Medium/long term evaluation of lipid profile after bariatric surgery (gastric bypass versus sleeve gastrectomy).

INTRODUCTION: Bariatric surgery aims to reduce weight and resolve the comorbidities associated with obesity. Few studies have assessed mid/long-term changes in lipid profile with sleeve gastrectomy versus gastric bypass. This study was conducted to assess and compare changes in lipid profile with each procedure after 60 months. METHODS: This was an observational, retrospective study of analytical cohorts enrolling 100 patients distributed into two groups: 50 had undergone gastric bypass (GBP) surgery and 50 sleeve gastrectomy (SG) surgery. Total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) levels were measured before surgery and at 1, 6, 12, 24, 36, 48, and 60 months. Weight loss and the resolution of dyslipidemia with each of the procedures were also assessed. RESULTS: Ninety-five of the 100 patients completed follow-up. At 60 months, TC and LDL levels had significantly decreased in the BPG group (167.42 ±â€¯31.22 mg/dl and 88.06 ±â€¯31.37 mg/dl, respectively), while there were no differences in the SG group. Increased HDL levels were seen with both procedures (BPG: 62.69 ±â€¯16.3 mg/dl vs. SG: 60.64 ±â€¯18.73 mg/dl), with no difference between the procedures. TG levels decreased in both groups (BPG: 86.06 ±â€¯56.57 mg/dl vs. SG: 111.09 ±â€¯53.08 mg/dl), but values were higher in the BPG group (P < .05). The percentage of overweight lost (PSP) was higher in the BPG group: 75.65 ±â€¯22.98 mg/dl vs. the GV group: 57.83 ±â€¯27.95 mg/dl. CONCLUSION: Gastric bypass achieved better mid/long-term results in terms of weight reduction and the resolution of hypercholesterolemia as compared to sleeve gastrectomy. While gastric bypass improved all lipid profile parameters, sleeve gastrectomy only improved HDL and triglyceride levels.

Metástasis muscular de adenocarcinoma gástrico: A propósito de un caso y revisión de la literatura / Skeletal Muscle Metastasis from Gastric Adenocarcinoma: A Case Report and Review of the Literature

Resumen Los pacientes diagnosticados de adenocarcinoma gástrico pueden desarrollar metástasis hepáticas o carcinomatosis peritoneal, pero la presencia de metástasis musculares es extremadamente infrecuente, con muy pocos casos descritos. Presentamos a una paciente de 44 años con una tumoración dolorosa en miembro superior izquierdo. Fue tratada un año antes de un adenocarcinoma gástrico con cirugía y quimioterapia. Mediante pruebas de imagen y biopsia, se le diagnosticó metástasis muscular única de adenocarcinoma gástrico, siendo intervenida realizando exéresis quirúrgica.

Abstract Patients diagnosed with gastric adenocarcinoma may develop liver metastases or peritoneal carcinomatosis, but the presence of muscle metastases is extremely rare, with very few cases reported. We present a 44-year-old female patient with a painful tumor in her left upper limb. She was treated with surgery and chemotherapy for gastric adenocarcinoma a year before. By imaging tests and biopsy, she was diagnosed with a single muscle metastasis from gastric adenocarcinoma and underwent surgical exeresis.

Improving the prediction of acute myeloid leukaemia outcomes by complementing mutational profiling with ex vivo chemosensitivity.

Refractoriness to induction therapy and relapse after complete remission are the leading causes of death in patients with acute myeloid leukaemia (AML). This study focussed on the prediction of response to standard induction therapy and outcome of patients with AML using a combined strategy of mutational profiling by next-generation sequencing (NGS, n = 190) and ex vivo PharmaFlow testing (n = 74) for the 10 most widely used drugs for AML induction therapy, in a cohort of adult patients uniformly treated according to Spanish PETHEMA guidelines. We identified an adverse mutational profile (EZH2, KMT2A, U2AF1 and/or TP53 mutations) that carries a greater risk of death [hazard ratio (HR): 3·29, P < 0·0001]. A high correlation was found between the ex vivo PharmaFlow results and clinical induction response (69%). Clinical correlation analysis showed that the pattern of multiresistance revealed by ex vivo PharmaFlow identified patients with a high risk of death (HR: 2·58). Patients with mutation status also ran a high risk (HR 4·19), and the risk was increased further in patients with both adverse profiles (HR 4·82). We have developed a new score based on NGS and ex vivo drug testing for AML patients that improves upon current prognostic risk stratification and allows clinicians to tailor treatments to minimise drug resistance.

