Effectiveness and safety of the radiofrequency ablation of single hyperfunctioning parathyroid lesions suggestive of adenomas in primary hyperparathyroidism.

INTRODUCTION: Radiofrequency ablation (RFA) has emerged as a minimally invasive approach to single parathyroid adenoma in primary hyperparathyroidism; however, there is limited evidence on its effectiveness. OBJECTIVE: To evaluate the effectiveness and safety of RFA to treat hyper-functioning parathyroid lesions suggestive of adenomas. MATERIAL AND METHODS: A prospective study was conducted in consecutive patients with primary hyperparathyroidism treated with RFA for single parathyroid lesions in our reference center between November 2017 and June 2021. Pre-treatment (baseline) and follow-up analytical data were gathered on total protein-adjusted calcium, parathyroid hormone [PTH], phosphorus, and 24-h urine calcium. Effectiveness was defined as complete response (normal calcium and PTH), partial response (reduced but not normalized PTH with normal serum calcium), or disease persistence (elevated calcium and PTH). SPSS 15.0 was used for statistical analysis. RESULTS: Four of thirty-three enrolled patients were lost to the follow-up. The final sample comprised 29 patients (22 females) with mean age of 60.93 ± 13.28 years followed up for a mean of 16.29 ± 7.23 months. Complete response was observed in 48.27%, partial response in 37.93%, and hyperparathyroidism persistence in 13.79%. Serum calcium and PTH levels were significantly lower at 1 and 2 years of post-treatment than at baseline. Adverse effects were mild, with two cases of dysphonia (self-limited in one patient) and no cases of hypocalcaemia or hypoparathyroidism. CONCLUSION: RFA may be a safe and effective technique to treat hyper-functioning parathyroid lesions in selected patients.

Nanotechnology in reproduction: Vitamin E nanoemulsions for reducing oxidative stress in sperm cells.

Vitamin E is considered a powerful biological antioxidant; however, its characteristics such as high hydrophobicity and low stability limit its application. We propose to use nanotechnology as an innovative tool in spermatology, formulating nanoemulsions (NE) that accommodate vitamin E, protecting it from oxidation and promoting its release into the medium. The protective effect of the NE against oxidative stress was assessed in red deer epididymal sperm incubated at 37 °C. Cryopreserved sperm from eleven stags were thawed and extended to 400 × 106 sperm/ml in Bovine Gamete Medium (BGM). Once aliquoted, the samples were supplemented with the NE at different concentrations (0, 6 and 12 mM), with or without induced oxidative stress (100 µM Fe2+/ascorbate). The samples were evaluated after 0, 2 and 4 h of incubation at 37 °C. Motility (CASA), viability, mitochondrial membrane potential, acrosomal status, lipoperoxidation (C11 BODIPY 581/591), intracellular reactive oxygen species (ROS) production and DNA status (SCSA®) were assessed. After 2 and 4 h of incubation, the NE were able to prevent the deleterious effects of oxidative stress, thus improving total and progression motility (P ˂0.05). Moreover, the highest concentration tested (12 mM) improved almost every sperm kinematic variable (P ˂0.05) and preserved sperm viability in samples subjected to oxidative stress. In addition, 12 mM of NE protected the acrosomes integrity, maintained and protected mitochondrial activity, prevented sperm lipoperoxidation and reduced ROS production (P ˂0.05) in samples subjected to oxidative stress. This work indicates for the first time that vitamin E formulated in NE could be a new approach against sperm oxidative damage. This could be highly relevant for sperm physiology preservation in the context of assisted reproduction techniques.

Use of micafungin as antifungal prophylaxis in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Spain (GETH-MIC).

