Lipoprotein profile assessed by 1H NMR, BMI and blood pressure are associated with vascular alterations in children with familial hypercholesterolaemia.

BACKGROUND AND AIMS: Children with familial hypercholesterolaemia (FH) have elevated low-density lipoprotein cholesterol (LDL-C) concentrations since birth, which increases the risk of cardiovascular disease in adulthood. Arterial injury and stiffness parameters, including carotid intima media thickness (cIMT), pulse wave velocity (PWV) and distensibility (DIST), can be detected early in childhood. We studied the associations between cIMT, PWV and DIST with the lipoprotein profile assessed by proton nuclear magnetic resonance (1H NMR) and with influential variables such as blood pressure (BP) or body mass index (BMI) in children with FH. METHODS AND RESULTS: In this cross-sectional study, we included 201 children (96 with FH and 105 non-FH controls). Clinical history, physical examination and standard biochemical studies were performed. FH genetic testing was performed when clinically indicated. Carotid ultrasonography and an advanced lipoprotein profile by 1H NMR were performed. Multivariate and classification methods were used. There were no differences between cIMT, PWV and DIST between FH and non-FH children. FH children presented more total LDL and large, medium and small particles. Small LDL particles, BMI and systolic BP determined the presence of pathological IMT in the FH group. LDL size, high-density lipoproteins and very low-density lipoprotein particles together with blood pressure determined the presence of pathological arterial wall elasticity. CONCLUSIONS: Alterations in lipoprotein parameters assessed by are associated with early structural and functional arterial characteristics in children with FH. BMI and BP act as boosting factors. Cardiovascular prevention should start early in children with FH, encompassing all components of a healthy lifestyle.

Gut microbiota is associated with metabolic health in children with obesity.

BACKGROUND AND AIMS: We aimed to describe and characterize the gut microbiota composition and diversity in children with obesity according to their metabolic health status. METHODS: Anthropometry, Triglycerides, HDL cholesterol, HOMA-IR, and systolic and diastolic blood pressure (SBP, DBP) were evaluated (and z-score calculated) and faecal samples were collected from 191 children with obesity aged from 8 to 14. All children were classified depending on their cardiometabolic status in either a "metabolically healthy" (MHO; n = 106) or "metabolically unhealthy" (MUO; n = 85) group. Differences in gut microbiota taxonomies and diversity between groups (MUO vs MHO) were analysed. Alpha diversity index was calculated as Chao1 and Simpson's index, and ß-diversity was calculated as Adonis Bray-Curtis index. Spearman's correlations and logistic regressions were performed to study the association between cardiometabolic health and the microbiota. RESULTS: Children in the MUO presented significantly lower alpha diversity and richness than those in the MHO group (Chao1 index p = 0.021, Simpson's index p = 0.045, respectively), whereas microbiota ß-diversity did not differ by the cardiometabolic health status (Adonis Bray-Curtis, R2 = 0.006; p = 0.155). The MUO group was characterized by lower relative abundances of the genera Christensenellaceae R7 group (MHO:1.42% [0.21-2.94]; MUO:0.47% [0.02-1.60], p < 0.004), and Akkermansia (MHO:0.26% [0.01-2.19]; MUO:0.01% [0.00-0.36], p < 0.001) and higher relative abundances of Bacteroides (MHO:10.6% [4.64-18.5]; MUO:17.0% [7.18-27.4], p = 0.012) genus. After the adjustment by sex, age, and BMI, higher Akkermansia (OR: 0.86, CI: 0.75-0.97; p = 0.033), Christensenellaceae R7 group (OR: 0.86, 95% CI: 075-0.98; p = 0.031) and Chao1 index (OR: 0.86, CI: 0.96-1.00; p = 0.023) represented a lower risk of the presence of one or more altered cardiovascular risk factors. CONCLUSION: Lower proportions of Christensenellaceae and Akkermansia and lower diversity and richness seem to be indicators of a metabolic unhealthy status in children with obesity.

Mental performance in 8-year-old children fed reduced protein content formula during the 1st year of life: safety analysis of a randomised clinical trial.

