Rspo2-LGR4 exacerbates hepatocellular carcinoma progression via activation of Wnt/ß-catenin signaling pathway.

BACKGROUND: The leucine-rich repeat-containing G-protein-coupled receptor 4 (LGR4) plays an important role in stem cell differentiation, organ development and cancer. Whether LGR4 affects the progression of hepatocellular carcinoma (HCC) remains unknown. This study aimed to reveal the role of LGR4 in HCC. METHODS: Clinical samples of HCC were collected to assess the expression of LGR4 and its correlation with patients' clinical characteristics. The expression level of LGR4 in HCC cells was altered by pharmacological and genetic methods, and the role of LGR4 in HCC progression was analyzed by in vivo and in vitro assays. HCC was induced by diethylnitrosamine (DEN) and carbon tetrachloride (CCl4) in wild-type and LGR4 deficient mice, the effect of LGR4 on HCC was examined by histopathological evaluation and biochemical assays. RESULTS: LGR4 expression was up-regulated in HCC samples, and its expression level was positively correlated with tumor size, microvascular invasion (MVI), TNM stage and pathological differentiation grade of HCC patients. In the mouse HCC model induced by DEN+CCl4, knockdown of LGR4 effectively inhibited the progression of HCC. Silencing of LGR4 inhibited the proliferation, migration, invasion, stem cell-like properties and Warburg effect of HCC cells. These phenotypes were promoted by R-spondin2 (Rspo2), an endogenous ligand for LGR4. Rspo2 markedly increased the nuclear translocation of ß-catenin, whereas IWR-1, an inhibitor of Wnt/ß-catenin signaling, reversed its effect. Deficiency of LGR4 significantly reduced the nuclear translocation of ß-catenin and the expression of its downstream target genes cyclinD1 and c-Myc. CONCLUSIONS: LGR4 promotes HCC progression via Wnt/ß-catenin signaling pathway.

Importance of timely metadata curation to the global surveillance of genetic diversity.

Genetic diversity within species represents a fundamental yet underappreciated level of biodiversity. Because genetic diversity can indicate species resilience to changing climate, its measurement is relevant to many national and global conservation policy targets. Many studies produce large amounts of genome-scale genetic diversity data for wild populations, but most (87%) do not include the associated spatial and temporal metadata necessary for them to be reused in monitoring programs or for acknowledging the sovereignty of nations or Indigenous peoples. We undertook a distributed datathon to quantify the availability of these missing metadata and to test the hypothesis that their availability decays with time. We also worked to remediate missing metadata by extracting them from associated published papers, online repositories, and direct communication with authors. Starting with 848 candidate genomic data sets (reduced representation and whole genome) from the International Nucleotide Sequence Database Collaboration, we determined that 561 contained mostly samples from wild populations. We successfully restored spatiotemporal metadata for 78% of these 561 data sets (n = 440 data sets with data on 45,105 individuals from 762 species in 17 phyla). Examining papers and online repositories was much more fruitful than contacting 351 authors, who replied to our email requests 45% of the time. Overall, 23% of our email queries to authors unearthed useful metadata. The probability of retrieving spatiotemporal metadata declined significantly as age of the data set increased. There was a 13.5% yearly decrease in metadata associated with published papers or online repositories and up to a 22% yearly decrease in metadata that were only available from authors. This rapid decay in metadata availability, mirrored in studies of other types of biological data, should motivate swift updates to data-sharing policies and researcher practices to ensure that the valuable context provided by metadata is not lost to conservation science forever.

Importancia de la curación oportuna de metadatos para la vigilancia mundial de la diversidad genética Resumen La diversidad genética intraespecífica representa un nivel fundamental, pero a la vez subvalorado de la biodiversidad. La diversidad genética puede indicar la resiliencia de una especie ante el clima cambiante, por lo que su medición es relevante para muchos objetivos de la política de conservación mundial y nacional. Muchos estudios producen una gran cantidad de datos sobre la diversidad a nivel genético de las poblaciones silvestres, aunque la mayoría (87%) no incluye los metadatos espaciales y temporales asociados para que sean reutilizados en los programas de monitoreo o para reconocer la soberanía de las naciones o los pueblos indígenas. Realizamos un "datatón" distribuido para cuantificar la disponibilidad de estos metadatos faltantes y para probar la hipótesis que supone que esta disponibilidad se deteriora con el tiempo. También trabajamos para reparar los metadatos faltantes al extraerlos de los artículos asociados publicados, los repositorios en línea y la comunicación directa con los autores. Iniciamos con 838 candidatos de conjuntos de datos genómicos (representación reducida y genoma completo) tomados de la colaboración internacional para la base de datos de secuencias de nucleótidos y determinamos que 561 incluían en su mayoría muestras tomadas de poblaciones silvestres. Restauramos con éxito los metadatos espaciotemporales en el 78% de estos 561 conjuntos de datos (n = 440 conjuntos de datos con información sobre 45,105 individuos de 762 especies en 17 filos). El análisis de los artículos y los repositorios virtuales fue mucho más productivo que contactar a los 351 autores, quienes tuvieron un 45% de respuesta a nuestros correos. En general, el 23% de nuestras consultas descubrieron metadatos útiles. La probabilidad de recuperar metadatos espaciotemporales declinó de manera significativa conforme incrementó la antigüedad del conjunto de datos. Hubo una disminución anual del 13.5% en los metadatos asociados con los artículos publicados y los repositorios virtuales y hasta una disminución anual del 22% en los metadatos que sólo estaban disponibles mediante la comunicación con los autores. Este rápido deterioro en la disponibilidad de los metadatos, duplicado en estudios de otros tipos de datos biológicos, debería motivar la pronta actualización de las políticas del intercambio de datos y las prácticas de los investigadores para asegurar que en las ciencias de la conservación no se pierda para siempre el contexto valioso proporcionado por los metadatos.

