A problem-based learning experience in a radiology rotation for sixth-year medical students.

OBJECTIVE: To analyse a problem-based learning experience (PBL) in the sixth year of medicine, within a course organised in successive rotations of 12 school days for 7 annual groups. MATERIAL AND METHODS: Each group was divided into subgroups of 6-8 students. Each subgroup was assigned two cases with radiographic images that they had to prepare and present in a joint session in which the students discussed each case and the teacher acted as moderator, without providing solutions. Finally, they had 15 days to complete the debate in an online forum and prepare a written report on each case. RESULTS: During 6 consecutive years, 1001 students participated, whose annual grades ranged between 7.7 ±â€¯1.6 and 9.0 ±â€¯0.7 (mean ±â€¯standard deviation). No correlation was found between the degree of difficulty assigned to the cases and the mean score obtained by each group (R2 = 0.0115). Sixty-six point two percent completed a questionnaire rating various aspects of this experience above 4 out of 5 points and providing overall scores above 8.3 out of 10 points in the different years. The students found this experience appropriate to the objectives of the subject and useful for their educational needs. CONCLUSIONS: PBL allows students to acquire skills of understanding, reasoning and deepening in radiological diagnosis. This study demonstrates that an experience based on PBL can be included in a radiology course organised in a traditional way, allowing students to be graded regardless of the difficulty of the cases.

Comparison of sediment bioavailable methods to assess the potential risk of metal(loid)s for river ecosystems.

A heavily impacted river basin (Caudal River, NW Spain) by Hg and Cu mining activities, abandoned decades ago, was used to evaluate the environmental quality of their river sediments. The obtained results compared with reference values established by the US EPA and the Canadian Council of Ministers of the Environment for river sediments, have shown that the main elements of environmental concern are arsenic (As), mercury (Hg) and, to a lesser extent, copper (Cu), which reach concentrations up to 1080, 80 and 54 mg kg-1, respectively. To understand the role that river sediments play in terms of risk to ecosystem health, a comparison has been made between the total content of metal(oid)s in the sediments and the bioavailable contents of the same elements in pore water, passive DGT (Diffusive Gradients in Thin films) samplers and the sediment extractant using acetic acid. A good correlation between the As and Cu contents in the DGTs and the pore water was found, resulting in a transfer from the pore water to the DGT of at least 47 % of the Cu and more than 75 % of the As when the concentrations were low, with a deployment time of 4 days. When As and Cu concentrations were higher, their transfer was not so high (above 23.6 % for As and 19.3 % for Cu). The transfer of Hg from the pore water to the DGT was practically nil and does not seem to depend on the content of this metal. The fraction extracted with acetic acid, conventionally accepted as bioavailable, was clearly lower than that captured by DGTs for As and Cu (≤5 % and ≤8.5 % of the total amount, respectively), while it was similar for Hg (0.2 %).

Cytogenomic characterization of small supernumerary marker chromosomes in patients with pigmentary mosaicism.

Introduction: The combination of gene content on the marker chromosome, chromosomal origin, level of mosaicism, origin mechanism (chromothripsis), and uniparental disomy can influence the final characterization of sSMCs. Several chromosomal aberrations, including sSMCs, have been observed in 30%-60% of patients with pigmentary mosaicism, and in more than 80%, chromosomal abnormalities are present in the mosaic state. In patients with pigmentary mosaicism the most representative chromosomes involved in sSMCs are 3, 5, 6, 9, 10, 13, 15, 18, 20, and X. In this study, we included the complete clinical, cytogenetic, and molecular characterization of seven patients with pigmentary mosaicism associated with the presence of SMCs of different chromosomal origins. Methods: The patients were diagnosed by the Genetics and Dermatology Department of three different hospitals. Cytogenetic and FISH analyses were performed on peripheral blood, light skin, and dark skin. FISH analysis was performed using different probes, depending on the marker chromosome description. Different array analysis was performed. Results: To date, of the seven cases studied, the chromosomal origins of six were successfully identified by FISH or array analysis. The chromosomes involved in SMCs were 6, 9, 15, and 18, X. The most frequently found was the centric minute structure. Discussion: To date, this group of seven patients constitutes the largest clinical and cytogenetically finely described study of cases with pigmentary mosaicism associated with sSMCs. Undoubtedly, analysis of the two skin types is a fundamental part of our study, as numerical differences may occur in the cell lines found in each skin type. The knowledge generated in this study will help delineate a very heterogeneous entity more accurately, and in the future, analyzing more patients with PM will likely establish a more definite association with the presence of this genetic alteration.

