Clinical profile of patients with paraneoplastic neuromyelitis optica spectrum disorder and aquaporin-4 antibodies.

BACKGROUND: In a minority of patients with neuromyelitis optica spectrum disorder (NMOSD) and aquaporin-4 antibodies (AQP4-IgG), the disease has a paraneoplastic origin. It is unknown whether these patients have distinctive clinical features. OBJECTIVE: To report the clinical features of a series of patients with paraneoplastic NMOSD and AQP4-IgG and to review previously reported cases. METHODS: Retrospective analysis of clinical records of 156 patients with NMOSD and AQP4-IgG and review of previously reported patients with paraneoplastic NMOSD and AQP4-IgG. Paraneoplastic patients were defined as those with cancer identified within 2 years of the diagnosis of NMOSD. RESULTS: Five (3.2%) of 156 patients had paraneoplastic NMOSD, and 12 previously reported patients were identified. The most common tumors were adenocarcinoma of the lung (five patients) and breast (five). Compared with the 151 non-paraneoplastic NMOSD patients, the 17 (5 current cases and 12 previously reported) were older at symptom onset (median age = 55 (range: 17-87) vs 40 (range: 10-77) years; p = 0.006), more frequently male (29.4% vs 6.6%; p = 0.009), and presented with severe nausea and vomiting (41.2% vs 6.6%; p < 0.001). The frequency of longitudinal extensive transverse myelitis (LETM) as heralding symptom was similar in both groups, but patients with paraneoplastic NMOSD were older than those with non-paraneoplastic NMOSD (median age: 63 (range: 48-73) vs 43 (range: 14-74) years; p = 0.001). CONCLUSION: Patients, predominantly male, with NMOSD and AQP4-IgG should be investigated for an underlying cancer if they present with nausea and vomiting, or LETM after 45 years of age.

Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial.

Pulmonary hypertension is a serious complication of chronic obstructive pulmonary disease (COPD) that currently has no established pharmacological treatment. This study aimed to assess whether concomitant treatment with sildenafil would enhance the results of pulmonary rehabilitation in patients with COPD and increased pulmonary arterial pressure (PAP). In this double-blind, randomised controlled trial patients received 20 mg sildenafil or placebo three times daily and underwent pulmonary rehabilitation for 3 months. The primary end-point was the gain in the cycle endurance time at a constant work-rate. Secondary end-points included performance in the incremental exercise test, 6-min walk distance and quality of life. 63 patients with severe COPD and moderately increased PAP were randomised. Cycle endurance time increased by 149 s (95% CI 26-518 s) in the sildenafil group and by 169 s (95% CI 0-768 s) in the placebo group (median change difference -7 s, 95% CI -540-244 s; p=0.77). Gains in the incremental exercise test, 6-min walk distance and quality of life at the end of the study did not differ between groups. Measurements of arterial oxygenation and adverse events were similar in both groups. In patients with severe COPD and moderately increased PAP, concomitant treatment with sildenafil does not improve the results of pulmonary rehabilitation in exercise tolerance.

Toward an improved assessment of quality of life in endometriosis: evaluation of the Spanish version of the Endometriosis Health Profile 30.

PURPOSE: Our main objective is to evaluate the psychometric properties of the Spanish version of the EHP-30 questionnaire. The secondary aim is to evaluate the differences in the scores of the core EHP-30 scales between patients with either surgical treatment or conservative management of endometriosis. METHODS: Cross-sectional study conducted into a tertiary hospital endometriosis reference unit. All patients (n = 223) pre-surgically completed the core EHP-30 questionnaire, the EQ-5D questionnaire (n = 184) and a visual analogue scale (n = 210) for endometriosis-related pain. Demographical and clinical data were recorded. RESULTS: Psychometric characteristics of the Spanish core EHP-30 questionnaire were investigated. Statistical analyses confirmed the five-structure factor, a high degree of internal consistency and of item-total correlation for all the assessed items. Convergent validity between EQ-5D and EHP-30 items and between VAS and EHP-30 subscale pain was observed. Additionally, patients with surgical management rendered significantly higher scores in the core EHP-30 subscales "pain" and "control and powerlessness". CONCLUSIONS: We present the reliability, validity and acceptability of the Spanish core EHP-30 questionnaire, providing clinicians and researchers with an improved tool to assess the endometriosis-related quality of life. Additionally, we show that patients subsidiaries of surgical treatment for endometriosis present with higher pain and powerlessness than those with conservative management.

