Association between Poor Oral Health and Frailty in Middle-Aged and Older Individuals: A Cross-Sectional National Study.

OBJECTIVES: Older adults with poor oral health may be at higher risk of being pre-frail or frail. However, very few studies have examined this association in Latin American countries and middle-aged individuals. Therefore, we aimed to investigate the association between oral health and frailty status among Chilean adults ≥40 years. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: We included 3,036 participants ≥40 years from the Chilean National Health Survey 2016-2017. METHODS: Frailty status was assessed with a 49-item frailty index, while the number of teeth, self-reported oral health, tooth decay, use of prostheses, and oral pain were the oral health conditions included. To assess the association between oral health conditions and frailty, we used multinomial logistic regression models status adjusted for sociodemographic and lifestyle variables. RESULTS: Overall, 40.6% and 11.8% of individuals were classified as pre-frail and frail, respectively. After adjusting for confounders, individuals with ≤20 teeth had a higher likelihood of being frail (odds ratio (OR): 1.94 [95% CI: 1.18-3.20]) than people with >20 teeth. Moreover, people with bad or very bad oral health, as well as oral pain, had a higher likelihood of being pre-frail (OR: 2.04 [95% CI: 1.40-2.97] and OR: 2.92 [95% CI: 1.58-5.39], respectively). Middle-aged individuals with fewer teeth and poor self-reported oral health had a higher likelihood of being pre-frail and frail than people ≥60. CONCLUSIONS AND IMPLICATIONS: Individuals with poor global oral health were more likely to be pre-frail or frail. This association seems to be stronger in people <60 years old. Our results are consistent with previously published reports.

Consumer behavior in confinement times: Food choice and cooking attitudes in Spain.

The present study provides an overview of the food related behavior of the Spanish population during the confinement period due to the Covid-19 sanitary emergency. A national survey was responded by 600 volunteers, who answered questions related to food consumption, home-food and cooking related habits (F&C), and the Spanish version of the Dutch Eating Behavior Questionnaire. In general, most consumers could be considered "External eaters"; F&C questionnaire allowed segmenting the population in "low-cooking engagement", "health -concerned" and "health-disregarded" groups. These consumers' segments reported different behavior, highlighting, for example, the increase of snacks and ultra-processed food consumption of the health-disregarded group.

Active learning narrows achievement gaps for underrepresented students in undergraduate science, technology, engineering, and math.

We tested the hypothesis that underrepresented students in active-learning classrooms experience narrower achievement gaps than underrepresented students in traditional lecturing classrooms, averaged across all science, technology, engineering, and mathematics (STEM) fields and courses. We conducted a comprehensive search for both published and unpublished studies that compared the performance of underrepresented students to their overrepresented classmates in active-learning and traditional-lecturing treatments. This search resulted in data on student examination scores from 15 studies (9,238 total students) and data on student failure rates from 26 studies (44,606 total students). Bayesian regression analyses showed that on average, active learning reduced achievement gaps in examination scores by 33% and narrowed gaps in passing rates by 45%. The reported proportion of time that students spend on in-class activities was important, as only classes that implemented high-intensity active learning narrowed achievement gaps. Sensitivity analyses showed that the conclusions are robust to sampling bias and other issues. To explain the extensive variation in efficacy observed among studies, we propose the heads-and-hearts hypothesis, which holds that meaningful reductions in achievement gaps only occur when course designs combine deliberate practice with inclusive teaching. Our results support calls to replace traditional lecturing with evidence-based, active-learning course designs across the STEM disciplines and suggest that innovations in instructional strategies can increase equity in higher education.

B cells are sufficient to prime the dominant CD4+ Tfh response to Plasmodium infection.

CD4+ T follicular helper (Tfh) cells dominate the acute response to a blood-stage Plasmodium infection and provide signals to direct B cell differentiation and protective antibody expression. We studied antigen-specific CD4+ Tfh cells responding to Plasmodium infection in order to understand the generation and maintenance of the Tfh response. We discovered that a dominant, phenotypically stable, CXCR5+ Tfh population emerges within the first 4 d of infection and results in a CXCR5+ CCR7+ Tfh/central memory T cell response that persists well after parasite clearance. We also found that CD4+ T cell priming by B cells was both necessary and sufficient to generate this Tfh-dominant response, whereas priming by conventional dendritic cells was dispensable. This study provides important insights into the development of CD4+ Tfh cells during Plasmodium infection and highlights the heterogeneity of antigen-presenting cells involved in CD4+ T cell priming.

