[Predictive models of gestational diabetes, a new prediction mode]. / Modelos predictivos de diabetes gestacional, un nuevo modelo de predicción.

OBJECTIVES: Recognized the value of gestational diabetes (GD) as a health problem, our aim in this work has been to analyze the diagnostic performance of the different today's existing criteria (GEDE, O'Sullivan and Carpenter) after the overload of 100 g of glucose and revise how to increase its efficiency. MATERIALS AND METHODS: We carried out a description of all the variables. In the analytical phase of the work, we used Pearson's Chi square to see if there were differences in the percentage of cases collected in each health center and the proportions contrast test to study the differences between the experimental prevalence. We completed binary logistic regression models using as result variable having or not having gestational diabetes (yes/no) and as predictors the four measurements of the curve with 100 g of glucose overload. To decide which model was better, the stepwise backward-forward analysis and the surface of the ROC curve generated by each of them were considered. RESULTS: We obtained a sample of 170 pregnant women from six different Primary Care Area of Seville health centers who had shown a positive O'Sullivan test with a median age of 35 years. There were significant differences in the prevalence proportions according to the criteria used: GEDE/O'Sullivan p < 0.001; GEDE/Carpenter p < 0.001. Logistic models with three and four predictor variables were equal in discriminatory diagnostic capacity when the GEDE criteria were used (area under the ROC curve = 0.96, 95% CI: 0.93-0.98). The back-forward stepwise analysis stayed with the three-variable model as the most parsimonious. The same did not occur when applying the other two criteria. CONCLUSIONS: Regarding an observational design, we state that there are significant differences in the prevalence proportions observed according to the criteria applied (p < 0.001) and we can also support that using the GEDE criteria, the taking of the third hour could be dispensed with, based on Bayesian criteria and the application of the ROC curve analysis.

Vitamin D receptor (VDR) expression in different molecular subtypes of canine mammary carcinoma.

BACKGROUND: The molecular-based classification of canine mammary carcinomas (CMCs) has been the focus of much current research. Both in canines and humans, the triple-negative (TN) molecular subtype of mammary cancer is defined by a lack of expression of progesterone receptor (PR), oestrogen receptor (ER) and HER2. It has a poor prognosis; no effective targeted therapy is available. Vitamin D displays anticarcinogenic properties, and the expression of its receptor (VDR) has been found in different molecular subtypes, being about 30-40 % of TN breast cancer (TNBC) positive to it. We assessed the VDR expression in the different molecular subtypes of 58 CMCs from 45 female dogs using an immunohistochemical panel for the molecular classification of included: PR, ER, HER2, cytokeratin (CK) 5, CK14, and Ki67. In addition, we studied the relationship among the molecular subtypes of CMCs and clinicopathologic parameters. RESULTS: Investigation showed VDR positivity in 45.0 % of the triple-negative CMCs (TNCMCs), 27.3 % of luminal B and 19.0 % of luminal A. Luminal A was the most molecular subtype represented of the total tumours (36.2 %), followed of TNCMCs (34.5 %), luminal B (20.7 %) and HER2-overexpression (10.3 %). Both HER2-overexpression and TNCMC subtypes were positively related to lymphatic invasion (P = 0.028), simple histologic subtype (P = 0.007), a higher histological grade (P = 0.045) and a trend to higher proliferation index (P = 0.09). CONCLUSIONS: The highest VDR expression was observed in TNCMC, being almost half of them (45 %) positive to this receptor. VDR expression was absent in HER2-overexpression tumours and low in luminal A and B molecular subtypes.

Multifractal structure of the monthly rainfall regime in Catalonia (NE Spain): Evaluation of the non-linear structural complexity.

The complex non-linear regime of the monthly rainfall in Catalonia (NE Spain) is analyzed by means of the reconstruction fractal theorem and the multifractal detrended fluctuation analysis algorithm. Areas with a notable degree of complex physical mechanisms are detected by using the concepts of persistence (Hurst exponent), complexity (embedding dimension), predictive uncertainty (Lyapunov exponents), loss of memory of the mechanism (Kolmogorov exponent), and the set of multifractal parameters (Hölder exponents, spectral asymmetry, spectral width, and complexity index). Besides these analyses permitting a detailed description of monthly rainfall pattern characteristics, the obtained results should also be relevant for new research studies concerning monthly amounts forecasting at a monthly scale. On one hand, the number of necessary monthly data for autoregressive processes could change with the complexity of the multifractal structure of the monthly rainfall regime. On the other hand, the discrepancies between real monthly amounts and those generated by some autoregressive algorithms could be related to some parameters of the reconstruction fractal theorem, such as the Lyapunov and Kolmogorov exponents.

