Is unicentric familial papillary thyroid microcarcinoma different from multicentric?

BACKGROUND: Familial papillary thyroid microcarcinoma (FPTMC) appears to be more aggressive than sporadic papillary thyroid microcarcinoma (SPTMC). However, there are authors who indicate that unicentric FPTMC has a similar prognosis to SPTMC. The objective is to analyze whether unicentric FPTMC has a better prognosis than multicentric FPTMC. DESIGN AND METHODS: Type of study: National multicenter longitudinal analytical observational study. STUDY POPULATION: Patients with FPTMC. STUDY GROUPS: Two groups were compared: Group A (unicentric FPTMC) vs. Group B (multicentric FPTMC). STUDY VARIABLES: It is analyzed whether between the groups there are: a) differentiating characteristics; and b) prognostic differences. STATISTICAL ANALYSIS: Cox regression analysis and survival analysis. RESULTS: Ninety-four patients were included, 44% (n = 41) with unicentric FPTMC and 56% (n = 53) with multicentric FPTMC. No differences were observed between the groups according to socio-familial, clinical or histological variables. In the group B a more aggressive treatment was performed, with higher frequency of total thyroidectomy (99 vs. 78%; p = 0.003), lymph node dissection (41 vs. 15%; p = 0.005) and therapy with radioactive iodine (96 vs. 73%; p = 0.002). Tumor stage was similar in both groups (p = 0.237), with a higher number of T3 cases in the group B (24 vs. 5%; p = 0.009). After a mean follow-up of 90 ± 68.95 months, the oncological results were similar, with a similar disease persistence rate (9 vs. 5%; p = 0.337), disease recurrence rate (21 vs. 8%; p = 0.159) and disease-free survival (p = 0.075). CONCLUSIONS: Unicentric FPTMC should not be considered as a SPTMC due to its prognosis is similar to multicentric FPTMC.

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.

Biological behavior of familial papillary thyroid microcarcinoma: Spanish multicenter study.

PURPOSE: Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain. METHODS: Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence). RESULTS: Ninety-four patients were analyzed. During a mean follow-up of 73.3 ± 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 ± 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210-5.473; p = 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638-1000; p < 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405-333.333; p < 0.001). CONCLUSION: FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA.

Association between antibiotic pressure and the risk of colonization/infection by multidrug-resistant Acinetobacter baumannii complex: a time series analysis.

OBJECTIVE: To analyze the association between antibiotic pressure and the risk of colonization/infection by Acinetobacter baumannii complex (AB), evaluating both the individual and general prescriptions of antibiotics. METHODS: This is an analytical, observational, case-control study on patients admitted to an Intensive Care Unit (ICU) during an AB outbreak (14 months). A five-year time series was constructed with the monthly incidence of cases of infection/colonization with strains of AB resistant to each antibiotic administered and with the monthly consumption of these antibiotics in the ICU. RESULTS: We identified 40 patients either infected (23) or colonized (17) by AB and 73 controls. We found an epidemic multidrug-resistant clone of AB in 75% of cases. Risk factors associated with the development of AB infection/colonization were: greater use of medical instruments, the presence of a tracheostomy, cutaneous ulcers, surgical lesions and prior antibiotic therapies. The regression analysis of individual use of antibiotics showed that prior treatment with ceftazidime, ceftriaxone, amoxicillin/clavulanate, imipenem, levofloxacin, linezolid, and vancomycin was a risk factor for acquiring AB. ARIMA models showed that the relationship were greatest and statistically significant when the treatment occurred between 6 months (ceftazidime) and 9 months (imipenem and levofloxacin) prior. CONCLUSIONS: The dynamic and aggregate relationship between the incidence of infection/colonization by multidrug-resistant strains of AB and prior antibiotic treatment was statistically significant for intervals of 6 to 9 months.

Historical evolution of the diseases caused by non-pigmented rapidly growing mycobacteria in a University Hospital.

