Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases.

PURPOSE: The present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. METHODS: retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid and others) and degree of malignancy (benign, premalignant, malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen´s kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. RESULTS: Of 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79.0%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen´s kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1 respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. CONCLUSION: Most of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.

[Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain]. / Impacto del COVID-19 en una enfermedad rara (melanoma uveal) en una unidad de referencia nacional de tumores intraoculares en España.

Objective: To analyze the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumor included in the Orphanet catalog of rare diseases) in a Spanish national reference unit for intraocular tumors during the first year of the pandemic. Material and methods: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analyzing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumor size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. Results: Eighty-two patients with uveal melanoma were included, of which 42(51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumor size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumor size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95% CI,1.10-90.25; p = 0.04, respectively). Conclusions: The increase in tumor size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain.

OBJECTIVE: To analyse the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumour included in the Orphanet catalogue of rare diseases) in a Spanish national reference unit for intraocular tumours during the first year of the pandemic. METHOD: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analysing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumour size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. RESULTS: Eighty-two patients with uveal melanoma were included, of which 42 (51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumour size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumour size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95%CI, 1.10-90.25; p = 0.04, respectively). CONCLUSIONS: The increase in tumour size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Nicotiana hairy roots for recombinant protein expression, where to start? A systematic review.

BACKGROUND: Hairy roots are a plant-tissue culture raised by Rhizobium rhizogenes infection (formerly known as Agrobacterium rhizogenes). Nowadays, these roots have been gaining more space in biotechnology due to their benefits for the recombinant expression of valuables proteins; it includes simplified downstream processing, protein rhizosecretion, and scalability in bioreactors. However, due to methodological inconsistency among reports, the tissue platform is still a promising technology. METHODS AND RESULTS: In the current paper, we propose the first step to overcome this issue through a systematic review of studies that employ Nicotiana hairy roots for recombinant expression. We conducted a qualitative synthesis of 36 out of 387 publications initially selected. Following the PRISMA procedure, all papers were assessed for exclusion and inclusion criteria. Multiple points of root culture were explored, including transformation methods, root growth curve, external additives, and scale-up with bioreactors to determine which approaches performed best and what is still required to achieve a robust protocol. CONCLUSION: The information presented here may help researchers who want to work with hairy roots in their laboratories trace a successful path to appraisal the literature status.

Correlated Chained Gaussian Processes for Datasets With Multiple Annotators.

The labeling process within a supervised learning task is usually carried out by an expert, which provides the ground truth (gold standard) for each sample. However, in many real-world applications, we typically have access to annotations provided by crowds holding different and unknown expertise levels. Learning from crowds (LFC) intends to configure machine learning paradigms in the presence of multilabelers, residing on two key assumptions: the labeler's performance does not depend on the input space, and independence among the annotators is imposed. Here, we propose the correlated chained Gaussian processes from the multiple annotators (CCGPMA) approach, which models each annotator's performance as a function of the input space and exploits the correlations among experts. Experimental results associated with classification and regression tasks show that our CCGPMA performs better modeling of the labelers' behavior, indicating that it consistently outperforms other state-of-the-art LFC approaches.

[Clinical and epidemiologic description of a severe outbreak of Salmonellosis in an urban nursery school]. / Descripción clínica y epidemiológica de un brote grave de salmonelosis en una escuela infantil urbana.

