Genistein supplementation has no effects on vitamin D levels in healthy Spanish postmenopausal women.

Background: In vitro studies have shown that genistein inhibits the CYP240 enzyme, which is involved in the degradation of 1,25-dihydroxycholecalciferol and its precursor 25-hydroxycholecalciferol, and increases their plasma levels. However, no clinical studies have primarily assessed the synergistic effect of isoflavones on vitamin D levels. The aim of this study was to evaluate the possible additive effect of genistein supplementation on vitamin D levels, calcium metabolism and bone remodeling markers in healthy postmenopausal women during the spring-summer months. Patients and methods: We made a prospective, double-blind study with 150 healthy postmenopausal women that were randomized to three groups. One received placebo, another received calcium (1000 mg/day) and vitamin D (cholecalciferol, 800 U/day) and the third received calcium (1000 mg/day), vitamin D (cholecalciferol, 800 U/day) and genistein (90 mg/day). The study period was from May to September (spring-summer). Vitamin D, PTH, CTX and P1NP were determined by electrochemiluminescence at baseline and after 12 weeks. Results: Vitamin D levels increased in all groups: placebo (23±9 ng/ml vs. 29±10 ng/ml, p<0.05), calcium+vitamin D (26±10 ng/ml vs. 33±8 ng/ml, p<0.05) and calcium+vitamin D+genistein (24±9 ng/ml vs. 31±8 ng/l, p<0.05) without between-group differences. At study end, the percentage of women with vitamin D <20 ng/ml (11%) and <30 ng/ml (39%) had fallen without between-group differences. The effects on calcium metabolism and bone remodeling markers were similar between groups: rises in vitamin D were significantly linked to reductions in PTH, CTX and P1NP. Conclusion: Adding genistein to supplementation with calcium and vitamin D provided not additional changes in vitamin D levels, calcium metabolism or bone remodeling markers in healthy Spanish postmenopausal women during the spring-summer months.

Acute calculous cholecystitis: a real-life management study in a tertiary teaching hospital

Aim: to describe the management of acute calculous cholecystitis in a tertiary teaching hospital and the outcomes obtained. Material and methods: a retrospective single tertiary center cohort study. Results: medical records of 487 patients were analyzed. The mean follow-up was 44.5 +/- 17.0 months. Treatment alternatives were cholecystectomy (64.3%), conservative treatment (23.0%), endoscopic retrograde cholangiopancreatography (17.4%), percutaneous cholecystostomy (10.7%) and endoscopic ultrasound-guided gallbladder drainage (0.8%). Most cholecystectomies were delayed (88.8%). Recurrences occurred in 38.2% of patients. Although cholecystectomy was the therapeutic approach with the lowest recurrence rate once performed, 44.6% of patients that underwent delayed surgery had pre-surgical recurrences. Conclusions: delayed cholecystectomy is still commonly performed, even though it is related with a high frequency of preoperative recurrences

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Acute calculous cholecystitis: a real-life management study in a tertiary teaching hospital.

AIM: to describe the management of acute calculous cholecystitis in a tertiary teaching hospital and the outcomes obtained. MATERIAL AND METHODS: a retrospective single tertiary center cohort study. RESULTS: medical records of 487 patients were analyzed. The mean follow-up was 44.5 ± 17.0 months. Treatment alternatives were cholecystectomy (64.3%), conservative treatment (23.0%), endoscopic retrograde cholangiopancreatography (17.4%), percutaneous cholecystostomy (10.7%) and endoscopic ultrasound-guided gallbladder drainage (0.8%). Most cholecystectomies were delayed (88.8%). Recurrences occurred in 38.2% of patients. Although cholecystectomy was the therapeutic approach with the lowest recurrence rate once performed, 44.6% of patients that underwent delayed surgery had pre-surgical recurrences. CONCLUSIONS: delayed cholecystectomy is still commonly performed, even though it is related with a high frequency of preoperative recurrences.

Episodios de salmonelosis no tifoidea en pacientes adultos del Área Valladolid Oeste en 2017: evaluación de la idoneidad de la petición del cultivo microbiológico y del tratamiento pautado / Episodes of nontyphoidal salmonellosis in adult patients of the Valladolid West Area in 2017: evaluation of the suitability of the microbiological culture request and the prescribed treatment

