An overview of preconcentration techniques combined with inductively coupled plasma mass spectrometry for trace element determination in biological studies.

In the last decades, the determination of trace elements in biological materials has emerged as an important area of study because of its relevance to human health and the environment. Inductively coupled plasma mass spectrometry (ICP-MS) has proven to be a powerful tool for trace element analysis, owing to its high sensitivity and ability to determine several elements in a single measurement. However, given the complex nature of biological matrices and the presence of elements, most of them at ultratrace levels, it becomes crucial to complement ICP-MS with preconcentration techniques to increase the sensitivity and selectivity of analytical methods. This article presents an exhaustive overview of liquid- and solid-phase preconcentration techniques used in combination with ICP-MS for trace element determination in different biological samples from 2000 to the present. An in-depth discussion of the advances on the application of state-of-the-art solvents and materials in trace element extraction and preconcentration is presented. Special attention is given to different strategies for elemental speciation analysis, employing both chromatographic and non-chromatographic techniques. The role of automation in these methodologies is also described. Finally, future trends and challenges related to this topic are discussed.

Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group.

OBJECTIVE: To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR). METHODS: A task force including 29 rheumatologists/internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1-5 scale) and agreement (LOA) (0-10 scale) were evaluated. RESULTS: Two overarching principles and five recommendations were developed. LOE was 4-5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care. CONCLUSIONS: These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR.

Diversity of Behavior after Collisions of Sn and Si Nanoparticles Found Using a New Density Functional Tight-Binding Method.

We present a new approach to studying nanoparticle collisions using density functional based tight binding (DFTB). A novel DFTB parametrization has been developed to study the collision process of Sn and Si clusters (NPs) using molecular dynamics (MD). While bulk structures were used as training sets, we show that our model is able to accurately reproduce the cohesive energy of the nanoparticles using density functional theory (DFT) as a reference. A surprising variety of phenomena are revealed for the Si/Sn nanoparticle collisions, depending on the size and velocity of the collision: from core-shell structure formation to bounce-off phenomena.

Density Functional Tight-Binding Model for Lithium-Silicon Alloys.

The predictive power of molecular dynamic simulations is mainly restricted by the time scale and model accuracy. Many systems of current relevance are of such complexity that they require addressing both issues simultaneously. This is the case of silicon electrodes in Li-ion batteries, where different LixSi alloys are formed during charge/discharge cycles. While first-principles treatments for this system are seriously limited by the computational cost of exploring its large conformational space, classical force fields are not transferable enough to represent it accurately. Density Functional Tight Binding (DFTB) is an intermediate complexity approach capable of capturing the electronic nature of different environments with a relatively low computational cost. In this work, we present a new set of DFTB parameters suited to model amorphous LixSi alloys. LixSi is the usual finding upon cycling the Si electrodes in the presence of Li ions. The model parameters are constructed with a particular emphasis on their transferability for the entire LixSi composition range. This is achieved by introducing a new optimization procedure that weights stoichiometries differently to improve the prediction of their formation energies. The resulting model is shown to be robust for predicting crystal and amorphous structures for the different compositions, giving excellent agreement with DFT calculations and outperforming state-of-the-art ReaxFF potentials.

Ring currents modulate optoelectronic properties of aromatic chromophores at 25 T.

The properties of organic molecules can be influenced by magnetic fields, and these magnetic field effects are diverse. They range from inducing nuclear Zeeman splitting for structural determination in NMR spectroscopy to polaron Zeeman splitting organic spintronics and organic magnetoresistance. A pervasive magnetic field effect on an aromatic molecule is the aromatic ring current, which can be thought of as an induction of a circular current of π-electrons upon the application of a magnetic field perpendicular to the π-system of the molecule. While in NMR spectroscopy the effects of ring currents on the chemical shifts of nearby protons are relatively well understood, and even predictable, the consequences of these modified electronic states on the spectroscopy of molecules has remained unknown. In this work, we find that photophysical properties of model phthalocyanine compounds and their aggregates display clear magnetic field dependences up to 25 T, with the aggregates showing more drastic magnetic field sensitivities depending on the intermolecular interactions with the amplification of ring currents in stacked aggregates. These observations are consistent with ring currents measured in NMR spectroscopy and simulated in time-dependent density functional theory calculations of magnetic field-dependent phthalocyanine monomer and dimer absorption spectra. We propose that ring currents in organic semiconductors, which commonly comprise aromatic moieties, may present new opportunities for the understanding and exploitation of combined optical, electronic, and magnetic properties.

