Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study.

PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.

[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]. / Impacto de la pandemia COVID-19 en la formación sanitaria especializada en un centro docente.

OBJECTIVE: Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center. METHODS: Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation. RESULTS: The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources. CONCLUSIONS: The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

Analysing body composition as compositional data: An exploration of the relationship between body composition, body mass and bone strength.

Human body composition is made up of mutually exclusive and exhaustive parts (e.g. %truncal fat, %non-truncal fat and %fat-free mass) which are constrained to sum to the same total (100%). In statistical analyses, individual parts of body composition (e.g. %truncal fat or %fat-free mass) have traditionally been used as proxies for body composition, and have been linked with a range of health outcomes. But analysis of individual parts omits information about the other parts, which are intrinsically co-dependent because of the constant sum constraint of 100%. Further, body mass may be associated with health outcomes. We describe a statistical approach for body composition based on compositional data analysis. The body composition data are expressed as logratios to allow relative information about all the compositional parts to be explored simultaneously in relation to health outcomes. We describe a recent extension to the logratio approach to compositional data analysis which allows absolute information about the total of the compositional parts (body mass) to be considered alongside relative information about body composition. The statistical approach is illustrated by an example that explores the relationships between adults' body composition, body mass and bone strength.

The adiposity of children is associated with their lifestyle behaviours: a cluster analysis of school-aged children from 12 nations.

BACKGROUND: The relationship between children's adiposity and lifestyle behaviour patterns is an area of growing interest. OBJECTIVES: The objectives of this study are to identify clusters of children based on lifestyle behaviours and compare children's adiposity among clusters. METHODS: Cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment were used. PARTICIPANTS: the participants were children (9-11 years) from 12 nations (n = 5710). MEASURES: 24-h accelerometry and self-reported diet and screen time were clustering input variables. Objectively measured adiposity indicators were waist-to-height ratio, percent body fat and body mass index z-scores. ANALYSIS: sex-stratified analyses were performed on the global sample and repeated on a site-wise basis. Cluster analysis (using isometric log ratios for compositional data) was used to identify common lifestyle behaviour patterns. Site representation and adiposity were compared across clusters using linear models. RESULTS: Four clusters emerged: (1) Junk Food Screenies, (2) Actives, (3) Sitters and (4) All-Rounders. Countries were represented differently among clusters. Chinese children were over-represented in Sitters and Colombian children in Actives. Adiposity varied across clusters, being highest in Sitters and lowest in Actives. CONCLUSIONS: Children from different sites clustered into groups of similar lifestyle behaviours. Cluster membership was linked with differing adiposity. Findings support the implementation of activity interventions in all countries, targeting both physical activity and sedentary time.

[Progressive encephalitis due to anti-DPPX antibodies: a case with good response to treatment with rituximab]. / Encefalitis progresiva por anticuerpos anti-DPPX: un caso con buena respuesta al tratamiento con rituximab.

TITLE: Encefalitis progresiva por anticuerpos anti-DPPX: un caso con buena respuesta al tratamiento con rituximab.

Recycling of plastic waste: Presence of phthalates in plastics from households and industry.

Plastics recycling has the potential to substitute virgin plastics partially as a source of raw materials in plastic product manufacturing. Plastic as a material may contain a variety of chemicals, some potentially hazardous. Phthalates, for instance, are a group of chemicals produced in large volumes and are commonly used as plasticisers in plastics manufacturing. Potential impacts on human health require restricted use in selected applications and a need for the closer monitoring of potential sources of human exposure. Although the presence of phthalates in a variety of plastics has been recognised, the influence of plastic recycling on phthalate content has been hypothesised but not well documented. In the present work we analysed selected phthalates (DMP, DEP, DPP, DiBP, DBP, BBzP, DEHP, DCHP and DnOP) in samples of waste plastics as well as recycled and virgin plastics. DBP, DiBP and DEHP had the highest frequency of detection in the samples analysed, with 360µg/g, 460µg/g and 2700µg/g as the maximum measured concentrations, respectively. Among other, statistical analysis of the analytical results suggested that phthalates were potentially added in the later stages of plastic product manufacturing (labelling, gluing, etc.) and were not removed following recycling of household waste plastics. Furthermore, DEHP was identified as a potential indicator for phthalate contamination of plastics. Close monitoring of plastics intended for phthalates-sensitive applications is recommended if recycled plastics are to be used as raw material in production.

[Prevalence of multiple sclerosis in the Region of Murcia]. / Prevalencia de la esclerosis multiple en la Region de Murcia.