INTRODUCCIÓN: Las salmonelosis gastroenteríticas suponen aún la segunda causa diagnosticada de diarrea infecciosa en nuestro medio, la mayoría de estos cuadros clínicos son leves y autolimitados y por eso el uso de antibióticos está circunscrito a pocos supuestos. El objetivo del trabajo fue describir los episodios de diarrea por Salmonella enterica subsp. enterica, valorando la idoneidad de la petición y del uso de antibióticos de acuerdo a los criterios que figuran en la metodología. MATERIAL Y MÉTODOS: Se realizó un estudio observacional descriptivo retrospectivo recabando datos de la historia clínica. RESULTADOS: Se incluyeron 122 episodios. El motivo guía de consulta fue la diarrea, que generó una mayor demanda en los Servicios de Urgencia Hospitalaria (42,6%). Se aislaron sobre todo el serotipo Enteritidis (53,3%) y Typhimurium (40,2%). La adecuación de la petición del coprocultivo fue alta, 90,2%. Se prescribió antibiótico en el 64,6% (79) de los episodios, la mayoría en pacientes menores de 65 años (58 episodios), con una media de edad de 48,43 años. Los episodios se trataron principalmente con ciprofloxacino y azitromicina, en 57 y 14 episodios respectivamente. La duración media de la antibioterapia fue de 6 días. Existió un adecuado uso de los antibióticos en un 49,1%. Cuando el origen de la petición fue el Servicio de Urgencias hospitalario resultó inadecuado en el 63,5% (33) de ellos. Fue inadecuado en un 60,0% (39) de episodios cuando se aisló Salmonella serotipo Enteriditis. En casi la mitad, el 48,85% (42) de los 58 episodios en que se prescribió antibiótico entre los menores de 65 años (86), no estaba indicado. CONCLUSIONES: Se deberían implementar acciones formativas enfocadas a optimizar el manejo de antibióticos en esta entidad así como promover contribuciones que describan esta realidad

INTRODUCTION: Gastroenteritic salmonellosis is still the second cause diagnosed of infectious diarrhea, most of these clinical pictures are mild and self-limited and therefore the use of antibiotics is limited to few cases. The aim of the study was to describe the episodes of diarrhea caused by Salmonella enterica subsp. enterica, assessing the suitability of the request and the use of antibiotics according to the criteria included in the methodology. MATERIAL AND METHODS: A retrospective, descriptive, observational study was conducted, collecting data from the clinical history. RESULTS: A total of 122 episodes were included. The reason for consultation was diarrhea, which generated a greater demand in the Hospital Emergency Services (42.6%). The most frequent serotypes isolated were Enteritidis (53.3%), and Typhimurium (40.2%). The adequate request of the stool was 90.2%. Antibiotic was prescribed in 64.6% (79) of the episodes, most patients under 65 years (58 episodes), the average age was 48.43 years. They were treated mainly with ciprofloxacin and azithromycin, in 57 and 14 episodes, respectively. The average duration of antibiotic treatment was 6 days. There was an adequate use of antibiotics in 49.1% of episodes. When the origin of the request was the Hospital Emergency Service, it was inadequate in 63.5% (33) of them. It was inadequate in 60.0% (39) of episodes when ser. Enteritidis was isolated. Almost half, 48.85% (42) of the 58 episodes in which antibiotics were prescribed among those under 65 (86), were treated without being indicated. CONCLUSIONS: Training actions should be implemented focused on optimizing the management of antibiotics in this entity

Comparative study of the prevalence of the human papilloma virus in Spanish and foreign women participating in a population screening programme in Castilla y León. / Estudio comparativo de la prevalencia de virus de papiloma humano en las mujeres españolas y extranjeras, participantes en un programa de cribado poblacional en Castilla y León.

INTRODUCTION: The objective of this study was to compare the prevalence of human papilloma virus (HPV) in Spanish and foreign women in a cervical cancer screening programme of Castilla y León and foreign women living in the community who participated in the programme. METHODS: This was an observational, descriptive, cross - sectional, retrospective study of period prevalence. The sample consisted of all the women included in the cervical cancer prevention programme of the Regional Ministry of Health of the Junta de Castilla y León who were screened for cervical cancer during the period from 2012 to 2014, aged between 25 and 64 years of age. RESULTS: Of the 190,203 cervical smear samples collected, 10.2% were foreign (n=19,329). The prevalence of HPV in the foreign women was 23.51%, significantly higher than in the Spanish women (P<.001). The presence of morphological and microbiological changes in the foreign women was also greater. CONCLUSIONS: This study makes an important contribution, since it comprised a voluminous population screening sample. The prevalence of HPV in the foreign women was significantly higher than in the women born in Spain. It is important to continue studying this type of population, who are difficult to recruit for cultural reasons.

