Full kinetic modeling analysis of [18F]fluorocholine Positron Emission Tomography (PET) at initial diagnosis of high-grade glioma.

PURPOSE: The main objective was to characterize the tracer uptake kinetics of [18F]fluoromethylcholine ([18F]F-CHO) in high-grade gliomas (HGG) through a full PET kinetic modeling approach. Secondarily, we aimed to explore the relationship between the PET uptake measures and the HGG molecular features. MATERIALS AND METHODS: Twenty-four patients with a suspected diagnosis of HGG were prospectively included. They underwent a dynamic brain [18F]F-CHO-PET/CT, from which a tumoral time-activity curve was extracted. The plasma input function was obtained through arterial blood sampling with metabolite correction. These data were fitted to 1- and 2-tissue-compartment models, the best of which was selected through the Akaike information criterion. We assessed the correlation between the kinetic parameters and the conventional static PET metrics (SUVmax, SUVmean and tumor-to-background ratio TBR). We explored the association between the [18F]F-CHO-PET quantitative parameters and relevant molecular biomarkers in HGG. RESULTS: Tumoral time-activity curves in all patients showed a rapid rise of [18F]F-CHO uptake followed by a plateau-like shape. Best fits were obtained with near-irreversible 2-tissue-compartment models. The perfusion-transport constant K1 and the net influx rate Ki showed strong correlation with SUVmax (r = 0.808-0.861), SUVmean (r = 0.794-0.851) and TBR (r = 0.643-0.784), p < 0.002. HGG was confirmed in 21 patients, of which those with methylation of the O-6-methylguanine-DNA methyltransferase (MGMT) gene promoter showed higher mean Ki (p = 0.020), K1 (p = 0.025) and TBR (p = 0.001) than the unmethylated ones. CONCLUSION: [18F]F-CHO uptake kinetics in HGG is best explained by a 2-tissue-compartment model. The conventional static [18F]F-CHO-PET measures have been validated against the perfusion-transport constant (K1) and the net influx rate (Ki) derived from kinetic modeling. A relationship between [18F]F-CHO uptake rate and MGMT methylation is suggested but needs further confirmation.

Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness.

INTRODUCTION: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. METHODS: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18-80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. RESULTS: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. CONCLUSION: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function.

Sentido y significado de vejez de los residentes de la calle Zanja, 2017-2019 / Sense and meaning of old age of residents in Zanja Street, 2017-2019

Introducción: En Cuba, en el 2016, las personas mayores de 60 años constituían el 19,8 por ciento de la población, y La Habana era una de las provincias más envejecidas. En 2018 aumentó a 20,4 por ciento. En la calle Zanja, residen pobladores de distintos grupos étnicos, con herencias y tradiciones culturales diversas y diferentes visiones del sentido y significado de vejez. Objetivo: Caracterizar el sentido de vejez de los adultos mayores y el significado de vejez de los niños, adolescentes, jóvenes y adultos medios, residentes en la calle Zanja. Métodos: Se realizó un estudio exploratorio, a partir de una metodología mixta: cualitativa y cuantitativa. Se utilizó el método observacional y, en consecuencia, se decidió hacer uso de las técnicas de entrevista en profundidad, la observación no participante, con sus correspondientes guías, la técnica porcentual y la triangulación de datos. Resultados: Los adultos mayores manifestaron satisfacción de las necesidades materiales y espirituales en un alto nivel; aunque el 50 por ciento de los jubilados declaró no recibir atención de las organizaciones a las que pertenecían. Un alto porcentaje de adultos medios opinaron que los adultos mayores son personas importantes y útiles, tienen experiencia y constituyen ayuda. Los niños, adolescentes y jóvenes refirieron que lo que más les gusta de sus abuelos es que los quieren y los ayudan y lo que no les gusta es que pelean y se enferman. Conclusiones: Si los adultos mayores son importantes para las familias, comunidad y sociedad, es preciso mejorar las condiciones materiales de su existencia y del entorno y que se sientan reconocidos por sus aportes(AU)

