Actualización en carcinoma diferenciado de tiroides refractario a radioyodo / Update on iodine-refractory differentiated thyroid carcinoma

La terapia con radioyodo constituye un pilar fundamental en la terapia adyuvante de rutina de los pacientes con carcinoma diferenciado de tiroides de alto riesgo. Sin embargo, un porcentaje no despreciable de estos pacientes desarrollaran un estado de refractariedad a este tratamiento, mostrando un peor pronóstico, disminuyendo la supervivencia y la esperanza de vida, lo que demuestra una clara necesidad de explorar distintos abordajes terapéuticos. El tratamiento de los pacientes refractarios al radioyodo sigue siendo un desafío, disponiendo en la actualidad de distintas opciones terapéuticas novedosas que deben ser conocidas por las distintas especialidades relacionadas con el carcinoma diferenciado de tiroides (CDT). El objetivo del presente trabajo es hacer una revisión del CDT refractario al tratamiento con yodo radiactivo, centrándose especialmente en la definición de yodorrefractariedad, destacando su importancia por su elevada mortalidad, e introducir las diferentes opciones terapéuticas disponibles para estos pacientes (AU)

Radioiodine therapy represents a fundamental pillar in the routine adjuvant therapy of patients with high-risk differentiated thyroid carcinoma. However, a non-negligible percentage of these patients will develop iodine refractoriness, showing a worse prognosis, as well a lower survival, which demonstrates a clear need to explore different therapeutic approaches. Iodine refractory patient treatment continues to be a challenge, currently having different novel therapeutic options that should be known by the different specialties related to differentiated thyroid carcinoma (DTC). The aim of this work is to review iodine refractory thyroid carcinoma treatment, focusing especially on the definition of iodine refractoriness, highlighting its importance due to its high mortality, and introducing the different therapeutic options available for these patients (AU)

Update on iodine-refractory differentiated thyroid carcinoma.

Radioiodine therapy represents a fundamental pillar in the routine adjuvant therapy of patients with high-risk differentiated thyroid carcinoma. However, a non-negligible percentage of these patients will develop iodine refractoriness, showing a worse prognosis, as well a lower survival, which demonstrates a clear need to explore different therapeutic approaches. Iodine refractory patient treatment continues to be a challenge, currently having different novel therapeutic options that should be known by the different specialties related to differentiated thyroid carcinoma (DTC). The aim of this work is to review iodine refractory thyroid carcinoma treatment, focusing especially on the definition of iodine refractoriness, highlighting its importance due to its high mortality, and introducing the different therapeutic options available for these patients.

18F-DCFPyL PET/CT guidelines.

The objective of this guide is to provide to nuclear medicine physicians a tool based on scientific evidence and prepared by consensus of experts, to perform the 18F-DCFPyL PET/CT procedure with safely and efficiently for patients with prostate cancer who present PSMA overexpression. For them, some recommendations will be established for 18F-DCFPyL PET/CT examination: reconstruction parameters, presentation of the images and their interpretation. The possible false positives of the procedure will be analysed, how to interpret them and how to avoid them. Finally, all exploration should lead to the preparation of a report that answers the clinician's question. For this, it is recommended to prepare a structured report that includes the PROMISE criteria as well as the classification of the findings according to PSMA-RADS parameters.

Critical review of technologies for the on-site treatment of hospital wastewater: From conventional to combined advanced processes.

This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.

Sulfonamides photoassisted oxidation treatments catalyzed by ilmenite.

This work assesses the feasibility of several advanced oxidation processes (CWPO Catalytic Wet Peroxide Oxidation), Photocatalysis and their combination (CWPO-Photoassisted process) for sulfonamide antibiotic degradation. Raw ilmenite was used as catalyst in both processes, because of the presence of iron and titanium in its structure. Despite both treatments allowed reaching a total starting antibiotic depletion working at pH0 = 3 and T0 = 30 °C within 30 min reaction time, significant differences were observed in terms of mineralization. Thus, whereas photocatalytic process just reduced 35% of initial TOC after 120 min, a 85% of mineralization was reached in the presence of H2O2 (CWPO-Photoassisted process) which was related to the oxidation pathway. Only a 35% of mineralization was reached in case of CWPO. In this sense, the degradation route under CWPO-Photoassisted process displayed a mechanism based on the hydroxylation that led to lower molecular weight intermediates. On the contrary, under photocatalysis conditions, the appearance of higher molecular weight intermediates due to organic radical recombination indicates the prevailing of a condensation mechanism.

