Conservation of the Pal/Rim Pathway in Ustilaginomycetes.

The ability of fungi to effectively sense and internalize signals related to extracellular changing environments is essential for survival. This adaptability is particularly important for fungal pathogens of humans and plants that must sense and respond to drastic environmental changes when colonizing their hosts. One of the most important physicochemical factors affecting fungal growth and development is the pH. Ascomycota fungal species possess mechanisms such as the Pal/Rim pathway for external pH sensing and adaptation. However, the conservation of this mechanism in other fungi, such as Ustilaginomycetes is still little studied. To overcome this knowledge gap, we used a comparative genomic approach to explore the conservation of the Pal/Rim pathway in the 13 best sequenced and annotated Ustilaginomycetes. Our findings reveal that the Rim proteins and the Endosomal Sorting Complex Required for Transport (ESCRT) proteins are conserved in Ustilaginomycetes. They conserve the canonical domains present in Pal/Rim and ESCRT proteins of Ascomycota. This study sheds light on the molecular mechanisms used by these fungi for responding to extracellular stresses such as the pH, and open the door to further experimentations for understanding the molecular bases of the signaling in Ustilaginomycetes.

Transcriptomic analysis of Chaetoceros muelleri in response to different nitrogen concentrations reveals the activation of pathways to enable efficient nitrogen uptake.

Nitrogen is the principal nutrient deficiency that increases lipids and carbohydrate content in diatoms but negatively affects biomass production. Marine diatom Chaetoceros muelleri is characterized by lipid and carbohydrate accumulation under low nitrogen concentration without affecting biomass. To elucidate the molecular effects of nitrogen concentrations, we performed an RNA-seq analysis of C. muelleri grown under four nitrogen concentrations (3.53 mM, 1.76 mM, 0.44 mM, and 0.18 mM of NaNO3). This research revealed that changes in global transcription in C. muelleri are differentially expressed by nitrogen concentration. "Energetic metabolism", "Carbohydrate metabolism" and "Lipid metabolism" pathways were identified as the most upregulated by N deficiency. Due to N limitation, alternative pathways to self-supply nitrogen employed by microalgal cells were identified. Additionally, nitrogen limitation decreased chlorophyll content and caused a greater response at the transcriptional level with a higher number of unigenes differentially expressed. By contrast, the highest N concentration (3.53 mM) recorded the lowest number of differentially expressed genes. Amt1, Nrt2, Fad2, Skn7, Wrky19, and Dgat2 genes were evaluated by RT-qPCR. In conclusion, C. muelleri modify their metabolic pathways to optimize nitrogen utilization and minimize nitrogen losses. On the other hand, the assembled transcriptome serves as the basis for metabolic engineering focused on improving the quantity and quality of the diatom for biotechnological applications. However, proteomic and metabolomic analysis is also required to compare gene expression, protein, and metabolite accumulation.

Quercetin, a Flavonoid with Great Pharmacological Capacity.

Quercetin is a flavonoid with a low molecular weight that belongs to the human diet's phenolic phytochemicals and nonenergy constituents. Quercetin has a potent antioxidant capacity, being able to capture reactive oxygen species (ROS), reactive nitrogen species (RNS), and reactive chlorine species (ROC), which act as reducing agents by chelating transition-metal ions. Its structure has five functional hydroxyl groups, which work as electron donors and are responsible for capturing free radicals. In addition to its antioxidant capacity, different pharmacological properties of quercetin have been described, such as carcinostatic properties; antiviral, antihypertensive, and anti-inflammatory properties; the ability to protect low-density lipoprotein (LDL) oxidation, and the ability to inhibit angiogenesis; these are developed in this review.

Genetic modification of Candida maltosa, a non-pathogenic CTG species, reveals EFG1 function.