In humans, maximum brain development occurs between the third trimester of gestation and 2 years of life. Nutrition during these critical windows of rapid brain development might be essential for later cognitive functioning and behaviour. In the last few years, trends on protein recommendations during infancy and childhood have tended to be lower than that in the past. It remains to be demonstrated that lower protein intakes among healthy infants, a part of being able to reduce obesity risk, is safe in terms of mental performance achievement. Secondary analyses of the EU CHOP, a clinical trial in which infants from five European countries were randomised to be fed a higher or a lower protein content formula during the 1st year of life. Children were assessed at the age of 8 years with a neuropsychological battery of tests that included assessments of memory (visual and verbal), attention (visual, selective, focused and sustained), visual-perceptual integration, processing speed, visual-motor coordination, verbal fluency and comprehension, impulsivity/inhibition, flexibility/shifting, working memory, reasoning, visual-spatial skills and decision making. Internalising, externalising and total behaviour problems were assessed using the Child Behaviour Checklist 4-18. Adjusted analyses considering factors that could influence neurodevelopment, such as parental education level, maternal smoking, child's gestational age at birth and head circumference, showed no differences between feeding groups in any of the assessed neuropsychological domains and behaviour. In summary, herewith we report on the safety of lower protein content in infant formulae (closer to the content of human milk) according to long-term mental performance.

Current perspectives in Bietti crystalline dystrophy.

Bietti crystalline dystrophy (BCD) is a rare-inherited disease caused by mutations in the CYP4V2 gene and characterized by the presence of multiple shimmering yellow-white deposits in the posterior pole of the retina in association with atrophy of the retinal pigment epithelium (RPE) and chorioretinal atrophy. The additional presence of glittering dots located at the corneal limbus is also a frequent finding. The CYP4V2 protein belongs to the cytochrome P450 subfamily 4 and is mainly expressed in the retina and the RPE and less expressed in the cornea. The disease has its metabolic origin in the diminished transformation of fatty acid substrates into n-3 polyunsaturated fatty acids due to a dysregulation of the lipid metabolism. In this review, we provide updated insights on clinical and molecular characteristics of BCD including underlying mechanisms of BCD, genetic diagnosis, progress in the identification of causative genetic and epigenetic factors, available techniques of exploration and development of novel therapies. This information will help clinicians to improve accuracy of BCD diagnosis, providing the patient reliable information regarding prognosis and clinical prediction of the disease course.

Escisión Mesorrectal Total Transanal (Tatme): Aspectos Prácticos De La Técnica Quirúrgica / Transanal Total Mesorectal Excision: Practical Aspects Of Surgical Technique

INTRODUCCIÓN: El cáncer de recto es la séptima neoplasia más frecuente en España con una incidencia de 12570 casos/100.000 hab/año. La supervivencia a 5 años en Europa es del 55-62 % y tiende a aumentar gracias a la introducción de cambios en el tratamiento y nuevas técnicas quirúrgicas. La TaTME permite visualizar directamente el margen distal del tumor, evita las dificultades técnicas que aparecen al introducir las endograpadoras lineales en pelvis estrechas para seccionar el recto y ofrece una visualización directa de las estructuras pélvicas durante la EMT. El objetivo de este estudio es describir la técnica quirúrgica de la TaTME minuciosamente destacando los aspectos más prácticos del procedimiento. MATERIAL Y MÉTODOS: Se ha realizado una búsqueda bibliográfica sistemática en la base de datos Cochrane, MEDLINE y EMBASE mediante los términos "transanal total mesorectal excision". RESULTADOS: Durante la fase transanal se coloca el dispositivo gel-point monopuerto y multicanal transanal para la creación del neumorrecto. La luz del recto se cierra mediante una sutura en bolsa de tabaco. Tras completar la rectotomía se procede a la escisión mesorrectal total. Para la fase abdominal se crea un neumoperitoneo. Los vasos mesentéricos inferiores se seccionan en origen. Una vez que ambos equipos han avanzado en la escisión mesorrectal los campos se comunican abriendo el por el plano anterior. Se pueden construir varios tipos de anastomosis colorrectales. CONCLUSIÓN: La TaTME es un tratamiento quirúrgico del cáncer de recto medio y bajo seguro y factible

