[Medicine consumption as a factor associated with the state of fragility of the elderly patient in Spain]. / El consumo de medicamentos como factor asociado al estado de fragilidad en personas mayores de 65 años en España.

INTRODUCTION: Frailty in the elderly is a concept in constant evolution, with a significant impact on the morbidity and mortality of patients. We assessed the associative strength of the Timed Up and Go test (TUG) and medication consumption in frailty and associated risk using various methods. MATERIAL AND METHODS: Observational, cross-sectional, multicenter study carried out in 128 Primary Care Centers distributed throughout Spain, has a total sample of 2422 patients over 65 years of age, estimating the prevalence of frailty with the TUG test. Descriptive analysis of the categorical variables and associative strength of TUG for frailty and medication consumption was performed with distribution of absolute and relative frequencies and multinomial logistic regression. SPSS 22.0 was used, considering statistical significance p=0.05. RESULTS: The prevalence of frailty in the sample was 13.7%, accepting as frailty those subjects who obtained a score >20s in performing the TUG test. A third of these subjects classified as frail took more than 30s to complete the test and 32.5% of those studied would be classified as "pre-frail". We found a slight difference in the prevalence of frailty if we analyze the data according to sex, being 10.8% in men compared to 15.8% in women. Regarding pharmacological consumption, 72.8% of the subjects consume 5 or more drugs daily with similar proportions by sex, and with an average consumption of 6.57 drugs. The drugs with the greatest association with the degree of frailty were drugs used for dementia (40% of individuals who consumed them were considered frail), antiparkinsonian drugs (38%), antipsychotics (34%), antianemics (26.2%), anticoagulants (22.2%) and antiepileptics (21.1%). CONCLUSIONS: The incidence of frailty in elderly patients in Spain is initially notable, being present in 13.7% through the application of the TUG test. The age variable is the one that is most significantly associated with the frailty of the elderly patient. An association was demonstrated between the degree of frailty and total medication consumption. The prevalence of frailty was 4.7% in the non-polypharmacy group compared to 15.4% in the polypharmacy group and reaching 23.4% in the extreme polypharmacy group. The drugs with a greater association with the patient's degree of frailty were those used in the neurological/psychiatric sphere (antidementia, antiparkinsonian, antipsychotic or antiepileptic drugs).

The interferon in idiopathic inflammatory myopathies: Different signatures and new therapeutic perspectives. A literature review.

Idiopathic inflammatory myopathies (IIM), even though sharing common clinical manifestations, are characterized by diversified molecular pathogenetic mechanisms which may account for the partial inefficacy of currently used immunomodulatory drugs. In the last decades, the role of interferon (IFN) in IIM has been extensively elucidated thanks to genomic and proteomic studies which have assessed the molecular signature at the level of affected tissues or in peripheral blood across distinct IIM subtypes. A predominant type I IFN response has been shown in dermatomyositis (DM), being especially enhanced in anti-melanoma differentiation-associated gene 5 (MDA5)+ DM, while a type 2 IFN profile characterizes anti-synthetase syndrome (ASyS) and inclusion body myositis (IBM); conversely, a less robust IFN footprint has been defined for immune-mediated necrotizing myopathy (IMNM). Intracellular IFN signaling is mediated by the janus kinase/signal transducer and activator of transcription (JAK/STAT) through dedicated transmembrane receptors and specific cytoplasmic molecular combinations. These results may have therapeutic implications and led to evaluating the efficacy of new targeted drugs such as the recently introduced janus kinase inhibitors (JAKi), currently approved for the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. In this review we aim to summarize the most significant evidence of IFN role in IIM pathogenesis and to describe the current state of the art about the ongoing clinical trials on IFN-targeting drugs, with particular focus on JAKi.