Estudio comparativo de la prevalencia de virus de papiloma humano en las mujeres españolas y extranjeras, participantes en un programa de cribado poblacional en Castilla y León / Comparative study of the prevalence of the human papilloma virus in Spanish and foreign women participating in a population screening programme in Castilla y León

INTRODUCCIÓN: El objetivo propuesto ha sido comparar la prevalencia de virus de papiloma Humano (VPH) en las mujeres españolas y extranjeras pertenecientes al programa de cribado de cáncer de cérvix de Castilla y León, y las mujeres extranjeras residentes en la comunidad que han participado en el programa. MÉTODOS: Se trata de un estudio observacional descriptivo transversal, retrospectivo, de prevalencia de periodo. La muestra consta de todas las mujeres incluidas en el programa de prevención de cáncer de cérvix de la Consejería de Sanidad de la Junta de Castilla y León a quienes se realizó una prueba de cribado de cáncer de cérvix, durante el periodo de 2012 a 2014, con edades comprendidas entre los 25 y los 64 años de edad. RESULTADOS: De las 190.203 muestras de frotis de cérvix recopiladas el 10,2% fueron extranjeras (n = 19.329). La prevalencia de VPH en mujeres extranjeras fue del 23,51%, significativamente mayor que en las mujeres españolas (p < 0,001). También resultó ser mayor la presencia de alteraciones morfológicas y microbiológicas en las mujeres extranjeras. CONCLUSIONES: El presente estudio realiza una importante aportación, al tratarse de una voluminosa muestra proveniente de un screening de tipo poblacional. Evidenciando, significativamente, la mayor prevalencia de VPH en mujeres extranjeras que en las mujeres nacidas en España. Siendo importante continuar estudiando este tipo de población que por motivos culturales no es fácil su captación

INTRODUCTION: The objective of this study was to compare the prevalence of human papilloma virus (HPV) in Spanish and foreign women in a cervical cancer screening programme of Castilla y León and foreign women living in the community who participated in the programme. METHODS: This was an observational, descriptive, cross - sectional, retrospective study of period prevalence. The sample consisted of all the women included in the cervical cancer prevention programme of the Regional Ministry of Health of the Junta de Castilla y León who were screened for cervical cancer during the period from 2012 to 2014, aged between 25 and 64 years of age. RESULTS: Of the 190,203 cervical smear samples collected, 10.2% were foreign (n = 19,329). The prevalence of HPV in the foreign women was 23.51%, significantly higher than in the Spanish women (P < .001). The presence of morphological and microbiological changes in the foreign women was also greater. CONCLUSIONS: This study makes an important contribution, since it comprised a voluminous population screening sample. The prevalence of HPV in the foreign women was significantly higher than in the women born in Spain. It is important to continue studying this type of population, who are difficult to recruit for cultural reasons

Normalized second and fourth finger lengths in male and female partners and IVF cycle outcomes.

RESEARCH QUESTION: Hox genes are involved in limb formation during normal embryological development. Their modulation by circulating maternal oestrogens and androgens determines the length of the second and fourth fingers of the adult hand. Do these same intrauterine hormone levels also determine fertility outcomes in the adult? DESIGN: To study the association between the length of the second and fourth fingers of both partners undergoing IVF (as a surrogate of their previous intrauterine exposure to oestrogens and androgens) with treatment outcome after IVF, data corresponding to 256 IVF cycles were analysed. Finger length was normalized to the individual height. RESULTS: In the female partner, a longer normalized second finger length of the left (2DLN) hand, reflecting a high intrauterine exposure to oestrogens, was independently and significantly (P = 0.011) associated with obtaining at least one top-quality embryo in a multivariate model. Conversely, in the male partner a longer normalized fourth finger length of the left hand (4DLN), reflecting a high intrauterine exposure to androgens, was independently and significantly (P = 0.032) associated with obtaining at least one top-quality embryo in the same multivariate model. In the female partner, 2DLN was inversely and significantly (P = 0.01) associated with achievement of pregnancy. CONCLUSIONS: Intrauterine exposure to high levels of oestrogens and androgens in females and males, respectively, predisposes to the production of higher-quality embryos under in-vitro conditions during adulthood. Paradoxically, this also seems to result in a lower pregnancy rate.

Role of Full-spectrum Endoscopy in Colorectal Cancer Screening: Randomized Trial.

GOALS: The aim of this study was to compare a new, full-spectrum endoscope (Fuse; EndoChoice, Alpharetta, GA) to standard forward-viewing colonoscopy in the detection of colorectal neoplasms. BACKGROUND: Colonoscopy, the gold standard for the detection of colorectal cancer, fails to detect 22% to 28% of polyps, increasing the risk of interval cancer. Endoscopic improvement of the adenoma detection rate decrease interval carcinomas. Full-spectrum endoscopy (FUSE) (330-degree field of view), in a tandem study, has been shown to reduce the adenoma miss rate. STUDY: Prospective, randomized study of 249 patients in patients referred from the colorectal screening program with a positive fecal occult blood test (FOBT). Patients were randomized to standard forward-viewing colonoscopy (170 degrees) or to full-spectrum colonoscopy with the Fuse system (330 degrees). Study variables were the adenoma detection rate, the polyp detection rate, the mean number of adenomas per procedure, the lesions detected according to the location, morphology and size, cecal intubation rate, total procedure time, insertion time to the cecum, therapeutic success, and adverse events. RESULTS: The Fuse system did not produce a significantly higher adenoma detection rate than standard forward-viewing colonoscopy (FUSE 73.1% vs. standard colonoscopy 68.1%; P=0.47) but did have a significantly longer insertion time (FUSE 6.2 min vs. standard colonoscopy 4.2 min; P< 0.001). Further analysis failed to reveal any significant difference in polyp/adenoma detection rates by lesion size or colonic section. CONCLUSIONS: FUSE did not detect significantly more colorectal neoplasia than forward viewing colonoscopy in a medium-risk CRC screening population with positive FOBT.

