Combination of white matter hyperintensities and Aß burden is related to cognitive composites domain scores in subjective cognitive decline: the FACEHBI cohort.

BACKGROUND: To explore whether the combination of white matter hyperintensities (WMHs) and amyloid-beta (Aß) deposition is associated with worse cognitive performance on cognitive composites (CCs) domain scores in individuals with subjective cognitive decline (SCD). METHODS: Two hundred participants from the FACEHBI cohort underwent structural magnetic resonance imaging (MRI), 18F-florbetaben positron emission tomography (FBB-PET), and neuropsychological assessment. WMHs were addressed through the Fazekas scale, the Age-Related White Matter Changes (ARWMC) scale, and the FreeSurfer pipeline. Eight CCs domain scores were created using the principal component analysis (PCA). Age, sex, education, and apolipoprotein E (APOE) were used as adjusting variables. RESULTS: Adjusted multiple linear regression models showed that FreeSurfer (B - .245; 95% CI - .1.676, - .393, p = .016) and ß burden (SUVR) (B - .180; 95% CI - 2.140, - .292; p = .070) were associated with face-name associative memory CCs domain score, although the latest one was not statistically significant after correction for multiple testing (p = .070). There was non-significant interaction of these two factors on this same CCs domain score (p = .54). However, its cumulative effects on face-name associative performance indicated that those individuals with either higher WMH load or higher Aß burden showed the worst performance on the face-name associative memory CCs domain score. CONCLUSIONS: Our results suggest that increased WMH load and increased Aß are independently associated with poorer episodic memory performance in SCD individuals, indicating a cumulative effect of the combination of these two pathological conditions in promoting lower cognitive performance, an aspect that could help in terms of treatment and prevention.

Isoperistaltic gastric tube: a surgical alternative in a pharyngoesophageal burn - a clinical case. / Tubo gástrico isoperistáltico, alternativa quirúrgica en quemadura faringoesofágica. Caso clínico.

INTRODUCTION: Caustic burns still cause complex esophageal lesions in the pediatric population. However, therapeutic possibilities in severe cases are limited. A surgical approach allowing for a longer neoesophagus, an isoperistaltic esophagus, and a better vascularization, with a lower risk of complications such as necrosis, stenosis, or perforation, is proposed. CLINICAL CASE: 16-month-old patient who accidentally ingested caustic soda. This caused a IIIb degree burn compromising the pharynx down to the stomach. Esophageal replacement with an isoperistaltic gastric tube was carried out, which allowed for a neoesophagus of appropriate length, an optimal vascularization for the graft, and physiological peristalsis. COMMENTS: The surgical approach proposed allows the esophagus to be irrigated from the right gastro-omental artery, thus preserving irrigation of the greater curvature. It also allows for a longer esophagus, and thanks to anatomical positioning, for physiological peristalsis.

INTRODUCCION: Las quemaduras por ingesta de cáusticos en la población pediátrica continúan siendo causa de lesiones esofágicas complejas. Sin embargo, las posibilidades terapéuticas en casos severos son limitadas. Se propone un abordaje quirúrgico en el cual se obtiene mayor longitud del neoesófago, esófago isoperistáltico y mejor vascularización con el subsecuente menor riesgo de complicaciones (necrosis, estenosis, perforación). CASO CLINICO: Paciente de 16 meses de edad, quien presenta ingesta accidental de sosa cáustica que ocasiona quemadura grado IIIb que compromete desde la faringe hasta el estómago. Se realizó reemplazo esofágico con tubo gástrico isoperistáltico, con lo cual se obtuvo un neoesófago de longitud apropiada, vascularización óptima para el injerto y peristaltismo fisiológico. COMENTARIOS: El abordaje quirúrgico propuesto permite obtener un esófago con irrigación proveniente de la arteria gastroepiploica derecha, preservando irrigación de la curvatura mayor, una longitud mayor y por el posicionamiento anatómico del esófago con un peristaltismo fisiológico.

