Text mining and word embedding for classification of decision making variables in breast cancer surgery.

INTRODUCTION: Decision making in surgical oncology of the breast has increased its complexity over the last twenty years. This Delphi survey investigates the opinion of an expert panel about the decision making process in surgical procedures on the breast for oncological purposes. METHODS: Twenty-seven experts were invited to partake into a Delphi Survey. At the first round they have been asked to provide a list of features involved in the decision making process (patient's characteristics; disease characteristics; surgical techniques, outcomes) and comment on it. Using text-mining techniques we extracted a list of mono-bi-trigrams potentially representative of decision drivers. A technique of "natural language processing" called Word2vec was used to validate changes to texts using synonyms and plesionyms. Word2Vec was also used to test the semantic relevance of n-grams within a corpus of knowledge made up of books edited by panel members. The final list of variables extracted was submitted to the judgement of the panel for final validation at the second round of the Delphi using closed ended questions. RESULTS: 52 features out of 59 have been approved by the panel. The overall consensus was 87.1% CONCLUSIONS: Text mining and natural language processing allowed the extraction of a number of decision drivers and outcomes as part of the decision making process in surgical oncology on the breast. This result was obtained transforming narrative texts into structured data. The high level of consensus among experts provided validation to this process.

Mecanismos patogénicos de infección por SARS-CoV-2 y enfermedad renal: una perspectiva clínico-molecular / Pathogenic mechanisms of SARS-CoV-2 infection and kidney disease: a clinical and molecular perspective

La infección por SARS-CoV-2 se ha convertido en unproblema mundial de salud pública. Su presentaciónclínica es variada, desde benigna hasta un síndrome dedistrés respiratorio agudo, afectación sistémica y fallomultiorgánico. La severidad del cuadro clínico depen-de de factores biológicos del virus y del huésped y decomorbilidades como la enfermedad renal. Además, lainteracción entre el virus, la enzima convertidora deangiotensina 2 y la respuesta inmunológica exacerbadapodría conducir al desarrollo de lesión renal aguda. Sinembargo, las implicaciones de la infección por SARS-CoV-2 sobre las células renales, las repercusiones pro-nósticas en los pacientes con enfermedad renal crónicay su efecto a largo plazo sobre la función renal no estándel todo claras. El objetivo es revisar el papel del SARS-CoV-2 en la enfermedad renal aguda y crónica, y sus po-sibles mecanismos patogénicos en la afectación renal.

The SARS-CoV-2 infection has become as a worldwidepublic health emergency. It exhibits a variety of clinicalpresentations, ranging from benign to acute respira-tory distress syndrome, systemic involvement, andmultiorganic failure. The severity of the clinical picturedepends on host and virus biological features and thepresence of comorbidities such as chronic kidney dis-ease. In addition, the interaction between the virus,angiotensin-converting enzyme 2, and the exacerbatedimmune response could lead to the development ofacute kidney injury. However, the implications of SARS-CoV-2 infection on renal cells, the prognosis of patientswith chronic kidney disease, and the long-term behav-ior of renal function are not entirely understood. Thisreview aims to explore the role of SARS-CoV-2 in acuteand chronic kidney disease and the possible pathogen-ic mechanisms of renal involvement.(AU)

[Pathogenic mechanisms of SARS-CoV-2 infection and kidney disease: a clinical and molecular perspective].

The SARS-CoV-2 infection has become as a worldwide public health emergency. It exhibits a variety of clinical presentations, ranging from benign to acute respiratory distress syndrome, systemic involvement, and multiorganic failure. The severity of the clinical picture depends on host and virus biological features and the presence of comorbidities such as chronic kidney disease. In addition, the interaction between the virus, angiotensin-converting enzyme 2, and the exacerbated immune response could lead to the development of acute kidney injury. However, the implications of SARS-CoV-2 infection on renal cells, the prognosis of patients with chronic kidney disease, and the long-term behavior of renal function are not entirely understood. This review aims to explore the role of SARS-CoV-2 in acute and chronic kidney disease and the possible pathogenic mechanisms of renal involvement.

