High prevalence of dysfibrinogenemia among patients with chronic thromboembolic pulmonary hypertension.

The mechanism by which chronic thromboembolic pulmonary hypertension (CTEPH) develops after acute pulmonary thromboembolism is unknown. We previously reported that fibrin from CTEPH patients is relatively resistant to fibrinolysis in vitro. In the present study, we performed proteomic, genomic, and functional studies on fibrin(ogen) to investigate whether abnormal fibrin(ogen) might contribute to the pathogenesis of CTEPH. Reduced and denatured fibrinogen from 33 CTEPH patients was subjected to liquid chromatography-mass spectrometry analysis. Fibrinogen from 21 healthy controls was used to distinguish atypical from commonly occurring mass peaks. Atypical peaks were further investigated by targeted genomic DNA sequencing. Five fibrinogen variants with corresponding heterozygous gene mutations (dysfibrinogenemias) were observed in 5 of 33 CTEPH patients: Bbeta P235L/gamma R375W, Bbeta P235L/gamma Y114H, Bbeta P235L, Aalpha L69H, and Aalpha R554H (fibrinogens(San Diego I-V)). Bbeta P235L was found in 3 unrelated CTEPH patients. Functional analysis disclosed abnormalities in fibrin polymer structure and/or lysis with all CTEPH-associated mutations. These results suggest that, in some patients, differences in the molecular structure of fibrin may be implicated in the development of CTEPH after acute thromboembolism.

Cellular Expression of PD-L1 in the Peripheral Blood of Lung Cancer Patients is Associated with Worse Survival.

Background: Lung cancer treatment has become increasingly dependent upon invasive biopsies to profile tumors for personalized therapy. Recently, tumor expression of programmed death-ligand 1 (PD-L1) has gained interest as a potential predictor of response to immunotherapy. Circulating biomarkers present an opportunity for tumor profiling without the risks of invasive procedures. We characterized PD-L1 expression within populations of nucleated cells in the peripheral blood of lung cancer patients in hopes of expanding the role of liquid biopsy in this setting.Methods: Peripheral blood samples from a multi-institutional prospective study of patients with clinical diagnosis of lung cancer were subjected to cytomorphometric and immunohistochemical evaluation using single-cell, automated slide-based, digital pathology. PD-L1 expression was determined by immunofluorescence.Results: PD-L1 expression was detected within peripheral circulating cells associated with malignancy (CCAM) in 26 of 112 (23%) non-small cell lung cancer patients. Two distinct populations of nucleated, nonhematolymphoid, PD-L1-expressing cells were identified; cytokeratin positive (CK+, PD-L1+, CD45-) and cytokeratin negative (CK-, PD-L1+, CD45-) cells, both with cytomorphometric features (size, nuclear-to-cytoplasm ratio) consistent with tumor cells. Patients with >1.1 PD-L1(+) cell/mL (n = 14/112) experienced worse overall survival than patients with ≤1.1 PD-L1(+) cell/mL (2-year OS: 31.2% vs. 78.8%, P = 0.00159). In a Cox model adjusting for stage, high PD-L1(+) cell burden remained a significant predictor of mortality (HR = 3.85; 95% confidence interval, 1.64-9.09; P = 0.002).Conclusions: PD-L1 expression is detectable in two distinct cell populations in the peripheral blood of lung cancer patients and is associated with worse survival.Impact: These findings could represent a step forward in the development of minimally invasive liquid biopsies for the profiling of tumors. Cancer Epidemiol Biomarkers Prev; 26(7); 1139-45. ©2017 AACR.

Psychometric Properties of the Attitudinal Beliefs Questionnaire about Suicidal Behavior (CCCS-18).

