Spinal gunshot wounds: A retrospective, multicenter, cohort study. / [Artículo traducido] Lesiones vertebrales por proyectil de arma de fuego: estudio de cohorte retrospectivo, multicéntrico.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Spinal gunshot wounds: A retrospective, multicenter, cohort study.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Evolution of social mood in Spain throughout the COVID-19 vaccination process: a machine learning approach to tweets analysis.

OBJECTIVES: This paper presents a new approach based on the combination of machine learning techniques, in particular, sentiment analysis using lexicons, and multivariate statistical methods to assess the evolution of social mood through the COVID-19 vaccination process in Spain. METHODS: Analysing 41,669 Spanish tweets posted between 27 February 2020 and 31 December 2021, different sentiments were assessed using a list of Spanish words and their associations with eight basic emotions (anger, fear, anticipation, trust, surprise, sadness, joy and disgust) and three valences (neutral, negative and positive). How the different subjective emotions were distributed across the tweets was determined using several descriptive statistics; a trajectory plot representing the emotional valence vs narrative time was also included. RESULTS: The results achieved are highly illustrative of the social mood of citizens, registering the different emerging opinion clusters, gauging public states of mind via the collective valence, and detecting the prevalence of different emotions in the successive phases of the vaccination process. CONCLUSIONS: The present combination in formal models of objective and subjective information would therefore provide a more accurate vision of social reality, in this case regarding the COVID-19 vaccination process in Spain, which will enable a more effective resolution of problems.

Diagnosis of multiple sclerosis using multifocal ERG data feature fusion.

The purpose of this paper is to implement a computer-aided diagnosis (CAD) system for multiple sclerosis (MS) based on analysing the outer retina as assessed by multifocal electroretinograms (mfERGs). MfERG recordings taken with the RETI-port/scan 21 (Roland Consult) device from 15 eyes of patients diagnosed with incipient relapsing-remitting MS and without prior optic neuritis, and from 6 eyes of control subjects, are selected. The mfERG recordings are grouped (whole macular visual field, five rings, and four quadrants). For each group, the correlation with a normative database of adaptively filtered signals, based on empirical model decomposition (EMD) and three features from the continuous wavelet transform (CWT) domain, are obtained. Of the initial 40 features, the 4 most relevant are selected in two stages: a) using a filter method and b) using a wrapper-feature selection method. The Support Vector Machine (SVM) is used as a classifier. With the optimal CAD configuration, a Matthews correlation coefficient value of 0.89 (accuracy = 0.95, specificity = 1.0 and sensitivity = 0.93) is obtained. This study identified an outer retina dysfunction in patients with recent MS by analysing the outer retina responses in the mfERG and employing an SVM as a classifier. In conclusion, a promising new electrophysiological-biomarker method based on feature fusion for MS diagnosis was identified.

Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital.

ANTECEDENTS AND OBJECTIVE: To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS: Retrospective cohort study of patients with COVID-19 admitted from 26th February 2020, who had been discharged or died up to 29th April 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS: Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) y cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335 UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345 IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS: The presence of cardiopathy, levels of LDH≥345 IU/L and age≥65 years, are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.

Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital. / Comorbilidad y factores pronósticos al ingreso en una cohorte COVID-19 de un hospital general.

ANTECEDENTS AND OBJECTIVE: To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS: Retrospective cohort study of patients with COVID-19 admitted from 26th February, who had been discharged or died, up to 29th April, 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS: Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV-2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) and cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS: The presence of cardiopathy, levels of LDH≥345IU/L and age ≥65 years are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.

Diagnostic ability of multifocal electroretinogram in early multiple sclerosis using a new signal analysis method.