Neurogenic ppendicopathy. A report of 8 cases.

INTRODUCTION: Neurogenic appendicopathy is not a very well-known disease. OBJECTIVE: To analyze the experience in the management of neurogenic appendicopathy in a tertiary hospital, assessing its clinical presentation, histological staging, the treatment carried out and its clinical evolution. METHOD: The study population included patients with histopathological criteria for neurogenic appendicopathy who did not present with MEN 2B syndrome, neurofibromatosis type I or Cowden syndrome. An analysis was carried out of tissue samples taken from a simple appendectomy after a diagnosis of neurogenic appendicopathy between 2000 and 2013, inclusive. The histopathological criteria were neurogenic hyperplasia with S-100 protein positivity and neuron-specific enolase in the immunohistochemical analysis. RESULTS: Of the 4,969 samples from the appendectomies analyzed, 0.16% (n = 8) met histopathological criteria of neurogenic appendicopathy. The age at presentation was 27.8 ± 12 years. Four patients were male and four were female. All patients started with abdominal pain in the right iliac fossa (RIF), and were operated on due to a diagnosis of acute appendix, with a simple appendectomy being performed. In four cases, another associated disease accounted for the pain in the RIF. With regard to histopathological type, submucosal neurogenic hyperplasia was present in five patients and fibrous obliteration in three patients. No statistically significant differences were found between the histological types. After surgery, during a mean follow up of 73.2 ± 28 months (15-105), all the patients remained asymptomatic. CONCLUSION: Neurogenic appendicopathy is an uncommon entity that can evolve as abdominal pain which is similar to acute appendix. Simple appendectomy is curative.

Deep eutectic solvents as a green alternative for trace element analysis in food and beverage samples: Recent advances and challenges.

Metals and metalloids have different effects on human health even at trace levels. Some of them are essential for living organisms while others can be toxic. Therefore, the determination of trace elements in food and beverage is highly important to understand their impact in human health. A new generation of solvents named deep eutectic solvents (DES) has emerged as a green alternative for trace element analysis, owing to their low toxicity, biodegradability, and high extraction capacity. In recent years, the application of DES in extraction techniques for trace element analysis in food and beverage samples has increased significantly. This review summarizes recent advances and challenges on the application of DES to develop microextraction techniques useful for the analysis of samples with complex matrices. The importance of the use of biodegradable substances instead of classic organic solvents, which are toxic, volatile, and flammable in methods for elemental analysis with a positive environmental impact is also highlighted. Finally, conclusions and future challenges arising from the use of DES in microextraction techniques are discussed.

Towards better mortality prediction in cancer patients in the ICU: a comparative analysis of prognostic scales: systematic literature review.

OBJECTIVE: To evaluate the predictive ability of mortality prediction scales in cancer patients admitted to intensive care units (ICUs). DESIGN: A systematic review of the literature was conducted using a search algorithm in October 2022. The following databases were searched: PubMed, Scopus, Virtual Health Library (BVS), and Medrxiv. The risk of bias was assessed using the QUADAS-2 scale. SETTING: ICUs admitting cancer patients. PARTICIPANTS: Studies that included adult patients with an active cancer diagnosis who were admitted to the ICU. INTERVENTIONS: Integrative study without interventions. MAIN VARIABLES OF INTEREST: Mortality prediction, standardized mortality, discrimination, and calibration. RESULTS: Seven mortality risk prediction models were analyzed in cancer patients in the ICU. Most models (APACHE II, APACHE IV, SOFA, SAPS-II, SAPS-III, and MPM II) underestimated mortality, while the ICMM overestimated it. The APACHE II had the SMR (Standardized Mortality Ratio) value closest to 1, suggesting a better prognostic ability compared to the other models. CONCLUSIONS: Predicting mortality in ICU cancer patients remains an intricate challenge due to the lack of a definitive superior model and the inherent limitations of available prediction tools. For evidence-based informed clinical decision-making, it is crucial to consider the healthcare team's familiarity with each tool and its inherent limitations. Developing novel instruments or conducting large-scale validation studies is essential to enhance prediction accuracy and optimize patient care in this population.