The purpose of this study was to analyze psychometric properties of the Spanish version of Attitudinal Beliefs Questionnaire about Suicidal Behavior CCCS-18 (Ruiz, Navarro-Ruiz, Torrente, & Rodríguez, 2005). The participants were 277 subjects, 81.2% (225) women and 18.8% (52) men. The average age was 39.95 years old (SD = 15.9). A confirmatory factor analysis was performed to test the adequacy of the four-factor model proposed by the authors. As a result it was obtained a three-factor model (χ2/df = 1.96; CFI = .98; sRMR = .060; RMSEA = .059), with indices reflecting adequate goodness of fit. The reliability of the test using the omega coefficient showed satisfactory values (ω h = .95, CI 95% = [.94, .96]). The results indicate a close relation between the CCCS-18 dimensions and the suicidal tendency, showing discriminant validity properties. Predictive validity was also found in the significant correlations between the measures obtained in the questionnaire and a risk index resulting from the suicidal ideation predictor variables that were part of a logistic regression equation; CCCS-18 (r = .26, p < .001), F1, Legimization and terminal disease (r = .163, p < .01), F2, Moral dimension (r = .22, p < .001) and F3, Suicide itself (r = .252, p < .001). CONCLUSIONS: The CCCS-18 shows reliability and validity, as well as being a test of easy and brief application.

Thoracic Extramedullary Hematopoiesis Mimicking Metastatic Cancer.

Thoracic extramedullary hematopoiesis (EMH) is a rare manifestation in patients with myeloproliferative neoplasm. A 76-year-old woman with a long-standing history of polycythemia vera presented with a 2-month history of worsening dyspnea and left-sided wheezing. A chest computed tomography showed an ill-defined soft tissue mass encasing the left mainstem bronchus causing airway obstruction, associated with paratracheal and paraesophageal lymphadenopathy. Endobronchial ultrasound-guided fine needle aspiration of the soft tissue mass and mediastinoscopy with excisional biopsy of a paratracheal lymph node demonstrated EMH with increased myeloid blasts. A bone marrow biopsy confirmed postpolycythemic myelofibrosis consistent with progression of polycythemia vera to myelofibrosis. We describe the bronchoscopic management of a case of EMH presenting as a mediastinal mass, mimicking malignancy.

Perfil, motivación, satisfacción y compromiso de un voluntariado de acompañamiento en duelo. Propiedades psicométricas de los cuestionarios Organizational Commitment Questionnarie y Job Diagnostic Survey / Profile, motivation, satisfaction and commitment of the bereavement volunteer. Psychometric properties of the Organizational Commitment and Job Diagnostic Questionnaire

En este artículo se analiza si las propias experiencias marcan la motivación de elección, satisfacción y compromiso con un voluntariado centrado en acompañamiento a personas en duelo. Para ello se realiza un análisis psicométrico de los cuestionarios utilizados. Contestaron al cuestionario 79 voluntarios (tasa de respuesta: 64%), de los 123 inscritos en la base de datos del Centro. El 69,6% (55) mujeres y el 30,4% (24) hombres, edad media: 48 años (dt 12,95). Más del 72% (56) cursaron estudios superiores, son creyentes y el voluntariado está relacionado con su profesión. El 67,1% (53) trabajan y el 96,2% (75) ha tenido pérdida significativa. De media, llevan 12 años como voluntario y 2 años en el Centro. La media en compromiso con la organización fue 48 (Organizational Commitment Questionnarie) y en potencial motivador del puesto, 114 (Job Diagnostic Survey). El perfil de voluntarios muestra un historial mayoritario de voluntariado en el que después de sufrir una pérdida se dirige hacia la ayuda recibida. Las vivencias propias marcan la elección del tipo de voluntariado y posiblemente su permanencia sin excluir otras motivaciones

In this article it is analyzed whether self-experiences mark the motivation of choice, satisfaction and commitment of a volunteer focused on accompanying people in mourning. To do this, a psychometric analysis was performed on the questionnaires used. A total of 79 volunteers out of the 123 registered in the database of the Centre answered the questionnaire (response rate: 64%). The mean age was 48 years (SD 12.95), and 69.6% (55) were women and 30.4% (24) were men. More than 72% (56) attended high school, are believers and volunteering is related to their profession. More than two-thirds 67.1% (53) worked, and 96.2% (75) has had a significant loss. On average, they have been volunteers for 12 years, with 2 years at the Center. The mean score in the commitment to the organization was 48 (Organizational Commitment Questionnaire), and 114 in the motivational potential of the job (Job Diagnostic Survey). The profile of volunteers showed a wide volunteer history after having suffered a loss, and is associated to the help received. Personal experiences decide the choice of the type of volunteer work, and possibly its tenure, without excluding other motivations

Evaluation of genetic mutations associated with Mycobacterium tuberculosis resistance to amikacin, kanamycin and capreomycin: a systematic review.