Tubo gástrico isoperistáltico, alternativa quirúrgica en quemadura faringoesofágica. Caso clínico / Isoperistaltic gastric tube: a surgical alternative in a pharyngoesophageal burn - a clinical case

INTRODUCCIÓN: Las quemaduras por ingesta de cáusticos en la población pediátrica continúan siendo causa de lesiones esofágicas complejas. Sin embargo, las posibilidades terapéuticas en casos severos son limitadas. Se propone un abordaje quirúrgico en el cual se obtiene mayor longitud del neoesófago, esófago isoperistáltico y mejor vascularización con el subsecuente menor riesgo de complicaciones (necrosis, estenosis, perforación). CASO CLÍNICO: Paciente de 16 meses de edad, quien presenta ingesta accidental de sosa cáustica que ocasiona quemadura grado IIIb que compromete desde la faringe hasta el estómago. Se realizó reemplazo esofágico con tubo gástrico isoperistáltico, con lo cual se obtuvo un neoesófago de longitud apropiada, vascularización óptima para el injerto y peristaltismo fisiológico. COMENTARIOS: El abordaje quirúrgico propuesto permite obtener un esófago con irrigación proveniente de la arteria gastroepiploica derecha, preservando irrigación de la curvatura mayor, una longitud mayor y por el posicionamiento anatómico del esófago con un peristaltismo fisiológico

INTRODUCTION: Caustic burns still cause complex esophageal lesions in the pediatric population. However, therapeutic possibilities in severe cases are limited. A surgical approach allowing for a longer neoesophagus, an isoperistaltic esophagus, and a better vascularization, with a lower risk of complications such as necrosis, stenosis, or perforation, is proposed. CLINICAL CASE: 16-month-old patient who accidentally ingested caustic soda. This caused a IIIb degree burn compromising the pharynx down to the stomach. Esophageal replacement with an isoperistaltic gastric tube was carried out, which allowed for a neoesophagus of appropriate length, an optimal vascularization for the graft, and physiological peristalsis. COMMENTS: The surgical approach proposed allows the esophagus to be irrigated from the right gastro-omental artery, thus preserving irrigation of the greater curvature. It also allows for a longer esophagus, and thanks to anatomical positioning, for physiological peristalsis

The role of radioactive iodine in the management of patients with differentiated thyroid cancer - An oncologic surgical perspective.

With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a "one-size-fits-all" recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects. This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy.

Colorectal cancer guidelines seldom include the patient perspective.

OBJECTIVES: This study aimed to describe how colorectal practice guidelines (PGs) incorporate the patient perspective. STUDY DESIGN AND SETTING: We searched in the Guidelines International Network library, MEDLINE, National Guideline Clearinghouse, NHS Evidence database, and TRIP database. Two authors independently selected the PGs. We considered recommendations rated or worded as weak or conditional or suggesting multiple options, as potentially preference sensitive. Two authors independently evaluated if, in potentially sensitive recommendations, the patient perspective was incorporated. RESULTS: We included 28 PGs that contained 588 recommendations, being 256 potentially preference sensitive. Ten PGs (36%) included patients in the development process, and 12 (43%) provided information about patients' perspectives. Nine PGs (32%) included recommendations in which the patient perspective was explicitly considered, and 13 (46.4%) that recommended a discussion with the patient. From a total of 588 recommendations, 9.7% (25/256) of potentially preference-sensitive recommendations considered the patient perspective. The inclusion of patients in the development process was associated with a more frequent incorporation of the patient perspective in potentially preference sensitive recommendations (70% vs. 0%; P < 0.001). CONCLUSIONS: Guideline users should be aware that the incorporation of the patient perspective in colorectal cancer PGs is suboptimal. Guideline developers should make efforts to incorporate the patient perspective, especially in preference-sensitive recommendations.

Assessing the efficacy and acceptability of an internet-delivered intervention for resilience among college students: A pilot randomised control trial protocol.

BACKGROUND: Exposure to new stressors places college students at increased risk for developing mental health problems. Preventive interventions aimed at enhancing resilience have the potential to improve mental health and well-being in college students and internet-delivery may improve access to these interventions. However, few studies have evaluated the efficacy of online interventions for resilience in college students. The present study seeks to assess the feasibility [initial efficacy and acceptability] of a newly developed internet-delivered intervention for resilience provided with human or automated support, in a sample of college students. METHOD: A pilot randomised controlled trial including three groups: 1) an intervention group with human support; 2) an intervention group with automated support; and 3) a waiting list control group. The intervention, Space for Resilience, is based on positive psychology and consists of seven modules, delivered over a period of eight weeks. Primary outcomes measures will include the Connor-Davidson Resilience Scale (CD-RISC) and the Pemberton Happiness Index (PHI). Secondary outcomes measures will include the Brief Resilience Scale (BRS), the Patient Health Questionnaire - 4 items (PHQ-4), the Rosenberg Self-Esteem Scale (RSES), and the Perceived Stress Scale - 4 items (PSS-4). Acceptability will be examined using the Satisfaction with Treatment (SAT) questionnaire. Analysis will be conducted on an intention-to-treat basis. DISCUSSION: The study seeks to establish the initial efficacy and acceptability of an internet-delivered intervention for resilience with human support and automated support. Apart from determining the impact of the intervention on acceptability and effectiveness, this study will be a first to explore more clearly the relative benefits of different support modes.