OBJECTIVE: We describe clinically and epidemiologically an outbreak of gastrointestinal infection by Salmonella enterica ser. (serotype) Enteritidis in an urban infant school, which led to high morbidity and significant social alarm. The immediate communication, as well as the adequate study of the outbreak, in both aspects, allowed identifying the pathogen and establishing control measures in a reasonable period of time. Controversial aspects such as the indication of antibiotherapy or the moment of closing the center are discussed. METHODS: We retrospectively collected clinical, analytical and epidemiological information and we reviewed the methodology of the outbreak study and its results. RESULTS: A total of 57 children (3-45 months), were affected and had microbiological confirmation. Diarrhea and fever were the main symptoms. 74% went to the hospital and 37% were admitted (mean stay 3.3 days). Factors associated with admission were: dehydration, significant elevation of acute phase reactants and coagulopathy. Twelve patients received parenteral cefotaxime. There were 2 complications: 1 bacteremia and 1 readmission. The initial suspicion of the origin of the outbreak was food, but the analysis of the control samples was negative. Five workers were positive (2 symptomatic). Epidemiologic Surveillance concluded that the probable origin of the outbreak was an asymptomatic carrier and improper diapers handling. The center was closed for 8 days. Cleaning and disinfection measures were carried out, as well as instruction on diaper changing, and the carriers were followed. CONCLUSIONS: Clustering in time and space of cases should be reported immediately for early control of the outbreak. Children may present severe forms of Salmonella gastroenteritis.

Development and validation of a new methodological platform to measure behavioral, cognitive, and physiological responses to food interventions in real time.

To fully understand the causes and mechanisms involved in overeating and obesity, measures of both cognitive and physiological determinants of eating behavior need to be integrated. Effectively synchronizing behavioral measures such as meal micro-structure (e.g., eating speed), cognitive processing of sensory stimuli, and metabolic parameters, can be complex. However, this step is central to understanding the impact of food interventions on body weight. In this paper, we provide an overview of the existing gaps in eating behavior research and describe the development and validation of a new methodological platform to address some of these issues. As part of a controlled trial, 76 men and women self-served and consumed food from a buffet, using a portion-control plate with visual stimuli for appropriate amounts of main food groups, or a conventional plate, on two different days, in a random order. In both sessions participants completed behavioral and cognitive tests using a novel methodological platform that measured gaze movement (as a proxy for visual attention), eating rate and bite size, memory for portion sizes, subjective appetite and portion-size perceptions. In a sub-sample of women, hormonal secretion in response to the meal was also measured. The novel platform showed a significant improvement in meal micro-structure measures from published data (13 vs. 33% failure rate) and high comparability between an automated gaze mapping protocol vs. manual coding for eye-tracking studies involving an eating test (ICC between methods 0.85; 90% CI 0.74, 0.92). This trial was registered at Clinical Trials.gov with Identifier NCT03610776.

Sleep quality and memory function in healthy ageing.

OBJECTIVE: To study the relationship between sleep quality and memory in healthy ageing. METHODS: The study included 99 people older than 50 years (69 women and 30 men; mean age, 68.74 ± 7.18 years) with no associated diseases. Patients completed digital versions of the Word Learning (WL) and Visual Paired Associates (VPA) tests and the Pittsburgh Sleep Quality Index (PSQI) questionnaire to assess the quality of sleep. RESULTS: PSQI score was negatively correlated with VPA and WL test performance. Performance in these 2 memory tests decreased in line with sleep quality. In addition, performance in VPA test was negatively correlated with subjective sleep quality, duration, and sleep disturbances. Performance on the WL test was negatively correlated with subjective sleep quality and efficiency. Participants' sex showed a weak effect on VPA performance and sleep latency. CONCLUSIONS: Medical professionals working with elderly patients should take into consideration the effect of poor sleep quality on memory. Cognitive impairment in these patients may be a manifestation of a neuroendocrine imbalance due to a disrupted circadian rhythm. More research is needed to prove this hypothesis.

Electrocatalytic activity of calcined manganese ferrite solid nanospheres in the oxygen reduction reaction.

In this study, we synthesized MnFe2O4 solid nanospheres (MSN) calcined at different temperatures (200-500 °C) and MSN-based materials mixed with carbon black, for their use as electrocatalysts in the oxygen reduction reaction (ORR) in alkaline medium (0.1 M KOH). It was demonstrated that the calcination temperature of MSN material determined its chemical surface composition and microstructure and it had an important effect on the electrocatalytic properties for ORR, which in turn was reflected in the performance of MSN/CB-based electrocatalysts. The study revealed that the presence of Mn species plays a key role in the ORR activity. Among tested, MSN200/CB and MSN350/CB exhibited the best electrochemical performances together with outstanding stability.