OBJECTIVE: Non-pigmented rapidly growing mycobacteria (NPRGM) are a group of organisms of increasing interest due to the growing number of potential patients and the difficulties for a proper treatment in many of them. However, the evolution of these diseases in a long period of time and its evolutionary changes has been described only in a scanty number of reports. METHODS: We performed a retrospective study between January 1st 2004 and December 31st 2017 in order to evaluate the clinical significance and types of diseases caused by NPRGM. Patients with isolates of NPRGM during this period were selected for the study, and clinical charts were reviewed using a predefined protocol. RESULTS: During this period we identified 59 patients (76 clinical samples) with isolates of NPRGM, with 12 cases of clinical disease and one patient with doubtful significance (including 6 respiratory tract infections, 2 catheter infections, 1 skin and soft tissue infection, 1 disseminated infection, 1 conjunctivitis, 1 prosthetic joint infection and 1 mastitis). Fifty percent of M. chelonae isolates, 37.5% of M. abscessus isolates and 23.33% of M. fortuitum isolates were clinically significant. None of the isolates of other species were significant. CONCLUSIONS: Most isolates in respiratory samples were contaminants/colonizations. M. abscessus was the main etiological agent in respiratory syndromes, whereas M. chelonae and M. fortuitum were more frequently associated with other infections, especially clinical devices and skin and soft tissue infections.

Rustic Chato Murciano pig breed: Effect of the weight on carcass and meat quality.

Carcass and meat quality parameters of two different weights of pigs from the rustic breed Chato Murciano (Murcia Region, south-eastern Spain) were studied: light weight (LW, 147.98 ±â€¯3.78 kg live weight) and heavy weight (HW, 176.07 ±â€¯4.78 kg live weight). No weight-dependent effects were observed on carcass quality (carcass yield, length, back fat thickness) or on moisture, pH, and the L* and a* coordinates. The HW group had a higher fat content and cholesterol values than the LW group. None of the fatty acids analysed in the respective meats showed differences between groups (P > .05), except C16:0, C18:2 and C18:3. The HW group had higher values for unsaturated and polyunsaturated fatty acids and the n6/n3 index than LW, and lower values for saturated fat and the Saturated/Polyunsaturated fat ratio and a lower Atherogenesis Index. In conclusion, meat and fat quality are influenced by the final live weight of Chato Murciano pigs.

[Economic evaluation of the Alfred 60/AST device implantation for bacterial growth detection with automatic sewing machine]. / Evaluación económica de la implantación del autoanalizador Alfred 60/AST de detección de crecimiento bacteriano con sembrador automático.

OBJECTIVE: It is becoming increasingly necessary to automatize screening of urine samples to culture at Microbiology laboratories. Our objective was to estimate the budget threshold from which the Alfred 60/AST device would be profitable for our hospital. METHODS: Cost minimization study by decision trees, carried out in a General Hospital. The cost of traditional urine culture and urine processing using Alfred-60/AST were compared. Traditional processing involves the culture of all urine specimens received onto blood and MacConkey agar, and identification of every microorganism isolated by Vitek-2 system. The autoanalyzer would only inoculate the positive urines onto a chromogenic media, directly identifying the Escherichia coli isolates. RESULTS: The variables with the greatest economic impact in the model were the probability of obtaining a positive culture, the prevalence of E. coli in the urine cultures and the cost per sample using Alfred-60/AST. The multivariate sensitivity analysis showed that the model was solid. The bivariate sensitivity analysis showed that the model is suceptible to cost modification, mainly of the automatic device. At a threshold value of 1.40 euros/determination, the automatic processing would decrease the annual costs in 2,879 euros. CONCLUSIONS: The introduction of the Alfred-60/AST device in our laboratory at 1.40 euros/determination would reduce urine processing workload, saving time and costs.

[Monoclonal spread of multi-drug resistant CTX-M-15-producing Klebsiella pneumoniae. Impact of measures to control the outbreak]. / Diseminación monoclonal de Klebsiella pneumoniae productora de CTX-M-15 multirresistente. Impacto de las medidas para controlar el brote.