Meta-analysis of routine calcium/vitamin D3 supplementation versus serum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy.

BACKGROUND: The aim was to assess the effectiveness of routine administration of calcium +/- vitamin D3 compared with a serum calcium level-based strategy to prevent symptomatic hypocalcaemia after thyroidectomy. METHODS: RCTs comparing routine supplementation of calcium +/- vitamin D3 with treatment based on serum calcium levels measured after total thyroidectomy, published between 1980 and 2017, were identified in MEDLINE, Embase, LILACS and Google Scholar databases. Risk of bias was evaluated using the Cochrane Collaboration tool. Risk differences were calculated by random-effects meta-analysis. Meta-regression and cumulative meta-analysis were used to explore the best therapeutic approach. RESULTS: Fifteen studies with 3037 patients were included, and seven treatment comparisons were made. Routine supplementation with calcium + vitamin D3 offered a lower risk of symptomatic (risk difference (RD) -0·25, 95 per cent c.i. -0·32 to -0·18) and biochemical (RD -0·24, -0·31 to -0·17) hypocalcaemia than treatment based on measurement of calcium levels. The number needed to treat was 4 (95 per cent c.i. 3 to 6) for symptomatic hypocalcaemia. No publication bias was found; although heterogeneity was high for some comparisons, sensitivity analysis did not change the main results. CONCLUSION: Routine postoperative administration of calcium + vitamin D3 is effective in decreasing the rate of symptomatic and biochemical hypocalcaemia.

Correlations between plasma and PET beta-amyloid levels in individuals with subjective cognitive decline: the Fundació ACE Healthy Brain Initiative (FACEHBI).

BACKGROUND: Peripheral biomarkers that identify individuals at risk of developing Alzheimer's disease (AD) or predicting high amyloid beta (Aß) brain burden would be highly valuable. To facilitate clinical trials of disease-modifying therapies, plasma concentrations of Aß species are good candidates for peripheral AD biomarkers, but studies to date have generated conflicting results. METHODS: The Fundació ACE Healthy Brain Initiative (FACEHBI) study uses a convenience sample of 200 individuals diagnosed with subjective cognitive decline (SCD) at the Fundació ACE (Barcelona, Spain) who underwent amyloid florbetaben(18F) (FBB) positron emission tomography (PET) brain imaging. Baseline plasma samples from FACEHBI subjects (aged 65.9 ± 7.2 years) were analyzed using the ABtest (Araclon Biotech). This test directly determines the free plasma (FP) and total plasma (TP) levels of Aß40 and Aß42 peptides. The association between Aß40 and Aß42 plasma levels and FBB-PET global standardized uptake value ratio (SUVR) was determined using correlations and linear regression-based methods. The effect of the APOE genotype on plasma Aß levels and FBB-PET was also assessed. Finally, various models including different combinations of demographics, genetics, and Aß plasma levels were constructed using logistic regression and area under the receiver operating characteristic curve (AUROC) analyses to evaluate their ability for discriminating which subjects presented brain amyloidosis. RESULTS: FBB-PET global SUVR correlated weakly but significantly with Aß42/40 plasma ratios. For TP42/40, this observation persisted after controlling for age and APOE ε4 allele carrier status (R2 = 0.193, p = 1.01E-09). The ROC curve demonstrated that plasma Aß measurements are not superior to APOE and age in combination in predicting brain amyloidosis. It is noteworthy that using a simple preselection tool (the TP42/40 ratio with an empirical cut-off value of 0.08) optimizes the sensitivity and reduces the number of individuals subjected to Aß FBB-PET scanners to 52.8%. No significant dependency was observed between APOE genotype and plasma Aß measurements (p value for interaction = 0.105). CONCLUSION: Brain and plasma Aß levels are partially correlated in individuals diagnosed with SCD. Aß plasma measurements, particularly the TP42/40 ratio, could generate a new recruitment strategy independent of the APOE genotype that would improve identification of SCD subjects with brain amyloidosis and reduce the rate of screening failures in preclinical AD studies. Independent replication of these findings is warranted.