Candida maltosa is closely related to important pathogenic Candida species, especially C. tropicalis and C. albicans, but it has been rarely isolated from humans. For this reason, through comparative studies, it could be a powerful model to understand the genetic underpinnings of the pathogenicity of Candida species. Here, we generated a cohesive assembly of the C. maltosa genome and developed genetic engineering tools that will facilitate studying this species at a molecular level. We used a combination of short and long-read sequencing to build a polished genomic draft composed of 14 Mbp, 45 contigs and close to 5700 genes. This assembly represents a substantial improvement from the currently available sequences that are composed of thousands of contigs. Genomic comparison with C. albicans and C. tropicalis revealed a substantial reduction in the total number of genes in C. maltosa. However, gene loss seems not to be associated to the avirulence of this species given that most genes that have been previously associated with pathogenicity were also present in C. maltosa. To be able to edit the genome of C. maltosa we generated a set of triple auxotrophic strains so that gene deletions can be performed similarly to what has been routinely done in pathogenic Candida species. As a proof of concept, we generated gene knockouts of EFG1, a gene that encodes a transcription factor that is essential for filamentation and biofilm formation in C. albicans and C. tropicalis. Characterization of these mutants showed that Efg1 also plays a role in biofilm formation and filamentous growth in C. maltosa, but it seems to be a repressor of filamentation in this species. The genome assembly and auxotrophic mutants developed here are a key step forward to start using C. maltosa for comparative and evolutionary studies at a molecular level.

School Connectedness and Adolescent E-cigarette Susceptibility in an Urban Sample of Middle and High School Students.

Adolescent school connectedness generally protects from risk behaviors such as tobacco use; however, its relationship to e-cigarette use is unclear. This study examines the relationship between adolescent school connectedness and e-cigarette susceptibility in a diverse longitudinal sample. This secondary analysis of a school-based intervention surveyed 608 middle (66%) and high school (34%) students from 10 schools at 3 time points over 1 year. At baseline, respondents had a mean age of 14 years, 54% were female, and 71% were BIPOC (Black, Indigenous, People of Color). Logistic regression models examined unadjusted and adjusted associations between school connectedness (both baseline and concurrent) and e-cigarette susceptibility over time. E-cigarettes represented the most prevalent form of current nicotine-containing product use in spring 2019 (2.3%), and most respondents reported no e-cigarette susceptibility (69%). E-cigarette susceptibility remained relatively stable during the study. Higher baseline school connectedness levels were associated with lower odds of e-cigarette susceptibility over time. Similarly, higher concurrent school connectedness scores were associated with lower odds of e-cigarette susceptibility over time: spring 2019 (OR, 0.39; 95% CI, 0.32, 0.47), fall 2019 (OR, 0.49; 95% CI, 0.34, 0.72), and spring 2020 (OR, 0.64; 95% CI, 0.47, 0.87). Findings were similar for middle and high school students and did not differ significantly after adjusting for other covariates. Adolescents' school connectedness appears to protect from e-cigarette susceptibility over time, underscoring the importance of promoting positive school experiences to reduce adolescent risk e-cigarette use.

Proloterapia con dextrosa al 25% para el manejo del dolor en pacientes con fascitis planta / Prolotherapy with 25% dextrose for pain management in patients with plantar fasciitis

Introducción. La fascitis plantar (FP) es la principal causa de dolor en la parte inferior del talón y la proloterapia es una de las posibles opciones terapéuticas.Objetivo. Determinar el efecto de la proloterapia con dextrosa al 25% en la disminución del nivel de dolor en pacientes con FP.Metodología. Estudio de cohorte retrospectivo realizado en 70 pacientes con FP sometidos a proloterapia con dextrosa al 25% en una institución médica de Colombia en 2021. El nivel de dolor con el pie en reposo se midió con la escala visual análoga (EVA) en cada sesión de proloterapia, las cuales se realizaron a los 0, 1, 4, 7. 10 y 13 meses. Se realizó un análisis de varianza (ANOVA) con la prueba de Friedman y un análisis multivariado mediante modelos lineales mixtos para determinar la asociación entre variables. Resultados. Se realizaron 245 sesiones de proloterapia. La edad promedio fue 53 años y 80% de los pacientes eran mujeres. Las medianas de puntaje en la EVA fueron 9, 8, 6, 5, 4 y 2 en las 6 sesiones de proloterapia, respectivamente. Se evidenció una disminución progresiva del nivel de dolor a lo largo del tratamiento; sin embargo, solo hubo diferencias estadísticamente significativas desde la primera hasta la tercera sesión (p<0,05). Conclusiones. La proloterapia con dextrosa al 25% tuvo buenos resultados, ya que el nivel de dolor del pie en reposo disminuyó progresivamente, especialmente desde la primera sesión hasta la tercera