Síndrome de desmoralización. Estimación de la prevalencia en una población de pacientes en cuidados paliativos en domicilio / The demoralisation syndrome. An estimation of its prevalence in patients receiving palliative care at home

OBJETIVO: El síndrome de desmoralización (SD) es una situación psicoemocional que se caracteriza por la desesperanza, el desamparo, la pérdida de sentido y el distrés existencial. Pretendemos conocer la prevalencia del SD en nuestro medio en pacientes avanzados atendidos por un equipo de cuidados paliativos. METODOLOGÍA: Se incluyeron de manera consecutiva 100 pacientes en situación avanzada atendidos por el Equipo de Soporte Domiciliario de Cuidados Paliativos que dieron su consentimiento informado. Mantenían unas condiciones físicas y neuropsicológicas suficientes para completar una entrevista semiestructurada y los cuestionarios específicos (ESASr, termómetro de malestar emocional, PPS, Barthel, HADS).como criterios diagnósticos del SD se emplearon los de Kissane. El estudio recibió la aprobación del Comité Ético del Área de Salud. RESULTADOS: Se encontraron 4 casos de SD, lo que supone una prevalencia del 4% (IC 95%: 2-10%). Estos enfermos que se mostraron diferentes del resto de la muestra en las siguientes características: edad <70 años (p = 0,02), estudios universitarios (p = 0,03), ausencia de actitud religiosa (p = 0,07) y presencia de sufrimiento (p = 0,01). También presentaban una mayor intensidad en síntomas como cansancio (p = 0,01), ansiedad (p <0,001) y desánimo (p = 0,07). CONCLUSIÓN: En nuestro medio hemos encontrado una prevalencia de SD únicamente del 4% en una población de pacientes atendidos por un Equipo Domiciliario de Cuidados Paliativos. Es probable que las condiciones para entrar en el estudio y el empleo de criterios diagnósticos relativamente estrictos hayan influido en este resultado

OBJECTIVE: The demoralisation syndrome (DS) is a psycho-emotional situation characterized by despair, helplessness, loss of meaning, and existential distress. We intend to establish the prevalence of DS in advanced patients treated by a Palliative Care Team in our SETTING: METHODOLOGY: We included 100 consecutive advanced patients treated at home by a Palliative Care Team. To be included we required informed consent, and adequate physical and neuropsychological conditions to complete a semi-structured interview and the questionnaires (ESASr, PPS, Barthel, emotional distress thermometer, HADS). We used Kissane's diagnostic criteria of DS. The study was approved by our Ethics Committee. RESULTS: Four cases of DS were found, representing a prevalence of 4% (95% CI: 2% to 10%). The characteristics of these patients that were different from the rest of the sample were: age <70 years (p = 0.02), university studies (p = 0.03), absence of religious attitude (p = 0.07), presence of suffering (p = 0.01). They also showed greater intensity of symptoms such as asthenia (p = 0.01), anxiety (p < 0.001), and depression (p = 0.07). CONCLUSIONS: In our setting we found a prevalence of DS of only 4% in a population of patients treated by a Home Palliative Care Team. The conditions for entering the study and the use of relatively strict diagnostic criteria may have influenced this result

Cocaine Allergy in Drug-Dependent Patients and Allergic People.

BACKGROUND: Adverse reactions to local anesthetics (LAs), especially esters, are not uncommon, but true allergy is rarely diagnosed. To our knowledge, currently there is no reliable method of determining IgE-mediated hypersensitivity to LAs and cocaine. OBJECTIVE: To assess the clinical value of allergy tests (prick, IgE, challenges, and arrays) in people suffering hypersensitivity reactions (asthma and anaphylaxis) during local anesthesia with cocaine derivatives and drug abusers with allergic symptoms after cocaine inhalation. METHODS: We selected cocaine-dependent patients and allergic patients who suffered severe reactions during local anesthesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity, and predictive value) of allergy tests using cocaine and coca leaf extracts in determining cocaine allergy was assessed, taking a positive challenge as the criterion standard. RESULTS: After prick tests, specific IgE, and challenge with cocaine extract, 41 of 211 patients (19.4%) were diagnosed as sensitized to cocaine. Prick tests and IgE to coca leaves (coca tea) had a good sensitivity (95.1% and 92.7%, respectively) and specificity (92.3 and 98.8%, respectively) for the diagnosis of cocaine allergy and LA-derived allergy. CONCLUSIONS: Cocaine may be an important allergen. Drug abusers and patients sensitized to local anesthesia and tobacco are at risk. Both prick tests and specific IgE against coca leaf extract detected sensitization to cocaine. The highest levels were related to severe clinical profiles.