Is IIIG9 a New Protein with Exclusive Ciliary Function? Analysis of Its Potential Role in Cancer and Other Pathologies.

The identification of new proteins that regulate the function of one of the main cellular phosphatases, protein phosphatase 1 (PP1), is essential to find possible pharmacological targets to alter phosphatase function in various cellular processes, including the initiation and development of multiple diseases. IIIG9 is a regulatory subunit of PP1 initially identified in highly polarized ciliated cells. In addition to its ciliary location in ependymal cells, we recently showed that IIIG9 has extraciliary functions that regulate the integrity of adherens junctions. In this review, we perform a detailed analysis of the expression, localization, and function of IIIG9 in adult and developing normal brains. In addition, we provide a 3D model of IIIG9 protein structure for the first time, verifying that the classic structural and conformational characteristics of the PP1 regulatory subunits are maintained. Our review is especially focused on finding evidence linking IIIG9 dysfunction with the course of some pathologies, such as ciliopathies, drug dependence, diseases based on neurological development, and the development of specific high-malignancy and -frequency brain tumors in the pediatric population. Finally, we propose that IIIG9 is a relevant regulator of PP1 function in physiological and pathological processes in the CNS.

Glioblastoma Invasiveness and Collagen Secretion Are Enhanced by Vitamin C.

Aims: Glioblastoma (GB) is one of the most aggressive brain tumors. These tumors modify their metabolism, increasing the expression of glucose transporters, GLUTs, which incorporate glucose and the oxidized form of vitamin C, dehydroascorbic acid (DHA). We hypothesized that GB cells preferentially take up DHA, which is intracellularly reduced and compartmentalized into the endoplasmic reticulum (ER), promoting collagen biosynthesis and an aggressive phenotype. Results: Our results showed that GB cells take up DHA using GLUT1, while GLUT3 and sodium-dependent vitamin C transporter 2 (SVCT2) are preferably intracellular. Using a baculoviral system and reticulum-enriched extracts, we determined that SVCT2 is mainly located in the ER and corresponds to a short isoform. Ascorbic acid (AA) was compartmentalized, stimulating collagen IV secretion and increasing in vitro and in situ cell migration. Finally, orthotopic xenografts induced in immunocompetent guinea pigs showed that vitamin C deficiency retained collagen, reduced blood vessel invasion, and affected glomeruloid vasculature formation, all pathological conditions associated with malignancy. Innovation and Conclusion: We propose a functional role for vitamin C in GB development and progression. Vitamin C is incorporated into the ER of GB cells, where it favors the synthesis of collagen, thus impacting tumor development. Collagen secreted by tumor cells favors the formation of the glomeruloid vasculature and enhances perivascular invasion. Antioxid. Redox Signal. 37, 538-559.

Effect of Molecular Weight and Nanoarchitecture of Chitosan and Polycaprolactone Electrospun Membranes on Physicochemical and Hemocompatible Properties for Possible Wound Dressing.

