Non-tumoral metastatic lesions as a debut of primary biliary cholangitis and concomitant sarcoidosis.

Sarcoidosis is included within the multisystemic granulomatous diseases with autoimmune character. The case of a 51-year-old man with hemoptysis, cholestasis and bone lesions is presented. After ruling out infectious, inflammatory and neoplastic entities, a diagnosis of sarcoidosis and autoimmune hepatitis with primary biliary cholangitis was established.

Endotoxin and Cytokine Sequential Hemoadsorption in Septic Shock and Multi-Organ Failure.

The mortality of septic shock remains high [Ann Intensive Care. 2017;7:19], so apart from usual therapy based on source control and antibiotics, some patients may need rescue therapies. Blood purification systems may play a role by facilitating the nonspecific removal of inflammatory mediators and microbiological toxins. There are different hemoadsorption systems, we describe in this case report the sequential use of Polymyxin B (PMX) endotoxin-adsorbing column (Toraymixin PMX-20R; Toray, Tokyo, Japan) and Cytosorb® (Cytosorbents Corp., New Jersey, USA).

The importance of body satisfaction to physical self-concept and body mass index in Spanish adolescents.

This research examines the association between measured body mass index (BMI) and the perception of BMI by young students. Moreover, this research tests the importance of BMI and self-concept, in order to predict body dissatisfaction in high school students. The sample consisted of 2087 individuals from different high schools in Extremadura, Spain, both males (n = 1046) and females (n = 1041), ranging in age from 15 to 17 years old (M = 15.42; SD = 0.86). Initially, participants' BMIs were assessed through anthropometry. Later, all individuals were asked about their weight and height, and their self-reported BMI was calculated. Participants also answered a questionnaire about their perception of self-concept, as well as completed a test about body image perception using Stunkard images. Outcomes revealed that factors concerning self-concept and perceived BMI explained body dissatisfaction. Finally, results are discussed with the aim of improving knowledge in body dissatisfaction context.

The extracellular serine protease from Staphylococcus epidermidis elicits a type 2-biased immune response in atopic dermatitis patients.

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease with skin barrier defects and a misdirected type 2 immune response against harmless antigens. The skin microbiome in AD is characterized by a reduction in microbial diversity with a dominance of staphylococci, including Staphylococcus epidermidis (S. epidermidis). Objective: To assess whether S. epidermidis antigens play a role in AD, we screened for candidate allergens and studied the T cell and humoral immune response against the extracellular serine protease (Esp). Methods: To identify candidate allergens, we analyzed the binding of human serum IgG4, as a surrogate of IgE, to S. epidermidis extracellular proteins using 2-dimensional immunoblotting and mass spectrometry. We then measured serum IgE and IgG1 binding to recombinant Esp by ELISA in healthy and AD individuals. We also stimulated T cells from AD patients and control subjects with Esp and measured the secreted cytokines. Finally, we analyzed the proteolytic activity of Esp against IL-33 and determined the cleavage sites by mass spectrometry. Results: We identified Esp as the dominant candidate allergen of S. epidermidis. Esp-specific IgE was present in human serum; AD patients had higher concentrations than controls. T cells reacting to Esp were detectable in both AD patients and healthy controls. The T cell response in healthy adults was characterized by IL-17, IL-22, IFN-γ, and IL-10, whereas the AD patients' T cells lacked IL-17 production and released only low amounts of IL-22, IFN-γ, and IL-10. In contrast, Th2 cytokine release was higher in T cells from AD patients than from healthy controls. Mature Esp cleaved and activated the alarmin IL-33. Conclusion: The extracellular serine protease Esp of S. epidermidis can activate IL-33. As an antigen, Esp elicits a type 2-biased antibody and T cell response in AD patients. This suggests that S. epidermidis can aggravate AD through the allergenic properties of Esp.

TLR4 sensing of IsdB of Staphylococcus aureus induces a proinflammatory cytokine response via the NLRP3-caspase-1 inflammasome cascade.

