Stargardt's pigmentosa: A novel combination of two inherited retinal dystrophies.

60-year-old woman referring visual disability. She presented bone spicule pigmentation and retinal atrophy in all peripheral retina, as well as macular retinal flecks. Multimodal imaging showed typical findings of both inherited retinal dystrophies (IRD). Electroretinogram confirmed rod dysfunction. Biallelic mutations were found in ABCA4 and CNGA1 genes. Although not common, different IRDs may be present in a same patient at the same time. This is the first reported case of the combination of RP with late-onset Stargardt's disease. We propose the name 'Stargardt's pigmentosa' for this novel clinical entity.

Neutrino-Induced Coherent π

MINERvA has measured the ν_{µ}-induced coherent π^{+} cross section simultaneously in hydrocarbon (CH), graphite (C), iron (Fe), and lead (Pb) targets using neutrinos from 2 to 20 GeV. The measurements exceed the predictions of the Rein-Sehgal and Berger-Sehgal PCAC based models at multi-GeV ν_{µ} energies and at produced π^{+} energies and angles, E_{π}>1 GeV and θ_{π}<10°. Measurements of the cross-section ratios of Fe and Pb relative to CH reveal the effective A scaling to increase from an approximate A^{1/3} scaling at few GeV to an A^{2/3} scaling for E_{ν}>10 GeV.

Simultaneous Measurement of Muon Neutrino ν_{µ} Charged-Current Single π

Neutrino-induced charged-current single π^{+} production in the Δ(1232) resonance region is of considerable interest to accelerator-based neutrino oscillation experiments. In this Letter, high statistic differential cross sections are reported for the semiexclusive reaction ν_{µ}A→µ^{-}π^{+}+ nucleon(s) on scintillator, carbon, water, iron, and lead targets recorded by MINERvA using a wideband ν_{µ} beam with ⟨E_{ν}⟩≈6 GeV. Suppression of the cross section at low Q^{2} and enhancement of low T_{π} are observed in both light and heavy nuclear targets compared with phenomenological models used in current neutrino interaction generators. The cross sections per nucleon for iron and lead compared with CH across the kinematic variables probed are 0.8 and 0.5 respectively, a scaling which is also not predicted by current generators.

Relación entre grosor coroideo y densidad vascular en población joven sana / Relationship between choroidal thickness and vascular density in young healthy population

Antecedentes y objetivo El objetivo es analizar la densidad vascular (DV) coroidea en individuos sanos y compararla con el grosor coroideo (GC). Materiales y métodos Estudio transversal incluyendo individuos entre 18 y 35 años, caucásicos y con longitud axial (LA) 21-26 mm. Se estudió la coroides con tomografía de coherencia óptica-angiografía (OCTA) Triton DRI (Topcon) y se obtuvo un cubo macular de 6x6 mm. El software dio los valores de GC automáticamente. Los valores de DV se obtuvieron mediante codificación en números de los colores de los mapas de DV. Resultados Se analizaron 102 ojos (51 pacientes). La edad media fue 27,32 ± 3,94 años, la presión intraocular media fue 18,07 ± 2,38 mmHg, y la LA media fue 23,71 ± 0,66 mm. El GC fue mayor en el eje vertical y menor al acercarse a los lados nasal y temporal. El mayor GC se encontró en la mácula superior. La mayor DV coroidea fue en la fóvea y en la región yuxtapapilar. La menor DV coroidea se halló en la mácula superior e inferior. Se encontraron correlaciones moderadas inversas entre GC y DV coroidea en las regiones yuxtapapilar e inferior. Conclusiones La coroides tiene un patrón de grosor diferente del de la retina. Los vasos coroideos representan un porcentaje muy alto de la coroides en las regiones peripapilar y fóvea. Por el contrario, la mácula superior e inferior muestra valores bajos de DV (AU)

Background and purpose The purpose is to analyze choroidal vascular density (VD) in healthy individuals and to compare it with choroidal thickness (CT). Materials and methods Cross-sectional study enrolling healthy individuals between 18 and 35 years old of Caucasian race and with an axial length (AL) 21–26 mm. Choroid was imaged with swept-source optical coherence tomography angiography (OCTA) Triton DRI (Topcon) and a macular cube of 6 mm × 6 mm was obtained. CT values were automatically given by the software. VD values were obtained through codifying colors of the VD map into numbers. Results One hundred and two (51 patients) were analyzed. Mean age was 27.32 ± 3.94 years old, mean intraocular pressure was 18.07 ± 2.38 mmHg, and mean AL was 23.71 ± 0.66 mm. CT was higher in the vertical axis and lower when approaching nasal and temporal sides. The highest CT was in superior macula. The highest choroidal VD were in the fovea and in the juxtapapillary region. The lowest choroidal VD were found in superior and inferior macular areas. Moderate inverse correlations between CT and choroidal VD were found in the juxtapapillary and inferior regions. Conclusions The choroid has a thickness pattern that differs from retina. Choroidal vessels represent a very high percentage of choroid in the peripapillary region and in the fovea. On the contrary, superior and inferior macula reveals low values of VD (AU)

Simultaneous Measurement of ν_{µ} Quasielasticlike Cross Sections on CH, C, H_{2}O, Fe, and Pb as a Function of Muon Kinematics at MINERvA.