[Early source control of infection in patients seen in the emergency department: a systematic review]. / Control precoz del foco de infección en los pacientes atendidos en el servicio de urgencias: una revisión sistemática.

OBJECTIVE: The term source (or focus) control encompasses all those physical measures that can be used to reduce the inoculum and modify those factors in the infectious medium that promote microbial growth or foreign antimicrobial defenses of the host. The main objective of this systematic review (SR) is to know and compare whether early detection and control of the focus (in less than 6 hours) in adult patients treated in the ED for severe infection or sepsis, compared to not controlling the focus or delayed focus control (more than 12 hours) is more effective and safer (improves clinical evolution, mortality, complications, hospital stay or need for ICU admission). METHODS: A systematic review is carried out following the PRISMA regulations in the databases of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2000 to December 31, 2023 without language restrictions and using a combination of MESH terms: "Source Control", "Early" "Infection OR Bacterial Infection OR Sepsis", "Emergencies OR Emergency OR Emergency Department" and "Adults". Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively. RESULTS: A total of 1,658 articles were identified, of which 2 that met the inclusion criteria and were classified as high quality were finally analyzed. The included studies represent a total of 2,404 patients with 678 cases in which an intervention was performed to control the focus (28.20%). In the first study, 28-day mortality was lower in patients who underwent an intervention to control the focus (12.3% vs. 22.5%; P <0.001), with an adjusted HR of 0.538 (95% CI: 0.389-0.744; P<0.001). In the second, it was demonstrated that the time elapsed from when the patient was evaluated for the first time and was hemodynamically stabilized, until the start of surgery was associated with his survival at 60 days with an OR of 0.31 (95% CI: 0.19-0.45; P <0.0001). In fact, for each hour of delay an adjusted OR of 0.29 (95% CI: 0.16-0.47; P<0.0001) is established. So if the intervention is performed before 2 hours at 60 days, 98% of the patients are still alive, if it is performed between 2-4 hours it is reduced to 78%, if it is between 4-6 hours it drops to 55%, but if it is done for more than 6 hours there will be no survivors at 60 days. CONCLUSIONS: This review shows that source control carried out after the evaluation of patients attending the ED reduces short-term mortality (30-60 days) and that it would be advisable to implement any required source control intervention as soon as possible, ideally early (within 6 hours).

Prophylactic treatment with the c-Abl inhibitor, neurotinib, diminishes neuronal damage and the convulsive state in pilocarpine-induced mice.

The molecular mechanisms underlying seizure generation remain elusive, yet they are crucial for developing effective treatments for epilepsy. The current study shows that inhibiting c-Abl tyrosine kinase prevents apoptosis, reduces dendritic spine loss, and maintains N-methyl-d-aspartate (NMDA) receptor subunit 2B (NR2B) phosphorylated in in vitro models of excitotoxicity. Pilocarpine-induced status epilepticus (SE) in mice promotes c-Abl phosphorylation, and disrupting c-Abl activity leads to fewer seizures, increases latency toward SE, and improved animal survival. Currently, clinically used c-Abl inhibitors are non-selective and have poor brain penetration. The allosteric c-Abl inhibitor, neurotinib, used here has favorable potency, selectivity, pharmacokinetics, and vastly improved brain penetration. Neurotinib-administered mice have fewer seizures and improved survival following pilocarpine-SE induction. Our findings reveal c-Abl kinase activation as a key factor in ictogenesis and highlight the impact of its inhibition in preventing the insurgence of epileptic-like seizures in rodents and humans.