OBJECTIVE: The fungal infections remain an important problem in the allogeneic stem cell trasnsplantation (allo-SCT) setting and thus, anti-fungal prophylaxis is commonly used. The antifungal drug should offer activity, at least against Candida and Aspergillus spp., a good safety profile and low probability interactions. Micafungin could theoretically fulfill these requisites. The aim of the study was to describe the experience with micafungin as primary prophylaxis in patients undergoing allo-SCT in a cohort of Spanish centres, and to evaluate its efficacy and tolerability in this population. METHODS: Retrospective multicentre observational study including all consecutive adult patients admitted for allo-SCT in participating centres of the Grupo Español de Trasplante Hematopoyético (GETH), from January 2010 to December 2013, who received micafungin as primary prophylaxis during the neutropenic period. RESULTS: A total of 240 patients from 13 centres were identified and 159 patients were included for the analysis. Most patients (95.6%) received 50 mg/day of micafungin. During the follow-up, 7 (4.4%) patients developed breakthrough invasive fungal disease, 1 proven and 6 probable; one patient discontinued the drug because of serious drug interactions. Prophylaxis with micafungin was considered effective in 151 (94.9%) patients. CONCLUSIONS: According to our experience, micafungin is an appropriate alternative for antifungal prophylaxis in patients undergoing an allo-HSCT, because its efficacy, its low profile of drug interactions and side-effects.

Sangrado intraoperatorio de amigdalectomía en población pediátrica. Influencia de factores quirúrgicos y anestésicos / Intraoperative bleeding of tonsillectomy in pediatric patients. Effects of surgical and anesthesia technique

INTRODUCTION: Tonsillectomy with or without adenoidectomy is one of the most frequent surgeries in the pediatric population. It has become predomi- nantly an outpatient procedure. Therefore, it is of utmost importance identi- fying the factors that influence the intraoperative bleeding to prevent posto- perative complications and rehospitalization. MATERIAL AND METHODS: An observational cross-sectional study was carried out. Patients between 1 and 14 years old that underwent to tonsillectomy with or without adenoidectomy since November 2015 to May 2017 were included. 709 cases were evaluated. Intraoperative bleeding was assessed by the volumetric method. A multivariate analysis was performed using a generalized linear regression model. RESULTS: The average intraoperative bleeding was estimated in 1.9 ml/kg (95% CI: 1.7 -2.05). The use of propofol (30% increase in bleeding) and surgical time (2% increase for every minute) were risk factors. The use of electrocautery was as- sociated with a 50% decrease in bleeding in comparison with conventional dis- section (p = 0.001). CONCLUSION: The use of propofol and a prolonged surgical time were risk factors for intraoperative bleeding. The use of electrosurgery was a protective factor.

INTRODUCCIÓN: La amigdalectomía con o sin adenoidectomía, es una de las cirugías más frecuente en población pediátrica. Desde hace varios años se ha vuelto una intervención predominantemente ambulatoria, por lo que lograr identificar los factores que influyen en el sangrado intraoperatorio es de suma importancia para prevenir complicaciones postoperatorias y reshospitalización. MATERIAL Y MÉTODO: Se realizó un estudio observacional de corte-transversal. Se incluyó a pacientes entre 1 y 14 años sometidos a amigdalectomía con o sin adenoidectomía entre noviembre de 2015 y mayo de 2017, obteniendo un total de 709 casos evaluados. Se determinó el sangrado intraoperatorio de forma volumétrica. Posteriormente, se realizó un análisis multivariado con un modelo de regresión lineal generalizado. RESULTADOS: Se cuantificó el sangrado intraoperatorio promedio en 1,9 ml/kg (IC 95%; 1,7-2,05). El uso de propofol (aumento del 30% del sangrado) y tiempo quirúrgico (2% por cada incremento de un minuto) fueron factores de riesgo. Mientras que el uso de electro bisturí se asoció con una disminución del 50% en relación al no uso (p = 0,001). CONCLUSIONES: Fueron factores de riesgo para sangrado intraoperatorio el uso de propofol y un tiempo quirúrgico prolongado. El uso de electrobisturí constituyó un factor protector.