This Letter presents the first simultaneous measurement of the quasielasticlike neutrino-nucleus cross sections on C, water, Fe, Pb, and scintillator (hydrocarbon or CH) as a function of longitudinal and transverse muon momentum. The ratio of cross sections per nucleon between Pb and CH is always above unity and has a characteristic shape as a function of transverse muon momentum that evolves slowly as a function of longitudinal muon momentum. The ratio is constant versus longitudinal momentum within uncertainties above a longitudinal momentum of 4.5 GeV/c. The cross section ratios to CH for C, water, and Fe remain roughly constant with increasing longitudinal momentum, and the ratios between water or C to CH do not have any significant deviation from unity. Both the overall cross section level and the shape for Pb and Fe as a function of transverse muon momentum are not reproduced by current neutrino event generators. These measurements provide a direct test of nuclear effects in quasielasticlike interactions, which are major contributors to long-baseline neutrino oscillation data samples.

Relationship between choroidal thickness and vascular density in young healthy population.

BACKGROUND AND PURPOSE: The purpose is to analyze choroidal vascular density (VD) in healthy individuals and to compare it with choroidal thickness (CT). MATERIALS AND METHODS: Cross-sectional study enrolling healthy individuals between 18 and 35 years old of Caucasian race and with an axial length (AL) 21-26 mm. Choroid was imaged with swept-source optical coherence tomography angiography (OCTA) Triton DRI (Topcon) and a macular cube of 6 × 6 mm was obtained. CT values were automatically given by the software. VD values were obtained through codifying colors of the VD map into numbers. RESULTS: 102 (51 patients) were analyzed. Mean age was 27.32 ±â€¯3.94 years old, mean intraocular pressure was 18.07 ±â€¯2.38 mmHg, and mean AL was 23.71 ±â€¯0.66 mm. CT was higher in the vertical axis and lower when approaching nasal and temporal sides. The highest CT was in superior macula. The highest choroidal VD were in the fovea and in the juxtapapillary region. The lowest choroidal VD were found in superior and inferior macular areas. Moderate inverse correlations between CT and choroidal VD were found in the juxtapapillary and inferior regions. CONCLUSIONS: The choroid has a thickness pattern that differs from retina. Choroidal vessels represent a very high percentage of choroid in the peripapillary region and in the fovea. On the contrary, superior and inferior macula reveals low values of VD.

Revisión sistemática de los métodos para incrementar la eficacia de la resonancia magnética en el diagnóstico precoz de cáncer de próstata clínicamente significativo / Systematic review of methods used to improve the efficacy of magnetic resonance in early detection of clinically significant prostate cancer

Contexto y objetivo El cáncer de próstata (CP) es la neoplasia maligna con mayor incidencia a nivel mundial después del cáncer de pulmón. El objetivo de este estudio es revisar la literatura para conocer qué métodos permiten mejorar la eficacia de la estrategia actual de diagnóstico precoz del CP clínicamente significativo (csCP), basada en la realización de la resonancia magnética (RM) y biopsias dirigidas cuando se detectan lesiones sospechosas, además de la biopsia sistemática. Adquisición de la evidencia Se realizó una revisión sistemática de la literatura en PubMed, Web of Science y Cochrane según los criterios Preferred reporting items for systematic reviews and meta-analyses (PRISMA), utilizando los términos de búsqueda: RM multiparamétrica, RM biparamétrica, densidad de antígeno prostático específico (PSA), prostate cancer antigen 3 (PCA3), Prostate Health Index (PHI), 4 K score, cáncer de próstata, diagnóstico precoz. Se identificaron 297 referencias y, a través de los criterios de selección Participants, Interventions, Comparisons and Outcomes (PICO), se seleccionaron 21 publicaciones para sintetizar la evidencia. Síntesis de la evidencia Con la consolidación de la RM como prueba de elección el diagnóstico del CP, la densidad de PSA (DPSA) es una herramienta de gran importancia incluyéndose en nomogramas predictores, sin coste añadido. La PSAD y los biomarcadores, en asociación con la RM, ofrecen un poder diagnóstico elevado con un área bajo la curva (ABC) por encima del 0,7. Únicamente, el modelo SHTLM3 integra biomarcadores en la elaboración de un nomograma. Los modelos predictores ofrecen una eficacia constante en las diferentes series, con un ABC superior a 0,8 en asociación con la RM. Conclusiones La eficacia de la RM, para diagnosticar el csCP, se puede mejorar con diferentes parámetros con el objetivo de generar modelos predictivos que apoyen la toma de decisiones (AU)