INTRODUCTION: Multiple sclerosis (MS) is a demyelinating inflammatory disease of the central nervous system with immune-mediated pathogenesis. Recent research points to an increase in its prevalence, and a number of studies relate Epstein-Barr virus (EBV) with its aetiology. AIMS: This study seeks to analyse the prevalence of MS in the Region of Murcia, and includes a description of the clinical characteristics at the time of onset of the disease, and of the EBV serological status of patients with MS. PATIENTS AND METHODS: We conducted a retrospective epidemiological study based on a sample consisting of the population living within the central-west healthcare area of the Region of Murcia (257,865 inhabitants). Clinical and serological data extracted from different sources were analysed. RESULTS: Prevalence of MS in the population under study: 88 cases/100,000 inhabitants. Prevalence of MS together with isolated demyelinating syndrome: 98.4 cases/100,000 inhabitants. Mean incidence of MS: 5.8 cases/100,000 inhabitants/year. At the onset of MS, 67.8% were females, 81.9% presented a relapsing-remitting course, the mean age was 31.4 years, the sensory system was the most frequently compromised (45.1%), onset was monofocal in 55.4% and the degree of disability on the Expanded Disability Status Scale was 2.1 points. The seroprevalence of EBV was 99.3%. The reactivation of EBV infection was related to the clinical activity of MS in 10 patients (45.4%). CONCLUSIONS: Currently, the prevalence of MS in the Region of Murcia is similar to that estimated in other Spanish autonomous regions. The study confirms the trend of increased prevalence observed over the last few decades.

TITLE: Prevalencia de la esclerosis multiple en la Region de Murcia.Introduccion. La esclerosis multiple (EM) es una enfermedad inflamatoria desmielinizante del sistema nervioso central con patogenia inmunomediada. Recientes estudios indican un aumento de su prevalencia, y numerosos trabajos relacionan el virus de Epstein-Barr (VEB) con su etiologia. Objetivo. Analisis de prevalencia de la EM en la Region de Murcia, incluyendo la descripcion de las caracteristicas clinicas en el momento del inicio de la enfermedad, y del estado serologico del VEB de los pacientes con EM. Pacientes y metodos. Estudio epidemiologico retrospectivo, tomando como muestra la poblacion residente en el area sanitaria centro-oeste de la Region de Murcia (257.865 habitantes). Se analizan datos clinicos y serologicos extraidos de diferentes fuentes. Resultados. Prevalencia de la EM en la poblacion estudiada: 88 casos/100.000 habitantes. Prevalencia de la EM junto con el sindrome desmielinizante aislado: 98,4 casos/100.000 habitantes. Incidencia media de la EM: 5,8 casos/100.000 habitantes/año. En el inicio de la EM, el 67,8% eran mujeres, el 81,9% presentaba un curso recurrente-remitente, la edad media era de 31,4 años, el sistema funcional mas frecuentemente afectado era el sensitivo (45,1%), el inicio fue monofocal en el 55,4% y el grado de discapacidad en la Expanded Disability Status Scale era de 2,1 puntos. La seroprevalencia del VEB fue del 99,3%. La reactivacion de la infeccion por VEB se relaciono con actividad clinica de EM en 10 pacientes (45,4%). Conclusiones. Actualmente, la prevalencia de la EM en la Region de Murcia es similar a la estimada en otras comunidades autonomas españolas. El estudio confirma la tendencia de incremento de prevalencia observada en las ultimas decadas.

[Satisfaction with primary care nursing: use of measurement tools and explanatory factors]. / Satisfacción con la enfermera en atención primaria: herramientas de medida y factores explicativos.

OBJECTIVES: This study aims to assess the psychometric properties of two measurement tools for patient satisfaction with nursing care in Primary Care, the satisfaction level, and the personal and consultation characteristics associated with its variability. METHODS: Subjects randomly selected in 23 Health Care centres in the Community of Madrid were included. Satisfaction was measured by means of the AMABLE and Baker questionnaires, in which the psychometric properties were evaluated. Sociodemographic characteristics of the consultations, variables related to health status, and other related to the consultation process were collected. An explanatory model using Generalized Estimating Equations was constructed. RESULTS: The 662 subjects expressed a mean satisfaction of 4.95/5 (SD .25) with AMABLE, and 4.83/5 (SD .42) with the Baker questionnaire. AMABLE had a single dimension (Cronbach's alpha .85), and Baker three: professional care (mean 4.76, SD .48 Cronbach's alpha .74), depth of relationship (mean 3.76, SD 1.18, Cronbach's alpha .73), and perceived time (mean 4.42, SD .86, Cronbach's alpha .47). Ageing, a better perception of health status, and appointments arranged by nurses were associated with higher expressed satisfaction. Home care, hospital admissions, delayed consultation, extended family, or high family income were associated with lower satisfaction. CONCLUSIONS: Satisfaction with nurse consultations in Primary Care was very high, and varied depending on personal characteristics and on the type of consultation. The assessed tools allowed this outcome to be measured properly.