IMPORTANCE: The prevalence of multidrug-resistant Staphylococcus aureus is of global concern, and vaccines are urgently needed. The iron-regulated surface determinant protein B (IsdB) of S. aureus was investigated as a vaccine candidate because of its essential role in bacterial iron acquisition but failed in clinical trials despite strong immunogenicity. Here, we reveal an unexpected second function for IsdB in pathogen-host interaction: the bacterial fitness factor IsdB triggers a strong inflammatory response in innate immune cells via Toll-like receptor 4 and the inflammasome, thus acting as a novel pathogen-associated molecular pattern of S. aureus. Our discovery contributes to a better understanding of how S. aureus modulates the immune response, which is necessary for vaccine development against the sophisticated pathogen.

[Implementation of diabetic retinopathy screening using digital retinography in primary care]. / Implantación del cribado de retinopatía diabética mediante retinografía digital en atención primaria.

OBJECTIVE: To improve early detection and monitoring of diabetic retinopathy (DR) in two primary care centers (PCC) using a non-mydriatic retinal camera (NMRC). DESIGN: Prospective longitudinal descriptive study. LOCATION: Area 11 Primary Care, Madrid. PARTICIPANTS: Adult patients with diabetes (DM) without funduscopic examination in the last two years (FO). INTERVENTIONS: Implementation process of screening for DR by NMRC in PCC. Digital photography of the retina made by nursing staff. Interpretation of retinal images by an ophthalmologist. MEASUREMENTS: Number of DM with FO. Number of patients with DR. Metabolic control in the last two years (HbA1c). STUDY PERIOD: September 2009-September 2011. RESULTS: DM increased from 2850 to 3357. The proportion of patients with FO increased from 6.7% (95% CI: 5.7-7.6%) to 32.4% (95% CI: 30.8-34.0%) (P<.001). The prevalence of DR increased from 3.85% (95% CI: 3.14-4.58%) to 4.3% (95% CI: 3.59-4.99%). The percentage of patients with FO and DR decreased from 60% (95% CI: 52.77-67.23%) to 14% (95% CI: 11.87-16.09%) (P<.001). The proportion of DM with HbA1c increased from 21.9% (95% CI: 20.36-23.43%) to 52.4% (95% CI: 50.69-54.10%) (P<.001). The mean HbA1c in patients with DR and without DR was 7.8 (95% CI: 7.50-8.06) and 7.1 (IC95% CI: 7.08-7.22) (P<.001), respectively. CONCLUSIONS: NMRC in PCC is accompanied by an increase in the number of diabetics with FO examination. The implementing of DR screening is possible if an NMRC is available, along with available resources, the motivation of the professionals involved and management commitment. A longer follow-up is required to determine its impact on referral rates to ophthalmology service, and to only refer those with dubious images.

[Six minute walk test: From normal to morbid obesity subject]. / Prueba de caminata de 6 minutos: del sujeto normal a la obesidad mórbida.

Introduction: Morbid obesity is associated with alterations in the ability to walk, however, the behavior of the 6-minute walk test in subjects with increases in body mass index is unknown. Objective: To describe the behavior of the 6-minute walk test in subjects with normal body mass index to morbid obesity. Methods: Through an analytical cross-sectional design, subjects of both genders from 18 to 60 years old with body mass index were studied: Normal (BMI:18.5-24.9); overweight (BMI:25-29.9); obesity (BMI:30-39.9); morbid obesity (BMI:>40) kg/m2. A 6-minute walk test was performed, demographic variables and pathological personal history were delimited. BMI categories were analyzed with one-way ANOVA and Bonferroni adjustment, and gender with t-test, both for independent groups, and Pearson's correlations for the various variables. Results: 480 subjects of both genders were studied in four groups. Age: men 43 ± 11 and women 45 ± 10 years old. Percentage diabetes mellitus (6.7%), arterial hypertension (18.3%). Meters walked men vs. women by body mass index (normal: 483 ± 56 vs. 449 ± 61; overweight: 471 ± 55 vs. 441 ± 44; obesity: 455 ± 70 vs. 421 ± 47; morbid obesity: 443 ± 49 vs. 403 ± 54, p < 0.05). Correlation body mass index-meters walked: r: -0.446 (p < 0.0001). Conclusions: Meters walked in the 6-minute walk test decreased as body mass index increased. The male gender walked more meters in all categories.