Effect of Bacillus-direct-fed microbial on leaky gut, serum peptide YY concentration, bone mineralization, and ammonia excretion in neonatal female turkey poults fed with a rye-based diet.

Rye is high in nonstarch polysaccharides (NSP), a complex carbohydrate which cannot be digested by poultry as they lack the endogenous enzymes to do so. Exogenous carbohydrases must therefore be supplemented to avoid the antinutritional effects associated with a high NSP diet. The objectives of the present study were to evaluate the effects of a rye-based diet with and without supplementation of a Bacillus direct-fed microbial (DFM) on body weight, bone mineralization, and leaky gut, as well as its role on influencing serum concentrations of peptide YY (PPY) and the ammonia concentration in turkey manure. Two independent trials were conducted. In each experiment, day-of-hatch female turkey poults were neck tagged and randomly assigned to either a control rye-based diet or a rye-based diet supplemented with the DFM (n = 25 birds/group). At 10 days-of-age, poults in both groups were administered with an appropriate dose of fluorescein isothiocyanate-dextran (FITC-d) by oral gavage. One hour later, all poults were euthanized. Blood was collected to evaluate serum FITC-d and PPY concentrations. Furthermore, in Trial 2 only, both tibias were removed for assessment of bone parameters, and turkey manure was collected to evaluate physicochemical analysis. In both trials, poults treated with the DFM showed a significant increase (P < 0.05) in body weight and body weight gain as compared with control nontreated poults. Poults that received the DFM also had a significant reduction in serum levels of PPY and FITC-d when compared with control nontreated poults. In Trial 2, turkeys treated with the DFM had a substantial increase in tibia strength, tibia diameter, total ash, calcium, and phosphorus when compared with control nontreated turkeys. Their manure was also shown to have a significant reduction in the concentration of ammonia. This is the first report of a commercial DFM reducing the concentration of this compound in turkey manure. In summary, the results of the present study confirm that turkeys fed with a rye-based diet have a significant increase in gut permeability, a reduced body weight, and decreased bone mineralization when compared with turkeys fed with the DFM. Turkeys that received the rye-based diet supplemented with the Bacillus-DFM also had a significant reduction in the serum concentration of PPY when compared with control turkeys. This finding suggests a possible prebiotic effect of rye, warranting future studies to test this effect. Further studies to evaluate the microbiota diversity, as well as the concentration of ceca short-chain fatty acids, are also necessary to confirm the reliability of PPY as a potential metabolomic biomarker in poultry.

Evaluation of in ovo Bacillus spp. based probiotic administration on horizontal transmission of virulent Escherichia coli in neonatal broiler chickens.

This study evaluated the effect of in ovo Bacillus spp. base probiotic (BBP) administration on hatchability, Gram-negative bacteria (GNB) recovery, performance, and microbiota composition in 2 independent trials using a virulent E. coli seeder challenge model. In each trial, one hundred and eighty 18-day-old embryos were allocated into 1 of 2 groups: Control and treated group (inoculated with 107 BBP). On day 19 of embryogenesis, seeder embryos (n = 18) were inoculated with 4.5 × 104E. coli/mL+272 µg/mL tetracycline and segregated into mesh hatching bags. Twelve chicks per group were euthanized at hatch and at day 7 to evaluate the gastrointestinal composition of total GNB or total aerobic pasteurized bacteria. Also, in trial 2, ceca content from five chickens at day 7 were collected to evaluate microbiota composition. Embryos inoculated with BBP showed a significant (P < 0.05) reduction in the total number of GNB at day-of-hatch (DOH) and day 7. Probiotic treatment increased BW at DOH and day 7, and BW gain (days 0 to 7) when compared with Control chickens. Proteobacteria phylum was significantly reduced, while the Firmicutes was significantly increased by the BBP as compared to the Control (P < 0.05). At family level, Enterobacteriaceae was significantly decreased, while the Lachnospiraceae was significantly elevated in the BBP as compared to the Control group (P < 0.05). The genus Oscillospira was significantly enriched in the BBP group, whereas the unidentified genus of family Enterobacteriaceae in the Control group (P < 0.05). The BBP group increased the bacterial species richness, although there was no significant difference between treatments (P > 0.05). Interestingly, beta diversity showed a significant difference in bacterial community structure between Control and BBP groups (P < 0.05). The results of the present study suggest that in ovo administration of a BBP can reduce the severity of virulent E. coli horizontal transmission and infection of broiler chickens during hatch. The reduction in the severity of the transmission and infection by the BPP might be achieved through alterations of microbiota composition and its community structure.