PURPOSE: To determine if a novel analysis method will increase the diagnostic value of the multifocal electroretinogram (mfERG) in diagnosing early-stage multiple sclerosis (MS). METHODS: We studied the mfERG signals of OD (Oculus Dexter) eyes of fifteen patients diagnosed with early-stage MS (in all cases < 12 months) and without a history of optic neuritis (ON) (F:M = 11:4), and those of six controls (F:M = 3:3). We obtained values of amplitude and latency of N1 and P1 waves, and a method to assess normalized root-mean-square error (FNRMSE) between model signals and mfERG recordings was used. Responses of each eye were analysed at a global level, and by rings, quadrants and hemispheres. AUC (area under the ROC curve) is used as discriminant factor. RESULTS: The standard method of analysis obtains further discrimination between controls and MS in ring R3 (AUC = 0.82), analysing N1 waves amplitudes. In all of the retina analysis regions, FNRMSE value shows a greater discriminating power than the standard method. The highest AUC value (AUC = 0.91) was in the superior temporal quadrant. CONCLUSION: By analysing mfERG recordings and contrasting them with those of healthy controls it is possible to detect early-stage MS in patients without a previous history of ON.

Coding Prony's method in MATLAB and applying it to biomedical signal filtering.

BACKGROUND: The response of many biomedical systems can be modelled using a linear combination of damped exponential functions. The approximation parameters, based on equally spaced samples, can be obtained using Prony's method and its variants (e.g. the matrix pencil method). This paper provides a tutorial on the main polynomial Prony and matrix pencil methods and their implementation in MATLAB and analyses how they perform with synthetic and multifocal visual-evoked potential (mfVEP) signals. This paper briefly describes the theoretical basis of four polynomial Prony approximation methods: classic, least squares (LS), total least squares (TLS) and matrix pencil method (MPM). In each of these cases, implementation uses general MATLAB functions. The features of the various options are tested by approximating a set of synthetic mathematical functions and evaluating filtering performance in the Prony domain when applied to mfVEP signals to improve diagnosis of patients with multiple sclerosis (MS). RESULTS: The code implemented does not achieve 100%-correct signal approximation and, of the methods tested, LS and MPM perform best. When filtering mfVEP records in the Prony domain, the value of the area under the receiver-operating-characteristic (ROC) curve is 0.7055 compared with 0.6538 obtained with the usual filtering method used for this type of signal (discrete Fourier transform low-pass filter with a cut-off frequency of 35 Hz). CONCLUSIONS: This paper reviews Prony's method in relation to signal filtering and approximation, provides the MATLAB code needed to implement the classic, LS, TLS and MPM methods, and tests their performance in biomedical signal filtering and function approximation. It emphasizes the importance of improving the computational methods used to implement the various methods described above.

[Prevalence of human papillomavirus in Spanish women from a population screening program]. / Prevalencia de virus del papiloma humano en mujeres españolas de un programa de cribado poblacionales de riesgo.

OBJECTIVE: The human papillomavirus (HPV), is necessary to cause a woman developing cervical cancer. The aim of the study was to estimate the prevalence of women with HPV infection, covered by the program of prevention and early detection of cervical cancer of Castile and León (Spain). METHODS: Samples of women included in the screening program were analyzed. Including a total of 120,326 cervical swab samples, collected in the period from January 2012 to December 2014. RESULTS: 12,183 HPV positive samples were detected, representing a prevalence of 9.6 ‰, (IC 95% 9.5%-9.8%) in the female population. High-risk HPV were found in higher proportion that HPV low-risk genotypes. HPV prevalence correlates inversely with women age. Coinfections of multiple genotypes were found in one third of screened women population. CONCLUSIONS: Data showed in this study are the first and wider Spanish results from a cervical cancer screening program population non opportunistic based on HPV detection. These results would serve as a reference for future prevalence studies and to evaluate the future impact of HPV vaccination campaigns.

[Pulse wave velocity of the leg minus that of the arm measured with a custom device correlates to the coronary calcium quantification]. / La velocidad de onda de pulso de la pierna menos brazo medida con un dispositivo propio se correlaciona con la cuantificación de calcio coronario.

