Molecular Evolution of RAMOSA1 (RA1) in Land Plants.

RAMOSA1 (RA1) is a Cys2-His2-type (C2H2) zinc finger transcription factor that controls plant meristem fate and identity and has played an important role in maize domestication. Despite its importance, the origin of RA1 is unknown, and the evolution in plants is only partially understood. In this paper, we present a well-resolved phylogeny based on 73 amino acid sequences from 48 embryophyte species. The recovered tree topology indicates that, during grass evolution, RA1 arose from two consecutive SUPERMAN duplications, resulting in three distinct grass sequence lineages: RA1-like A, RA1-like B, and RA1; however, most of these copies have unknown functions. Our findings indicate that RA1 and RA1-like play roles in the nucleus despite lacking a traditional nuclear localization signal. Here, we report that copies diversified their coding region and, with it, their protein structure, suggesting different patterns of DNA binding and protein-protein interaction. In addition, each of the retained copies diversified regulatory elements along their promoter regions, indicating differences in their upstream regulation. Taken together, the evidence indicates that the RA1 and RA1-like gene families in grasses underwent subfunctionalization and neofunctionalization enabled by gene duplication.

Milk fatty acid profile from grass feeding strategies on 2 Holstein genotypes: Implications for health and technological properties.

The objective of the study was to determine if a feeding system with a variable supply of grass promoted rapid changes in the fatty acid profile and technological and health indices of milk obtained from North American (NAHF) and New Zealand (NZHF) Holstein-Friesian cows. Two feeding strategies were conducted: fixed grass (GFix) and maximized grass intake when available (GMax). The results showed that as the grass intake increased in the GMax treatments, the relative amount of palmitic acid in milk decreased, whereas oleic, linoleic, linolenic, and conjugated linoleic acids increased, causing a reduction in the atherogenic, thrombogenic, and spreadability calculated indices. The changes occurred in rapid response to the changing diet, with reductions ranging from approximately 5 to 15% in the healthy and technological indices within a period of 15 d of grass intake increase. Differences were found between the 2 genotypes, with NZHF responding faster to changes in grass intake.

Changes in antibody binding and functionality after humanizing a murine scFv anti-IFN-α2: From in silico studies to experimental analysis.

The structural and dynamic changes introduced during antibody humanization continue to be a topic open to new contributions. For this reason, the study of structural and functional changes of a murine scFv (mu.scFv) anti-rhIFN-α2b after humanization was carried out. As it was shown by long molecular dynamics simulations and circular dichroism analysis, changes in primary sequence affected the tertiary structure of the humanized scFv (hz.scFv): the position of the variable domain of light chain (VL) respective to the variable domain of heavy chain (VH) in each scFv molecule was different. This change mainly impacted on conformation and dynamics of the complementarity-determining region 3 of VH (CDR-H3) which led to changes in the specificity and affinity of humanized scFv (hz.scFv). These observations agree with experimental results that showed a decrease in the antigen-binding strength of hz.scFv, and different capacities of these molecules to neutralize the in vitro rhIFN-α2b biological activity. Besides, experimental studies to characterize antigen-antibody binding showed that mu.scFv and hz.scFv bind to the same antigen area and recognize a conformational epitope, which is evidence of docking results. Finally, the differences between these molecules to neutralize the in vitro rhIFN-α2b biological activity were described as a consequence of the blockade of certain functionally relevant amino acids of the cytokine, after scFv binding. All these observations confirmed that humanization affected the affinity and specificity of hz.scFv and pointed out that two specific changes in the frameworks would be responsible.

Interplay between psychosocial and heart failure related factors may partially explain limitations in self-efficacy in patients with heart failure: Insights from a real-world cohort of 1,123 patients.