Identifying American climate change free riders and motivating sustainable behavior.

Free riders, who benefit from collective efforts to mitigate climate change but do not actively contribute, play a key role in shaping behavioral climate action. Using a sample of 2096 registered American voters, we explore the discrepancy between two groups of free riders: cynics, who recognize the significance of environmental issues but do not adopt sustainable behaviors, and doubters, who neither recognize the significance nor engage in such actions. Through statistical analyses, we show these two groups are different. Doubters are predominantly male, younger, with lower income and education, exhibit stronger conspiracy beliefs, lower altruism, and limited environmental knowledge, are more likely to have voted for Trump and lean towards conservative ideology. Cynics are younger, religious, higher in socioeconomic status, environmentally informed, liberal-leaning, and less likely to support Trump. Our research provides insights on who could be most effectively persuaded to make climate-sensitive lifestyle changes and provides recommendations to prompt involvement in individual sustainability behaviors. Our findings suggest that for doubters, incentivizing sustainability through positive incentives, such as financial rewards, may be particularly effective. Conversely, for cynics, we argue that engaging them in more community-driven and social influence initiatives could effectively translate their passive beliefs into active participation.

Biomarkers of Bipolar Disorder in Late Life: An Evidence-Based Systematic Review.

PURPOSE OF REVIEW: Review the current evidence on biomarkers for bipolar disorder in the older adults. We conducted a systematic search of PubMed MEDLINE, PsycINFO, and Web of Science databases using the MeSH search terms "Biomarkers", "Bipolar Disorder", "Aged" and and "Aged, 80 and over". Studies were included if they met the following criteria: (1) the mean age of the study population was 50 years old or older, (2) the study included patients with bipolar disorder, and (3) the study examined one type of biomarkers or more including genetic, neuroimaging, and biochemical biomarkers. Reviews, case reports, studies not in English and studies for which no full text was available were excluded. A total of 26 papers were included in the final analysis. RECENT FINDINGS: Genomic markers of bipolar disorder in older adults highlighted the implication of serotonin metabolism, while the expression of genes involved in angiogenesis was dysregulated. Peripheral blood markers were mainly related with low grade inflammation, axonal damage, endothelial dysfunction, and the dysregulation of the HPA axis. Neuroanatomical markers reflected a dysfunction of the frontal cortex, a loss of neurones in the anterior cingulate cortex and a reduction of the hippocampal volume (in patients older than 50 years old). While not necessarily limited to older adults, some of them may be useful for differential diagnosis (neurofilaments), disease staging (homocysteine, BDNF) and the monitoring of treatment outcomes (matrix metalloproteinases). Our review provides a comprehensive overview of the current evidence on biomarkers for bipolar disorder in the older adults. The identification of biomarkers may aid in the diagnosis, treatment selection, and monitoring of bipolar disorder in older adults, ultimately leading to improved outcomes for this population. Further research is needed to validate and further explore the potential clinical utility of biomarkers in this population.

Goos-Hänchen shift for coupled vibrational modes in a semiconductor structure.

We present a theoretical investigation of the Goös-Hanchen shift (GHS) experienced by acoustic and optical vibrational modes reflected and transmitted from the surfaces of a semiconductor thin film sandwiched between two semi-infinite media. Our study focuses on the impact of the incident angle on the GHS, considering the coupling between longitudinal and transverse modes. For acoustic vibrations, our findings reveal that the GHS can reach magnitudes up to seven times larger than the thickness of the thin film and up to 20 times larger than the incident wavelength. Besides, it is shown that this significant amplification of the GHS highlights the strong influence of the incident angle and the frequency of the modes involved. In the case of optical vibrations, we observe even more pronounced GHS values, exceeding 30 times the incident wavelength. This demonstrates the potential of GHS in acoustical systems, which opens up possibilities for applications in the design of acoustic devices.