Tissue engineering has focused on the development of biomaterials that emulate the native extracellular matrix. Therefore, the purpose of this research was oriented to the development of nanofibrillar bilayer membranes composed of polycaprolactone with low and medium molecular weight chitosan, evaluating their physicochemical and biological properties. Two-bilayer membranes were developed by an electrospinning technique considering the effect of chitosan molecular weight and parameter changes in the technique. Subsequently, the membranes were evaluated by scanning electron microscopy, Fourier transform spectroscopy, stress tests, permeability, contact angle, hemolysis evaluation, and an MTT test. From the results, it was found that changes in the electrospinning parameters and the molecular weight of chitosan influence the formation, fiber orientation, and nanoarchitecture of the membranes. Likewise, it was evidenced that a higher molecular weight of chitosan in the bilayer membranes increases the stiffness and favors polar anchor points. This increased Young's modulus, wettability, and permeability, which, in turn, influenced the reduction in the percentage of cell viability and hemolysis. It is concluded that the development of biomimetic bilayer nanofibrillar membranes modulate the physicochemical properties and improve the hemolytic behavior so they can be used as a hemocompatible biomaterial.

Elemental Speciation Analysis in Environmental Studies: Latest Trends and Ecological Impact.

Speciation analysis is a key aspect of modern analytical chemistry, as the toxicity, environmental mobility, and bioavailability of elemental analytes are known to depend strongly on an element's chemical species. Henceforth, great efforts have been made in recent years to develop methods that allow not only the determination of elements as a whole, but also each of its separate species. Environmental analytical chemistry has not ignored this trend, and this review aims to summarize the latest methods and techniques developed with this purpose. From the perspective of each relevant element and highlighting the importance of their speciation analysis, different sample treatment methods are introduced and described, with the spotlight on the use of modern nanomaterials and novel solvents in solid phase and liquid-liquid microextractions. In addition, an in-depth discussion of instrumental techniques aimed both at the separation and quantification of metal and metalloid species is presented, ranging from chromatographic separations to electro-chemical speciation analysis. Special emphasis is made throughout this work on the greenness of these developments, considering their alignment with the precepts of the Green Chemistry concept and critically reviewing their environmental impact.

Ultra-sensitive Sb speciation analysis in water samples by magnetic ionic liquid dispersive liquid-liquid microextraction and multivariate optimization.

Efficient separation and preconcentration of inorganic Sb species in different water samples were performed in this work by a novel dispersive liquid-liquid microextraction (DLLME) method based on the application of a magnetic ionic liquid (MIL) and electrothermal atomic absorption spectroscopy (ETAAS) detection. The Sb(iii) species was selectively extracted by complexation with ammonium diethyldithiophosphate (DDTP) and 45 µL of the MIL trihexyl(tetradecyl)phosphonium tetrachloroferrate ([P6,6,6,14]FeCl4) as extractant. Subsequently, a magnetic rod was applied for phase separation, introducing it directly into the sample solution, and the MIL phase was then diluted in chloroform. Afterwards, 15 µL of this solution was injected into the graphite furnace of ETAAS for Sb determination. A multivariate study was performed to obtain the optimal extraction conditions. Selective reduction of Sb(v) to Sb(iii) with 1% (w/v) KI before preconcentration was applied for total inorganic Sb determination and Sb(v) concentration was calculated by subtraction. The analytical performance of the method included extraction efficiencies of 98.0% for Sb(iii) and 92.6% for Sb(v), LOD of 0.02 µg L-1 for Sb(iii) and relative standard deviations of 3.1% for Sb(iii) and 3.5% for Sb(v) (at 6 µg L-1 Sb(iii) and Sb(v), n = 10). The calibration linear range was 0.08-20 µg L-1. The results showed that the proposed methodology was highly sensitive and selective for Sb speciation analysis in tap, dam, mineral, wetland, underground, rain and river water samples.

SVCT2 Overexpression and Ascorbic Acid Uptake Increase Cortical Neuron Differentiation, Which Is Dependent on Vitamin C Recycling between Neurons and Astrocytes.