The role of laryngectomy in locally advanced thyroid carcinoma. Review of 16 cases.

SUMMARY: Locally advanced disease with larynx invasion is a challenge to the surgeon, but laryngectomy is almost never necessary in thyroid carcinoma. The aim of this study was to review the clinical outcomes of patients with locally advanced thyroid carcinoma invading the larynx who underwent laryngectomy. A case series of patients treated in a tertiary care hospital was reviewed. Data about the type of operation, method of reconstruction, complications and overall survival of 16 patients operated on between 2002 and 2015 with larynx invasion is presented. There were 10 females. The mean age was 63 ± 8.8 years. Besides total thyroidectomy and neck dissection, four patients underwent total pharyngolaryngectomy, 11 total laryngectomy and one hemi-laryngectomy. Reconstruction was made with regional flaps in 10 patients (7 pectoral/Bakamjian flaps and 3 gastric pull-through procedures) and a jejunum free flap in one patient. Two patients needed carotid artery reconstruction. Five tumours were classic (conventional) papillary carcinoma variants, while the others were aggressive histological varieties (insular, tall cell, sclerosing). The mean tumour size was 4.3 ± 1.6 cm. All tumours had lymphovascular invasion and 12 had positive lymph nodes. Concomitantly, oesophageal/hypopharyngeal invasion was present in 7 cases and invasion of carotid vessels in 2 cases. There were two postoperative deaths and two anastomotic leaks that were treated conservatively. The mean overall survival was 31 ± 33 months (median 27.6 months, range 0-120). Laryngectomy is an alternative surgical procedure to control selected cases of advanced thyroid carcinoma that offers good local control and long term survival.

Conocimiento e investigación sobre la autonomía profesional en enfermería. Revisión narrativa / Knowledge and research about nursing professional autonomy. Narrative review / Conhecimento e pesquisa sobre autonomia profissional em enfermagem. Revisão narrativa

Introducción: Enfermería como disciplina se encuentra en un momento trascendental a la luz de los desarrollos científicos que están en espera de ser incorporados en el cuidado y que necesitan enfermeros autónomos en su práctica profesional, por lo cual en el presente trabajo se realizó una revisión narrativa del concepto de autonomía. Objetivo: Describir el concepto, medición e investigaciones sobre la autonomía profesional en estudiantes de enfermería. Desarrollo: La autonomía profesional ha acompañado la evolución de la enfermería; ha pasado por momentos de invisibilidad hasta ser parte de la definición de la profesión y su práctica. Por lo anterior, la medición de este constructo ha cobrado gran importancia, identificándose tres categorías, en primer lugar se encuentran los instrumentos que buscan explorar la actitud de la enfermera y las características de los pacientes, en segundo lugar, los que fijan su perspectiva desde el desempeño laboral de la enfermera y por último se destacan aquellos que hacen una diferenciación de la medición según características como sexo y experticia; estos instrumentos han sido empleados en estudios principalmente transversales que han establecido comparaciones con otras profesiones. Conclusiones: Dada la importancia del concepto de autonomía y su escasa descripción, medición y evaluación como constructo de la identidad profesional en enfermería, así como la escasez de trabajos publicados en español; se identificó la necesidad de realizar investigaciones con instrumentos válidos, en diseños longitudinales que establezcan los factores asociados al desarrollo de la autonomía profesional y contribuyan al fortalecimiento de esta característica en el personal de enfermería.

Introduction: The discipline of Nursing is situated in a transcendental moment because, among other, the scientific developments which are being incorporated into the healthcare process are to be utilized by autonomous nurses. Thus, this study is aimed at narratively reviewing the concept of autonomy. Objective: To describe the concept, measurement, and related research, regarding professional autonomy among nursing students. Development: Professional autonomy has accompanied the evolution of nursing from, at some points being invisible, to now being an explicit part of the profession's definition and practice. Because of this, the construct's measurement has become more important. Three types of instruments have been suggested: those with a focus in the exploration of attitudes of nurses and patients; those with a perspective towards the nurses' performance; and those based on specific characteristics such as sex and expertise. These instruments have been mainly used in transversal studies for comparisons. Conclusions: Given the importance of the concept, considering the scant information related to the description, measurement, and assessment as a nursing professional identity construct, and also considering the scant Spanish-published related studies, a need was identified to do research with longitudinal designs and validated instruments which can reveal the factors associated with the development and strengthening of professional autonomy in nursing personnel.