Introduction. Plantar fasciitis (PF) is the main cause of pain in the bottom of the heel and prolotherapy is one of the possible therapeutic options. Objective. Determine the effect of prolotherapy with 25% dextrose in reducing the level of pain in patients with PF.Methodology. Retrospective cohort study conducted in 70 patients with PF undergoing prolotherapy with 25% dextrose in a medical institution in Colombia in 2021. The level of pain with the foot at rest was measured with the visual analogue scale (VAS) in each session of prolotherapy, which were performed at 0, 1, 4, 7, 10 and 13 months. An analysis of variance (ANOVA) with the Friedman test and a multivariate analysis using linear mixed models were performed to determine the association between variables. Results. 245 prolotherapy sessions were carried out. The average age was 53 years and 80% of the patients were women. The median VAS scores were 9, 8, 6, 5, 4 and 2 in the 6 prolotherapy sessions, respectively. A progressive decrease in the level of pain is evident throughout the treatment; However, there were only statistically significant differences from the first to the third session (p<0.05). Conclusions. Prolotherapy with 25% dextrose had good results, since the level of foot pain at rest progressively decreased, especially from the first session to the third.

Factores que determinan la elección de alimentos procesados por estudiantes universitarios en el contexto de las etiquetas de advertencia nutricional

Las etiquetas de advertencia nutricional (EAN) informan a los estudiantes acerca de los alimentos procesados que exceden los niveles de nutrientes críticos. Sin embargo, aún es escasa la evidencia cómo funcionan las EAN en las decisiones alimentarias. El objetivo de esta investigación fue relacionar el efecto de las EAN en la toma de decisiones de alimentación de estudiantes universitarios, considerando los constructos de la teoría del comportamiento planificado (TCP), carrera de formación y variables sociodemográficas. A través de un muestreo no probabilístico se entrevistaron a 384 estudiantes universitarios. El cuestionario incluyó los factores de la TCP, correspondiente a las actitud, norma subjetiva, control percibido e intención de evitar la compra de alimentos procesados con EAN, más las carreras de formación y variables sociodemográficas. Los resultados del análisis factorial y regresión múltiple identificaron los determinantes de la intención de evitar comprar alimentos procesados con EAN. Los modelos muestran una actitud negativa de los estudiantes a las EAN lo que no activa la conducta de evasión por parte de los jóvenes. Mientras que la norma subjetiva, el control percibido y la formación en carreras de salud contribuyen positivamente a la intención de evitar alimentos con EAN. Los resultados evidencian que la TCP ayuda a entender el funcionamiento de las EAN en universitarios. Sin embargo, los hallazgos sugieren utilizar herramientas comunicacionales de mediano plazo dirigidas a jóvenes sin formación en salud para que estos realicen una elección informada de alimentos procesados y así reducir enfermedades no transmisibles asociadas a los malos hábitos alimentarios.

Nutrition Warning Labels (NWLs) inform students about processed foods that exceed critical nutrient levels. However, evidence on how NWLs influence food decisions is still scarce. The objective of this research was to relate the effect of NWLs on the decision-making of university students, considering the constructs of the theory of planned behavior (TPB), university major, and sociodemographic variables. Through non-probability sampling, 384 university students were interviewed. The questionnaire included the factors of the TPB, corresponding to the attitude, subjective norm, perceived control, and intention to avoid the purchase of foods processed with NWLs, plus field of study and sociodemographic variables. Factor analysis and multiple regression results identified the determinants of the intention to avoid buying processed foods with NWLs. The models showed a negative attitude of the students to the NWLs, which did not activate avoidance behavior on the part of young people. At the same time, the subjective norm, the perceived control, and the training in health careers contribute positively to the intention to avoid foods with NWLs. The results show that the TPB helps understand the operation of NWLs in university students. However, the findings suggest using medium-term communication tools aimed at young people without health training to make an informed choice of processed foods and thus reduce non-communicable diseases associated with poor eating habits.