Introduction: In Cuba, in 2016, people over the age of 60 made up 19.8 percent of the population, and Havana was one of the most aged provinces. In 2018 it increased to 20.4 percent. In Zanja Street, people of different ethnic groups reside, with diverse cultural heritage and traditions and different visions of the sense and meaning of old age. Objective: Characterize the sense of old age of older adults and the old-age meaning of children, adolescents, young people and average adults, residing on Zanja Street. Methods: An exploratory study was carried out, based on a mixed methodology: qualitative and quantitative. he observational method was used and, consequently, it was decided to make use of in-depth interview techniques, non-participating observation, with their corresponding guidelines, percentage technique and data triangulation. Results: Older adults expressed satisfaction with material and spiritual needs at a high level; although 50 percent of retirees reported not receiving care from the organizations to which they belonged. A high percentage of average adults said that older adults are important and useful people, they have experience and are helpful. Children, teenagers and young people said that what they love most about their grandparents is that they love and help them and what they don't like is that they argue and get sick. Conclusions: If older adults are important to the families, communities and the society, the material conditions of their life and environment need to be improved, and so they can feel acknowledge for their contributions(AU)

Sinergia educación, prevención, promoción de salud comunitaria desde el paradigma de la sociocultura / Synergy between education, prevention, promotion of community health from the sociocultural paradigm / Sinergia educação, prevenção, promoção da saúde comunitaria desde o paradigma socio-cultural

Objetivo: Analizar la sinergia de la educación, prevención y promoción de la salud concebida como una construcción sociocultural mediada por las prácticas culturales que desarrollan las personas de una comunidad cubana durante los años 2013-2017. Materiales y Métodos: Estudio de caso único que combina las perspectivas cuantitativa y cualitativa de investigación, con el empleo de la observación participante, cuestionarios, entrevistas en profundidad en el escenario comunitario y la consulta a expertos, además de los procedimientos teóricos analítico-sintético, así como la inducción y deducción. Resultados: Los resultados revelan la existencia de prácticas culturales comunitarias relacionadas con la salud, en las que se produce una simbiosis de la educación, prevención y promoción de salud como elementos esenciales del proceso salud-enfermedad. Conclusiones: El contexto comunitario en que se desarrolla el proceso salud-enfermedad está mediado por prácticas culturales, lo que propicia la concepción de la salud como una construcción sociocultural inherente a la actividad humana, la cual debe garantizarse mediante la educación, prevención y promoción de salud concebidas como todo un sistema integrado.

Objective: To analyze the synergy between education, prevention and promotion of health conceived as a sociocultural construction mediated by the cultural practices developed by people of a Cuban community during the years 2013-2017. Materials and Methods: Single case study that combines the quantitative and qualitative perspectives of research with the use of participant observation, questionnaires, indepth interviews in the community setting and the consultation to experts, besides the analytic-synthetic theoretical procedures, as well as induction and deduction. Results: The results reveal the existence of community cultural practices related to health in which a symbiosis between education, prevention and promotion of health as essential elements of the health-disease process is produced. Conclusions: The community context in which the health-disease process takes place is mediated by cultural practices which favors the conception of health as an sociocultural construction inherent to the human activity, which must be guaranteed through education, prevention and promotion of health conceived as an entire integrated system.

Objetivo: Analisar a sinergia da educação, prevenção e promoção da saúde concebida como uma construção sociocultural mediada pelas práticas culturais que desenvolvem as pessoas duma comunidade cubana durante os anos 2013-2017. Materiais e Métodos: Estudo de caso único que mistura as perspectivas quantitativa e qualitativa de pesquisa, com o emprego da observação participante, questionários, entrevistas em profundidade no cenário comunitário e a consulta a expertos, além dos procedimentos teóricos analítico-sintético, assim como a indução e dedução. Resultados: Os resultados revelam a existência de práticas culturais comunitárias relacionadas com a saúde, nas que se produze uma simbioses da educação, prevenção e promoção de saúde como elementos essenciais do processo saúde- doença. Conclusões: O contexto comunitário no que se desenvolve o processo saúde-doença está mediado por práticas culturais, o que propicia a concepção da saúde como uma construção sociocultural inerente à atividade humana, a qual deve garantir-se mediante a educação, prevenção e promoção de saúde concebidas como um sistema integrado.

