formed during the retrograde stage. Magnetite microstructure studied by electron backscatter diffraction (EBSD) suggests Mag-4 formation under fluid-assisted dynamic conditions, which is consistent with the tectonic evolution of the emplacement. We propose that the San Manuel deposit formed by pulsed hydrothermal fluids derived from anatexis of crustal rocks during peridotite emplacement, promoting reequilibration processes that led to the magnesioferrite-magnetite zoning

De novo erythroleukemia chromosome features include multiple rearrangements, with special involvement of chromosomes 11 and 19

Erythroid leukemia (ERL or AML-M6) is an uncommon subtype of acute myeloid leukemia, the clinical, morphological, and genetic behavior of which needs further characterization. We analyzed a homogeneous group of 23 de novo AML-M6 patients whose bone marrow cells showed complex karyotypes. We also analyzed eight leukemia cell lines with erythroid phenotype, performing detailed molecular cytogenetic analyses, including spectral karyotyping (SKY) in all samples. The main features are: (1) A majority of patients (56%) had hypodiploidy. Loss of genetic material was the most common genetic change, especially monosomies of chromosome 7 or 18, and deletions of chromosome arm 5q. Taken together, 87% of the cases displayed aberrations involving chromosome 5 or 8. (2) We describe a novel, cryptic, and recurrent translocation, t(11;19)(p11.2;q13.1). Another translocation, t(12;21)(p11.2;q11.2), was found to be recurrent in a patient with ERL and in the K562 cell line. (3) MLL gene rearrangements were detected in 20% of cases (three translocations and three amplifications) and, overall, we defined 52 rearrangements (excluding deletions) with a mean of 2.3 translocations per patient. (4) Of the structural aberrations, 21% involved chromosomes 11 and 19. Most of the rearrangements were unbalanced; only 13 reciprocal translocations were observed. The general picture of chromosomal aberrations in cell lines did not reflect what occurred in patient samples. However, both primary samples and cell lines shared three common breakpoints at 19q13.1, 20q11.2, and 21q11.2. This is the first molecular cytogenetic description of the karyotype abnormalities present in patients with ERL. It should assist in the identification of genes involved in erythroleukemogenesis

Machine learning methods applied to combined Raman and LIBS spectra: Implications for mineral discrimination in planetary missions

Producción CientíficaThe combined analysis of geological targets by complementary spectroscopic techniques could enhance the characterization of the mineral phases found on Mars. This is indeed the case with the SuperCam instrument onboard the Perseverance rover. In this framework, the present study seeks to evaluate and compare multiple machine learning techniques for the characterization of carbonate minerals based on Raman-LIBS (Laser-Induced Breakdown Spectroscopy) spectroscopic data. To do so, a Ca-Mg prediction curve was created by mixing hydromagnesite and calcite at different concentration ratios. After their characterization by Raman and LIBS spectroscopy, different multivariable machine learning (Gaussian process regression, support vector machines, ensembles of trees, and artificial neural networks) were used to predict the concentration ratio of each sample from their respective datasets. The results obtained by separately analyzing Raman and LIBS data were then compared to those obtained by combining them. By comparing their performance, this work demonstrates that mineral discrimination based on Gaussian and ensemble methods optimized the combine of Raman-LIBS dataset outperformed those ensured by Raman and LIBS data alone. This demonstrated that the fusion of data combination and machine learning is a promising approach to optimize the analysis of spectroscopic data returned from Mars.Agencia Estatal de Investigación, grant (PID2022-142490OB-C32)Ministerio de Economía y Competitividad (MINECO),Grant/Award Number (RDE2018-102600-T

Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments

Study objective: The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane in the emergency setting in Europe. Methods: This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score >= 4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2x3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief. Results: Three hundred five patients were randomized (methoxyflurane 156; standard analgesic treatment 149). Most patients in the standard analgesic treatment group (70%) received intravenous first-step analgesics and 9.4% of patients were treated with opioids. Mean decrease from baseline in Numeric Rating Scale pain intensity score was greater for methoxyflurane than standard analgesic treatment at all points, with a significant treatment difference overall up to 20 minutes (repeated-measures model 2.47 versus 1.39; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first pain relief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for pain control and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment. Conclusion: These results support consideration of methoxyflurane as a nonnarcotic, easy-to-administer, rapid-acting, first-line alternative to currently available analgesic treatments for trauma pain