Dyslipidaemia and other cardiovascular risk factors in relation to manifest cardiovascular disease in patients with chronic obstructive pulmonary disease in the Canary Islands. / Relación entre la dislipidemia y otros factores de riesgo cardiovasculares conocidos con la presencia de enfermedad cardiovascular en pacientes con enfermedad pulmonar obstructiva crónica de las Islas Canarias.

INTRODUCTION: Cardiovascular disease has a negative impact on the vital prognosis of patients with chronic obstructive pulmonary disease (COPD), where dyslipidaemia (DLP) and arterial hypertension (AHT) are considered the most prevalent risk factors. The objective of this study was 1) to assess the relationship between diagnosed DLP and cardiovascular disease in COPD patients and compare it with other known cardiovascular risk factors and 2) to determine the relationship between the different cardiovascular comorbidities and the severity groups according to the GOLD 2017 classification. METHODS: A cross-sectional, observational study was performed in 454 outpatients with COPD during their follow up. We calculated the prevalence of each of the cardiovascular comorbidities and the probability of each of the cardiovascular risk factors to occur jointly with a vascular disease (RRij). RESULTS: A total of 66.7% of the patients had DLP, whereby DLP was related to cerebrovascular accidents (CVA) (RRij 1.36, P=.0054), chronic kidney disease (CKD) (RRij 1.34, P=.00023), and peripheral arterial disease (PAD) (RRij 1.38, P=.00015). AHT was mostly related to CVA (RRij 1.41, P=.0014) and CKD (RRij 1.42, P<.0001). Type 2 diabetes mellitus (T2DM) correlated with PAD (RRij 1.90, P=.0001), heart failure (HF) (RRij 1,74, P=.0002), and CKD (RRij 1.76, P<.0001), and obesity was associated with HF (RRij 1.60, P=.0009) and CKD (RRij 1.54, P=.0001). CONCLUSION: DLP was related to CVA, CKD, and PAD. AHT and T2DM are the conditions that mostly relate to HF and CVA.

Reference genes for RT-qPCR normalisation in different tissues, developmental stages and stress conditions of amaranth.

Studies of gene expression are very important for the identification of genes that participate in different biological processes. Currently, reverse transcription quantitative real-time PCR (RT-qPCR) is a high-throughput, sensitive and widely used method for gene expression analysis. Nevertheless, RT-qPCR requires precise normalisation of data to avoid the misinterpretation of experimental data. In this sense, the selection of reference genes is critical for gene expression analysis. At this time, several studies focus on the selection of reference genes in several species. However, the identification and validation of reference genes for the normalisation of RT-qPCR have not been described in amaranth. A set of seven housekeeping genes were analysed using RT-qPCR, to determine the most stable reference genes in amaranth for normalisation of gene expression analysis. Transcript stability and gene expression level of candidate reference genes were analysed in different tissues, at different developmental stages and under different types of stress. The data were compared using the geNorm, NormFinder and Bestkeeper statistical methods. The reference genes optimum for normalisation of data varied with respect to treatment. The results indicate that AhyMDH, AhyGAPDH, AhyEF-1α and AhyACT would be optimum for accurate normalisation of experimental data, when all treatment are analysed in the same experiment. This study presents the most stable reference genes for normalisation of gene expression analysis in amaranth, which will contribute significantly to future gene studies of this species.

Vitamin D receptor expression in canine mammary gland and relationship with clinicopathological parameters and progesterone/oestrogen receptors.