Fasting ghrelin levels after gastric bypass and vertical sleeve gastrectomy: An analytic cohort study. / Comportamiento de ghrelina en ayunas después de bypass gástrico y gastrectomía vertical: estudio de cohortes analítico.

BACKGROUND AND OBJECTIVE: Neuronal populations involved in the regulation of food intake, particularly the orexigenic (appetite-stimulating) hormone ghrelin, are found in the hypothalamus. Changes in plasma ghrelin levels have been observed following different bariatric surgery procedures, but the results from different studies are contradictory. Much remains unknown regarding the role of ghrelin in the weight loss process following bariatric surgery. Our objective was to describe the behaviour of fasting ghrelin levels, comparing the changes occurring between 2 different surgical techniques (gastric bypass versus vertical sleeve gastrectomy) and their correlation with weight loss. PATIENTS AND METHOD: A prospective, observational, analytic cohort study of 54 patients (27 for each surgical technique) with a 12-month follow-up period. We analysed demographic data, anthropometric data, comorbidities, weight loss and evolution of fasting ghrelin. RESULTS: The behaviour of acylated ghrelin was similar with the 2 surgical techniques, with no significant differences between gastric bypass and vertical sleeve gastrectomy. With both procedures, there was an increase in acylated ghrelin on day 5 and a subsequent decrease, and levels then gradually increased to reach values at 12 months that were higher than those reported preoperatively. This increase in ghrelin levels did not affect weight loss, since one year post-surgery, 30% weight loss was achieved with both types of surgery. CONCLUSIONS: We observed an increase in fasting acylated ghrelin levels at one year of follow-up with both surgical techniques, with 30% weight loss.

Differences in ex-vivo Chemosensitivity to Anthracyclines in First Line Acute Myeloid Leukemia.

BACKGROUND: Induction schedules in acute myeloid leukemia (AML) are based on combinations of cytarabine and anthracyclines. The choice of the anthracycline employed has been widely studied in multiple clinical trials showing similar complete remission rates. MATERIALS AND METHODS: Using an ex vivo test we have analyzed if a subset of AML patients may respond differently to cytarabine combined with idarubicin, daunorubicin or mitoxantrone. Bone marrow (BM) samples of 198 AML patients were incubated for 48 hours in 96 well plates, each well containing different drugs or drug combinations at different concentrations. Ex vivo drug sensitivity analysis was made using the PharmaFlow platform maintaining the BM microenvironment. Drug response was evaluated as depletion of AML blast cells in each well after incubation. Annexin V-FITC was used to quantify the ability of the drugs to induce apoptosis, and pharmacological responses were calculated using pharmacokinetic population models. RESULTS: Similar dose-respond graphs were generated for the three anthracyclines, with a slight decrease in EC50 with idarubicin (p=1.462E-06), whereas the interpatient variability of either drug was large. To identify those cases of selective sensitivity to anthracyclines, potency was compared, in terms of area under the curve. Differences in anthracycline monotherapy potency greater than 30% from 3 pairwise comparisons were identified in 28.3% of samples. Furthermore, different sensitivity was detected in 8.2% of patients comparing combinations of cytarabine and anthracyclines. DISCUSSION: A third of the patients could benefit from the use of this test in the first line induction therapy selection, although it should be confirmed in a clinical trial specifically designed.

Piezoelectric MEMS Resonators for Cigarette Particle Detection.