Fracasos de la embolización en el tratamiento del mioma uterino / Embolization failures in the treatment of uterine myoma

La embolización de la arteria uterina ha sido descrita como un método efectivo y seguro en el tratamiento de los miomas sintomáticos. Se presentan 3 casos de pacientes con útero miomatoso sintomático, y su tratamiento mediante esta técnica. En estos 3 casos, las complicaciones postembolización de los miomas hizo necesaria la práctica de una histerectomía. Así mismo se describen otras complicaciones derivadas de la técnica señaladas en la revisión bibliográfica realizada

Uterine artery embolization has been described as an effective and safe treatment for women with symptomatic uterine leiomyomata. We report three cases of women with symptomatic myomatous uterus and their treatment by this approach. In these three cases, hysterectomy was required due to complications following the embolizations. We also describe other complications of this therapeutic approach that came to light in the literature review

Long-term outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy.

Treatment outcome in older patients with acute promyelocytic leukemia (APL) is lower compared with younger patients, mainly because of a higher induction death rate and postremission non-relapse mortality (NRM). This prompted us to design a risk- and age-adapted protocol (Programa Español de Tratamientos en Hematología (PETHEMA)/HOVON LPA2005), with dose reduction of consolidation chemotherapy. Patients aged ⩾60 years reported to the PETHEMA registry and were treated with all-trans retinoic acid (ATRA) plus anthracycline-based regimens according to three consecutive PETHEMA trials that were included. We compared the long-term outcomes of the LPA2005 trial with the preceding PETHEMA trials using non-age-adapted schedules (LPA96&LPA99). From 1996 to 2012, 389 older patients were registered, of whom 268 patients (69%) were eligible. Causes of ineligibility were secondary APL (19%), and unfit for chemotherapy (11%). Median age was 67 years, without relevant differences between LPA2005 and LPA96&LPA99 cohorts. Overall, 216 patients (81%) achieved complete remission with no differences between trials. The 5-year NRM, cumulative incidence of relapse, disease-free survival and overall survival in the LPA2005 vs the LPA96&99 were 5 vs 18% (P=0.15), 7 vs 12% (P=0.23), 87 vs 69% (P=0.04) and 74 vs 60% (P=0.06). A less intensive front-line regimen with ATRA and anthracycline monochemotherapy resulted in improved outcomes in older APL patients.

Relation between dengue and climate trends in the Northwest of Mexico.

Dengue is native to tropical areas. It has expanded into temperate and arid zones in Mexico. Due to climate change, it is urgent to study the behavior of this disease in northwestern Mexico. Incidence of dengue fever and monthly maximum and minimum temperature and rainfall were obtained for 1990-2013 for the State of Baja California Sur. The relation between monthly and seasonal climate data with dengue records was analyzed by Pearson's correlation. The analysis shows that the minimum temperature has increased and the climate factor significantly correlates with dengue. Temperature variations have decreased. In this state, incidence of dengue cases directly correlates with minimum monthly temperature. It is expected that, as minimum temperatures increase to the end of this century, it will likely lead to increasing incidence of dengue. Preventive actions are recommended.

PO-04 - A new genetic risk score for predicting venous thromboembolic events in cancer patients receiving chemotherapy.