Introdução: A enfermagem como disciplina encontra-se em um momento transcendental à luz dos desenvolvimentos científicos que estão na espera de ser incorporados no cuidado, e que necessitam enfermeiros autônomos em sua prática profissional, pelo qual no presente trabalho realizou-se uma revisão narrativa do conceito de autonomia. Objetivo: Descobrir o conceito, medição e pesquisas sobre a autonomia profissional em estudantes de enfermagem. Desenvolvimento: A autonomia profissional tem acompanhado a evolução da enfermagem; tem passado por momentos de invisibilidade até ser parte da definição da profissão e sua prática. Portanto, a medição deste construto cobrou grande importância, identificando-se três categorias, em primeiro lugar encontram-se os instrumentos que buscam explorar a atitude da enfermeira e as características dos pacientes, em segundo lugar, os que fixam sua perspectiva desde o desempenho laboral da enfermeira e por último destacam-se aqueles que fazem uma diferenciação da medição segundo características como sexo e expertise; estes instrumentos têm sido empregados em estudos principalmente transversais que estabeleceram comparações com outras profissões. Conclusões: Dada a importância do conceito de autonomia e sua escassa descrição, medição e avaliação como constructo da identidade profissional em enfermagem, assim como a escassez de trabalhos publicados em espanhol; identificou-se a necessidade de realizar pesquisas com instrumentos válidos, em desenhos longitudinais que estabeleçam os fatores associados ao desenvolvimento da autonomia profissional e contribuam no reforço desta característica no pessoal de enfermagem.

[Social cognition and cognitive functions in patients with epilepsy treated with eslicarbazepine acetate]. / Cognicion social y funciones cognitivas en pacientes con epilepsia tratados con acetato de eslicarbacepina.

INTRODUCTION: Epilepsy is accompanied by cognitive disorders, frequently aggravated by the use of antiepileptic drugs, which can affect social empathy. AIM: To analyse the impact of treatment with eslicarbazepine acetate (ESL) on social cognition and prefrontal cognitive functions in adults with focal epilepsy. PATIENTS AND METHODS: We conducted a prospective single-centre study with patients aged between 18 and 65 years with focal seizures treated with ESL. The patients were evaluated in their baseline visit and at six months after starting ESL treatment by means of tasks designed for theory of mind, executive and attentional functions, auditory-verbal memory, quality of life, and anxiety and depression. RESULTS: Forty-one patients were treated with ESL, and 30 completed the follow-up. A significant improvement was observed in the theory of mind tasks. In the analysis stratified by sex, the men showed greater improvement. A cognitive improvement was observed in the Wisconsin Card Sorting Test, Symbol Digit, Backward Digit Span and Stroop tests. No differences were found in the Quality of Life in Epilepsy-31 Inventory or in the Hospital Anxiety and Depression Scale. These results were independent of the reduction in the number of seizures and the ESL dosage. CONCLUSION: Treatment with ESL could improve some aspects of theory of mind in patients with epilepsy, especially in men and independently of the control of seizures, with no changes in quality of life, anxiety or depression.

TITLE: Cognicion social y funciones cognitivas en pacientes con epilepsia tratados con acetato de eslicarbacepina.Introduccion. La epilepsia se acompaña de alteraciones cognitivas, frecuentemente agravadas por el uso de farmacos antiepilepticos, que pueden afectar a la empatia social. Objetivo. Analizar el impacto del tratamiento con acetato de eslicarbacepina (ESL) en la cognicion social y las funciones cognitivas prefrontales en adultos con epilepsia focal. Pacientes y metodos. Estudio prospectivo y unicentrico realizado en pacientes de 18 a 65 años con crisis focales, tratados con ESL. Los pacientes fueron evaluados en la visita basal y a los seis meses tras iniciar ESL mediante tareas para la teoria de la mente, funciones ejecutivas y atencionales, memoria audioverbal, calidad de vida, y ansiedad y depresion. Resultados. Cuarenta y un pacientes fueron tratados con ESL y 30 completaron el seguimiento. Se observo una mejoria significativa en las tareas de teoria de la mente. En el analisis estratificado por sexo, los hombres mejoraron mas. Se observo una mejoria cognitiva en las pruebas Wisconsin Card Sorting Test, Symbol Digit, Backward Digit Span y test de Stroop. No hubo diferencias en el cuestionario Quality of Life in Epilepsy-31 Inventory ni en la escala de depresion y ansiedad hospitalaria (HADS). Estos resultados fueron independientes de la reduccion del numero de crisis y de la dosis de ESL. Conclusion. El tratamiento con ESL podria mejorar algunos aspectos de la teoria de la mente en pacientes con epilepsia, especialmente en hombres e independientemente del control de las crisis, sin cambios en la calidad de vida, ansiedad o depresion.