Prevalence of primary eosinophilic colitis in patients with chronic diarrhea and diarrhea-predominant irritable bowel syndrome.

INTRODUCTION: Primary eosinophilic colitis (PEC) is an inflammatory disease caused by the infiltration of eosinophils into the mucosa of the colon, determined after having ruled out other possible causes. It is characterized by abdominal pain and diarrhea and its prevalence is unknown. AIMS: To know the prevalence of PEC in patients with chronic diarrhea and in those with clinical criteria for diarrhea-predominant irritable bowel syndrome (IBS-D). PATIENTS AND METHODS: All patients with chronic noninflammatory diarrhea that were consecutively seen over a decade were studied through colonoscopy, with systematic biopsy. Patients with a known or decompensated organic disease, alarm features, abnormal minimal laboratory test results, and factors associated with eosinophilia were excluded. Patients with the clinical criteria for IBS-D (Rome III) were selected from the general group. Eosinophilic colitis was defined as the presence of > 35 eosinophils/100 epithelial cells per field in any of the segments. RESULTS: From the 683 patients seen, a total of 545 patients (361 women) were included in the study. Twenty-two cases of PEC were detected, resulting in a prevalence of 4.0%. A total of 343 patients had IBS-D criteria (223 women), with 16 cases of PEC detected, for a prevalence of 4.7%. Colonoscopy was normal, or almost normal, in all the PEC cases detected. CONCLUSIONS: The prevalence of PEC was 4.0% in the patients with chronic diarrhea and 4.7% in the patients with IBS-D. Peripheral eosinophilia appeared to be the main distinctive clinical characteristic, but systematic biopsy was essential for making the diagnosis.

Metastatic involvement of optic nerve in patient with breast and lung neoplasia.

Metastases are the most common adult intraocular tumors. However, those located in the optic nerve are very uncommon and are usually associated with spread to other locations such as the central nervous system, which darkens the prognosis. There is a case of a 67-year-old woman who reports progressive vision loss in the right eye of 15 days of evolution. The ophthalmological examination shows a relative afferent pupil defect in this eye and a pseudoedema of the papilla with retinal hemorrhages in the fundus. Personal history and characteristics of the optic nerve suggest the diagnosis of metastatic infiltration.

Intraocular metastasis as a systemic presentation of neuroendocrine differentiation of prostate carcinoma.

A 68 year-old male was referred for assessment of an amelanotic lesion in the right eye (RE) that was associated with a gradual loss of visual acuity (VA), of 2 months onset, as the main symptom. It was noted in his medical history, that 6 years ago, he had prostate cancer treated with prostatectomy, lymphadenectomy, and coadjuvant local radiotherapy (RT). He was asymptomatic until 6 months ago, when a metastasis was discovered in the left femur, which was treated with radiotherapy. There were no findings of interest in the left eye (LE). His AV was very low in his RE, and in the eye fundus examination a mass without pigment was observed in the posterior pole with an adjacent exudative retinal detachment. Due to his personal history and results of the complementary tests such as ultrasound and magnetic resonance, the most likely diagnostic option was metastasis of prostate carcinoma, subsequently being confirmed with the histopathology results. Despite 4 cycles of chemotherapy, the patient did not show any clinical or radiological response, worsening until his death 3 months later.

Incidence of enterovirus in patients with acute gastroenteritis.