INTRODUCTION: Rectal cancer is the seventh most common cancer in Spain with an incidence of 12570 cases/100000 h/year. The 5-year overall survival of rectal cancer in Europe was 55-62% and this rate tends to improve due to new challenges and the development of new surgical techniques. TaTME offers a direct vision of the distal end of tumour, it avoids technical difficulties for in-troducing staplers down a narrow pelvis and it improves a direct visualization of pelvic structures during total mesorectal excision. The aim of this study is to describe the surgical technique for TaTME selecting the most practical aspects of this procedure. MATERIAL AND METHODS: The relevant studies were identified by a search of MEDLINE, EMBASE and Cochrane Oral Health Group Specialized Register using terms transanal total mesorectal excision. RESULTS: During transanal phase pneumorectum is created using Gel Point Path Transanal Access platform. The rectal lumen is closed with a purse.string suture. After a complete rectotomy the total mesorectal excision is performed circumferentially. Pneu-moperitoenum is created for abdominal phase. When transanal and abdominal teams have achieved a complete total mesorectal excision both planes are connected at the anterior plane. Several types of colorectal anastomosis can be performed. CONCLUSIÓN: TaTME is a secure and feasible surgical treatment for low-mid rectal cancer

Quality of anthropometric measurements in Spanish Intensive Care Units (The CAMIES Study). / Calidad de la medición antropométrica en las Unidades de Medicina Intensiva españolas (Estudio CAMIES).

INTRODUCTION: Real body weight and height are essential data to be obtained in all critically ill patients (CIP), due to their influence in the designing of therapies and monitoring. Visual estimation is a very inaccurate practice. No precise descriptions of anthropometric measurements among CIP are available in the clinical practice guides. OBJECTIVE: To describe anthropometric quality in CIP, health professional perception of such quality, and its influencing factors. DESIGN: Computer-assisted telephone or self-interviewing. SETTING: Doctors and nurses of all Spanish Intensive Care Units (ICU) attending adults. RELEVANT VARIABLES: Anthropometric practices were described in detail, along with the proclivity to obtain real measurements, and the influence of professional experience, the number of ICU beds, and the health professional group involved. RESULTS: A total of 481 questionnaires were collected from 176 hospitals (36.8% from physicians). The availability of measuring tools is limited (weight 68.7% - height 76.7%), with no relation to the number of ICU beds (weight P=.343, height P=.61). Visual estimation was the most frequent way of obtaining measurements (weight 65.9% - height 64.8%), even when measuring tools were available. Willingness to take real measurements was very low, especially among physicians, and professional experience was associated to increased rejection (P<.001). CONCLUSIONS: Visually estimated measurements exceed real measurements in the routine practice of Spanish ICUs. Measurement tools are not widely available in the ICU, and even when available, their use is not guaranteed. The surveyed population does not view anthropometric measures as being important for clinical practice. An effort should be made by scientific societies to promote reliable anthropometric practice in Spanish ICUs.

Medicina basada en la evidencia y la cirugía del cáncer de recto / Evidence based medicine and surgery for rectal cancer

Introducción: El cáncer colorrectal es la cuarta neoplasia más frecuente en el mundo. La supervivencia del cáncer de recto tiende a aumentar debido a las actualizaciones en las estrategias terapéuticas basadas en recomendaciones que siguen las pautas de la medicina basada en la evidencia. El objetivo de este artículo es realizar una revisión sobre la evidencia científica publicada en relación a la cirugía del cáncer de recto. Material y Métodos: Se ha realizado una búsqueda bibliográfica sistemática en la base de datos Cochrane, MEDLINE y EMBASE mediante los términos "rectal cancer AND surgical treatment AND evidence based medicine". Resultados: El tratamiento del cáncer de recto requiere de un equipo multidisciplinar que considere guías clínicas elaboradas por las sociedades médicas. Se recomienda la resección quirúrgica en bloque del recto y de los tejidos invadidos por tumor junto con la obtención de márgenes de resección libres (distal y circunferencial) y la escisión completa del mesorrecto. El lavado y las pruebas de estanqueidad de la anastomosis intraoperatorios mejoran los resultados de la cirugía. La cirugía laparoscópica del cáncer de recto realizada por cirujanos expertos mejora la recuperación postoperatoria con los mismos resultados oncológicos. Conclusión: La medicina basada en la evidencia proporciona unas recomendaciones para el tratamiento quirúrgico del cáncer de recto con el fin de lograr los mejores resultados