Background and Objective Prostate cancer (PC) is the malignant neoplasm with the highest incidence after lung cancer worldwide. The objective of this study is to review the literature on the methods that improve the efficacy of the current strategy for the early diagnosis of clinically significant PC (csPC), based on the performance of magnetic resonance imaging (RM) and targeted biopsies when suspicious lesions are detected, in addition to systematic biopsy. Evidence acquisition A systematic literature review was performed in PubMed, Web of Science and Cochrane according to the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), using the search terms: multiparametric magnetic resonance imaging, biparametric magnetic resonance imaging, biomarkers in prostate cancer, prostate cancer y early diagnosis. A total of 297 references were identified and, using the PICO selection criteria, 21 publications were finally selected to synthesize the evidence. Evidence synthesis With the consolidation of MRI as the test of choice for the diagnosis of prostate cancer, the role of PSA density (PSAD) becomes relevant as a predictive tool included in prediction nomograms, without added cost. PSAD and diagnostic markers, combined with MRI, offer a high diagnostic power with an area under curve (AUC) above 0,7. Only the SHTLM3 model integrates markers in the creation of a nomogram. Prediction models also offer consistent efficacy with an AUC greater than 0,8 when associating MRI. Conclusions The efficacy of MRI in clinically significant prostate cancer detection can be improved with different parameters in order to generate predictive models that support decision making (AU)

Measurement of the axial vector form factor from antineutrino-proton scattering.

Scattering of high energy particles from nucleons probes their structure, as was done in the experiments that established the non-zero size of the proton using electron beams1. The use of charged leptons as scattering probes enables measuring the distribution of electric charges, which is encoded in the vector form factors of the nucleon2. Scattering weakly interacting neutrinos gives the opportunity to measure both vector and axial vector form factors of the nucleon, providing an additional, complementary probe of their structure. The nucleon transition axial form factor, FA, can be measured from neutrino scattering from free nucleons, νµn → µ-p and [Formula: see text], as a function of the negative four-momentum transfer squared (Q2). Up to now, FA(Q2) has been extracted from the bound nucleons in neutrino-deuterium scattering3-9, which requires uncertain nuclear corrections10. Here we report the first high-statistics measurement, to our knowledge, of the [Formula: see text] cross-section from the hydrogen atom, using the plastic scintillator target of the MINERvA11 experiment, extracting FA from free proton targets and measuring the nucleon axial charge radius, rA, to be 0.73 ± 0.17 fm. The antineutrino-hydrogen scattering presented here can access the axial form factor without the need for nuclear theory corrections, and enables direct comparisons with the increasingly precise lattice quantum chromodynamics computations12-15. Finally, the tools developed for this analysis and the result presented are substantial advancements in our capabilities to understand the nucleon structure in the weak sector, and also help the current and future neutrino oscillation experiments16-20 to better constrain neutrino interaction models.

Systematic review of methods used to improve the efficacy of magnetic resonance in early detection of clinically significant prostate cancer.

BACKGROUND AND OBJECTIVE: Prostate cancer (PC) is the malignant neoplasm with the highest incidence after lung cancer worldwide. The objective of this study is to review the literature on the methods that improve the efficacy of the current strategy for the early diagnosis of clinically significant PC (csPC), based on the performance of magnetic resonance imaging (RM) and targeted biopsies when suspicious lesions are detected, in addition to systematic biopsy. EVIDENCE ACQUISITION: A systematic literature review was performed in PubMed, Web of Science and Cochrane according to the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), using the search terms: multiparametric magnetic resonance imaging, biparametric magnetic resonance imaging, biomarkers in prostate cancer, prostate cancer y early diagnosis. A total of 297 references were identified and, using the PICO selection criteria, 21 publications were finally selected to synthesize the evidence. EVIDENCE SYNTHESIS: With the consolidation of MRI as the test of choice for the diagnosis of prostate cancer, the role of PSA density (PSAD) becomes relevant as a predictive tool included in prediction nomograms, without added cost. PSAD and diagnostic markers, combined with MRI, offer a high diagnostic power with an area under curve (AUC) above 0.7. Only the SHTLM3 model integrates markers in the creation of a nomogram. Prediction models also offer consistent efficacy with an AUC greater than 0.8 when associating MRI. CONCLUSIONS: The efficacy of MRI in clinically significant prostate cancer detection can be improved with different parameters in order to generate predictive models that support decision making.