Integrative Systemic Supervision: Promoting Supervisees' Theoretical Integration in Systemic Therapy.

Integrative systemic therapy (IST) is a meta-theoretical perspective, grounded in systemic theory and integration, that transcends therapy models in individual, couple, and family therapy. To foster supervisees' theoretical integration and systemic thinking, two of IST's primary tools-the essence diagram and blueprint-are described and applied to inform an integrative, systemic meta-perspective for supervision. Recommendations, specific guiding questions, and examples are provided to operationalize these tools in the multi-level supervision system (i.e., supervisor-supervisee-client system). IST supervisors and other supervisors who are interested in integrative, systemic training can use these tools to guide the process of supervision and strengthen supervisees' ability to hypothesize, plan, converse, and read clients' feedback in relation to the various tasks of therapy. The essence diagram and blueprint are applied to facilitate case consultation and cultivate the development of supervisees' clinical competencies. Particularly, the problem-solving focus of IST has been adapted to include a competency-based and professional growth-oriented dimension for supervision to better promote supervisees' development. Lastly, the advantages and challenges of IST-influenced supervision are discussed.

La terapia sistémica integral (TSI) es una perspectiva metateórica basada en la teoría sistémica y la integración, que trasciende los modelos de terapia en la terapia individual, de pareja y familiar. Para fomentar la integración teórica de los supervisados y el pensamiento sistémico, se describen y se aplican dos de las herramientas principales de la TSI-el diagrama del eje y el diseño- a fin de respaldar una metaperspectiva integradora y sistémica de la supervisión. Se ofrecen recomendaciones, preguntas orientadoras específicas y ejemplos para poner en funcionamiento estas herramientas en el sistema de supervisión multinivel (p. ej.: sistema supervisor-supervisado-paciente). Los supervisores de la TSI y otros supervisores que estén interesados en la capacitación integradora y sistémica pueden usar estas herramientas para guiar el proceso de supervisión y fortalecer la capacidad de los supervisados para plantear hipótesis, planificar, conversar y leer los comentarios de los pacientes en relación con las diferentes tareas de la terapia. El diagrama del eje y el diseño se aplican para facilitar la consulta de casos y cultivar el desarrollo de las competencias clínicas de los supervisados. Particularmente, se ha adaptado el eje de resolución de problemas de la TSI para incluir una dimensión basada en competencias y orientada al crecimiento profesional a fin de que la supervisión promueva mejor el desarrollo de los supervisados. Por último, se comentan las ventajas y las dificultades de la supervisión influida por la TSI.

Transcending Therapy Models and Managing Complexity: Suggestions from Integrative Systemic Therapy.

Integrative Systemic Therapy (IST) is a metatheoretical perspective for the conduct of individual, couple, and family therapy. Following a brief description of IST, this article presents developments in IST and their implication for psychotherapy integration. The nature of problem solving in IST is clarified, and the relationship between IST's essential problem-solving tasks and its core decision-making process is defined. Particular attention is paid to two dimensions of IST that have given it its name: integration and systems theory. The advantages of a therapy that is client system-centered and not model-driven are discussed, and a justification for "good enough" execution of interventions abstracted from specific models is provided. A procedure for balancing pragmatic demands of therapy with a commitment to account, as needed, for broader or deeper systemic issues is presented.

La terapia sistémica integrativa (TSI) es una perspectiva metateórica para llevar a cabo la terapia individual, de pareja y familiar. Después de una breve descripción de la TSI, este artículo presenta avances en dicha terapia y su implicancia para la integración en la psicoterapia. Se aclara la índole de la resolución de problemas en la TSI y se define la relación entre las tareas esenciales de resolución de problemas de la TSI y su proceso fundamental de toma de decisiones. Se presta atención particularmente a dos dimensiones de la TSI que le han dado su nombre: la integración y la teoría de sistemas. Se explican las ventajas de una terapia que está centrada en el sistema del paciente y no dirigida por un modelo, y se justifica la ejecución "suficientemente buena" de intervenciones abstraída de modelos específicos. Finalmente, se presenta un procedimiento para equilibrar las exigencias pragmáticas de la terapia con un compromiso de tener en cuenta, cuando fuera necesario, cuestiones sistémicas más amplias o profundas.