BACKGROUND AND AIMS: Worse self-care is associated with a higher risk of readmission and mortality in patients with heart failure (HF). Little is known about how the interplay between clinical and psycho-social factors may modulate self-care behaviours in these patients. The aim of our study was to identify clinical, and particularly psycho-social factors associated with worse self-care and assess their interaction inpatients with heart failure. METHODS AND RESULTS: We conducted an observational, prospective, cohort study of 1,123 consecutive patients with chronic heart failure. Self-care was assessed with the modified European Heart Failure Self-care Behavior Scale 9-item version (EHFSCBS-9), and both clinical and psycho-social profile of the patients included were also meticulously evaluated. A total of 484 patients (43%) were women, mean age was 72 years, and mean left ventricular ejection fraction was 44.5%. In multivariable analyses combining clinical and psycho-social factors, low social support (OR 3.53, 95% CI [2.13-5.86]; p-value <0.001), absence of caregiver support (OR 2.16, 95% CI [1.34 -3.48]; p-value 0.001) and depressive symptoms (OR 2.40, 95% CI [1.53-3.77]; p-value <0.001) were independent determinants of impaired global self-care. Advanced functional class was associated with better self-care (OR 0.43, 95%CI [0.26-0.70]; p-value 0.001). No other clinical factors remained significantly associated with self-care in these joint models. In discrimination analyses, models containing psycho-social determinants outperformed models only containing heart failure -related (clinical) variables (all p-values<0.001). CONCLUSION: Impairment in self-care behaviour is strongly determined by psycho-social factors. Specifically, low social support, the lack of caregiver support and the presence of depressive symptoms are the main drivers of the risk of impairment of self-care in heart failure patients. Evaluation of self-care and self-care interventions should be complemented by a comprehensive psycho-social assessment in patients with heart failure. ABBREVIATIONS: DAMOCLES, Definition of the neuro-hormonal Activation, Myocardial function, genOmic expressionand CLinical outcomes in hEart failure patients; NYHA, New York Heart Failure Association; GAM, Generalized Additive Model; BMI, Body Mass Index; GDS, GeriatricDepression Scale.

Neurohormonal activation induces intracellular iron deficiency and mitochondrial dysfunction in cardiac cells.

BACKGROUND: Iron deficiency (ID) is common in patients with heart failure (HF) and is associated with poor outcomes, yet its role in the pathophysiology of HF is not well-defined. We sought to determine the consequences of HF neurohormonal activation in iron homeostasis and mitochondrial function in cardiac cells. METHODS: HF was induced in C57BL/6 mice by using isoproterenol osmotic pumps and embryonic rat heart-derived H9c2 cells were subsequently challenged with Angiotensin II and/or Norepinephrine. The expression of several genes and proteins related to intracellular iron metabolism were assessed by Real time-PCR and immunoblotting, respectively. The intracellular iron levels were also determined. Mitochondrial function was analyzed by studying the mitochondrial membrane potential, the accumulation of radical oxygen species (ROS) and the adenosine triphosphate (ATP) production. RESULTS: Hearts from isoproterenol-stimulated mice showed a decreased in both mRNA and protein levels of iron regulatory proteins, transferrin receptor 1, ferroportin 1 and hepcidin compared to control mice. Furthermore, mitoferrin 2 and mitochondrial ferritin were also downregulated in the hearts from HF mice. Similar data regarding these key iron regulatory molecules were found in the H9c2 cells challenged with neurohormonal stimuli. Accordingly, a depletion of intracellular iron levels was found in the stimulated cells compared to non-stimulated cells, as well as in the hearts from the isoproterenol-induced HF mice. Finally, neurohormonal activation impaired mitochondrial function as indicated by the accumulation of ROS, the impaired mitochondrial membrane potential and the decrease in the ATP levels in the cardiac cells. CONCLUSIONS: HF characteristic neurohormonal activation induced changes in the regulation of key molecules involved in iron homeostasis, reduced intracellular iron levels and impaired mitochondrial function. The current results suggest that iron could be involved in the pathophysiology of HF.

Antimyotoxic Activity of Synthetic Peptides Derived from Bothrops atrox Snake Gamma Phospholipase A2 Inhibitor Selected by Virtual Screening.