Enteroviruses (EV) have been linked to lymphocytic meningitis and exanthems, but they may also be involved in acute gastroenteritis (AGE), a condition whose aetiological agent often remains unidentified. In this work 1214 samples from individuals with AGE were studied with the aim of establishing the incidence of EV. The samples were collected between September and December in three different years and subjected to real-time genomic amplification in order to determine the viral load (VL). Of the 1214 samples studied, infection by a single virus was found in 328 cases (27%) and coinfection in 69 (5.7%). While adenoviruses (AdV) were the most frequent (14.8% of total), EV were present in 126 (10.4%) of the individuals tested. Of the 126 EV-positive samples, this virus was found as a single infection and coinfection in 76 (6.3%) and 50 (4.1%) cases, respectively. VL for EV was 5.58±1.51 log copies/ml (range 3.73-9.69) in the former and 6.27±1.75 (range 3.73-10.5) (p=0.02) in the latter. EV were identified in 97 children under 5 (16.9%) and in 29 (4.5%) patients over 5. Patients less than 5 years showed a higher VL that those more than 5 years age [6.08±1.57 (range 3.82-9.69) vs. 5.07±1.53 (range 3.73-10.58); (p=0.002)]. There was a high incidence of EV in AGE patients, and they were more frequent in those under 5, where they were found to replicate more efficiently. These results therefore indicate that testing for EV should be included in the diagnosis of AGE.

Prevalence of primary eosinophilic colitis in patients with chronic diarrhea and diarrhea-predominant irritable bowel syndrome. / Prevalencia de colitis eosinofílica primaria en pacientes con diarrea crónica y síndrome de intestino irritable con predominio de diarrea.

INTRODUCTION: Primary eosinophilic colitis (PEC) is an inflammatory disease caused by the infiltration of eosinophils into the mucosa of the colon, determined after having ruled out other possible causes. It is characterized by abdominal pain and diarrhea and its prevalence is unknown. AIMS: To know the prevalence of PEC in patients with chronic diarrhea and in those with clinical criteria for diarrhea-predominant irritable bowel syndrome (IBS-D). PATIENTS AND METHODS: All patients with chronic noninflammatory diarrhea that were consecutively seen over a decade were studied through colonoscopy, with systematic biopsy. Patients with a known or decompensated organic disease, alarm features, abnormal minimal laboratory test results, and factors associated with eosinophilia were excluded. Patients with the clinical criteria for IBS-D (Rome III) were selected from the general group. Eosinophilic colitis was defined as the presence of>35eosinophils/100 epithelial cells per field in any of the segments. RESULTS: From the 683 patients seen, a total of 545 patients (361 women) were included in the study. Twenty-two cases of PEC were detected, resulting in a prevalence of 4.0%. A total of 343 patients had IBS-D criteria (223 women), with 16 cases of PEC detected, for a prevalence of 4.7%. Colonoscopy was normal, or almost normal, in all the PEC cases detected. CONCLUSIONS: The prevalence of PEC was 4.0% in the patients with chronic diarrhea and 4.7% in the patients with IBS-D. Peripheral eosinophilia appeared to be the main distinctive clinical characteristic, but systematic biopsy was essential for making the diagnosis.

[Variability between health areas in antibiotic consumption among pediatric outpatients of Principado de Asturias, Spain (2005-2018)]. / Variabilidad entre áreas sanitarias en el consumo extrahospitalario de antibióticos de uso sistémico en la población pediátrica del Principado de Asturias, España (2005-2018).

OBJECTIVE: Antibiotics in Spain are mainly prescribed in the community sector, remarking a high variability between areas. The aim of this study is to describe the variability between health areas in the antibiotic consumption in the pediatric population of Asturias during 2005-2018 period. METHODS: Retrospective and comparative study using data about consumption of antibacterial agents for systemic use (J01C group in ATC, Anatomical Therapeutic Chemical, classification) in the pediatric outpatients of the eight health areas of Principado de Asturias between 2005 and 2018, based on defined daily dose (DDD) per 1000 inhabitants and day (DID). RESULTS: Mean antibiotic consumption in pediatric outpatients in Principado de Asturias (2005-2018) was 14 DID (CI95% 13.4 - 14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). ß-lactam penicillins was the most consumed therapeutic group (10.7 DID). There were statistically significant differences among the areas with the highest and the lowest consumption rates (Avilés, 19 DID; Oviedo, 11.5 DID). A high variability between health areas was observed when analysing data temporally (difference of 11.8 DID in 2011) and therapeutic groups. The consumption of macrolides in Langreo health area and quinolones in Jarrio health area were 2.3 and 4.1 times higher, respectively, comparing to Gijón health area. CONCLUSIONS: There is a wide quantitative and qualitative variability of antibiotic consumption in the pediatric outpatients among the different health areas of Asturias.