Smartphone Abuse Amongst Adolescents: The Role of Impulsivity and Sensation Seeking.

Adolescence is the stage of development where the reward and emotional regulation systems are yet to be adjusted and where most excessive behaviors start, like smartphone abuse. In addition, in this evolutionary period adolescents are more susceptible to behavioral changes through specific interventions or educational programs. Thus, it is fundamental to analyze the personality profile of those adolescents showing excessive mobile phone usage to properly approach later prevention strategies. Impulsivity is one of the most repeated variables associated with teenage addictions, although it has been observed that not all impulsive behaviors need to be detrimental. The aim of this study is to analyze how impulsivity affects smartphone addiction directly, but also indirectly, by assessing its association with sensation seeking variables (thrill and adventure seeking, experience seeking, disinhibition, and boredom susceptibility) which are in turn decisive when using these technologies improperly. The sample was made up of 614 adolescents aged 13-18 attending secondary education from Burgos, Spain. Dickman Impulsivity Inventory, Sensation Seeking Scale, and Ad-hoc questionnaire on adolescent self-perception as to smartphone use were applied. Results show that 41.4% of participants admit to abusing smartphones sometimes, while 18.3% admit to abusing them more frequently and 24% to, at least ever, having defined themselves as smartphone addicts. Stepwise regression analysis revealed that gender (female), dysfunctional impulsivity and sensation seeking (disinhibition and thrill and adventure seeking) evidence 15.7% of variance in smartphone abuse. In addition, sensation seeking (thrill and adventure seeking, disinhibition, and boredom susceptibility) were found to mediate the relationship between dysfunctional impulsivity and smartphone abuse. Therefore, dysfunctional impulsivity was directly connected with teenage smartphone abuse, but also had an indirect stronger association through thrill and adventure seeking, disinhibition and boredom susceptibility.

Validation of the immunohistochemical expression of programmed death ligand 1 (PD-L1) on cytological smears in advanced non small cell lung cancer.

Introduction The assessment of PD-L1 expression by immunohistochemistry is mandatory for the administration as first-line therapy of the anti PD-1 check-point inhibitor Pembrolizumab in patients with advanced non-small-cell lung cancer (NSCLC). Currently, only formalin-fixed paraffin-embedded samples are acceptable for PD-L1 immunostaining with the anti-PD-L1 antibodies 22-C3 and SP263. We investigated retrospectively the accuracy of the anti PD-L1 antibodies 22-C3, 28-28, SP263 in 50 paired histological samples and cytological smears of NSCLC patients. Results The accuracy of the three antibodies for the detection of PD-L1 in histological samples was higher for the antibody SP263 (AUC/ROC = 1) compared to the clones 28-8 (AUC/ROC =,991) and 22-C3 (AUC/ROC =,942). The overall concordance between histological samples and cytological smears using the SP263 clone was moderate (kappa = 0,364). However when the cyto-histological concordance was calculated using just the <50% vs ≥50% cut-off the agreement (kappa = 0.626) was good. The accuracy of the antibody SP263 in cytological smears was good (AUC/ROC =,921). A fluorescent in situ hybridization analysis on 10 histological cases positive for PD-L1 at immunohistochemistry showed amplification of the CD274 gene only in one case. Conclusions Immunocytochemical staining for PD-L1 in diagnostic cytological smears of NSCLC is feasible and applicable at least using the >50% cancer cell cut-off. The three antibodies SP263, 22-C3 and 28-8 are all suitable for the diagnostic detection of PD-L1 on tissue sections with a superiority of the SP263 clone. The implementation of PD-L1 immunocytochemistry on cytological smears will likely expand the pool of NSCLC patients candidate to first-line immunotherapy.

The relationship between the levels of salivary cortisol and the presence of xerostomia in menopausal women. A preliminary study.

UNLABELLED: Xerostomia is a particularly frequent occurrence among menopausal women, and is often associated with depression. OBJECTIVES: To evaluate the relationship between unstimulated salivary flow rate and the presence of xerostomia, and to determine the levels of salivary cortisol and its relationship with xerostomia. STUDY DESIGN: Thirty women were selected from patients attending the Department of Medicine and Buccofacial surgery, and formed into two groups, study and control. Samples of unstimulated salivary flow were collected, and the amounts of salivary cortisol determined using the ELISA technique (enzyme-linked immunosorbent assay). RESULTS: The mean unstimulated salivary flow rates for the control and study group were 0.37 +/- 0.28 ml/min and 0.24 +/- 0.18 ml/min, respectively. The concentration of salivary cortisol was 3.47 +/- 1.64 ng/ml for the control group and 2.29 +/- 2.60 ng/ml for the study group. The statistical tests applied showed no significant differences for either variable between the two groups in the study. CONCLUSIONS: The results of the present study indicate that there is no relationship between variations in the rates of unstimulated salivary flow and the corresponding concentration of cortisol.