Aclimatación a la alta temperatura y tolerancia al calor (TL50) en 6 variedades de Chenopodium quinoa / High temperature acclimation and termotolerance (TL50) in 6 varieties of Chenopodium quinua

Se estudió la capacidad de aclimatación de 6 variedades de Chenopodium quinoa Willd. (Kancolla, Salcedo, Ccoito, Negra collana, Pasancalla e Illpa) a alta temperatura. Las plantas de quinua se obtuvieron a partir de semillas, las que crecieron en macetas, en un sombreadero, hasta el estado fenológico de 6 hojas verdaderas. Estas fueron expuestas a un tratamiento por calor en una cámara de crecimiento con termostato a 34/32 °C día/noche (D/N) por 3 días y a baja intensidad luminosa. Las no aclimatadas crecieron en las mismas condiciones pero a la temperatura de 22/20 °C D/N. La tolerancia a la alta temperatura se determinó exponiendo discos de hojas a diferentes tiempos (8, 16, 32 y 64 min) a 50 °C (baño maría), midiendo la termoestabilidad de la membrana celular, por la pérdida electrolitos utilizando un conductimetro. El grado de termotolerancia fue hallado según el TL50(tiempo letal al 50% de daño). Los resultados muestran que las variedades Pasancalla e Illpa presentaron capacidad de aclimatación, la variedad más termotolerante fue la variedad Illpa TL50= 64 min cuando fue aclimatada y la más sensible fue la variedad Pasancalla TL50= 8 min cuando no fue aclimatada. También se observó que el porcentaje de daño celular se incrementó a medida que el tiempo de exposición a la alta temperatura fue mayor

The capacity of acclimatization at high temperature of 6 varieties (Kancolla, Salcedo, Ccoito, Negra collana, Pasancalla and Illpa) of Chenopodium quinoa Willd was studied. Quinoa plants were obtained from seeds, which grew in pots, in a grennhouse, until the phenological stage of 6 true leaves. These were exposed to a heat treatment in a growth chamber with a thermostat at 34/32 °C day/night (D/N) for 3 days and at low light intensity. The non-acclimated plants grew under the same conditions but at temperature of 22/20 °C D/N. The tolerance to high temperature was determined by exposing leaf discs at different times (8, 16, 32 and 64 min) at 50 °C (warm bath), measuring the thermostability of the cell membrane trough the loss of electrolytes with a conductimeter. The degree of thermotolerance was found according to the TL50 (time lethal to 50% of damage). The results showed that the varieties Pasancalla and Illpa presented acclimatization capacity, the most thermotolerant variety was the variety Illpa TL50 = 64 min when it was acclimatized and the most sensitive was Pasancalla TL50 = 8 min when it was not acclimatized. It was also observed that the percentage of cell damage increased as the exposure time to the high temperature was higher.

FACEHBI: A Prospective Study of Risk Factors, Biomarkers and Cognition in a Cohort of Individuals with Subjective Cognitive Decline. Study Rationale and Research Protocols.