During brain development, sodium-vitamin C transporter (SVCT2) has been detected primarily in radial glial cells in situ, with low-to-absent expression in cerebral cortex neuroblasts. However, strong SVCT2 expression is observed during the first postnatal days, resulting in increased intracellular concentration of vitamin C. Hippocampal neurons isolated from SVCT2 knockout mice showed shorter neurites and low clustering of glutamate receptors. Other studies have shown that vitamin C-deprived guinea pigs have reduced spatial memory, suggesting that ascorbic acid (AA) and SVCT2 have important roles in postnatal neuronal differentiation and neurite formation. In this study, SVCT2 lentiviral overexpression induced branching and increased synaptic proteins expression in primary cultures of cortical neurons. Analysis in neuroblastoma 2a (Neuro2a) and human subventricular tumor C3 (HSVT-C3) cells showed similar branching results. SVCT2 was mainly observed in the cell membrane and endoplasmic reticulum; however, it was not detected in the mitochondria. Cellular branching in neuronal cells and in a previously standardized neurosphere assay is dependent on the recycling of vitamin C or reduction in dehydroascorbic acid (DHA, produced by neurons) by glial cells. The effect of WZB117, a selective glucose/DHA transporter 1 (GLUT1) inhibitor expressed in glial cells, was also studied. By inhibiting GLUT1 glial cells, a loss of branching is observed in vitro, which is reproduced in the cerebral cortex in situ. We concluded that vitamin C recycling between neurons and astrocyte-like cells is fundamental to maintain neuronal differentiation in vitro and in vivo. The recycling activity begins at the cerebral postnatal cortex when neurons increase SVCT2 expression and concomitantly, GLUT1 is expressed in glial cells.

Measurement of galactosyl-deficient IgA1 by the monoclonal antibody KM55 contributes to predicting patients with IgA nephropathy with high risk of long-term progression.

BACKGROUND AND OBJECTIVE: About 25% of patients with IgA nephropathy (IgAN) progress to stage 5 chronic kidney disease (CKD) after years of evolution. Various tools have been developed in recent years designed to predict which of the patients will had poorer outcomes. The value of circulating galactosyl-deficient IgA1 (Gd-IgA1) has been related to a worse evolution of IgAN in several studies. There are also some publications that relate higher APRIL values with a worse evolution. Recently, a new method has been developed that allows measuring the value of circulating Gd-IgA1 in a simpler way than those previously available. The objective of this study is to analyze the influence of circulating Gd-IgA1, measured by this method, on the progression of IgAN. MATERIALS AND METHODS: Forty-nine patients with a diagnosis of IgAN demonstrated by renal biopsy were selected in our center, without having received prior immunosuppressive treatment, for whom frozen serum was available. The median follow-up was 4 years. Gd-IgA1 was measured by lectin-independent ELISA with the monoclonal antibody KM55 (IgA1 kit Cat. No. 30111694. IBL Int., Hamburg, Germany). Likewise, APRIL levels were also measured in these patients. RESULTS: 19 (38.8%) patients reached stage 5 CKD. The fourth quartile of circulating Gd-IgA1 was related to a higher cumulative risk of reaching stage 5 CKD in the Kaplan-Meier analysis (risk at the 5th year 39.4% vs. 24.3%, log rank p=0.019). The Gd-IgA1 value was related to an increased risk of CKD stage 5 (HR 1.147, 95% CI 1.035-1.270, p=0.009), regardless of glomerular filtration rate, proteinuria, the percentage of sclerosed glomeruli and the value of segmental sclerosis. We did not find significant differences in the APRIL values. CONCLUSIONS: The value of circulating Gd-IgA1 measured by the monoclonal antibody KM55 is related to a worse evolution of patients with IgAN independently of other variables, so it could be included in the study of patients to improve the prediction of the risk of disease progression.

[Measurement of galactosyl-deficient IgA1 by the monoclonal antibody KM55 contributes to predicting patients with IgA nephropathy with high risk of long-term progression]. / La determinación de IgA1 galactosil deficiente mediante el anticuerpo monoclonal KM55 contribuye a predecir a los pacientes con nefropatía IgA con alto riesgo de progresión a largo plazo.