[Magnetic resonance imaging of the prostate: usefulness of diffusion sequences in detecting postembolization ischemia in patients with benign prostatic hyperplasia]. / Resonancia magnética de próstata: utilidad de la secuencia de difusión en la detección de isquemia postembolización en pacientes con hiperplasia prostática benigna.

OBJECTIVE: To analyze the usefulness of diffusion magnetic resonance (MR) sequences before and after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: We analyzed MR studies done before (7-10 days) and after (30 days) PAE in 19 patients with BPH treated with PAE between June 2012 and December 2013. We used 1.5 Tesla scanners with body surface coils. In pre-PAE MR studies, we recorded mean b40 values and minimum (min) and maximum (max) apparent diffusion coefficient (ADC) values. In post-PAE MR studies, we recorded b40, b400, and b1000 values and min, mean, and max ADC values. We compared diffusion behavior/ADC before and after PAE and areas without ischemia. We correlated these with decreased prostatic volume (PV). RESULTS: We identified ischemia with contrast in 8 (42.1%) patients. No significant difference was found in mean b40 (p= 0.1650) or in the b40 ratio (p= 0.8868) between patients with ischemia and those without before PAE. Min b40, b40 ratio, and min ADC values differed significantly between ischemic areas and nonischemic areas within patients [p= 0.048 (b40min and ratio) and p= 0.002 (min ADC)]. No significant correlation was found between the percentage decrease in PV and mean b40 (p= 0.8490) or b40 ratio (p=0.8573). CONCLUSION: Post-PAE ischemia generates objective changes in diffusion and ADC values that enable ischemic sectors to be differentiated from nonischemic sectors. Future studies should analyze whether it is possible to subjectively differentiate between these areas through the visualization of nonischemic sectors and the feasibility of replacing them with contrast to detect ischemia.

[Contraindications to succinylcholine in the intensive care unit. A prevalence study]. / Prevalencia de contraindicaciones a succinilcolina en unidades de cuidados intensivos.

OBJECTIVE: To determine the prevalence of contraindications to succinylcholine in patients admitted to the ICU. DESIGN: An observational study was carried out, describing the frequency of succinylcholine contraindication by stays, and associating the contraindications to population variables. SETTING: The adult general ICU of a reference hospital. PATIENTS: Clinical-surgical critically ill patients. Thirty consecutive days were analyzed. INTERVENTIONS: None. VARIABLES: Population variables: age, sex, APACHE II and SOFA scores, illness, days of hospitalization, mechanical ventilation and renal replacement therapy. CONTRAINDICATIONS: hyperkalemia, bedridden patients, rhabdomyolysis, muscle trauma, burns, infusion of neuromuscular blocking agents, acute renal failure, chronic renal failure, intraocular hypertension, intracranial hypertension, statin use, malignant hyperthermia, neuromuscular disease, spinal cord sectioning, bradycardia < 50 bpm, succinylcholine allergy, and pseudo-cholinesterase deficiency. RESULTS: A total of 102 patients were admitted, aged 60 ± 16 years (56.9% males), with the generation of 657 stays. Main diseases: elective heart surgery (33%), respiratory failure (22%) and sepsis (14%). We documented 466 stays (70.9%) with contraindications, particularly bedridden patients (n=140), neuromuscular blocking agents (n=101), acute renal failure (n=126), statin use (n=167), neuromuscular disease (n=159) and bradycardia (n=76). We recorded 74 stays (11.3%) at high risk of complications, secondary to hyperkalemic risk associated to receptor dysregulation. A high risk of complications was associated to advanced age, prolonged hospitalization, prolonged length of stay in the ICU, higher APACHE II and SOFA scores, mechanical ventilation and renal replacement therapy. CONCLUSION: Given the high prevalence of contraindications to succinylcholine observed, we discourage its use in patients admitted to the ICU.

FLAIR hyperintensity in the subarachnoid space: Main differentials.

The fluid-attenuated inversion recovery (FLAIR) sequence forms part of the vast majority of current diagnostic protocols for brain MRI. This sequence enables the suppression of the signal from cerebrospinal fluid, facilitating the detection of disease involving the subarachnoid space. The causes of hyperintensity in the arachnoid space in this sequence can be divided into two main categories: hyperintensity due to disease and hyperintensity due to artifacts. Hyperintensity due to tumors, inflammation, vascular disease, or hypercellularity of the cerebrospinal fluid or hematic contents is well known. However, numerous other non-pathological conditions, mainly due to artifacts, that are also associated with this finding are a potential source of diagnostic errors.

Executive Summary of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management.

The Airway section of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) present the Guidelines for the integral management of difficult airway in adult patients. This document provides recommendations based on current scientific evidence, theoretical-educational tools and implementation tools, mainly cognitive aids, applicable to the treatment of the airway in the field of anesthesiology, critical care, emergencies and prehospital medicine. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations and optimization in the progression of the application of strategies to preserve adequate alveolar oxygenation in order to improve safety and quality of care.

Cerebral microbleeds. Utility of SWI sequences.