BACKGROUND: Several studies have aimed to identify molecules that inhibit the toxic actions of snake venom phospholipases A2 (PLA2s). Studies carried out with PLA2 inhibitors (PLIs) have been shown to be efficient in this assignment. OBJECTIVE: This work aimed to analyze the interaction of peptides derived from Bothrops atrox PLIγ (atPLIγ) with a PLA2 and to evaluate the ability of these peptides to reduce phospholipase and myotoxic activities. METHODS: Peptides were subjected to molecular docking with a homologous Lys49 PLA2 from B. atrox venom modeled by homology. Phospholipase activity neutralization assay was performed with BthTX-II and different ratios of the peptides. A catalytically active and an inactive PLA2 were purified from the B. atrox venom and used together in the in vitro myotoxic activity neutralization experiments with the peptides. RESULTS: The peptides interacted with amino acids near the PLA2 hydrophobic channel and the loop that would be bound to calcium in Asp49 PLA2. They were able to reduce phospholipase activity and peptides DFCHNV and ATHEE reached the highest reduction levels, being these two peptides the best that also interacted in the in silico experiments. The peptides reduced the myotubes cell damage with a highlight for the DFCHNV peptide, which reduced by about 65%. It has been suggested that myotoxic activity reduction is related to the sites occupied in the PLA2 structure, which could corroborate the results observed in molecular docking. CONCLUSION: This study should contribute to the investigation of the potential of PLIs to inhibit the toxic effects of PLA2s.

Safety and Therapeutic Profile of a GnRH-Based Vaccine Candidate Directed to Prostate Cancer. A 10-Year Follow-Up of Patients Vaccinated With Heberprovac.

Heberprovac is a GnRH based vaccine candidate containing 2.4 mg of the GnRHm1-TT peptide as the main active principle; 245 µg of the very small size proteoliposomes adjuvant (VSSP); and 350 µL of Montanide ISA 51 VG oil adjuvant. The aim of this study was to assess the safety and tolerance of the Heberprovac in advanced prostate cancer patients as well as its capacity to induce anti-GnRH antibodies, the subsequent effects on serum levels of testosterone and PSA and the patient overall survival. The study included eight patients with histologically-proven advanced prostate cancer with indication for hormonal therapy, who received seven intramuscular immunizations with Heberprovac within 18 weeks. Anti-GnRH antibody titers, testosterone and PSA levels, as well as clinical parameters were recorded and evaluated. The vaccine was well tolerated. Significant reductions in serum levels of testosterone and PSA were seen after four immunizations. Castrate levels of testosterone were observed in all patients at the end of the immunization schedule, which remained at the lowest level for at least 20 months. In a 10-year follow-up three out of six patients who completed the entire trial survived. In contrast only one out eight patients survived in the same period in a matched randomly selected group receiving standard anti-hormonal treatment. Heberprovac vaccination showed a good security profile, as well as immunological, biochemical and, most importantly, clinical benefit. The vaccinated group displayed survival advantage compared with the reference group that received standard treatment. These results warrant further clinical trials with Heberprovac involving a larger cohort.

An unusual cysteine VL87 affects the antibody fragment conformations without interfering with the disulfide bond formation.

The Cys residues are almost perfectly conserved in all antibodies. They contribute significantly to the antibody fragment stability. The relevance of two natural contiguous Cys residues of an anti-recombinant human-follicle stimulation hormone (rhFSH) in a format of single-chain variable fragment (scFv) was studied. This scFv contains 5 Cys residues: VH22 and VH92 in the variable heavy chain (VH) and VL23, VL87 and VL88 in the variable light chain (VL). The influence of two unusual contiguous Cys at positions VL87 and VL88 was studied by considering the wild type fragment and mutant variants: VL-C88S, VL-C87S, VL-C87Y. The analysis was carried out using antigen-binding ability measurement by indirect specific ELISA and a detailed molecular modeling that comprises homology methods, long molecular dynamics simulations and docking. We found that VL-C87 affected the antibody fragment stability without interfering with the disulfide bond formation. The effect of mutating the VL-C87 by a usual residue at this position like Tyr caused distant structural changes at the VH region that confers a higher mobility to the VH-CDR2 and VH-CDR3 loops improving the scFv binding to the antigen.

The Mexican consensus on probiotics in gastroenterology. / Consenso mexicano sobre probióticos en gastroenterología.

INTRODUCTION: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS: Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS: Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.

Rational design of nitrofuran derivatives: Synthesis and valuation as inhibitors of Trypanosoma cruzi trypanothione reductase.