OBJECTIVE: To describe an outbreak of multi-drug resistant extended-spectrum ß-lactamases-producing Klebsiella pneumoniae (MDR-ESBL-KPN) and the impact of measures for its control. METHODS: We reviewed the patients´ clinical records with MDR-ESBL-KPN isolation during 2013-2016 with resistance to fluoroquinolones, aminoglycosides, fosfomycin, and nitrofurantoin; susceptible to imipenem, meropenem, colistin, and tigecycline and variable to ertapenem and cotrimoxazole (Vitek-2). The genetic relationship between 35 isolates was established by PFGE and MLST. Control measures were put in place in January 2016. RESULTS: We detected 269 patients colonized and/or infected by KPN-ESBL-MDR with a common resistance phenotype; the strains studied carried the blaCTX-M-15 gene and formed a single cluster belonging to ST11. The outbreak was detected at the end of 2015, although it began in 2013 in an elderly center. The acquisition source of the strains was: 6% community-acquired, 37% hospital-acquired (76% in internal medicine) and 57% related to long health care facilities (78% of hospitalizations in the last year). Ninety-four percent of patients had at least one underlying disease, 90% received antibiotics previously and 49% had some invasive devices. After the introduction of control measures, the incidence of cases in the quarter was reduced from 29 to 15. CONCLUSIONS: We detected a monoclonal outbreak of MDR-CTX-M-15-KPN in 2015, with predominance of health-care associated cases. The success in the rapid spread of the outbreak was due to the delay in its detection and to the fact that most of the patients had previously received antibiotics. The control measures reduced the number of isolates by 50%.

[Results of the implementation of an Antimicrobial Stewardship Program in the "Gerencia de Atención Integrada" of Alcazar de San Juan (Castilla La Mancha)]. / Resultados de la implantación de un Programa de Optimización de Antimicrobianos en la Gerencia de Atención Integrada de Alcázar de San Juan (Castilla La Mancha).

OBJECTIVE: Our aim was to evaluate the efficiency of an ASP after its implementation in 2016 in a Spanish hospital quality system. METHODS: Efficiency of the ASP was measured by process and outcome indicators at the level of the patient's quality of life, antimicrobial consumption and percentage of resistance to them during the 2016-2017 period. In 2017, the failures mode and effects analysis (FMEA) methodology was applied. An annual satisfaction survey was conducted. RESULTS: The clinical indicators were within the threshold of acceptability, as well as the empirical prescription of antimicrobials, the consumption of antibiotics (reduction of 77 DDD in the first semester of 2016 to 26 in the second semester of 2017) and the renal (gentamicin) and neurological (carbapenems) toxicity. The FMEA identified as a main risk the lack of adequacy of the empirical treatment once the antibiogram was obtained; thus, a corrective action was taken in 2017. Regarding the microbiological indicators, the incidence of multi-drug resistant and carbapenemase-producing enterobacteria, and that of methicillin-resistant Staphylococcus aureus, were reduced. Eighty-three percent of the counselling activities carried out were accepted. The surveys revealed a good acceptance and spread of the program, the need for protocols and training in the use of antibiotics. CONCLUSIONS: The implementation of the ASP in the quality system was efficient. The consumption of antibiotics and the adverse effects derived from their use were reduced, improving the quality of life of patients, and reducing health costs.

Consumers' sensitivity to androstenone and the evaluation of different cooking methods to mask boar taint.

Boar taint is an unpleasant odour and flavour present in some entire male pigs that is due to the presence of androstenone and skatole. The aim of the study was to assess the sensitivity of 150 consumers to androstenone and to compare the acceptability and liking of meat from castrated and entire pigs, cooked with different cooking methods. Meat samples consisted of loins from castrated (CM) and entire male pigs (EM) with high levels of androstenone cooked by two cooking methods: sous-vide and fried/breaded with garlic and parsley. Consumers evaluated smell and flavour acceptability, and overall liking of CM and EM for each cooking method. The results of the study showed that dislike of androstenone odour increased significantly with sensitivity. The results of acceptability and overall liking were similar in CM and EM for both cooking methods. Therefore, the two cooking methods used in the study may be useful to mask boar taint.

PEGylated PLGA nanospheres optimized by design of experiments for ocular administration of dexibuprofen-in vitro, ex vivo and in vivo characterization.

