Alzheimer's Disease Biomarker Decision-Making among Patients with Mild Cognitive Impairment and Their Care Partners.

BACKGROUND: Alzheimer's disease (AD) biomarker tests can be ordered as part of the diagnostic workup of patients with mild cognitive impairment (MCI). Little is known about how patients with MCI and their care partners decide whether to pursue testing. OBJECTIVE: To examine factors that influence AD biomarker testing decisions among patients with MCI and their care partners. DESIGN: We performed structured research interviews with patients with MCI and their study partners to assess the importance of eight factors in the decision whether to undergo AD biomarker testing (6-point Likert scale; 1-extremely unimportant to 6-extremely important): cost, fear of testing procedures, learning if AD is the cause of cognitive problems, concern about health insurance, instructing future planning, informing treatment decisions, family members' opinions, and doctor recommendation. SETTING: Two researchers administered interviews with participants in-person (i.e., participant home, research center) or remotely (i.e., telephone, video-conference). PARTICIPANTS: We completed interviews with 65 patients with a diagnosis of MCI and 57 study partners, referred by dementia specialist clinicians from the University of California, Irvine health system. MEASUREMENTS: We used generalized estimating equations (GEE) to examine the mean importance of each factor among patients and study partners, and the mean difference in importance of each factor within dyads. RESULTS: One third of participants reported the patient had previously undergone AD biomarker testing. Fifty-five percent of patients and 65% of study partners who reported no previous testing indicated a desire for the patient to be tested. GEE analyses found that patients and study partners rated the following factors with highest importance: informing treatment decisions (mean score 5.29, 95% CI: 5.06, 5.52 for patients; mean score 5.56, 95% CI: 5.41, 5.72 for partners); doctor recommendation (4.94, 95% CI: 4.73, 5.15 for patients; 5.16, 95% CI: 4.97, 5.34 for partners); and instructing future planning (4.88, 95% CI: 4.59, 5.16 for patients; 5.11, 95% CI: 4.86, 5.35 for partners). High dyadic agreement was observed for all factors except fear of testing, which patients rated with lower importance than their study partners. CONCLUSIONS: Biomarker testing for AD in patients with MCI is a rapidly evolving practice and limited data exist on patient perspectives. In this study, most patients and their care partners were interested in testing to help inform treatment decisions and to plan for the future. Participants placed high importance on clinician recommendations for biomarker testing, highlighting the need for clear communication and education on the options, limitations, risks, and benefits of testing.

Chronic Periodontitis Genome-wide Association Study in the Hispanic Community Health Study / Study of Latinos.

Chronic periodontitis (CP) has a genetic component, particularly its severe forms. Evidence from genome-wide association studies (GWASs) has highlighted several potential novel loci. Here, the authors report the first GWAS of CP among a large community-based sample of Hispanics/Latinos. The authors interrogated a quantitative trait of CP (mean interproximal clinical attachment level determined by full-mouth periodontal examinations) among 10,935 adult participants (mean age: 45 y, range: 18 to 76 y) from the Hispanic Community Health Study / Study of Latinos. Genotyping was done with a custom Illumina Omni2.5M array, and imputation to approximately 20 million single-nucleotide polymorphisms was based on the 1000 Genomes Project phase 1 reference panel. Analyses were based on linear mixed models adjusting for sex, age, study design features, ancestry, and kinship and employed a conventional P < 5 × 10-8 statistical significance threshold. The authors identified a genome-wide significant association signal in the 1q42.2 locus ( TSNAX-DISC1 noncoding RNA, lead single-nucleotide polymorphism: rs149133391, minor allele [C] frequency = 0.01, P = 7.9 × 10-9) and 4 more loci with suggestive evidence of association ( P < 5 × 10-6): 1q22 (rs13373934), 5p15.33 (rs186066047), 6p22.3 (rs10456847), and 11p15.1 (rs75715012). We tested these loci for replication in independent samples of European-American ( n = 4,402) and African-American ( n = 908) participants of the Atherosclerosis Risk in Communities study. There was no replication among the European Americans; however, the TSNAX-DISC1 locus replicated in the African-American sample (rs149133391, minor allele frequency = 0.02, P = 9.1 × 10-3), while the 1q22 locus was directionally concordant and nominally significant (rs13373934, P = 4.0 × 10-2). This discovery GWAS of interproximal clinical attachment level-a measure of lifetime periodontal tissue destruction-was conducted in a large, community-based sample of Hispanic/Latinos. It identified a genome-wide significant locus that was independently replicated in an African-American population. Identifying this genetic marker offers direction for interrogation in subsequent genomic and experimental studies of CP.

[Functional evaluation of the supraspinatus tendon repair comparing mini-open and open techniques]. / Evaluación funcional de la reparación del tendón del supraespinoso comparando técnica mínimamente invasiva contra técnica abierta.