Trends of maxillofacial trauma: An update from the prospective register of a multicenter study in emergency services of Chile.

BACKGROUND: Determine the behavior of the maxillofacial trauma of adults treated in 3 tertiary care centers in the central zone of Chile. MATERIAL AND METHODS: descriptive, cross-sectional, multicenter study, based on the prospective records of maxillofacial trauma cases attended between May 2016 and April 2017 by dental and maxillofacial clinical teams of Adult Emergency Units of hospitals Dr. Sótero del Río (metropolitan region), Carlos Van Buren and Dr. Gustavo Fricke (region V). Age, sex, date of occurrence, type of trauma according to ICD-10, etiology, legal medical prognosis and associated injuries were recorded, stratifying by sex and age. Chi square and unpaired Wilcoxon tests were used to compare by groups. RESULTS: 2.485 cases and 3.285 injuries were investigated. The male: female ratio was 1.7: 1 with age under 30 predominant, followed by older adults. Variability was observed in the yearly, weekly and daily presentation. The highest frequencies were in January and September, weekends and at night. The main etiologies were violence (42.3%), falls (13.1%) and road traffic crashes (12.9%) with differences by age and sex (p <0.05). 31,9% of the injuries occurred in hard tissue, being fractures in nasal bones predominant (S02.2). CONCLUSIONS: the profile of the maxillofacial trauma in Chile seems to be mixed by age, affecting young people and the elderly. The male sex predominates; the main cause, which varies by age group, is violence. Their surveillance is possible from hospital emergency records.

A Feasibility Study of High-Strength Bi-2223 Conductor for High-Field Solenoids.

We performed a feasibility study on a high-strength Bi2-x Pb x Sr2Ca2Cu3O10-x (Bi-2223) tape conductor for high-field solenoid applications. The investigated conductor, DI-BSCCO Type HT-XX, is a pre-production version of Type HT-NX, which has recently become available from Sumitomo Electric Industries (SEI). It is based on their DI-BSCCO Type H tape, but laminated with a high-strength Ni-alloy. We used stress-strain characterizations, single- and double-bend tests, easy- and hard-way bent coil-turns at various radii, straight and helical samples in up to 31.2 T background field, and small 20-turn coils in up to 17 T background field to systematically determine the electro-mechanical limits in magnet-relevant conditions. In longitudinal tensile tests at 77 K, we found critical stress- and strain-levels of 516 MPa and 0.57%, respectively. In three decidedly different experiments we detected an amplification of the allowable strain with a combination of pure bending and Lorentz loading to ≥ 0.92% (calculated elastically at the outer tape edge). This significant strain level, and the fact that it is multi-filamentary conductor and available in the reacted and insulated state, makes DI-BSCCO HT-NX highly suitable for very high-field solenoids, for which high current densities and therefore high loads are required to retain manageable magnet dimensions.

Scanning electron microscopy of bacteria Tetrasphaera duodecadis.

This study reports the characterization of the Tetrasphaera duodecadis bacteria and the techniques used therein. In order to evaluate the morphological characteristics of the T. duodecadis bacteria scanning electron microscope (SEM) was used throughout its different growth stages. These microorganisms were grown in vitamin B12 broths with 1% tryptone, 0.2% yeast extract, and 0.1% glucose. The turbidimetric method was employed for the determination of bacterial concentration and growth curve. The SEM results show small agglomerates of 0.8 ± 0.05 µm during the lag phase, and rod-like shapes during the exponential phase with similar shapes in the stationary phase.

Sciatic nerve regeneration is not inhibited by anti-NGF antibody treatment in the adult rat.

