Straightforward Synthesis of Bis[(trifluoromethyl)sulfonyl]ethylated Isocoumarins from 2-Ethynylbenzoates.

Herein, we report a facile isocoumarin and isoquinolone preparation by taking advantage of an initial bis(triflyl)ethylation [triflyl = (trifluoromethyl)sulfonyl] reaction, followed by heterocyclization, which contrasts with our previous results on cyclobutene formation. The efficiency of the catalyst- and irradiation-free heterocyclization/bis(triflyl)ethylation sequence showed exquisite dependence on the electronic nature of the substituents at the 2-ethynylbenzoate(benzamide) precursors. Molecular docking of model bis(triflyl)ethylated isocoumarins on human acetylcholinesterase (hAChE) revealed promising biological activities through selective coordination on both the catalytic active site and peripheral active site.

Carcinoma papilar tiroideo con invasión locorregional: reporte de caso / Papillary thyroid crcinoma with locoregional invasion: case report

El cáncer diferenciado de tiroides incluye el tipo papilar y folicular que representan más del 80% de los casos y tienen un excelente pronóstico. Existen varios subtipos histológicos y las variantes foliculares son probablemente las más comunes. La incidencia de cáncer papilar variante folicular ha ido en aumento. En un reporte de un solo centro, cerca del 40% de los cánceres papilares eran variantes foliculares1. El subtipo infiltrativo de la variante folicular presenta sectores que invaden el parénquima tiroideo no neoplásico y carece de una cápsula tumoral bien definida. Tiene un comportamiento biológico y un perfil molecular que es más similar al tumor papilar clásico2. Existen características clínicas y patológicas asociadas con riesgo más alto de recurrencia tumoral y mortalidad; entre ellos se describen el tamaño del tumor primario y la presencia de invasión de tejidos blandos3. En la invasión de estructuras adyacentes, los sitios más comprometidos incluyen los músculos pretiroideos, el nervio laríngeo recurrente, el esófago, la faringe, laringe y la tráquea. Además, puede haber otras estructuras involucradas como: la vena yugular interna, la arteria carótida y los nervios vago, frénico y espinal4. El compromiso de los ganglios linfáticos y la incidencia de metástasis ganglionares en adultos depende de la extensión de la cirugía. Entre los que se realizan una disección radical modificada del cuello, hasta el 80% tienen metástasis en los ganglios linfáticos y el 50% de ellas son microscópicas5. Clínicamente los tumores localmente avanzados cursan con disfonía, disfagia, disnea, tos o hemoptisis, pero la ausencia de síntomas no descarta la invasión local. Según las guías de la American Thyroid Association6 son variables de mal pronóstico: la edad del paciente, el tamaño del tumor primario, la extensión extra tiroidea y la resección quirúrgica incompleta.

Differentiated thyroid cancer includes papillary and follicular types that represent more than 80% of cases and have an excellent prognosis. There are several histologic subtypes, and follicular variants are probably the most common. The incidence of papillary follicular variant cancer has been increasing. In a singlecenter report, about 40% of papillary cancers were follicular variants1. The infiltrative subtype of the follicular variant presents sectors that invade the non-neoplastic thyroid parenchyma and lacks a well-defined tumor capsule. It has a biological behavior and a molecular profile that is more similar to the classic papillary tumor2. There are clinical and pathological characteristics associated with a higher risk of tumor recurrence and mortality; These include the size of the primary tumor and the presence of soft tissue invasion3. In the invasion of adjacent structures, the most compromised sites include the pre-thyroid muscles, the recurrent laryngeal nerve, the esophagus, the pharynx, larynx and trachea. In addition, there may be other structures involved such as: the internal jugular vein, the carotid artery and the vagus, phrenic and spinal nerves4. The involvement of the lymph nodes and the incidence of lymph node metastases in adults depends on the extent of the surgery. Among those who undergo a modified radical neck dissection, up to 80% have lymph node metastases and 50% of them are microscopic5. Clinically locally advanced tumors present with dysphonia, dysphagia, dyspnea, cough, or hemoptysis, but the absence of symptoms does not rule out local invasion. According to the American Thyroid Association guidelines6, there are variables with a poor prognosis: the age of the patient, the size of the primary tumor, the extra-thyroid extension, and incomplete surgical resection.