Great Britain's power system with a high penetration of renewable energy: Dataset supporting future scenarios.

The share of variable renewable energy (VRE) is forecasted to increase in the energy sector to meet decarbonization targets and/or reduce their dependence on fossil fuels. The modeling of future power system scenarios is crucial to assess the role of different flexibility options, including low-carbon technologies. The data presented here support the research article "The role of energy storage in Great Britain's future power system: focus on hydrogen and biomass". These data include updated parameters, inputs, equations, biomass resource potential and biomass demand to balance bio-power and bio-hydrogen requirements. The Future Renewable Energy Performance into the Power System Model (FEPPS), a rule-based model that includes flexibility and stability constraints, has been used, and the hourly results of future scenarios by 2030 and 2040 are provided. Researchers, policymakers, and investors could use this paper as these data provide insights into the role of different technologies (including hydrogen and biomass) in power generation, system flexibility, decarbonization and costs.

Persuadable voters decided the 2022 midterm: Abortion rights and issues-based frameworks for studying election outcomes.

Leading up to the 2022 Congressional midterm elections, all predictions pointed to a Republican wave, given factors such as the incumbent president's low approval rate and a struggling national economy. Accordingly, the underwhelming performance of the Republican Party surprised many, resulting in an election that became known as the "asterisk election" due to its unusual and seemingly unpredictable outcome. This study delves into the specifics of the 2022 midterms, exploring factors that may have influenced the results beyond those traditionally considered by political scientists. Our analysis particularly seeks to understand whether a sudden shift in the public salience of specific issues could have influenced voters' preferences, leading them to consider factors they might not have otherwise. To achieve this, we analyzed data from a nationally representative sample of registered voters surveyed immediately after the midterm elections. Our findings reveal that the issue of abortion played a pivotal role during this election. The prominence of abortion was not predestined, as evidenced by a comparative analysis with data from a survey conducted after the 2020 presidential election. Indeed, it seems that the decision by the Supreme Court to overturn Roe v. Wade in June 2022 significantly increased the salience of abortion. This unexpected policy shock had a significant impact on the behavior of voters in the 2022 midterm elections.

Growth dynamics of nanocolumnar thin films deposited by magnetron sputtering at oblique angles.

The morphology of numerous nanocolumnar thin films deposited by the magnetron sputtering technique at oblique geometries and at relatively low temperatures has been analyzed for materials as different as Au, Pt, Ti, Cr, TiO2, Al, HfN, Mo, V, WO3and W. Despite similar deposition conditions, two characteristic nanostructures have been identified depending on the material: a first one defined by highly tilted and symmetric nanocolumnar structures with a relatively high film density, and a second one characterized by rather vertical and asymmetric nanocolumns, with a much lower film density. With the help of a model, the two characteristic nanostructures have been linked to different growth dynamics and, specifically, to different surface relaxation mechanisms upon the incorporation of gaseous species with kinetic energies above the surface binding energy. Moreover, in the case of Ti, a smooth structural transition between the two types of growths has been found when varying the value of the power used to maintain the plasma discharge. Based on these results, the existence of different surface relaxation mechanisms is proposed, which quantitatively explains numerous experimental results under the same conceptual framework.

A review of three decades of use of the cattle brucellosis rough vaccine Brucella abortus RB51: myths and facts.