The vitamin D receptor (VDR) belongs to the nuclear class II receptor family. VDR is a ligand transcription factor and mediates the actions of calcitriol, the active product of vitamin D synthesis. Nowadays, it is known that the biological actions of calcitriol include the capacity to modulate cancer features, such as proliferation and differentiation, apoptosis, angiogenesis, invasion and metastasis. VDR expression has been demonstrated in human breast cancer and vitamin D has emerged as a promising targeted therapy. We analyse the VDR expression in normal and neoplastic canine mammary tissue samples and its relationship with clinicopathological parameters and progesterone/oestrogens receptors (PR/ER). Expression of VDR, Ki67 (to evaluate the proliferation index, PI), PR and ER was assessed in 50 mammary gland tissue samples from 41 female dogs by immunohistochemistry. VDR-positive staining was found in the nuclei of both myoepithelial and luminal epithelial cell layers. VDR expression was higher in normal mammary tissue (37/37 cases, 100%) then followed by benign tumours (6/15 cases, 40%) and malignant tumours (9/34 cases, 26.5%) (P = .001). Female dogs aged ≥10 years had lower VDR expression compared with dogs younger (P = .017). Relationship between VDR and breed, number of tumours, tumour size, histologic subtype, histologic grade of malignancy, PI and PR and ER expression was not observed. Studies with more samples are necessary to further evaluate the possible role of VDR in the biological behaviour of canine mammary tumours, and to corroborate the possibility to use the dog as model for human breast cancer.

[Resistance rates and phenotypic characterization of Streptococcus pyogenes in a paediatric population in Northern Spain (2005-2015)]. / Cambios evolutivos en las tasas y fenotipos de resistencia de Streptococcus pyogenes en una población pediátrica de Asturias, España (2005-2015).

OBJECTIVE: Streptococcus pyogenes is a significant cause of bacterial infections in children. The aim of the study is to analyse resistance rates and phenotypes of S. pyogenes isolates in a paediatric population in Northern Spain over the last 11 years. METHODS: Descriptive retrospective study of S. pyogenes isolates from paediatric patients between 2005 and 2015 in a region of Asturias (Spain). Resistance rates and changes in erythromycin resistance phenotypes in two time periods (2005-2009 and 2010-2015) were studied. RESULTS: A total of 1,794 S. pyogenes isolates were registered (70% from 2005 to 2009). 87.5% were obtained from pharyngeal swabs and 0.2% from blood cultures. Resistance rates to tetracycline (8.8% to 4.3%, p=0.02), erythromycin (22% to 9.3%, p<0.01) and clindamycin (6% to 1.7%, p<0.01) decreased between the two study periods. A reduction in erythromycin-resistant isolates with the MLSB phenotype was observed. CONCLUSIONS: A decrease in S. pyogenes resistance rates to erythromycin and clindamycin and a change in the erythromycin resistance phenotype were observed along the study period.

Is time to search the Wells Score 4.0? / ¿Ha llegado el momento de buscar la escala de Wells 4.0?

BACKGROUND: Wells score for deep vein thrombosis presents problems for implementation in the hospital emergencies, mainly due to the complexity of its enforcement. OBJECTIVE: To assess whether the inclusion of D-dimer as a predictor might lead to a simplification of this clinical decision rule. PATIENTS AND METHODS: A database of deep vein thrombosis patients was studied by logistic regression model in which the 10 predictors in the Wells score and the dimer D were included. The diagnosis was made with compression ultrasonography with Doppler signal. D-dimer was determined by a quantitative method of latex, a technique immunofiltration or a turbidimetric technique. RESULTS: 577 patients (54.1% women) were studied, with a mean age of 66.7 (14.2) years. 25.1% were diagnosed with deep vein thrombosis. Only four variables were independent, building a weighted model with greater predictive ability (area under the curve) than the original model (0.844 vs. 0.751, p<0.001). Both models showed an acceptable safety, with a similar rate of failure (0.8% vs. 1%). The simplified model allowed to select a higher percentage of patients who could have benefited from the non performance of the imaging test (20.6% vs. 15.8%, p=0.039). CONCLUSIONS: The introduction of D-dimer in a regression model simplifies the Wells score and maintain the same efficacy and safety, which could improve its implementation in the hospital emergencies.

Influence of exposure to tobacco cigarette smoke on the eosinophil count in the nasal mucosa of young patients with perennial allergic rhinitis.