Dexibuprofen-loaded PEGylated PLGA nanospheres have been developed to improve the biopharmaceutical profile of the anti-inflammatory drug for ocular administration. Dexibuprofen is the active enantiomer of ibuprofen and therefore lower doses may be applied to achieve the same therapeutic level. According to this, two batches of nanospheres of different drug concentrations, 0.5 and 1.0mg/ml respectively, have been developed (the latter corresponding to the therapeutic ibuprofen concentration for inflammatory eye diseases). Both batches were composed of negatively charged nanospheres (--14.1 and --15.9mV), with a mean particle size below 200nm, and a high encapsulation efficiency (99%). X-ray, FTIR, and DSC analyses confirmed that the drug was dispersed inside the matrix of the nanospheres. While the in vitro release profile was sustained up to 12h, the ex vivo corneal and scleral permeation profile demonstrated higher drug retention and permeation in the corneal tissue rather than in the sclera. These results were also confirmed by the quantification of dexibuprofen in ocular tissues after the in vivo administration of drug-loaded nanospheres. Cell viability studies confirmed that PEGylated-PLGA nanospheres were less cytotoxic than free dexibuprofen in the majority of the tested concentrations. Ocular in vitro (HET-CAM test) and in vivo (Draize test) tolerance assays demonstrated the non-irritant character of both nanosphere batches. In vivo anti-inflammatory effects were evaluated in albino rabbits before and after inflammation induction. Both batches confirmed to be effective to treat and prevent ocular inflammation.

Evaluation of different strategies to mask boar taint in cooked sausage.

The use of smoking and/or spices was evaluated for their ability to mask boar taint in frankfurters manufactured from entire pigs with high levels of androstenone. Five frankfurter types were considered: control, smoked, flavouring+smoked, spicy and spicy+smoked. A trained panel in androstenone perception carried out a sensory profile on the different sausages. The highest scores for androstenone perception (odour, flavour and aftertaste) were found in frankfurters that included no masking strategy which indicated the effectiveness of the evaluated strategies. Regarding masking strategies, the contribution of spices and smoking to sensory perception of frankfurters was detected by the panellists. Smoking was the best strategy to mask androstenone odour, while the use of spices masked androstenone odour to a greater extent than androstenone flavour. Only the combined use of spices and smoking was able to eliminate the perception of androstenone. The application of this strategy in frankfurters could be an alternative in the commercialization of entire pigs.

Feeding Iberian × Duroc cross pigs with crude glycerine: Effects of diet and gender on carcass and meat quality.

Ninety (45 castrated males and 45 gilts) Iberian × Duroc pigs were used in this study. During the finishing period (95-160 kg body weight, 74 days) animals received conventional feed (control G0) or the same feed plus 5% (G5) or 10% (G10) of crude glycerine to partially replace wheat. In general, neither the diet nor gender affected ultrasound, carcass or meat quality parameters. The G10 had lower values of cooking loss and a* than the G5 and G0 groups. The fatty acids, C10:0, C12:0 and C18:3, in intramuscular fat were lower in both glycerine groups. Polyunsaturated fatty acids and 18:2 decreased and C20:0 increased at the subcutaneous fat of G10 animals. Castrated males produced carcasses with higher backfat thickness and fat content. Castrated males had a higher SFA content in subcutaneous fat than females (P<0.001). In conclusion, up to 10% crude glycerine could be used in the Iberian × Duroc diet.

Polyclonality among clinical strains of non-pigmented rapidly growing mycobacteria: phenotypic and genotypic differences and their potential implications.

To investigate the potential implications (especially the implications in clinical significance and antimicrobial susceptibility) of polyclonality among rapidly growing mycobacteria, we performed random amplified polymorphic DNA analysis in 64 clinical isolates of which the clinical significance was established. Phenotypic characteristics (antimicrobial susceptibility test, colony morphology and growth rate) of each clone were studied. Polyclonality was detected in 13 of the isolates (20.3%). There was a relationship between monoclonality and clinical significance (p 0.0096). Monoclonal and polyclonal isolates showed different behaviour in antimicrobial susceptibility. There was a strong relationship between monoclonality and those species that are more pathogenic for humans, and also with clinical significance of the isolates.

Permeation studies through porcine small intestine of furosemide solutions for personalised paediatric administration.