Alternativa didáctica para la formación de las habilidades tácticas en taekwondistas categoría 11-12 años / Alternativa didática para a formação de capacidades tácticas na categoria de taekwondistas de 11-12 anos de idade / Didactical alternative for the formation of the tactical skills in 11-12 aged taekwondo athletes

RESUMEN La enseñanza-aprendizaje de la táctica se orienta hacia la formación de las habilidades para el combate, de tal modo, el comportamiento táctico configura el modo de actuación que evidencia el nivel alcanzado en este proceso. Las habilidades referidas se conceptualizan desde dos perspectivas: habilidades técnico-tácticas y tácticas. La primera carece de una visión holística que integre los componentes físico, teórico y psicológico; por el contrario, la segunda destaca la interacción de estos y reconoce algunas singularidades de la táctica. No obstante, son insuficientes las propuestas de acciones didácticas desde el desarrollo de la clase. Consecuentemente, se ha limitado la formación de las habilidades tácticas en el taekwondo, en efecto el comportamiento táctico de los taekwondistas de la categoría 11-12 años exhibe limitaciones. El presente artículo propone una estrategia didáctica para el tratamiento de la táctica, sustentado en elementos de la dinámica de la clase. La totalidad de especialistas consultados coincidieron en la pertinencia, aplicabilidad y relevancia social de la propuesta, lo cual se evidenció en los valores obtenidos por consenso mediante los puntos de corte. Los métodos empleados fueron la observación, el análisis-síntesis, sistémico estructural funcional, consulta a especialistas mediante una encuesta, distribución empírica de frecuencias y los puntos de corte.

RESUMO O ensino-aprendizagem de tácticas está orientado para a formação de competências de combate, de tal forma que o comportamento táctico configura o modo de ação que mostra o nível alcançado neste processo. As competências referidas são conceptualizadas a partir de duas perspectivas: competências técnico-tácticas e tácticas. A primeira carece de uma visão holística que integre os componentes físicos, teóricos e psicológicos; pelo contrário, a segunda enfatiza a interação destes e reconhece algumas singularidades de tácticas. No entanto, as propostas de ações didáticas do desenvolvimento da classe são insuficientes. Consequentemente, a formação de capacidades tácticas no taekwondo tem sido limitada, com efeito, o comportamento táctico dos taekwondistas da categoria dos 11-12 anos de idade apresenta limitações. Este artigo propõe uma estratégia didática para o tratamento de tácticas, com base em elementos da dinâmica da classe. Todos os especialistas consultados concordaram sobre a pertinência, aplicabilidade e relevância social da proposta, o que foi evidenciado nos valores obtidos por consenso através dos pontos de corte. Os métodos utilizados foram observação, análise-síntese, sistémica estrutural funcional, consulta com especialistas através de um inquérito, distribuição empírica de frequências e pontos de corte.

ABSTRACT The teaching learning of tactics is oriented towards the formation of combat skills, in such a way, tactical behavior configures the mode of action that shows the level reached in this process. The referred skills are conceptualized from two perspectives: technical-tactical skills and tactical skills. The first lacks a holistic vision that integrates the physical, theoretical and psychological components; on the contrary, the second one highlights their interaction and recognizes some singularities of the tactic. However, the proposals for didactic actions from the development of the class are insufficient. Consequently, the training of tactical skills in Taekwondo has been limited; in fact, the tactical behavior of taekwondo players in the 11-12 year category exhibits limitations. This article proposes a didactic strategy for the treatment of tactics, based on elements of class dynamics. All the specialists consulted agreed on the relevance, applicability and social relevance of the proposal, which was evidenced in the values obtained by consensus through the cut-off points. The methods used were observation, analysis-synthesis, functional structural systemic, and consultation with specialists through a survey, empirical frequency distribution and cut-off points.