Elevated nerve growth factor (NGF) is believed to play a role in many types of pain. An NGF-blocking antibody (muMab 911) has been shown to reduce pain and hyperalgesia in pain models, suggesting a novel therapeutic approach for pain management. Since NGF also plays important roles in peripheral nervous system development and sensory nerve outgrowth, we asked whether anti-NGF antibodies would adversely impact peripheral nerve regeneration. Adult rats underwent a unilateral sciatic nerve crush to transect axons and were subcutaneously dosed weekly for 8weeks with muMab 911 or vehicle beginning 1day prior to injury. Plasma levels of muMab 911 were assessed from blood samples and foot print analysis was used to assess functional recovery. At 8-weeks post-nerve injury, sciatic nerves were prepared for light and electron microscopy. In a separate group, Fluro-Gold was injected subcutaneously at the ankle prior to perfusion, and counts and sizes of retrogradely labeled and unlabeled dorsal root ganglion neurons were obtained. There was no difference in the time course of gait recovery in antibody-treated and vehicle-treated animals. The number of myelinated and nonmyelinated axons was the same in the muMab 911-treated crushed nerves and intact nerves, consistent with observed complete recovery. Treatment with muMab 911 did however result in a small decrease in average cell body size on both the intact and injured sides. These results indicate that muMab 911 did not impair functional recovery or nerve regeneration after nerve injury in adult rats.

Prevalencia de traumatismos dentoalveolares en pacientes infantiles del complejo asistencial Dr. Sótero del Río / Prevalence of dental trauma of infants attended at Dr. Sótero del Río Hospital

En el presente estudio descriptivo de incidencia, 604 niños menores de 15 años fueron examinados y atendidos en la Clínica de Odontopediatría del Complejo Asistencial Dr. Sotero del Río, con diagnóstico de Traumatismo Dentoalveolar (TDA), desde Enero a Diciembre del 2010. El propósito de este estudio fue caracterizar los TDA de acuerdo a la clasificación de Andreasen y Andreasen, determinar su frecuencia y distribución estacional, tipo y número de dientes afectados, distribución de género y edad, lugar de ocurrencia y causa. Para ambas denticiones, en conjunto, más de dos dientes comprometidos presentaron una frecuencia de 58.77 por ciento. Los análisis se dividieron por dentición y hubo 636 dientes definitivos y 414 temporales. En dentición definitiva se observó una mayor frecuencia en Mayo (15.36 por ciento), Abril (13.02 por ciento) y Noviembre (13.02 por ciento). Las fracturas coronarias no complicadas son las más frecuentes (40.88 por ciento) y los dientes más afectados fueron los incisivos centrales maxilares (77.66 por ciento). Los niños sufren más TDA que las niñas (64.97 por ciento). La mayor frecuencia de TDA para ambos géneros es a los 8 años. La principal causa fue caídas en el colegio (46.87 por ciento). En dentición temporal se observó mayor cantidad de casos en primavera-verano (53.74 por ciento). Siendo más frecuente en los meses Noviembre y Febrero (30.84 por ciento). Subluxación fue el diagnostico más frecuentes con un 39.61 por ciento. Los dientes más afectados fueron los incisivos centrales maxilares en un 82.13 por ciento. El género masculino fue el más afectado (62.56 por ciento). La edad en que se observó mayor frecuencia de TDA fueron los 2 años. La principal causa fue caídas en la casa (29.07 por ciento).

In this incidence descriptive study 604 infants less than fifteen years of age were examined and attended at the Pedodontic Clinic from Dr. Sótero del Río hospital with a diagnostic of dental trauma between January and December 2010. The purpose of this research protocol was to characterize dental trauma according to the Andreasen and Andreasen classification, and also to determine their frequency, seasonal distribution, type and number of the affected teeth, place of occurrence and trauma´s cause. All diagnostics were divided by dentition, 636 were from permanent and 414 from deciduous dentition. For both dentitions trauma in two teeth and more were in a frequency of 58.77 percent. On permanent dentition a mayor frequency of trauma was observed in May (15.36 percent), April (13.02 percent) and November (13.02 percent). The most frequent trauma was uncomplicated crown fracture (40.88 percent) and the most frequent teeth affected were the upper central incisors (77.66 percent). Boys suffered more trauma than girls (64.97 percent). The highest frequencies of trauma for both genders occurred at eight years of age. The main causes of traumas were: falls at school (46.87 percent). On deciduous dentition a mayor frequency of trauma was observed in spring and summer (53.74 percent) where November and February concentrated the highest rates (30.84 percent). Sub-luxation was the most frequent diagnostic at 39.61 percent. The most frequent teeth affected were also the upper central incisors at 82.13 percent. Boys also suffered more trauma than girls (62.56 percent). The highest frequencies of trauma for both genders occurred at two years of age. The main cause was home falls (29.07 percent).