Depression in Alzheimer's Disease: A Delphi Consensus on Etiology, Risk Factors, and Clinical Management.

Background: Alzheimer's disease (AD) and other forms of dementia are among the most common causes of disability in the elderly. Dementia is often accompanied by depression, but specific diagnostic criteria and treatment approaches are still lacking. This study aimed to gather expert opinions on dementia and depressed patient management to reduce heterogeneity in everyday practice. Methods: Prospective, multicenter, 2-round Modified Delphi survey with 53 questions regarding risk factors (11), signs and symptoms (7), diagnosis (8), and treatment (27) of depression in dementia, with a particular focus on AD. The questionnaire was completed by a panel of 37 expert physicians in neurodegenerative diseases (19 neurologists, 17 psychiatrists, and 1 geriatrician). Results: Consensus was achieved in 40 (75.5%) of the items: agreement in 33 (62.3%) and disagreement in 7 (13.2%) of them. Among the most relevant findings, depression in the elderly was considered an early sign (prodromal) and/or a dementia risk factor, so routine cognitive check-ups in depressed patients should be adopted, aided by clinical scales and information from relatives. Careful interpretation of neuropsychological assessment must be carried out in patients with depression as it can undermine cognitive outcomes. As agreed, depression in early AD is characterized by somatic symptoms and can be differentiated from apathy by the presence of sadness, depressive thoughts and early-morning awakening. In later-phases, symptoms of depression would include sleep-wake cycle reversal, aggressive behavior, and agitation. Regardless of the stage of dementia, depression would accelerate its course, whereas antidepressants would have the opposite effect. Those that improve cognitive function and/or have a dual or multimodal mode of action were preferred: Duloxetine, venlafaxine/desvenlafaxine, vortioxetine, tianeptine, and mirtazapine. Although antidepressants may be less effective than in cognitively healthy patients, neither dosage nor treatment duration should differ. Anti-dementia cholinesterase inhibitors may have a synergistic effect with antidepressants. Exercise and psychological interventions should not be applied alone before any pharmacological treatment, yet they do play a part in improving depressive symptoms in demented patients. Conclusions: This study sheds light on several unresolved clinical challenges regarding depression in dementia patients. Further studies and specific recommendations for this comorbid patient population are still needed.

Focus on Depression in Parkinson's Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics.

Major and minor forms of depression are significant contributors to Parkinson's disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently, consistent clinical guideline recommendations. Here, we carried out a prospective, multicentre, 2-round modified Delphi survey with 49 questions about the aetiopathological mechanisms of depression in Parkinson's disease (10), clinical features and connections with motor and nonmotor symptoms (10), diagnostic criteria (5), and therapeutic options (24). Items were assessed by a panel of 37 experts (neurologists, psychiatrists, and a geriatrist), and consensus was achieved in 81.6% of them. Depressive symptoms, enhanced by multiple patient circumstances, were considered Parkinson's disease risk factors but not clinical indicators of motor symptom and disease progression. These patients should be systematically screened for depression while ruling out both anhedonia and apathy symptoms as they are not necessarily linked to it. Clinical scales (mainly the Geriatric Depression Scale GDS-15) can help establishing the diagnosis of depression, the symptoms of which will require treatment regardless of severity. Efficacious and well-tolerated pharmacological options for Parkinson's comorbid depression were selective serotonin reuptake inhibitors (especially sertraline), dual-action serotonin and norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine, and duloxetine), multimodal (vortioxetine, bupropion, mirtazapine, and tianeptine), and anti-Parkinsonian dopamine agonists (pramipexole, ropinirole, and rotigotine). Tricyclic antidepressants and combining type B monoamine oxidase inhibitors with serotonergic drugs have serious side effects in these patients and therefore should not be prescribed. Electroconvulsive therapy was indicated for severe and drug-refractory cases. Cognitive behavioural therapy was recommended in cases of mild depression. Results presented here are useful diagnostic and patient management guidance for other physicians and important considerations to improve future drug trial design.

Evaluation of nutrients removal (NO3-N, NH3-N and PO4-P) with Chlorella vulgaris, Pseudomonas putida, Bacillus cereus and a consortium of these microorganisms in the treatment of wastewater effluents.