Introduction: Colorectal cancer is the fourth most common malignant in the world. The improvement in the 5-year survival for rectal cancer is probably related to multidimensional management included in clinical practice guidelines based on the scientific evidence. This systematic review was to evaluate the recommendations about surgery for rectal cancer. Materials and Methods: The relevant studies were identified by a search of MEDLINE, EMBASE and Cochrane Oral Health Group Specialized Register using terms rectal cancer AND surgical treatment AND evidence based medicine. Results: Management of rectal cancer requires a coordinated multidisciplinary team that applies the recommendations included in clinical practice guidelines. Surgical resection for rectal cancer follow the main oncologic principles as resection on bloc for locally advanced rectal tumors, adequate distal and circumferential margins and complete mesorectal excision. Intraluminal rectal washout and anastomotic leak testing were recommended. Laparoscopic approach by expert surgeons improves immediate postoperative outcomes and is as safe as the open approach in terms of oncological results. Conclusion: Adherence to evidence-based medicine included in surgical guidelines and personalization improves outcomes in rectal cancer surgery

Association of early protein intake and pre-peritoneal fat at five years of age: Follow-up of a randomized clinical trial.

BACKGROUND AND AIMS: The double-blind randomized European Childhood Obesity Project (CHOP) demonstrated that reduced protein content in infant formula leads to a lower body mass index (BMI) up to six years of age. Here we aimed at assessing pre-peritoneal fat, a marker of visceral fat, in children participating in the CHOP trial. METHODS AND RESULTS: Healthy term formula-fed infants in five European countries were randomized either to higher (n = 550) or lower (n = 540) protein formulas in the first year of life. Infants who were exclusively breastfed for at least three months (n = 588) were enrolled as an observational (non randomized) group. At age 5 years, subcutaneous fat (SC) and pre-peritoneal fat (PP) were measured by ultrasound in a subgroup of 275 children. The PP fat layer was thicker in the higher compared to the lower protein group (adjusted estimated difference: 0.058 cm, 95%CI 0.002; 0.115; p = 0.043), while SC fat was not different. Girls showed a thicker SC fat layer than boys. CONCLUSIONS: Higher protein intake in formula-fed infants appears to enhance pre-peritoneal fat tissue accumulation at the age of 5 years, but not of subcutaneous fat, which may trigger adverse metabolic and health consequences.

Fish consumption in mid-childhood and its relationship to neuropsychological outcomes measured in 7-9 year old children using a NUTRIMENTHE neuropsychological battery.

BACKGROUND: Long-chain polyunsaturated fatty acids (LCPUFA), particularly n-3 LCPUFA, play a central role in neuronal growth and the development of the human brain. Fish is the main dietary source of n-3 LCPUFA. To assess the relation between fish consumption, estimated dietary n-3 LCPUFA intake and cognition and behaviour in childhood in a multi-centre European sample. METHODS: Children from 2 European studies, CHOP and NUHEAL, were assessed at 8 and 7.5 years of age, respectively. Different outcomes of neuropsychological development (assessed with the standardized NUTRIMENTHE Neuropsychological Battery (NNB) consisting of 15 subtests) were related with outcomes from a food-frequency questionnaire (FFQ) focussing on the consumption of fish. RESULTS: A total of 584 children completed the FFQ and the neuropsychological tests. We found no associations with calculated DHA or EPA intakes for any of the neuropsychological domains. Children who consumed 2 fish meals per week including one of fatty fish, showed no substantive differences in the cognitive domains from the children who did not. However negative associations with fatty fish consumption were found for social problems (p = 0.019), attention problems (p = 0.012), rule-breaking problems (p = 0.019) and aggressive behaviour problems (p = 0.032). No association was observed with internalizing problems. Higher levels of externalizing problems (p = 0.018) and total problems (p = 0.018) were associated with eating less fatty fish. CONCLUSIONS: Children who consumed 2 fish meals per week including one of fatty fish were less likely to show emotional and behavioural problems than those who did not.