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy.

BACKGROUND: Conflicting evidence challenges clinical decision-making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. METHODS: Studies on radiotherapy and breast reconstruction (1985 to September 2017) were screened using MEDLINE, Embase and CENTRAL. The literature review yielded 30 controversial key questions. A set of key statements was derived and the highest levels of clinical evidence (LoE) for each of these were summarized. Nineteen panellists convened for dedicated discussions at the International Oncoplastic Breast Surgery Meeting to express agreement, disagreement or abstention for the generated key statements. RESULTS: The literature review identified 1522 peer-reviewed publications. A list of 22 key statements was produced, with the highest LoE recorded for each statement. These ranged from II to IV, with most statements (11 of 22, 50 per cent) supported by LoE III. There was full consensus for nine (41 per cent) of the 22 key statements, and more than 75 per cent agreement was reached for half (11 of 22). CONCLUSION: Poor evidence exists on which to base patient-informed consent. Low-quality studies are conflicting with wide-ranging treatment options, precluding expert consensus regarding optimal type and timing of breast reconstruction in the context of radiotherapy. There is a need for high-quality evidence from prospective registries and randomized trials in this field.

ANTECEDENTES: El hecho de que la evidencia disponible sea conflictiva supone un reto para la toma de decisiones a la hora de considerar la reconstrucción mamaria en el contexto de radioterapia (radiotherapy, RT). En el seno de un panel de expertos reunidos durante el International Oncoplastic Breast Surgery Meeting celebrado en Milán en 2017, se revisó la literatura disponible y se generaron y discutieron los aspectos más relevantes. MÉTODOS: Se hizo una búsqueda bibliográfica de los estudios de RT y reconstrucción mamaria (1985-septiembre de 2017) en las bases MEDLINE, EMBASE y CENTRAL. La revisión de la literatura permitió identificar 30 cuestiones clave controvertidas. A partir de ellas, se construyeron una serie de afirmaciones, para las que se obtuvo el mayor nivel de evidencia (levels of clinical evidence, LoE) posible. El acuerdo, desacuerdo o abstención respecto a las cuestiones propuestas fueron el resultado de las discusiones de 19 expertos reunidos durante el International Oncoplastic Breast Surgery Meeting. RESULTADOS: Se identificaron 1.522 artículos publicados en revistas con peer review. Se elaboró una lista de 22 afirmaciones clave y se anotó el LoE más alto obtenido para cada una de ellas. El grado de variabilidad fue de II a IV, pero la mayoría de las afirmaciones (54,5%) obtuvieron un LoE III. Hubo un consenso total en el 41% (9/22) de las afirmaciones, mientras que se obtuvo más de un 75% de acuerdo en la mitad de las afirmaciones (11/22). CONCLUSIÓN: La evidencia en la que basar el consentimiento informado en estos pacientes es escasa. Se trata de estudios de baja calidad con gran variedad de opciones terapéuticas, que dificultan el consenso de los expertos acerca del tipo y momento óptimo para la reconstrucción mamaria en el contexto de RT. Para obtener datos de mayor calidad se precisan estudios prospectivos y ensayos clínicos en este campo.

Open-Label Clinical Trials of Oral Pulse Dexamethasone for Adults with Idiopathic Nephrotic Syndrome.