75SeHCAT scan in bile acid malabsorption in chronic diarrhoea. / Gammagrafía con 75SeHCAT en la diarrea crónica por malabsorción de ácidos biliares.

Chronic diarrhoea is a common entity in daily clinical practice and it leads to a loss in these patients quality of life. It may be the main symptom of multiple ethiologies including bile acid malabsorption (BAM) which has a comparable prevalence to celiac disease. The BAM results from imbalances in the homeostasis of bile acids in the enterohepatic circulation. It can be a consequence of ileal disease or ileal dysfunction (BAM type i), it can be considered idiopathic or primary (BAM type ii) or associated with other gastrointestinal entities (BAM type iii). Among the different diagnostic methods available, 75SeHCAT study is the primary current method due to its sensitivity, specificity, safety and low cost. The main disadvantage is that it's not available in all countries, so other diagnostic methods have appeared, such as serum measurement of FGF19 and C4, however they are significantly more complex and costly. The first-line treatment of bile acid diarrhoea is bile acid sequestrant, such as cholestyramine, which can be difficult to administer due to its poor tolerability and gastrointestinal side effects. These are less prominent with newer agents such as colesevelam. In summary, the BAM is a common entity underdiagnosed and undertreated, so it is essential to establish a diagnosis algorithm of chronic diarrhoea in which the 75SeHCAT study would be first or second line in the differential diagnosis of these patients.

[Subtrochanteric fracture in children treated with minimally invasive surgery: case report]. / Fractura subtrocantérica en niños manejada con cirugía de mínima invasión: Reporte de casos.

Subtrochanteric fractures in children are rare events that occur in only 4% of all femur fractures; most injuries occur as a result of high-energy trauma, being young male patients the most affected. The management of this type of injury is controversial; there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement, and the use of external fixators. Most suggest that for children under 10 a nonoperative approach should be preferred and that older ones should be managed surgically, but it is between six and 12-year-olds that most of the controversy exists. In this article, we present the management of this entity with a proximal fracture plate using a minimally invasive technique.

Las fracturas subtrocantéricas en niños son eventos poco frecuentes que se presentan en solo 4% de todas las fracturas de fémur; la mayoría de las lesiones ocurren como resultado de traumas de alta energía, siendo el paciente joven de sexo masculino el más afectado. El manejo de este tipo de lesión es controversial; existen muchas modalidades de tratamiento, como el uso de espica de yeso en 90-90, reducción cerrada y uso de clavos elásticos o rígidos endomedulares, reducción abierta y fijación con placas y, finalmente, el uso de fijadores externos. La mayoría proponen que para niños menores de 10 años, se debe preferir el manejo no quirúrgico y en mayores, el manejo quirúrgico, pero la discusión se produce entre los seis y 12 años de edad, en donde está la mayor parte de la polémica. En la actualidad, en el Hospital Universitario de Santander, tratamos este tipo de fracturas mediante técnica de mínima incisión con placa autobloqueada para fémur proximal en niños, con buenos resultados.

Synthesis of high surface area carbon adsorbents prepared from pine sawdust-Onopordum acanthium L. for nonsteroidal anti-inflammatory drugs adsorption.

Chemically activated carbon materials prepared from pine sawdust-Onopordum acanthium L. were studied for the removal of diclofenac and naproxen from aqueous solution. Several carbons, using different proportions of precursors were obtained (carbon C1 to carbon C5) and the chemical modification by liquid acid and basic treatments of C1 were carried out. The textural properties of the carbons, evaluated by N2 adsorption-desorption isotherms, revealed that the treatments with nitric acid and potassium hydroxide dramatically reduced the specific surface area and the pore volume of the carbon samples. The surface chemistry characterization, made by thermal programmed decomposition studies, determination of isoelectric point and Boehm's titration, showed the major presence of lactone and phenol groups on the activated carbons surface, being higher the content when the acidic strength of the carbon increased. Diclofenac and naproxen kinetic data onto C1 carbon followed pseudo-second order model. The adsorption equilibrium isotherms of C1 and the modified carbons were well described by both Sips and GAB isotherm equations. The highest adsorption capacity was found for naproxen onto C1 activated carbon, 325 mg g(-1), since the liquid acid and basic functionalization of the carbon led to a severe decreasing in the adsorption removal of the target compounds.