Adherence to disease-modifying therapies in spanish patients with relapsing multiple sclerosis: two-year interim results of the global adherence project.

The post-marketing international Global Adherence Project investigated adherence to disease-modifying therapy for relapsing-remitting multiple sclerosis. We report adherence data from the first 2 years in the Spanish subset of patients (n = 254 at baseline). The overall adherence rate was 85.4%. Patients taking intramuscular (IM) interferon-ß (IFNß)-1a were significantly more adherent (96.4%) compared with patients taking subcutaneous (SC) IFNß-1a 22 µg (79.1%; p = 0.0064), SC IFNß-1a 44 µg (79.6%; p = 0.0064) and glatiramer acetate (82.7%; p = 0.0184). At year 1 (n = 142), the overall adherence rate was 86.6%. Patients on IM IFNß-1a were significantly more adherent than patients on SC IFNß-1a 22 µg (93.9 vs. 66.7%; p = 0.0251). At year 2 (n = 131), the overall adherence rate was 82% (87.5% for IM IFNß-1a, 80.0% for SC IFNß-1a 22 µg, 77.8% for SC IFNß-1a 44 µg, 85.2% for IFNß-1b, and 80.0% for glatiramer acetate). In conclusion, adherence remained high among all disease-modifying therapies over the first 2 years of the study and was significantly higher for IM IFNß-1a, at visit 1, compared with SC IFNß-1a.

Herramientas para mejorar la adherencia al tratamiento con inmunomoduladores en pacientes con esclerosis múltiple / Proposals to improve adherence to immunomodulatory therapies in patients with multiple sclerosis

Introducción: El objetivo de este trabajo fue evaluar los factores, identificados en el estudio global de adherencia (GAP), asociados con la adherencia a los fármacos inmunomoduladores (IMA) en pacientes con esclerosis múltiple (EM) para proponer medidas directas que mejoren la adherencia. Se propuso elaborar cuestionarios que permitiesen detectar, previamente y durante el seguimiento, a pacientes en riesgo de falta de adherencia.Métodos: Se celebraron dos reuniones con investigadores participantes en el estudio GAP en España. Se agruparon factores relacionados con la no adherencia asociados al tratamiento, paciente, enfermedad y profesionales de la salud. Se formaron 4 grupos de trabajo. Cada grupo trabajó de forma individual sobre un factor teniendo en cuenta el diagnóstico de la EM, manejo y aplicación de la medicación, seguimiento y retirada o cambio de tratamiento. Se acordó un borrador de propuestas y herramientas (cuestionarios).Resultados: Se debe proporcionar a los pacientes un resumen de las características de los tratamientos, de modo positivo y simple, así como tiempo para plantear dudas. La entrega de cuestionarios a los pacientes al inicio del tratamiento y durante el seguimiento para evaluar características individuales puede ayudar a conocer su grado de adherencia y actuar en consecuencia. Los pacientes deben ser educados en la identificación y el manejo de las reacciones adversas. Conclusiones: Se recomienda la educación terapéutica para favorecer la adherencia a los tratamientos e identificar a los pacientes no adherentes. Proponemos 2 cuestionarios, de inicio y de seguimiento, para poder estratificar a los pacientes en función de su adherencia (AU)

Introduction: The objective of this work was to assess the factors identified in the Global Adherence Project (GAP) in disease-modifying therapy (DMT) in patients with multiple sclerosis (MS) and to propose measures directed at improving adherence. It was proposed to prepare questionnaires to detect patients at risk of non-adherence before and during the follow-up. Methods: Two meetings were held by Spanish researchers involved in the GAP project. Factors associated with non-adherence were grouped in therapy-, patient-, disease- and health care professional-related factors. Four working groups were created. Each group studied one individual,factor, taking into account the stages of diagnosis, management and administering treatment, follow-up and discontinuation or change of treatment. A draft of proposals and tools (questionnaires) was agreed.Results: Patients should be provided with summaries of treatments, in a positive and simple way, and have time to discuss any doubts. Questionnaires should be given to patients at the start of treatment and during follow-up, so that individual characteristics can be assessed in order to monitor their adherence and act accordingly. Patients should be instructed in the management of the most common adverse reactions. Conclusion:Therapeutic education to improve adherence to treatments and identification of non-adherent patients is recommended. We propose 2 questionnaires, initial and follow up, to stratify patients depending on their adherence (AU)

[Proposals to improve adherence to immunomodulatory therapies in patients with multiple sclerosis]. / Herramientas para mejorar la adherencia al tratamiento con inmunomoduladores en pacientes con esclerosis múltiple.