Sinergia educación, prevención, promoción de salud comunitaria desde el paradigma de la sociocultura / Synergy between education, prevention, promotion of community health from the sociocultural paradigm / Sinergia educação, prevenção, promoção da saúde comunitaria desde o paradigma socio-cultural

Resumen Objetivo: Analizar la sinergia de la educación, prevención y promoción de la salud concebida como una construcción sociocultural mediada por las prácticas culturales que desarrollan las personas de una comunidad cubana durante los años 2013-2017. Materiales y Métodos: Estudio de caso único que combina las perspectivas cuantitativa y cualitativa de investigación, con el empleo de la observación participante, cuestionarios, entrevistas en profundidad en el escenario comunitario y la consulta a expertos, además de los procedimientos teóricos analítico-sintético, así como la inducción y deducción. Resultados: Los resultados revelan la existencia de prácticas culturales comunitarias relacionadas con la salud, en las que se produce una simbiosis de la educación, prevención y promoción de salud como elementos esenciales del proceso salud-enfermedad. Conclusiones: El contexto comunitario en que se desarrolla el proceso salud-enfermedad está mediado por prácticas culturales, lo que propicia la concepción de la salud como una construcción sociocultural inherente a la actividad humana, la cual debe garantizarse mediante la educación, prevención y promoción de salud concebidas como todo un sistema integrado.

Abstract Objective: To analyze the synergy between education, prevention and promotion of health conceived as a sociocultural construction mediated by the cultural practices developed by people of a Cuban community during the years 2013-2017. Materials and Methods: Single case study that combines the quantitative and qualitative perspectives of research with the use of participant observation, questionnaires, in- depth interviews in the community setting and the consultation to experts, besides the analytic-synthetic theoretical procedures, as well as induction and deduction. Results: The results reveal the existence of community cultural practices related to health in which a symbiosis between education, prevention and promotion of health as essential elements of the health-disease process is produced. Conclusions: The community context in which the health-disease process takes place is mediated by cultural practices which favors the conception of health as an sociocultural construction inherent to the human activity, which must be guaranteed through education, prevention and promotion of health conceived as an entire integrated system.

Resumo Objetivo: Analisar a sinergia da educação, prevenção e promoção da saúde concebida como uma construção sociocultural mediada pelas práticas culturais que desenvolvem as pessoas duma comunidade cubana durante os anos 2013-2017. Materiais e Métodos: Estudo de caso único que mistura as perspectivas quantitativa e qualitativa de pesquisa, com o emprego da observação participante, questionários, entrevistas em profundidade no cenário comunitário e a consulta a expertos, além dos procedimentos teóricos analítico-sintético, assim como a indução e dedução. Resultados: Os resultados revelam a existência de práticas culturais comunitárias relacionadas com a saúde, nas que se produze uma simbioses da educação, prevenção e promoção de saúde como elementos essenciais do processo saúde- doença. Conclusões: O contexto comunitário no que se desenvolve o processo saúde-doença está mediado por práticas culturais, o que propicia a concepção da saúde como uma construção sociocultural inerente à atividade humana, a qual deve garantir-se mediante a educação, prevenção e promoção de saúde concebidas como um sistema integrado.

Increased rate of FEV1 decline in HIV patients despite effective treatment with HAART.