BACKGROUND: Venous thromboembolism (VTE) is one of the major causes of cancer-associated mortality. Risk for developing VTE increases when in chemotherapy, mainly in the outpatient setting. Current risk scores for predicting chemotherapy-associated VTE have low/moderate discrimination capacity. These models use clinical parameters. ThromboinCode (TiC) is a new tool for VTE risk prediction using an algorithm that combines a genetic risk score (GRS) with subject's VTE clinical risk parameters (cancer type and cancer disease status "CDS", included). AIMS: To evaluate whether TiC predicts better the risk for chemotherapy-associated VTE than Khorana score. METHODS: A prospective, observational study including 251 patients with locally advanced or metastatic cancer (colon, stomach, pancreas and lung) receiving systemic outpatient chemotherapy. Patients are followed-up for 6 months. Three predictive models were compared: a) Khorana score; b) Khorana score plus CDS and c) TiC. Genetic variants included in TiC are FVL, PT, F5 rs118203906 and rs118203905, F12 rs1801020, F13 rs5985, SERPINC1 rs121909548, SERPINEA10 rs2232698 and A1 blood group rs8176719, rs7853989, rs8176743, rs8176750. Clinical risk factors in TiC are age, sex, family history of VTE, BMI, smoking, diabetes, type of cancer and CDS. Prediction capacity of each model was assessed in terms of the discrimination (area under the receiver operating characteristic curve, AUC). RESULTS: The incidence of VTE at 6 months was 23.11%. Korana score had an AUC of 0.550 (95% CI 0.485-0.613, p=0.2162), sensitivity 64.41, specificity 46.56, positive likelihood ratio of 1.21, negative likelihood ratio of 0.76. Khorana score+CDS prediction model had an AUC of 0.609 (95% CI 0.545-0.670, p=0.008), sensitivity 70.69, specificity 50.53, positive likelihood ratio of 1.25, negative likelihood ratio of 0.67. Discrimination increased significantly with TiC (AUC: 0.70; 95% CI 0.636 - 0.753, p<0.0001), sensitivity 79.31, specificity 55.44, positive likelihood ratio of 1.78, negative likelihood ratio of 0.37. The discrimination with TiC was significantly higher than with the other two predictive models (p<0.05). CONCLUSIONS: We conclude that TiC predicts chemotherapy-associated VTE risk significantly better than Khorana score with CDS.

Estapedotomía mediante láser CO2: nuestra experiencia y resultados en régimen de Cirugía Mayor Ambulatoria / CO2 laser stapedotomy: our experience and results in a Day Care Surgery procedure

Introducción: El uso del láser en cirugía de la otosclerosis muestra buenos resultados de seguridad y eficacia en la literatura. Mostramos nuestra experiencia en esta cirugía. Métodos: Presentamos un estudio retrospectivo de 5 años (2010 a 2014) comparando la cirugía instrumental con estapedectomía y la estapedotomía láser CO2 , y la evolución del procedimiento a Cirugía Mayor Ambulatoria (CMA). Resultados: Revisamos 50 cirugías (28 estapedectomías instrumentales y 22 estapedotomías láser CO2 ; relación mujeres/hombres 1,17; edad media 44,95; umbral aéreo medio en 0,5 a 4 khz prequirúrgico de 62,02 decibelios (db) y Rinne medio 34,75 db. Los resultados audiométricos obtenidos fueron Rinne de 10 db o menor en el grupo instrumental frente a láser del 78,6 % y 77,3 %, con cierre del Rinne del 67,3 % frente un 74,5 % (p 0,67 y 0,35). Recogimos vértigo como complicación más prevalente y trascendente para la ambulatorización, con 35,7 % frente a 22,7 % (p 0,36). Iniciamos la ambulatorización de la estapedotomía láser con 16 casos de CMA (Grupo 1) frente 34 casos con ingreso (28 instrumentales y 6 láser, Grupo 2), con un índice de ambulatorización del 62,5 y 80 % en 2013 y 2014; tasa de ingresos 16,67 y 20 %, sin reingresos, y una estancia media hospitalaria de 0,2 días en el Grupo 1 frente a la 1,3 en el Grupo 2 (p < 0,001). Conclusiones: A pesar de la baja casuística los resultados son alentadores en seguridad y eficacia de la cirugía láser estapedial, con buena eficiencia para conversión a cirugía sin ingreso (AU)