BACKGROUND: To assess the influence of exposure to tobacco cigarette smoke on the eosinophil count and the frequency of apoptosis of eosinophils in the nasal mucosa of teenagers with perennial allergic rhinitis. METHODS: Fifty patients were evaluated (aged 10 to 19 years old): 25 patients with and 25 patients with no recent exposure to tobacco cigarette smoke, by means of The Global Youth Tobacco Survey and cotinine/creatinine ratio. After a clinical evaluation, all the patients replied to a validated questionnaire of the severity of nasal symptoms; then, a nasal sample was processed to identify the eosinophil count and the frequency of apoptosis of eosinophils. RESULTS: Patients with active exposure to tobacco cigarette smoke had higher eosinophil counts than patients with no exposure to the smoke. In the two groups, apoptosis of eosinophils in the nasal mucosa was scarce and no significant correlation was observed between the frequency/severity of the nasal symptoms and the eosinophil count. CONCLUSION: Teenagers with perennial allergic rhinitis and active exposure to tobacco cigarette smoke may show increased eosinophil counts in the nasal mucosa, which might not be related to apoptosis of eosinophils or to the frequency/severity of nasal symptoms.

Evaluación clínico-nutricional y del funcionamiento familiar en niños con alto nivel de riesgo de padecer inmunodeficiencia primaria / Family functioning, nutritional and clinical assessment of children with high risk of primary immunodeficiency

Antecedentes. Los estados de inmunodeficiencia impactan en el funcionamiento familiar. Objetivo. Comparar el funcionamiento familiar y aspectos clínico-nutricionales entre niños con alto nivel de sospecha de inmunodeficiencias primarias y aquellos con menor nivel de sospecha. Lugar de aplicación. Clínica de atención primaria. Diseño. Estudio transversal con grupos comparados. Población. 400 niños entre 1 año y 7 años 11 meses de edad, asignados a dos grupos, uno integrado por aquellos con puntaje ≥25 en la escala PRIDE (primary immunodeficiency disease evaluation), n=9 y otro integrado por aquellos que alcanzaron un puntaje ≤25 en la evaluación con la escala PRIDE, n=391. Material y métodos. Los grupos se compararon con respecto a funcionamiento familiar, estado nutricional y criterios clínicos de riesgo para inmunodeficiencias primarias. Resultados. Se encontraron asociaciones estadísticamente significativas de puntaje PRIDE con infecciones respiratorias altas >8, episodios de otitis media aguda ≥4, episodios de sinusitis aguda ≥2, infecciones de vías respiratorias bajas ≥2, no respuesta a ≥3 esquemas de antibióticos para un mismo cuadro de infección, infecciones urinarias >6, infecciones del sistema nervioso central, enfermedades alérgicas o autoinmunes concomitantes, caída del cordón umbilical > 30 días y funcionamiento familiar. Las áreas más dañadas del funcionamiento familiar fueron roles y armonía. Conclusiones. Hubo diferencias en el funcionamiento familiar y factores de riesgo relacionados con infección y predisposición a ella entre los niños con puntaje PRIDE ≥25 y aquellos con puntaje <25. (AU)

Background. Immunodeficiency states impact on family functioning. Objective. To compare family functioning, clinical and nutritional status among children with high suspicion of primary immunodeficiencies versus those in which the level of suspicion is lower. Design. Cross-sectional study with compared groups. Population. 400 children between 1 year and 7 years 11 months of age, assigned to two groups according to PRIDE (primary immunodeficiency disease evaluation) ³25 average, n=9 and the other composed of those who scored below 25 on the assessment with that scale, n = 391. Material and methods. The groups were compared regarding: family functioning, nutritional status and clinical risk criteria for primary immunodeficiencies. Results. Statistically significant associations were found among PRIDE scoring with following variables: upper respiratory infections >8, episodes of acute media otitis ³4, two o more episodes of lower respiratory infections, sinusitis ³ 2, three or more schedules of antibiotics to treat the same infection, more than six urinary tract infections in the past year, central nervous system infections, allergic or autoimmune concomitant diseases, drop of umbilical cord > 30 days and family functioning. The most damaged areas of family functioning were roles and harmony. Conclusions. There were differences in family functioning and related risk factors for both infection and predisposition to that between children receiving 25 or more points after PRIDE evaluation and those with PRIDE score below 25(AU)

Rhinomanometry in young patients with perennial allergic rhinitis with/without recent exposure to tobacco smoke.