OBJECTIVE: The pulse wave velocity (PWV) in the great arteries is an indicator of vascular risk. Our objective was to identify the PWV index between the arms and legs that best correlates with the coronary calcium quantification (CCQ) and to compare it with other methods. MATERIAL AND METHODS: Eight-one patients without vascular disease underwent the following measurements: CCQ; carotid intima-media thickness (IMT); carotid-femoral PWV (cfPWV), using COMPLIOR; and PWV in the arms and legs, with our own device (abiPWV, ankle brachial index PWV). RESULTS: The difference in PWVs between the leg and arm (l-a PWV) measured with abiPWV was the index that best correlated with CCQ (r=0.401, P<.001). The correlation between IMT and CCQ and between CF-PWV and CCQ were r=0.366, P=.001; and r=0.385, P=.001, respectively. For a CCQ score higher than 100 as a marker of significant coronary arteriosclerosis, the areas under the curve for l-a PWV, IMT and cfPWV were 0.721 (P=.002), 0.758 (P<.001) and 0.636 (P=.058), respectively. CONCLUSIONS: For patients without vascular disease, the l-a PWV measured with abiPWV appears to be the index that best correlates with the CCQ. This association is comparable to that between IMT and CCQ and between cfPWV and CCQ. The abiPWV is an easy-to-use device that can help improve vascular risk stratification.

A signal-to-noise-ratio-based analysis of multifocal visual-evoked potentials in multiple sclerosis risk assessment.

OBJECTIVE: To study the value of using the signal-to-noise ratio (SNR) of multifocal visual-evoked potentials (mfVEPs) in assessment of subjects at risk of developing multiple sclerosis (MS). METHODS: MfVEP signals were obtained from 15 patients with radiologically isolated syndrome (RIS), from 28 patients with clinically isolated syndrome (CIS), from 28 with clinically definite MS and from 24 control subjects. The CIS and MS groups were divided into two subgroups: those with eyes affected by optic neuritis (ON) and those without (non-ON). The mfVEPs' SNR was obtained for both the whole visual field and at various eccentric rings. The area under the curve (AUC) was calculated by comparing the control subjects' mfVEP SNR values with those of the RIS, CIS and MS groups. RESULTS: In whole visual field analysis, risk of developing MS increased as SNR decreased (SNRCONTROL=0.70, SNRRIS=0.62, SNRCIS-nonON=0.54, SNRCIS-ON=0.40, SNRMS-nonON=0.52, SNRMS-ON=0.40). Ring 5 (9.8°-15° eccentricity) was most affected by the SNR decrease, as indicated by its higher AUC values (AUCFULL_EYE=0.81, AUCRING_5=0.89). A significant relationship (Spearman correlation, ρRING_5=0.61) between SNR values and disability severity on the Expanded Disability Status Scale (EDSS) was observed in clinically definite MS patients. CONCLUSION: A new method based on analysis of the SNR of mfVEP signal amplitude improves assessment of patients at risk of developing MS. SIGNIFICANCE: Improved mfVEP assessment of MS-risk patients was achieved by using SNR values at 9.8°-15° eccentricity of the visual field.

The hippocampus participates in the control of locomotion speed.

The hippocampus role in sensory-motor integration remains unclear. In these experiments we study its function in the locomotor control. To establish the connection between the hippocampus and the locomotor system, electrical stimulation in the CA1 region was applied and EMG recordings were obtained. We also evaluated the hindlimbs and forelimbs kinematic patterns in rats with a penetrating injury (PI) in the hippocampus as well as in a cortex-injured group (CI), which served as control. After the PI, tamoxifen a selective estrogen receptor modulator (SERM) that has been described as a neuroprotector and antiinflammatory drug, or vehicle was administered. Electrical stimulation in the hippocampus produces muscle contractions in the contralateral triceps, when 6 Hz or 8 Hz pulse trains were applied. The penetrating injury in the hippocampus reduced the EMG amplitude after the electrical stimulation. At 7 DPI (days post-injury) we observed an increase in the strides speed in all four limbs of the non-treated group, decreasing the correlation percentage of the studied joints. After 15 DPI the strides speed in the non-treated returned to normal. These changes did not occur in the tamoxifen group nor in cortex-injured group. After 30 days, the nontreated group presented a reduction in the number of pyramidal cell layer neurons at the injury site, in comparison to the tam-treated group. The loss of neurons, may cause the interruption of the trisynaptic circuit and changes in the locomotion speed. Tamoxifen preserves the pyramidal neurons after the injury, probably resulting in the strides speed recovery.