Validity of autorefractor based screening method for irregular astigmatism compared to the corneal topography- a cross sectional study.

AIM: To present a method of screening for irregular astigmatism with an autorefractor and its determinants compared to corneal topography. METHODS: This cross-sectional validity study was conducted in 2013 at an eye hospital in Spain. A tabletop autorefractor (test 1) was used to measure the refractive status of the anterior surface of the cornea at two corneal meridians of each eye. Then corneal topography (test 2) and Bogan's classification was used to group eyes into those with regular or no astigmatism (GRI) and irregular astigmatism (GRII). Test 1 provided a single absolute value for the greatest cylinder difference (Vr). The receiver operating characteristic (ROC) were plotted for the Vr values measured by test 1 for GRI and GRII eyes. On the basis a Vr value of 1.25 D as cut off, sensitivity, specificity were also calculated. RESULTS: The study sample was comprised of 260 eyes (135 patients). The prevalence of irregular astigmatism was 42% [95% confidence interval (CI): 36, 48]. Based on test 2, there were 151 eyes in GRI and 109 eyes in GRII. The median Vr was 0.75 D (25% quartile, 0.5 D) for GRI and 1.75 D (25% quartile, 1.25 D) for GRII. The area under curve was 0.171 for GRI and 0.83 for GRII. The sensitivity of test I was 78.1% and the specificity was 76.1%. CONCLUSION: A conventional autorefractor can be effective as a first level screening method to detect irregular corneal astigmatism in places where corneal topography facilities are not available.

Descripción de las características de la cetoacidosis diabética al inicio en una muestra de pacientes con diabetes mellitus tipo 1 / Description of the characteristics of the diabetic ketoacidosis debut in a sample of patients with type 1 diabetes mellitus

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Descripción de las enfermedades autoinmunes acompañantes de la diabetes mellitus tipo 1 en un área sanitaria / Description of disease type 1 diabetes mellitus associated autoimmune disease in a health area

FUNDAMENTO Y OBJETIVO: Describir la patología autoinmune al inicio y en el seguimiento asociadas a la diabetes mellitus tipo 1 (DM1), así como exponer la importancia del cribado al comienzo y en el seguimiento de la DM1 en nuestro entorno de trabajo. PACIENTES Y MÉTODOS: Estudio observacional descriptivo transversal del periodo 2001-2011 de pacientes con inicio de DM1 menores de 19 años, correspondientes al Área de Salud Oeste de Valladolid. A todos los pacientes de nuestra muestra durante el período estudiado se realizaron estudios para las enfermedades comórbiles de la DM1 (síndromes autoinmunes poliendocrinos, enfermedad de Addison, anemia perniciosa, vitíligo, enfermedad tiroidea, enfermedad celíaca). RESULTADOS: Se realizaron anticuerpos antitiroideos al ingreso (anticuerpos antiperoxidasa, anti-TPO) en el 85,9% de los pacientes (67 casos), siendo positivos en el 23,9% (16 casos) tanto al inicio como en el seguimiento. La patología tiroidea más común fue la tiroiditis linfocitaria crónica. Se realizó al inicio de la DM1 el cribado de la enfermedad celíaca en el 75,6% (59 casos) de los pacientes, siendo positivos el 3,4% de los pacientes (2 casos), y el 1,7% (un caso) en el seguimiento. Ningún paciente de nuestra población presentó síndromes autoinmunes poliendocrinos, enfermedad de Addison, anemia perniciosa, ni vitíligo. CONCLUSIONES: Quizá con las recomendaciones internacionales actuales y el consenso médico se pueda realizar el cribado rutinario de las enfermedades autoinmunes comórbiles con DM1 de manera estandarizada. Es conveniente realizar el cribado de enfermedades autoinmunes relacionadas con la DM1, tanto en el momento del diagnóstico de la enfermedad como periódicamente en el seguimiento posterior