BACKGROUND AND OBJECTIVE: About 25% of patients with IgA nephropathy (IgAN) progress to stage 5 chronic kidney disease (CKD) after years of evolution. Various tools have been developed in recent years designed to predict which of the patients will had poorer outcomes. The value of circulating galactosyl-deficient IgA1 (Gd-IgA1) has been related to a worse evolution of IgAN in several studies. There are also some publications that relate higher APRIL values with a worse evolution. Recently, a new method has been developed that allows measuring the value of circulating Gd-IgA1 in a simpler way than those previously available. The objective of this study is to analyze the influence of circulating Gd-IgA1, measured by this method, on the progression of IgAN. MATERIALS AND METHODS: Forty-nine patients with a diagnosis of IgAN demonstrated by renal biopsy were selected in our center, without having received prior immunosuppressive treatment, for whom frozen serum was available. The median follow-up was 4 years. Gd-IgA1 was measured by lectin-independent ELISA with the monoclonal antibody KM55 (IgA1 kit Cat. No. 30111694. IBL Int., Hamburg, Germany). Likewise, APRIL levels were also measured in these patients. RESULTS: 19 (38.8%) patients reached stage 5 CKD. The fourth quartile of circulating Gd-IgA1 was related to a higher cumulative risk of reaching stage 5 CKD in the Kaplan-Meier analysis (risk at the 5th year 39.4% vs. 24.3%, log rank p=0.019). The Gd-IgA1 value was related to an increased risk of CKD stage 5 (HR 1.147, 95% CI 1.035-1.270, p=0.009), regardless of glomerular filtration rate, proteinuria, the percentage of sclerosed glomeruli and the value of segmental sclerosis. We did not find significant differences in the APRIL values. CONCLUSIONS: The value of circulating Gd-IgA1 measured by the monoclonal antibody KM55 is related to a worse evolution of patients with IgAN independently of other variables, so it could be included in the study of patients to improve the prediction of the risk of disease progression.

IIIG9 inhibition in adult ependymal cells changes adherens junctions structure and induces cellular detachment.

Ependymal cells have multiple apical cilia that line the ventricular surfaces and the central canal of spinal cord. In cancer, the loss of ependymal cell polarity promotes the formation of different types of tumors, such as supratentorial anaplastic ependymomas, which are highly aggressive in children. IIIG9 (PPP1R32) is a protein restricted to adult ependymal cells located in cilia and in the apical cytoplasm and has unknown function. In this work, we studied the expression and localization of IIIG9 in the adherens junctions (cadherin/ß-catenin-positive junctions) of adult brain ependymal cells using confocal and transmission electron microscopy. Through in vivo loss-of-function studies, ependymal denudation (single-dose injection experiments of inhibitory adenovirus) was observed, inducing the formation of ependymal cells with a "balloon-like" morphology. These cells had reduced cadherin expression (and/or delocalization) and cleavage of the cell death marker caspase-3, with "cilia rigidity" morphology (probably vibrational beating activity) and ventriculomegaly occurring prior to these events. Finally, after performing continuous infusions of adenovirus for 14 days, we observed total cell denudation and reactive parenchymal astrogliosis. Our data confirmed that IIIG9 is essential for the maintenance of adherens junctions of polarized ependymal cells. Eventually, altered levels of this protein in ependymal cell differentiation may increase ventricular pathologies, such as hydrocephalus or neoplastic transformation.

Emergency esophagojejunostomy in type IV hiatal hernia: A case report.

Reconstruction of the digestive tract is a surgical challenge; we propose a novel and successful alternative using a large vascularized pedicled jejunum anastomosed to the cervical esophagus in an emergency situation. A 65-year-old female patient in follow-up due to a gigantic type IV paraesophageal hernia, whom underwent surgical hernial defect correction, had friable gastric tissue and esophageal lesions that forced an urgent esophagojejunostomy. Immediate post-operative recovery had no incidents and during the outpatient follow-up no complications were reported. This case report represents a paradigm change in the impossibility of raising the vascularized pedicled jejunum to the neck in an emergency situation.

La reconstrucción del tracto digestivo es un reto quirúrgico. Proponemos una alternativa novedosa y exitosa utilizando un gran yeyuno pediculado vascularizado anastomosado al esófago cervical en situación de emergencia. Una paciente de 65 años en seguimiento por una hernia paraesofágica tipo IV requirió corrección quirúrgica del defecto herniario; tenía tejido gástrico friable y lesiones esofágicas que forzaron una esofagoyeyunostomía urgente. La recuperación posoperatoria inmediata no tuvo incidentes y el seguimiento ambulatorio no mostró complicaciones. Este reporte de caso rompe el paradigma de la imposibilidad de ascender el yeyuno pediculado vascularizado al cuello en una situación de emergencia.