Modeling the formation of cell-matrix adhesions on a single 3D matrix fiber.

Cell-matrix adhesions are crucial in different biological processes like tissue morphogenesis, cell motility, and extracellular matrix remodeling. These interactions that link cell cytoskeleton and matrix fibers are built through protein clutches, generally known as adhesion complexes. The adhesion formation process has been deeply studied in two-dimensional (2D) cases; however, the knowledge is limited for three-dimensional (3D) cases. In this work, we simulate different local extracellular matrix properties in order to unravel the fundamental mechanisms that regulate the formation of cell-matrix adhesions in 3D. We aim to study the mechanical interaction of these biological structures through a three dimensional discrete approach, reproducing the transmission pattern force between the cytoskeleton and a single extracellular matrix fiber. This numerical model provides a discrete analysis of the proteins involved including spatial distribution, interaction between them, and study of the different phenomena, such as protein clutches unbinding or protein unfolding.

Development of an APC-targeted multivalent E2-based vaccine against Bovine Viral Diarrhea Virus types 1 and 2.

The aim of this study was to develop and test a multivalent subunit vaccine against Bovine Viral Diarrhea Virus (BVDV) based on the E2 virus glycoprotein belonging to genotypes 1a, 1b and 2a, immunopotentiated by targeting these antigens to antigen-presenting cells. The E2 antigens were expressed in insect cells by a baculovirus vector as fusion proteins with a single chain antibody, named APCH I, which recognizes the ß-chain of the MHC Class II antigen. The three chimeric proteins were evaluated for their immunogenicity in a guinea pig model as well as in colostrum-deprived calves. Once the immune response in experimentally vaccinated calves was evaluated, immunized animals were challenged with type 1b or type 2b BVDV in order to study the protection conferred by the experimental vaccine. The recombinant APCH I-tE21a-1b-2a vaccine was immunogenic both in guinea pigs and calves, inducing neutralizing antibodies. After BVDV type 1b and type 2 challenge of vaccinated calves in a proof of concept, the type 1b virus could not be isolated in any animal; meanwhile it was detected in all challenged non-vaccinated control animals. However, the type 2 BVDV was isolated to a lesser extent compared to unvaccinated animals challenged with type 2 BVDV. Clinical signs associated to BVDV, hyperthermia and leukopenia were reduced with respect to controls in all vaccinated calves. Given these results, this multivalent vaccine holds promise for a safe and effective tool to control BVDV in herds.

Expression and characterization of the gD protein of HSV-2 fused to the tetramerization domain of the transcription factor p53.

The highly immunogenic glycoprotein D (gD) of herpes simplex virus type 2 (HSV-2) is a very important element for entry of this virus into host cells. These characteristics have made this protein a very interesting HSV-2 subunit vaccine candidate. Despite efforts to prevent genital herpes using gD-based subunit vaccines, to date, clinical trials using this antigen have failed. Therefore, using a small animal model, we sought to determine if a tetramerized truncated form of gD subunit vaccine, produced by recombinant baculovirus infected insect larvae, would elicit better protection against genital herpes than a monomeric gD-2 subunit vaccine. Three out of 5 mice immunized with the tetramerized antigen produced in a baculovirus expression vector system, survived a lethal challenge with a wild type HSV-2 strain (for more than 3 weeks after challenge). In contrast, all the mice (5) immunized with the truncated protein, produced by the same methodology, died within 2 weeks after challenge. These results suggest that multimerization (increasing the structural complexity) of the truncated gD antigen might be more likely protective than the monomer form. Also the use of an alternative cost-efficient eukaryotic expression system is described.