In this work, we demonstrate the potential of a piezoelectric resonator for developing a low-cost sensor system to detect microscopic particles in real-time, which can be present in a wide variety of environments and workplaces. The sensor working principle is based on the resonance frequency shift caused by particles collected on the resonator surface. To test the sensor sensitivity obtained from mass-loading effects, an Aluminum Nitride-based piezoelectric resonator was exposed to cigarette particles in a sealed chamber. In order to determine the resonance parameters of interest, an interface circuit was implemented and included within both open-loop and closed-loop schemes for comparison. The system was capable of tracking the resonance frequency with a mass sensitivity of 8.8 Hz/ng. Although the tests shown here were proven by collecting particles from a cigarette, the results obtained in this application may have interest and can be extended towards other applications, such as monitoring of nanoparticles in a workplace environment.

A precision medicine test predicts clinical response after idarubicin and cytarabine induction therapy in AML patients.

Complete remission (CR) after induction therapy is the first treatment goal in acute myeloid leukemia (AML) patients and has prognostic impact. Our purpose is to determine the correlation between the observed CR/CRi rate after idarubicin (IDA) and cytarabine (CYT) 3 + 7 induction and the leukemic chemosensitivity measured by an ex vivo test of drug activity. Bone marrow samples from adult patients with newly diagnosed AML were included in this study. Whole bone marrow samples were incubated for 48 h in well plates containing IDA, CYT, or their combination. Pharmacological response parameters were estimated using population pharmacodynamic models. Patients attaining a CR/CRi with up to two induction cycles of 3 + 7 were classified as responders and the remaining as resistant. A total of 123 patients fulfilled the inclusion criteria and were evaluable for correlation analyses. The strongest clinical predictors were the area under the curve of the concentration response curves of CYT and IDA. The overall accuracy achieved using MaxSpSe criteria to define positivity was 81%, predicting better responder (93%) than non-responder patients (60%). The ex vivo test provides better yet similar information than cytogenetics, but can be provided before treatment representing a valuable in-time addition. After validation in an external cohort, this novel ex vivo test could be useful to select AML patients for 3 + 7 regimen vs. alternative schedules.

Trastornos hipertensivos en el embarazo con infección urinaria / Hypertensive disorders of pregnancy associated with urinary tract infection

Objetivo: determinar la incidencia de los trastornos hipertensivos del embarazo en pacientes con infección del tracto urinario (ITU) en los Hospitales de San José e Infantil Universitario de San José, Bogotá, Colombia, en 2015. Materiales y métodos: cohorte de embarazadas que asistieron a urgencias con ITU que requirieron tratamiento intrahospitalario y seguimiento para establecer la ocurrencia de trastornos hipertensivos. La frecuencia de estos se describe sobre la base de incidencias acumuladas, así como en términos de la incidencia en cada nivel individual de gravedad de la ITU. Resultados: 138 embarazadas cumplieron con los criterios requeridos, edad media de 25 años (RIQ: 21-29), 42% cursaban el primer embarazo. El germen más aislado fue Escherichia coli. La incidencia de trastornos hipertensivos fue 21,7%. El trastorno más frecuente fue la preeclampsia y el tipo de ITU que más se presentó fue bacteriuria asintomática (35.5%). Conclusión: la ocurrencia de trastornos hipertensivos en embarazadas con infección del tracto urinario fue de 21,7%. Es importante investigar las infecciones del tracto urinario durante el embarazo como posibles factores generadores de preeclampsia

Objective: to present the basic mathematical, physical and radiological principles behind tractography, as well as, providing a review of the main tracts in the brain and their applications in neuroscience from the Fundación Universitaria de Ciencias de la Salud (FUCS) in Bogota D.C., Colombia experience. Materials and Methods: bibliographic review and use of a 1.5 T or 3T MR imaging system to describe tractography images in central nervous system disorders. Results: the main features of tractography are shown based on cases at our institution. Discussion: there are no identified studies on the usefulness of tractography in the vast majority of brain related pathologies. Although this procedure is currently available, clinical information is scarce, as the image-processing techniques are lengthy and in most institutions, protocols have not been determined to reconstruct each of the tracts in the brain. Conclusions: it is possible to reconstruct brain tracts using 1.5T and 3T scanners, identifying the major brain tracts and their relationship with brain tumors, cranioencephalic trauma, substance abuse and other conditio

Drug Discovery Testing Compounds in Patient Samples by Automated Flow Cytometry.