Categorías diagnósticas y resultados a corto plazo en los pacientes con sospecha de COVID-19 atendidos en un servicio de urgencias / Diagnostic groups and short-term outcomes in suspected COVID-19 cases treated in an emergency department

OBJETIVO: EL objetivo principal fue describir el perfil clínico y la mortalidad a los 30 días de diferentes categorías diagnósticas en los casos de COVID-19 atendidos en un servicio de urgencias (SU). MÉTODO: Análisis secundario del registro COVID-19_URG-HCSC. Se seleccionaron los casos sospechosos de COVID-19 atendidos en un SU de Madrid desde el 28 de febrero hasta el 31 de marzo de 2020. La muestra se dividió: 1) sospecha con PCR no realizada (S/PCR NR); 2) sospecha con PCR negativa (S/PCR-); 3) sospecha con PCR positiva (S/PCR+); 4) alta sospecha con PCR negativa o no realizada (AS/PCR- o NR); y 5) alta sospecha con PCR positiva (AS/PCR+). Se recogieron variables clínicas, radiológicas y microbiológicas del episodio de urgencias. La variable de resultado principal fue la mortalidad por cualquier causa a los 30 días. Las variables secundarias fueron el ingreso y la gravedad del episodio. RESULTADOS: Se incluyeron 1.993 pacientes; 17,2% S/PCR NR, 11,4% S/PCR-, 22,1% S/PCR+, 11,7% AS/PCR- o NR y 37,6% AS/PCR+. Se hallaron diferencias estadísticamente significativas respecto a las variables demográficas, comorbilidad, clínicas, radiográficas, analíticas y terapéuticas y de resultados a corto plazo en función las categorías diagnósticas. La mortalidad global a los 30 días fue de un 11,5%, 56,5% casos fueron hospitalizados y 19,6% casos sufrieron un episodio grave. Las categorías de AS y de S/PCR+ tuvieron un incremento del riesgo ajustado de mortalidad a los 30 días y de sufrir un episodio grave durante el ingreso hospitalario respecto a S/PCR-. En relación al ingreso, solo las categorías de AS tuvieron un incremento del riesgo ajustado de hospitalización respecto a la categoría de S/PCR-. CONCLUSIONES: Existen diferentes categorías diagnósticas de la enfermedad COVID-19 en función del perfil clínico y microbiológico que tienen correlato con el pronóstico a 30 días

OBJECTIVE: The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings. METHODS: Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clínico San Carlos in Madrid, Spain. We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020. The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR); 2) suspected, negative PCR (S/PCR-); 3) suspected, positive PCR (S/PCR+); 4) highly suspected, no PCR, or negative PCR (HS/no or PCR-); and 5) highly suspected, positive PCR (HS/PCR+). We collected clinical, radiologic, and microbiologic data related to the emergency visit. The main outcome was 30-day all-cause mortality. Secondary outcomes were hospitalization and clinical severity of the episode. RESULTS: A total of 1993 cases (90.9%) were included as follows: S/no-PCR, 17.2%; S/PCR-, 11.4%; S/PCR+, 22.1%; HS/no PCR or PCR-, 11.7%; and HS/PCR+, 37.6%. Short-term outcomes differed significantly in the different groups according to demographic characteristics; comorbidity and clinical, radiographic, analytical, and therapeutic variables. Thirty-day mortality was 11.5% (56.5% in hospitalized cases and 19.6% in cases classified as severe). The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases. Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases

Unmeasurable severe hypernatremia: A different way of using the calculated serum osmolality formula / Hipernatremia incalculable severa: una manera diferente de utilizar la fórmula de osmolaridad sérica

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The use of cell cycle arrest biomarkers in the early detection of acute kidney injury. Is this the new renal troponin? / El uso de biomarcadores de detección del ciclo celular para el diagnóstico precoz del fracaso renal agudo. ¿La nueva troponina renal?