Reservorios venosos subcutáneos tipo port-a-cath. Ventajas del acceso quirúrgico mediante venotomía cefálica / Port-A-Cath implantable venous access system. Advantages ofsurgical access by cephalic venotomy

Introducción: La colocación de dispositivos implantables permanentes ha aumentado exponencialmente debido al aumento de indicaciones. El objetivo de este artículo es demostrar las ventajas de la utilización de la disección de vena cefálica para la colocación de sistemas venosos centrales. Métodos: Estudio longitudinal, descriptivo y retrospectivo, en el cual analizamos 265 pacientes consecutivos, recogidos entre enero de 2010 y octubre de 2013, a los que se les colocó un reservorio venoso subcutáneo mediante venotomía de la vena cefálica en el surco deltopectoral como acceso primario. Se detallan complicaciones intraoperatorias y postoperatorias tempranas y tardías. Resultados: En 253 pacientes se canaliza la vena cefálica, representando una tasa de éxito del 95,5 %. No se asocian complicaciones intraoperatorias como neumotórax o hemotórax. La tasa de complicaciones tempranas es el del 4 %, y tardías del 11,5 %, con un seguimiento mínimo de ocho meses. Se asociaron a retirada del sistema en 14 pacientes. Conclusión: El acceso por vena cefálica en régimen de cirugía mayor ambulatoria es seguro, con una alta tasa de éxito en nuestro estudio, y con una tasa de complicaciones tempranas y tardías bajas igual al acceso mediante punción sin riesgo de neumo-hemotórax (AU)

Introduction: The use of totally implantable access ports has increased exponentially due to the increase of indications. The objective of this article is to demonstrate the advantages of using surgical venous cutdowns of the cefalic vein to place central venous systems. Patients and methods: Longitudinal, descriptive and retrospective study, which analyzed 265 consecutive patients, collected between January 2010 and October 2013. In these patients a subcutaneous venous reservoir was placed by opening the cephalic vein in the deltopectoral groove as primary access. Intraoperative and postoperative early and late complications were documented in detail. Results: The primary success rate was 95.5 % for the venous cutdowns. No intraoperative complications such as pneumothorax or haemothorax were associated. The early complication rate is 4 %; late complications rate is 11.5 %, with a minimum follow-up of eight months. In 14 cases the complications were associated with the removal of the system. Conclusion: The surgical venous cutdown in ambulatory surgery is safe, with a high success rate in our study, and a rate of early and late complications like puncture of the subclavian vein approach, without risk of pneumo-haemothorax (AU)

An experimental subunit vaccine based on Bluetongue virus 4 VP2 protein fused to an antigen-presenting cells single chain antibody elicits cellular and humoral immune responses in cattle, guinea pigs and IFNAR(-/-) mice.

Bluetongue virus (BTV), the causative agent of bluetongue disease (BT) in domestic and wild ruminants, is worldwide distributed. A total of 27 serotypes have been described so far, and several outbreaks have been reported. Vaccination is critical for controlling the spread of BTV. In the last years, subunit vaccines, viral vector vaccines and reverse genetic-based vaccines have emerged as new alternatives to conventional ones. In this study, we developed an experimental subunit vaccine against BTV4, with the benefit of targeting the recombinant protein to antigen-presenting cells. The VP2 protein from an Argentine BTV4 isolate was expressed alone or fused to the antigen presenting cell homing (APCH) molecule, in the baculovirus insect cell expression system. The immunogenicity of both proteins was evaluated in guinea pigs and cattle. Titers of specific neutralizing antibodies in guinea pigs and cattle immunized with VP2 or APCH-VP2 were high and similar to those induced by a conventional inactivated vaccine. The immunogenicity of recombinant proteins was further studied in the IFNAR(-/-) mouse model where the fusion of VP2 to APCH enhanced the cellular immune response and the neutralizing activity induced by VP2.