BACKGROUND: In adults with primary focal segmental glomerulosclerosis (FSGS), daily prednisone may induce complete remissions (CR) and partial remissions (PR), but relapses are frequent and adverse events are common. METHODS: We carried out 2 open-label, uncontrolled trials to explore the efficacy and tolerability of pulse oral dexamethasone as an alternative to daily prednisone. We enrolled adult patients with proteinuria > 3.5 g/day despite the use of renin-angiotensin-aldosterone blockade. In the first trial, we enrolled 14 subjects with FSGS and administered 4 dexamethasone doses (25 mg/m2) daily for 4 days, repeated every 28 days over 32 weeks. The second trial involved a more intensive regimen. Eight subjects received 4 dexamethasone doses of 50 mg/m2 every 4 weeks for 12 weeks, followed by 4 doses of 25 mg/m2 every 4 weeks for 36 weeks; subjects were randomized to 2 doses every 2 weeks or 4 doses every 4 weeks. RESULTS: In the first trial, we enrolled 13 subjects with FSGS and 1 with minimal change disease and found a combined CR and PR rate of 36%. In the second trial, we enrolled 8 subjects. The combined CR and PR rate was 29%. Analysis combining both trials showed a combined CR and PR rate of 33%. Adverse events were observed in 32% of subjects, with mood symptoms being most common. There were no serious adverse events related to the study. CONCLUSION: We conclude that high dose oral dexamethasone is well tolerated by adults with idiopathic nephrotic syndrome and may have some efficacy.

De-escalation of complexity in oncoplastic breast surgery: Case series from a specialized breast center.

INTRODUCTION: Oncoplastic breast surgery has evolved the surgical treatment of breast cancer over the past two decades. This practice still lacks validation and poses several dilemmas in terms of safety, local and systemic control, timing of adjuvant treatments and cost-effectiveness. Our case series investigates the effects of a reduced surgical complexity on cosmetic results and quality of life. METHODS: We treated 76 consecutive patients affected by early stage breast cancer from January 2016 to April 2017. We employed a decision support system to assist the final shared decision making. The communication process before surgery included new specific information on recent evidence about local control of disease and outcomes after multimodality treatment. In order to estimate the oncoplastic complexity, we created a new score based on scars, bilateral procedures and type and timing of reconstructions. We compared the outcomes of this series to that of a previous one from the same institution. RESULTS: The medium complexity score (CS) in the current series was significantly lower compared to that of the previous series (medium CS cohort 1 = 3.1 vs medium CS cohort 2 = 1.51; p = 0.001). Complications according to Clavien-Dindo classification did not vary significantly between the two series (p = 0.7). The increased use of primary systemic treatment did not translate into a significantly lower mastectomy rate (cohort 1 = 20% vs cohort 2 = 16%; p = n.s.). There was no significant difference in breast deformities after breast conserving surgery (p = 0.2). The BCCT.Core demonstrated a 67.1% occurrence of "good" results. Quality of life in patients who underwent breast-conserving surgery measured using the Breast-Q demonstrated similar results in the pre-post-op assessment. CONCLUSIONS: This study hypothesizes that a proper information may impact on patient's decisions and may reduce surgical complexity. This reduction likely has no effects on the main surgical outcomes estimated using standard tools. More investigations should be performed on a larger multi-institutional scale to confirm these conclusions.

Implementing dimer metadynamics using gromacs.

We develop a Gromacs implementation of dimer metadynamics (DM) (JCTC 13, 425 [2017]) for enhanced sampling through artificial delocalization effects. This implementation is based entirely on a Plumed collective variable developed for this purpose, the fine tuning of Gromacs input parameters, modified forcefields and custom nonbonded interactions. We demonstrate this implementation on alanine dipeptide in vacuum and in water, and on the 12-residue alanine polypeptide in water and compare the results with a standard multiple-replica technique such as parallel tempering. In all the considered cases, this comparison is consistent and the results with DM are smoother and require shorter simulations, thus proving the consistency and effectiveness of this Gromacs implementation. © 2018 Wiley Periodicals, Inc.