OBJECTIVES: Define the concept of cerebral microbleeds (CMBs) and describe the most useful MRI sequences for detecting this finding. Review the entities that most frequently present with CMBs and that may benefit from the use of susceptibility-weighted imaging (SWI) sequences. CONCLUSIONS: SWI is a useful MRI sequence for the detection and characterization of microhemorrhages, venous structures and other sources of susceptibility in imaging. SWI is particularly sensitive to local magnetic field inhomogeneities generated by certain substances and is superior to T2* GRE sequences for this assessment. CMBs may be seen in different neurologic conditions, in certain infrequent clinical contexts and have a key role as a biomarker status in gliomas (ITTS) and as a marker of inflammatory activity in multiple sclerosis.

Recommendations for airway management in a suspected or confirmed case with COVID-19. A protocol of the Department of Cardiovascular Anesthesia of the National Institute of Cardiology Ignacio Chávez / Recomendaciones para el manejo de la vía aérea en caso sospechoso y/o confirmado con COVID-19. Protocolo del Departamento de Anestesiología Cardiovascular del Instituto Nacional de Cardiología Ignacio Chávez

The new coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), detected in Wuhan, China, causes coronavirus disease 2019 (COVID-19), which was declared pandemic, and has caused more than 19 million confirmed cases and more than 700 thousand deaths worldwide. When our institution was converted to COVID's hospital since early April 2020, specific care protocols were developed, with the aim of improving the quality of care and safety of patients and the staff involved in their management. Airway management represents one of the highest risks of direct contact infection with aerosol generation (orotracheal intubation, secretion aspiration, extubation, cardiopulmonary resuscitation, high flow oxygen therapy, noninvasive ventilation, and invasive ventilation). We present the current recommendations for airway management as well as a step-by-step airway management protocol to carry out a more secure procedure based on the literature reported so far.

El nuevo coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), detectado en Wuhan (China), causante de la enfermedad por coronavirus 2019 (COVID-19), que se declaró como pandemia, ha causado más de 19 millones de casos confirmados y más de 700 mil muertes en el mundo. Nuestra institución se reconvirtió a hospital COVID desde principios de abril del 2020, con lo que se desarrollaron protocolos de atención específicos, con el objetivo de mejorar la calidad de atención y seguridad de los pacientes y el personal involucrado en su manejo. El manejo de la vía aérea representa uno de los riesgos más altos de contagio por contacto directo en la generación de aerosoles (intubación orotraqueal, aspiración de secreciones, extubación, resucitación cardiopulmonar, terapia de oxígeno de alto flujo, ventilación no invasiva y ventilación invasiva). Presentamos las recomendaciones actuales para el manejo de la vía aérea, así como un protocolo de manejo paso a paso para llevar a cabo un procedimiento con mayor seguridad basados en la literatura reportada hasta el momento.

Sequence-based typing of clinical and environmental Legionella pneumophila isolates in Shenyang, China.

INTRODUCTION: We performed SBT (sequence-based typing) on clinical and environmental Legionellapneumophila isolates in Shenyang (China). We analyzed and compared the results with those obtained by PFGE (pulsed field gel electrophoresis). METHODS: Twenty-two L. pneumophila isolates were collected from two patients with L. pneumophila infection, two hospitals, and 13 office buildings. There were two clinical isolates, one strain isolated from domestic tap water, another from shower water and 18 strains from cooling tower water. All these isolates were analyzed by SBT and PFGE methods. RESULTS: The 22 isolates were divided into 7 types by SBT. Five isolates belonged to novel sequence types (ST2345, ST2344, ST2406, ST2407, and ST2408) and one isolate belonged to ST328. The STs were not obtained for two of the isolates. The remaining 14 isolates belonged to ST1. PFGE typing divided the 22 isolates into 14 pulsotypes. The main pulsotype was SYC, which included seven isolates. CONCLUSION: Both typing methods showed that predominant clonal lines exist in the Shenyang region, with high levels of genetic polymorphisms. Five novel STs were identified, indicating a unique genetic composition of L. pneumophila strains in this region, which are significantly different from those found in other environmental water systems in the world.

Sequence-based typing of clinical and environmental Legionella pneumophila isolates in Shenyang, China.

INTRODUCTION: We performed SBT (sequence-based typing) on clinical and environmental Legionellapneumophila isolates in Shenyang (China). We analyzed and compared the results with those obtained by PFGE (pulsed field gel electrophoresis). METHODS: Twenty-two L. pneumophila isolates were collected from two patients with L. pneumophila infection, two hospitals, and 13 office buildings. There were two clinical isolates, one strain isolated from domestic tap water, another from shower water and 18 strains from cooling tower water. All these isolates were analyzed by SBT and PFGE methods. RESULTS: The 22 isolates were divided into 7 types by SBT. Five isolates belonged to novel sequence types (ST2345, ST2344, ST2406, ST2407, and ST2408) and one isolate belonged to ST328. The STs were not obtained for two of the isolates. The remaining 14 isolates belonged to ST1. PFGE typing divided the 22 isolates into 14 pulsotypes. The main pulsotype was SYC, which included seven isolates. CONCLUSION: Both typing methods showed that predominant clonal lines exist in the Shenyang region, with high levels of genetic polymorphisms. Five novel STs were identified, indicating a unique genetic composition of L. pneumophila strains in this region, which are significantly different from those found in other environmental water systems in the world.