Evaluación del coste económico de la técnica de la biopsia selectiva del ganglio centinela en melanoma / Cost Analysis of Sentinel Lymph Node Biopsy in Melanoma

INTRODUCCIÓN Y OBJETIVO: La técnica de la biopsia selectiva del ganglio centinela (BSGC) es la mejor herramienta para la estadificación ganglionar en el melanoma, permitiendo la realización de una linfadenectomía selectiva, es decir, reservada solo a aquellos pacientes que muestran el GC positivo para metástasis. Nuestro objetivo fue evaluar el coste económico de la técnica de la BSGC, ya que se ha convertido en el procedimiento recomendado como estándar en la atención al paciente con melanoma, y es necesaria para la inclusión de los pacientes en los ensayos clínicos. Existe además escasa bibliografía en nuestro medio sobre su relevancia económica. MÉTODO: De forma prospectiva se recogieron 100 pacientes a los que se realizó la técnica entre los años 2007-2010 con un procesamiento histológico transhiliar bivalvo multisecciones. Realizamos un cálculo aproximado del precio de la técnica utilizando las tarifas de precios oficiales de la Región de Murcia. RESULTADOS: El porcentaje de positividad de nuestra serie fue del 20%, con un número medio de ganglios de 1,96 y un 44% de melanomas delgados. El precio total de la técnica es de 9.486,57- 10.471,29 euros, siendo una parte muy importante de la misma atribuible al procesamiento histopatológico (5.769,36 euros). DISCUSIÓN: La técnica de la BSGC tiene un precio muy considerable, aunque en consonancia con otras referencias americanas previamente descritas. La optimización de la técnica vendrá dada en función de la selección cada vez más adecuada de los pacientes que deben someterse a ella, y a la estandarización de un modelo histopatológico sensible en la detección, pero a la vez sencillo en el procesamiento

INTRODUCTION AND OBJECTIVE: Sentinel lymph node biopsy (SLNB) is the most useful tool for node staging in melanoma. SLNB facilitates selective dissection of lymph nodes, that is, the performance of lymphadenectomy only in patients with sentinel nodes positive for metastasis. Our aim was to assess the cost of SLNB, given that this procedure has become the standard of care for patients with melanoma and must be performed whenever patients are to be enrolled in clinical trials. Furthermore, the literature on the economic impact of SLNB in Spain is scarce. METHOD: From 2007 to 2010, we prospectively collected data for 100 patients undergoing SLNB followed by transhilar bivalving and multiple-level sectioning of the node for histology. Our estimation of the cost of the technique was based on official pricing and fee schedules for the Spanish region of Murcia. RESULTS: The rate of node-positive cases in our series was 20%, and the mean number of nodes biopsied was 1.96; 44% of the patients in the series had thin melanomas. The total cost was estimated at between D 9486.57 and D 10 471.29. Histopathology accounted for a considerable portion of the cost (D 5769.36). DISCUSSION: The cost of SLNB is high, consistent with amounts described for a US setting. Optimaluse of SLNB will come with the increasingly appropriate selection of patients who should undergo the procedure and the standardization of a protocol for histopathologic evaluation that is both sensitive and easy to perform

Cost analysis of sentinel lymph node biopsy in melanoma.

INTRODUCTION AND OBJECTIVE: Sentinel lymph node biopsy (SLNB) is the most useful tool for node staging in melanoma. SLNB facilitates selective dissection of lymph nodes, that is, the performance of lymphadenectomy only in patients with sentinel nodes positive for metastasis. Our aim was to assess the cost of SLNB, given that this procedure has become the standard of care for patients with melanoma and must be performed whenever patients are to be enrolled in clinical trials. Furthermore, the literature on the economic impact of SLNB in Spain is scarce. METHOD: From 2007 to 2010, we prospectively collected data for 100 patients undergoing SLNB followed by transhilar bivalving and multiple-level sectioning of the node for histology. Our estimation of the cost of the technique was based on official pricing and fee schedules for the Spanish region of Murcia. RESULTS: The rate of node-positive cases in our series was 20%, and the mean number of nodes biopsied was 1.96; 44% of the patients in the series had thin melanomas. The total cost was estimated at between €9486.57 and €10471.29. Histopathology accounted for a considerable portion of the cost (€5769.36). DISCUSSION: The cost of SLNB is high, consistent with amounts described for a US setting. Optimal use of SLNB will come with the increasingly appropriate selection of patients who should undergo the procedure and the standardization of a protocol for histopathologic evaluation that is both sensitive and easy to perform.