Effect of forage type, season, and ripening time on selected quality properties of sheep milk cheese.

The aim of this research was to study changes in the microbial populations, free AA profile, biogenic amine content, and sensory characteristics of ripened cheeses (100 and 180 d) produced in different seasons (summer, autumn, winter, and spring) from pasteurized sheep milk from 8 commercial flocks fed hay or silage diets. Twenty-one individual AA and 6 biogenic amines were determined by ultra-high performance liquid chromatography. Type of conserved forage for sheep feeding did not affect the variables studied, which is of great interest because hay and silage are low-cost ingredients for sheep feeding. Proteolysis led total free AA concentrations ranging between 35,179.26 and 138,063.71 mg/kg of cheese at 180 d of ripening. γ-Aminobutyric acid, which has been associated with beneficial effects on human health, was the second most abundant AA in all cheese samples, accounting for 15% of total free AA. Spring cheeses showed 2-fold higher concentrations of γ-aminobutyric acid than summer and autumn cheeses at the end of ripening. Overall, spring, winter, and autumn cheeses had lower average concentration of biogenic amines (431.99 mg/kg of cheese) than summer cheeses (825.70 mg/kg of cheese) as well as better sensory characteristics. Therefore, this study could provide the dairy industry with useful information for producing cheeses with valuable nutritional and sensory quality for consumers.

Effectiveness of nanoscale zero-valent iron for the immobilization of Cu and/or Ni in water and soil samples.

In the last few years, the effectiveness of nanoscale zero-valent iron (nZVI) as a treatment for polluted waters and soils has been widely studied. However, little data are available on its efficacy for metal immobilization at low and moderate doses. In this study, the effectiveness of two doses of commercial nZVI (1 and 5%) to immobilize Cu and/or Ni in water and acidic soil samples was evaluated. The influence of the nanoremediation technology on iron availability, physico-chemical soil properties and soil phytotoxicity was also assessed. The results show that the effectiveness of nZVI to immobilize Cu and Ni in water and soil samples was determined by the dose of the nanomaterial and the presence of both metals. Nickel immobilization was significantly decreased by the presence of Cu but the opposite effect was not observed. nZVI showed better immobilization capacity in water than in soil samples. In water, the dose of 5% completely removed both metals, whereas at a lower dose (1%) the percentage of immobilized metal decreased, especially for Ni in Cu + Ni samples. In soil samples, 5% nZVI was more effective in immobilizing Ni than Cu, with a 54% and 21% reduction of leachability, respectively, in single contaminated samples. In Cu + Ni soil samples, nZVI treatment led to a significant decrease in Ni immobilization, similar to that observed in water samples. The application of nZVI induced a dose-dependent increase in available Fe-a relevant effect in the context of soil rehabilitation. Germination assays of Medicago sativa and Vicia sativa seeds revealed that treatment with nZVI did not induce phytotoxicity under the experimental conditions tested, and that the phytotoxicity induced by Ni decreased significantly after the treatment. Thus, the use of nZVI emerges as an interesting option for Cu and/or Ni immobilization in water samples. The effectiveness of nZVI to remove Cu from acidic soil samples was moderate, while for Ni it was strongly dependent on the presence of Cu. These observations therefore indicate that the results in water samples cannot be extrapolated to soil samples.

Bilateral mirror hand: 2-year follow-up and literature review.

