“Antivacunas” y dudas parentales en vacunación infantil: recuperemos la confianza en los profesionales sanitarios.

Los programas de vacunación infantil son reiteradamente mencionados entre los grandes logros en salud pública a lo largo de la historia de la humanidad. Sin embargo, ya desde sus inicios, el éxito de las vacunas fue puesto en cuestión por parte de individuos y grupos con diversas motivaciones e intereses. En este artículo se muestran algunos de los principales argumentos presentes en situaciones de rechazo o de duda parental ante la vacunación infantil, y se mencionan algunas propuestas de actuación y respuesta

La malacofauna marina de las fases holocenas en la Cueva del Toll (Moià, Barcelona): nuevas aportaciones para el Neolítico nororiental

[EN]: The entrance to the South Gallery of the Toll Cave was discovered in the 40's of the last century. Since then, several works have highlighted the importance of the archaeo-pale-ontological site at both regional and peninsular levels. Focusing on the Holocene levels, the research suggests prolonged use of it, at least from Epicardial times to the late Bronze Age. Among the vast amount of material recovered, we highlight, to the interest of our study, several marine shells. Under the current research project, new specimens have been recovered. Tax-onomic identification shows that they are marine gastropods. The technology, use-wear and chemical analysis suggests that they were anthropically modified by making holes for use as hanging elements. The shells were being tinted with red pigment. The spatial and stratigraphic position of the specimens lead, us to interpret them as part of a single bead, deposited at the bottom of a Neolithic structure.[ES]: La entrada a la Galería Sur de la Cueva del Toll (Moià, Barcelona) fue descubierta en los años 40 del pasado siglo. Desde entonces, las distintas intervenciones realizadas han puesto de manifiesto la importancia del yacimiento arqueo-paleontológico tanto a nivel regional como peninsular. Centrándonos en los niveles holocenos de la cavidad, las investigaciones realizadas indican un uso prolongado de la misma, al menos desde el Neolítico Antiguo, hasta finales del Bronce inicial. Entre la variada cantidad de materiales recuperados destacan por el interés del presente estudio, varios restos de malacofauna marina. En el marco del actual proyecto de investigación, han sido recuperados nuevos ejemplares pertenecientes a las especies Columbella rustica y Nassarius cuvieri. El análisis tecnológico, traceológico y químico de las mismas sugiere que fueron modificadas antrópicamente mediante la realización de perforaciones para su uso, siendo tintadas con pigmentos rojizos. La posición estratigráfica y espacial de los ejemplares nos lleva a interpretar las mismas como parte de un único abalorio, depositado en el fondo de una estructura neolítica.El proyecto de intervención arqueológica esta cofinanciado por el Departamento de Cultura y Medios de Comunicación de la Generalitat de Cataluña.Peer Reviewe

Combinatory effect of BRCA1 and HERC2 expression on outcome in advanced non-small-cell lung cancer

BACKGROUND: BRCA1 is a main component of homologous recombination and induces resistance to platinum in preclinical models. It has been studied as a potential predictive marker in lung cancer. Several proteins modulate the function of BRCA1. The E3 ubiquitin ligase HERC2 facilitates the assembly of the RNF8-UBC13 complex to recruit BRCA1 to DNA damage sites. The combined analysis of multiple components of the pathway leading to the recruitment of BRCA1 at DNA damage sites has the potentiality to improve the BRCA1 predictive model. METHODS: We retrospectively analyzed 71 paraffin-embedded tumor samples from advanced non-small-cell lung cancer patients treated with first-line platinum based chemotherapy and measured the mRNA expression levels of BRCA1, RNF8, UBC13 and HERC2 using real-time PCR. The mRNA expression was categorized using median value as cut-off point. RESULTS: The median progression-free survival of all 71 patients was 7.2 months whereas the median overall survival of the study population was 10.7 months. Among patients with low BRCA1 expression, the median PFS was 7.4 months in the presence of low HERC2 levels and 5.9 months for patients expressing high HERC2 levels (p\u2009=\u20090.01). The median OS was 15.3 months for patients expressing low levels of both genes and 7.4 months for those with low BRCA1 but high HERC2 (p\u2009=\u20090.008). The multivariate analysis showed that among patients with Eastern Cooperative Oncology Group performance status 0-1, the combined low expression of both BRCA1 and HERC2 clearly reduced the risk of progression (p\u2009=\u20090.03) and of death (p\u2009=\u20090.004). CONCLUSIONS: These findings confirm the potentiality of integrated DNA repair components analysis in predicting the sensitivity to platinum in lung cancer. The study indicates a predictive role for HERC2 mRNA expression and paves the way for further refinement of the BRCA1 predictive model