Functional ex vivo assays that predict a patient's clinical response to anticancer drugs for guiding cancer treatment have long been a goal, but few have yet proved to be reliable. To address this, we have developed an automated flow cytometry platform for drug screening that evaluates multiple endpoints with a robust data analysis system that can capture the complex mechanisms of action across different compounds. This system, called PharmaFlow, is used to test peripheral blood or bone marrow samples from patients diagnosed with hematological malignancies. Functional assays that use the whole sample, retaining all the microenvironmental components contained in the sample, offer an approach to ex vivo testing that may give results that are clinically relevant. This new approach can help to predict the patients' response to existing treatments or to drugs under development, for hematological malignancies or other tumors. In addition, relevant biomarkers can be identified that determine the patient's sensitivity, resistance, or toxicity to a given treatment. We propose that this approach, which better recapitulates the human microenvironment, constitutes a more predictive assay for personalized medicine and preclinical drug discovery.

Cambios hemodinámicos por doppler en fetos con retardo del crecimiento intrauterino de 26-34 semanas a 24 y 48 horas de la administración materna de betametasona / Hemodynamic changes detected by doppler between 26-34 weeks pregnancies with iugr 24 and 48 hours after betamethasone administration

Identificar cambios en el índice de pulsatilidad (IP) de las arterias umbilical y cerebral media después de aplicar betametasona en pacientes con retardo del crecimiento intrauterino (RCIU) entre 26 y 34 semanas. Métodos: 22 pacientes hospitalizadas con embarazos únicos entre las 26 y 34 semanas asociadas con RCIU, con indicación de maduración pulmonar que no se encontraban en trabajo de parto, recibieron protocolo completo de maduración, toma de doppler fetoplacentario inicial y a las 24 y 48 horas. Resultados: 68,2% presentaron trastorno hipertensivo del embarazo, 81,8% (n:18) negaron enfermedad crónica asociada, no se documentaron anomalías fetales mayores ni se sospechó infección fetal. El promedio del IP de la arteria umbilical al ingreso fue 1,62 (DE 0,41) y de la cerebral media 1,97 (DE 0,61). En el doppler de 48 horas se observaron cambios del IP en la umbilical (p =0.0079) y la cerebral media (p=0.0149), respecto al basal. Conclusiones: en RCIU entre las semanas 26 y 34 hay variaciones con significación estadística del IP en el doppler de las arterias umbilical y cerebral media que no siempre se asociaron con cambios en la estadificación del doppler actual y no tienen importancia clínica. La hipertensión gestacional asociada puede ser un factor de confusión. Palabras clave: cambios hemodinámicos, doppler, retardo del crecimiento intrauterino, betametasona. Abreviaturas: IP, índice de pulsatilidad: RCIU, retardo en el crecimiento intrauterino...

To identify changes in the pulsatility index (PI) of the umbilical and middle cerebral arteries after betamethasone administration in pregnancies at 26-34 gestational weeks with intrauterine growth retardation (IUGR). Methods: the study comprised 22 hospitalized women with singleton pregnancies at 26- 34 weeks with IUGR, not in labor, with indication of fetal lung maturity enhancement who received a complete treatment protocol and an initial fetoplacental Doppler repeated after 24 and 48 hours. Results: pregnancy-induced hypertension was present in 68.2%, 81.8% (n: 18) denied having an associated chronic illness, no major fetal anomalies or suspicion of fetal infection were documented. The average PI of the umbilical artery at admission was 1.62 (SD 0.41) and of the middle cerebral artery 1.97 (SD 0.61). PI changes observed in the Doppler performed after 48 hours were (p =0.0079) in the umbilical artery and (p=0.0149) in the middle cerebral artery, compared with baseline PI. Conclusions: there are statistically significant variations of Doppler PI in the umbilical and middle cerebral arteries in IUGR between week 26 and 34 which were not always related with changes of current Doppler stages and have no clinical importance. The associated gestational hypertension may constitute a confounding factor...