INTRODUCTION: Previous studies have reported that the rate of FEV1 decline over time is increased in HIV patients but the mechanisms underlying this observation are unclear. Since current HIV treatment with Highly Active Antiretroviral Therapy (HAART) results in very good immune-viral control, we hypothesized that HAART should normalize the elevated rate of FEV1 decline previously reported in HIV patients if it was somehow related to the immune alterations caused by HIV, particularly in never smokers or quitters, since smoking is a well established risk factor for accelerated FEV1 decline in the general population. METHODS: We explored this hypothesis in a prospectively recruited cohort of 188 HIV (smoker and non-smoker) patients treated with HAART in Palma de Mallorca (Spain) and followed-up for 6 years. The cross-sectional characteristics of this cohort have been published elsewhere. RESULTS: We found that: (1) HAART resulted in good immune-viral control; (2) the rate of FEV1 decline remained abnormally elevated, even in non-smokers and quitters; and, (3) alcohol abuse during follow-up was related to FEV1 decline in these patients. DISCUSSION: Despite adequate immune-viral control by HAART, lung function decline remains increased in most HIV patients, even in non-smokers and quitters. Alcohol abuse is a preventable risk factor to decrease the accelerated FEV1 decline in this population.

La tríada salud-trabajo-ambiente y su impacto en los trabajadores / The health-work-environment triad and its impact on workers

La dinámica del mundo de hoy requiere de nuevos conocimientos para hacer análisis de los problemas en el área de salud, trabajo y ambiente mediante nuevas dimensiones. El objetivo del presente artículo original de revisión crítica y conceptual, es describir y producir conocimientos acerca de cómo interactuan salud- trabajo-ambiente como construcción que se desarrolla desde la perspectiva de la sociocultural y cómo impacta esta en los trabajadores. Para ello, se siguió una metodología consistente en la revisión bibliográfica y la aplicación de entrevistas y cuestionarios. Los resultados y conclusiones revelan reflexiones, conceptualizaciones y teorizaciones, que evidencian que la tríada en cuestión existe en interacción como resultado no solo de factores económicos, sino también socioculturales, por lo que requiere que el debate se asuma, además, desde la dimensión cultural, para tener un conocimiento y comprensión más integral acerca de su impacto en los trabajadores(AU)

The dynamics of today's world requires new knowledge that allows the analysis of problems in health, work and environment by means of new dimensions. The objective of this critical and conceptual review is to describe and generate knowledge on the interaction between health, work and environment, as a construct developed from a sociocultural perspective and how it impacts workers. We combined a literature review with interviews and surveys. The results and conclusions reveal reflections, conceptualizations and theories that evidence the existence of this triad as a result of interactions not limited only to economic factors, but also sociocultural. For this reason, the debate should incorporate a cultural dimension, in order to achieve better knowledge and a more holistic understanding of its impact on workers(AU)

Risk of postoperative complications in chronic obstructive lung diseases patients considered fit for lung cancer surgery: beyond oxygen consumption.

OBJECTIVES: Patients with poor lung function usually undergo cardiopulmonary exercise testing (CPET) and those with a predicted postoperative maximal oxygen consumption (VO2 max) of >10 ml/kg/min undergo lung resection surgery and still some complications are observed. We aimed to determine other parameters beyond VO2 able to predict postoperative complications in patients undergoing lung resection surgery. METHODS: This is an observational study with longitudinal follow-up. Patients with forced expiratory volume in 1 second (FEV1) or diffusing capacity for carbon monoxide of <40% underwent CPET and those with VO2 max of >10 ml/kg/min were considered fit for surgery. Patients were followed up prospectively for 12 months and postoperative complications and survival were recorded. Physiological parameters obtained during CPET and pulmonary function tests were analysed. RESULTS: Eighty-three chronic obstructive pulmonary disease (COPD) patients were evaluated for surgery between 2010 and 2015. Twenty-four patients were considered unfit for surgery and received an alternative therapy. Fifty-five patients had a VO2 max of >10 ml/kg/min and underwent lung surgery. Among them, 4% died and 41% developed complications postoperatively. Baseline minute ventilation to carbon dioxide output (VE/VCO2) slope was significantly higher among those who developed postoperative complications or died (P = 0.047). Furthermore, VE/VCO2 slope of >35 (at maximal exercise) was the single parameter most strongly associated with the probability of mortality and postoperative complications (hazard ratio 5.14) with a survival probability of 40% after 1 year of follow-up. In a multivariable model, VO2, VE/VCO2 slope of >35 and work load were independently associated with the probability of having an event. CONCLUSIONS: VO2 is not the unique parameter to consider when CPET is performed to evaluate the postoperative risk of lung cancer surgery in COPD patients. The signs of ventilatory inefficiency such as VE/VCO2 slope predict complications better than VO2 does.