Introducción: La obesidad mórbida se asocia a alteraciones de la capacidad de caminar, sin embargo se desconoce cómo es el comportamiento de la prueba de caminata de 6 minutos en sujetos con incrementos del índice de masa corporal (IMC). Objetivo: Describir el comportamiento de la prueba de caminata de 6 minutos en sujetos con IMC normal hasta la obesidad mórbida. Métodos: Mediante un diseño transversal analítico se estudiaron sujetos de ambos sexos de 18 a 60 años con IMC: normal (18.5-24.9 kg/m2), sobrepeso (25-29.9 kg/m2), obesidad (30-39.9 kg/m2), obesidad mórbida (> 40 kg/m2). Se les realizó prueba de caminata de 6 minutos, se acotaron variables demográficas y antecedentes personales patológicos. Se analizaron las categorías de IMC con ANOVA de una vía y ajuste de Bonferroni y los sexos con prueba t, ambos para grupos independientes y correlaciones de Pearson para las diversas variables. Una p < 0.05 fue considerada estadísticamente significativa. Resultados: Se estudiaron 480 sujetos de ambos sexos en cuatro grupos. Edad: hombres 43 ± 11 y mujeres 45 ± 10 años. Porcentaje diabetes mellitus (6.7%), hipertensión arterial (18.3%). Metros caminados hombres vs. mujeres por IMC (normal: 483 ± 56 vs. 449 ± 61; sobrepeso: 471 ± 55 vs. 441 ± 44; obesidad: 455 ± 70 vs. 421 ± 47; obesidad mórbida: 443 ± 49 vs. 403 ± 54; p < 0.05). Correlación IMC-metros caminados r: ­0.446 (p < 0.0001). Conclusiones: Los metros caminados en la prueba de caminata de 6 minutos disminuyeron conforme incrementó el IMC. El sexo masculino caminó más metros en todas las categorías.

Interaction of nonionic surfactants and hydrophilic ionic liquids in aqueous solutions: can short ionic liquids be more than a solvent?

The interaction between an ethoxylated nonionic surfactant (C(12-14)EO(8)) and three conventional hydrophilic imidazolium-based ionic liquids (bmim-octyl SO(4), bmim-methyl SO(4), and bmim-BF(4)) in aqueous solution has been investigated. In most of the reported studies where a surfactant is dissolved in an ionic liquid aqueous solution, conventional ionic liquids are merely considered to be solvents. Consequently, the resulting critical micelle concentration (cmc) is considered to be that of the surfactant. However, given that the three ionic liquids selected showed the typical shape of a surface-active compound when the surface tension was plotted against concentration, the role of these compounds as secondary surfactants and consequently the possibility of mixed-micelle formation have been investigated. Different series of experiments where a surfactant and an ionic liquid were combined in a wide range of mole ratios have been performed and treated as typical binary surfactant systems in aqueous solution. It has been found for the three surfactant/ionic liquid systems that depending on the surfactant mole fraction, α(1), attractive or repulsive interactions in mixed-micelle formation are produced. Therefore, when we select the appropriate α(1) these systems can be adjusted to a given application, depending on whether monomers or micelles are mainly required.

Characterization of a proteomic profile associated with organ dysfunction and mortality of sepsis and septic shock.