Personalized medicine is a challenging research area in paediatric drug design since no suitable pharmaceutical forms are currently available. Furosemide is an anthranilic acid derivative used in paediatric practice to treat cardiac and pulmonary disorders in premature infants and neonates. However, it is not commercialized in suitable dosage forms for paediatrics. Elaborating new paediatric formulations when no commercial forms are available is a common practice in pharmacy laboratories; amongst these, oral liquid formulations are the most common. We developed two extemporaneous paediatric oral solutions of furosemide (pure powder). The characterization and stability study were also performed. Parameters such as organoleptic characteristics, rheology, pH, content of active substance, and microbial stability were evaluated at three temperatures for two months. Evaluation of all these parameters showed that both solutions were stable for 60 days at 4 and 25 °C. Moreover, ex vivo studies were performed to evaluate the permeation behaviour of developed solutions through porcine small intestine to evaluate the potential paediatric biological parameters influencing the bioavailability and efficacy. A validated spectrofluorometric method was also used for this purpose. Our results guarantee a correct dosification, administration and potential efficacy of furosemide when is formulated in liquid oral forms for the treatment of cardiac and pulmonary disorders in children.

TBARs distillation method: revision to minimize the interference from yellow pigments in meat products.

The aim was to study the effect of the incubation method and TBA reagent (concentration/solvent) on yellow pigment interference in meat products. Distillates from red sausage, sucrose, malondialdehyde and a mixture of sucrose-malondialdehyde were reacted with four different TBA solutions at five different temperature/time relations. Two TBA solutions were prepared at 20mM using 90% glacial acetic acid or 3.86% perchloric acid. In addition, an 80mM TBA solution was prepared using distilled water adjusted to pH4 and another using 0.8% TBA in distilled water. The temperature/time relations were: (1) 35min in a boiling water bath; (2) 70°C/30min; (3) 40°C/90min; (4) room temperature (r.t.) (24°C) in dark conditions for 20h; and (5) 60min in a boiling water bath. The results showed that aqueous or diluted acid solutions of TBA reagent and the application of 100°C for less than 1h provided the best conditions to minimize the presence of yellow pigments and maximize pink pigment formation in meat products.

Crude glycerine inclusion in Limousin bull diets: animal performance, carcass characteristics and meat quality.

Three hundred and six Limousin young bulls (7±1months of age, initial body weight 273±43kg) were used to evaluate the effect of crude glycerine supplementation on animal performance, carcass characteristics and meat quality. Animals were assigned to three different diets: Control (0% of crude glycerine), G2 and G4 (2 and 4% of crude glycerine, respectively). The diets were administrated ad libitum for 240days (final body weight 644±24kg). Average daily weight gain, average daily feed intake, the gain:feed ratio, ultrasound measures in vivo, carcass characteristics, pH, water holding capacity, drip losses, and cooking losses were not affected (P>0.05) by diets. Diet decreased C16:0 (P<0.01) and C16:1 (P<0.05) contents in meat. The G4 meat showed lower C12:0, C14:0, C17:0, C18:0, C18:1, C18:2, C18:3, c9,t11-c18:2, C20:0 and C20:4 levels (P<0.05) than control. Glycerine increased desirable fatty acid percentages (P<0.05) in intramuscular fat.

Observational cross-sectional study of compliance with the fast track protocol in elective surgery for colon cancer in Spain.

PURPOSE: The purpose of this study was to establish the degree of compliance with the fast track (enhanced recovery) protocol in habitual clinical practice and to determine which measures are fundamental for achieving the results obtained by applying the entire protocol. METHODS: Observational, cross-sectional, multicenter trial was conducted. Participating hospitals prospectively recorded data from at least ten consecutive patients undergoing surgery for colon cancer who were applied some or all of the items comprising the enhanced recovery protocol. The data were analyzed both globally and dividing the sample into the two groups of patients. RESULTS: Data on 363 patients from 25 hospitals were recorded, one hundred seventy-three in the "non-fast track" group and 190 in the "fast track" group. The non-fast track group complied with a mean of 5.4 (±1.8) items and the fast track group with a mean of 8.4 (±1.8) items. The mean functional hospital stay was 7.3 (±5.1) days in the non-fast track group and 6.2 (±5.1) days in the fast track group (p < 0.05). Morbidity was 31.1 % in the fast track group and 24.3 % in the non-fast track group, though the differences were not statistically significant. The only prognostic factors that have an impact on improving the results are measures against hypothermia and mobilization before 24 h. CONCLUSION: Compliance with the enhanced recovery protocol is not exhaustive in habitual clinical practice. However, greater compliance was associated with shorter hospital stay without any increase in morbidity. The only items clearly associated with reduced functional hospital stay were measures against hypothermia and mobilization before 24 h.