Therapeutic dietary approach to children with autistic spectrum disorder / Abordaje dietético terapéutico de niños con trastorno del espectro autista

Autism spectrum disorder (ASD) is a neuropsychiatric disease, characterized by deficits in social communication, presence of restricted interests and repetitive behaviors. This review aims to address the different nutrients that can be included in the diet of patients with ASD in order to reduce the different signs and symptoms present in this disorder. Different bibliographic sources were reviewed, such as PubMed, MEDLINE, ScienceDirect, Embase, and SciELO, using the keywords "Probiotics", "Vitamin B", Vitamin C", "Gluten", "Omega-3" and "Autism Spectrum Disorder". It was found that probiotics and gluten improve gastrointestinal symptoms and, in addition, like vitamins B6, B9, B12 and C, as well as omega 3, help improve neurobehavioral symptoms, language and social behavior of children with ASD.

El trastorno del espectro autista (TEA) es una enfermedad neuropsiquiátrica, caracterizada por déficits en la comunicación social y la presencia de intereses restringidos y conductas repetitivas. La presente revisión tiene por objetivo abordar los diferentes nutrientes que pueden incluirse en la dieta de los pacientes con TEA con el fin de disminuir los diferentes signos y síntomas presentes en este trastorno. Se revisaron diferentes fuentes bibliográficas como PubMed, MEDLINE, ScienceDirect, Embase, y SciELO, empleando las palabras claves "Probióticos", "Vitamina B", Vitamina C", "Gluten", "Omega 3" y "Trastorno del Espectro Autista". Se encontró que los probióticos y el gluten mejoran los síntomas gastrointestinales y, además, al igual que las vitaminas B6, B9, B12 y C, así como el omega 3, ayudan al mejoramiento de síntomas neuroconductuales, lenguaje y conducta social del niño con TEA.

Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population.

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.

Advances in the systemic treatment of therapeutic approaches in biliary tract cancer.

INTRODUCTION: Biliary tract cancers (BTCs) are a rare and heterogenous group with an increasing incidence and high mortality rate. The estimated new cases and deaths of BTC worldwide are increasing, but the incidence and mortality rates in South East Asia are the highest worldwide, representing a real public health problem in these regions. BTC has a poor prognosis with a median overall survival <12 months. Thus, an urgent unmet clinical need for BTC patients exists and must be addressed. RESULTS: The backbone treatment of these malignancies is chemotherapy in first- and second-line setting, but in the last decade a rich molecular landscape has been discovered, expanding conceivable treatment options. Some druggable molecular aberrations can be treated with new targeted therapies and have already demonstrated efficacy in patients with BTC, improving clinical outcomes, such as the FGFR2 or IDH1 inhibitors. Many other molecular alterations are being discovered and the treatment of BTC will change in the near future from our current clinical practice. CONCLUSIONS: In this review we discuss the epidemiology, molecular characteristics, present treatment approaches, review the recent therapeutic advances, and explore future directions for patients with BTC. Due to the rich molecular landscape of BTC, molecular profiling should be carried out early. Ongoing research will bring new targeted treatments and immunotherapy in the near future.

Cytotoxic screening and antibacterial activity of Withaferin A.

Cancer and bacterial infections are among the leading causes of death worldwide. Plant-derived bioactive compounds constitute promising alternatives for development of new therapeutics. This study aimed at evaluating the biological activity of Withaferin A using 6 tumor cell lines: A549 (lung cancer), U87MG (glioblastoma), SH-SY5Y (neuroblastoma), B16-F10 (mouse melanoma), HeLa (uterine colon cancer) and K562 (chronic myeloid leukemia). In addition, 17 other standard bacterial strains and several multidrug resistant bacteria (MDR) clinical isolates were examined. Cell viability was assessed using the following assays: MTT, neutral red, and dsDNA PicoGreen®. Further, oxidative stress was measured by quantification of reactive oxygen species (ROS) production. The activity against bacteria was determined by the minimum inhibitory concentration (MIC), minimum bacterial concentration (CBM) and antibiofilm activity in the production of strains. Withaferin A was effective, as evidenced by its cytotoxic activity in tumor cell lines, enhanced ROS production in tumor cells and bactericidal and antibiofilm activity. Data demonstrated that Withaferin A may be therapeutically considered as an antitumor and antibacterial agent.