Values below detection limit in compositional chemical data.

Samples representing part of a whole, usually called compositional data in statistics, are commonplace in analytical chemistry--say chemical data in percentage, ppm, or µg g(-1). Their distinctive feature is that there is an inherent relationship between all the analytes constituting a chemical sample as they only convey relative information. Some compositional data analysis principles and the log-ratio based methodology are outlined here in practical terms. Besides, one often finds that some analytes are not present in sufficient concentration in a sample to allow the measuring instruments to effectively detect them. These non-detects are usually labelled as "

[Impact of the long active beta-2 agonists inhaled therapy on the quality of life in asthmatic patients]. / Impacto de la terapia inhalada con beta-2 agonistas de larga duración sobre la calidad de vida en pacientes asmáticos.

OBJECTIVE: To assess the impact of the addition of inhaled therapy with long acting beta2-agonists (formoterol) on the health related quality of life (HRQL) in asthmatic patients treated with inhaled corticosteroids and poorly controlled. METHODS: Observational prospective naturalistic study with a cohort of 343 ambulatory patients during 6 months. We collected socio-demographic, clinical and lung function variables. The HRQL was assessed by means of a generic scale (SF-36) and a specific one (Marks's AQLQ). RESULTS: They were evaluated 268 patients (78%). mean age 48.6 years (SD 16.28), 64.15% women. Women and the subjects with worse socioeconomic situation had poor basal HRQL scores. During the follow-up an average improvement in FEV1 of 0.26 l (SD 0.44; p <0.001) was observed. The average change in the AQLQ was -1.92 (-2.09-1.75) being the larger improvement in the breathlessness domain. The average change in SF-36 was 5.13 (4.75-5.51) for physical standardized component and 5.23 (4.83-5.63) for mental component. The effect size was "large" with the measurement of the AQLQ and "moderate" with SF-36. The AQLQ and SF-12 scores are strongly correlated. basally and after the treatment (r > 0.5). CONCLUSION: To add long acting beta2-agonists to the asthmatic patients treated with inhaled corticosteroids and poorly controlled, under usual clinical practice conditions, is associated with an improvement of the HRQL perception measured by means of generic and specific instruments.

[Plasmapheresis: its use in multiple sclerosis and other demyelinating processes of the central nervous system. An observation study]. / Plasmaféresis: su utilidad en esclerosis múltiple y otros procesos desmielinizantes del sistema nervioso central. Estudio observacional.

INTRODUCTION: We present a retrospective observation study aimed at analyzing the value of plasmapheresis in the management of patients with multiple sclerosis (MS) and other acute demyelinating processes affecting the central nervous system (CNS) who show severe exacerbations that do not respond well to conventional therapy with corticoids. PATIENTS AND METHODS: A total of 11 patients were included in the study: nine with MS, one disseminated acute encephalomyelitis and one case of transverse myelitis. All of them presented an acute or subacute neurological deficit, which prevented them from carrying out their day to day activities, with or without repercussions on the EDSS, and with the risk of suffering a severe residual disability after not responding to intravenous methylprednisolone pulses. Each patient was submitted to three exchanges per week, for 2 weeks, with association of orally administered prednisone and they were then evaluated after the last session and at one, six and twelve months. RESULTS: Following plasmapheresis all the patients experienced a significant drop in disability and seven of them (77.7% of the total number with MS) even improved during the first month with respect to their basal situation ( an extension of the Lazarus effect ). After a year s follow up, 100% of the patients still maintained the basal situation that was recovered from before exacerbation, and only two relapses were recorded. The patients with MS presented a transient exacerbation after the second exchange. New therapy with immunosuppressants, immunomodulators or both was associated in eight cases. CONCLUSIONS: We consider plasmapheresis to be a safe, effective therapeutic procedure in the management of patients with MS and other demyelinating processes affecting the CNS. Its use should be considered as first choice in severe relapses and in swiftly progressing forms that do not respond to intravenous methylprednisolone.

Toward gene therapy for human CD3 deficiencies.

The CD3 subunits of the T cell receptor-CD3 complex (TCR-CD3) help to regulate surface TCR-CD3 expression, and participate in signal transduction leading to intrathymic selection and peripheral antigen recognition by T lymphocytes. Humans who lack individual CD3 chains show impairments in the expression and activation-induced downregulation of TCR-CD3, and the defective immune responses that result may be lethal. We have investigated delivery of a normal CD3 chain to treat disorders of this type. Retroviral transduction of CD3gamma into CD3gamma-deficient peripheral blood T lymphocytes from two unrelated patients selectively corrected the observed TCR-CD3 expression and downregulation defects, but unexpectedly seemed to cause adverse effects that can be explained by an autoreactive recognition mechanism. These data support the feasibility of gene therapy for human CD3 deficiencies, but also suggest that gene transfer into postthymic lymphocytes carrying mutations on T cell recognition or activation pathways may disrupt their intrathymic calibration and become harmful to the host.