Clinical Audits in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Workflow

Objectives: Previous clinical audits for chronic obstructive pulmonary disease (COPD) have provided valuable information on the clinical care delivered to patients admitted to medical wards because of COPD exacerbations. However, clinical audits of COPD in an outpatient setting are scarce and no methodological guidelines are currently available. Based on our previous experience, herein we describe a clinical audit for COPD patients in specialized outpatient clinics with the overall goal of establishing a potential methodological workflow.Methods: A pilot clinical audit of COPD patients referred to respiratory outpatient clinics in the region of Andalusia, Spain (over 8 million inhabitants), was performed. The audit took place between October 2013 and September 2014, and 10 centers (20% of all public hospitals) were invited to participate. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The usefulness of formally scheduled regular follow-up visits was assessed. Two different databases (resources and clinical database) were constructed. Assessments were planned over a year divided by 4 three-month periods, with the goal of determining seasonal-related changes. Exacerbations and survival served as the main endpoints.Conclusions: This paper describes a methodological framework for conducting a clinical audit of COPD patients in an outpatient setting. Results from such audits can guide health information systems development and implementation in real-world settings.This study was financially supported by an unrestricted grant from Laboratorios Menarini, SA (Barcelona, Spain)

Variation in dopamine D2 and serotonin 5-HT2A receptor genes is associated with working memory processing and response to treatment with antipsychotics

Dopamine D2 and serotonin 5-HT2A receptors contribute to modulate prefrontal cortical physiology and response to treatment with antipsychotics in schizophrenia. Similarly, functional variation in the genes encoding these receptors is also associated with these phenotypes. In particular, the DRD2 rs1076560 T allele predicts a lower ratio of expression of D2 short/long isoforms, suboptimal working memory processing, and better response to antipsychotic treatment compared with the G allele. Furthermore, the HTR2A T allele is associated with lower 5-HT2A expression, impaired working memory processing, and poorer response to antipsychotics compared with the C allele. Here, we investigated in healthy subjects whether these functional polymorphisms have a combined effect on prefrontal cortical physiology and related cognitive behavior linked to schizophrenia as well as on response to treatment with secondgeneration antipsychotics in patients with schizophrenia. In a total sample of 620 healthy subjects, we found that subjects with the rs1076560 T and rs6314 T alleles have greater fMRI prefrontal activity during working memory. Similar results were obtained within the attentional domain. Also, the concomitant presence of the rs1076560 T/rs6314 T alleles also predicted lower behavioral accuracy during working memory. Moreover, we found that rs1076560 T carrier/rs6314 CC individuals had better responses to antipsychotic treatment in two independent samples of patients with schizophrenia (n¼63 and n¼54, respectively), consistent with the previously reported separate effects of these genotypes. These results indicate that DRD2 and HTR2A genetic variants together modulate physiological prefrontal efficiency during working memory and also modulate the response to antipsychotics. Therefore, these results suggest that further exploration is needed to better understand the clinical consequences of these genotype–phenotype relationships

Selection Signatures in Worldwide Sheep Populations

The diversity of populations in domestic species offers great opportunities to study genome response to selection. The recently published Sheep HapMap dataset is a great example of characterization of the world wide genetic diversity in sheep. In this study, we re-analyzed the Sheep HapMap dataset to identify selection signatures in worldwide sheep populations. Compared to previous analyses, we made use of statistical methods that (i) take account of the hierarchical structure of sheep populations, (ii) make use of linkage disequilibrium information and (iii) focus specifically on either recent or older selection signatures. We show that this allows pinpointing several new selection signatures in the sheep genome and distinguishing those related to modern breeding objectives and to earlier post-domestication constraints. The newly identified regions, together with the ones previously identified, reveal the extensive genome response to selection on morphology, color and adaptation to new environments