INTRODUCTION: Mirror hand syndrome is a very rare congenital deformity, also called cubital dimelia, characterized by the absence of the thumb, as well as the duplication of the fingers in a symmetrical image and, in some cases, with a duplication of the bones of the forearm. METHODS: The current treatment consists of a thumb reconstruction through thumb pollicization, although there are alternatives such as rotating osteotomy, syndactylization or conservative treatment. In this article we present the case of a girl with a non-classic bilateral mirror hand, the clinical and radiological findings, the bilateral surgical technique in two surgical times with six months of difference and two years follow-up. RESULTS: Complete mobility arches, as well as a good hand holding function were achieved with metacarpophalangeal thumb flexion 0-40o, interphalangeal 5-45o and abduction-adduction 0-50o. We achieved a complete opposition of the new thumb with respect to the other fingers. The strength of the clamp between the fingers was 75.2% of the normal force for her given age, while the strength of the lateral clamp of 66.3% and that of the grip of the fist was 69.1%. CONCLUSION: The surgical technique in the present case (pollicization of the thumb) is an excellent option, achieving objectives of fine and gross motor skills, and good cosmetic results.

INTRODUCCIÓN: Mano en espejo es una deformidad congénita muy rara, en ocasiones conocida como dimelia cubital, caracterizada por la ausencia del dedo pulgar, así como la duplicación de los dedos en imagen simétrica y, de forma clásica, también de los huesos del antebrazo. MÉTODOS: El tratamiento actual consiste en una reconstrucción del pulgar mediante pulgarización, aunque existen alternativas como osteotomía rotadora, sindactilización o el tratamiento conservador. En este artículo se presenta el caso de una niña con mano en espejo no clásica bilateral, los hallazgos clínicos, radiológicos, la reconstrucción quirúrgica de ambas manos consistente en pulgarización tipo Buck-Gramcko bilateral en dos tiempos quirúrgicos con seis meses de diferencia y el seguimiento a corto plazo. RESULTADOS: Presentó arcos de movilidad completos, así como una buena función de sujeción de la mano, se lograron con la flexión del pulgar metacarpofalángica 0-40o, interfalángica 5-45o y abducción-aducción 0-50o. Logramos una oposición del nuevo pulgar con respecto a los otros dedos. La fuerza de la pinza entre los dedos fue del 75.2% de la fuerza normal para la edad, mientras que la fuerza de la pinza lateral fue de 66.3% y la de la empuñadura fue de 69.1%. CONCLUSIÓN: La técnica quirúrgica utilizada en el presente caso demuestra una excelente opción, logrando objetivos de pinza gruesa, pinza fina y agarres, así como un buen resultado cosmético.

Prospective, multicenter study on the economic and clinical impact of gene-expression assays in early-stage breast cancer from a single region: the PREGECAM registry experience.

INTRODUCTION: The aim of this study is to evaluate the cost-effectiveness and impact of gene-expression assays (GEAs) on treatment decisions in a real-world setting of early-stage breast cancer (ESBC) patients. METHODS: This is a regional, prospective study promoted by the Council Health Authorities in Madrid. Enrolment was offered to women with estrogen receptor-positive, human epidermal growth factor receptor 2-negative, node-negative or micrometastatic, stage I or II breast cancer from 21 hospitals in Madrid. Treatment recommendations were recorded before and after knowledge of tests results. An economic model compared the cost-effectiveness of treatment, guided by GEAs or by common prognostic factors. RESULTS: 907 tests (440 Oncotype DX® and 467 MammaPrint®) were performed between February 2012 and November 2014. Treatment recommendation changed in 42.6% of patients. The shift was predominantly from chemohormonal (CHT) to hormonal therapy (HT) alone, in 30.5% of patients. GEAs increased patients' confidence in treatment decision making. Tumor grade, progesterone receptor positivity and Ki67 expression were associated with the likelihood of change from CHT to HT (P < 0.001) and from HT to CHT (P < 0.001). Compared with current clinical practice genomic testing increased quality-adjusted life years by 0.00787 per patient and was cost-saving from a national health care system (by 13.867€ per patient) and from a societal perspective (by 32.678€ per patient). CONCLUSION: Using GEAs to guide adjuvant therapy in ESBC is cost-effective in Spain and has a significant impact on treatment decisions.