Current practice of rapid sequence induction in adults: A national survey among anesthesiologists in Spain. / Práctica actual de la inducción de secuencia rápida en adultos: una encuesta nacional entre anestesiólogos en España.

BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice.

Analysis of morphological measurements of the trigeminal nerve in the linac stereotactic radiosurgery simulation targeting the root entry zone in trigeminal neuralgia.

PURPOSE: To describe the anatomical measurements of the trigeminal nerve in patients with trigeminal neuralgia (TN) during Linac (linear accelerator)-based stereotactic radiosurgery (SRS) simulation, targeting the root entry zone (REZ), with a 30% isodose line tangential to the pons, using 4-mm and 6-mm collimators. METHODS: In this retrospective study, 53 TN patients, who underwent Fiesta sequence scanning prior to any treatment modality, were assessed. Bilateral measurements were obtained from the cisternal segment of the trigeminal nerve, the trigeminal-pontine angle, and the lateral width of the pontine cistern on the Fiesta MRI sequence. Linac-based SRS simulations were estimated with a radiation dosage of 90Gy to 30% isodose line tangential to the pons, with both 4- and 6-mm collimators. Distances from the calculated targets to the pons and the Gasserian ganglion were measured for later analysis. The statistical analysis was performed comparing the affected side against the unaffected side. RESULTS: Right trigeminal nerve was affected in 36 patients (67.9%), and left one in 17 (32.1%) patients. The mean length of the trigeminal nerve was 9.8mm (range: 4.6-16.8mm) on the affected side, and 10.5mm (range: 5.6-18.4mm) on the unaffected side (p=.02). The mean trigeminal-pontine angle was 12.5° (range: 5.4° to 19.5°) on the affected side, and 10.2° (range: 5.0° to 30.5°) on the unaffected side (p=.01). In the simulations, the distances from the estimated targets to the pons and the Gasserian ganglion were not statistically different between sides. The variation of target-pons and target-ganglion distances was statistically significant on the affected side with the change of collimators (p<.001). CONCLUSIONS: In this anatomical study, significant differences were identified in the length of the affected trigeminal nerve and trigeminal-pontine angle compared to the unaffected side in TN patients in Fiesta sequences prior to surgery or radiosurgery. Significant variation of the target location was found on the REZ between the 4- and 6-collimators during the Linac-based SRS simulations with the estimated radiation dosage of 90Gy and 30% isodose line tangential to the pons.

Use of Magnetic Resonance Imaging for N-Staging in Patients with Non-Small Cell Lung Cancer. A Systematic Review.

INTRODUCTION: The aim of this study is to assess the diagnostic value of the magnetic resonance imaging (MRI) in differentiating metastasic from non-metastatic lymph nodes in NSCLC patients compared with computed tomography (CT) and fluorodeoxyglucose (FDG) - positron emission tomography (PET) or both combined. METHODS: Twenty-three studies (19 studies and 4 meta-analysis) with sample size ranging between 22 and 250 patients were included in this analysis. MRI, regardless of the sequence obtained, where used for the evaluation of N-staging of NSCLC. Histopathology results and clinical or imaging follow-up were used as the reference standard. Studies were excluded if the sample size was less than 20 cases, if less than 10 lymph nodes assessment were presented or studies where standard reference was not used. Papers not reporting sufficient data were also excluded. RESULTS: As compared to CT and PET, MRI demonstrated a higher sensitivity, specificity and diagnostic accuracy in the diagnosis of metastatic or non-metastatic lymph nodes in N-staging in NSCLC patients. No study considered MRI inferior than conventional techniques (CT, PET or PET/CT). Other outstanding results of this review are fewer false positives with MRI in comparison with PET, their superiority over PET/CT to detect non-resectable lung cancer, to diagnosing infiltration of adjacent structures or brain metastasis and detecting small nodules. CONCLUSION: MRI has shown at least similar or better results in diagnostic accuracy to differentiate metastatic from non-metastatic mediastinal lymph nodes. This suggests that MRI could play a significant role in mediastinal NSCLC staging.