BACKGROUND AND OBJECTIVE: To describe the onset of autoimmune disease and monitoring associated with type 1 diabetes mellitus (T1DM) in a sample of patients under 19 years, and to explain the importance of the onset and monitoring screening of T1DM in this health area. PATIENTS AND METHODS: An observational descriptive study was conducted on patients under 19 years-old with onset of type 1 diabetes mellitus in the health district of West Valladolid (Spain) during the period from 2001 to 2011. The results of the diagnostic tests for diseases associated with T1DM (autoimmune polyendocrine syndromes, Addison's disease, pernicious anemia, vitiligo, thyroid disease, celiac disease) were recorded). RESULTS: Antithyroid antibodies were performed (peroxidase antibodies, anti-TPO) in 85.9% of patients (67 cases), being positive in 23.9% (16 cases) at onset and during follow-up. The most common thyroid disease was chronic lymphocytic thyroiditis. Screening for celiac disease was performed in 75.6% (59 cases) of patients, being positive in 3.4% of patients at onset, and 1.7% (1 case) in the follow-up. None of the patients in our population sample presented with autoimmune polyendocrine syndromes, Addison's disease, pernicious anemia, or vitiligo. CONCLUSIONS: The results suggest that it may be worthwhile screening for autoimmune diseases associated with T1DM, both at the time of diagnosis of disease and periodically during the follow-up of T1DM. Perhaps, with current international recommendations and medical consensus, screening for autoimmune diseases associated with T1DM could become routine

Contribution of ¹¹¹In-pentetreotide SPECT/CT imaging to conventional somatostatin receptor scintigraphy in the detection of neuroendocrine tumours.

AIM: The aim of the study was to assess the contribution of 111In-pentetreotide single-photon emission computed tomography/computed tomography (SPECT/CT) imaging to conventional somatostatin receptor scintigraphy (SRS) in terms of lesion characterization and localization in the detection of neuroendocrine tumours (NETs). MATERIALS AND METHODS: A total of 107 patients with suspected or confirmed NET underwent SRS and SPECT/CT after the injection of 148-222 MBq of 111In-pentetreotide. SRS and SPECT/CT images were interpreted independently. Each site of abnormal tracer uptake was recorded according to the anatomical localization, and as being consistent or not with NET. The findings were confirmed with pathological and/or clinical/imaging follow-up data. RESULTS: A final diagnosis of NET was achieved in 49/107 patients (45.8%). No evidence of NET was found in the rest. SPECT/CT resulted in a significant reduction of indeterminate cases [14/107 (13.1%) vs. 1/107 (0.9%); P<0.001] and correctly reclassified one patient as negative for NET and another as positive for NET. SPECT/CT had 87.8% sensitivity and 96.6% specificity on a patient-based analysis, statistically higher than SRS (P<0.001). A total of 160 foci were detected (108 NETs and 52 physiological/benign tumours). SRS correctly classified 105/160 foci (65.6%) and remained inaccurate for 55 lesions. These 55 included 31 indeterminate lesions, 12 lesions detected only by SPECT/CT and 12 false-positive lesions. The number of foci correctly classified on the SPECT/CT images was 151/160 (94.4%), whereas two remained indeterminate and seven were false-positive findings. CONCLUSION: SPECT/CT provides incremental diagnostic value over SRS, mainly because of a precise anatomical localization that helps discriminate between tumour lesions and physiological uptake. SPECT/CT may detect unsuspected lesions in a small proportion of patients.

Prospective observational study to evaluate risk factors for falls in institutionalized elderly people: the role of cystatin C.

AIM: To evaluate the role of balance and gait disorders, comorbidities and laboratory abnormalities in the occurrence of falls in an institutionalized elderly population. METHODS: We made a non-interventional, prospective, observational study in elderly institutionalized people. Comorbidities and information on treatments were obtained. Function and cognition were measured using the Katz Index, the Tinetti Balance and Gait, lower extremity function tests and the Mini-Mental test. At the inclusion, the analytical was made including cystatin C. Falls were recorded for 20 months after inclusion. RESULTS: Patients with falls were older (85 ± 7 vs. 82 ± 8, p = 0.04) and more often female (88 vs. 12 %, p = 0.01). Dyslipidemia, hypertension and antihypertensive treatment were associated with an increased risk of falls. Cystatin C was higher in patients with falls (0.96 ± 0.21 vs. 1.12 ± 0.29, p = 0.02). Functional tests showed differences in the Tinetti balance test (15 ± 2 vs. 13 ± 3, p = 0.04) and lower extremity function balance test (2.8 ± 1.2 vs. 2.2 ± 1.2, p = 0.05). The Mini-Mental State Examination (MMSE) scores were worse in patients with falls (22 ± 4 vs. 25 ± 4, p = 0.01). Only female status (6.2, p = 0.03), the MMSE scores (1.2, p = 0.02) and cystatin C (5.3, p = 0.02) were independent risk factors for falls after logistic regression. CONCLUSIONS: Female sex, cognitive impairment and cystatin C were risk factors for falls in non-dependent institutionalized elderly people.

Expression of genes related to energy metabolism (osteocalcin, FOXO1, insulin receptor, and SOST) in bone cells of Goto-Kakizaki rats and response to bariatric surgery.