[Surgical treatment of subtrochanteric fractures in children]. / Tratamiento quirúrgico de fracturas subtrocantéricas en niños.

Subtrochanteric fractures in children are rare events, occur in only 4% of all femur fractures, most injuries occur as a result of high energy trauma, being young males patient the most affected. The management of this type of injury is controversial, there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement and external fixators. Most suggest that children under 10 should be preferred non-operative and for older than 12 surgical management is indicated, but the discussion is between 6 and 12 years old. Through this article we present the treatment of such entity with a proximal fracture plate using a minimally invasive technique.

Las fracturas subtrocantéricas en niños son eventos poco frecuentes que se presentan en sólo 4% de todas las fracturas de fémur, la mayoría de lesiones ocurren como resultado de traumas de alta energía, siendo el paciente joven de sexo masculino el más afectado. El manejo de este tipo de lesión es controversial, existen muchas modalidades de tratamiento como el uso de espica de yeso en 90-90, reducción cerrada y uso de clavos elásticos o rígidos endomedulares, reducción abierta y fijación con placas y finalmente, el uso de fijadores externos. La mayoría propone que para niños menores de 10 años debe preferirse el manejo no quirúrgico y en mayores el manejo quirúrgico, pero la discusión se produce entre los 6 y 12 años de edad, período en el que radica la mayor parte de la polémica. En la actualidad tratamos este tipo de fracturas en el hospital universitario mediante técnica de mínima incisión con placa autobloqueada para fémur proximal en niños con buenos resultados.

[Nuclear medicine in Spain: high technology 2013]. / Medicina nuclear en España: alta tecnología 2013.

This article details the high technology equipment in Spain obtained through a survey sent to the three main provider companies of equipment installed in Spain. The geographical distribution of high technology by Autonomous Communities and its antiquity have been analyzed.

Comparison of Fenton and Fenton-like oxidation for the treatment of cosmetic wastewater.

The treatment of cosmetic wastewaters by Fenton (Fe²âº/H2O2) and Fenton-like (Fe³âº/H2O2) oxidation has been studied. From batch and continuous experiments it has been proved that both versions of the Fenton process lead to quite similar results in terms of chemical oxygen demand (COD) and total organic carbon reduction although the COD shows a slightly higher rate in the early stages of reaction. COD reductions of around 55% after 2 h reaction time and 75-80% with 4 h residence time were reached in batch and continuous experiments, respectively, conducted at pH around 3, ambient temperature (20 °C), with 200 mg/L of Fe dose and an initial H2O2/COD weight ratio corresponding to the theoretical stoichiometric value. Achieving the locally allowable limit of COD for industrial wastewater discharge into the municipal sewer system takes no more than 30 min reaction time under those conditions by both Fenton systems. However, the Fenton-like process, where iron is fed as Fe(3+), would be preferable for industrial applications since the ferric sludge resulting upon final neutralization of the effluent can be recycled to the process. A second-order kinetic equation with respect to COD fitted fairly well the experimental results at different temperatures, thus providing a simple practical tool for design purposes.

[Femoral head chondroblastoma and reconstruction with osteochondral allograft. Case report]. / Condroblastoma de la cabeza femoral y reconstrucción con aloinjerto osteocondral. Reporte de caso.

Femoral head chondroblastoma is an infrequent tumor, accounting for approximately 1-2% of benign bone tumors. It occurs more frequently in young male patients. It's most frequent locations include the proximal humerus, proximal femur, distal femur and proximal tibia. The femoral head is the third most frequent site of this tumor. There is no specific treatment for this entity; reported treatments range from acetabular osteotomies and osteochondral grafts, to vascularized fibular grafts, all of them with good results. However, this tumor is clinically unpredictable if left untreated. We report a case managed with osteochondral graft and followed-up for three years after the surgical procedure.

Validation of stationary phases in (111)In-pentetreotide planar chromatography.