Continuous-wavelet-transform analysis of the multifocal ERG waveform in glaucoma diagnosis.

The vast majority of multifocal electroretinogram (mfERG) signal analyses to detect glaucoma study the signals' amplitudes and latencies. The purpose of this paper is to investigate application of wavelet analysis of mfERG signals in diagnosis of glaucoma. This analysis method applies the continuous wavelet transform (CWT) to the signals, using the real Morlet wavelet. CWT coefficients resulting from the scale of maximum correlation are used as inputs to a neural network, which acts as a classifier. mfERG recordings are taken from the eyes of 47 subjects diagnosed with chronic open-angle glaucoma and from those of 24 healthy subjects. The high sensitivity in the classification (0.894) provides reliable detection of glaucomatous sectors, while the specificity achieved (0.844) reflects accurate detection of healthy sectors. The results obtained in this paper improve on the previous findings reported by the authors using the same visual stimuli and database.

Software for analysing multifocal visual evoked potential signal latency progression.

BACKGROUND: This paper describes a new non-commercial software application (mfVEP(2)) developed to process multifocal visual-evoked-potential (mfVEP) signals in latency (monocular and interocular) progression studies. METHOD: The software performs analysis by cross-correlating signals from the same patients. The criteria applied by the software include best channels, signal window, cross-correlation limits and signal-to-noise ratio (SNR). Software features include signal display comparing different tests and groups of sectors (quadrants, rings and hemispheres). RESULTS: The software's performance and capabilities are demonstrated on the results obtained from a patient with acute optic neuritis who underwent 9 follow-up mfVEP tests. Numerical values and graphics are presented and discussed for this case. CONCLUSIONS: The authors present a software application used to study progression in mfVEP signals. It is also useful in research projects designed to improve mfVEP techniques. This software makes it easier for users to manage the signals and allows them to choose various ways of selecting signals and representing results.

Filtering multifocal VEP signals using Prony's method.

BACKGROUND: This paper describes use of Prony's method as a filter applied to multifocal visual-evoked-potential (mfVEP) signals. Prony's method can be viewed as an extension of Fourier analysis that allows a signal to be decomposed into a linear combination of functions with different amplitudes, damping factors, frequencies and phase angles. METHOD: By selecting Prony method parameters, a frequency filter has been developed which improves signal-to-noise ratio (SNR). Three different criteria were applied to data recorded from control subjects to produce three separate datasets: unfiltered raw data, data filtered using the traditional method (fast Fourier transform: FFT), and data filtered using Prony's method. RESULTS: Filtering using Prony's method improved the signals' original SNR by 44.52%, while the FFT filter improved the SNR by 33.56%. The extent to which signal can be separated from noise was analysed using receiver-operating-characteristic (ROC) curves. The area under the curve (AUC) was greater in the signals filtered using Prony's method than in the original signals or in those filtered using the FFT. CONCLUSION: filtering using Prony's method improves the quality of mfVEP signal pre-processing when compared with the original signals, or with those filtered using the FFT.

Outcomes in weight loss, fasting blood glucose and glycosylated hemoglobin in a sample of 415 obese patients, included in the database of the European accreditation council for excellence centers for bariatric surgery with laparoscopic one anastomosis gastric bypass.