Estrés y estrategias de afrontamiento en personas con discapacidad intelectual: revisión sistemática / Stress and coping strategies in people with intellectual disabilities: A systematic review

En los últimos años se han realizado estudios sobre el estrés en población general pero no en personas con discapacidad. El objetivo fue hacer una revisión sistemática del impacto del estrés y las estrategias de afrontamiento que utilizan las personas con discapacidad intelectual. De diversas bases de datos: EBSCO host, CSIC, PubMed, Psyke, PubPsych, ERIC, Scopus, WOS se obtuvieron 137 artículos potenciales publicados entre 2007-2016. Tres cumplían con los criterios de inclusión. Los resultados indicaron que las personas con discapacidad intelectual tienen especiales dificultades para hacer frente a las relaciones interpersonales, utilizan más el afrontamiento evitativo que el activo, usan más las estrategias activas centradas en el problema que en la emoción, salvo en situaciones muy angustiosas en las cuales utilizan más el afrontamiento defensivo. Se necesitan más estudios, principalmente en nuestro entorno, que permitan el establecimiento de conclusiones sólidas respecto al manejo del estrés en esta población

Over recent years, studies have been conducted on stress in the general population but not in people with disabilities. The objective of this study was to conduct a systematic review of the impact of stress, as well as the coping strategies used by people with intellectual disabilities. 137 potential articles published between 2007 and 2016 were obtained from various databases: EBSCO host, CSIC, PubMed, Psyke, PubPsych, ERIC, Scopus and WOS. Three met the inclusion criteria. The results suggested that people with intellectual disabilities have particular difficulties in dealing with interpersonal relationships, tend to use avoidance coping strategies rather than active coping strategies, and use active strategies that are more focused on the problem than on the emotion, except in very distressing situations, in which case they employ defensive coping strategies. More studies are needed, particularly in our setting, in order to establish solid conclusions regarding the management of stress in this population

Patogenia del cáncer oral por el virus del papiloma humano / Pathogenesis of oral cancer for human papiloma virus

Introducción: El cáncer oral representa el 1-2% de todos los cánceres del organismo, correspondiendo el 90% a carcinomas orales de células escamosas (COCE). Los factores de riesgo clásicamente implicados en el desarrollo del cáncer oral son la edad avanzada, el sexo masculino y la exposición prolongada a hábitos como el alcohol, el tabaco y la nuez de betel. Sin embargo, el incremento en los últimos años de la incidencia de COCE en pacientes jóvenes sin exposición a factores de riesgo clásicos ha puesto en manifiesto la presencia de otros posibles agentes etiopatogénicos, entre los que destaca el virus del papiloma humano (VPh). Objetivos: Poner de manifiesto el desarrollo molecular del COCE por la intervención del VPh como oncovirus y sus características. Resultados: Los estudios determinan el alto riesgo oncogénico que presenta el subtipo 16 y 18 del VPh actuando a través de sus proteínas E6 y E7, afectando directamente al p53, a la proteína del Retinoblastoma (pRb) y otras enzimas implicadas en la regulación del ciclo celular como la PI3K, alterándose así los procesos de apoptosis, proliferación y diferenciación celular. Conclusiones: El VPh juega un papel importante como carcinógeno en la aparición del COCE, con un pronóstico más favorable respecto a otros factores etiológicos. El proceso de oncogénesis en el desarrollo del COCE a partir del VPh está determinado por los subtipos de alto riesgo, así como la expresión de las proteínas virales E6 y E7, responsables de inhibir la actividad de los genes supresores de tumores del ciclo celular (AU)