Resultados de una encuesta sobre la práctica clínica habitual en el empleo de albúmina en UCI / Results of a survey on albumin use in clinical practice in intensive care units

INTRODUCCIÓN: Las soluciones de albúmina humana se emplean en diversas enfermedades, aunque su indicación no es clara en todas. Presentan un coste elevado y su beneficio no se encuentra plenamente establecido. Resulta interesante conocer cuál es la presencia de las soluciones de albúmina en la práctica clínica diaria de los intensivistas. OBJETIVO: Documentar prácticas clínicas habituales y describir la variabilidad de las mismas en cuanto al empleo de soluciones de albúmina en enfermos críticos. DISEÑO: Encuesta enviada mediante correo electrónico a unidades de cuidados intensivos (UCI) españolas y sudamericanas. Periodo: Planificación y realización durante el año 2012. Ámbito: UCI españolas y sudamericanas. MÉTODOS: Cuestionario de 35 preguntas. RESULTADOS: Se han analizado 57 encuestas. El empleo de las soluciones de albúmina fue esporádico o no se empleaba en el paciente crítico (96,5%). La excepción fueron los pacientes hepatópatas (un 87,7% de los encuestados la administraba). Un elevado porcentaje declaró conocer la evidencia científica disponible sobre el empleo de albúmina en pacientes hepatópatas (82,5%) y no hepatópatas (77,2%). El 5,3% de los encuestados prefería basarse en su experiencia para establecer las indicaciones del empleo de albúmina. CONCLUSIONES: El empleo de soluciones de albúmina no es frecuente en las UCI, salvo en pacientes hepatópatas. Los profesionales del enfermo crítico manifiestan tener un amplio conocimiento de la evidencia científica. Las opiniones emitidas, acerca del empleo de albúmina, son acordes con las recomendaciones establecidas, sobre todo, en pacientes hepatópatas. La experiencia profesional prevalece en escasas ocasiones sobre las recomendaciones publicadas

BACKGROUND: Human albumin solutions are used in a number of disorders, though their indications are not clear in all circumstances. These solutions are costly, and their benefit has not been established in all settings. It is therefore interesting to assess the presence of albumin solutions in the daily clinical practice of critical care professionals. OBJECTIVES: To report the standard clinical practices and to describe the variability of albumin solutions use in critically ill patients. DESIGN: A survey sent by e-mail to Spanish and South American Intensive Care Units (ICUs) Period: Planning and execution during the year 2012. METHODS: A questionnaire comprising 35 questions. RESULTS: Fifty-seven surveys were analyzed. The use of albumin solutions was sporadic or negligible in critically ill patients (96.5%). The exceptions were patients with liver disease (87.7% of the responders administered albumin to these patients). A high percentage of professionals claimed to know the available scientific evidence on the use of albumin in patients with liver disease (82.5%) and in patients without liver disease (77.2%). Only 5.3% of the responders preferred to rely on their own experience to establish the indications of albumin use. CONCLUSIONS: The use of albumin solutions is infrequent in ICUs, except in patients with liver disease. Evidence-based knowledge on albumin use is declared to be extensive in ICUs. As a rule, opinions on the use of albumin solutions are based on the scientific recommendations, especially in patients with liver disease. Professional experience rarely prevails over the published clinical guidelines

Comparison of strategies for the production of FMDV empty capsids using the baculovirus vector system.

Recombinant FMDV empty capsids have been produced in insect cells and larvae using the baculovirus expression system, although protein yield and efficiency of capsid assembly have been highly variable. In this work, two strategies were compared for the expression of FMDV A/Arg/01 empty capsids: infection with a dual-promoter baculovirus vector coding for the capsid precursor (P12A) and the protease 3C under the control of the polyhedrin and p10 promoters, respectively (BacP12A-3C), or a single-promoter vector coding the P12A3C cassette (BacP12A3C). Expression levels and assembly into empty capsids were analyzed in insect cells and larvae. We observed that the use of the single-promoter vector allowed higher levels of expression both in insect cells and larvae. Recombinant capsid proteins produced by both vectors were recognized by monoclonal antibodies (mAbs) directed against conformational epitopes of FMDV A/Arg/01 and proved to self-assemble into empty capsids (75S) and pentamers (12S) when analyzed by sucrose gradient centrifugation.