Update on adrenal cortical neoplasia

The adrenal cortex gives rise to a biologically heterogenous group of neoplasms, each with a distinct morphology, antigen expression and molecular profile. Adrenal cortical adenomas have excellent prognosis and are usually cured by surgical resection alone, while adrenal cortical carcinomas are very aggressive tumors with a poor prognosis regardless of therapy. These tumors are rare and often challenging for a pathologist to diagnose, as significant overlap exists between benign and malignant lesions in some cases. In this review, we attempt to summarize most important histologic and clinical features of adrenal cortical adenomas and carcinomas, clarify the use of different grading systems, the use of special stains and the differential diagnosis for practicing pathologists. Most relevant hereditary syndromes associated with adrenal cortical tumors are listed. Updates in molecular alterations in adrenal cortical neoplasms and hyperplastic diseases as well as their clinical significance and potential therapeutic implications are also discussed.     

X-ray diffraction and electrochemical impedance spectroscopy study of zinc coated LiNi0.5Mn1.5O4 electrodes

Coating and doping with zinc have been used to modify LiNi_0.5Mn_1.5O₄ powders prepared at 700 and 800 °C. As previously found in the literature, surface treatment with zinc leads to a net improvement of the electrochemical performance of the 5-V electrode in lithium cells. X-ray diffraction reveals the occurrence of surface ZnO, which disappears after heating at 500 °C. This indicates that ZnO forms a coating, although zinc can also be incorporated in the LiNi_0.5Mn_1.5O₄ framework. The electrochemical oxidation of both bare LiNi_0.5Mn_1.5O₄ and zinc treated products has been followed by ex situ X-ray diffraction of charged electrodes. For both materials a decrease in the cubic unit cell parameter and the formation of two cubic phases during lithium extraction has been found. Lattice contraction is significantly larger in the sample modified with zinc. EIS measurements give direct evidence of the better stabilization of the electrode surface in the coated material.     

Valoración del paciente que solicita muerte asistida

Resumen El equipo médico debe estar preparado para evaluar a los pacientes que solicitan muerte asistida. En esta revisión hemos recopilado de la literatura internacional los criterios médicos y psicológicos para evaluar a los pacientes que solicitan muerte asistida con la finalidad de aliviar las necesidades fisicas, psicológicas y sociales de los pacientes y sus familias. Se realizó un estudio de tipo exploratorio seleccionando los artículos que propusieran protocolos de valoración psicológica y médica de los pacientes que solicitan muerte asistida. Se analizó qué aspectos son los que se evalúan con mayor frecuencia en la literatura internacional. Se identificaron dos posturas generales para la valoración del paciente: por un lado la valoración de su competencia para la toma de decisiones y por otro la valoración del sufrimiento físico, seguido por el sufrimiento psicológico, social, existencial/espiritual, la relación médico-paciente y la relación médico-familiares. Finalmente se enumeran una serie de principios que pueden guiar al clínico ante la petición de muerte asistida.      

An open-label efficacy pilot study with pimecrolimus cream 1% in adults with facial seborrhoeic dermatitis infected with HIV

BACKGROUND: Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals. OBJECTIVE: A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD. METHODS: In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography. MAIN OUTCOME MEASURES: Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period. CONCLUSION: Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.     

In-vitro maturation of human germinal vesicle stage oocytes: role of cumulus cells and epidermal growth factor in the culture medium

In-vitro maturation (IVM) of oocytes is a promising technique to reduce the costs and avert the side-effects of gonadotrophin stimulation for in-vitro fertilization (IVF). The pregnancy rates from oocytes matured in vitro are much lower than those of in-vivo stimulation cycles indicating that optimization of IVM remains a challenge. Therefore, we investigated the effect of supplementation of the medium with gonadotrophins, oestradiol and epidermal growth factor (EGF) and the effect of retaining or removing the cumulus cells on nuclear and cytoplasmic maturation of immature oocytes. Human germinal vesicle (GV) oocytes obtained after gonadotrophin stimulation for intracytoplasmic sperm injection (ICSI) were cultured in a complex defined medium either supplemented with gonadotrophins, oestradiol and physiological concentrations of EGF (2 ng/ml) or gonadotrophins and oestradiol alone. The cumulus cells were either removed or kept intact. In GV stage oocytes cultured without cumulus (group I) significantly more oocytes reached the metaphase II (MII) stage at 30 h in media supplemented with EGF (64.3 versus 33.9%, P < 0.003). For oocytes cultured with intact cumulus (group II), more oocytes reached MII at 30 h than in group I, but there was no difference in medium with or without EGF supplementation (81.8 and 79.8% respectively). Cytoplasmic maturation of MII oocytes was judged from their capability to activate and fertilize after ICSI. In group I, the rates of activation and normal fertilization were similar. However, in group II, significantly more oocytes underwent normal fertilization in the EGF-supplemented than the unsupplemented group (71.7 versus 45.6%, P < 0.05). The cleavage rates of the fertilized oocytes were similar in the sibling oocyte subgroups cultured with or without EGF supplementation, but the overall cleavage rates were higher in cumulus-intact compared to cumulus-denuded oocytes (88.9 versus 47.8%, P < 0.001). Thus, supplementation of the maturation medium with EGF and maintenance of the cumulus during culture improve the nuclear and cytoplasmic maturation of human oocytes in vitro.