Introduction: Oral cancer represents 1-2% of all cancer in the organism, 90% corresponding to oral squamous cell carcinomas (OSCC). Risk factors traditionally involved in the development of oral cancer are advanced age, male sex, and prolonged exposure to habits such as alcohol, tobacco, and betel nut. The increase in the incidence of OSCC in young patients without exposure to classical risk factors in recent years has revealed the presence of other possible etiopathogenic agents, especially the human Papilloma Virus (hPV). Objectives: Describe the molecular development of the OSCC by the hPV intervention as oncovirus and its characteristics. Results: Different studies show the high oncogenic risk of hPV 16 and 18 subtypes acting through their E6 and E7 proteins, directly affecting p53, Retinoblastoma protein (pRb) and other enzymes involved in the regulation of the cycle Cell as the PI3K, altering the processes of apoptosis, cell proliferation and differentiation. Conclusions: hPV plays an important role as a carcinogen in the onset of OSCC, with a more favorable prognosis regarding other etiological factors. The process of oncogenesis in the development of COCE from hPV is determined by the high risk subtypes as well as the expression of the viral proteins E6 and E7 responsible for inhibiting the activity of the cell cycle tumor suppressor genes (AU)

Figuras de Lichtenberg en un caso de fulguración / Lichtenberg figures

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Role of a research ethics committee in follow-up and publication of results.

Follow-up of clinical trials is a commitment rarely fulfilled by research ethics committees (RECs). We assessed the output of clinical trials submitted in 1997 to our REC, and talked to principal investigators, sponsors, contract research organisations, or a combination of these. During 1997, our REC reviewed 166 clinical trials, and approved 158. The recruitment rate was lower than expected in 45% (64/143) of all initiated clinical trials; 64% (92/143) were finished in accordance with protocol. 3 years after, the results of only 21% (26/123) of finished clinical trials were published in peer-reviewed journals, rising to 31% (38/123) if in-press articles were included. RECs should devote more effort and resources to assess public dissemination of results of clinical trials.

Cerámicas dentales: clasificación y criterios de selección / Dental ceramics: Classification and selection criteria

Hoy en día, hablar de restauraciones estéticas implica hablar de cerámica sin metal. Han sido tan importantes y revolucionarios los cambios y aportaciones en este campo en los últimos años que en la actualidad existen multitud de sistemas cerámicos. Todos ellos buscan el equilibrio entre los factores estéticos, biológicos, mecánicos y funcionales. Sin embargo, existen diferencias considerables entre ellos. Por lo tanto, para seleccionar la cerámica más adecuada en cada caso, es necesario conocer las principales características de estos materiales y de sus técnicas de confección. Esta elección no debe ser delegada al técnico de laboratorio, sino que debe ser responsabilidad del odontoestomatólogo porque él es quien conoce y controla las variables que condicionan el éxito de la restauración a largo plazo. En este artículo, se revisan los principales sistemas cerámicos disponibles actualmente y se analiza su comportamiento clínico. Por último, se exponen unas pautas para orientar al profesional en la toma de decisiónes (AU)

At the present time, to speak about aesthetic restorations implies speaking about alloy free ceramics. This field has experienced important changes and revolutionary contributions. This has led to the introduction of a multitude of all-ceramic systems. All of these quest for a balance between the aesthetic, biological, mechanical and functional factors. However, considerable differences exist among them. Therefore, to select the most suitable ceramic in every case, it is necessary to know the main features of these materials and the laboratory procedures. Porcelain selection should not be left up to the laboratory technician. Material selection should be the responsibility of the clinician because he knows and controls the variables that determine the long-term success of the restoration. This article reviews the all-ceramic systems now available and its clinical performance. Lastly, decision making guidelines for the clinician are detailed (AU)

Videoconferencia entre los servicios de prevención: una nueva forma de comunicación y transmisión de experiencias en el marco de un convenio de colaboración / No disponible

Objetivos: Intercambio del conocimiento, compartir equipos técnicos e incrementar la actividad científica. Metodología: Dado que parte de las tareas de los profesionales de los SPP son: evaluación de las condiciones de trabajo y la elaboración, aplicación y desarrollo de los protocolos técnicos y sanitarios, se hace imprescindible el trabajo entre los SPP, que enriquece el conocimiento y permite la transferencia científica. En julio de 2010, se aprobó un convenio de colaboración entre los SPP de los hospitales de la Santa Creu i Sant Pau (Barcelona) y la Corporació Parc Taulí (Sabadell). Resultados: Se han compartido equipos de mediciónpara la evaluación de parámetros de higiene, con criterios técnicos y asistenciales y protocolos de vigilancia de la salud. Se han instaurado las videoconferencias como sesiones periódicas entre los servicios para estrechar los vínculos y reafirmar la colaboración. Conclusiones: El trabajo entre los dos SPP permite y promueve el trabajo transversal. En sí mismo, trabajar en equipo, es un conocido factor amortiguador del riesgo psicosocial que en el caso de los equipos de los SPP, no es menospreciable. Las nuevas tecnologías ya disponibles en hospitales como herramientas de comunicación son claves para llevar a término el trabajo y la colaboración entre dos equipos diferentes, separados por la distancia. Permiten la asistencia simultánea de los dos equipos, la discusión compartida y el consenso (AU)