BACKGROUND: Obesity is a risk factor for the development of diseases such as type 2 Diabetes Mellitus. Bariatric surgery with laparoscopic single anastomosis gastric bypass is an effective treatment for morbid obesity and diabetes type 2 complete remission, and it has been proven to generate an improvement in glycemic levels and glycosylated hemoglobin (HbA1c) keeping the weight loss for a long time. MATERIAL AND METHODS: In a period of time between June 2002 until May 2012, 2070 patients underwent surgery with LOAGB technique. Between January 2010 an May 2012, 415 patients were included in the European Accreditation Council for Excellence Centers for Bariatric Surgery (EAC-BS) database, from which 79 patients with a glycemic level disturbance in the preoperative blood sample where chosen. Of this group, 47 patients were pre-diabetic (fast plasma glucose ≥ 110 mg/dl ≤ 125 mg/dl) and glycosylated hemoglobin (HbA1c) levels between 5.7-6.4% and 32 were diabetic (fast plasma glucose ≥ 126 mg/dl) and glycosylated hemoglobin (HbA1c) levels ≥ 6.5%. We described the weight evolution, the excess body mass index lost percentage (%EBMIL) the glycemia and the glycosylated hemoglobin levels; and we reported regular laboratory controls during the first year after surgical intervention. RESULTS: Both patient groups achieved their lowest mean weight loss 12 months after surgery, being average weight in the pre-diabetic group 62,41 ± 10,93 and 68,36 ± 11,16 in the diabetic group. Since 3 months after surgery, pre-diabetic patients achieve a mean BMI < 30, according to the Spanish Society for Obesity Study (SEEDO 2007) this amount is outside of the definition of obesity. Not being the case of the diabetic patients who don´t achieve this result until 6 months after surgery. The weight loss was excellent in both study groups, achieving an excess body mass index loss percentage (% EBMIL) greater than 65%, since the first three-month postoperative control. Glycemia levels descend in both groups, achieving the pre-diabetic group a mean glycemia level of < 110 mg/ dl in the second day after LOAGB surgery. Pre-diabetic patients maintain more stable glycemia with better controls, and very favorable outcomes 12 months after surgery. The diabetic patients achieve the mean glycemia level of < 110 mg/dl at the first month after surgery and maintained it 12 months after surgery which is the time of this study. The glycosylated hemoglobin levels descended in both groups, achieving levels of 4% three months after surgery in the prediabetic group and 4.8% at six months in the diabetic group. CONCLUSION: LOAGB proved to be an efficient bariatric technique for complete remission of pre-diabetes and diabetes mellitus type 2 and also with the excess weight loss resolution. We showed that the excess weight loss, the glycemia and glycosylated hemoglobin levels continue being normal after one year of follow up after surgery. The best results are obtained in pre-diabetic patients who underwent LOAGB, this group is integrated with people who are at high risk of suffering a deterioration of their obesity and a rapid advance of the diabetes and the associated comorbidities, that's why surgery has to be performed as soon as possible when the medical exam continues being favorable.