Patologías congénitas de la comunicación según el DSM-V: actualizaciones en neuropsicología infantil / Congenital diseases of communication according to the DSM-V: updates child neuropsychology

En el presente artículo, se describen las actualizaciones relacionadas con las patologías de la comunicación, estrictamente de carácter congénito, según las últimas revisiones publicadas por la American Psychiatric Association en su quinta edición, las cuales consideran las principales contribuciones de las neurociencias, a partir de las investigaciones realizadas en torno a la temática de los trastornos del neurodesarrollo que, durante las dos últimas décadas, han suscitado un amplio escenario de posibilidades para una mayor comprensión de las distintas alteraciones en esta esfera del desarrollo psicológico, redefiniendo y esclareciendo con mayor precisión aquellas características relevantes de los diversos cuadros clínicos afines. Asimismo, estos estudios han contribuido con reveladores hallazgos, tanto a nivel sintomatológico como sindrómico, para un mejor entendimiento de estas patologías del desarrollo temprano, siendo estos aportes de gran relevancia dentro del campo de la neuropsicología infantil, cuya integración de estrategias tanto clínicas como educativas ha favorecido su pertinente participación en el tratamiento en estas dificultades, fortaleciendo así tanto el ejercicio del diagnóstico diferencial como de aquellos procedimientos de rehabilitación, cuya rigurosidad se fundamenta en el uso de métodos controlados y modernos enfoques afines a esta disciplina mencionada.

In this article, updates related to communication disorders, strictly congenital character, are described, according to the latest reviews published by the American Psychiatric Association in its fifth edition, which considered the main contributions of neuroscience, based on the research conducted around the theme of neurodevelopmental disorders, which during the past two decades, have attracted widespread scenario of possibilities for greater understanding of the various changes in the area of psychological development, redefining and clarifying more precisely those relevant characteristics of the various related clinical conditions. Furthermore, these studies have contributed to revealing findings, both syndromic and symptomatic level, for a better understanding of these early development disorders, being highly relevant contributions in the field of child neuropsychology, which integration of clinical and educational strategies has favored its relevant participation in treatment on these difficulties, thereby strengthening the exercise of differential diagnosis and rehabilitation of those procedures, which rigor is based on the controlled use of modern methods and approaches related to this discipline.

[Histological regression of liver fibrosis with immunosuppressive therapy in autoimmune hepatitis]. / Regresión histológica de la fibrosis hepática con tratamiento inmunosupresor en hepatitis autoinmune.

UNLABELLED: Reversibility of liver fibrosis with immunosuppressive therapy (IT) has been described in autoimmune hepatitis (AIH). OBJECTIVE: To compare initial fibrosis and fibrosis after IT in patients with AIH. METHODS: A total of 54 patients were admitted with positive ANA or AML antibodies, or both, elevated IgG immunoglobulins and who met international criteria for a diagnosis of AIH. The mean age was 39 years (range 13-65) and there were 47 women (87%). Two liver biopsies were taken: one at diagnosis and another at a mean of 28±8 months after initiation of IT with prednisone and azathioprine. The degree of inflammation (0-18) and fibrosis (0-6) according to Ishak score was compared between the initial and the follow-up biopsy. RESULTS: Fibrosis decreased from 2.9±0.3 to 2.2±0.3 (p=0.005) and histological activity index from 6.8±0.45 to 2.6±0.2 (P<.001). In subgroups, fibrosis decreased from 3.6±0.4 to 1.4±0.3 (P<.001) in 22 patients (41%), was unchanged in 27 (50%) and increased in five (9%). There were seven patients with histological cirrhosis at IT initiation. After IT, four showed a reduction in Ishak score (achieving scores of 0-3). Transaminase values were not associated with histological improvement. CONCLUSION: Fibrosis in patients with AIH significantly improved with IT, emphasizing the importance of studying the prognostic factors associated with this favorable response.