OBJECTIVES: The aim of this experimental study was to evaluate the expression of 4 genes (osteocalcin, sclerostin (SOST), insulin receptor, and transcription factor forkhead box protein (FOXO1) in the bone cells of Goto-Kakizaki (GK) rats and the expression of these genes in response to bariatric surgery. METHODS: We designed an experimental study with 3 arms (Wistar rats, nonoperated GK rats, and GK rats with gastrojejunal bypass). Gene expression (osteocalcin, insulin receptor, FOXO1, SOST) was measured at baseline and after surgery. Plasma levels of glucose, insulin, homeostasis model assessment (HOMA), glucagon-like peptide 1 (GLP-1), and the production of insulin were measured at baseline and at 60 minutes by pancreatic islets. RESULTS: GK rats had decreased levels of expression of osteocalcin (50.86 ± 19.21 versus 16.78 ± 22.11, P = .031), insulin receptor (1.45 ± .44 versus .54 ± .35, P = .020), and SOST (.92 ± .05 versus .43 ± .47, P = .048) compared with Wistar rats. Gene expression in GK rats, operated and nonoperated, was similar. In nonoperated GK rats, there was a negative correlation between the SOST gene and plasma insulin (r:-.786, P = .021) and the production of insulin by pancreatic islets at 60 minutes (r:-0.857, P = .014). GLP-1 increased after surgery. CONCLUSION: Diabetic GK rats presented a reduced expression of the osteocalcin, insulin receptor, and SOST genes. There was an inverse relationship between SOST and plasma and local insulin. We found no changes in the expression of bone genes that regulate energy metabolism after gastrojejunal bypass.

Effect of two types of bariatric surgery (gastrojejunal bypass and sleeve gastroplasty) on gene expression of bone remodeling markers in Goto-Kakizaki rats.

BACKGROUND: The aim of this study was to evaluate gene expression of bone remodeling markers in type 2 diabetic Goto-Kakizaki (GK) nonobese rats after gastrojejunal bypass and sleeve gastroplasty and their relationship with hormonal parameters. METHODS: We designed an experimental study in three groups of GK rats (nonoperated gastrojejunal bypass and sleeve gastroplasty). Gene expression of markers of bone remodeling and levels of insulin, leptin, and glucagon-like peptide-1 (GLP-1) were determined. RESULTS: GK rats had decreased levels of osteocalcin expression compared with Wistar rats. Gene expression of markers of bone remodeling in GK rats was similar in the three groups studied, although there was a trend to decreased receptor activator for nuclear factor κ B ligand (RANKL) in gastroplasty rats. Significant differences in the osteocalcin/RANKL ratio were observed between controls and gastrojejunal bypass rats compared with gastroplasty rats. The behavior of gastrointestinal hormones was antagonistic (GLP-1 gastrojejunal bypass 1.54 ± 0.24 ng/ml vs. GLP-1 gastroplasty 0.673 ± 0.09, p = 0.0001; leptin gastrojejunal bypass 1,178 ± 0.474 pg/ml vs. leptin gastroplasty 7,391 ± 4,054 pg/ml, p = 0.002). There was a reduction in leptin in the bypass group associated with an increase in gastrectomized rats. In gastrectomized rats, there was a trend toward an inverse relationship between leptin and RANKL (r = -0.771, p = 0.072). This relationship was more marked in the totality of operated rats, n = 12 (r = -0.608, p = 0.036). CONCLUSION: Our results show a more favorable profile of sleeve gastroplasty on bone remodeling. There was a trend to an increase in the expression of the osteocalcin gene, which is probably mediated by increased expression of leptin that inhibits the expression of RANKL.

Papel de la variante del promotor G308 del factor de necrosis tumoral α sobre el peso y parámetros metabólicos tras una dieta rica en grasas monoinsaturadas frente a una dieta rica en grasas poliinsaturadas / Role of G308 promoter variant of tumor necrosis factor alpha gene on weight loss and metabolic parameters after a high monounsaturated versus a high polyunsaturated fat hypocaloric diets