Quantum Symmetry from Enhanced Sampling Methods.

We address the problem of the minus sign sampling for two-electron systems using the path integral approach. We show that this problem can be reexpressed as one of computing free energy differences and sampling the tails of statistical distributions. Using metadynamics, a realistic problem like that of two electrons confined in a quantum dot can be solved. We believe that this is a strategy that can possibly be extended to more complex systems.

Chemical elemental analysis of single acoustic-levitated water droplets by laser-induced breakdown spectroscopy.

Laser-induced breakdown spectroscopy is presented for trace element detection of liquid samples by analyzing a single droplet levitated by ultrasonic waves. A single liquid droplet is placed in the node of a standing acoustic wave produced by a uniaxial levitator for further chemical analysis. The acoustic levitator consists of a commercial Langevin-type transducer, attached to a concave mechanical amplifier, and a concave reflector. A micro-syringe was used to manually place individual liquid droplet samples in the acoustic levitation system. For chemical analysis, a laser-induced plasma is produced by focusing a single laser pulse on the levitated water droplet after it partially dries. The performance of the acoustic levitator on micron-sized droplets is discussed, and the detection of Ba, Cd, Hg, and Pb at parts per million (milligrams/liter) and sub-parts per million levels is reported. The process, starting from placing the sample in the acoustic levitator and ending on the chemical identification of the traces, takes a few minutes. The approach is particularly interesting in applications demanding limited volumes of liquid samples and relative simple and inexpensive techniques.

Datos Fisiológicos de Baja California: PhysioBC, Resultados en Electrocardiografía 1 / Physiological Data of Baja California: PhysioBC, Electrocardiographic Results 1

Resumen: En la actualidad, el contar con una base de datos que represente fisiológicamente a una región o estado de la república conlleva un esfuerzo en conjunto entre diversas instituciones. Debido a su inexistencia, los investigadores recurren a bases de datos extranjeras organizadas para el desarrollo de estudios. Un ejemplo es el desarrollo de algoritmos matemáticos de detección de patologías en relación a individuos con una población y una forma de vida diferente a la nuestra. PhysioBC®, tiene como objetivo difundir libremente datos fisiológicos adquiridos en la población de Baja California, a fin de que se desarrollen modelos precisos de detección de patologías acorde a la genética y forma de vida de nuestra comunidad. En este trabajo presentamos los pasos de creación de su primera sección de datos electrocardiográficos, debido a que los datos reportados por el INEGI en 2012, de las 14,756 muertes, el 19% tenían origen cardiovascular. Actualmente se cuenta con 50 registros tomados en la industria maquiladora de Mexicali y 64 tomados en voluntarios. Estos se dividen en estándar de 12 derivaciones y de alta resolución de 3 derivaciones. Todos ellos se encuentran libres para su descarga en diversos formatos en la misma plataforma PhysioBC®.

Abstract: Currently, having a database that represents physiologically a region or state of the republic involves a joint effort among research and clinical institutions. Due to their non-existence, researchers normally use foreign international databases organized for research purposes. One example is the development of mathematical algorithms for detecting pathologies in individuals with a population who have a different way of living than ours. PhysioBC®, aims to freely disseminate physiological data acquired in the population of Baja California, in order to develop precise models of pathology detection according to the genetics and way of living of our community. Because the data reported by INEGI in 2012, out of the 14,756 deaths, 19% had cardiovascular origin problems, in this paper, we present the steps of creating PhysioBC® first section, called electrocardiographic data. Currently we have 50 records taken in the manufacturing industry of Mexicali and 64 taken in volunteers. The records are divided into standard 12-lead and high-resolution 3-lead. All of them are free for download in different formats at PhysioBC® website.

Dietary Habits and Risk of Kidney Function Decline in an Urban Population.