The rational design and synthesis of a series of 5-nitro-2-furoic acid analogues are presented. The trypanocidal activity against epimastigote forms of Trypanosoma cruzi and the toxic effects on human HeLa cells were tested. Between all synthetic compounds, three of thirteen had an IC50 value in the range of Nfx, but compound 13 exhibited an improved effect with an IC50 of 1.0 ± 0.1 µM and a selective index of 70 in its toxicity against HeLa cells. We analyzed the activity of compounds 8, 12 and 13 to interfere in the central redox metabolic pathway in trypanosomatids, which is dependent of reduced trypanothione as the major pivotal thiol. The three compounds behaved as better inhibitors of trypanothione reductase than Nfx (Ki values of 118 µM, 61 µM and 68 µM for 8, 12 and 13, respectively, compared with 245 µM for Nfx), all following an uncompetitive enzyme inhibition pattern. Docking analysis predicted a binding of inhibitors to the enzyme-substrate complex with binding energy calculated in-silico that supports such molecular interaction.

First Steps in the Aggregation Process of Copolymers Based on Thymine Monomers: Characterization by Molecular Dynamics Simulations and Atomic Force Microscopy.

Atomistic molecular dynamic simulations were performed to study the structure of isolated VBT-VBA (vinylbenzylthymine-vinylbenzyltriethylammonium chloride) copolymer chains in water at different monomeric species ratios (1:1 and 1:4). The geometric parameters of the structure that the copolymers form in equilibrium together with the basic interactions that stabilize them were determined. Atomic force microscopy (AFM) measurements of dried diluted concentrations of the two copolymers onto highly oriented pyrolytic graphite (HOPG) substrates were carried out to study their aggregation arrangement. The experiments show that both copolymers arrange in fiber-like structures. Comparing the diameters predicted by the simulation results and those obtained by AFM, it can be concluded that individual copolymers arrange in bunches of two chains, stabilized by contra-ions-copolymer interactions for the 1:1 copolymerization ratio at the ionic strength of our samples. In contrast, for the 1:4 system the individual copolymer chains do not aggregate in bunches. These results remark the relevance of the copolymerization ratio and ionic strength of the solvent in the mesoscopic structure of these materials.

Evaluación de 10 años del primer programa institucional de uso racional de antibióticos en Gipuzkoa: 1999-2009 / Assessment of the first 10 years institutional programme on rational use of antibiotics in Gipuzkoa: 1999-2009

En 1999 el COF de Gipuzkoa puso en marcha un programa institucional con el objetivo de promover el uso racional de antibióticos, conocer la situación de la demanda y dispensación de antibióticos con y sin receta en las farmacias de Gipuzkoa y reforzar la actuación profesional del farmacéutico. En este estudio se presenta la evaluación de los resultados de 10 años de duración del programa. Método: Se diseñó un protocolo de actuación y un procedimiento de recogida de datos en la farmacia, para su posterior evaluación, siendo la participación voluntaria. Resultados: Se presentan los datos obtenidos en 3 puntos de corte, al inicio del programa (1999), a los cinco y a los 10 años del inicio (2009). El número de farmacias participantes disminuyó desde 152 (54,7%) a 86 (30,6%), con una media de 280 farmacias existentes en la provincia. El número de solicitudes de antibióticos sin receta disminuyó de un 13,6% a un 1,5% respecto a la solicitud total de antibióticos, con o sin receta. En cuanto a la dispensación de antibióticos sin receta se pasó de un 68,9% al 39,2% respecto a los solicitados sin receta. Sobre la demanda total de antibióticos, con o sin receta, se pasó del 9,8% al 0,6%. Conclusiones: Durante los 10 años de duración del I Programa institucional de uso racional de antibióticos en Gipuzkoa, se disminuyó tanto la solicitud de antibióticos sin receta, como la dispensación de los mismos sin receta. Este tipo de Programas contribuyen a mejorar el uso prudente de antibióticos