Introduction: Laser in stapes surgery could improve in security and efficacy in reported studies. We expose our experience. Methods: A 5 years (2010 to 2014) retrospective study to assess instrumental stapedectomy versus CO2 laser stapedotomy in otosclerosis patients and evolution to in day surgery procedure. Results: We review 50 procedures (28 instrumental stapedectomy and 22 CO2 laser stapedotomy), ratio women/men 1,17, mean age 44.95 years, air threshold mean in 0.5 to kHz before surgery of 62.02 decibels (db) and mean of air/bone gap of 34.75 db. The audiologic results were an air/bone gap closure of 10 db or less in stapedectomy group versus laser stapedotomy group of 78.6 % and 77.3 %, with a air/bone gap mean closure of 67,3 % and 74.5 % (p 0.67 and 0.35 respectively). We compile vertigo as the most prevalent and important for day-care surgery possibility, with 35,7 % in first group versus 22.7 % (p 0,36). We reported 16 cases of day care stapedotomy (Group 1) and 34 cases with minimum one day hospitalization (28 instrumental stapedectomy and 6 laser stapedotomy, group 2), with a day-care index of 62,5 % y 80 % in 2013 and 2014 respectively, hospitalization index of 16.67 % and 20 %, without re-hospitalization, and a hospitalization day mean of 0,2 in Group 1 versus 1,3 in Group 2 (p < 0.001). Conclusions: Despite our low casuistry the results are encouraging regarding security and efficacy of laser stapedotomy and efficiency for its convertion to day-care surgery (AU)

Traqueostomía percutánea con técnica Ciaglia Blue Rhino: experiencia en Hospital Clínico FUSAT de Rancagua / Percutaneous tracheostomy Ciaglia Blue Rhino technique: revision 2 years of experience

Introducción: La traqueostomía descrita ya hacia el 1500 AC, en las últimas décadas ha evolucionado al desarrollo de sistemas de abordaje mínimamente invasivos o percutáneos, de los cuales la técnica de Ciaglia Blue Rhino (dilatador único), es la más utilizada en la actualidad. Objetivo: Se realizó un estudio retrospectivo descriptivo de las traqueostomías realizadas en el Hospital Clínico FUSAT de Rancagua, entre los años 2006 y 2012, con el fin de evaluar ventajas, desventajas e incidencia de complicaciones de la técnica abierta versus la técnica percutánea en nuestras manos. Material y método: Se incluyeron 64 traqueostomías consecutivas de las cuales 42 fueron percutáneas con técnica de Ciaglia Blue Rhino y el resto con técnica abierta clásica. Resultados: Al analizar los resultados encontramos ventajas de la técnica percutánea como un importante acortamiento del tiempo quirúrgico (de 45,27 minutos en la técnica clásica a 15,28 minutos promedio en la técnica percutánea), una menor incidencia de complicaciones (14% en procedimiento percutáneo versus 27% en procedimiento abierto) y una curva de aprendizaje relativamente rápida que permitió que la indicación para el procedimiento percutáneo pasara desde 68% en la primera mitad de la serie al 92% en la segunda mitad de ésta. Conclusión: Creemos que la técnica es segura en manos de otorrinolaringólogos y debería incorporarse como una herramienta más al arsenal quirúrgico de la especialidad.

Introduction: The tracheostomy described as about 1500 BC, only in recent decades has seen the development of systems for minimally invasive or percutaneous, of which the Ciaglia Blue Rhino technique (single dilator), is most often used today. Aim: We performed a retrospective study of tracheostomies performed at the FUSAT Clinical Hospital from Rancagua, between 2006 and 2012, in order to evaluate advantages, disadvantages and incidence of complications of open surgery versus percutaneous technique in our hands. Material and methods: Included 64 tracheostomies of which 42 were percutaneous Ciaglia Blue Rhino technique. Results: In analyzing the results highlights shortening surgical time from 45.27 minutes for classical technique to 15.28 minutes for percutaneous (statistically significant) in relation to complications, they showed a lower incidence in the group with percutaneous technique, the learning curve of the procedure is quick, reaching its indication in our series more than 90% of cases once acquired experience. Conclusion: We believe that the technique is safe in the hands of Otolaryngologists and should be incorporated as another tool to the arsenal surgical specialty.