Background and objective: The aim of our study was to investigate the influence of G-308 promoter variant of the tumor necrosis factor (TNF) alpha gene on metabolic changes and weight loss secondary to a high monounsaturated fat vs a high polyunsaturated fat hypocaloric diet in obese subjects. Patients and method: A sample of 261 obese subjects were enrolled in a consecutive prospective way, from May 2011 to July 2012 in a tertiary hospital. In the basal visit, patients were randomly allocated during 3 months to Diet M (high monounsaturated fat hypocaloric diet) and Diet P (high polyunsaturated fat hypocaloric diet). Results: One hundred and ninety seven patients (73.2%) had the genotype G-308G and 64 (26.8%) patients had the genotype G-308A. There were no significant differences between the effects (on weight, body mass index (BMI), waist circumference, fat mass) in either genotype group with both diets. With the diet type P and in genotype G-308G, glucose levels (−6.7(22.1) mg/dl vs −3.7(2.2) mg/dl: p = 0.02), HOMA-R (−0.6(2.1) units vs −0.26(3.1) units: p = 0.01), insulin levels (−1.7(6.6) UI/L vs −0.6(7.1) UI/L: p = 0.009), total cholesterol levels (−15.3(31.1) mg/dl vs −8.4(22.1) mg/dl: p = 0.01), LDL cholesterol levels (−10.7(28.1) mg/dl vs −3.8(21.1) mg/dl: p = 0.008) and triglycerides (−12.1(52.1) mg/dl vs −6.6(43.1) mg/dl: p = 0.02) decreased. Conclusion: Carriers of the G-308G promoter variant of TNF alpha gene have a better metabolic response than A-308 obese with a high polyunsaturated fat hypocaloric diet (AU)

Fundamento y objetivo: El objetivo de este estudio es investigar la influencia de la variante G-308 del promotor del gen TNF-αsobre los cambios metabólicos y pérdida de peso secundaria a una dieta hipocalórica rica en grasas monoinsaturadas frente a una dieta rica en grasas poliinsaturadas. Pacientes y método: Una muestra de 261 obesos fue reclutada de una manera prospectiva consecutiva, desde mayo de 2011 a julio de 2012 en un hospital terciario. En la visita basal fueron aleatorizados a recibir las siguientes dietas durante al menos 3 meses: dieta M (rica en grasa monoinsaturada) y dieta P (rica en grasa poliinsaturada). Resultados: Ciento noventa y siete (73,2%) obesos presentaron el genotipo G-308G, y 64 (26,8%), el genotipo G-308A. No hubo diferencias significativas en la mejoría de peso, IMC, circunferencia de la cintura y masa grasa con ambas dietas y en ambos genotipos. Tras la dieta P y con el genotipo G-308G, los niveles de glucosa (−6,7 [22,1] vs. −3,7 [2,2] mg/dl; p = 0,02), HOMA-R (−0,6 [2,1] vs. −0,26 [3,1] unidades; p = 0,01), insulina (−1,7 [6,6] vs. −0,6 [7,1] UI/l; p = 0,009), colesterol total (−15,3 [31,1] vs. −8,4 [22,1] mg/dl; p = 0,01), colesterol LDL (−10,7 [28,1] vs. −3,8 [21,1] mg/dl; p = 0,008) y triglicéridos (−12,1 [52,1] mg/dl vs. −6,6 [43,1] mg/dl; p = 0,02) disminuyeron. Conclusión: Los portadores del genotipo G-308G presentan mayores beneficios metabólicos tras la pérdida de peso generada por la dieta rica en grasas poliinsaturadas (AU)

Role of G308 promoter variant of tumor necrosis factor alpha gene on weight loss and metabolic parameters after a high monounsaturated versus a high polyunsaturated fat hypocaloric diets.

BACKGROUND AND OBJECTIVE: The aim of our study was to investigate the influence of G-308 promoter variant of the tumor necrosis factor (TNF) alpha gene on metabolic changes and weight loss secondary to a high monounsaturated fat vs a high polyunsaturated fat hypocaloric diet in obese subjects. PATIENTS AND METHOD: A sample of 261 obese subjects were enrolled in a consecutive prospective way, from May 2011 to July 2012 in a tertiary hospital. In the basal visit, patients were randomly allocated during 3 months to Diet M (high monounsaturated fat hypocaloric diet) and Diet P (high polyunsaturated fat hypocaloric diet). RESULTS: One hundred and ninety seven patients (73.2%) had the genotype G-308G and 64 (26.8%) patients had the genotype G-308A. There were no significant differences between the effects (on weight, body mass index (BMI), waist circumference, fat mass) in either genotype group with both diets. With the diet type P and in genotype G-308G, glucose levels (-6.7(22.1)mg/dl vs -3.7(2.2)mg/dl: p = 0.02), HOMA-R (-0.6(2.1)units vs -0.26(3.1)units: p = 0.01), insulin levels (-1.7(6.6)UI/L vs -0.6(7.1)UI/L: p = 0.009), total cholesterol levels (-15.3(31.1)mg/dl vs -8.4(22.1)mg/dl: p = 0.01), LDL cholesterol levels (-10.7(28.1)mg/dl vs -3.8(21.1)mg/dl: p = 0.008) and triglycerides (-12.1(52.1)mg/dl vs -6.6(43.1)mg/dl: p = 0.02) decreased. CONCLUSION: Carriers of the G-308G promoter variant of TNF alpha gene have a better metabolic response than A-308 obese with a high polyunsaturated fat hypocaloric diet.