In this research removal of NH3-N, NO3-N and PO4-P nutrients from municipal wastewater was studied, using Chlorella vulgaris, Pseudomonas putida, Bacillus cereus and an artificial consortium of them. The objective is to analyze the performance of these microorganisms and their consortium, which has not been previously studied for nutrient removal in municipal wastewater. A model wastewater was prepared simulating the physicochemical characteristics found at the wastewater plant in Chapala, Mexico. Experiments were carried out without adding an external carbon source. Results indicate that nutrient removal with Chlorella vulgaris was the most efficient with a removal of 24.03% of NO3-N, 80.62% of NH3-N and 4.30% of PO4-P. With Bacillus cereus the results were 8.40% of NO3-N, 28.80% of NH3-N and 3.80% of PO4-P. The removals with Pseudomonas putida were 2.50% of NO3-N, 41.80 of NH3-N and 4.30% of PO4-P. The consortium of Chlorella vulgaris-Bacillus cereus-Pseudomonas putida removed 29.40% of NO3-N, 4.2% of NH3-N and 8.4% of PO4-P. The highest biomass production was with Bacillus cereus (450 mg/l) followed by Pseudomonas putida (444 mg/l), the consortium (205 mg/l) and Chlorella vulgaris (88.9 mg/l). This study highlights the utility of these microorganisms for nutrient removal in wastewater treatments.

Influence of the Cation Adducts in the Analysis of Matrix-Assisted Laser Desorption Ionization Imaging Mass Spectrometry Data from Injury Models of Rat Spinal Cord.

Imaging mass spectrometry (IMS) is quickly becoming a technique of reference to visualize the lipid distribution in tissue sections. Still, many questions remain open, and data analysis has to be optimized to avoid interpretation pitfalls. Here we analyze how the variation on the [Na+]/[K+] relative abundance affects the detection of lipids between sections of spinal cord of (uninjured) control rats and of models of spinal cord demyelination and traumatic contusion injury. The [M + Na]+/[M + K]+ adducts ratio remained approximately constant along transversal and longitudinal sections of spinal cord from control animals, but it strongly changed depending on the type of lesion. A substantial increase in the abundance of [M + Na]+ adducts was observed in samples from spinal cord with demyelination, while the intensity of the [M + K]+ adducts was stronger in those sections from mechanically injured spinal cords. Such changes masked the modifications in the lipid profile due to the injury and only after summing the signal intensity of all adducts and corresponding monoprotonated molecular ions of each detected lipid in a single variable, it was possible to unveil the real changes in the lipid profile due to the lesion. Such lipids included glycerophospholipids (both diacyl and aryl-acyl), sphingolipids, and nonpolar lipids (diacyl and triacylglycerols), which are the main lipid classes detected in positive-ion mode. Furthermore, the results demonstrate the sensitivity of the technique toward modification in tissue homeostasis and that the [M + Na]+/[M + K]+ ratio may be used to detect alterations in such homeostasis.

[Cardiac surgery in the elderly: comparison of medium-term clinical outcomes in octogenarians and the elderly from 75 to 79 years]. / Cirugía cardiaca en el anciano: comparación de resultados a medio plazo entre octogenarios y ancianos de 75 a 79 años.

INTRODUCTION AND OBJECTIVES: The age of patients undergoing cardiac surgery has increased in recent years. Our aims were to investigate the medium-term clinical outcomes of surgery in octogenarians and to compare them with outcomes in other elderly individuals of a less advanced age. METHODS: We investigated early mortality, the incidence of postoperative complications, medium-term survival and factors associated with these parameters in 589 consecutive elderly patients undergoing surgery: 140 were octogenarians aged 80-87 years (group I) while 449 were aged between 75 and 79 years (group II). RESULTS: The two groups were similar. There was no difference in mortality (10.0% in group I vs. 10.9% in group II) or in the incidence of postoperative complications (22% in group I vs. 30% in group II). Emergency surgery, combined surgery and pulmonary hypertension were all independent predictors of mortality and of major postoperative complications. The 5-year survival rate was 79% in group I and 65% in group II (P=.832) and the cardiac event-free survival rate was 75% in group I and 64% in group II (P=.959). Overall, 97% of patients in both groups were in functional class I or II. The additive EuroSCORE and preoperative atrial fibrillation were both associated with increased mortality during follow-up. Being an octogenarian was not a predictor (hazard ratio=0.78; 95% confidence interval, 0.51-1.21; P=.373). CONCLUSIONS: In selected octogenarians, cardiac surgery gives similar results to those obtained in other elderly individuals of a less advanced age. The medium-term survival rate and quality of life are good. Pulmonary hypertension, emergency surgery and combined surgery all increased risk in these patients.