Risk Factors of Metastatic Lymph Nodes in Papillary Thyroid Microcarcinoma. / Factores de riesgo de metástasis ganglionares en el microcarcinoma papilar de tiroides.

INTRODUCTION: Papillary thyroid microcarcinoma (PTMC) usually has an indolent course, but some have worse prognostic factors, such as the presence of central (6.9%-51.5%) and lateral (3%-49.6%) lymph node metastases. The aim of this study is to analyze the factors associated with PTMC with metastatic lymph nodes and its long-term prognosis. METHODS: Retrospective study whose study population consists of patients with PTMC (size ≤1cm). Patients with previous thyroid surgery, other synchronous malignancies and ectopic location of the PTMC were excluded. Two groups were compared: PTMC without metastatic lymph nodes (group 1) and PTMC with metastatic lymph nodes (group 2). A multivariate analysis using a logistic regression model and a Kaplan-Meier survival analysis with log-rank test were performed. RESULTS: Out of the 161 selected patients, 9.3% (n=15) had metastatic lymph nodes. Multifocality (OR 5.284, 95%CI 1.056-26.443; P=.043) and extrathyroidal extension (OR 7.687, 95%CI 1.405-42.050; P=.019) were associated with the presence of metastatic lymph nodes. In PTMC with metastatic lymph nodes, more aggressive treatments were performed: lymphadenectomy (4.8% vs. 100%; P<.001) and radioactive iodine (24.7% vs. 100%; P<.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 6.7%; P=.093). No patients died due to the disease. CONCLUSIONS: Multifocality and extrathyroidal extension of PTMC were associated with the presence of metastatic lymph nodes. Metastatic PTMC, with more aggressive treatments, presents an excellent long-term prognosis.

Incidental versus clinical diagnosis of papillary thyroid microcarcinoma. Long-term prognosis. / Diagnóstico incidental versus clínico del microcarcinoma papilar de tiroides. Pronóstico a largo plazo.

INTRODUCTION: The incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent years, especially in patients operated on for presumably benign thyroid disease. The aim of this study was to analyze the differences between PTMC incidentally diagnosed and PTMC clinically diagnosed, as well as its long-term prognosis. MATERIAL AND METHODS: The study population consisted of patients with a histological diagnosis of PTMC. Patients with previous thyroid surgery, other synchronous thyroid or extrathyroid malignancies and an ectopic location of PTMC were excluded. Two groups were compared: patients with PTMC incidentally diagnosed (group 1) and patients with PTMC clinically diagnosed (group 2). A multivariate analysis of differentiating factors was performed. RESULTS: PTMC clinically diagnosed had a high frequency of hypothyroidism (4.6% vs. 18.9%; P=.004), extrathyroidal extension (5.7% vs. 17.6%; P=.018), metastatic lymph nodes (1.1% vs. 18.9%; P<.001) and lymphocytic thyroiditis (5.7% vs. 27%; P<.001). In the multivariate analysis, metastatic lymph nodes (OR: 22.011, IC 95%: 2.621-184.829; P=.004) and lymphocytic thyroiditis (OR: 4.949; IC 95%: 1.602-15.288; P=.005) were associated with the clinical diagnosis of PTMC. During a mean follow-up of 119.8±65.1 months, one recurrence was detected in group 2 (0% vs. 1,4%; P=.460). No patient died due to the disease. CONCLUSIONS: PTMC clinically diagnosed, although it has more aggressive histopathological characteristics (extrathyroidal extension and metastatic lymph nodes), presents a long-term prognosis similar to the PTMC incidentally diagnosed. The presence of metastatic lymph nodes and lymphocytic thyroiditis were independent factors associated with PTMC clinically diagnosed.