Percepción del farmacéutico sobre su actuación e implicación profesional en la dispensación y entrega gratuita a la población de la Comunidad de Madrid de test de antígenos de autodiagnóstico de COVID-19 / Pharmacist's perception of their performance and professional involvement in the dispensing and free delivery of COVID-19 self-diagnostic antigen tests to the population of the Community of Madrid

Introducción: en 2021, la Comunidad de Madrid dio un paso más en su lucha contra la pandemia al incorporar la red de farmacias comunitarias a su Programa de Salud Pública para la detección precoz, vigilancia y control de COVID-19, en concreto con su participación en la realización de prue bas rápidas de antígenos para el diagnóstico de la infección por SARS-CoV-2 y con la provisión a la población de pruebas gratuitas para el autodiagnóstico. Desde el Colegio Oficial de Farmacéuticos de Madrid se consideró pertinente llevar a cabo un estudio con el objetivo de determinar la percepción global del farmacéutico comunitario sobre su actuación e implicación profesional, así como la de manda de información por parte de la población durante la campaña de dispensación y entrega de test gratuitos. Métodos: estudio observacional descriptivo prospectivo transversal. Realizado, mediante la téc nica de encuesta entre el 4 y 17 de mayo de 2022 a través de un cuestionario online. Resultados: el 76,8 % de los farmacéuticos ofrecieron, de forma habitual, información técnica sobre los test a los pacientes que la solicitaban. El 8,3 % de los farmacéuticos indican que la gran mayoría de los pacientes a los que ya les habían dispensado el test regresaron a la farmacia para so licitar información sobre los mismos y un 11,2 % indican que la mayoría de los pacientes que acudían a retirar los test, les pedían que les realizaran el test en la farmacia. La intervención más frecuente, conforme a las respuestas del 61,0 % de los encuestados, fue la de proporcionar información sobre cómo utilizar el test e interpretar los resultados (AU)

incorporating the community pharmacy network to its public health program for the early detection, surveillance, and control of COVID-19. Specifically, pharmacies participated in the performance of rapid antigen testing for the diagnosis of SARS-CoV-2 infection and provided the population with free self-test ing kits. From the Official College of Pharmacy of Madrid (“Colegio Oficial de Farmacéuticos de Madrid”), a study was conducted to evaluate the professional involvement and role of community pharmacists, as well as the degree of information demanded by the public during the distribution of self-testing kits. Methods: This was an observational, cross-sectional, prospective study that employed online surveys collected between May 4th and 17th 2022. Results: 76.8% of pharmacists offered technical information to approximately 58% of users that came to retrieve their self-testing kits. 26% of users returned for additional advice, and 1/3 of users asked for the test to be conducted in the pharmacy. The most frequent intervention (61%) was providing infor mation on test usage and interpretation. In most cases (56.7%), pharmacists spent between 1-5 minutes in the distribution of self-testing kits, with a lower percentage (20.3%) spending between 5-10 minutes. Notably, 98.3% of pharmacists identified that this public health campaign altered their daily workflow, with 86% considering that there should have been financial compensation for their involvement. Conclusions: This study highlighted the crucial role that pharmacists played in the public health cam paign against COVID-19. Moreover, it reflected the pharmacists’ opinions on their involvement in this novel role, separate from their traditional workflow, that ultimately contributed to improving population health (AU)

Simultaneous Measurement of Proton and Lepton Kinematics in Quasielasticlike ν_{µ}-Hydrocarbon Interactions from 2 to 20 GeV.

Neutrino charged-current quasielastic-like scattering, a reaction category extensively used in neutrino oscillation measurements, probes nuclear effects that govern neutrino-nucleus interactions. This Letter reports the first measurement of the triple-differential cross section for ν_{µ} quasielastic-like reactions using the hydrocarbon medium of the MINERvA detector exposed to a wideband beam spanning 2≤E_{ν}≤20 GeV. The measurement maps the correlations among transverse and longitudinal muon momenta and summed proton kinetic energies, and compares them to predictions from a state-of-art simulation. Discrepancies are observed that likely reflect shortfalls with modeling of pion and nucleon intranuclear scattering and/or spectator nucleon ejection from struck nuclei. The separate determination of leptonic and hadronic variables can inform experimental approaches to neutrino-energy estimation.

Impacto en el manejo diagnóstico/terapéutico de la ecocardiografía básica dirigida a objetivos concretos en una UCI de cirugía cardíaca / Impact of goal directed basic echocardiography on diagnostic and therapeutic management in an ICU of cardiac surgery

OBJETIVO: Pocos estudios han evaluado el impacto en el diagnóstico y tratamiento de la ecocardiografía transtorácica básica en los pacientes postoperados de cirugía cardíaca. El objetivo de nuestro estudio fue valorar el impacto de la ecocardiografía transtorácica básica en el manejo diagnóstico y terapéutico de estos pacientes. DISEÑO: Durante 18 meses se estudiaron prospectivamente todos los pacientes postoperados de cirugía cardíaca que ingresaron en el Servicio de Medicina Intensiva de un hospital universitario. Se realizó una valoración clínica a todos ellos para establecer un diagnóstico y un tratamiento inicial. Se realizó una ecocardiografía transtorácica básica para valoración diagnóstica, que se comparó con la valoración clínica. En caso de discrepancia, se valoró cambiar el tratamiento en función a la ecocardiografía y se evaluó la respuesta terapéutica. Se realizó un análisis descriptivo de los hallazgos. RESULTADOS: Se incluyeron 136 pacientes y se realizaron 203 ecocardiografías. La ecocardiografía transtorácica difería del diagnóstico inicial en 101 (49,8%) ecocardiografías. En 56 de estas (55,44%) se obtuvo un diagnóstico alternativo, lo que comportó un cambio en el tratamiento en 30pacientes (53,6%). Encontramos mejoría clínica significativa en 26 de estos pacientes (86,76%) en los siguientes 30-60min. CONCLUSIONES: La ecocardiografía transtorácica básica es útil en el manejo diagnóstico y terapéutico de los pacientes postoperados de cirugía cardíaca. En la mitad de las ecocardiografías realizadas no se pudo confirmar el diagnóstico clínico. En la mayoría de los pacientes en que observamos cambio en el diagnóstico debido a la ecocardiografía, se observó mejoría clínica tras el cambio de tratamiento