[Peak oxygen uptake during the six-minute walk test in diffuse interstitial lung disease and pulmonary hypertension]. / Consumo máximo de oxígeno durante la prueba de marcha de 6 minutos en la enfermedad pulmonar intersticial difusa y en la hipertensión pulmonar.

INTRODUCTION: The six-minute walk test (6MWT) is widely used in evaluating diffuse interstitial lung disease (ILD) and pulmonary hypertension (PH). However, their physiological determining factors have not been well defined. OBJECTIVE: To evaluate the physiological changes that occur in ILD and PH during the 6MWT, and compare them with the cardiopulmonary exercise test (CPET). MATERIAL AND METHODS: Thirteen patients with ILD and 14 with PH were studied using the 6MWT and CPET on an ergometer cycle. The respiratory variables were recorded by means of telemetry during the 6MWT. RESULTS: Oxygen consumption (VO(2)), respiratory and heart rate reached a plateau from minute 3 of the 6MWT in both diseases. The VO(2) did not differ from the peak value in the CPET (14+/-2 and 15+/-2 ml/kg/min, respectively, in ILD; 16+/-6 and 16+/-6 ml/kg/min, in PH). The arterial oxygen saturation decreased in both diseases, although it was more marked in ILD (-12+/-5%, p<0,01). The ventilatory equivalent for CO(2) (V(E)/VCO(2)) in PH during the 6MWT was strongly associated with functional class (FC) (85+/-14 in FC III-IV, 44+/-6 in FC I-II; p<0,001). CONCLUSIONS: The 6MWT in ILD and PH behaves like a maximal effort test, with similar VO(2) to the CPET, demonstrating a limit in oxygen transport capacity. Monitoring using telemetry during the 6MWT may be useful for the clinical evaluation of patients with ILD or PH.

[Study of celiac disease in patients with non-alcoholic fatty liver and autoimmune hepatic diseases]. / Estudio de enfermedad celíaca en pacientes con enfermedad por hígado graso no alcohólico y con hepatopatías autoinmunes.

UNLABELLED: Celiac disease (CD) has been associated with non-alcoholic fatty liver disease (NAFLD) and other chronic liver diseases (CLD), such as primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC). AIM: To study the frequency of serological markers of CD in patients with NAFLD and CLD and their correlation with duodenal biopsy. PATIENTS AND METHODS: In patients with NAFLD, PBC, AIH and PSC, we studied anti-endomysium (AE) IgA by indirect immunofluorescence and anti-gliadin IgA-IgG (AG) and human anti-tissue transglutaminase (tTG) IgA antibodies by an ELISA technique. Patients with positive serology for at least one marker underwent endoscopy with duodenal biopsies. RESULTS: Positive CD markers were found in 9 of 101 patients (8.9%): 7 patients were positive for tTG alone, 1 for AE and AG, and 1 patient for 3 antibodies. Positivity was as follows: 3/38 (7.9%) in NAFLD, 3/44 (6.8%) in PBC, 2/16 (12.5%) in AIH and 1/3 in PSC. Endoscopy was performed in 8 patients, with normal duodenal biopsy in 7 and 1 patient with Marsh stage 1 CD with NAFLD, positive AE and AG. The only patient with 3 positive markers died during the study without undergoing endoscopy. None of the patients had symptoms suggestive of CD. CONCLUSION: A high prevalence of positive tTG was found in patients with CLD and NAFLD. However, duodenal biopsy should be performed in these patients, given that the results of this procedure were normal in most patients in this study.