Comparación entre rocuronio y succinilcolina para secuencia de intubación rápida en departamento de emergencias / Rocuronium and succinilcholine comparison in emergency department

Introduction: The rapid intubation sequence is a basic intervention for the management of the airway in the emergency department. The use of neuromuscular blockers is essential for this intervention. Succinylcholine and rocuronium being the most used, which present pharmacological differences between them. Methods: A single-blind, randomized, controlled study was conducted of all patients who were admitted to the emergency department of the Hospital Municipal de Urgencias and who required a rapid intubation sequence for 13 months using succinylcholine or rocuronium as a neuromuscular blocking drug. Intubation conditions, ease of intubation were assessed, and serum potassium was recorded on admission and 15 minutes after the infusion of the blocker. Results: 80 patients were included in the study, 35 for the rocuronium group and 45 for the succinylcholine group. For the analysis, patients with intubation conditions were classified as clinically acceptable or clinically poor according to the Goldberg scale. In the Rocuronium group 94.3% were clinically acceptable conditions, 5.7% poor conditions and with succinylcholine 82.2% were acceptable conditions and 17.8% in poor conditions. Better intubation conditions are observed with Rocuronium compared to Succinylcholine (RR 0.73 IC 95% 0.23-2,31) but without statistically significant differences. Regarding alteration of serum potassium, there were no statistically significant differences between the two regarding its incidence (RR 1.0 IC 95% 0.53-1.87). Conclusions: Although several studies indicate the superiority of succinylcholine in creating better conditions over rocuronium for intubation, in our study carried out in an emergency department it was observed that rocuronium generates better intubation conditions in relation to succinylcholine although without statistically significant differences and there were no differences in serum potassium levels between both drugs.

Introducción: La secuencia de intubación rápida es una intervención fundamental para el manejo de la vía aérea en la especialidad de Medicina de Emergencias. El uso de bloqueantes neuromusculares es esencial para esta intervención siendo los más usados la succinilcolina y el rocuronio los cuales presentan diferencias farmacológicas entre sí. Método: Se realizó un estudio controlado, aleatorizado, a simple ciego de todos los pacientes que ingresaron al Shock Room del Hospital Municipal de Urgencias y que requirieron secuencia de intubación rápida durante 13 meses utilizando succinilcolina o rocuronio como fármaco bloqueante neuromuscular. Se valoraron condiciones de intubación y facilidad de intubación y se registró el potasio sérico al ingreso y a los 15 minutos posteriores a la infusión del bloqueante. Resultados: Se incluyeron en el estudio a 80 pacientes, 35 para el grupo rocuronio y 45 para el grupo succinilcolina. Para el análisis se clasificaron a los pacientes con condiciones de intubación en clínicamente aceptables o clínicamente pobres según la escala de Goldberg. Del grupo rocuronio el 94,3% tenían condiciones clínicamente aceptables, 5,7% condiciones pobres y con succinilcolina el 82,2% en condiciones aceptables y 17,8% en condiciones pobres. Se observaron mejores condiciones de intubación con rocuronio respecto a succinilcolina (RR 0,73 IC 95% 0,23-2,31), pero sin diferencias estadísticamente significativas. En cuanto a alteración del potasio sérico no hubo diferencias estadísticamente significativas entre ambos respecto a su incidencia (RR 1,0 IC 95% 0,53-1,87). Conclusiones: Aunque varios estudios indican una la superioridad de la succinilcolina en crear mejores condiciones sobre el rocuronio para la intubación, en nuestro estudio realizado en un departamento de emergencias se observó que el rocuronio genera mejores condiciones de intubación en relación a succinilcolina aunque sin diferencias estadísticamente significativas y no hay diferencias en la elevación del potasio sérico entre ambos fármacos.

Síndrome de Cornelia de Lange y su relación con la erupción dentaria: análisis caso clínico / Analisar o caso de um paciente com síndrome de Cornelia de Lange e sua relação com la erupção dentária / Dental eruption aspects of Cornelia de Lange syndrome: case report

El Síndrome de Cornelia de Lange (SCDL), es una anomalía genética cuya prevalencia es de 1:62.000- 1:45.000 de los nacimientos. Se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Se caracteriza por presentar alteraciones físicas generales, alteración cognitiva y del lenguaje; y rasgos orofaciales como la sinofridia, hirsutismo, también existe maloclusión, retardo de la erupción, apiñamiento, anodoncia, malformación de las extremidades, retraso del desarrollo pre y postnatal y otras malformaciones congénitas. Objetivo: Analizar el caso de paciente con síndrome de Cornelia de Lange y su relación con algunos hallazgos reportados en la literatura especialmente la erupción dentaria. Se presenta paciente lactante femenina de 2 años y 5 meses, procedente de Valencia, con diagnóstico genético de Síndrome de Cornelia de Lange, plumbemia, y litiasis biliar, que acude a la consulta del Postgrado de Odontopediatría de la Universidad de Carabobo por presentar retardo en la erupción dentaria. Se realiza historia clínica, examen clínico general donde se observa retraso psicomotor, del lenguaje y características fenotípicas propias del síndrome. A la evaluación clínica intrabucal se observa rebordes gingivales con inserción normal de frenillos y ausencia de unidades dentarias (retardo de erupción). La erupción dentaria puede verse afectada en pacientes con diagnóstico de Síndrome de Cornelia de Lange, tanto en su cronología como en la secuencia de erupción.