BACKGROUND: Rapid molecular diagnostics for detecting multidrug-resistant and extensively drug-resistant tuberculosis (M/XDR-TB) primarily identify mutations in Mycobacterium tuberculosis (Mtb) genes associated with drug resistance. Their accuracy, however, is dependent largely on the strength of the association between a specific mutation and the phenotypic resistance of the isolate with that mutation, which is not always 100%. While this relationship is well established and reliable for first-line anti-TB drugs, rifampin and isoniazid, it is less well-studied and understood for second-line, injectable drugs, amikacin (AMK), kanamycin (KAN) and capreomycin (CAP). METHODOLOGY/PRINCIPAL FINDINGS: We conducted a systematic review of all published studies evaluating Mtb mutations associated with resistance to AMK, KAN, CAP in order to characterize the diversity and frequency of mutations as well as describe the strength of the association between specific mutations and phenotypic resistance in global populations. Our objective was to determine the potential utility and reliability of these mutations as diagnostic markers for detecting AMK, KAN and CAP resistance. Mutation data was reviewed for 1,585 unique clinical isolates from four continents and over 18 countries. Mutations in the rrs, tlyA, eis promoter and gidB genes were associated with AMK, KAN and/or CAP resistance. CONCLUSIONS/SIGNIFICANCE: The rrs A1401G mutation was present in the majority of AMK, KAN and CAP resistant Mtb strains reviewed, but was also found in 7% of CAP susceptible strains. The 1401 mutation alone, however, was not found with sufficient frequency to detect more than 70-80% of global Mtb strains resistant to AMK and CAP, and 60% of strains resistant to KAN. Additional mutations in the rrs, eis promoter, tlyA and gidB genes appear to be associated with resistance and could improve sensitivity and specificity of future diagnostics.

Diagnostic approach to deep venous thrombosis and pulmonary embolism in the critical care setting.

Considerable progress has been made during the last 30 years in the prevention, diagnosis, and therapy of venous thromboembolism. This article discusses the epidemiology, pathophysiology, and clinical presentation of the disease as well as the diagnostic uncertainty that exists in the critical care setting. Diagnostic approaches for deep venous thrombosis and pulmonary embolism are considered, including clinical prediction rules, D-dimer, contrast venography, duplex ultrasonography, computed tomographic angiography and venography, magnetic resonance imaging, ventilation­perfusion scanning, chest radiograph, arterial blood gases, electrocardiography, and echocardiography.

Validation of a brief version of the Inventory of Life Factors Interfering Grief and Complicated Grief (ILFIGv2) / Validación de una versión breve del Inventario de Factores Vitales que Interfieren Duelo y Duelo Complicado (IFVIDv2)

There are some life circumstances that can interfere with a normal mourning process. In order to identify these factors, the Inventory of Life Factors Interfering Grief and Complicated Grief (ILFIG) was first published in 2017. The present study aims to validate a briefer version of the questionnaire, the ILFIGv2. In this second version, the six dimensions of the questionnaire (Guilt, Inheritance, Economy, Sexuality, Immortality and Sense of presence) were hidden, and the items were reduced to 24. With a total sample of 248 respondents, a six-factor structure was tested. Confirmatory factor analysis model obtained reasonable goodness of fit indices: χ2(237) = 383.409, p < .001; CFI = 0.984, TLI = 0.981; RMSEA = 0.050, 95% CI [0.041 - 0.059], providing validity evidences based on the internal structure of the test. Validity evidences based on the relation with other variables were also provided by external criteria correlation. Regarding reliability, all the subscales of the ILFIGv2 obtained Cronbach's alpha and omega coefficients above .70 and .80, respectively. A brief version of ILFIG has been validated. It heralds a potential means to prevent and avoid grief lengthening, as it can measure unexpressed aspects which, according to grievers, demand attention