BACKGROUND: Long-term longitudinal studies with multimodal biomarkers are needed to delve into the knowledge of preclinical AD. Subjective cognitive decline has been proposed as a risk factor for the development of cognitive impairment. Thus, including individuals with SCD in observational studies may be a cost-effective strategy to increase the prevalence of preclinical AD in the sample. OBJECTIVES: To describe the rationale, research protocols and baseline characteristics of participants in the Fundació ACE Healthy Brain Initiative (FACEHBI). DESIGN: FACEHBI is a clinical trial (EudraCT: 2014-000798-38) embedded within a long-term observational study of individuals with SCD. SETTING: Participants have been recruited at the memory clinic of Fundació ACE (Barcelona) from two different sources: patients referred by a general practitioner and individuals from an Open House Initiative. PARTICIPANTS: 200 individuals diagnosed with SCD with a strictly normal performance in a comprehensive neuropsychological battery. MEASUREMENTS: Individuals will undergo an extensive neuropsychological protocol, risk factor assessment and a set of multimodal biomarkers including florbetaben PET, structural and functional MRI, diffusion tensor imaging, determination of amyloid species in plasma and neurophthalmologic assessment with optical coherence tomography. RESULTS: Two hundred individuals have been recruited in 15 months. Mean age was 65.9 years; mean MMSE was 29.2 with a mean of 14.8 years of education. CONCLUSIONS: FACEHBI is a long-term study of cognition, biomarkers and lifestyle that has been designed upon an innovative symptom-based approach using SCD as target population. It will shed light on the pathophysiology of preclinical AD and the role of SCD as a risk marker for the development of cognitive impairment.

The impact of family history on non-medullary thyroid cancer.

INTRODUCTION: Around 10% of patients with non-medullary thyroid cancer (NMTC) will have a positive family history for the disease. Although many will be sporadic, families where 3 first-degree relatives are affected can be considered to represent true familial non-medullary thyroid cancer (FNMTC). The genetic basis, impact on clinical and pathological features, and overall effect on prognosis are poorly understood. METHODS: A literature review identified articles which report on genetic, clinical, therapeutic and screening aspects of FNMTC. The results are presented to allow an understanding of the genetic basis and the impact on clinical-pathological features and prognosis in order to inform clinical decision making. RESULTS: The genetic basis of FNMTC is unknown. Despite this, significant progress has been made in identifying potential susceptibility genes. The lack of a test for FNMTC has led to a clinical definition requiring a minimum of 3 first-degree relatives to be diagnosed with NMTC. Although some have shown an association with multi-centric disease, younger age and increased rates of extra-thyroidal extension and nodal metastases, these findings are not supported by all. The impact of FNMTC is unclear with all groups reporting good outcome, and some finding an association with more aggressive disease. The role of screening remains controversial. CONCLUSION: FNMTC is rare but can be diagnosed clinically. Its impact on prognostic factors and the subsequent role in influencing management is debated. For those patients who present with otherwise low-risk differentiated thyroid cancer, FNMTC should be included in risk assessment when discussing therapeutic options.

Unicentric Castleman's disease in the posterior cervical space mimicking a schwannoma.

INTRODUCTION: Castleman's disease (CD) is a benign and rare lymphoid tissue disease of undetermined origin. It affects the neck infrequently; therefore its preoperative diagnosis is difficult and can be confused with other hypervascular lesions. CASE REPORT: We present a case of unicentric hyaline-vascular CD in the posterior cervical space (PCS) evaluated by MRI and initially presumed to be a cervical schwannoma. DISCUSSION: As shown with our case, unicentric CD should be included in the differential diagnosis for masses in the PCS, especially when a hypervascular lesion like a schwannoma is suspected. The finding of central low intensity areas in a fissured and radial pattern in T2 sequences can help to consider CD when dealing with PCS masses as shown by previous cases and our reported experience.

BEHAVIOUR OF EARLY THYROGLOBULIN AFTER TOTAL THYROIDECTOMY FOR DIFFERENTIATED THYROID CANCER.

CONTEXT: The objectives of treatment of thyroid carcinoma include hormonal suppression, radioiodine ablation and follow-up with serum thyroglobulin (Tg). Tg levels should not be measured before six weeks post-thyroidectomy. OBJECTIVE: To describe the behaviour of early postoperative Tg in patients who underwent total thyroidectomy and its ability to predict the serum Tg levels after suppression. DESIGN: This is a retrospective cohort study. SUBJECTS AND METHODS: Adult patients who underwent total thyroidectomy with at least two postoperative measurements of serum Tg, negative TgAb and concomitant serum TSH values were included. Tg, TgAb and TSH level measurements were completed two weeks postoperatively and during the follow-up period. RESULTS: Twenty-nine patients fulfilled all criteria. The median serum Tg level at two weeks after surgery was 3.8 ug/L (0.3 -300) with a serum TSH level of 69.9 mU/L; 11-227. At the two-week measurement, 16 (55%) patients had serum Tg levels lower than 5 ug/L and 4 patients had levels between 5-10 µg/L. CONCLUSIONS: Postoperative early serum Tg could be an alternative to values measured six months after surgery and could be used as a predictive tool to make earlier therapeutic decisions.