A síndrome de Cornelia de Lange (SCDL) é uma anormalidade genética com prevalência de 1: 62.000-1: 45.000 de nascimentos. É atribuído principalmente a mutações nos genes NIPBL, SMC3 e SMC1A. Caracteriza-se por apresentar alterações físicas gerais, alteração cognitiva e de linguagem; e características orofaciais, como sinofrídios, hirsutismo, também há má oclusão, erupção retardada, aglomeração, anodontia, malformação de membros, atraso no desenvolvimento pré-natal e pós-natal e outras malformações congênitas. Objetivo: Analisar o caso de um paciente com síndrome de Cornelia de Lange e sua relação com alguns achados relatados na literatura, principalmente erupção dentária. Apresentamos uma paciente de enfermagem de Valência com 2 anos e 5 meses de idade, com diagnóstico genético da síndrome de Cornelia de Lange, plumbemia e litíase biliar, que compareceu à consulta de pós-graduação em Odontopediatria da Universidade de Carabobo por apresentar atraso erupção dentária. História clínica, exame clínico geral, onde são observados retardo psicomotor, linguagem e características fenotípicas da síndrome. Uma avaliação clínica intraoral mostra sulcos gengivais com inserção normal de aparelho e ausência de unidades dentárias (erupção tardia). A erupção dentária pode ser afetada em pacientes diagnosticados com Síndrome de Cornelia de Lange, tanto na cronologia quanto na sequência da erupção.

Cornelia de Lange Syndrome (SCDL) is a genetic abnormality with a prevalence of 1: 62,000- 1: 45,000 of births. It is mainly attributed to mutations in the NIPBL, SMC3 and SMC1A genes. It is characterized by presenting general physical alterations, cognitive and language alteration; and orofacial features such as sinofridia, hirsutism, there is also malocclusion, delayed eruption, crowding, anodontia, limb malformation, prenatal and postnatal developmental delay, and other congenital malformations. Objective: To analyze the case of a patient with Cornelia de Lange syndrome and its relationship with some findings reported in the literature, especially dental eruption. We present a 2-year-old and 5-month-old female nursing patient from Valencia with a genetic diagnosis of Cornelia de Lange Syndrome, plumbemia, and biliary lithiasis, who attended the Pediatric Dentistry Postgraduate consultation at the University of Carabobo for presenting delay in tooth eruption. Clinical history, general clinical examination where psychomotor retardation, language and phenotypic characteristics of the syndrome are observed. A clinical intraoral evaluation shows gingival ridges with normal insertion of braces and absence of dental units (delayed eruption). The dental eruption can be affected in patients diagnosed with Cornelia de Lange Syndrome, both in its chronology and in the eruption sequence.

The effect of letter string length and report condition on letter recognition accuracy.

PURPOSE: Letter sequence recognition accuracy has been postulated to be limited primarily by low-level visual factors. The influence of high level factors such as visual memory (load and decay) has been largely overlooked. This study provides insight into the role of these factors by investigating the interaction between letter sequence recognition accuracy, letter string length and report condition. METHODS: Letter sequence recognition accuracy for trigrams and pentagrams were measured in 10 adult subjects for two report conditions. In the complete report condition subjects reported all 3 or all 5 letters comprising trigrams and pentagrams, respectively. In the partial report condition, subjects reported only a single letter in the trigram or pentagram. Letters were presented for 100ms and rendered in high contrast, using black lowercase Courier font that subtended 0.4° at the fixation distance of 0.57m. RESULTS: Letter sequence recognition accuracy was consistently higher for trigrams compared to pentagrams especially for letter positions away from fixation. While partial report increased recognition accuracy in both string length conditions, the effect was larger for pentagrams, and most evident for the final letter positions within trigrams and pentagrams. The effect of partial report on recognition accuracy for the final letter positions increased as eccentricity increased away from fixation, and was independent of the inner/outer position of a letter. CONCLUSIONS: Higher-level visual memory functions (memory load and decay) play a role in letter sequence recognition accuracy. There is also suggestion of additional delays imposed on memory encoding by crowded letter elements.

Identificación y secuenciación de SARS-CoV-2 en una leona africana (Panthera leo), bajo el cuidado técnico profesional, en Colombia

Objetivo Identificar y caracterizar el virus SARS-CoV-2 en una leona africana (Panthera leo), hembra, de edad avanzada, que presentó por varios meses signos relacionados con enfermedad respiratoria atípica. Métodos Se tomaron muestras de hisopados nasales 23 días después de haber reportado secreción nasal inicial. Se realizó la detección del virus SARS-Cov2 mediante RT-qPCR y posteriormente se caracterizó el genoma completo mediante secuencia Illumina. Resultados Desde el punto de vista clínico, los resultados encontrados en las muestras de sangre no mostraron cambios evidentes que se pudieran relacionar con el virus o con todos los signos descritos desde el inicio del caso. Para la secuenciación genómica los análisis mostraron una alineación múltiple comparativa entre los tres genomas (muestra Leona, FIP u NC_045512 [Wu han]) por medio de Mauve, centrado en los genes Spike, E y M (archivo complementario, parte B). Se logró identificar 5 segmentos muy similares entre Leona y NC_045512 (Wuhan). Conclusiones Es necesario adelantar más investigaciones para estandarizar el diagnóstico de esta patología en los animales. Así mismo, se requieren estudios genómicos en estas especies. Además, se evidenció con la revisión del estado de la cuestión que existen muchos vacíos del conocimiento en la implicación zoonótica de la pandemia y en el conocimiento de este virus en animales domésticos y silvestres, lo que supone un reto importante para las investigaciones de aquí en adelante.