OBJECTIVE: Explore the association between following a Dietary Approaches to Stop Hypertension (DASH)-accordant diet and kidney end points among urban adults. DESIGN: Prospective cohort study. SETTING: Healthy Aging in Neighborhoods of Diversity across the Life Span study. SUBJECTS: A total of 1,534 urban dwelling participants of the Healthy Aging in Neighborhoods of Diversity across the Life Span study with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/minute/1.73 m2. INTERVENTION: DASH diet accordance determined via a score based on nine target nutrients. MAIN OUTCOME MEASURE: Rapid kidney function decline (eGFR decline >3 mL/minute/1.73 m2 per year), incident chronic kidney disease (CKD) (follow-up eGFR <60 mL/minute/1.73 m2), and eGFR decline >25%. RESULTS: Participants' mean age was 48 years, and 59% were African-American. Median DASH score was 1.5 (range, 0-8). Over a median of 5 years, 13.4% experienced rapid eGFR decline, including 15.2% among participants not following a DASH-accordant diet (score ≤1) and 12.0% with higher accordance (score >1) (P = .08). Outcomes varied by hypertension status. In multinomial logistic regression models, following adjustment for sociodemographic and clinical factors, including total energy intake, low DASH diet accordance was associated with rapid eGFR decline among participants with hypertension (risk ratio, 1.68; 95% confidence interval: 1.17-2.42) but not among those without hypertension (risk ratio, 0.83; 95% confidence interval: 0.56-1.24; P interaction .001). There was no statistically significant association between DASH diet accordance and incident CKD or eGFR decline >25%. Results were similar when DASH diet accordance was analyzed in tertiles. CONCLUSIONS: Among urban adults, low accordance to a DASH-type diet was not associated with incident CKD, but was associated with higher risk of rapid eGFR decline among those with hypertension, yet not among those without hypertension. Further study of dietary patterns as a potential target for improving kidney outcomes among high-risk populations is warranted.

Simulating the Effects of Sea Level Rise on the Resilience and Migration of Tidal Wetlands along the Hudson River.

Sea Level Rise (SLR) caused by climate change is impacting coastal wetlands around the globe. Due to their distinctive biophysical characteristics and unique plant communities, freshwater tidal wetlands are expected to exhibit a different response to SLR as compared with the better studied salt marshes. In this study we employed the Sea Level Affecting Marshes Model (SLAMM), which simulates regional- or local-scale changes in tidal wetland habitats in response to SLR, and adapted it for application in a freshwater-dominated tidal river system, the Hudson River Estuary. Using regionally-specific estimated ranges of SLR and accretion rates, we produced simulations for a spectrum of possible future wetland distributions and quantified the projected wetland resilience, migration or loss in the HRE through the end of the 21st century. Projections of total wetland extent and migration were more strongly determined by the rate of SLR than the rate of accretion. Surprisingly, an increase in net tidal wetland area was projected under all scenarios, with newly-formed tidal wetlands expected to comprise at least 33% of the HRE's wetland area by year 2100. Model simulations with high rates of SLR and/or low rates of accretion resulted in broad shifts in wetland composition with widespread conversion of high marsh habitat to low marsh, tidal flat or permanent inundation. Wetland expansion and resilience were not equally distributed through the estuary, with just three of 48 primary wetland areas encompassing >50% of projected new wetland by the year 2100. Our results open an avenue for improving predictive models of the response of freshwater tidal wetlands to sea level rise, and broadly inform the planning of conservation measures of this critical resource in the Hudson River Estuary.

Enhanced decolorization of dyes by an iron modified clay and thermodynamic parameters.