Massive digestive bleeding as a result of gastric heterotopy: a case report. / Sangrado digestivo masivo por heterotopia gástrica. Reporte de un caso.

INTRODUCTION: Gastric heterotopy is a rare entity in the pediatric population. It occurs in the gastrointestinal tract, leading to digestive bleeding. CLINICAL CASE: This is the case of a 10-year-old boy with gastric tissue in the proximal jejunum, which caused two massive digestive bleeding episodes. Diagnostic techniques included endoscopic capsule, enteroscopy, and biopsy. The patient was scheduled for laparotomy and resection. After one year of follow-up, he remained asymptomatic. DISCUSSION: Gastric heterotopy approach represents a diagnostic challenge. Owing to how rare it is, there is no global consensus in terms of treatment. However, surgery is the definitive therapy. In this case, decision was made not to perform intestinal resection and anastomosis, but resection of the compromised intestinal wall. No malignity was reported in the literature reviewed.

INTRODUCCION: La heterotopia gástrica es una entidad infrecuente en la población pediátrica. Se presenta en el tracto gastrointestinal llevando a cuadros clínicos de sangrado digestivo. CASO CLINICO: Se reporta el caso de un escolar de 10 años, el cual presentó tejido gástrico en el yeyuno proximal, originando sangrado digestivo masivo en dos ocasiones. La secuencia de apoyos diagnósticos requirió cápsula endoscópica, enteroscopia y biopsia. Fue llevado a laparotomía y resección de la lesión. En el seguimiento al año se mantuvo asintomático. DISCUSION: Su abordaje genera un reto diagnóstico. Debido a su infrecuente presentación no hay un consenso global para el tratamiento, sin embargo, la intervención quirúrgica es la terapia definitiva. En este caso no se hizo resección intestinal y anastomosis sino resección de la pared intestinal comprometida. No se reportó malignidad en la literatura revisada.

Validation and comparison of Breast Graded Prognostic Assessment scores in patients with breast cancer and brain metastases.

PURPOSE: Brain metastases (BM) occur in 15-35% of patients with metastatic breast cancer, conferring poor prognosis and impairing quality of life. Clinical scores have been developed to classify patients according to their prognosis. We aimed to check the utility of the Breast Graded Prognostic Assessment (B-GPA) and its modified version (mB-GPA) and compare them in routine clinical practice. METHODS: This is an ambispective study including all patients with breast cancer BM treated in a single cancer comprehensive center. We analyzed the overall survival (OS) from BM diagnosis until death. The Kaplan-Meier method and Cox proportional hazard regression model were used in the analyses. ROC curves were performed to compare both scores. RESULTS: We included 169 patients; median age was 50 years. HER2-positive and triple negative patients were 33.7% and 20.7%, respectively. At the last follow-up, 90% of the patients had died. Median OS was 12 months (95% confidence interval 8.0-16.0 months). OS was worse in patients with > 3 BM and in patients with triple negative subtype. CONCLUSIONS: In our series, we confirm that B-GPA and mB-GPA scores correlated with prognosis. ROC curves showed that B-GPA and mB-GPA have similar prognostic capabilities, slightly in favor of mB-GPA.

Penile cancer: prognostic and predictive factors in clinical decision-making.

Penile cancer (PC) is a typical tumor of non-industrialized countries. The incidence is 20-30 times higher in Africa and South America, considering the elevated prevalence of sexually transmitted diseases. Histologically, PC includes squamous cell carcinoma (SCPC), the most frequent, and nonsquamous carcinoma (NSCPC). Early diagnosis is the goal, whereas later diagnosis relates to poor functional outcomes and worse prognosis. The 5-year survival rate is 85% for patients with histologically regional negative lymph nodes, compared to 29%-40% for those with histologically regional positive lymph nodes. To date no new drugs are approved, and there are few new data about molecular mechanisms underlying tumorigenesis. The SCPC remains a rare tumor and the current therapeutic algorithm is based principally on retrospective analysis and less on prospective trials. In this review article, biomarkers of prognosis and efficacy of current treatments are summarized with a focus on those that have the potential to affect treatment decision-making in SCPC.