Introducción: La obesidad es un factor de riesgo para el desarrollo de enfermedades tales como la diabetes mellitus tipo II. La cirugía bariátrica laparoscópica de una anastomosis también conocida como mini-bypass con las modificaciones del doctor Carbajo, es un tratamiento efectivo para el manejo de la obesidad mórbida y para obtener una completa remisión de la diabetes tipo II y se ha demostrado que se genera una mejoría de los niveles de glicemia y de hemoglobina glicosilada (HbA1c) manteniendo la pérdida de peso por un largo período de tiempo. Material y métodos: En un período de tiempo entre junio del 2002 hasta mayo de 2012, 2070 pacientes se intervinieron quirúrgicamente con la técnica bariátrica laparoscópica de una anastomosis gástrica (BAGUA). Entre enero de 2010 y mayo de 2012, 415 pacientes fueron incluidos en la base de datos del Consejo Europeo de acreditación para centros de excelencia de cirugía bariátrica, de los cuales se escogieron 79 pacientes que presentaban trastornos de los niveles de glicemia en sus pruebas sanguíneas preoperatorias. De este grupo 47 pacientes se clasificaron como pre-diabéticos con niveles de glucosa en sangre ≥110 mg/ dl ≤ 125 mg/dl y unos niveles de hemoglobina glicosilada ( HbA1C) entre 5.7-6.4% y 32 como diabéticos con niveles de glucosa en sangre ≥ 126 mg/dl y niveles de hemoglobina glicosilada (HbA1C) ≥ 6.5%. Nosotros describimos la evolución de los cambios en el peso, el porcentaje de pérdida del índice de masa corporal, los niveles de glicemia y de hemoglobina glicosilada de los pacientes estudiados y reportamos los resultados de los controles de laboratorio practicados regularmente durante el primer año postoperatorio. Resultados: ambos grupos de pacientes alcanzaron su máxima pérdida de peso a los 12 meses postoperatorios, siendo el peso promedio en el grupo de pre-diabéticos 62,41 ± 10,93 y 68,36 ± 11,16 en el grupo de diabéticos. Los pacientes pre-diabéticos alcanzaron desde los 3 meses de postoperatorio un índice de masa corporal (IMC) < 30, que de acuerdo con el estudio sobre Obesidad de la Sociedad Española (SEEDO 2007) esta cantidad se encuentra por fuera de la definición de obesidad, no siendo el caso del grupo de pacientes diabéticos que no alcanzaron este resultado hasta los 6 meses de postoperatorio. La pérdida de peso fue excelente en ambos grupos alcanzando un porcentaje de pérdida de índice de masa corporal mayor de 65% desde los primeros 3 meses de control postoperatorio. Los niveles de glicemia bajaron en ambos grupos, alcanzando el grupo de pre-diabéticos un nivel de glicemia < 110 mg/dl desde el segundo día postoperatorio de BAGUA. Los pacientes pre-diabéticos mantuvieron un nivel de glicemia estable con mejor control y una muy favorable evolución a los 12 meses de postoperatorio. Los pacientes diabéticos alcanzaron el nivel de glicemia < 110 mg/dl en el primer mes postoperatorio y lo mantuvieron así a los 12 meses de postoperatorio, tiempo en el que se elaboró este estudio. Los niveles de hemoglobina glicosilada descendieron en ambos grupos, alcanzando niveles de 4% a los 3 meses de postoperatorio en los pacientes prediabéticos y un 4,8% a los 6 meses en el grupo de los pacientes diabéticos. Conclusión: BAGUA mostró ser una técnica quirúrgica bariátrica eficiente para la remisión completa de la pre-diabetes y la diabetes tipo II así como de la pérdida del exceso de peso. Nosotros demostramos que la pérdida del exceso de peso, los niveles de glicemia y de hemoglobina glicosilada continuaron siendo normales al año de seguimiento postoperatorio. Los mejores resultados se obtuvieron en el grupo de pre-diabéticos a quienes se les practicó BAGUA. Este grupo está integrado por personas que se encuentran en riesgo de sufrir un deterioro de su obesidad y un rápido avance hacia diabetes y a las comorbilidades asociadas, está es la razón por la cual esta cirugía debe realizarse lo más pronto posible mientras las pruebas médicas de los pacientes sigan siendo favorables.

Aromatase and estrogen receptor alpha mRNA expression as prognostic biomarkers in patients with astrocytomas.

Estrogens are oncogenic hormones at a high level in breast, prostate, endometrial and lung cancer. Estrogens are synthesized by aromatase which has been used as a biomarker both in breast and lung cancer. Estrogen biological activities are executed by their classic receptors (ERα and ERß). ERα has been described as a cancer promoter and ERß, as a possible tumor suppressor. Both receptors are present at low levels in primary multiforme glioblastoma (GBM). The GBM frequency is 50 % higher in men than in women. The GBM patient survival period ranges from 7 to 18 months. The purpose of this pilot study was to evaluate aromatase and estrogen receptor expression, as well as 17ß-estradiol concentration in astrocytoma patients biopsies to obtain a prognosis biomarker for these patients. We analyzed 36 biopsies of astrocytoma patients with a different grade (I-IV) of malignity. Aromatase and estrogen receptor mRNA expression were analyzed by semiquantitative RT-PCR, and the E2 levels, by ELISA. E2 concentration was higher in GBM, compared to grade II or III astrocytomas. The number of cells immunoreactive to aromatase and estrogen receptors decreased as the grade of tumor malignity increased. Aromatase mRNA expression was present in all biopsies, regardless of malignity grade or patient age or gender. The highest expression of aromatase mRNA in GBM patients was associated to the worst survival prognostic (6.28 months). In contrast lowest expression of ERα mRNA in astrocytoma patients had a worst prognosis. In conclusion, aromatase and ERα expression could be used as prognosis biomarkers for astrocytoma patients.

Improved measurement of intersession latency in mfVEPs.