The sorption processes of red 5 (R5) and yellow 5 (Y5) dyes by iron modified and sodium bentonite in aqueous solutions was evaluated. The modified clay was prepared, conditioned and characterized. The sodium clay did not remove any of either dye. The sorption kinetics and isotherms of R5 and Y5 dyes by iron modified clay were determined. The maximum removal percentages achieved were 97% and 98% for R5 and Y5, respectively, and a contact time of 72 h; the experimental data were best adjusted to Ho model. The isotherms of both dyes were best adjusted to the Langmuir model and the maximum adsorption capacities of the modified clay were 11.26 mg/g and 5.28 mg/g for R5 and Y5, respectively. These results indicate that adsorption processes have a high probability to be described as chemisorption on a homogeneous material. Temperature range between 283 and 213 K does not affect the adsorption of Y5 by the iron modified clay, but the adsorption process of R5 was affected, and the thermodynamic parameters could be calculated, which indicate a chemisorption mechanism.

Mixing effects in the crystallization of supercooled quantum binary liquids.

By means of Raman spectroscopy of liquid microjets, we have investigated the crystallization process of supercooled quantum liquid mixtures composed of parahydrogen (pH2) or orthodeuterium (oD2) diluted with small amounts of neon. We show that the introduction of the Ne impurities affects the crystallization kinetics in terms of a significant reduction of the measured pH2 and oD2 crystal growth rates, similarly to what found in our previous work on supercooled pH2-oD2 liquid mixtures [Kühnel et al., Phys. Rev. B 89, 180201(R) (2014)]. Our experimental results, in combination with path-integral simulations of the supercooled liquid mixtures, suggest in particular a correlation between the measured growth rates and the ratio of the effective particle sizes originating from quantum delocalization effects. We further show that the crystalline structure of the mixtures is also affected to a large extent by the presence of the Ne impurities, which likely initiate the freezing process through the formation of Ne-rich crystallites.

Retirada de implantes mamarios y corrección simultánea con colgajo dermoglandular inferior. Técnica de mastopexia con autoprótesis / Breast implant explantation and simultaneous correction with inferior dermoglandular flap authoprosthesis technique

Los cirujanos plásticos nos enfrentamos cada vez con más frecuencia en nuestra consulta a pacientes que desean o necesitan retirar sus implantes mamarios. Algunas de estas pacientes rechazan la idea de un reemplazo protésico, pero son exigentes con el resultado cosmético postoperatorio. Describimos la técnica empleada en 68 casos consecutivos y los resultados que hemos obtenido al tratar las secuelas en la mama tras la retirada de los implantes, fundamentalmente una disminución de volumen asociada a ptosis y excedente cutáneo. Esta técnica se basa en la extracción de los implantes y correccion mamaria simultanea con colgajo dermoglandular inferior que denominamos "autoprotesis" asociado a injerto graso simultáneo. Los resultados logran mejorar la forma, proyección y conificacion de la mama tras la retirada de los implantes, con un alto grado de satisfacción por parte de las pacientes (AU)

Plastic surgeons are frequently faced during consultation with patients who want or need breast implant explantation. Some of these patients reject the idea of a prosthetic replacement, but are demanding with the postoperative cosmetic result. We describe the technique used in 68 consecutive cases and our results to deal with breast alterations after breast implant explantation, leaving a decreased mammary volume, ptosis and a loosy cutaneous excedent. With this technique of explantation and simultaneous breast correction with de-epithelialized dermoglandular flap, "authoprosthesis", associated with simultaneous fat grafting, we can get a good result regarding the shape, projection and coning of the explanted breast, with high patient satisfaction (AU)

Phase III development of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire module for women undergoing breast reconstruction.

