Osteoma osteoide de rodilla Dos casos de difícil diagnóstico

Presentamos dos casos de osteoma osteoide yuxtacortical de localización infrecuente en la rodilla y de difícil diagnóstico. La gammagrafía reveló la localización de la lesión y la tomografía axial computerizada (TAC) en cortes finos indicó el lugar exacto, facilitando así la planificación del abordaje quirúrgico de la zona. La resonancia magnética no aportó datos de interés. Tras la cirugía, la sintomatología previa remitió completamente en ambos casos.We present two cases of osteoid osteoma affecting the knee, a very infrequent localization and therefore of difficult diagnosis. The scintigraphy was found to be of valuable assitance in revealing the presence of this lesion at the knee and CT-scan was likewise useful for its precision in localizing the tumor as a basis for deciding upon a viable surgical approach. MRI did not contribute some date. After surgical resection of the tumor, a complete relief of the symptoms was experienced in both patients

Factores pronósticos en el tratamiento del condrosarcoma

Los autores 30 condrosarcomas tratados en su Departamento. Estudiando la distribución por sexos, edad, localización, supervivencia y los factores pronósticos respecto a la relación entre el tipo histológico, localización, tratamiento, origen y tiempo de evolución. Concluyen que son factores de mal pronóstico el grado histológico III, localización central, especialmente en ilíaco, origen primario de la enfermedad y un tiempo mayor de 6 meses entre el diagnóstico y el tratamientoThe authors are reviewed 30 chondrosarcomas seen at their department of orthopaedics surgery. They studied the age distribution, sex, localization, survival and the prognostic factors between histopathology, localization, origin, treatment and evolution times. It is concluyed that the grade III, central localization (specially in pelvis), primary origin and evolution times more than six months between diagnosis and treatment are bad prognostic factors in chondrosarcoma of bone

Catalysis to discriminate single atoms from subnanometric ruthenium particles in ultra-high loading catalysts

We report a procedure for preparing ulta-high metal loading (10-20 % w/w Ru) Ru@C60 nanostructured catalysts comprising exclusively Ru single atoms. We show that by changing the Ru/C60 ratio and the nature of the solvent used during the synthesis, it is possible to increase the Ru loading up to 50% w/w, and to produce hetero-structures containing subnanometric Ru nanoparticles. Several techniques such as high-resolution transmission electron microscopy (HRTEM), scanning transmission electron microscopy – high angle annular dark field (STEM-HAADF), Raman spectroscopy, wideangle X-ray scattering (WAXS), extended X-ray absorption fine structure (EXAFS) and X-ray photoelectron spectroscopy (XPS) together with theoretical calculations were used to characterize these materials. At such high metal loading, the distinction between Ru single atoms and clusters is not trivial, even with this combination of techniques. We evaluated the catalytic properties of these materials for the hydrogenation of nitrobenzene and 2,3-dimethyl-2-butene. The catalysts containing only Ru single atoms are much less active for these reactions than the ones containing clusters. For nitrobenzene hydrogenation, this is because electro-deficient Ru single atoms and few atom Run clusters are not performant for H2 activation compared to larger clusters (n ≥ 13), as shown by density functional theory (DFT) calculations. For the more crowded substrate 2,3-dimethyl-2-butene, DFT calculations have shown that this is due to steric hindrance. These simple tests can thus been used to distinguish samples containing metallic sub-nanometer nanoparticles. These novel catalysts are also extremely active for the hydrogenation of -substituted 2,3-dimethyl-2-butene

Regulación de la eutanasia y el suicidio asistido en España. ¿Hacia qué modelo se dirige la opinión pública?

Objective: To compare the attitudes of Spanish citizens with existing legal models on euthanasia and assisted suicide to identify which of them the citizens could agree with. Methods: Data collected by the <em>Social Research Centre</em> in Study 2,803 “care for patients who are terminally ill” in 2009 were analysed. Descriptive analysis and comparisons with McNemar test were carried out. Results: Spanish populationclearly supports the practice of euthanasia for the terminally ill. Agreement is lower in the case of physician assisted suicide and degenerative diseases. Conclusions: The Belgian model matches the approach favoured by Spanish public opinion closest. This represents a starting point for the social, political and legal debate needed to regulate individuals’ rights at the end of life.<br><br>Introducción: Comparar las actitudes de los ciudadanos españoles con los modelos legales existentes sobre eutanasia y suicidio asistido para identificar con cuál de ellos la ciudadanía podría estar más de acuerdo. Metodología: Se analizaron los datos recogidos por el Centro de Investigaciones Sociológicas en el Estudio 2.803 “Atención para pacientes con enfermedad terminal”. Realizamos análisis descriptivos y comparaciones mediante la prueba de <em>McNemar</em>. Resultados: La población española apoya claramente la práctica de eutanasia en enfermos terminales. El suicidio médico asistido y los casos de enfermedad degenerativa hacen disminuir el grado de aceptación. Conclusiones: El modelo belga es el que mejor se ajusta a las opiniones de la ciudadanía española. Se considera un punto de partida, para conducir el debate social, político y jurídico, necesario para lograr una regulación de los derechos que asisten a los ciudadanos al final de la vida