Green does not always mean go: A sulfated galactan from Codium isthmocladum green seaweed reduces melanoma metastasis through direct regulation of malignancy features.

Melanoma is the most lethal form of skin cancer, with a worldwide increase in incidence. Despite the increased overall survival of metastatic melanoma patients given recent advances in targeted and immunotherapy, it still has a poor prognosis and available treatment options carry diverse severe side effects. Polysaccharides from seaweed have been shown to exert antitumor activities. Here we show in vitro and in vivo antitumor activities of a sulfated homogalactan (named 3G4S) from Codium isthmocladum seaweed in the B16-F10 murine melanoma cell line. 3G4S did not induce cytotoxicity or proliferation changes; however, it was able to reduce solid tumor growth and metastasis, while not inducing side effects in mice. B16-F10 cells traits related to the metastatic cascade were also impaired by 3G4S, reducing cell invasion, colony-forming capacity and membrane glycoconjugates. Therefore, 3G4S shows promising antitumor activities without the commonly associated drawbacks of cancer treatments and can be further explored.

Potencial reprodutivo (PR) de touros Nelore avaliados por parâmetros andrológicos e comportamento sexual. Classificação por pontos: nova proposição / [Reproductive potential of Nelore bulls evaluated by andrological parameters and sexual behavior. Classification by points - a new proposition]

Este estudo teve por objetivo comparar variações de parâmetros andrológicos e comportamentais de touros Nelore de diferentes faixas etárias, calcular seu potencial reprodutivo (PR) e propor uma nova tabela de classificação por pontos, de acordo com as médias atualmente alcançadas por eles nas características estudadas. Foram utilizados dados de 6162 exames andrológicos de touros da raça Nelore, entre 12 e 80 meses de idade, em regime de monta natural. O número de touros classificados como aptos consistiu em 88,9% dos animais avaliados (n=5480), sendo 51,6% desses considerados excelentes (n=2827), 41,2% muito bons (n=2257) e 7,2% considerados bons (n=394). Entre os animais questionáveis (n=682; 11,1%), 79,6% foram classificados como inaptos temporários (n=542) e 20,4% (n=139) como animais descarte, de acordo com o exame andrológico, independentemente do teste da libido. O número de touros classificados como excelentes se reduziu para 752 (12,2%) quando dados de comportamento sexual foram incluídos para definição do seu PR. Concluiu-se que o uso de tabelas de classificação andrológica por pontos com atualizações técnicas beneficia a seleção mais apurada de touros Nelore. O teste da libido é ferramenta importante para a determinação do PR, o qual permite melhor aproveitamento dos reprodutores.(AU)

This study aimed to compare variations of andrological and behavioral parameters from Nelore bulls of different ages, to calculate their reproductive potential (RP) and propose a new classification table by points, considering current averages in each reproductive trait studied. Data were collected from 6162 breeding soundness examinations of Nelore bulls aged between 12 and 80 months, under natural mating. According to andrological parameters, regardless of the libido test, the number of bulls classified as approved was 88.9% (n= 5480), being 51.6% considered as excellent (n= 2827), 41.2% very good (n= 2257) and 7.2% considered as good (n= 394). Among the animals considered as questionable (n= 682; 11.1%), 79.6% were classified as temporarily reproved (n= 542) and 20.4% (n= 139) as discarded animals. The number of bulls classified as excellent decreased to 752 (12.2%) when sexual behavior data were included to define their RP. It was concluded that the use of tables for andrological classification by points with technical updates improves the reproductive selection of Nelore bulls. The libido test is an important tool for RP determination which provides better utilization of the sires.(AU)

Prototyping Trastuzumab Docetaxel Immunoliposomes with a New FCM-Based Method to Quantify Optimal Antibody Density on Nanoparticles.