Cattle brucellosis is a severe zoonosis of worldwide distribution caused by Brucella abortus and B. melitensis. In some countries with appropriate infrastructure, animal tagging and movement control, eradication was possible through efficient diagnosis and vaccination with B. abortus S19, usually combined with test-and-slaughter (T/S). Although S19 elicits anti-smooth lipopolysaccharide antibodies that may interfere in the differentiation of infected and vaccinated animals (DIVA), this issue is minimized using appropriate S19 vaccination protocols and irrelevant when high-prevalence makes mass vaccination necessary or when eradication requisites are not met. However, S19 has been broadly replaced by vaccine RB51 (a rifampin-resistant rough mutant) as it is widely accepted that is DIVA, safe and as protective as S19. These RB51 properties are critically reviewed here using the evidence accumulated in the last 35 years. Controlled experiments and field evidence shows that RB51 interferes in immunosorbent assays (iELISA, cELISA and others) and in complement fixation, issues accentuated by revaccinating animals previously immunized with RB51 or S19. Moreover, contacts with virulent brucellae elicit anti-smooth lipopolysaccharide antibodies in RB51 vaccinated animals. Thus, accepting that RB51 is truly DIVA results in extended diagnostic confusions and, when combined with T/S, unnecessary over-culling. Studies supporting the safety of RB51 are flawed and, on the contrary, there is solid evidence that RB51 is excreted in milk and abortifacient in pregnant animals, thus being released in abortions and vaginal fluids. These problems are accentuated by the RB51 virulence in humans, lack diagnostic serological tests detecting these infections and RB51 rifampicin resistance. In controlled experiments, protection by RB51 compares unfavorably with S19 and lasts less than four years with no evidence that RB51-revaccination bolsters immunity, and field studies reporting its usefulness are flawed. There is no evidence that RB51 protects cattle against B. melitensis, infection common when raised together with small ruminants. Finally, data acumulated during cattle brucellosis eradication in Spain shows that S19-T/S is far more efficacious than RB51-T/S, which does not differ from T/S alone. We conclude that the assumption that RB51 is DIVA, safe, and efficaceous results from the uncritical repetition of imperfectly examined evidence, and advise against its use.

Efectos de la pandemia en una consulta de tabaquismo / Effects of the pandemic on a smoking consultation

Objetivo. Análisis de las diferencias entre pacientes atendidos en la unidad hospitalaria de tabaquismo del H. Doctor Peset de Valencia, antes de la pandemia y con posterioridad, para valorar resultados obtenidos en cuanto a abstinencia tabáquica. Material y método. Estudio retrospectivo observacional analizando las mismas variables en dos periodos temporales: pacientes atendidos por primera vez durante el año previo a la pandemia (enero-diciembre 2019) y entre junio de 2021 y junio de 2022 (postpandemia). Se valoran datos demográficos, comorbilidades, dependencia, tratamiento farmacológico prescrito y éxitos obtenidos. Resultados. Diferencias en el número de pacientes atendidos con una reducción de 645 a 115. Incremento de trastornos psiquiátricos de 16,1% a 30,4%. Entre los tratamientos prescritos hay variación en vareniclina (46% a 13,9%) y en citisina (0 a 27,8%). La tasa de abstinencia a los 12 meses disminuye de 37,6% a 8,7% y el porcentaje de abstinencia entre los que completan el seguimiento pasa de 72% a 15,62%. No hay variación significativa en el resto de las variables estudiadas. Conclusión. El impacto de la pandemia en esta consulta se ha reflejado no solo en el drástico descenso del número de pacientes atendidos, sino también en un notable aumento de la comorbilidad psiquiátrica. Además, preocupa la reducción del porcentaje de pacientes que consiguen deshabituación. (AU)

Objective. Analysis of the differences between patients seen in a hospital smoking cessation unit of the H. Doctor Peset de Valencia before and after the pandemic to evaluate the results obtained regarding smoking abstinence. Material and methods. A retrospective observational study analyzing the same variables in two time periods: patients seen for the first time during the year prior to the pandemic (January-December 2019) and between June 2021 and June 2022 (post-pandemic). Demographic data, comorbidities, dependency, drug treatment prescribed and successes obtained are evaluated. Results. Differences were found in the number of patients seen, with a reduction from 645 to 115 and an increase of psychiatric disorders from 16.1% to 30.45. Among the treatments prescribed, there were variations in varenicline (46% to 13.9%) and in cytisine (0 to 27.8%). Abstinence rate at 12 months decreased from 37.6% to 8.7% and the abstinence percentage among those who completed the follow-up from 72% to 15.62%. There are no significant variations in the rest of the variables studied. Conclusion. The impact of the pandemic in this consultation has not only been reflected in the drastic decrease in the number of patients seen but also on a notable increase in psychiatric comorbidity. In addition, the reduction in the percentage of patients who achieved cessation is of concern. (AU)

Checklist of Orchidaceae from Caquetá, Colombia.