INTRODUCTION: The objective of this work was to assess the factors identified in the Global Adherence Project (GAP) in disease-modifying therapy (DMT) in patients with multiple sclerosis (MS) and to propose measures directed at improving adherence. It was proposed to prepare questionnaires to detect patients at risk of non-adherence before and during the follow-up. METHODS: Two meetings were held by Spanish researchers involved in the GAP project. Factors associated with non-adherence were grouped in therapy-, patient-, disease- and health care professional-related factors. Four working groups were created. Each group studied one individual,factor, taking into account the stages of diagnosis, management and administering treatment, follow-up and discontinuation or change of treatment. A draft of proposals and tools (questionnaires) was agreed. RESULTS: Patients should be provided with summaries of treatments, in a positive and simple way, and have time to discuss any doubts. Questionnaires should be given to patients at the start of treatment and during follow-up, so that individual characteristics can be assessed in order to monitor their adherence and act accordingly. Patients should be instructed in the management of the most common adverse reactions. CONCLUSION: Therapeutic education to improve adherence to treatments and identification of non-adherent patients is recommended. We propose 2 questionnaires, initial and follow up, to stratify patients depending on their adherence.

[Global adherence project to disease-modifying therapies in patients with relapsing multiple sclerosis: 2-year interim results]. / Estudio global de adherencia a los tratamientos inmunomoduladores en pacientes con esclerosis múltiple remitente recidivante: resultados a 2 años.

BACKGROUND: In this article we report adherence data from the first 2 years in a subset of patients from the Global Adherence Project (GAP; n=2,648) in Spain. METHODS: A questionnaire assessing adherence to Disease-modifying therapies (DMTs), was distributed annually to patients and their treating neurologists. Non-adherence was defined as missing a DMT injection or changing a dose in the four weeks prior to completing the survey. Patients signed informed consent and Ethics Committees approved annual follow-ups, visit 1 (V1) and visit 2 (V2) in 15 out of 18 centres in Spain. RESULTS: A total of 254 patients were enrolled in Spain. Patients had a mean age of 37.9 years and 70.4% were female, and had been on their treatment for a median time of 28 months, and the overall adherence rate was 85.4%. Patients taking intramuscular interferon beta (IFNB)-1a (Avonex®) were significantly more adherent (94.6%) compared with patients taking subcutaneous (s.c.) IFNB-1a 22.g (Rebif®22) (79.1%; p=0.0064), s.c. IFNB-1a 44.g (Rebif®44) (79.6%; p=0.0064) and glatiramer acetate (GA) (82.7%; p=0.0184). At V1 (n=142), the overall adherence rate was 86.6% and patients on Avonex® were significantly more adherent than patients on Rebif®22 (93.9% versus 66.7%; p=0.0251). At V2 (n=131), the overall adherence rate was 82.4% (Avonex®, 87.5%; Rebif®22, 80%; Rebif®44, 77.8%; Betaferon®, 85.2%, and Copaxone®, 80%) without significant differences. CONCLUSIONS: Adherence remained high over the first 2 years of the study. It was highest with Avonex®, being significant on first assessment, after 40.5 months of therapy, on average compared with other DMTs and at year 1 compared with Rebif®22.