INTRODUCTION: Since Pall-German stopped manufacturing ITLC-SG, it has become necessary to validate alternative stationary phases. OBJECTIVE: To validate different stationary phases versus ITLC-SG Pall-Gelman in the determination of the radiochemical purity (RCP) of (111)In-pentetreotide ((111)In-Octreoscan) by planar chromatography. MATERIAL AND METHODS: We conducted a case-control study, which included 66 (111)In-pentetreotide preparations. We determined the RCP by planar chromatography, using a freshly prepared solution of 0,1M sodium citrate (pH 5) and the following stationary phases: ITLC-SG (Pall-Gelman) (reference method), iTLC-SG (Varian), HPTLC silica gel 60 (Merck), Whatman 1, Whatman 3MM and Whatman 17. For each of the methods, we calculated: PRQ, relative front values (RF) of the radiopharmaceutical and free (111)In, chromatographic development time, resolution between peaks. We compared the results obtained with the reference method. The statistical analysis was performed using the SPSS program. The p value was calculated for the study of statistical significance. RESULTS: The highest resolution is obtained with HPTLC silica gel 60 (Merck). However, the chromatographic development time is too long (mean=33.62minutes). Greater resolution is obtained with iTLC-SG (Varian) than with the reference method, with lower chromatographic development time (mean=3.61minutes). Very low resolutions are obtained with Whatman paper, essentially with Whatman 1 and 3MM. Therefore, we do not recommend their use. CONCLUSIONS: Although iTLC-SG (Varian) and HPTLC silica gel 60 (Merck) are suitable alternatives to ITLC-SG (Pall-Gelman) in determining the RCP of (111)In-pentetreotide, iTLC-SG (Varian) is the method of choice due to its lower chromatographic development time.

[Dislocation and necrosis of the first, second and third wedges. Management with the Masquelet technique. A case report]. / Luxación y necrosis de la primera, segunda y tercera cuña, manejo con técnica de Masquelet. Reporte de un caso.

The induced membrane technique was first described by Masquelet in 1986. It was initially used for the reconstruction of long bone shaft defects, particularly of the femur and tibia. The technique consists of two stages. During the first stage a membrane is induced to provide support to the grafts and supply growth factors that contribute to provide a favorable receiving bed for the future graft. During the second stage the poly-methyl-methacrylate spacer is removed and replaced with bone grafts, usually harvested from the iliac crest. Given that this technique has proven good results, it started to be used at other bone sites. We present herein the case of a patient with a large bone defect in the midfoot in whom the Masquelet technique was used with iliac crest grafts. Arthrodesis with a distal radius plate was performed to improve medial column stability, with favorable clinical and functional results.

Upper bounds on superpartner masses from upper bounds on the Higgs boson mass.

The LHC is putting bounds on the Higgs boson mass. In this Letter we use those bounds to constrain the minimal supersymmetric standard model (MSSM) parameter space using the fact that, in supersymmetry, the Higgs mass is a function of the masses of sparticles, and therefore an upper bound on the Higgs mass translates into an upper bound for the masses for superpartners. We show that, although current bounds do not constrain the MSSM parameter space from above, once the Higgs mass bound improves big regions of this parameter space will be excluded, putting upper bounds on supersymmetry (SUSY) masses. On the other hand, for the case of split-SUSY we show that, for moderate or large tanß, the present bounds on the Higgs mass imply that the common mass for scalars cannot be greater than 10(11) GeV. We show how these bounds will evolve as LHC continues to improve the limits on the Higgs mass.

Enhanced Pd pillared clays by Rh inclusion for the catalytic hydrodechlorination of chlorophenols in water.

Bimetallic Pd-Rh catalysts supported on pillared clays have been prepared and tested for aqueous-phase hydrodechlorination (HDC) using 4-chlorophenol (4-CP) as target compound. These bimetallic catalysts combine the higher activity of Rh with the better stability of Pd found in previous works with monometallic catalysts. Different combinations of Pd and Rh amounting to 1 wt% total metal load were tested and the catalyst with 0.75 wt% Pd and 0.25 wt% Rh yielded the best results. Ecotoxicity and biodegradability (measured as BOD(5)/COD ratio) of the effluents were checked. A significant decrease of ecotoxicity was observed while biodegradability was dramatically improved from 0.02 for the initial 4-CP solution up to values higher than 0.6.