Developing targeted nanoparticles is a rising strategy to improve drug delivery in oncology. Antibodies are the most commonly used targeting agents. However, determination of their optimal number at the surface remains a challenging issue, mainly due to the difficulties in measuring precisely surface coating levels when prototyping nanoparticles. We developed an original quantitative assay to measure the exact number of coated antibodies per nanoparticle. Using flow cytometry optimized for submicron particle analysis and beads covered with known amounts of human IgG-kappa mimicking various amounts of antibodies, this new method was tested as part of the prototyping of docetaxel liposomes coated with trastuzumab against Her2+ breast cancer. This quantification method allowed to discriminate various batches of immunoliposomes depending on their trastuzumab density on nanoparticle surface (i.e., 330 (Immunoliposome-1), 480 (Immunoliposome-2) and 690 (Immunoliposome-3), p = 0.004, One-way ANOVA). Here we showed that optimal number of grafted antibodies on nanoparticles should be finely tuned and highest density of targeting agent is not necessarily associated with highest efficacy. Overall, this new method should help to better prototype third generation nanoparticles.

Non-Cytotoxic Sulfated Heterorhamnan from Gayralia brasiliensis Green Seaweed Reduces Driver Features of Melanoma Metastatic Progression.

Melanoma is a form of skin cancer with high mortality owing to its fast progression and metastatic capacity. The treatments available nowadays are only palliative in advanced stages of the disease. Thus, alternative therapies for cancer treatment are in demand, and molecules from natural sources, such as polysaccharides, could represent new possible therapeutic approaches. Polysaccharides of freshwater and marine algae with biological activities, such as antitumor properties, are greatly reported in the scientific literature. In the present study, a sulfated heterorhamnan obtained from the green seaweed Gayralia brasiliensis (Gb1 fraction) was chemically characterized and its biological activities in the B16-F10 murine melanoma cell line were evaluated. The Gb1 polysaccharidic fraction tested concentrations presented low or absence of cytotoxicity to B16-F10 cells and neither cell proliferation nor cell cycle were altered. Interestingly, Gb1 treatment decreased B16-F10 cells migration and invasion capabilities and CD44 labeling, showing to be a promising compound for further in vitro and in vivo antitumor studies.

Severe obstructive sleep apnea is associated with circulating microRNAs related to heart failure, myocardial ischemia, and cancer proliferation.

PURPOSE: Obstructive sleep apnea (OSA) is associated with multiple comorbid conditions including cardiovascular diseases and cancer. There is a growing interest in exploring biomarkers to understand the related mechanisms and improve the risk stratification of OSA. Circulating microRNAs (miRNAs) are single noncoding strands of nearly 22 nucleotides that posttranscriptionally regulate target gene expression. Our aim was to identify miRNA profiles associated with OSA. METHODS: We studied 48 male subjects, mostly Caucasian (63%) and overweight, divided by polysomnography into the no OSA control group (n = 6), mild OSA group (n = 12), moderate OSA group (n = 15), and severe OSA group (n = 15). The study groups were matched for age, body mass index (BMI), and body fat composition. miRNA profiles were measured from peripheral whole blood using two steps: (1) microarray analysis comprising more than 2500 miRNAs in a subsample of 12 subjects (three from each group); and (2) validation phase using real-time quantitative polymerase chain reaction (RTqPCR). RESULTS: The microarray assessment identified 21 differentially expressed miRNAs among the groups. The RT-qPCR assessment showed that miR-1254 and miR-320e presented a gradual increase in expression parallel to OSA severity. Linear regression analysis showed that severe OSA was independently associated with miR-1254 (ß = 68.4; EP = 29.8; p = 0.02) and miR-320e (ß = 76.1; EP = 31.3; p = 0.02). CONCLUSION: Severe OSA is independently associated with miRNAs that are involved in heart failure (miR-1254), myocardial ischemia/reperfusion (miR-320e), and cell proliferation in some cancer types (miR-1254 and miR-320e). Future investigations addressing whether these miRs may provide prognostic information in OSA are needed.