OBJECTIVE: To compare two surgical techniques to address the painful shoulder syndrome with partial or total supraspinous tendon tear. METHODS: Patients with a diagnosis of complete supraspinous tendon tear who required surgical repair and subacromial decompression. One group was treated with acromioplasty and tendon plasty using an open approach (G1), and the second one underwent arthroscopy with tendon plasty using a minimally-invasive approach (G2). The surgical approach was not decided at random, but was based on the surgeons preference. The major outcome was functional assessment at postoperative month 12 using the UCLA scale. The variables compared were the operative time, anesthesia time, intraoperative bleeding, and immediate complications. Means and standard deviations were analyzed for the quantitative variables, and percentages for the qualitative variables. The U Mann-Whitney test was used to compare the ranges of non-related groups. RESULTS: Thirty-two patients were included in G1, and 13 in G2. No differences were found in age, gender, comorbid conditions, and the time elapsed before surgical treatment. G2 patients were found to have better function according to the UCLA scale (p = 0.032). No differences were reported in the operative time (60 versus 80 minutes, p = 0.12), anesthesia time (120 versus 97 minutes, p = 0.12), total bleeding (50 ml in both groups, p = 0.09), or length of stay (2 versus 1, p = 0.81). No immediate complications were reported. CONCLUSIONS: Arthroscopic repair plus a minimally-invasive approach to treat subacromial impingement and supraspinous tendon tear seems to provide better clinical outcomes based on function recovery and patient satisfaction.

Comparar dos técnicas quirúrgicas para la resolución del síndrome de hombro doloroso con lesión parcial o total del tendón del supraespinoso (SPS/RTS).

[Atipic osteosarcoma in the femoral shaft case report and review of the literature]. / Osteosarcoma con presentación atípica en tercio medio de diáfisis de fémur. Reporte de un caso clínico y revisión de la literatura.

Osteosarcoma is the most frequent primary malignant bone tumor. It is characterized by osteoid production by tumor cells. Its most frequent location is in the metaphyses of long bones, but a purely diaphyseal presentation is reported in 10% of cases. We report the case of a female 25 year-old patient whose symptoms of pain and swelling of the right mid thigh started four months before, without an apparent cause. Femur X-rays showed a tumor in the femoral shaft. The MRI showed extension to soft tissues with no compromise of the neurovascular bundle. The histopathologic report of the incisional biopsy was osteoblastic and chondroblastic osteosarcoma, classified as Enneking IIB, AJCC IIB. Treatment consisted of three cycles of neoadjuvant chemotherapy. Then intercalary femur resection plus reconstruction with centromedullary nailing and a diaphyseal spacer were performed. The histopathologic report was 95% necrosis (Huvos grade III). Three cycles of adjuvant chemotherapy were given and now, 18 months after completing the latter, the patient has no signs of local or distant tumor activity, and she can walk unassisted. Despite the fact that osteosarcoma does not occur usually in the mid shaft of long bones, we should always bear it in mind as part of the differential diagnosis for other conditions that occur more frequently in that region. Such location allows for a broad gamut of surgical approaches that spare the adjacent joints.

El osteosarcoma es el tumor maligno primario más frecuente del hueso. Se caracteriza por la formación de osteoide por las células tumorales. Su localización más frecuente es en las metáfisis de los huesos largos; sin embargo, la presentación puramente diafisaria se reporta en 10% de los casos. Se expone el caso de paciente del género femenino de 25 años que inició padecimiento cuatro meses previos a nuestra valoración al presentar dolor y aumento de volumen en tercio medio de muslo derecho, sin causa aparente. Las radiografías del fémur revelaron un tumor en la diáfisis del mismo. La resonancia magnética mostró extensión a partes blandas, sin compromiso del paquete neurovascular. Se tomó biopsia incisional con reporte histopatológico de osteosarcoma osteoblástico y condroblástico. Se clasificó como Enneking IIB, AJCC IIB. Inició tratamiento con tres ciclos de quimioterapia neoadyuvante y posteriormente se le realizó resección intercalar de fémur más reconstrucción con clavo centromedular y espaciador diafisario. El reporte histopatológico evidenció necrosis de 95% (Huvos grado III). Se continuó con tres ciclos de quimioterapia adyuvante. A 18 meses de concluida la quimioterapia adyuvante la paciente se encuentra sin datos de actividad tumoral local o a distancia, tolerando la deambulación sin auxiliares de la marcha. A pesar de que el osteosarcoma no se presenta de forma habitual en el tercio medio de la diáfisis de los huesos largos, debe siempre tomarse en cuenta como un diagnóstico diferencial con otras patologías de localización más frecuente en dicha región. Esta localización nos permite una amplia gama de alternativas quirúrgicas con la preservación de las articulaciones adyacentes.

Anestesia-analgesia epidural con bupivacaina y fentanil en cirugía de hemiabdomen superior / Epidural anesthesia-analgesia with bupivacaina and fentanil in surgery of hemiabdomen superior

Muchas veces, en aras de ganar tiempo, los anestesiólogos optamos por las variantes de técnicas anestésicas generales en detrimento de las alternativas locorregionales. Así, dentro de la anestesia regional, la epidural no es un proceder nuevo, aunque en la actualidad está retomando su utilidad, sobre todo en relación con la posibilidad de tratar el dolor postoperatorio.Una de las ventajas capitales radica en su beneficio respecto a la función respiratoria, ya que después de la cirugía abdominal alta y torácica se produce una importante reducción en la capacidad vital y en la capacidad residual funcional.Con el bloqueo epidural la capacidad vital tiene tendencia a recuperar los valores normales, acorta la duración de la hipoxemia postoperatoria y disminuye la incidencia de infecciones respiratorias, atelectásia o de soporte ventilatorio mecánico