Acute kidney injury (AKI) has a high prevalence in critical care patients. Early detection might prevent patients from developing chronic kidney disease and requirement for renal replacement therapy. If we compare AKI with acute coronary syndrome, in which an increase in cardiac troponin may trigger early diagnosis and therapeutic intervention, we could extrapolate a similar technique in patients with early AKI without changes in urinary frequency or serum creatinine. The objective is to identify biomarker-positive, creatinine-negative patients that would allow therapeutic interventions to be initiated before finding changes in serum creatinine, preventing kidney damage. Tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 are cell cycle arrest biomarkers that have demonstrated, in recent clinical trials, to have good sensitivity and specificity for early detection of AKI. Other recent studies have shown that the joint use of these biomarkers with serum creatinine and urine production could improve the prognosis of AKI in critical patients. The application of these biomarkers in clinical practice would enable the early identification of patients at risk of AKI, establishing interventions that would improve the survival of renal function

Existe una gran prevalencia del fracaso renal agudo (FRA) en pacientes críticos. La detección temprana prevendría el desarrollo de la enfermedad renal crónica y el requerimiento de terapias renales de sustitución. Si comparamos el FRA con el síndrome coronario agudo, en el que el uso de la troponina cardiaca permite el diagnóstico precoz y su consecuente terapia, se podría extrapolar técnica similar en pacientes con FRA temprano sin cambios en la frecuencia urinaria o creatinina sérica. El objetivo sería identificar a pacientes con un biomarcador positivo y la creatinina negativa que permitiera iniciar intervenciones terapéuticas antes de objetivar cambios en la creatinina sérica, previniendo el daño renal. El inhibidor tisular de metaloproteinasa-2 y la proteína de enlace 7 del factor de crecimiento insulínico, son biomarcadores de detención del ciclo celular, que han demostrado, en estudios recientes, tener adecuada sensibilidad y especificidad para la pronta identificación del FRA. Otros estudios recientes han mostrado que el uso conjunto de estos biomarcadores con la creatinina sérica y la producción de orina, pudieran mejorar el pronóstico del FRA en pacientes críticos. La aplicación de estos biomarcadores en la práctica clínica permitiría la identificación precoz de pacientes con riesgo de FRA estableciendo intervenciones que mejorarían la supervivencia de la función renal

Hypertension in the African American population: A succinct look at its epidemiology, pathogenesis, and therapy / Hipertensión en la población afroamericana: breve examen de su epidemiología, patogénesis y terapia

Arterial hypertension is prevalent in the black population in the United States. It is directly related to cardiovascular and kidney damage. Its pathogenesis is complex and includes the high incidence of obesity, salt sensitivity and the activation of the renin-angiotensinal dosteronesystem. This complexity requires a therapeutic combination that includes changes in dietary habits and appropriate antihypertensive regimes. The International Society of Hypertension in Blacks recommends initiating dietary intervention for values of systolic/diastolic arterial blood pressure above 115/75 mmHg and maintaining arterial blood pressure below 135/85 mmHg using appropiate antihypertensive medication. The most adequate antihypertensive drug for this population has yet to be determined (AU)

La hipertensión arterial es prevalente en la población de raza negra en los EEUU. Presenta una relación directa con el daño cardiovascular y renal. Su patogenia es compleja e incluye la alta incidencia de obesidad, sensibilidad a la sal, y la consecuente activación del sistema de la renina, angiotensina y aldosterona. Eso hace que requiera una combinación terapéutica que incluye cambios dietéticos y regímenes antihipertensivos adecuados. La Sociedad internacional de la hipertensión en pacientes de raza negra recomienda iniciar dietas de control para valores de tensión arterial sistólica/diastólica por encima de los 115/75 mmHg y mantener una tensión arterial por debajo de 135/85 mmHg con el uso de medicación antihipertensiva idónea. El fármaco antihipertensivo adecuado está por determinar en esta población (AU)

Tumor del estroma gastrointestinal. Puesta al día / Gastrointestinal stromal tumor. An update