A checklist of Orchidaceae from Caquetá, Colombia is presented here. We recorded 98 genera and 418 species, exceeding a previous inventory by 276 species. The checklist is conservative in the number of genera and species by including only taxa that were fully and reliably identified and that are either linked to a corresponding herbarium voucher, a living collection specimen or a photo taken in the field and published in iNaturalist by one of the authors or a collaborator. The documented species diversity in the region could dramatically increase in the next few years with additional collecting efforts in the eastern slopes of the Andes nested in Caquetá. About 9% (418/4600) of all Orchidaceae species recorded for Colombia are reported for this area, showing the important contribution to orchid diversity of Andean-Amazonian foothills of Caquetá.

Transfer matrix in 1D Dirac-like problems.

The transfer matrix method is considered to obtain the fundamental properties of 1D Dirac-like problems. The case of 1D problems in monolayer graphene is addressed. The main characteristics of the transfer matrix are analyzed, contrasting them with the ones corresponding to 1D Schrödinger-like problems. Analytic expressions for the transmission coefficient and bound states are obtained. The continuity between bound states and states of perfect transmission is demonstrated in general, and in particular showed for the case of single electrostatic barriers. These findings in principle can be extended to 2D materials with Hamiltonian similar to monolayer graphene such as silicene and transition metal dichalcogenides.

Cognitive outcomes following functional neurosurgery in refractory OCD patients: a systematic review.

Neurosurgery is a therapeutic option for patients with refractory obsessive-compulsive disorder who do not respond to previous treatments. Although its efficacy in reducing clinical symptomatology has been proven, few studies have analyzed its effects at the cognitive level. The aim of this systematic review was to describe the cognitive outcomes of functional neurosurgery in patients that went through capsulotomies or cingulotomies. PubMed, Medline, Scopus, PsycInfo, PsyArticles, and Web of Knowledge were searched for studies reporting cognitive outcomes in refractory obsessive-compulsive patients after capsulotomies and cingulotomies. The risk of bias was assessed with the Assessment Tool for Before-After (Pre-Post) Studies With No Control Group tool; 13 studies met inclusion criteria, including 205 refractory obsessive-compulsive disorder patients for both surgical procedures. Results showed a substantial number of studies that did report significant cognitive improvement after surgery, being this improvement specially related to memory and executive functions. The second-most frequent finding is the maintenance of cognitive performance (nor improvement or worsening). From a neuropsychological point of view, this outcome might be considered a success, given that it is accompanied by amelioration of obsessive-compulsive symptoms. Subtle cognitive adverse effects have also been reported. Neurosurgery procedures appear to be safe from a cognitive point of view. Methodological issues must be improved to draw clearer conclusions, but capsulotomies and cingulotomies constitute an effective alternative treatment for refractory obsessive-compulsive disorder patients.

Mine water as a source of energy: an application in a coalfield in Laciana Valley (León, NW Spain).

Mine water can be a renewable and economical source of geothermal and hydraulic energy. Nine discharges from closed and flooded coal mines in the Laciana Valley (León, NW Spain) have been studied. Various technologies for the energy use of mine water, as well as the influence of factors such as temperature, the need for water treatment, investment, potential customers and expansion capacity, have been evaluated by means of a decision-making tool. It is concluded that the most advantageous option is an open-loop geothermal system using the waters of a mountain mine, the temperature of which exceeds 14 °C and whose distance to customers is less than 2 km. A technical-economic viability study for a district heating network designed to supply heating and hot water to six public buildings in the nearby town of Villablino is presented. The proposed use of mine water might help areas that have been greatly affected socioeconomically by the closure of the mines and has other advantages compared to conventional energy systems, such as the reduction of CO2 emissions. Graphical Abstract: It showing the advantages of using mine water as an energy source for district heating and a simplified layout. Supplementary Information: The online version contains supplementary material available at 10.1007/s10098-023-02526-y.