Liver Cirrhosis From Chronic Hypervitaminosis A Resulting in Liver Transplantation: A Case Report.

Herein we report a case of liver dysfunction caused by consumption of vitamin A supplements leading to liver transplantation. The patient was a 48-year-old male with a medical history of congenital ichthyosiform erythroderma in treatment with vitamin A until 12 years of age, at which point he discontinued the supplements because he had developed ascites. Liver cirrhosis was diagnosed as secondary to hypervitaminosis A on the basis of histologic examination of liver biopsy and the absence of other potential causes of chronic liver disease. Despite interruption of administration of vitamin A, the patient continued to deteriorate over the years, with development of portal hypertension signs. His medical conditions were aggravated with the development of hepatic insufficiency manifested by refractory ascites, renal insufficiency, and severe encephalopathy and he underwent orthotopic liver transplantation, followed by disappearance of all signs of portal hypertension. This case highlights the need to take a careful history of consumption of vitamin A when evaluating a patient with liver failure.

Hydrogels for biomedical applications from glycol chitosan and PEG diglycidyl ether exhibit pro-angiogenic and antibacterial activity.

We aimed at producing a hydrogel from a chitosan (CS) derivative soluble in physiological conditions to avoid any purification step thus allowing to use the materials also as an in-situ forming material. So, we crosslinked glycol chitosan (GCS) with poly(ethylene glycol) diglycidyl ether (PEGDE) in water at 37 °C. The scaffolds, referred as GCS-PEG, were specifically designed to be used as wound dressing materials as such (after crosslinking) or as in-situ forming materials. Different amounts of PEGDE were tested. The obtained scaffolds showed macroscopic pores and a tailorable swelling in water by controlling the crosslinking degree. Moreover, GCS-PEG scaffolds displayed a significant antimicrobial activity against Staphylococcus aureus. In-vivo study using the chick embryo choriallantoic membrane resulted in a highly pronounced pro-angiogenic activity suggesting important tissue regeneration properties. Moreover, the employed materials are commercially available, no organic solvents are required and the scaling up is quite predictable.

Hospital bronchoscopy-related pseudo-outbreak caused by a circulating Mycobacterium abscessus subsp. massiliense.

Adolfo Lutz Institute in Sao Paolo State performs mycobacterial identification for many healthcare units, and in 2008 identified a possible outbreak involving patients submitted to bronchoscopy at the same hospital. This study aimed to analyse the clonality of isolates. Mycobacterium abscessus subsp. massiliense isolated from 28 patients, water from one bronchoscope and water from four automated endoscope reprocessing machines presented high similarity by pulsed-field gel electrophoresis. This strain was not found in the water supply, and it was hypothesized that an infected patient contaminated the bronchoscope, with further false-positive cultures from subsequent patients.

Safe therapeutics of murine melanoma model using a novel antineoplasic, the partially methylated mannogalactan from Pleurotus eryngii.

A heteropolysaccharide was isolated by cold aqueous extraction from edible mushroom Pleurotus eryngii ("King Oyster") basidiocarps and its biological properties were evaluated. Structural assignments were carried out using mono- and bidimensional NMR spectroscopy, monosaccharide composition, and methylation analyses. A mannogalactan having a main chain of (1→6)-linked α-d-galactopyranosyl and 3-O-methyl-α-d-galactopyranosyl residues, both partially substituted at OH-2 by ß-d-Manp (MG-Pe) single-unit was found. Biological effects of mannogalactan from P. eryngii (MG-Pe) were tested against murine melanoma cells. MG-Pe was non-cytotoxic, but reduced in vitro melanoma cells invasion. Also, 50mg/kg MG-Pe administration to melanoma-bearing C57BL/6 mice up to 10days decreased in 60% the tumor volume compared to control. Additionally, no changes were observed when biochemical profile, complete blood cells count (CBC), organs, and body weight were analyzed. Mg-Pe was shown to be a promising anti-melanoma molecule capable of switching melanoma cells to a non-invasive phenotype with no toxicity to melanoma-bearing mice.