El tumor del estroma gastrointestinal (GIST) es la neoplasia mesenquimal gastrointestinal más frecuente. Desde el descubrimiento de la inmunoexpresión de c-KIT y la existencia de mutaciones en KIT y PDGFRA ha sido un ejemplo de terapia molecular dirigida que permitió la aplicación de un tratamiento, el mesilato de imatinib, altamente eficaz. Desde entonces hay evidencia de que en realidad el GIST constituye un grupo heterogéneo desde el punto de vista clínico, morfológico, inmunohistoquímico y molecular. Esta variabilidad puede implicar distintos acercamientos diagnósticos y terapéuticos para cada caso particular, por lo que se debe establecer cuando hay que realizar estudio molecular. Es también imprescindible valorar el riesgo de recurrencia y metástasis para establecer un correcto pronóstico y por la posibilidad de utilizar terapia adyuvante. En este artículo se revisan tanto las características clínicas, morfológicas, inmunohistoquímicas y moleculares del GIST atendiendo a su complejidad, como la correcta valoración del riesgo (AU)

Gastrointestinal stromal tumor (GIST) is the most common gastrointestinal mesenchymal neoplasm. Since the discovery of c-KIT immunoexpression and the presence of KIT and PDGFRA mutations, it has represented an example of molecular targeted therapy that allowed the use of a highly effective treatment: imatinib mesylate. Since then there is evidence that GIST actually constitute a rather heterogeneous group from the clinical, morphological, immunohistochemical and molecular point of view. This variability may imply possible different diagnostic and therapeutic approaches for each specific case, making necessary to establish when molecular analyses must be performed. Is also mandatory to evaluate the risk of recurrence and metastases not only to know the prognosis but because adjuvant therapy may be used. n this paper the clinical, morphological, immunohistochemical and molecular features of GIST and the correct evaluation of risk are reviewed attending to its complexity (AU)

Necrotizing crescentic glomerulonephritis in a patient with positive serologies for lupus and antineutrophil cytoplasmic antibodies

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Recomendaciones para el estudio patológico de las metástasis hepáticas de cáncer colorrectal tras neoadyuvancia. Consenso Nacional de la Sociedad Española de Anatomía Patológica / Recommendations for the study of liver metastases of colorectal cancer after neoadjuvant therapy. National Consensus of the Spanish Society of Pathology (SEAP)

Las resecciones hepáticas por metástasis de cáncer colorrectal (CCR) son una pieza quirúrgica frecuente en muchos servicios de anatomía patológica. Si al aumento de la incidencia de CCR añadimos otros factores como la frecuencia de metástasis hepáticas sincrónicas o metacrónicas, la ampliación en los criterios quirúrgicos de resecabilidad y el tratamiento neoadyuvante que facilita la resecabilidad, nos encontramos con una patología en aumento. El estudio anatomopatológico de estas piezas quirúrgicas se ha modificado y ha aumentado su complejidad debido a que se deben valorar nuevos datos histológicos como son los cambios potenciales producidos por el tratamiento neoadyuvante quimioterápico en el hígado no tumoral, y en el tumor el grado de regresión tumoral patológico, por su valor pronóstico. Teniendo en cuenta estos antecedentes, un grupo de patólogos se propuso revisar su papel en el diagnóstico y pronóstico de los pacientes con metástasis hepáticas de CCR con el objetivo de elaborar unas recomendaciones prácticas de procedimiento. De esta revisión se han obtenido unas directrices que podrían ser adaptadas por los distintos departamentos de patología con el fin de unificar procedimientos y obtener diagnósticos comparables. En este trabajo se exponen los resultados de este consenso (AU)

Liver resections for colorectal cancer (CRC) metastasis are common in most pathology departments. In addition, the frequency of liver resections for CRC specimens has increased due to an increased incidence of CRC the frequency of synchronous or metachronous liver metastases, the use of neoadjuvant therapy, and the increased surgical criteria of resectability. The pathological study of the specimens should include new histological data, i.e.: changes caused by therapy, both in the tumour and in the liver parenchyma, such as the pathological tumour regression grade, and the histologic degree of liver damage by the therapy, because of its prognostic value. On this setting, a group of pathologists has elaborated a guideline proposal, in order to obtain a more uniform procedure and diagnosis of CRC liver metastasis specimens. The aim was to give useful recommendations in order to obtain homogeneous and comparable pathologic reports among different pathology departments. The results of this consensus are presented in this paper (AU)

Metabolic acidosis and progression of chronic kidney disease: incidence, pathogenesis, and therapeutic options