In 1999, Gipuzkoa Professional Association of Pharmacists set up an institutional programme with the following objectives: to promote the rational use of antibiotics; to know the situation of both: the demand and the dispensing of antibiotics, with and without prescription in Gipuzkoa pharmacies and to reinforce the professional role of the pharmacist. This study includes the evaluation of the results of the 10-year programme. Methods: A protocol of action and a data collection procedure in pharmacies were developed. The participation in the programme was voluntary. Results: Data obtained were presented with three different cut-off points: the beginning of the programme (1999), within five years of the beginning and within 10 years (2009). The number of pharmacies decreased from 152 (54.7%) to 86 (30.6%), with an average of 280 chemist’s shops in the province. The number of demands for antibiotics without prescription decreased from 13.6% to 1.5% in relation with the total amount of antibiotics demands, with and without prescription. The dispense of antibiotics without prescription went from 68.9% to 39.2% in relation with the antibiotics demanded without prescription. With respect to the total demand of antibiotics, it went from 9.8% to 0.6%. Conclusions: Both, the demand of antibiotics without prescription and their corresponding dispense were reduced during the 10-year institutional programme on rational use of antibiotics held in Gipuzkoa. This kind of programmes contributes to a better and more rational use of antibiotics

Structural properties of CHAPS micelles, studied by molecular dynamics simulations.

Detergents are essential tools to study biological membranes, and they are frequently used to solubilize lipids and integral membrane proteins. Particularly the nondenaturing zwitterionic detergent usually named CHAPS was designed for membrane biochemistry and integrates the characteristics of the sulfobetaine-type detergents and bile salts. Despite the available experimental data little is known about the molecular structure of its micelles. In this work, molecular dynamics simulations were performed to study the aggregation in micelles of several numbers of CHAPS (≤ 18) starting from a homogeneous water dilution. The force field parameters to describe the interactions of the molecule were developed and validated. After 50 ns of simulation almost all the systems result in the formation of stable micelles. The molecular shape (gyration radii, volume, surface) and the molecular structure (RDF, salt bridges, H-bonds, SAS) of the micelles were characterized. It was found that the main interactions that lead to the stability of the micelles are the electrostatic ones among the polar groups of the tails and the OH's from the ring moiety. Unlike micelles of other compounds, CHAPS show a grainlike heterogeneity with hydrophobic micropockets. The results are in complete agreement with the available experimental information from NMR, TEM, and SAXS studies, allowing the modeling of the molecular structure of CHAPS micelles. Finally, we hope that the new force field parameters for this detergent will be a significant contribution to the knowledge of such an interesting molecule.

Enhancing functional electrical stimulation for emerging rehabilitation robotics in the framework of HYPER project.

This paper presents the development of a novel functional electrical stimulation (FES) system. New approaches in emerging rehabilitation robotics propose the use of residual muscular activity or limbs movements during the rehabilitation process of neuromotor. More ambitious projects propose the use of FES systems to restore or compensate motor capabilities by controlling existing muscles or subject limbs. These emerging approaches require more sophisticated FES devices in terms of channels, signals controls and portability. In the framework of HYPER project, such devices are being developed to support the main objective of the project: the development of neurorobots and neuroprosthetics to restore functional motor capabilities in patients who suffered cerebrovascular accidents or spinal cord injury. The presented portable FES system includes novel elec-trostimulator circuits and improved channel switching capacities to enable emerging approaches in rehabilitation robotics.

Índice de esfuerzo del cuidador: test diagnóstico de sobrecarga en cuidadores de enfermos con demencia / Caregiver strain index: diagnostic test of burden in caregivers of dementia patients

INTRODUCCIÓN. Los cuidadores principales de enfermos con deterioro cognitivo han de soportar un sobreesfuerzo que conviene estudiar para gestionar adecuadamente su manejo. Su diagnóstico se ha efectuado en algunos medios con diferentes escalas que convendría valorar. Este estudio pretende evaluar la validez de la versión en castellano del Caregiver Strain Index (índice de esfuerzo del cuidador), en referencia a la Zarit Burden Interview, para detectar sobrecarga en cuidadores de familiares con demencia en nuestro medio. MATERIAL Y MÉTODOS. Estudio de validación de pruebas diagnósticas en 6 Centros de Salud en Guipúzcoa con 32 cuidadores principales. Se aplicó la escala Zarit Burden Interview traducida y adaptada y el Índice de Esfuerzo del Cuidador para calcular posteriormente la sensibilidad, la especificidad, el cociente de probabilidad positivo y la curva ROC. RESULTADOS. Se entrevistó a un total de 24 mujeres y 8 hombres con edades comprendidas entre los 27 y 85 años. La relación de parentesco con el enfermo fue principalmente hijos y esposos. La media de tiempo de cuidado fue 16,6 horas al día (DE 7,5). La prevalencia de sobrecarga en la muestra fue de 21,9% (IC 95%: 9,3-40%). Ambas pruebas presentan una buena correlación (r = 0,77; p < 0,001). La escala IEC presenta una sensibilidad del 100% (IC 95%: 59-100%), una especificidad del 72% (IC 95%: 50,6-88%) y un coeficiente de probabilidad (CPP) de 2,63. Si el punto de corte para el diagnóstico fuese 38 obtendría una sensibilidad (S) del 100% (IC 95%: 59,0-100), especificidad (E) de 84% (IC 95%: 63,9-95,5) y un CPP de 6,25. CONCLUSIÓN. La escala del índice de esfuerzo del cuidador es válida y útil en Atención Primaria para detectar la sobrecarga en cuidadores de enfermos con deterioro cognitivo (AU)