Aplicación de la técnica de árboles de clasificación y regresión en la valoración ecográfica de los nódulos tiroideos / Using Classification and Regression Trees in the ultrasound evaluation of thyroid nodules

Objetivo: Evaluar la capacidad de los árboles de clasificación y regresión (CART) en la valoración ecográfica de los nódulos tiroideos malignos. Materiales y métodos: Se realizaron 404 punciones aspiración con aguja fina (PAAF) a 384 pacientes. De los nódulos analizados, se registraron las características ecográficas (localización, tamano, morfología, contorno, consistencia, ecoestructura, ecogenicidad, calcificaciones y vascularización) y los resultados de la elastografía. Se aplicó el CART para investigar la relación entre los hallazgos ecográficos, la elastografía y el cáncer de tiroides. Resultados: El análisis CART determinó que la realización de una elastografía no aporta datos relevantes y que las zonas homogéneas pueden clasificar a los nódulos tiroideos en: 1.ª zona) caracterizada por ausencia de áreas de degeneración coloide e hipoecogenicidad asociada a malignidad; 2.ª zona) diferenciada por presencia de áreas de degeneración coloide combinada con ausencia de microcalcificaciones, constituyendo un indicador fiable de benignidad de los nódulos tiroideos; y 3.ª zona) la ausencia de hipoecogenicidad y una lesión menos alta que ancha deparan un indicador fiable de benignidad. El árbol de clasificación alcanzó una sensibilidad del 87,5% y un valor predictivo negativo del 98,8%. Discusión: El CART muestra una elevada capacidad de predicción de los nódulos malignos frente a otras técnicas lineales. Conclusión: La utilización de los árboles de clasificación provee una herramienta simple para la toma de decisión clínica con el objeto de reducir las PAAF innecesarias, con una elevada sensibilidad.

Objective: To evaluate the use of Classification and Regression Trees (CART) in the ultrasound evaluation of malignant thyroid nodules. Materials and methods: A study was performed on 404 fine needle aspirates (FNA), with biopsies being performed on 384. The information collected about the thyroid nodules was: ultrasound features (location, size, morphology, contour, consistency, echo-structure, echogenicity, calcification, and vascularisation) and elastography results. The CART technique was used to investigate the relationship between ultrasound findings and the thyroid cancer. Results: The CART analysis showed that elastography does not provide any relevant data, and that the homogeneous areas could classified the thyroid nodules into: 1st area) characterised by the absence of colloid degeneration areas and a hypo-echogenicity associated with malignancy; 2nd area) differentiated by the presence of colloid degeneration areas combined with absence of microcalcifications, constituting a reliable indicator of benign thyroid nodules; and a 3rd area) the absence of hypo-echogenicity and a lesion wider than it is long that provides a reliable indicator of being benign. The optimum tree produced a sensitivity of 87.5% and negative predictive value of 98.8%. Discussion: The CART technique demonstrated a high predictive capacity for malignant nodules compared to other linear techniques. Conclusion: The use of classification trees provides us with a simple tool for clinical decision making, in order to reduce unnecessary FNA biopsies, as well as achieving a high sensitivity.

Phytanic acid consumption and human health, risks, benefits and future trends: A review.

Phytanic acid is a methyl-branched fatty acid present in the human diet, derived from the enzymatic degradation of phytol and subsequently oxidized by the rumenal microbiota and certain marine organisms. Consequently, phytanic acid is carried into the human body by means of food ingestion, mostly via red meat, dairy products and fatty marine foods. This fatty acid accumulates in people with some peroxisomal disorders and is traditionally related to neurological damage. However, some benefits derived from phytanic acid intake have also been described, such as the prevention of metabolic syndrome or type 2 diabetes. The aim of this work was to conduct an overview of the literature on the phytanic acid content of foods, management of the phytanic content during food production and biochemical mechanisms of phytanic acid metabolism, as well as to assess the evidence for the health benefits and risks of phytanic acid consumption in human health.