OLA1 protects cells in heat shock by stabilizing HSP70.

The heat-shock response is an evolutionarily conserved cellular defense mechanism against environmental stresses, characterized by the rapid synthesis of heat-shock proteins (HSPs). HSP70, a highly inducible molecular chaperone, assists in refolding or clearance of damaged proteins, thereby having a central role in maintaining intracellular homeostasis and thermotolerance. To date, induction of HSP70 expression has been described extensively at the transcriptional level. However, post-translational regulation of HSP70, such as protein stability, is only partially understood. In this study, we investigated the role of OLA1 (Obg-like ATPase 1), a previously uncharacterized cytosolic ATPase, in regulating the turnover of HSP70. Downregulation of OLA1 in mammalian cells by either RNAi or targeted gene disruption results in reduced steady-state levels of HSP70, impaired HSP70 induction by heat, and functionally, increased cellular sensitivity to heat shock. Conversely, overexpression of OLA1 correlates with elevated HSP70 protein levels and improved thermal resistance. Protein-protein interaction assays demonstrated that binding of OLA1 to the HSP70 carboxyl terminus variable domain hinders the recruitment of CHIP (C-terminus of Hsp70-binding protein), an E3 ubiquitin ligase for HSP70, and thus prevents HSP70 from the CHIP-mediated ubiquitination. These findings suggest a novel molecular mechanism by which OLA1 stabilizes HSP70, leading to upregulation of HSP70 as well as increased survival during heat shock.

Identification, molecular characterisation and antimicrobial susceptibility of genomovars of the Burkholderia cepacia complex in Spain.

Burkholderia spp. strains collected in Spain over a 13-year period from patients with cystic fibrosis (CF) (n = 148), non-CF patients (n = 103) and from environmental sources (n = 64) were characterised. One hundred and forty-one of the examined strains were involved in seven suspected nosocomial disease outbreaks. Strains were identified by their 16s rRNA and recA genes. Their genetic relatedness, the possession of cable pili and the B. cepacia epidemic strain marker (BCESM), and their susceptibility to antimicrobial agents were studied using pulsed-field gel electrophoresis (PFGE), cblA and esmR genes analysis, and by the E-test, respectively. The genomovar distribution for the 315 strains was as follows: B. stabilis 29.5 %, B. cepacia 14.9 %, B. multivorans 11.1 %, B. cenocepacia IIIA 9.5 %, B. vietnamiensis 3.8 %, B. cenocepacia IIIB 3.5 %, and B. ambifaria and B. pyrrocinia 0.3 % each. The genetic diversity of the B. cepacia complex (Bcc) was ample, with 57 different SpeI types, showing a genetic similarity of 36.4-96.6 %. No strain carried cblA, whereas 25 B. cenocepacia genotypes harboured BCESM (23 from patients with CF). Antimicrobial resistance rates to tobramycin (TOB; 86 %) and imipenem (IPM; 67 %) were high. The strains from patients with CF showed significantly greater resistance to piperacillin (PIP), levofloxacin (LVX) and co-trimoxazole (SXT) than those isolated from non-CF patients (p < 0.05). In conclusion, B. cenocepacia was the most prevalent genomovar found in patients with CF (19.1 %), whereas B. cepacia was the most common among non-CF patients (20.7 %). B. stabilis (47.6 %) was the most common environmental genomovar. Susceptibility to antimicrobial agents depended on genomovar status and strain origin.