In the chronic kidney disease population metabolic acidosis is prevalent presenting already in the early stages of renal dysfunction. The pathogenesis associates the lack of bicarbonate production with the accumulation of organic/inorganic acids and the development of tubulointerstitial damage through ammonium retention and complement deposition. The empiric use of oral sodium bicarbonate represents an interesting therapeutic option that has been documented in a few clinical trials in human subjects. The availability of oral sodium, in its diverse forms, represents an inexpensive and simple way of treating an entity that could hasten the progression of kidney disease, as well as protein catabolism, bone disease and mortality (AU)

Hay una prevalencia importante de la acidosis metabólica en los pacientes que padecen enfermedad renal crónica, presentándose en niveles tempranos de pérdida de filtrado glomerular. La patogénesis se basa en la falta de síntesis de bicarbonato sérico con la acumulación de ácidos de naturaleza orgánica e inorgánica, ocasionando daño tubulointersticial a través de la retención de amoniaco y el depósito de complemento, aunque esta última hipótesis se ha cuestionado en el pasado. El uso empírico de bicarbonato oral representa una opción terapéutica interesante que ha sido utilizada en estudios clínicos recientes. La disponibilidad de bicarbonato de sodio oral en sus diversas formas representa una opción barata y simple de utilizar para decelerar la progresión de la enfermedad renal, sin mencionar las mejoras en el catabolismo proteico, la osteodistrofia renal y la mortalidad (AU)

Precisión de la tomografía de 64 cortes en el diagnóstico de reestenosis de stent coronario / Accuracy of the 64 multislice computed tomography in the diagnosis of coronary stent restenosis

Objetivo: Determinar la precisión de la coronariografía por tomografía de 64 cortes para la detección de la reestenosis de los stents. Método: Se examinaron 52 pacientes portadores de 76 stents coronarios con sospecha de reestenosis. Inicialmente se les realizó coronariografía mediante tomógrafo de 64 cortes y posteriormente coronariografía invasiva como patrón de referencia. Se calcularon los índices de eficiencia diagnóstica. Resultados: En los stents valorables de 3 mm o más de diámetro, la sensibilidad, especificidad, valor predictivo positivo y negativo de la tomografía fueron de 95, 98, 95 y 98% respectivamente, con razón de verosimilitud positiva de 42 (IC95%, 6 a 290) y negativa de 0.05 (IC95%, 0.01 a 0.35), validez de 97% y Kappa de 0.93 (IC95%, 0.83 a 1), (p ≤ 0.00001). En los stents valorables menores que 3 mm, disminuyeron apreciablemente los índices de eficiencia diagnóstica y de Kappa, perdiendo la significancia estadística (p > 0.05). Conclusión: La coronariografía por tomografía de 64 cortes es una técnica clínica no invasiva precisa, en la detección de la reestenosis de los stents, sobre todo en los stents de 3 mm o más, y segura, ya que permite identificar a los pacientes que necesitan o no la realización de una coronariografía invasiva de control.

Objective: To determine the accuracy of coronary angiography through 64-slice computed tomography in detecting in-stent restenosis. Method: Fifty-two patients with 76 coronary stents and suspicion of restenosis were examined. Initially, they underwent coronary angiography through 64-slice computed tomography, and subsequently invasive coronary angiography as gold standard. Diagnostic efficiency indexes were calculated. Results: In the stents of 3 mm or more of diameter, tomography sensitivity, specificity, positive and negative predictive value were 95, 98, 95 and 98% respectively, with positive likelihood ratio of 42 (CI95%, 6 to 290) and negative of 0.05 (CI95%, .01 to .35), validity of 97% and Kappa of 0.93 (CI95%, .83 to 1), (p ≤ 0.00001). In the stents smaller than 3 mm, the indexes of diagnostic efficiency and Kappa considerably decreased, loosing the statistical significance (p >0.05). Conclusions: Coronary angiography through 64-slice computed tomography is an accurate, non-invasive clinical technique for the detection of in-stent restenosis, especially with stents of 3 mm or more of diameter, and reliable allows identification of patients who need to undergo or not control invasive coronary angiography.