Existen algunas circunstancias vitales que pueden interferir el proceso de duelo normal. El Inventario de Factores Vitales que Interfieren Duelo y Duelo Complicado (IFVID) se publicó por primera vez, con el fin de identificar estos factores, en 2017. El presente estudio tiene como objetivo validar una versión breve del cuestionario, el IFVIDv2. En esta segunda versión, las seis dimensiones del cuestionario (Culpa, Herencia, Economía, Sexualidad, Inmortalidad y Sensación de presencia) se ocultaron y se redujeron a 24 el número de ítems. Con una muestra total de 248 encuestados, se contrastó una estructura de seis factores mediante análisis factorial confirmatorio. El modelo resultante obtuvo índices de ajuste razonables: χ2(237) = 383.409, p < .001; CFI = 0.984, TLI = 0.981; RMSEA = 0.050, 95% CI [0.041 - 0.059], aportando pruebas de validez basadas en la estructura interna del inventario. También se obtuvieron pruebas de validez basadas en la relación con otras variables por asociación con criterio externo. En cuanto a la fiabilidad, todas las subescalas del IFVIDv2 obtuvieron coeficientes alfa de Cronbach y omega por encima de .70 y .80, respectivamente. Se ha validado una versión breve de IFVID que constituye un instrumento con posibilidad de prevenir y evitar el prolongamiento del duelo, ya que es capaz de detectar aspectos no expresados que, según los dolientes, necesitan atención

Actitudes ante la muerte en voluntarios acompañando pacientes al final de la vida: estilos de apego y fatiga por compasión / Attitudes toward death in volunteer with patients at the end of life: attachment styles and compassion fatigue

OBJETIVO: Evaluar las actitudes hacia la muerte en voluntarios, negativas (evitación, aceptación de escape y miedo a la muerte) y positivas (aceptación neutral y acercamiento), teniendo en cuenta los estilos de apego y la fatiga por compasión. MÉTODO: La muestra estaba compuesta por 89 voluntarios de un centro sociosanitario, con una edad comprendida entre los 24 y los 81 años. Se llevó a cabo una regresión lineal para predecir las actitudes hacia la muerte, tanto positivas como negativas, partiendo de las variables calidad de vida profesional, satisfacción y fatiga por compasión, estilos de apego, edad, situación laboral, creencias religiosas, creencias en el más allá. RESULTADOS: La actitud positiva hacia la muerte obtuvo una R2 de 0,424, siendo las variables en la regresión creencias en el más allá (beta =0, 369, p < 0,001), creencias religiosas (beta = 0,272, p < 0,001), edad (beta = 0,195, p < 0,029) y situación laboral (beta = -0,186, p < 0,032). La actitud negativa hacia la muerte obtuvo un R2 = 0,118, siendo la única variable incluida en la ecuación el apego preocupado (beta = 0,347, p < 0,001). CONCLUSIÓN: Se establece un modelo capaz de predecir el 42 % de la varianza con respecto a las actitudes positivas hacia la muerte, y un 12 % hacia las actitudes negativas. Según se avanza en el nivel de creencias religiosas, creencias sobre el encuentro en más allá y edad, y cuanto menor es el tiempo de ocupación laboral se encuentra actitud más positiva hacia la muerte. Sin embargo, la actitud negativa hacia la muerte se define por un estilo de apego preocupado

OBJECTIVE: To evaluate the attitudes toward death in volunteers; negative (fear of death, avoidance and escape acceptance) and positive attitudes (approach acceptance and neutral acceptance), considering attachment styles and compassion fatigue. METHOD: The sample included 89 volunteers of a healthcare center, between 24 and 81 years-old. Multiple regression analysis were used to predict attitudes towards death, so much positive as negative, departing from the variables, professional quality of life, compassion satisfaction and fatigue, attachment styles, age, employment situation, religious beliefs and afterlife beliefs. RESULTS: Positive attitudes toward death showed R2 = 0.424, being included in regression equation the variables afterlife beliefs (beta = 0.369, p < 0.001), religious beliefs (beta = 0.272, p < 0.001), age (beta = 0.195, p < 0.029) and employment situation (beta = -0.186, p < 0.032). Negative attitudes toward death showed R2 = 0.118, being the only variable included in regression equation concerned attachment style (beta = 0.347, p < 0.001). CONCLUSION: A model predicting the 42 % of the variance with respect to positive death attitudes and 12 % to negative attitudes has been set. According to advancing the level of religious beliefs, afterlife beliefs and age, and the lower is the time of occupation, positive attitude towards death are developed. However the negative attitude toward death is defined by a concerned attachment style