PURPOSE: The purpose of the study is to present a method (Selfcorr) by which to measure intersession latency differences between multifocal VEP (mfVEP) signals. METHODS: The authors compared the intersession latency difference obtained using a correlation method (Selfcorr) against that obtained using a Template method. While the Template method cross-correlates the subject's signals with a reference database, the Selfcorr method cross-correlates traces across subsequent recordings taken from the same subject. RESULTS: The variation in latency between intersession signals was 0.8 ± 13.6 and 0.5 ± 5.0 ms for the Template and Selfcorr methods, respectively, with a coefficient of variability CV_TEMPLATE = 15.83 and CV_SELFCORR = 5.68 (n = 18, p = 0.0002, Wilcoxon). The number of analyzable sectors with the Template and Selfcorr methods was 36.7 ± 8.5 and 45.3 ± 8.7, respectively (p = 0.0001, paired t test, two tailed). CONCLUSIONS: The Selfcorr method produces smaller intersession mfVEP delays and variability over time than the Template method.

[Glycemic variability and oxidative stress in children, with type 1 diabetes attending a summer camp]. / Variabilidad glucémica y estrés oxidativo en niños con diabetes tipo 1 asistentes a un campamento.

OBJECTIVE: To assess glycemic variability, oxidative stress and their relationship in children and adolescents with type 1 diabetes (T1DM) attending a summer camp. PATIENTS AND METHOD: Cross-sectional study that included 54 children and adolescents with T1DM aged 7-16, attending a 7 day summer camp. Sociodemographic information, clinical data, and blood glucose values measured using an Accu-Chek Nano® glucose meter were recorded. Glucose variability markers (standard deviation [SD], low blood glucose index [LBGI], high blood glucose index [HBGI], mean amplitude of glycemic excursions [MAGE] and mean of daily differences [MODD]) were calculated. Oxidative stress was assessed by the measurement of 8-iso-prostaglandin F2 alpha (PGF2α) in a 24-hour urine sample collected at the end of the camp in 14 children. RESULTS: The Median SD, MAGE and MODD indexes were in the high range (61, 131 and 58 mg/dl, respectively), LBGI in the moderate range (3.3), and HBGI in the low range (4.5). The mean HbA1c was 7.6% and the median urinary excretion rate of 8-iso-PGF2α was 864.39 pg/mg creatinine. The Spearman correlation coefficients between markers of glycemic variability (SD, HBGI, MAGE, MODD) were significant. Non-significant correlations were found between markers of glycemic variability and urinary 8-iso-PGF2α. CONCLUSIONS: High glycemic variability was observed in children and adolescents attending a summer camp. However, no correlations were found between markers of glycemic variability and oxidative stress measured by urinary 8-iso-PGF2α. Further studies are needed to address the relationship between oxidative stress and glycemic variability in children with T1DM.

Is nuchal translucency a useful aneuploidy marker in fetuses with crown-rump length of 28-44 mm?

OBJECTIVE: To investigate whether increased nuchal translucency (NT) in fetuses with a crown-rump length (CRL) below 45 mm needs to be re-evaluated at a later stage, or whether the early NT measurement can be used effectively as an aneuploidy marker. METHODS: This was a prospective cohort study including all singleton fetuses with a CRL between 28 and 44 mm, scanned in our center during 2002-2012. The CRL, NT, fetal karyotype (when available) and pregnancy outcome were recorded. NT reference ranges were constructed using the Lambda-Mu-Sigma (LMS) method in non-referred pregnancies after exclusion of chromosomal anomalies. The 95(th) percentile was used to calculate detection rates for chromosomally abnormal fetuses. RESULTS: NT was successfully measured in 643 of 672 fetuses with a CRL of 28-44 mm. Subsequent cytogenetic analysis revealed 11 cases of trisomy 21, 14 cases of trisomy 13 or 18, three cases of monosomy X, three sex trisomies, three triploidies and 12 balanced anomalies. NT was above the 95(th) percentile in 64% of the fetuses with trisomy 21, in 71% with trisomy 13 or 18 and in all three cases of monosomy X. CONCLUSION: NT appears to be useful as a marker for the early detection of fetal trisomies at 9-10 weeks' gestation (28-44 mm CRL).