INTRODUCTION: The search for new biomarkers that allow an early diagnosis in sepsis and predict its evolution has become a necessity in medicine. The objective of this study is to identify, through omics techniques, potential protein biomarkers that are expressed in patients with sepsis and their relationship with organ dysfunction and mortality. METHODS: Prospective, observational and single-center study that included adult patients (≥ 18 years) who were admitted to a tertiary hospital and who met the criteria for sepsis. A mass spectrometry-based approach was used to analyze the plasma proteins in the enrolled subjects. Subsequently, using recursive feature elimination classification and cross-validation with a vector classifier, an association of these proteins with mortality and organ dysfunction was established. The protein-protein interaction network was analyzed with String software. RESULTS: 141 patients were enrolled in this study. Mass spectrometry identified 177 proteins. Of all of them, and by recursive feature elimination, nine proteins (GPX3, APOB, ORM1, SERPINF1, LYZ, C8A, CD14, APOC3 and C1QC) were associated with organ dysfunction (SOFA > 6) with an accuracy of 0.82 ± 0.06, precision of 0.85 ± 0.093, sensitivity 0.81 ± 0.10, specificity 0.84 ± 0.10 and AUC 0.82 ± 0.06. Twenty-two proteins (CLU, LUM, APOL1, SAA1, CLEBC3B, C8A, ITIH4, KNG1, AGT, C7, SAA2, APOH, HRG, AFM, APOE, APOC1, C1S, SERPINC1, IGFALS, KLKB1, CFB and BTD) were associated with mortality with an accuracy of 0.86 ± 0.05, a precision of 0.91 ± 0.05, a sensitivity of 0.91 ± 0.05, a specificity of 0.72 ± 0.17, and an area under the curve (AUC) of 0.81 ± 0.08 with a confidence interval of 95%. CONCLUSION: In sepsis there are proteomic patterns associated with organ dysfunction and mortality.

[Within-subject variability of the 6-minute walk test]. / Variabilidad intrasujeto de la prueba de caminata de seis minutos.

Background: The 6-minute walk test assesses the ability to perform exercise and it is widely used, of low cost, and of diverse variability. Objective: To define the usefulness of a second 6-minute walk test performed 30 minutes from the first. Material and methods. Material and methods: An observational, longitudinal and analytical study was carried out in subjects born and inhabitants from Mexico City, both genders, without cardiopulmonary disease. Their demographic variables were recorded. Differences were calculated with the t test for independent groups and variability with the Bland-Altman statistic; its magnitude, with the intraclass correlation coefficient and 95% confidence intervals (95% CI). A p < 0.05 was considered significant. Results: 200 tests from 100 subjects were studied. Average age was 36 ± 11 years. Body mass index average was 24.71 ± 3.24 kg/m2. 43 subjects were male (43%). The most frequent activity was arts and crafts in 38 (38%). Only 55 subjects (55%) increased by 24 the number of meters walked in the second test. Total of meters walked on walk 1 vs. 2 were: 437.65 ± 48.84 vs. 441.62 ± 11.49. Mean difference (bias) was of -4 (57.9, -65.9) and intraclass correlation coefficient of 0.800 (95% CI, 0.717-0.861). Conclusions: The 6-minute walk test is reproducible with wide variability. These results suggest to do only one 6-minute walk test.

Introducción: la prueba de caminata de seis minutos evalúa la capacidad para hacer ejercicio y es de amplio uso, bajo costo y variabilidad diversa. Objetivo: definir la utilidad de una segunda prueba de caminata de seis minutos realizada a 30 minutos de la primera. Material y métodos: se llevó a cabo un estudio observacional, longitudinal y analítico de sujetos nacidos y habitantes de la Ciudad de México, de ambos géneros, sin enfermedad cardiopulmonar. Se registraron sus variables demográficas. Las diferencias se calcularon con la prueba t para grupos independientes y la variabilidad con el estadístico de Bland-Altman; su magnitud, con el coeficiente de correlación intraclase e intervalos de confianza del 95% (IC 95%). Una p < 0.05 se consideró significativa. Resultados: se estudiaron 200 pruebas de 100 sujetos. La edad promedio fue de 36 ± 11 años. La media del índice de masa corporal fue 24.71 ± 3.24 kg/m2. Fueron 43 hombres (43%). La actividad más frecuente fueron las artes y los oficios en 38 (38%). Solo en 55 (55%) incrementaron en 24 los metros caminados en la segunda prueba. Los metros caminados totales de la caminata 1 frente a la 2 fueron 437.65 ± 48.84 frente a 441.62 ± 11.49. La diferencia media (sesgo) fue de −4 (57.9, −65.9) y el coeficiente de correlación intraclase de 0.800 (IC 95% 0.717-0.861). Conclusiones: la prueba de caminata de seis minutos es reproducible con variabilidad amplia. Estos resultados sugieren realizar solo una prueba de caminata de seis minutos.