Objective To identify and characterize the SARS-CoV-2 virus in an elderly African lioness (Panthera leo) that presented signs related to atypical respiratory disease for several months. Methods Nasal swab samples were taken 23 days after infection. have reported initial nasal discharge. Results The SARS-Cov2 virus was detected by RT-qPCR and the complete genome was subsequently characterized by Illumina sequencing. The results found in the blood samples did not show obvious changes that could be related to the virus or to the signs described from the beginning of the case. For genomic sequencing the analyzes showed a comparative multiple alignment between the three genomes (sample Leona, FIP or NC_045512 (Wu han)) by means of Mauve, focusing on the Spike, E and M genes (Supplementary file, part B); 5 very similar segments between Leona and NC_045512 (Wuhan) was identified. Conclusions It is necessary to carry out more research to standardize the diagnosis of this pathology in animals and guarantee access to it. Also, genomic studies in these species. Additionally, it was evidenced with the literature review that there are many knowledge gaps in the zoonotic implication of the Pandemic and in the knowledge of this virus in domestic and wild animals, which represents an important challenge for research from now on.

Amplificación directa de ADN de Bordetella pertussis purificado de hisopados nasofaríngeos por un método de bajo costo, rápido (60-segundos) y libre de equipos / Direct amplification of Bordetella pertussis DNA purified from nasopharyngeal swabs by a low-cost, fast (60-second), and equipment-free method

RESUMEN Objetivo. Desarrollar y evaluar un método de bajo costo basado en celulosa para la purificación rápida y amplificación directa de ADN de Bordetella pertussis de hisopados nasofaríngeos. Materiales y métodos. Se prepararon discos de celulosa y se evaluaron diferentes parámetros (buffers de lisis/lavado, número de discos y elución de ADN). El método se acopló a una amplificación directa por PCR en tiempo real (qPCR) y se estimó el rendimiento utilizando hisopados nasofaríngeos que fueron positivos (n=100) y negativos (n=50) para ADN B. pertussis por qPCR, comparado con el método basado en columnas de sílice. Se calculó el grado de concordancia, sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Se evaluó la factibilidad del método rápido para ser acoplado a un ensayo colorimétrico de amplificación isotérmica mediada por lazo (LAMP). Resultados. El método rápido con un disco de celulosa y buffer de lisis y lavado conteniendo PVP-40 y Tween 20, respectivamente, mostró una mayor capacidad para purificar ADN amplificable de B. pertussis. El método tuvo una sensibilidad de 89,0% (IC95%, 80,2%-94,9%) y una especificidad de 98,5% (IC95%, 92,1%-100,0%), con un buen grado de concordancia (Kappa=0,867; IC95% 0,788 - 0,946), respecto al método referencial. Los VPP y VPN fueron 98,6% (IC95%, 92,7,2%-100,0%) y 88,2% (IC95%, 78,7%-94,4%), respectivamente. Se evidenció una amplificación exitosa por LAMP, y se obtuvieron resultados comparables con el método por columnas de sílice. Conclusión. El método desarrollado es simple, de bajo costo y libre de equipos para la obtención rápida (60 segundos) de ADN en el punto de atención, y puede ser implementado en diversas técnicas moleculares orientados al diagnóstico oportuno y al estudio epidemiológico de tos ferina.

ABSTRACT Objective. To develop and evaluate a low-cost cellulose-based method for rapid purification and direct amplification of Bordetella pertussis DNA from nasopharyngeal swabs. Materials and methods. We prepared cellulose discs and evaluated different parameters (lysis/wash buffers, number of discs and DNA elution). The method was coupled to a direct real-time PCR (qPCR) amplification and the performance was estimated using nasopharyngeal swabs that were positive (n=100) and negative (n=50) for B. pertussis DNA by qPCR, compared to the silica column-based method. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and the degree of agreement. The feasibility of the rapid method to be coupled to a loop-mediated isothermal amplification colorimetric assay (LAMP) was evaluated. Results. The rapid method, with a cellulose disk and lysis and wash buffer containing PVP-40 and Tween 20, respectively, showed a greater capacity to purify amplifiable DNA from B. pertussis. The method had a sensitivity of 89.0% (95%CI: 80.2%-94.9%) and a specificity of 98.5% (95%CI: 92.1%-100.0%), with a good degree of agreement (Kappa=0.867; 95%CI: 0.788 - 0.946), compared to the reference method. The PPV and NPV were 98.6% (95%CI: 92.7.2%-100.0%) and 88.2% (95%CI: 78.7%-94.4%), respectively. Successful amplification by LAMP was evident, and comparable results were obtained with the silica column method. Conclusion. The developed method is simple, low-cost and equipment-free for rapid (60 seconds) DNA collection at the point of care, and can be implemented in various molecular techniques aimed at the timely diagnosis and epidemiological study of pertussis.