Utilidad de la PET/TAC en la estadificación mediastínica del cáncer de pulmón de células no pequeñas en estadio III (N2) / Utility of PET/CT for mediastinal staging of non-small cell lung cancer in stage III (N2)

Objetivo. Evaluar la validez diagnóstica de la tomografía por emisión de positrones con 18F-fluoro-2-deoxi-D-glucosa y la tomografía computarizada (PET/TAC) en la estadificación ganglionar mediastínica (N2) en pacientes con cáncer de pulmón de células no pequeñas (CPCNP) y analizar el papel de la estadificación mediante pruebas invasivas para la verificación de los hallazgos de la tomografía por emisión de positrones (PET)/tomografía computerizada (TAC). Material y métodos. Estudio retrospectivo incluyendo a pacientes con diagnóstico histopatológico de CPCNP, estadificados como N2 mediante TAC+C y estudiados con PET/TAC. Se confirmaron mediante análisis histopatológico de la pieza quirúrgica cuando se dispuso o por consenso iconográfico en el comité de tumores torácicos. Se ha calculado la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del estudio PET/TAC en la correcta clasificación de los pacientes N2. Resultados. Se incluyeron 34 pacientes clasificados como N2 mediante TAC+C. El PET/TAC clasificó a 30 pacientes como estadio N2. Se encontraron discrepancias en 4 pacientes, dos clasificados como N1 y dos como N0. Los resultados fueron confirmados histológicamente en 20 pacientes. El estudio PET/TAC no mostró falsos positivos. La sensibilidad fue del 94,7%, la especificidad y el valor predictivo positivo fue del 100% y el valor predictivo negativo del 50%. Conclusiones. El estudio PET/TAC presenta una alta sensibilidad y valor predictivo positivo en la correcta clasificación de pacientes con afectación ganglionar mediastínica (N2). Nuestros resultados sugieren que en pacientes con cáncer de pulmón potencialmente resecable, candidatos a tratamiento con quimioterapia neoadyuvante, la mediastinoscopia podría reservarse para la re-estadificación(AU)

Purpose. To evaluate the accuracy of integrated positron emission tomography with 18F-fluoro-2-deoxy-D-glucose (FDG) and computed tomography (PET/CT) in mediastinal lymph node staging in patients with potentially operable (N2) non-small cell lung cancer (NSCLC) and to ascertain the role of invasive staging in verifying positron emission tomography (PET)/computed tomography (CT) results. Material and methods. A retrospective study of consecutive patients with pathologically-proven NSCLC and N2 staging by enhanced CT was performed. A PET/CT scan was performed for all the patients. Lymph node staging was pathologically confirmed when it was possible or by consensus in the Thoracic Cancer Committee. Sensitivity, specificity, negative predictive value and positive predictive value of PET/CT in N2 cases were determined. Results. A total of 34 patients with N2 by CT were evaluated. PET/CT showed N2 in 30 patients. Discrepancies were found in four patients, two patients were classified as N1 in PET/CT and two patients as N0. Lymph node staging was pathologically confirmed in 20 patients. No false positives were found in PET/CT study. Sensitivity was 94.7%, specificity and positive predictive values were 100% and negative predictive value was 50%. Conclusions. Our data show that integrated PET/CT provides high sensitivity and positive predictive value in mediastinal nodal staging of NSCLC patients. Therefore, in patients with potentially resectable lung cancer, neoadjuvant chemotherapy candidate, mediastinoscopy could be reserved for restaging after induction therapy(AU)

[Utility of PET/CT for mediastinal staging of non-small cell lung cancer in stage III (N2)]. / Utilidad de la PET/TAC en la estadificación mediastínica del cáncer de pulmón de células no pequeñas en estadio III (N2).