Comparison of the 2000 and 2005 spatial distributions of heavy metals in wild mussels from the North-Atlantic Spanish coast.

Spatial distributions of Cd, Cu, Hg, Pb and Zn in Mytilus galloprovincialis in 41 sampling sites in the North-Atlantic Spanish coast were monitored in 2000 and 2005 to assess the coastal environmental pollution. A pool of mussel soft tissue was prepared using 50 or more individuals representing the available size range. Samples were grounded, homogenised and quantified by atomic absorption spectrometry. Quality of the chemical analyses was assessed by participation in periodic interlaboratory exercises. Univariate and multivariate statistical studies, Principal Components Analysis and Procrustes rotation (a technique intended to compare several data spaces) were carried out. Some decreasing trends were observed for the concentrations throughout the 2000-2005 period, mainly for Hg and Pb. In general, the Northern area showed higher median concentrations (e.g., 3.79 and 4.28 mg Pb/kg dry weight, and 0.160 and 0.191 mg Hg/kg dry weight, for 2000 and 2005, respectively) than the Atlantic ones (e.g., 1.47 and 1.44 mg Pb/kg dry weight, and 0.097 and 0.084 mgHg/kg dry weight, for 2000 and 2005, respectively). Nevertheless, some Atlantic sampling points, located far from human inputs (cities, industries, rivers, etc.) exhibited high concentrations of Cd, which was attributed to the influence of the natural upwelling processes which occur annually in that geographical region.

[Organizational procedures and health care management. A point of view from primary care centres]. / Medidas organizativas y práctica asistencial. Una perspectiva desde los centros de salud.

OBJECTIVE: We aimed to know how the directive teams perceive the implementation of organizational procedures in relation with the health care management in the primary care setting. DESIGN: Multicentre cross-sectional descriptive study. SETTING: Area 11 Madrid Primary Care Service, Spain. PARTICIPANTS: All directive teams of primary care centres (PCC) (n=38). MEASUREMENTS: Data were collected with a self-administered semiestructured questionnaire which included 21 main questions about procedures and use of internal organizational measures relating to the health care management in PCC, grouped in five sections: predictable and non predictable consultations(clinical and administrative), clinical schedules and office management. RESULTS: 100% response rate. 69% of PCC use internal procedures and computerized applications for the renewal of medical chronic prescriptions and 55% for temporary disability. 71% show nurse involvement in terms of dispensing medical prescriptions during clinical consultations. 42% keep on performing administrative procedures of specialized care. 21% don't get compliance with routine control of programs and in 29% of consultations duplicity of visits among medicine and nursing are expected. 97% follow a specific process for urgent attention. 84% request subsequent appointment in the previous clinical consultation. 29% have open schedules availables for 6 months. CONCLUSIONS: A wide variability of the implementation of organizational procedures in PCC was observed. Further research is needed to determine whether any organizational and professional changes could contribute to improve efficiency and patient satisfaction.

Secondary Impacts of COVID-19 Pandemic in Fatigue, Self-Compassion, Physical and Mental Health of People with Multiple Sclerosis and Caregivers: The Teruel Study.