OBJECTIVE: To assess the influence of environmental exposure to tobacco smoke on the nasal symptoms and nasal resistance of young patients with perennial allergic rhinitis. DESIGN: Cross-sectional study. SETTING: Tertiary referral centre. PARTICIPANTS: Fifty patients were evaluated (aged 10-19 years old): 25 patients with and 25 patients without recent exposure to tobacco smoke (confirmed by cotinine/creatinine ratio). MAIN OUTCOMES MEASURES: After a clinical evaluation, all the patients replied to a validated questionnaire of the severity of the nasal symptoms. Then total nasal airway resistance was recorded by active anterior rhinomanometry. RESULTS: Patients with exposure to tobacco smoke had a larger total resistance than patients without exposure (t-test, P < 0.01). No significant correlation was observed between the total score of the questionnaire of nasal symptoms and the nasal resistance. CONCLUSIONS: In young patients with perennial allergic rhinitis, exposure to tobacco smoke can be related to increased nasal resistance, which may not be recognised by the report of nasal symptoms.

[Giant colonic diverticulum. Report of a case and review of the literature]. / Divertículo colónico gigante. Informe de un caso y revisión de la bibliografía.

We report about a 67 year-old male patient with a giant colonic diverticulum and multiple comorbid conditions. The unusual clinical presentation and high surgical risk in this case required challenging therapeutic decisions that eventually lead to a left colon resection and complementary surgical procedures, despite the patient had been considered non-surgical candidate by two surgical teams before. A literature review from the last ten years was performed using Medline and Pubmed databases, looking for "giant colonic diverticulum". We found 43 case reports, one case series and one review article including 135 patients. Discussion is based on the information obtained from the literature review and the particular aspects of this interesting case.

Clinical validation of a molecular assay for intra-operative detection of metastases in breast sentinel lymph nodes.

BACKGROUND: In breast cancer patients, the status of the sentinel lymph nodes (SLNs) has been shown to accurately reflect the presence of metastases in the axillary lymph nodes (ALNs). Intra-operative SLN evaluation by frozen section histology may miss positive cases, leading to a second surgery for complete ALN dissection. Permanent section histology itself has tissue sampling limitations and is partially dependent on pathologist expertise. METHODS: A prospective study (N=78) was conducted in our institution to validate a new intra-operative molecular assay, the GeneSearch breast lymph node (BLN) assay. This assay quantifies the expression of mammaglobin and cytokeratin-19 genes using quantitative RT-PCR technology to determine SLN status. Fresh SLN sections (2 mm thick) were analyzed alternatively by BLN assay or post-operative histology (haematoxylin-eosin and immunohistochemistry). The subject was considered positive when histology revealed a focus >0.2 mm. RESULTS: BLN assay results corroborated with histologic results in 75 out of 78 patients for an overall agreement of 96%, a sensitivity of 92%, and a specificity of 97%. The positive and negative predictive values of the BLN assay were of 86% (12/14) and 98% (63/64), respectively. Interestingly, a statistically significant correlation was observed between the metastases' histologic size and both assay markers' expression levels as represented by cycle time to positivity (rho > or = 0.71, all p<0.0001). CONCLUSIONS: The performance of the BLN assay in identifying nodal metastases >0.2 mm was similar to that of permanent section histology, with the added advantages of an objective and rapid output that could be used for intra-operative decision to remove additional ALN.

[Malignant fibrous histiocytoma of the spermatic cord. Presentation of one case and literature revision]. / Histiocitoma fibroso maligno de cordón espermático. Presentación de un caso y revisión de la literatura.

We present a case of malignant fibrous histiocytoma (MFH) of the spermatic cord. An 80-years-old man was admitted to the hospital with a left scrotal mass, related to a genital traumatism several months ago. Under the suspicion of a testicular tumor, left radical orchiectomy was performed. Histological examination of the tumoral mass revealed a malignant fibrous histiocytoma. The tumor was firmly adhered to the spermatic cord. MFH is an extremely rare, highly malignant connective tissue tumor, which may, occasionally, affect the male genital tract. There are no agreed treatment principles. The overall prognosis is poor.