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Relación entre los niveles de cortisol salival y la presencia de xerostomía en mujeres menopaúsicas. Estudio preliminar / The relationship between the levels of salivary cortisol and the presence of xerostomia in menopausal women. A preliminary study

La xerostomía es un síntoma especialmente frecuente en las mujeres en torno a la menopausia, que se asocia en muchas ocasiones con estados depresivos.Objetivos: Valorar la relación entre las cifras del flujo salival total no estimulado y la presencia de xerostomía, y determinarlos niveles de cortisol salival y su relación con la misma.Diseño del estudio: Se seleccionaron 30 mujeres de los pacientes que acuden al Departamento de Medicina y Cirugía Bucofacial y se formaron dos grupos, estudio y control. Se recogieron muestras de flujo salival total no estimulado y mediante técnica de ELISA se determinaron las cifras de cortisol salival.Resultados: Las medias de flujo salival total no estimulado para el grupo control y estudio fueron de 0.37± 0.28 ml/min. y de 0.24± 0.18 ml/min. respectivamente. La concentración de cortisol salival fue de 3.47± 1.64 ng/ml. para el grupo control y de 2.29± 2.60 ng/ml. para el grupo estudio. Las pruebas estadísticas aplicadas no mostraron diferencias significativasentre los dos grupos del estudio para ambas variables.Conclusiones: Los resultados del presente estudio indican que no existe relación entre las variaciones en el flujo salival total no estimulado y las concentraciones de cortisol correspondientes

Xerostomia is a particularly frequent occurrence among menopausal women, and is often associated with depression.Objectives: To evaluate the relationship between unstimulated salivary flow rate and the presence of xerostomia, and to determine the levels of salivary cortisol and its relationship with xerostomia.Study design: Thirty women were selected from patients attending the Department of Medicine and Buccofacial surgery, and formed into two groups, study and control. Samples of unstimulated salivary flow were collected, and the amounts of salivary cortisol determined using the ELISA technique (enzyme-linked immunosorbent assay).Results: The mean unstimulated salivary flow rates for the control and study group were 0.37 ± 0.28 ml/min and 0.24 ± 0.18 ml/min, respectively. The concentration of salivary cortisol was 3.47 ± 1.64 ng/ml for the control group and 2.29 ± 2.60 ng/ml for the study group. The statistical tests applied showed no significant differences for either variable between the two groups in the study

Certificación de los procesos de gestión de muestras en investigación clínica en un servicio de farmacia hospitalario según normativa UNE-ISO-9001: 2000 / Certification of investigacion al medicinal products management according to normative

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No disponible

Cerámicas dentales: clasificación y criterios de selección / Dental ceramics: Classification and selection criteria

Hoy en día, hablar de restauraciones estéticas implica hablar de cerámica sin metal. Han sido tan importantes y revolucionarios los cambios y aportaciones en este campo en los últimos años que en la actualidad existen multitud de sistemas cerámicos. Todos ellos buscan el equilibrio entre los factores estéticos, biológicos, mecánicos y funcionales. Sin embargo, existen diferencias considerables entre ellos. Por lo tanto, para seleccionar la cerámica más adecuada en cada caso, es necesario conocer las principales características de estos materiales y de sus técnicas de confección. Esta elección no debe ser delegada al técnico de laboratorio, sino que debe ser responsabilidad del odontoestomatólogo porque él es quien conoce y controla las variables que condicionan el éxito de la restauración a largo plazo. En este artículo, se revisan los principales sistemas cerámicos disponibles actualmente y se analiza su comportamiento clínico. Por último, se exponen unas pautas para orientar al profesional en la toma de decisiónes

At the present time, to speak about aesthetic restorations implies speaking about alloy free ceramics. This field has experienced important changes and revolutionary contributions. This has led to the introduction of a multitude of all-ceramic systems. All of these quest for a balance between the aesthetic, biological, mechanical and functional factors. However, considerable differences exist among them. Therefore, to select the most suitable ceramic in every case, it is necessary to know the main features of these materials and the laboratory procedures. Porcelain selection should not be left up to the laboratory technician. Material selection should be the responsibility of the clinician because he knows and controls the variables that determine the long-term success of the restoration. This article reviews the all-ceramic systems now available and its clinical performance. Lastly, decision making guidelines for the clinician are detailed