Profitability of Concentrated Solar-Biomass hybrid power plants: Dataset of the stochastic techno-economic assessment.

An increasing share of dispatchable renewable generation is required to achieve energy decarbonisation goals and ensure a reliable supply to power grids. Concentrating solar power (CSP) plants hybridised with biomass boilers are promising alternatives to replace part of the peaking and baseload power generated from fossil fuel-based systems. This paper includes data related to the design variables, equations, valuation parameters and detailed results that support the research article "Market profitability of CSP-Biomass hybrid power plants: Towards a firm supply of renewable energy." The profitability assessment is based on integrating the hourly variation of electricity prices in the Iberian day-ahead market (MIBEL) to the results of the techno-economic model through a novel economic metric named Profitability Factor. In addition, stochastic simulations were conducted to capture the uncertainty of relevant input variables on the profitability of the proposed hybrid plants. The resulting datasets presented in this paper will provide insights for researchers looking to address the economic performance of renewable generation concepts from a market profitability approach. Furthermore, the data can be used by investors and policymakers to better understand the risks and implications associated with the profitability potential of these systems.

Development of an immune-nutritional prognostic index in patients with muscle-infiltrating bladder cancer candidates for radical cystectomy.

INTRODUCTION: Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear. OBJECTIVE: Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1). MATERIAL AND METHODS: A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan-Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis. RESULTS: Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate-poor prognostic groups. CONCLUSION: The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT.

Radiocirugía estereotáctica con Gamma Knife como tratamiento del temblor esencial y parkinsoniano: experiencia a largo plazo / Gamma Knife stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience

Introducción: La radiocirugía estereotáctica con Gamma Knife® (GK), sobre el núcleo ventral intermedio-medial del tálamo (VIM), unilateral es una opción neuroquirúrgica mínimamente invasiva para el temblor refractario. Se describe la experiencia de talamotomía con GK (TGK) en pacientes con temblor esencial (TE) y enfermedad de Parkinson (EP) de predominio tremórico de una unidad especializada en cirugía estereotáctica.MétodosSe revisan los pacientes tratados con TGK desde enero de 2014 hasta febrero de 2018. Se analizan variables clínico-demográficas, indicación, dosis empleada, eficacia (mediante subescalas de Fahn-Tolosa-Marin (FTM) y MDS-UPDRS motora) y efectos adversos (EA).ResultadosSe registraron 13 pacientes, seis con diagnóstico de EP de predominio tremórico, cuetro con TE refractario y tres casos de TE + EP. La mediana de edad fue 78 años (62-83), con siete pacientes > 75 años. Cuatro pacientes anticoagulados y dos con antecedentes de ictus previo. La dosis máxima de radiación aplicada fue 130 Gy. La media de seguimiento fue 30,0 (14,5) meses. Se observó una mejoría significativa del temblor en las subescalas de FTM del 63,6% a 12 meses y del 63,5% al final del seguimiento y en items de temblor de MDS-UPDRS del 71,3% a 12 meses y del 60,3% al final del seguimiento. Once pacientes refirieron mejoría significativa en su calidad de vida. Tres pacientes refirieron EA leves y transitorios.ConclusionesSe presenta la mayor serie de pacientes con TE y parkinsoniano tratados con TGK en España con seguimiento a largo plazo. La TGK puede ser un tratamiento seguro y con eficacia mantenida en temblor refractario, incluso en edad avanzada o en tratamiento anticoagulante. (AU)

Introduction: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit.MethodsWe reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months’ follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events.ResultsThirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects.ConclusionsThis is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants. (AU)