The secondary impacts of the COVID-19 pandemic are distress triggers and risk factors for mental health. Conversely, self-compassion skills and compassionate thoughts/behaviors towards suffering may contribute to their alleviation. Both psychological constructs are interrelated in life-threatening diseases such as multiple sclerosis (MS). The Teruel Study retrospectively evaluated the impact of strict confinement on the 44 people with MS of this Spanish province and 24 caregivers, specifically assessing (1) fears and perceptions; (2) self-compassion (people with MS) and compassion (caregivers); (3) physical and mental health, and fatigue. Despite better housing conditions, people with MS considered confinement very difficult to handle, more than their caregivers, but they were less afraid of COVID-19 and worsening of MS. Still, they recognized worse health than before confinement. Reclusion and lack of walks were the worst of confinement. Caregivers also referred to lack of leisure and uncertainty-fear. All agreed the best was staying with the family, but some found 'nothing' positive. Self-compassion remained moderate-high and strongly correlated with their moderate levels of social function, vitality, physical role, and global health. Physical and cognitive fatigue scores were high, and self-compassion negatively correlated with them, explaining a 19% variance in global health. The high compassion of the caregivers did not correlate with any variable.

Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay.

Reconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution's learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA; p = 0.50). Operative time was longer for IA (180 [150-205] versus 150 [120-180] minutes; p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3-6] days; p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution's learning curve.

Integrating video tracking and GPS to quantify accelerations and decelerations in elite soccer.

The aim of this study was to analyze the degree of agreement comparing number and distance covered in different acceleration and deceleration sections registered by a video tracking system (MEDIACOACH) and a GPS device (WIMU PRO) during official competition. Data from a Spanish professional club were registered over the course of a season. First, the descriptive statistics presented more bursts of accelerations and decelerations in WIMU PRO than in MEDIACOACH, whereas the distances covered recorded by both systems were similar. Second, negative relationships were found (i.e., negative bias) comparing WIMU PRO to MEDIACOACH in the number of accelerations and decelerations between 0/1 m/s2 and ½ m/s2 (p < 0.05), and in the distances covered in accelerations and decelerations (p < 0.05) between 0/1 m/s2 and in accelerations and decelerations registered between 2/3 m/s2 and more than 3 m/s2. Moreover, the differences in means (i.e., standardized mean bias) across the two devices were trivial (> 0.19) and small (0.2-0.59) for most variables. The standardized typical errors in the estimate (TEE) were moderate (0.3-0.59) and small to moderate (0.1-0.29 to 0.3-0.59), respectively. Also, the Intra class Correlation Coefficients (ICCs) for agreement and consistency between systems showed good and excellent values (> 0.90). The magnitude of change in means (%) between systems, defined as the percentage change between the numbers or values, was below 14% and 7% for number and distances covered, respectively. All scores in the smallest worthwhile change were lower than 9% and in the coefficients of variation were lower than 95% and 15%, respectively. Thus, both systems demonstrated an acceptable degree of agreement and could be useful in analyzing players' acceleration demands in professional soccer. However, caution is required when interpreting the results and a comparison with a gold standard is required in order to validate both systems.

Acute Kidney Injury and Organ Dysfunction: What Is the Role of Uremic Toxins?

Acute kidney injury (AKI), defined as an abrupt increase in serum creatinine, a reduced urinary output, or both, is experiencing considerable evolution in terms of our understanding of the pathophysiological mechanisms and its impact on other organs. Oxidative stress and reactive oxygen species (ROS) are main contributors to organ dysfunction in AKI, but they are not alone. The precise mechanisms behind multi-organ dysfunction are not yet fully accounted for. The building up of uremic toxins specific to AKI might be a plausible explanation for these disturbances. However, controversies have arisen around their effects in organs other than the kidney, because animal models usually depict AKI as a kidney-specific injury. Meanwhile, humans present AKI frequently in association with multi-organ failure (MOF). Until now, medium-molecular-weight molecules, such as inflammatory cytokines, have been proven to play a role in endothelial and epithelial injury, leading to increased permeability and capillary leakage, mainly in pulmonary and intestinal tissues.

Barriers and Facilitators of Colorectal Cancer Screening Among a Hispanic Community in Michigan.