Interferon-Gamma Release Assays Differentiate Between Mycobacterium avium Complex and Tuberculous Lymphadenitis in Children

OBJECTIVES: To assess the performance of interferon-gamma release assays (IGRAs) in the differential diagnosis between Mycobacterium avium complex (MAC) and tuberculosis (TB) in children affected with subacute/chronic submandibular/cervical lymphadenitis. STUDY DESIGN: Multicenter observational study comparing children with microbiologically-confirmed MAC lymphadenitis from the European NontuberculouS MycoBacterial Lymphadenitis in childrEn (ENSeMBLE) study with children with TB lymphadenitis from the Spanish Network for the Study of Pediatric TB (pTBred) database. RESULTS: Overall, 78 patients with MAC and 34 with TB lymphadenitis were included. Among MAC cases, 44/74 (59.5%) had positive tuberculin skin test (TST) results at the 5 mm cutoff, compared with 32/33 (97%) TB cases (p<0.001); at the 10 mm cutoff TST results were positive in 23/74 (31.1%) vs. 26/31 (83.9%), respectively (P < .001). IGRA results were positive in only 1/32 (3.1%) MAC cases who had undergone IGRA testing, compared with 21/23 (91.3%) TB cases (p<0.001). Agreement between TST and IGRA results was poor in MAC (23.3%;κ=0.017), but good in TB cases (95.6%;κ=0.646). IGRAs had a specificity of 96.9% (95%CI:84.3-99.8%), positive predictive value (PPV) of 95.4% (95%CI:78.2-99.8%), and negative predictive value (NPV) of 93.9% (95%CI:80.4-98.9%) for TB lymphadenitis. CONCLUSIONS: In contrast to TST, IGRAs have high specificity, NPV and PPV for TB lymphadenitis in children with subacute/chronic lymphadenopathy, and consequently can help to discriminate between TB and MAC disease. Therefore, IGRAs are useful tools in the diagnostic work-up of children with lymphadenopathy, particularly when culture- and PCR-results are negative

The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis

Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.published_or_final_versio

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Cryptic dispersal of Cyanidiophytina (Rhodophyta) in non-acidic environments from Turkey

Cyanidiophytina are a group of polyextremophilic red algae with a worldwide, but discontinuous colonization. They are restricted to widely dispersed hot springs, geothermal habitats, and also some human-altered environments. Cyanidiophytina are predominant where pH is prohibitive for the majority of eukaryotes (pH 0.5-3). Turkey is characterized by areas rich in volcanic activity separated by non-volcanic areas. Here we show that Cyanidiophycean populations are present in thermal baths located around Turkey on neutral/alkaline soils. All known genera and species within Cyanidiophytina were detected in Turkey, including Galdieria phlegrea, recorded up to now only in Italian Phlegrean Fields. By phylogenetic analyses, Turkish G. sulphuraria strains are monophyletic with Italian and Icelandic strains, and with Russian G. daedala strains. G. maxima from Turkey clustered with Icelandic, Kamchatka, and Japanese populations. The discovery of Cyanidiophytina in non-acidic Turkish soils raises new questions about the ecological boundaries of these extremophilic algae. This aids in the understanding of the dispersal abilities and distribution patterns of this ecologically and evolutionarily interesting group of algae

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Social hierarchy of pain and its connection to the memory of previously suffered pain

Background: Pain is a perception conditioned both by the painful experience and by each society¿s collective imagination. The general objective of the project which this work forms part of it was to discover what citizens think about different aspects of this complex experience. More precisely, this paper¿s objective is to get to know which is the worst pain that can be suffered according to Spaniards and what determines that hierarchy, bearing in mind that this work has chosen a broad definition of pain, including pains of different origins, namely, physical, psychological, and emotional pain. Materials and methods: The data from the CIS 3137 study ¿Social perceptions of pain¿ have been used, which is a survey module designed by the Institute of Advanced Social Studies (IESA) of the Spanish National Research Council (CSIC). A hierarchical multiple factor analysis has been performed, using the SPSS statistical analysis software, where the dependent variable is the citizen¿s opinion on which is the worst pain that can be suffered, recoded according to the origin of pain (physical, psychological, and emotional pain). Sociodemographic variables and variables linked to the experience of pain have been included as independent variables. Results and conclusion: Although the most frequent pains among Spanish citizens are those of a physical origin, especially those linked to musculoskeletal problems and pains of an orofacial origin, when they are asked about the worst pain a person can suffer, they do not mention this type of pain, but those of an emotional origin. It has also been possible to confirm that the pain that citizens refer to when asked about the worst pain that can be suffered, and, therefore, the hierarchy of pain held by Spanish citizens as a group, is conditioned, although not determined, by the pain that has previously been suffered ¿ by one¿s own experience of pain