OBJECTIVE: Few studies have evaluated the impact in diagnosis and therapeutic management of basic transthoracic echocardiography in postoperated cardiac surgery. The aim of our study was to evaluate the impact of basic transthoracic echocardiography in the management of this kind of patients. DESIGN: Over an 18-month period, we prospectively studied all patients admitted to a university hospital Intensive Care Unit following heart surgery. We evaluated clinically all of them to establish a diagnosis and an initial treatment. We performed basic transthoracic echocardiography for a diagnosis evaluation that was compared with clinical diagnosis. If they differed, we assessed to change treatment and evaluate the therapeutic response. We performed a descriptive analysis. RESULTS: We included 136 patients and performed 203 echocardiographies. Transthoracic echocardiography differed of initial diagnosis in 101 (49.8%) echocardiographies. In 56 of these echocardiographies (55.44%), we could give an alternative diagnosis with a change in the treatment in 30patients (53,6%). We found clinical improvement in 26 patients (86.76%) in the following 30-60minutes. CONCLUSIONS: Basic transthoracic echocardiography is useful in diagnostic and therapeutic management of postoperative cardiac surgery patients. We could not confirm the clinical diagnosis in half of the performed echocardiographies. In most patients in whom we observe a change in the diagnosis due to echocardiography, we observed a clinical improvement after changing the treatment

Epigenetic control of the EWS­FLI1 promoter in Ewing's sarcoma.

Ewing sarcoma (ES) is a primary bone marrow tumor that very rarely develops in extra­osseous tissues, such as lung. The hallmark of ES tumors is a translocation between chromosomes 11 and 22, resulting in a fusion protein, commonly referred to as EWS­FLI1. The epigenetic profile (histone acetylation and methylation enrichment of the promoter region) that may regulate the expression of the aberrant transcription factor EWS­FLI1, remains poorly studied and understood. Knowledge of epigenetic patterns associated with covalent histone modification and expression of enzymes associated with this process, can contribute to the understanding of the molecular basis of the disease, as well as to the identification of possible molecular targets involved in expression of the EWS­FLI1 gene, so that therapeutic strategies may be improved in the future. In the present study, the transcriptional activation and repression of the EWS­FLI1 fusion gene in ES was accompanied by selective deposition of histone markers on its promoter. The EWS­FLI1 fusion gene was evaluated in two patients with ES using conventional cytogenetic, fluorescence in situ hybridization and nested PCR assays, which revealed that the aberrant expression of the EWS­FLI1 gene is accompanied by enrichment of H3K4Me3, H3K9ac and H3K27ac at the promoter region.

Impact of goal directed basic echocardiography on diagnostic and therapeutic management in an ICU of cardiac surgery. / Impacto en el manejo diagnóstico/terapéutico de la ecocardiografía básica dirigida a objetivos concretos en una UCI de cirugía cardíaca.

OBJECTIVE: Few studies have evaluated the impact in diagnosis and therapeutic management of basic transthoracic echocardiography in postoperated cardiac surgery. The aim of our study was to evaluate the impact of basic transthoracic echocardiography in the management of this kind of patients. DESIGN: Over an 18-month period, we prospectively studied all patients admitted to a university hospital Intensive Care Unit following heart surgery. We evaluated clinically all of them to establish a diagnosis and an initial treatment. We performed basic transthoracic echocardiography for a diagnosis evaluation that was compared with clinical diagnosis. If they differed, we assessed to change treatment and evaluate the therapeutic response. We performed a descriptive analysis. RESULTS: We included 136 patients and performed 203 echocardiographies. Transthoracic echocardiography differed of initial diagnosis in 101 (49.8%) echocardiographies. In 56 of these echocardiographies (55.44%), we could give an alternative diagnosis with a change in the treatment in 30patients (53,6%). We found clinical improvement in 26 patients (86.76%) in the following 30-60minutes. CONCLUSIONS: Basic transthoracic echocardiography is useful in diagnostic and therapeutic management of postoperative cardiac surgery patients. We could not confirm the clinical diagnosis in half of the performed echocardiographies. In most patients in whom we observe a change in the diagnosis due to echocardiography, we observed a clinical improvement after changing the treatment.