BACKGROUND: Comprehensive outcome assessments after breast reconstruction (BRR) require surgery-specific patient-reported outcome measures. The aims of this study were to assess the relevance, acceptability and redundancy of questions/items (phase III pretesting) of a new BRR questionnaire evaluating patients' health-related quality of life before and after BRR. Phase III occurred in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) following earlier development phases that identified 31 items. METHODS: The EORTC BRR subgroup applied decision-making rules to each question according to eight EORTC criteria. A total of 197 patients (from the UK, Austria, Belgium, Italy and Sweden) were recruited. Forty-seven patients completed pre- and post-BRR questionnaires prospectively, and 150 reported post-BRR questionnaires only retrospectively. Qualitative debriefing interviews were undertaken in 189 patients. Preliminary psychometric analyses were performed. RESULTS: Thirty-one items fulfilled 'relevance', with none producing 'difficulties'. Ten items were not a priority for 10 per cent of respondents. Of these, two questions concerning muscle twitching in the affected breast and problem with donor-site swelling were deleted. Three redundant items were deleted: weakness in arm, which correlated significantly to the Quality of Life Questionnaire (QLQ) BR23 breast questionnaire, and shape and colour of the affected nipple. Descriptive statistics reduced the module to 26 items conceptualized into three provisional scales (disease treatment/surgery-related symptoms, sexuality and cosmetic outcome) within the newly completed questionnaire, EORTC QLQ-BRR26. CONCLUSION: The QLQ-BRR26 is available for psychometric validation in a large-field international sample. The intended use for QLQ-BRR26 is alongside EORTC QLQ-C30 and QLQ-BR23, in women treated by mastectomy for breast cancer and undergoing all types of BRR.

Serum IL-12 is increased in Mexican obese subjects and associated with low-grade inflammation and obesity-related parameters.

Interleukin-(IL-) 12 has been recently suggested to participate during development of insulin resistance in obese mice. Nevertheless, serum IL-12 levels have not been accurately determined in overweight and obese humans. We thus studied serum concentrations of IL-12 in Mexican adult individuals, examining their relationship with low-grade inflammation and obesity-related parameters. A total of 147 healthy individuals, 43 normal weight, 61 overweight, and 43 obese subjects participated in the study. Circulating levels of IL-12, tumor necrosis factor-alpha (TNF- α ), leptin, insulin, glucose, total cholesterol, and triglyceride were measured after overnight fasting in all of the study subjects. Waist circumference and body fat percentage were recorded for all the participants. Serum IL-12 was significantly higher in overweight and obese individuals than in normal weight controls. Besides being strongly related with body mass index (r = 0.5154), serum IL-12 exhibited a significant relationship with abdominal obesity (r = 0.4481), body fat percentage (r = 0.5625), serum glucose (r = 0.3158), triglyceride (r = 0.3714), and TNF- α (r = 0.4717). Thus, serum levels of IL-12 are increased in overweight and obese individuals and show a strong relationship with markers of low-grade inflammation and obesity in the Mexican adult population. Further research is needed to understand the role of IL-12 in developing obesity-associated alterations in humans.

"Estilos de vida en adolescentes de nivel medio superior de una comunidad semiurbana" / "Lifestyles in teen top-middle level of a semi-urban comunity"

Se propuso identificar los estilos de vida en adolescentes de una comunidad semiurbana, buscando respuesta a la pregunta: ¿Cuáles son los factores que se identifican en el instrumento Fantastic, en los estudiantes de la comunidad de Ixtlahuaca? Se trabajó con la variable de estilos de vida, ocupando el instrumento FANTASTIC. La muestra la conforman 1088 estudiantes, 603 hombres y 485 mujeres. La religión de mayor prevalencia es la católica con 844. Del instrumento se obtuvo una fiabilidad de .79, con 6 factores identificados: sentimientos negativos y estrés, satisfacción y pensamiento positivo, alimentación dañina, relajación y sueño, alcohol y tabaco, cafeína. Se concluye que se requiere manejo de hábitos saludables, prevención de adicciones y alimentación.

The proposal was to identify lifestyles among adolescents in a semi-urban community, seeking answers to the question: What are the factors that are identified in the Fantastic instrument in students Ixtlahuaca community? We worked with the lifestyle variable, holding the instrument FANTASTIC. The sample is formed by 1088 students, 603 men and 485 women. The most prevalent religion is Catholic with 844. The instrument yielded a reliability of .79, with 6 factors identified: negative feelings and stress, satisfaction and positive thinking, harmful food, relaxation and sleep, alcohol and snuff, caffeine. It is concluded that it is required management of healthy habits, addictions and alimentation prevention.