Social support and psychological well-being as possible predictors of complicated grief in a cross-section of people in mourning / Apoyo social y bienestar psicológico como posibles predictores de estado de duelo complicado en población de personas en duelo

Objective: To analyze the variations in complicated grief (CG) through sociodemograohic and functioning well variable: psychologycal well-beIng (PW), received social support (RSC) and satisfaction with the social support (SRSC).Method: transversal study, n= 110 people sample who arrive to a free grief listening centre through an ad hoc questionnaire including sociodemographic variables, complicated grief level according to Prigerson Inventory of Complicated Grief (ICG), well- being according to Well-being Ryff's Questionnaire and Sarason Questionnaire to social support measure. Descriptive and correlational (Pearson) analyses executed. Also, step by step backward multiple regression analyse.Results: Averaged CG 44.91, PW 119.23, RSC 10.56 people, SRSC 13.48. Predictive CG variables were: CG, PW, RSC, SRSC, postloss moths, pharmacological help received and parents relationship. Adjusted R-squared 42.4%.Conclusions: PW and satisfactory RSC could be considered CG level predictors. Recommendation is to study depressive symptoms, to clarify the influence in RSC perception. This study contributes to increase the centre efficiency, so that functioning well variables are able to predict CG level

Objetivo: Analizar las variaciones en estado de duelo complicado (DC) a través de variables sociodemográficas y de funcionamiento óptimo: bienestar psicológico (BP), apoyo social disponible (ASD) y satisfacción con el apoyo social disponible (SASD). Método: Estudio transversal, N = 110 personas que acuden a un centro gratuito de escucha de duelo (CE), a través de cuestionario que incluía aspectos sociodemográficos Inventario de Duelo Complicado de Prigerson (IDC), adaptación española del Cuestionario de Bienestar Psicológico de Ryff y versión abreviada del Cuestionario Sarason de Apoyo Social (SSQSR). Se realizó análisis descriptivo y correlacional con Pearson. Se utilizó regresión lineal múltiple por método paso a paso de eliminación hacia atrás.Resultados: El estado medio DC 40.91 (DT = 11.89), de BP 119.23 (DT = 18.75), de ASD 10.56 (DT = 6.31) personas y SASD 13.48 (DT = 4.17). Las variables predictivas del nivel de DC fueron: BP, ASD, SASD, meses desde la pérdida, recibir ayuda farmacológica previa y parentesco progenitor. El R- cuadrado ajustado resultó de 42.4%. Conclusiones: Podemos considerar BP y el SASD predictores del estado de DC. Sería adecuado esclarecer el efecto de sintomatología depresiva en la percepción de ASD. Este estudio contribuye a aumentar eficiencia del recurso, al poder predecir en parte el DC mediante variables que no implican deterioro del deudo

Psychometric properties of the Atitudinal Beliefs Questionnaire about Suicidal Behavior (CCCS-18)

The purpose of this study was to analyze psychometric properties of the Spanish version of Attitudinal Beliefs Questionnaire about Suicidal Behavior CCCS-18 (Ruiz, Navarro-Ruiz, Torrente, & Rodríguez, 2005). The participants were 277 subjects, 81.2% (225) women and 18.8% (52) men. The average age was 39.95 years old (SD = 15.9). A confirmatory factor analysis was performed to test the adequacy of the four-factor model proposed by the authors. As a result it was obtained a three-factor model (χ2/df = 1.96; CFI = .98; sRMR = .060; RMSEA = .059), with indices reflecting adequate goodness of fit. The reliability of the test using the omega coefficient showed satisfactory values (ωh = .95, CI 95% = [.94, .96]). The results indicate a close relation between the CCCS-18 dimensions and the suicidal tendency, showing discriminant validity properties. Predictive validity was also found in the significant correlations between the measures obtained in the questionnaire and a risk index resulting from the suicidal ideation predictor variables that were part of a logistic regression equation; CCCS-18 (r = .26, p < .001), F1, Legimization and terminal disease (r = .163, p < .01), F2, Moral dimension (r = .22, p < .001) and F3, Suicide itself (r = .252, p < .001). Conclusions: The CCCS-18 shows reliability and validity, as well as being a test of easy and brief application (AU)

No disponible