Adrenalectomía laparoscópica por metástasis metácrona. Experiencia en 12 casos

To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. MATERIAL AND METHODS: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. RESULTS: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5 cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. CONCLUSIONS: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery

Monitoring of Schmallenberg virus in Spanish wild artiodactyls, 2006-2015

Schmallenberg disease is an emerging disease that affects domestic and wild ruminants in Europe. An epidemiological survey was carried out to assess exposure to Schmallenberg virus (SBV) in wild artiodactyls in Spain between 2006 and 2015. A total of 1751 sera from wild artiodactyls, including 1066 red deer, 304 fallow deer, 192 mouflon, 109 wild boar, 49 roe deer and 31 Spanish ibex were tested for antibodies against SBV by ELISA and confirmed by virus neutralization test. SBV was not detected between the 2006/2007 and the 2010/2011 hunting seasons. Overall seroprevalence (including samples collected between the 2011/2012 and 2014/2015 hunting seasons) was 14.6% (160/1099; 95%CI: 12.7-16.6). Mean SBV seroprevalence was 13.3±2.6% in red deer, 23.9±4.2% in fallow deer, 16.4±6.1% in mouflon and 2.8±3.1% in wild boar. No antibodies against SBV were found in roe deer or Spanish ibex. The presence of SBV RNA was confirmed in three of 255 (1.2%) spleen samples from wild ruminants analysed by rRT-PCR. In a multivariate mixed-effects logistic regression model, the main risk factors associated with SBV seroprevalence were: species (fallow deer, red deer and mouflon), age (adults) and interactions between hunting areas of more than 1000 hectares and hunting season (2012/2013, 2013/2014 and 2014/2015). The hypothesis of endemic circulation of SBV in the last few years is supported by the detection of SBV RNA in animals sampled in 2011 and 2015, as well as antibodies detected at low level in juveniles in 2012, 2013 and 2014. The results indicate that SBV circulated in wild ruminant populations in Spain during the same period when the virus was first reported in northern Europe, and at least five months before the first case was officially reported in livestock in Spain

Association of crossed renal ectopia and aortic aneurism. Case report

OBJECTIVE: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional. METHODS: We present our case and perform a bibliographic review. RESULTS: To date and in our knowledge , seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia. CONCLUSIONS: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen

¿Existe un intervalo de tiempo de isquemia fría seguro para el injerto renal?

Objective: It is aimed to characterize the true relationship of the cold ischemia time (CIT) with graft survival and with the principal post-transplantation events.aterial and methods: We analyzed 378 kidney transplants, studying the relationship of the CIT with graft survival using a univariate analysis according to the COX model and seeking the optimum cutoff according to the Kaplan-Meier method and log-rank test. The relationship between CIT and the principal events of the post-transplant was studied using the binary logistic regression. Results: The mean follow-up of all the group was 77.8 months (± 51 SD) and the mean CIT was 14.8 hours (± 5.1 SD). The univariate analysis revealed that the CIT was not related with the graft survival as a continuous variable (OR = 1.04; 95% CI: 0.9-1.08; p > 0.05). On establishing the cutoff at 18 hours, we found differences in the actuarial survival. Survival at 5 years was 91% with CIT 18 h. Each hour of cold ischemia increased risk of delay in the graft function by 10% (OR = 1.1; 95% CI: 1.05-1.15; p < 0.001) and also conditioned a greater incidence of acute rejection (41.5% vs. 55.3%; p = 0.02) and less time to the first rejection episode (72.6 days ± 137 vs. 272.2 days ± 614.8; p = 0.023) after 18 hours. The CIT did not seem to be related (p < 0.05) with the rest of the post-transplantation events, such as surgical complications or hospital admissions. Conclusions: In our experience, cold ischemia under 18 hours does not seem to negatively affect graft survival