Evaluation of intensivist basic training in transthoracic echocardiography in the postoperative period of heart surgery / Evaluación de la formación de intensivistas en ecocardiografía transtorácica básica en el postoperatorio de cirugía cardíaca

Background: Transthoracic echocardiography can significantly change the management of many critical patients, and is being incorporated into many Intensive Care Units (ICU). Very few studies have examined the feasibility and impact of intensivists performing basic transthoracic echocardiography upon the management of critical patients after cardiac surgery. The present study therefore evaluates the quality of acquisition and accuracy of intensivist interpretation of basic transthoracic echocardiograms in the postoperative period of heart surgery. Methods: Over an 8-month period we prospectively studied 148 patients within 24h after admission to a university hospital ICU following heart surgery. We performed basic transthoracic echocardiography to evaluate ventricular function, pericardial effusion, hypovolemia and mitral regurgitation. Cohen's Kappa was used to compare transthoracic echocardiograms obtained by intensivists with basic versus advanced training. Concordance on image acquisition and interpretation was evaluated. Results: We analyzed data of adequate transthoracic echocardiograms in 148 patients (92.5%). Apical four-chamber view and advanced trainees obtained better quality images. Concordance was good for right and left ventricular function (kappa=0.7±0.14 and 0.87±0.05, respectively), and moderate for the remaining parameters. Interpretation concordance between basic and advanced training intensivists was good (kappa=0.73±0.05). Conclusions: Intensivists with basic training in echocardiography are capable of performing and interpreting echocardiograms in most patients during the postoperative period of heart surgery

Objetivo: La ecocardiografía transtorácica puede cambiar significativamente el manejo en muchos pacientes críticos y se está incorporando dentro de muchas unidades de cuidados intensivos (UCI). Pocos estudios han examinado la factibilidad y el impacto de la ecocardiografía transtorácica básica realizada por intensivistas en el manejo de los pacientes críticos después de una cirugía cardíaca. Por ello, nosotros evaluamos la calidad de adquisición y la precisión en la interpretación de la ecocardiografía básica realizada por intensivistas en los pacientes postoperados de cirugía cardíaca. Métodos: Durante 8 meses, estudiamos prospectivamente 148 pacientes postoperados de cirugía cardíaca dentro de las primeras 24h de ingreso en una UCI de un hospital universitario. Realizamos una ecocardiografía transtorácica básica para evaluar función ventricular, líquido pericárdico, hipovolemia y regurgitación mitral. Utilizamos el coeficiente kappa de Cohen para comparar las ecocardiografías transtorácicas realizadas por los intensivistas con formación básica versus avanzada. Evaluamos la concordancia en la adquisición de imágenes y su interpretación. Resultados: Analizamos los datos de las ecocardiografías transtorácicas de 148 pacientes (92,5%). La visión apical cuatro-cámaras y los intensivistas con formación avanzada obtuvieron mayor calidad de imagen. La concordancia fue buena para la función ventricular derecha e izquierda (kappa=0,7±0,14 y 0,87±0,05, respectivamente), y moderada para el resto de parámetros. La concordancia de la interpretación entre los intensivistas con formación básica y avanzada fue buena (kappa=0,73±0,05). Conclusiones: Los intensivistas formados en ecocardiografía transtorácica básica son capaces de obtener e interpretar las ecocardiografías en la mayoría de postoperados programados de cirugía cardíaca

Análisis del escenario microscópico de una biopsia prostática negativa como predictor del riesgo de cáncer de próstata. Una revisión sistemática / In Search for risk predictors at the microscopic scenario of a negative biopsy. A systematic review

Introducción: Las biopsias prostáticas (BP) de repetición, ante la persistencia de la sospecha de cáncer de próstata (CP), son frecuentes y su rendimiento bajo. En el contexto de una BP negativa existe un escenario microscópico (EM), que definimos como el conjunto de lesiones no neoplásicas identificable. La existencia de algunas de estas lesiones incrementa el riesgo de detección de CP en BP sucesivas, mientras que otras parecen tener un efecto protector. El objetivo de esta revisión sistemática es identificar el conjunto de lesiones que puede formar parte del EM de una BP negativa y analizar la evidencia actual de su asociación con el riesgo de detección de CP en BP sucesivas. Adquisición de la evidencia: Dos revisores independientes realizaron una búsqueda bibliográfica en Medline, Embase y Central Cochrane, con los términos de búsqueda: small acinar proliferation or ASAP or prostatic intraepithelial neoplasia or HGPIN or adjacent small atypical glands or pinatyp or atrophy or proliferative inflammatory atrophy or pia or prostatic inflammation or prostatitis and prostate cancer. Se identificaron 1.015 referencias y siguiendo los principios de la declaración PRISMA y de selección PICO, se identificaron 57 artículos originales válidos para esta revisión. Síntesis de la evidencia: La proliferación acinar atípica de célula pequeña se asocia a una tasa de detección de CP en BP sucesivas que oscila entre el 32 y 48%. La neoplasia intraepitelial prostática de alto grado (HGPIN) se asocia a CP entre el 13 y 42%, siendo su multifocalidad la que define el incremento en el riesgo de detección. La atrofia prostática, la atrofia proliferativa inflamatoria y la infamación prostática parecen tener un efecto protector sobre la detección de CP en BP sucesivas. Por otra parte, el riesgo de detección de CP en varones con HGPIN multifocal se reduce significativamente si coexiste atrofia proliferativa inflamatoria. Conclusiones: El EM de una BP negativa puede estar compuesto por las lesiones de proliferación acinar atípica de célula pequeña, HGPIN, atrofia prostática, atrofia proliferativa inflamatoria e infamación prostática ya que todas parecen estar asociadas al riesgo de detección de CP en BP sucesivas. Esta revisión nos permite generar la hipótesis de que el EM de una BP negativa puede ser de utilidad en la decisión indicar BP de repetición