Efficiency of pragmatic search strategies to update clinical guidelines recommendations.

BACKGROUND: A major challenge in updating clinical guidelines is to efficiently identify new, relevant evidence. We evaluated the efficiency and feasibility of two new approaches: the development of restrictive search strategies using PubMed Clinical Queries for MEDLINE and the use of the PLUS (McMaster Premium Literature Service) database. METHODS: We evaluated a random sample of recommendations from a national guideline development program and identified the references that would potentially trigger an update (key references) using an exhaustive approach. We designed restrictive search strategies using the minimum number of Medical Subject Headings (MeSH) terms and text words required from the original exhaustive search strategies and applying broad and narrow filters. We developed PLUS search strategies, matching Medical Subject Headings (MeSH) and Systematized Nomenclature of Medicine (SNOMED) terms with guideline topics. We compared the number of key references retrieved by these approaches with those retrieved by the exhaustive approach. RESULTS: The restrictive approach retrieved 68.1 % fewer references than the exhaustive approach (12,486 versus 39,136), and identified 89.9 % (62/69) of key references and 88 % (22/25) of recommendation updates. The use of PLUS retrieved 88.5 % fewer references than the exhaustive approach (4,486 versus 39,136) and identified substantially fewer key references (18/69, 26.1 %) and fewer recommendation updates (10/25, 40 %). CONCLUSIONS: The proposed restrictive approach is a highly efficient and feasible method to identify new evidence that triggers a recommendation update. Searching only in the PLUS database proved to be a suboptimal approach and suggests the need for topic-specific tailoring.

Editoriales en revistas médicas colombianas: el arte de opinar / Editorials in Colombian medical journals: The art of giving one's opinion / Editoriais em revistas médicas colombianas: a arte de opinar

Objetivo: evaluar las características de los artículos editoriales de revistas médicas de alta calidad. Metodología: una búsqueda permitió identificar las características esperadas de un artículo editorial. Se seleccionaron las revistas clasificadas A por Colciencias y se evaluaron todos los artículos editoriales. Se determinaron características de extensión, número de autores, número de referencias y adherencia a las condiciones consideradas estándar para este tipo de publicaciones. Resultados: se evaluaron 88 artículos editoriales. El 21% de los editoriales manifiesta una opinión. 10% de los títulos es extenso. El número promedio de palabras por artículo fue de 1 579. 9% está escrito en inglés y el 15% con múltiples autores. 35% tuvo más de ocho referencias bibliográficas. Conclusiones: los artículos editoriales de las revistas médicas en Colombia están lejos de las recomendaciones adoptadas desde el periodismo. Se debe educar a quien decide adoptar la función editorial de una revista médica.

Objective: To assess the characteristics of editorial articles in high quality Colombian medical journals. Methods: A standardized search allowed identifying the expected characteristics of editorial articles according to journalism. Colombian journals with "A" classification by Colciencias were selected and their editorial articles were evaluated. Article length, number of authors, number of references, and adherence to expected characteristics were determined. Results: Eighty-eight editorial articles were evaluated, of which 21% declared an opinion and 10% had long titles. The mean number of words per article was 1 579. Nine percent were written in English, 15% had multiple authors, and 35% had over eight references. Conclusions: Editorial articles in Colombian medical journals are still far from meeting journalism guidelines. It is necessary to educate those who adopt editorial roles of medical journals.

Objetivo: avaliar as características dos artigos editoriais de revistas médicas de alta qualidade. Metodologia: uma busca permitiu identificar as características esperadas de um artigo editorial. Se selecionaram as revistas classificadas A por Colciencias e se avaliaram todos os artigos editoriais. Se determinaram características de extensão, número de autores, número de referências e aderência às condições consideradas padrões para este tipo de publicações. Resultados: se avaliaram 88 artigos editoriais. 21% dos editoriais manifesta uma opinião. 10% dos títulos é extenso. O número médio de palavras por artigo foi de 1 579. 9% está escrito em inglês e 15% com múltiplos autores. 35% teve mais de oito referências bibliográficas. Conclusões: os artigos editoriais das revistas médicas na Colômbia estão longe das recomendações adotadas desde o jornalismo. Se deve educar a quem decide adotar a função editorial de uma revista médica.