INTRODUCTION: The principal caregivers of patientswith cognitive deterioration have to support an excess strainthat should be described in order to adequately handle itsmanagement. Its diagnosis has been made in some settingswith different scales that should be evaluated. This studyaims to evaluate the validity of the version of the CaregiverStrain Index in Spanish in reference to the Zarit Burden Interviewto detect burden in caregivers of family memberswith dementia in our setting.MATERIAL AND METHODS: Validation study of diagnostictests in 6 Health Care Sites of the Gipuzkoa providenceof the Basque Country in Spain with 32 principal caregivers.The Zarit Burden Interview scale that had beentranslated and adapted and the Caregiver Strain Index wereapplied to calculate sensitivity, specificity, positive likelihoodratio and the ROC curve.RESULTS: A total of 24 women and 8 men between theages of 27 and 85 years were interviewed. The family relationshipwith the patient was mainly children and spouses.The mean time of care was 16.6 h/day (SD: 7.5). Burden prevalencein the sample was 21.9% (95% CI: 9.3%-40%). Bothtests had a good correlation (r = 0.77; p < 0.001). The CSIscale had a sensitivity of 100% (95% CI: 59%-100%), specificityof 72% (95% CI: 50.6%-88%), PLR of 2.63. If the cutofffor the diagnosis was 38, a S of 100% (95% CI: 59.0-100),Sp of 84% (95% CI: 63.9-95.5) and PLC of 6.25 would be obtained (AU)

[Preoperative oral information prior to planned thyroid surgery: the surgeon, physician, lawyer and judge's point of view]. / Information orale et chirurgie programmée pour pathologie tumorale bénigne de la glande thyroïde: le point de vue du chirurgien, du médecin, de l'avocat, et du magistrat.

OBJECTIVE: Analysis of the consequence of the preoperative information delivered orally to patients requiring surgery for benign pathology of the thyroid gland from various perspective (head and neck surgeon, physician, judge, lawyer). METHODS: Prospective study conducted in an academic tertiary care referral center. Inception cohort of 123 patients with benign pathology of the thyroid gland consecutively informed orally and by the same surgeon during the years 2003-2004. Analysis of the consequences of the preoperative information, degree of memorization regarding the surgical related risks as well as the patient's opinion regarding this information. RESULTS: Due to the information regarding the risks related to surgery 14.6% of patients refused to undergo surgery. None of the patients remembered more than 4 out of the 6 main surgical risks. 68.8% of patients remembered only one or two surgical related risks. 12.2% of patients did not remember a single surgical related risk, 85.5% of patients remembered the risk of a unilateral laryngeal nerve paralysis, 41.1% the risk of death related to the completion of a general anesthesia and 21.1% the risk of a bilateral laryngeal nerve paralysis. Less than 11% of patients remembered the other risks (general risks related to any open field surgical approach, hypocalcemia and loss of breast feeding) Among the patients who had an opinion postoperatively, 87.6% had a positive opinion and 41.9% a negative opinion regarding the preoperative information related to the surgical related risks. Also, 28.4% of patients expressed simultaneously a positive and a negative opinion. CONCLUSION: Oral information of the patient regarding the surgical risks resulted in an important stress for the patient and modified the relation patient-surgeon. Due to the information, a non-neglectable group of patients elicited not to follow the advice of the surgeon. Various measures are discussed since the information on the surgical related risks is a must from a legal point of view but is also highly appreciated and requested by most of the patients.