Introduction: In cases of persistent suspicion of prostate cancer (PC), repeat prostate biopsies (PB) are frequently performed in spite of their low yield. In the context of a negative PB, there is a microscopic scenario (MS), which we define as the group of recognizable non-neoplastic lesions. While some of these lesions seem to have a protective effect, the existence of others increases the risk of PC detection in posterior PB. The objective of this systematic review is to identify the lesions that may belong to the MS of a negative PB and analyse the current evidence of their association with the risk of detecting PC in subsequent PBs. Evidence acquisition: Two independent reviewers conducted a literature search on Medline, Embase and Central Cochrane with the following search terms: small acinar proliferation, ASAP, prostatic intraepithelial neoplasia, HGPIN, adjacent small atypical glands, pinatyp, atrophy, proliferative inflammatory atrophy, pia, prostatic inflammation, prostatitis and prostate cancer. 1,015 references were first identified, and 57 original articles were included in the study, following the PRISMA declaration and the PICO selection principles. Evidence synthesis: Atypical small acinar proliferation is associated with PC detection in repeat PB with rates ranging between 32 and 48%. High-grade prostatic intraepithelial neoplasia (HGPIN) is related to PC in 13 to 42% of cases. Studies show that HGPIN, when multifocal, is a significant independent risk factor for PC. Prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation seem to act as protective factors on the detection of PC in repeat PB. On the other hand, the risk of PC detection reduces significantly in male patients with multifocal HGPIN and coexistent PIA. Conclusions: The MS of a negative PB may include atypical small acinar proliferation, HGPIN, prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation lesions, since they all seem to be associated with the risk of PC detection in repeat PB. This review has led us to create the hypothesis that the MS of a negative PB might be a valuable and useful tool when considering repeat PB

In Search for risk predictors at the microscopic scenario of a negative biopsy. A systematic review. / Análisis del escenario microscópico de una biopsia prostática negativa como predictor del riesgo de cáncer de próstata. Una revisión sistemática.

INTRODUCTION: In cases of persistent suspicion of prostate cancer (PC), repeat prostate biopsies (PB) are frequently performed in spite of their low yield. In the context of a negative PB, there is a microscopic scenario (MS), which we define as the group of recognizable non-neoplastic lesions. While some of these lesions seem to have a protective effect, the existence of others increases the risk of PC detection in posterior PB. The objective of this systematic review is to identify the lesions that may belong to the MS of a negative PB and analyse the current evidence of their association with the risk of detecting PC in subsequent PBs. EVIDENCE ACQUISITION: Two independent reviewers conducted a literature search on Medline, Embase and Central Cochrane with the following search terms: small acinar proliferation, ASAP, prostatic intraepithelial neoplasia, HGPIN, adjacent small atypical glands, pinatyp, atrophy, proliferative inflammatory atrophy, pia, prostatic inflammation, prostatitis and prostate cancer. 1,015 references were first identified, and 57 original articles were included in the study, following the PRISMA declaration and the PICO selection principles. EVIDENCE SYNTHESIS: Atypical small acinar proliferation is associated with PC detection in repeat PB with rates ranging between 32 and 48%. High-grade prostatic intraepithelial neoplasia (HGPIN) is related to PC in 13 to 42% of cases. Studies show that HGPIN, when multifocal, is a significant independent risk factor for PC. Prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation seem to act as protective factors on the detection of PC in repeat PB. On the other hand, the risk of PC detection reduces significantly in male patients with multifocal HGPIN and coexistent PIA. CONCLUSIONS: The MS of a negative PB may include atypical small acinar proliferation, HGPIN, prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation lesions, since they all seem to be associated with the risk of PC detection in repeat PB. This review has led us to create the hypothesis that the MS of a negative PB might be a valuable and useful tool when considering repeat PB.

Evaluation of intensivist basic training in transthoracic echocardiography in the postoperative period of heart surgery.