INTRODUCTION: Colorectal cancer (CRC) is the third leading cause in the USA for cancer-related deaths. Hispanics demonstrate the lowest CRC screening (CRCS) rate and research suggests that causes of screening disparities differ among ethnic groups and geographic locations. The aim of this study was to determine the rate of CRCS and to identify barriers and facilitators to screening in the Hispanic population of Flint, Michigan METHODS: Cross-sectional study. Consenting participants completed a previously validated survey in their language of preference. Variables obtained included sociodemographic information, insurance status, language preference, primary care physician (PCP), language spoken by PCP, recommendation of CRCS, acculturation, and fatalism. Univariate and multivariate logistic regressions were performed to determine the association between predictors associated with previous CRCS. RESULTS: Seventy subjects completed the survey. Overall previous CRCS rate was 60%. Multivariate results indicated that having a physician that speaks both English and Spanish significantly increases the likelihood of CRCS. It also indicated that those who have been living in the USA for equal or less than 30 years and those that physician had never recommended screening were less likely to have been screened. DISCUSSION: Our study provides important preliminary data that may help improve CRCS among this Hispanic population. Interventions include providing a list of bilingual physicians in the community and to educate them regarding CRCS to mitigate the lack of physician recommendations. Notably, this study highlights the importance of cultural sensitivity and competence in preventive healthcare to promote inclusiveness of minority populations.

Economic evaluation of surgical treatment of obesity. / Evaluación económica del tratamiento quirúrgico de la obesidad.

INTRODUCTION: Obesity surgery is the best treatment for extreme obesity, with demonstrated long-term positive outcomes. The potential cost-savings generated by the improvement of comorbidities after surgery can justify the allocation of more resources in the surgical treatment of obesity. METHODS: This was an observational, descriptive, longitudinal and retrospective study. Eligible patients underwent Roux-en-Y gastric bypass surgery at the Hospital Universitario Central de Asturias between 2003 and 2012. The established minimum follow-up period was two years. We calculated the individualized cost per patient treated (bottom-up) as well as per Diagnosis-Related Group (DRG) codes (top-down). RESULTS: Our study included 307 patients. The average cost per hospitalization calculated by DRG codes was €6,545.90, and the average cost per patient was €10,572.20. DRG 288 represented 91% of the series, with a value of €4,631. The number of medications also decreased during this period, from 2.86 to 0.78 per medically treated patient, representing a cost reduction of €4,433 per patient with all the obesity-related comorbidities analyzed. CONCLUSIONS: Two years after Roux-en-Y gastric bypass conducted at Hospital Universitario Central de Asturias, the savings in drug costs for patients with multiple pathologies would compensate the inherent costs of the surgical treatment itself. Our results showed that DRG-related costs was insufficient to make a correct economic evaluation, so we recommend an individualized cost calculating method.

Genetic control of soybean seed isoflavone content: importance of statistical model and epistasis in complex traits.

A major objective for geneticists is to decipher genetic architecture of traits associated with agronomic importance. However, a majority of such traits are complex, and their genetic dissection has been traditionally hampered not only by the number of minor-effect quantitative trait loci (QTL) but also by genome-wide interacting loci with little or no individual effect. Soybean (Glycine max [L.] Merr.) seed isoflavonoids display a broad range of variation, even in genetically stabilized lines that grow in a fixed environment, because their synthesis and accumulation are affected by many biotic and abiotic factors. Due to this complexity, isoflavone QTL mapping has often produced conflicting results especially with variable growing conditions. Herein, we comparatively mapped soybean seed isoflavones genistein, daidzein, and glycitein by using several of the most commonly used mapping approaches: interval mapping, composite interval mapping, multiple interval mapping and a mixed-model based composite interval mapping. In total, 26 QTLs, including many novel regions, were found bearing additive main effects in a population of RILs derived from the cross between Essex and PI 437654. Our comparative approach demonstrates that statistical mapping methodologies are crucial for QTL discovery in complex traits. Despite a previous understanding of the influence of additive QTL on isoflavone production, the role of epistasis is not well established. Results indicate that epistasis, although largely dependent on the environment, is a very important genetic component underlying seed isoflavone content, and suggest epistasis as a key factor causing the observed phenotypic variability of these traits in diverse environments.