PURPOSE: To evaluate the accuracy of integrated positron emission tomography with (18)F-fluoro-2-deoxy-D-glucose (FDG) and computed tomography (PET/CT) in mediastinal lymph node staging in patients with potentially operable (N2) non-small cell lung cancer (NSCLC) and to ascertain the role of invasive staging in verifying positron emission tomography (PET)/computed tomography (CT) results. MATERIAL AND METHODS: A retrospective study of consecutive patients with pathologically-proven NSCLC and N2 staging by enhanced CT was performed. A PET/CT scan was performed for all the patients. Lymph node staging was pathologically confirmed when it was possible or by consensus in the Thoracic Cancer Committee. Sensitivity, specificity, negative predictive value and positive predictive value of PET/CT in N2 cases were determined. RESULTS: A total of 34 patients with N2 by CT were evaluated. PET/CT showed N2 in 30 patients. Discrepancies were found in four patients, two patients were classified as N1 in PET/CT and two patients as N0. Lymph node staging was pathologically confirmed in 20 patients. No false positives were found in PET/CT study. Sensitivity was 94.7%, specificity and positive predictive values were 100% and negative predictive value was 50%. CONCLUSIONS: Our data show that integrated PET/CT provides high sensitivity and positive predictive value in mediastinal nodal staging of NSCLC patients. Therefore, in patients with potentially resectable lung cancer, neoadjuvant chemotherapy candidate, mediastinoscopy could be reserved for restaging after induction therapy.

[Molecular characterization of Streptococcus pyogenes from invasive disease and streptococcal toxic shock syndrome episodes]. / Caracterización molecular de Streptococcus pyogenes causantes de enfermedad invasora y síndrome de shock tóxico estreptocócico.

Streptococcus pyogenes causes a variety of common human diseases, including pharyngitis, scarlet fever and impetigo. Nevertheless, the past decades have witnessed a worldwide resurgence in invasive disease and streptococcal toxic shock syndrome (STSS). The objective of the present study is to evaluate the genetic diversity, virulence gene distribution (spe, sme and ssa genes) and susceptibility pattern of 10 S. pyogenes isolates causing invasive disease and STSS. The isolates were recovered from blood cultures of hospitalized patients at Hospital Santamarina and Nueva Clínica Chacabuco, Tandil, Buenos Aires, Argentina between 12/2000-04/2005. Two pulse field gel electrophoretic patterns predominated. The most frequent one included 5 characteristic isolates of emm1-T1 type, toxin gene profile speA, speB, speF, speG and smeZ. The second pattern included 2 characteristic isolates of emm3-TNT type (speB, speF, speG). The other 3 isolates corresponded to types emm49-TNT (speB, speC, speF, speG), emm75-T25 (speB, speF, speG) and emm83-TNT (speB, speF, speG, ssa, smeZ). All isolates were susceptible to penicillin, cefotaxime, erythromycin, clindamycin, chloramphenicol, tetracycline and rifampicin. The data from the present study demonstrated genetic diversity among the strains. Types emm1 and emm3 were prevalent in invasive disease. The empirical treatment with the combination of penicillin and clindamicin is still valid.

Molecular and pharmacological characterization of the melanocortin type 1 receptor in the sea bass.

Melanocortin 1 receptor (MC1R) plays a key role in the physiology of the vertebrate pigment system. Point mutations producing hyperactive or inactive receptors result in darkening or paling effects, respectively. We report the molecular and pharmacological characterization, as well as the tissue expression pattern, of the sea bass Mc1r. Similar to other MC1Rs, the sea bass gene is highly polymorphic and nine DNA polymorphisms, seven of them involving an amino acid substitution, were detected. SbMc1r is mainly expressed in the testis, fat and liver with moderate levels in the ventral and dorsal skin. The sea bass receptor was activated by all the melanocortins tested, with ACTH showing the lowest efficiency. The acetylation level of the MSH isoforms seems to be critical for the effectively of the agonist. Agouti-related protein (AGRP) drastically inhibited the basal activity of the receptor in vitro, as an inverse agonist does, but only in the presence of phosphodiesterase inhibitors. This observation suggests that sbMc1r is constitutively activated and inversely regulated by AGRP, which is expressed in the skin of different fish species.