BACKGROUND: Transthoracic echocardiography can significantly change the management of many critical patients, and is being incorporated into many Intensive Care Units (ICU). Very few studies have examined the feasibility and impact of intensivists performing basic transthoracic echocardiography upon the management of critical patients after cardiac surgery. The present study therefore evaluates the quality of acquisition and accuracy of intensivist interpretation of basic transthoracic echocardiograms in the postoperative period of heart surgery. METHODS: Over an 8-month period we prospectively studied 148 patients within 24h after admission to a university hospital ICU following heart surgery. We performed basic transthoracic echocardiography to evaluate ventricular function, pericardial effusion, hypovolemia and mitral regurgitation. Cohen's Kappa was used to compare transthoracic echocardiograms obtained by intensivists with basic versus advanced training. Concordance on image acquisition and interpretation was evaluated. RESULTS: We analyzed data of adequate transthoracic echocardiograms in 148 patients (92.5%). Apical four-chamber view and advanced trainees obtained better quality images. Concordance was good for right and left ventricular function (kappa=0.7±0.14 and 0.87±0.05, respectively), and moderate for the remaining parameters. Interpretation concordance between basic and advanced training intensivists was good (kappa=0.73±0.05). CONCLUSIONS: Intensivists with basic training in echocardiography are capable of performing and interpreting echocardiograms in most patients during the postoperative period of heart surgery.

DISEÑO DE UNA PLATAFORMA INTEROPERABLE PARA UN OBSERVATORIO DE HÁBITOS Y ESTILOS DE VIDA SALUDABLE / DESIGN OF A INTEROPERABLE OBSERVATORY PLATFORM FOR HABITS ANDHEALTHY LIFESTYLES / CONCEPÇÃO DE UMA PLATAFORMA INTEROPERÁVEL PARA UM OBSERVATÓRIO HÁBITOS E ESTILOS DE VIDA SAUDÁVEIS

Esta investigación muestra el diseño de una plataforma interoperable que hace uso del estándar HL7 (Health Level Seven) y permite el registro y análisis de datos relacionados con estilos de vida saludable y prácticas de actividad física en adultos y adultos mayores de las zonas rurales de Colombia. El proyecto se centra en la utilización de las TIC para generar un sistema interoperable que permita la consolidación de los datos, con el fin de facilitar cifras epidemiológicas, hacer diagnósticos que permitan generar estrategias de promoción de la salud y prevención de la enfermedad en las que se promueva la actividad física; y consolidar un marco de referencia para las entidades interesadas. Esta plataforma provee un servicio de integración que puede ser utilizado por entidades externas, compartiendo así información relacionada con hábitos y estilos de vida saludables. Dicha plataforma, utiliza tecnología web ASP.net, con un modelo arquitectural MVC (Modelo Vista Controlador), lenguaje C#, un motor de base de datos SQLServer y servicios web a nivel de integración que usa HL7 como estándar de intercambio de mensajes. Se generó una prueba de control realizada en el año 2014, en ocho municipios del departamento de Cundinamarca en los cuales se aplicaron 304 instrumentos, con los cuales se alimentó la plataforma.

This research shows the design of an interoperable platform that uses the HL7 standard (Health Level Seven) and allows the record and analysis of data related to healthy lifestyles and practices of physical activity in adults and older adults in rural areas of Colombia. The project focuses on the use of ICT to generate an interoperable system that allows the consolidation of data, in order to facilitate epidemiological records, make diagnoses that generate strategies for health promotion and disease prevention in which promote physical activity; and build a framework for stakeholders. This platform provides an integration service that can be used by external entities, to reporting information related to habits and healthy lifestyles. This platform uses web ASP.net technology with architectural model MVC (Model View Controller), C # language, a database SQLServer motor and web services to integration with HL7 standard for the exchange of information. Was performed a control test in to 2014, in eight municipalities of the department of Cundinamarca in which 304 instruments were applied to upload to the platform.

Esta pesquisa mostra o desenho de uma plataforma interoperável que usa o HL7 (Health Level Seven) padrão e permite a gravação e análise de dados relacionados com os estilos de vida saudáveis e prática de atividade física em adultos e idosos nas zonas rurais da Colômbia. O projecto centra-se na utilização das TIC para gerar um sistema de interoperabilidade que permite a consolidação de dados, a fim de facilitar números epidemiológicos, fazer diagnósticos que podem gerar estratégias para promover a saúde e prevenção de doença em que promoção da atividade física; e construir uma estrutura para as partes interessadas. Esta plataforma fornece um serviço de integração que pode ser usado por entidades externas, a partilha de informações relacionadas a hábitos e estilos de vida saudáveis. Esta plataforma, utilizando a tecnologia web ASP.net com um padrão de arquitetura MVC (Model View Controller), a linguagem C#, banco de dados SQLServer do motor e nível de integração de serviços web usando a troca de mensagens HL7 padrão. Um teste de controle realizado em 2014, em oito municípios de Cundinamarca em que foram aplicados 304 instrumentos, com os quais a plataforma foi alimentado foi gerado.