Cirugía cardiaca en el anciano: comparación de resultados a medio plazo entre octogenarios y ancianos de 75 a 79 años / Cardiac Surgery in the Elderly: Comparison of Medium-Term Clinical Outcomes in Octogenarians and the Elderly From 75 to 79 Years

Introducción y objetivos. La edad de los pacientessometidos a cirugía cardiaca se ha incrementado en losúltimos años. Pretendemos conocer los resultados a medioplazo de la cirugía en octogenarios, comparándoloscon los de otros ancianos de menos edad.Métodos. Analizamos la mortalidad precoz, la incidenciade complicaciones postoperatorias, la supervivencia amedio plazo y los factores asociados a éstas de 589 ancianos consecutivos sometidos a cirugía: 140 octogenarios entre 80 y 87 años (grupo I) y 449 entre 75 y 70 años (grupo II).Resultados. Ambos grupos fueron homogéneos. Nohubo diferencias en la mortalidad (I, 10%; II, 10,9%) e incidencia de complicaciones postoperatorias (I, 22%; II,30%). La cirugía de emergencia, la combinada y la hipertensión pulmonar se asociaron de manera independiente a la mortalidad y al desarrollo de complicaciones mayores. La supervivencia a 5 años fue del 79% (I) y el 65% (II) (p = 0,832) y la supervivencia libre de evento cardiaco fue del 75% (I) y el 64% (II) respectivamente (p = 0,959). El 97% de los pacientes de ambos grupos se encontraban en clase funcional I-II. El EuroSCORE aditivo y la fibrilaciónauricular preoperatoria se asociaron a una mayormortalidad en el seguimiento. Ser octogenario no fuepredictor (hazard ratio = 0,78; intervalo de confianza del 95%, 0,51-1,21; p = 0,373).Conclusiones. La cirugía cardiaca en octogenarios seleccionados ofrece resultados similares a los de otros ancianos más jóvenes, con una buena supervivencia y calidad de vida a medio plazo. La hipertensión pulmonar, la cirugía de emergencia y la combinada conllevan un riesgo elevado en estos pacientes

Introduction and objectives. The age of patientsundergoing cardiac surgery has increased in recentyears. Our aims were to investigate the medium-termclinical outcomes of surgery in octogenarians and tocompare them with outcomes in other elderly individualsof a less advanced age.Methods. We investigated early mortality, the incidenceof postoperative complications, medium-term survival andfactors associated with these parameters in 589consecutive elderly patients undergoing surgery: 140were octogenarians aged 80-87 years (group I) while 449were aged between 75 and 79 years (group II).Results. The two groups were similar. There was nodifference in mortality (10.0% in group I vs. 10.9% in group II) or in the incidence of postoperative complications (22% in group I vs. 30% in group II). Emergency surgery, combined surgery and pulmonary hypertension were all independent predictors of mortality and of major postoperative complications. The 5-year survival rate was 79% in group I and 65% in group II (P=.832) and the cardiac event-free survival rate was 75% in group I and 64% in group II (P=.959). Overall, 97% of patients in both groups were in functional class I or II. The additive EuroSCORE and preoperative atrial fibrillation were both associated with increased mortality during follow-up. Being an octogenarian was not a predictor (hazard ratio=0.78; 95% confidence interval, 0.51—1.21; P=.373).Conclusions. In selected octogenarians, cardiacsurgery gives similar results to those obtained in otherelderly individuals of a less advanced age. The mediumterm survival rate and quality of life are good. Pulmonary hypertension, emergency surgery and combined surgery all increased risk in these patients

[The placenta, from a residue to a treasure]. / La placenta de residuo a tesoro.