Estudio global de adherencia a los tratamientos inmunomoduladores en pacientes con esclerosis múltiple remitente recidivante: resultados a 2 años / Global adherence project to disease-modifying therapies in patients with relapsing multiple sclerosis: 2-year interim results

Introducción: En este artículo comunicamos resultados de adherencia a los 2 años en la subpoblación de pacientes del estudio Global de Adherencia GAP (n=2.648) en España. Métodos: Pacientes y neurólogos completaron cuestionarios anuales para evaluar la adherencia a los tratamientos inmunomoduladores (IMA). Se definió la falta de adherencia como la pérdida de una inyección o el cambio de dosis en las últimas 4 semanas previas a completar el cuestionario. Los pacientes firmaron el consentimiento informado. Estudio aprobado en 15 de 18 centros en los seguimientos anuales de la visita 1 (V1) y la visita 2 (V2) por los comités éticos. Resultados:Se incluyó a 254 pacientes en España; la media de edad fue 37,9 años y el 70,4% eran mujeres; la mediana de tiempo en tratamiento fue 28 meses y la tasa de adherencia conjunta, del 85,4%. Los pacientes en tratamiento con interferón beta (IFNB)-1a intramuscular (Avonex®) fueron significativamente más cumplidores (96,4%) que los pacientes tratados con IFNB-1a 22μg subcutáneo (s.c.) (Rebif®22) (79,1%; p=0,0064), IFNB-1a 44μg s.c. (Rebif®44) (79,6%; p=0,0064) y acetato de glatiramero (Copaxone®) (82,7%; p=0,0184). En V1 (n=142), la tasa de adherencia fue del 86,6%; los pacientes con Avonex® fueron significativamente más cumplidores que aquellos con Rebif®22 (el 93,9 frente al 66,7%; p=0,0251). En V2 (n=131), la tasa de adherencia fue del 82,4% (Avonex®, 87,5%; Rebif®22, 80%; Rebif®44, 77,8%; Betaferon®, 85,2%, y Copaxone®, 80%) sin diferencias significativas.Conclusiones: La adherencia permaneció alta los 2 años observados. Avonex® mostró mayor adherencia frente al resto; esta diferencia fue significativa en la visita basal, tras 40,5 meses de media en tratamiento y en V1 frente a Rebif®22 (AU)

Background: In this article we report adherence data from the first 2 years in a subset of patients from the Global Adherence Project (GAP; p=2,648) in Spain. Methods: A questionnaire assessing adherence to Disease-modifying therapies (DMTs), was distributed annually to patients and their treating neurologists. Non-adherence was defined as missing a DMT injection or changing a dose in the four weeks prior to completing the survey. Patients signed informed consent and Ethics Committees approved annual follow-ups, visit 1 (V1) and visit 2 (V2) in 15 out of 18 centres in Spain. Results: A total of 254 patients were enrolled in Spain. Patients had a mean age of 37.9 years and 70.4% were female, and had been on their treatment for a median time of 28 months, and the overall adherence rate was 85.4%. Patients taking intramuscular interferon beta (IFNB)-1a (Avonex®) were significantly more adherent (94.6%) compared with patients taking subcutaneous (s.c.) IFNB-1a 22μg (Rebif®22) (79.1%; p=0.0064), s.c. IFNB-1a 44μg (Rebif®44) (79.6%; p=0.0064) and glatiramer acetate (GA) (82.7%; p=0.0184). At V1 (n=142), the overall adherence rate was 86.6% and patients on Avonex® were significantly more adherent than patients on Rebif®22 (93.9% versus 66.7%; p=0.0251). At V2 (n=131), the overall adherence rate was 82.4% (Avonex®, 87.5%; Rebif®22, 80%; Rebif®44, 77.8%; Betaferon®, 85.2%, and Copaxone®, 80%) without significant differences.Conclusions: Adherence remained high over the first 2 years of the study. It was highest with Avonex®, being significant on first assessment, after 40.5 months of therapy, on average compared with other DMTs and at year 1 compared with Rebif®22 (AU)

[Indication for bone scans in early breast cancer staging]. / Indicación del rastreo óseo en la estadificación del cáncer de mama de inicio.

OBJECTIVE: Evaluate the indication for bone scanning during staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness. MATERIAL AND METHODS: The bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively. Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2 cm y 3 cm, and pre-treatment clinical stage. RESULTS: Out of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions <2 cm (Tis and T1) were diagnosed in 131 patients (53.5%), none of which had bone metastasis at time of diagnosis. Lesions >2 cm and 3 cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis. CONCLUSIONS: Ineffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor

Indicación del rastreo óseo en la estadificación del cáncer de mama de inicio / Indication of bone scans in early breast cancer staging