[Working atmosphere in primary care: what needs improving?]. / Clima laboral en atención primaria: qué hay que mejorar?

OBJECTIVE: To evaluate the factors linked to the perception of professional quality of life (PQL) in a health area. DESIGN: Analytical cross-sectional study. SETTING: Area 11, primary care, Madrid. PARTICIPANTS: The professionals in the area (1436) were stratified into three groups: I) doctors, pharmacists and psychologists; II) nurses, midwives, physiotherapists and social workers, and III) administrative and nursing assistants and caretakers. INTERVENTIONS: A satisfaction questionnaire (PQL-35) was sent out to 450 professionals selected at random. 282 replies were received (62.7%). All calculations used 95% confidence intervals. RESULTS: The mean PQL score (scale from 1 to 10) was 5.14 (4.90-5.37); for intrinsic motivation (IM), 7.41 (7.26-7.53); for management support (MS), 4.80 (4.64-4.96); and for work-loads (WL), 6.06 (5.91-6.21). Perception of PQL was higher in women, group II and professionals with fewer work demands. Perception of best MS was in women, urban centres and people in charge of administrative areas. Women and temporary workers had higher IM. WL perception was higher in groups I and III. Age, marital status, work shift, length of employment, number of companions and belonging to management committees were not related to PQL. In the multi-variate analysis MS was found to be the factor most affecting PQL. CONCLUSIONS: Perception of PQL is medium-low, with adequate intrinsic motivation but a certain discontent related to high work-loads and perception of scant management support.

Intraductal pancreatic carcinoma associated with pancreas divisum.

OBJECTIVE: we report the case of a 36 years old man with a pancreatic cancer associated to a pancreas divisum presenting as acute and relapsing recurrent pancreatitis. The coexistence of intraductal carcinoma and pancreas divisum is uncommon as let us do analyze its clinical, radiological and therapeutical features. CONCLUSIONS: 1. Pancreatic duct obstruction and pancreas divisum as congenital anomaly may be consider potential etiologies for pancreatic cancer. 2. Widespread use of magnetic resonance xholangiopancreatography and endoscopic retrograde xholangiopancreatography examinations together with brush cytology smears will allow more accurate approach to tumor diagnosis and management. 3. The use of pancreatoscopy in patients suffering from chronic pancreatitis may reveal helpful to discover intraductal neoplasms otherwise misdiagnosed.

Characterization of Herpesvirus saimiri-transformed T lymphocytes from common variable immunodeficiency patients.

Common variable immunodeficiency (CVID) is a very frequent but heterogeneous syndrome of antibody formation. The primary defect remains unknown, but many reports describe peripheral blood T lymphocyte dysfunctions in a substantial proportion of CVID patients, which may impair T--B cell collaboration. In order to investigate whether such putative defects were intrinsic to T cells or, rather, secondary to quantitative differences in T cell subset distribution, or to other described disorders, we have used Herpesvirus saimiri (HVS) for the targeted transformation of CVID CD4+ and CD8+ T cells and subsequent functional evaluation by flow cytometry of their capacity to generate cell surface (CD154, CD69) or soluble (IL-2, TNF-alpha, IFN-gamma) help after CD3 engagement. Unexpectedly, the results showed that 40 different CVID blood samples exposed to HVS gave rise with a significantly increased frequency to transformed CD4+ T cell lines, compared to 40 age-matched controls (27% versus 3%, P < or = 0.00002) suggesting the existence of a CVID-specific signalling difference which affects CD4+ cell transformation efficiency. The functional analysis of 10 CD4+ and 15 CD8+ pure transformed T cell lines from CVID patients did not reveal any statistically significant difference as compared to controls. However, half of the CD4+ transformed cell lines showed CD154 (but not CD69) induction (mean value of 46.8%) under the lower limit of the normal controls (mean value of 82.4%, P < or = 0.0001). Exactly the same five cell lines showed, in addition, a significantly low induction of IL-2 (P < or = 0.04), but not of TNF-alpha or IFN-gamma. None of these differences were observed in the remaining CD4+ cell lines or in any of the transformed CD8+ cell lines. We conclude that certain CVID patients show selective and intrinsic impairments for the generation of cell surface and soluble help by CD4+ T cells, which may be relevant for B lymphocyte function. The transformed T cell lines will be useful to establish the biochemical mechanisms responsible for the described impairments.