Midwifes are the ones in charge of the procedure to obtain a blood donation from the umbilical cord, a procedure which consists of informing mothers what the advantages and inconveniences of such a donation are, filling out the file for the blood bank, extracting the blood donation, and completing the patient's records for the pediatrician. In Spain, the Spanish Register of Bone Marrow Donors (REDMO in Spanish acronym) is the organization in charge of internal coordination and in conjunction with other countries, the bone marrow and umbilical cord blood donations. Every pregnant woman in good health who does not meet the criteria for being excluded as a donor by the umbilical cord blood banks is considered to be a possible umbilical cord blood donor. Once an umbilical cord blood donation is extracted, the donation is stored, identified, processed and revised so that it can be sent to the blood bank designated for the hospital and, once there, when the opportune moment arrives, to the place where there is a compatible receiver At the present time, the number of donations of umbilical cord blood is increasing; but on the list of reasons to not donate there appears, to a high degree, the lack of knowledge about this type of donation among pregnant women. Therefore, health professionals role to inform pregnant women about umbilical cord blood donations is important.

La placenta, de residuo a tesoro / The placenta, from a residue to a treasure

Las matronas son las encargadas delprocedimiento para obtener la donaciónde sangre de cordón umbilical, queconsiste en informar a la madre de lasventajas e inconvenientes de la donación,realizar el informe para el bancode sangre, efectuar la técnica de extracción,y cumplimentar los registros espedficospara el pediatra. En España, elREDMO (Registro Español de Donantesde Médula Ósea) se encarga de la coordinacióninterna y, junto a otros países,de las donaciones de médula ósea ysangre de cordón umbilical.Se considera posible donante deesta última a toda gestante sana que nocumpla los criterios de exclusión dictadospor los bancos de sangre de cordónumbilical. Tras su recogida es almacenada,identificada, procesada y revisadapara que pueda mandarse al Banco deSangre asignado al Hospital, y desdealli, llegado el momento, al lugar dondeexista un receptor compatible.En la actualidad el número de donacionesestá aumentado, pero dentro de las causas de no donación aparece, engran medida, el desconocimiento dedicha posibilidad por parte de las gestantes.Por tanto, es importante la laborinformativa de los profesionales sanitariosal respecto

Midwifes are the ones in charge of theprocedure to obtain a blood donationfrom the umbilical cord, a procedurewhich consists of informing motherswhat the advantages and inconveniencesof such a donation are, filling outthe file for the blood bank, extractingthe blood donation, and completing thepatient's records for the pediatrician.In Spain, the Spanish Register ofBone Marrow Donors (REDMO inSpanish acronym) is the organization incharge of internal coordination andin conjunction with other countries, thebone marrow and umbilical cord blooddonations. Every pregnant woman in goodhealth who does not meet the criteriafor being excluded as a donor by theumbilical cord blood banks is consideredto be a possible umbilical cordblood' donor: Once an umbilicalcord blood donation is extracted, thedonation is stored, identified, processedand revised so that it can be sent tothe blood bank designated for the hospitaland, once there, when the opportunemoment arrives, to the placewhere there is a compatible receiver.At the present time, the number ofdonations of umbilical cord blood isincreasing; but on the list of reasons tonot dona te there appears, to a highdegree, the lack of knowledge aboutthis type of donation among pregnantwomen. Therefore, health professionalsrole to inform pregnant womenabout umbilical cord blood donations isimportant

Discordia entre esposos y alteraciones psicopatológicas en sus hijos / Discord between husbands and psychopathological disorders in their children

Se realiza una revisión bibliográfica de la relación existente entre la discordia entre esposos y los trastornos mentales en niños tales como trastorno disocial, depresión y ansiedad. Se tratan las variables que median en dicha relación (AU)

Santa Teresa de Jesús y los cuidados de enfermería / Saint Teresa of Avila and nursing cares

Revisamos los escritos que la insigne mística y escritora del Siglo de Oro Español, Santa Teresa de Jesús, llevó a cabo acerca de la melancolía, dedicando una atención especial a los cuidados de enfermería que la santa preconiza para esta enfermedad mental (AU)