ObjetivosRevisar nuestra experiencia y reflexionar a la luz de la evidencia científica sobre la indicación del rastreo óseo (RO) en la estadificación del cáncer de mama de inicio en estadios precoces, con el fin de contribuir en la modificación de rutinas de baja eficacia.Material y métodosRevisión retrospectiva de los RO hechos en nuestro Servicio de Medicina Nuclear durante 2007 en las pacientes con cáncer de mama de inicio, analizando su resultado en función del tamaño clínico o anatomopatológico tumoral. Los RO para tumores T2 se analizaron estratificando las lesiones en dos grupos, <= o > de 3cm y en función de su estadio clínico pretratamiento.ResultadosSe incluyeron 245 rastreos, 237 de éstos (97%) fueron negativos y 8 de éstos (3%) fueron positivos para metástasis óseas. En 131 pacientes (53,5%) se diagnosticaron lesiones<2cm (Tis y T1) y ninguna tenía metástasis óseas. Se hallaron 84 lesiones (34%) que eran >2cm y <=5cm (T2) y entre éstas, el 3,6% de las pacientes presentó metástasis óseas, sin diferencias entre lesiones <=3cm y >3cm. El RO no modificó el estadio en ninguna de las 66 pacientes con tumores T2 en estadio IIA clínico, mientras que sí lo hizo en 2 de las 12 pacientes en estadio clínico IIB. El 20% de las 15 pacientes con lesiones T3 y el 13% de las 15 pacientes con T4 presentaron metástasis óseas en el diagnóstico.ConclusionesEs necesario modificar rutinas poco eficientes excluyendo de las indicaciones del RO la estadificación de las neoplasias de mama de inicio con lesiones <=2cm y lesiones en estadio clínico IIA, siendo necesaria su realización previa al tratamiento en el resto de los casos(AU)

ObjectiveEvaluate the indication for bone scanning during staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness.Material and methodsThe bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively. Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2cm y <=5cm (T2) were analyzed in two groups stratified by tumor size, <=3cm or >3cm, and pre-treatment clinical stage.ResultsOut of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions<2cm (Tis and T1) were diagnosed in 131 patients (53.5%), none of which had bone metastasis at time of diagnosis. Lesions >2cm and <=5cm (T2) were diagnosed in 84 patients (34%), of which 3.6% had bone metastasis. There were no differences in the rate of bone metastases in patients with stage T2 disease and lesions <=3cm vs. >3cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis.ConclusionsIneffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor <=2cm, clinical stage IIA. Pre-treatment bone scanning is still indicated in T2 IIB, T3 and T4 disease(AU)

SPECT-TAC de baja dosis con 67Ga en un caso de espondilodiscitis y hernia de Schmorl / 67Ga SPECT/Low-Dose CT. A case report of spondylodiscitis and Schmorl's node

Varón de 61 años con diagnóstico microbiológico de espondilodiscitis en L3-L4, en tratamiento antibiótico, al que se le realizó un estudio gammagráfico con 67Ga para evaluar la respuesta al tratamiento antibiótico por persistencia de clínica dolorosa.La gammagrafía planar con 67Ga mostró focos con captación patológica en los cuerpos vertebrales de L2 y de L4. Se realizó una SPECT-TAC de baja dosis de la región lumbar, obteniendo una imagen de espondilodiscitis activa en L3-L4 además de identificar un segundo foco en L2, que fue compatible con una hernia intraesponjosa de Schmorl.En este caso, la imagen híbrida de SPECT-TAC ha permitido evitar un falso positivo al localizar y caracterizar una lesión con captación patológica de 67Ga, mejorando la especificidad de la prueba y evitando un error diagnóstico(AU)

A 61-year-old male patient with microbiological diagnosis of L3-L4 spondylodiscitis and persist pain underwent a 67Ga scintigraphic study to assess the antibiotic treatment response.Pathological uptake foci in vertebral bodies of L2 and L4 were observed in the 67Ga planar scintigraphy. A SPECT low-dose CT of the lumbar spine was performed as part of anatomical correlated protocol, detecting an active spondylodiscitis in L3-L4 and a second uptake foci in L2 that was identify as a Schmorl's node.In this case the SPECT-CT hybrid image allowed us to avoid a false positive diagnosis to by locate and characterize an image with abnormal uptake of 67Ga, improving the test specificity and avoiding a wrong diagnosis(AU)